Search Results (1,122)

Background/Objectives: This single-cohort follow-up study describes the median overall survival (OS) in patients with unresectable head and neck squamous cell carcinoma (HNSCC) due to invasion of vital structures, which is under-represented in the current literature. Secondarily, subgroups were evaluated according to the type of presentation, in order to identify clinical characteristics and contribute to developing an appropriate treatment plan and managing patient’s expectations. Methods: This single-cohort observational study analysed the OS of 39 patients from the Otolaryngology Department with advanced-stage head and neck cancer with invasion of vital anatomical structures considered ineligible for surgical treatment. Secondarily, subgroups were evaluated according to type of presentation and various clinical characteristics. Results: A total of 39 patients radiologically classified as having unresectable HNSCC (i.e., unsuitable for surgical resection), with a mean age of 66.87 years, were included during a 24-month follow-up. By the end of the study, 56.4% of the patients had died. The median OS was 16.09 months. Statistically significant differences were observed when comparing human papilloma virus (HPV)-positive and -negative status and when comparing initial and recurrent tumours. Conclusions: The invasion of anatomical structures such as the skull base, internal carotid artery, and prevertebral space was associated with a marked decrease in survival, with an OS time of 16 months. This study provides valuable evidence in patients with unresectable HNSCC, highlighting tumour recurrence and HPV-negative status as important indicators of poor prognosis. Full article

A healthy vasculature with well-regulated perfusion and pulsatility is essential for the brain. One vascular structure that has received little attention is the carotid siphon. The proximal portion of the siphon is stiff due to the narrow location in the skull base, whilst the distal portion is highly flexible. This flexible part in combination with the specific curves lead to lower pulsatility at the cost of energy deposition in the arterial wall. This deposited energy contributes to damage and calcification. Severe siphon calcification stiffens the distal part of the siphon, leading to less damping of the pulsatility. Increased blood flow pulsatility is a possible cause of stroke and cognitive disorders. In this review, based on comprehensive multimodality imaging, we first describe the anatomy and physiology of the carotid siphon. Subsequently, we review the in vivo imaging data, which indeed suggest that the siphon attenuates pulsatility. Finally, the data as available in the literature are shown to provide convincing evidence that severe siphon calcifications and the calcification pattern are linked to incident stroke and dementia. Interventional studies are required to test whether this association is causal and how an assessment of pulsatility and the siphon calcification pattern can improve personalized medicine, working to prevent and treat brain disease. Full article

Background: Endonasal endoscopic approaches to the skull base are still under investigation, with research aiming to achieve minimally invasive procedures that maximize resection while minimizing complications. This study shares our experience with a mononostril technique and compares it with the existing literature on mononostril approaches for sellar lesions. Methods: A systematic review of eight large series, totaling 1520 patients who underwent endoscopic mononostril transsphenoidal surgery, was performed. The surgical technique was detailed, and parameters such as resection completeness, operative time, complications, and nasal symptoms were analyzed. Results: Gross total resection ranged from 56% to 100% for non-functioning adenomas, 54% to 89% for hormone-secreting adenomas, and 83% to 100% for other sellar lesions. The most common complications were CSF leaks (1.5–4.1%) and nasal issues, such as epistaxis or sinusitis (0–6%). Internal carotid artery injury occurred in 0–1% of cases. The average surgical duration was 87 to 168 min. Conclusions: The mononostril approach offers comparable resection rates, CSF leak risks, and morbidity to binostril or microsurgical methods. The mononostril approach is fast, minimally invasive, and preserves the nasal mucosa, making it a viable option for many sellar lesions. Full article

