Search Results (702)

A simple, fast, and cost-effective organic solvent-based protocol was developed for DNA extraction from deer antlers and prepared trophy skulls, eliminating the need for commercial kits or cryogenic grinding. The method combines bead-based mechanical homogenization with a 4 h enzymatic digestion in EDTA buffer containing N-lauryl sarcosine and Proteinase K, followed by phenol–chloroform–isoamyl alcohol purification and centrifugal filtration. DNA quality and quantity were evaluated using agarose gel electrophoresis, Qubit fluorometry, and Nanodrop spectrophotometry. The protocol was tested on 60 samples, comprising 30 antlers and 30 pedicle parts from prepared trophy skulls of roe deer (Capreolus capreolus), fallow deer (Dama dama), and red deer (Cervus elaphus). To assess suitability for downstream applications, species-specific microsatellite markers were amplified using multiplex PCR, successfully generating complete genotypes from all 60 samples. These results, along with a demonstrated case study, confirm that the developed protocol provides high-quality DNA suitable for molecular genetic investigations, enabling reliable genotyping from small amounts of both antler and processed trophy materials in forensic and conservation contexts. Full article

Background: Traumatic head injury (THI) includes a diverse range of hemorrhagic brain lesions (HBL), which are distinct phenotypes with characteristic pathophysiological mechanisms. Computed tomography (CT) is the cornerstone of the initial assessment and diagnosis; however, its sensitivity is limited, especially in mild head injury. Blood-derived biomarkers, including Neuron-Specific Enolase (NSE) and S-100B, have been extensively studied; however, their efficacy in distinguishing HBL subtypes remains unclear. We evaluated whether circulating serum levels of S-100B and NSE can discriminate between distinct intracranial HBLs and extracranial hemorrhagic lesions (ECH). Methods: This is an interim analysis of a prospective, randomized, double-blind clinical trial including 434 adult patients with blunt THI. HBL phenotypes identified by CT scan included subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma (EDH), and brain contusion (BC). Unique lesions were considered while overlapping lesions were excluded. Subgaleal hematoma (SGH) was included as an example of ECH. Serum S-100B was assessed within 6 h post-injury, while serum NSE was evaluated at admission, 24 h, and 48 h thereafter. Serum NSE and inflammatory cytokines were quantified in duplicates using a Human Magnetic Luminex 5-plex assay, while serum S-100B concentrations were measured separately. Serum epinephrine concentrations were quantified using an ELISA. Biomarker profiles were analyzed based on lesion phenotype, lesion multiplicity, injury pattern, and clinical outcomes, including hospital length of stay (HLOS) and the Glasgow Outcome Scale—Extended (GOSE). Results: Admission median S-100B levels were higher in patients with SAH (495 pg/mL) and lower in those with SGH (191 pg/mL); however, they did not show statistically significant difference among HBL phenotypes. They were significantly higher in patients with polytrauma TBI (420 pg/mL) compared to isolated TBI (258 pg/mL). Baseline and 48 h NSE concentrations were significantly higher in SDH (25,089 and 28,438 pg/mL) than in other THI lesions (p = 0.04). There were no statistically significant changes in NSE values over time across all THI lesions except for SDH in which they raised more after 48 h (p = 0.02). They had a significant drop in polytrauma over the time (p = 0.001). Compared to intracranial lesions, S-100 B levels were significantly lower in SGH and in skull fractures without intracranial hematomas. Both S-100B and NSE levels were elevated in individuals with unfavorable GOSE scores. Conclusions: In this secondary exploratory analysis, elevated serum NSE and S-100B levels discriminate between extra- and intracranial lesions and appear to represent distinct but complementary aspects of THI, indicating neuronal damage and its temporal evolution, and predicting clinical and functional outcomes. The present findings reflect association and not causation. Future studies incorporating larger or multicenter cohorts, volumetric imaging, and long-term outcomes are required to validate and refine biomarker-guided algorithms for personalized THI care. Full article

Reconstruction of the ear and temporal region presents unique challenges due to the complex anatomy of the lateral skull base and the need to restore both structural integrity and auditory function. Historically managed as separate entities, auricular reconstruction and hearing rehabilitation are increasingly approached in an integrated manner, supported by advances in microsurgical techniques and implantable hearing technologies. This narrative review synthesizes contemporary evidence on microsurgical reconstruction of the ear and temporal region in conjunction with hearing rehabilitation, analyzing a wide range of existing surgical techniques in an integrative manner. Reconstructive techniques discussed include local and regional flaps, free tissue transfer, auricular framework reconstruction using autologous cartilage or alloplastic materials, external auditory canal reconstruction, and subtotal petrosectomy. Hearing rehabilitation options reviewed encompass bone-anchored hearing systems, active and passive transcutaneous devices, middle ear implants, and cochlear implantation. Simultaneous reconstruction and implantation may reduce surgical burden and enable earlier hearing restoration in carefully selected patients, while staged approaches remain advantageous in complex or high-risk scenarios, particularly in the presence of chronic infection or extensive temporal bone surgery. Multidisciplinary collaboration, meticulous preoperative planning, and long-term follow-up are essential to optimize outcomes. Full article

Recent anatomical and morphometric studies indicate that the sella turcica is a structurally informative region and a distinctive anatomical formation that can exhibit shape variation among individuals. The aim of this study was to evaluate, in three dimensions, the extent to which sella turcica morphology differs among three sheep breeds (Akkaraman, Morkaraman, Zom) and between sexes. A total of 102 specimens were examined. All skulls were CT-scanned specifically for this study; the sella turcica region was reconstructed as a three-dimensional model, and 12 anatomical landmarks were manually digitized for each specimen. The findings showed that sella turcica size differed among breeds, with the Zom group exhibiting the largest sella turcica size. In contrast, no clear size difference was observed between females and males. Shape assessment also revealed differences among breeds, largely driven by the separation of Zom from Akkaraman and Morkaraman, whereas no distinct sex-related shape pattern was detected. Importantly, the breed-related shape differences persisted after accounting for size effects. Overall, these results suggest that the sella turcica carries a breed-associated morphological signal in sheep, while showing no pronounced sexual differentiation in the present sample. Full article

Background: Temporomandibular joint (TMJ) ankylosis is an uncommon condition in the modern world, yet it remains a significant treatment challenge. One of the main intraoperative difficulties is accurately and safely resecting the ankylotic mass. Objective: This study seeks to share our clinical experience with various types of complications and to review the literature on the clinical and technological evidence regarding the accuracy of surgical detachment of the ankylotic mass from the skull. Methods: A literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Search strategies were categorized into search 1 for evaluating 3D-printed technology and search 2 for computer-assisted surgical navigation. Results: One study was selected for search 1 and 2 for search 2. Also, three cases of intraoperative surgical complications associated with the resection of the ankylotic mass were presented. The 3D surgical cutting guides were found to be accurate in guiding the superior, inferior, and depth of the osteotomy. Angulation control was less than optimal. Navigation guiding proved accurate in