Objective: Craniopharyngioma recurrence risk studies comparing gross total resection (GTR) vs. subtotal resection (STR) with radiotherapy (XRT) provide inconclusive or contradictory results. This may be an effect of the small group sizes and diversity in the approaches used. Currently, the endoscopic endonasal approach (EEA) is preferred in craniopharyngioma management. Here, we aimed to perform a meta-analysis comparing recurrence risk after GTR vs. STR plus XRT in patients treated with the EEA regimen. Methods: We performed a systematic literature search of original English language papers on craniopharyngioma management published in the PubMed, Web of Science, and Scopus databases up to 18 October 2023. Eleven articles included data on recurrence rate after EEA: GTR vs. STR with XRT. We extracted the year of publication, number of patients, surgical approach, extent of resection, and follow-up duration. We used meta-analysis for the odds ratio (OR) in fixed and random effects models and Egger’s and Begg’s tests to assess heterogeneity and publication bias. Follow-up duration and time to recurrence were additionally included in Kaplan–Meier curves with log-rank test analysis. Results: We observed a lower recurrence rate in patients after GTR (10%) as compared to STR with XRT (30%), OR = 0.299, p < 0.001. To increase data reliability, we limited our analysis to studies with at least five patients in each subgroup and also observed lower recurrence in patients after GTR (12%) as compared to STR with XRT (27%), OR = 0.376, p = 0.011. Survival analysis confirmed significant differences in recurrence-free survival percentages between these groups (p = 0.008). Conclusions: To date, this is the largest meta-analysis evaluating the recurrence risk in patients undergoing EEA for craniopharyngioma resection, comparing outcomes between those treated with GTR and those treated with STR plus XRT. The results suggest that GTR significantly reduces recurrence risk. Full article

Objective: To evaluate the outcomes of a modified infratemporal fossa approach (ITFA) that preserves the posterior external auditory canal (EAC) in patients with tumors in the infratemporal fossa and skull base, focusing on postoperative hearing and facial nerve function. Methods: This retrospective study included nine patients who underwent ITFA with posterior EAC preservation for tumor removal while minimizing facial nerve rerouting. All surgeries were performed by a single surgeon. Preoperative and postoperative hearing levels, facial nerve function, tumor characteristics, and surgical outcomes were analyzed. Air-bone gaps (ABG) were assessed using pure tone audiometry, and facial nerve function was assessed using the House–Brackmann grading system. Results: The cohort consisted of eight female patients and one male patient, with a mean tumor size of 3.0 cm. Surgical outcomes were promising, with no statistically significant increase in postoperative ABG and well-preserved facial nerve function. Only one patient developed postoperative grade II facial palsy. A residual tumor was identified in one case with extensive meningioma, which has remained stable, and no recurrence or regrowth was noted during the follow-up period (mean: 3.7 years). The modified approach minimized complications related to conductive hearing loss and facial nerve dysfunction. Conclusions: The modified ITFA with posterior EAC preservation provides a promising alternative to conventional ITFA for managing deep-seated tumors. It preserves both hearing and facial nerve function while ensuring adequate tumor resection. Full article

Background: Sexual dimorphism in Asian elephants (Elephas maximus) is evident in external features, but skeletal differences remain underexplored. This study aimed to examine the skull, scapula, and pelvis using traditional morphometric methods to assess sex-related variation. Methods: Eleven skeletal specimens were analyzed, including nine skulls, eleven pelves, and eighteen scapulae. Linear measurements were obtained using measuring tape and calipers. Statistical analyses included Mann–Whitney U tests, Pearson’s correlation, and logistic regression for sex prediction. Results: No significant differences were found in skull measurements between sexes. However, the pelvis and scapula exhibited notable variation. Significant pelvic parameters included pelvic girdle length (p = 0.024), symphysis length (p = 0.012), and pubis shaft perimeter (p = 0.048). Scapular differences were observed in diagonal breadth, mediolateral width, and spine length. Logistic regression using pelvic measurements yielded 100% accuracy for female classification and 66.67% for males, with an overall prediction accuracy of 90.91%. Conclusions: The pelvis demonstrated the highest reliability for sex determination. These findings enhance the anatomical understanding of Asian elephants and support applications in conservation, forensic science, and population studies. Future research with larger sample sizes and advanced imaging may improve the precision of morphometric sex prediction models. Full article

Geometric morphometrics is performed on different species in different contexts. Here, the aim was to investigate morphological differences in the head of the Sanmartinero Creole bovine to examine head shape variations between sexes using geometric morphometric methods. A sample of cranial pictures of 43 animals (13 males and 30 females) was obtained, and form (size + shape) was studied by means of geometric morphometric techniques using a set of 14 landmarks. This approach eliminated potential dietary effects, ensuring that the observed shape variations were primarily due to intrinsic morphological differences. Sexual dimorphism was found in form (for both size and shape) of the head of the Sanmartinero Creole bovine breed. Males had significantly larger heads based on centroid size (U = 714, p = 0.0004), confirming true sexual size differences, and Principal Component Analysis revealed overlapping head shapes with sexual dimorphism concentrated at midline sagittal landmarks (between the most rostral and caudal orbit points) and paired lateral points, indicating that males have broader and longer heads. The two evaluated characters (head size and shape) are of special interest for the conservation of the breed, especially in those cases whose objectives are to maintain the uniqueness, distinctiveness, and uniformity of the populations. This study analyzed animals subjected to the same feeding program, ensuring the elimination of additional variables. Full article

Studies of prehistoric burials are fundamental for understanding cultural human evolution. Those found in the San Teodoro cave (northeastern Sicily) are significant for the discovery at the turn of the 1930s and 1940s of at least four individuals (ST1–ST4). About 15–16 kyr ago, the bodies of ST1–ST4 were intentionally buried, apparently in a manner original to the context of prehistoric burials, namely by covering them with a continuous layer of red ochre found to connect the graves. Since the earliest excavations, plagued by clandestine digging, there is no material memory of the stratigraphic transition from the burial layer to the subsequent anthropogenic deposit through the red ochre, and nothing certain is known about the orientation of ST3, the presence of grave goods and the ochre cover related to this burial. Moreover, there is no exhaustive knowledge of how much is actually left of the anthropogenic layers described in the old literature. Based on field observations and 3D reconstruction of ST3’s skull position and deposits at the San Teodoro site, we provide insights into anthropological issues, such as the rediscovery of the red ochre vestiges that reasonably covered the ST3 burial, and the burial context of this individual, and shed light on what actually remains of the stratigraphic units described in the 1940s. Full article

Lateral facial clefts are rare and often part of more complex syndromic neurocristopathies. According to Tessier’s classification, they correspond to facial cleft numbers 6, 7 and 8. Using micro-computer tomography (micro-CT), we analyzed their underlying bone defects (resolution 50 and 55 µm/voxel) in the context of the known syndrome-specific genetic background. Lateral facial clefts were diagnosed in three severely affected museum specimens representing mandibulofacial dysostosis type Treacher Collins syndrome (TCS), acrofacial dysostosis syndrome of Rodriguez (AFD-Rod) and tetra-amelia syndrome (TETAMS). The TCS specimen mainly showed an absence of the zygomatic bones and most of the lateral maxilla. The AFD-Rod specimen showed an extensive defect of the lateral maxilla, zygomatic bones, and mandible. The TETAMS specimen showed almost isolated agnathia. Possible relationships are discussed between the diverse facial bone defects due to apoptosis of neural crest-derived cells, known to be associated with ribosomopathies and spliceosomopathies, such as TCS and AFD-Rod, and the more targeted bone defects due to genetic variants known to cause TETAMS. Full article

Two new miniature tetra species of the genus Priocharax Weitzman and Vari 1987 are described, raising the known species diversity to twelve. Priocharax is characterized by several paedomorphic features such as reductions in the laterosensory system, number of fin rays, ossification of parts of the skull and the presence of a larval rayless pectoral fin in adults. The species described are found in the Rio Purus and Solimões drainages, in the state of Amazonas, Brazil and are diagnosed among themselves and from other species of the genus by the combination of meristic and osteological characters. Furthermore, the two species differ in overall body shape, with one having a deeper body and the other a more streamlined form. Sexual dimorphism was observed in both species. Molecular species delimitation analyses support the distinctiveness of these species. Similarly to Priocharax britzi and to P. conwayi, the specimens analyzed here were collected within and around protected areas, highlighting the importance of these areas for conservation and biodiversity knowledge. Full article

Background: Awake craniotomy (AC) surgeries are less common in the pediatric population in comparison to their adult counterparts. Nonetheless, they can be considered for selected cases whereby speech preservation is paramount during maximal safe resection of intracranial lesions. We describe a case of AC for the excision of a brain arteriovenous malformation (bAVM) with language mapping in a pediatric patient. Methods: A previously well 16-year-old male presented with a spontaneous left frontal intracranial hemorrhage. Neuroimaging confirmed the cause to be a left antero-temporal bAVM centered in the insula. A decision was made for AC bAVM excision with language mapping for speech preservation. Results: As part of the pre-operative preparation, the patient and his caregivers were reviewed by a multidisciplinary team. For the conduct of the AC, the asleep–awake–asleep technique was used with processed EEG to guide anesthesia management. Additional modifications to make the patient comfortable included the avoidance of rigid cranial skull pins, urinary catheterization and central line insertion at the start of the surgery. Conclusions: Our experience concurs with the evidence that AC in children is a feasible option for select individuals. To our knowledge, this is the first detailed case description of a pediatric patient undergoing AC with language mapping for a bAVM. Emphases include a strong rapport between the patient and the managing multidisciplinary team, flexibility to adjust conventional workflows and limitations of neuroimaging adjuncts. Full article

Introduction: Synovitis and damage to natural stabilizers of many axial and peripheral joints make patients with rheumatoid arthritis particularly susceptible to sagittal balance disorders of the axial skeleton. This may determine the high individual variability of cervical spine deformities as well as differences in the rate of development of disease symptoms in these patients, such as radiculopathy and myelopathy. Methods: In the scientific literature, in addition to systemic factors, more and more attention is paid to work on biomechanical factors in the development of cervical spine instability. One of the methods for assessing the influence of biomechanical factors, which can also be used in everyday practice, is the analysis of radiological parameters of sagittal balance. Results: Among the selected sagittal balance parameters studied, a statistical relationship between C4 and C5 distance and the OI parameter has been found, indicating a relationship to a parameter that remains constant throughout an individual’s life in the group of patients with disease duration over 20 years. Conclusions: The development of instability and deformity in the subaxial segment of the cervical spine in patients with rheumatoid arthritis may be the result of insufficiently understood components of biomechanical factors; hence, further research in this field is necessary. Full article

This article highlights the importance of evaluating the morphological characteristics of female dogs during breeding soundness examinations (BSEs) to assess their reproductive potential and ensure the health of future offspring. Key traits considered in this evaluation include body type, body condition score, skull size and shape, mammary gland conformation, and coat quality. Each of these factors plays a significant role in the health and fertility of breeding females. For example, deviations from breed standards in body size can lead to complications during pregnancy and whelping, while an inappropriate body condition score may disrupt hormonal balance and reproductive cycles. This review also addresses concerns related to brachycephalic breeds, whose conformation can contribute to respiratory and reproductive issues. Additionally, assessing vertebral and pelvic conformation is crucial to prevent dystocia and other complications during delivery. By systematically evaluating these morphological traits, veterinarians can promote ethical breeding practices that prioritize the welfare and genetic health of both breeding females and their puppies. Therefore, integrating comprehensive morphological evaluations into BSEs is essential for responsible dog breeding management, ultimately supporting better reproductive outcomes and healthier future generations. Full article

The results of radiotherapy in patients with primary malignant brain tumors are extremely dissatisfactory: the overall survival after a diagnosis of glioblastoma is typically less than three years. The development of spatially fractionated radiotherapy techniques could help to improve this bleak prognosis. In order to develop technical equipment and organ-specific therapy plans, dosimetry studies as well as radiobiology studies are conducted. Although perfect spheres are considered optimal phantoms by physicists, this does not reflect the wide variety of head sizes and shapes in our patient community. Depth from surface and X-ray dose absorption by tissue between dose entry point and target, two key parameters in medical physics planning, are largely determined by the shape and thickness of the skull bone. We have, therefore, designed and produced a biomimetic tool to correlate measured technical dose and biological response in human cancer cells: a brain phantom, produced from tissue-equivalent materials. In a first pilot study, utilizing our phantom to correlate technical dose measurements and metabolic response to radiation in human cancer cell lines, we demonstrate why an anthropomorphic phantom is preferable over a simple spheroid phantom. Full article

Currently, the electroencephalogram (EEG) cap is limited to a finite number of sizes based on head circumference, lacking the mechanical flexibility to accommodate the full range of skull dimensions. This reliance on head circumference data alone often results in a poor fit between the EEG cap and the user’s head shape. To address these limitations, we have developed a four-dimensional (4D) adjustable EEG cap. This cap features an adjustable mechanism that covers the entire cranial area in four dimensions, allowing it to fit the head shapes of nearly all adults. The system is compatible with 64 channels or lower electrode counts. We conducted a study with numerous volunteers to compare the performance characteristics of the 4D caps with the commercial (COML) caps in terms of contact pressure, preparation time, wearing impedance, and performance in brain–computer interface (BCI) applications. The 4D cap demonstrated the ability to adapt to various head shapes more quickly, reduce impedance during testing, and enhance measurement accuracy, signal-to-noise ratio (SNR), and comfort. These improvements suggest its potential for broader application in both laboratory settings and daily life. Full article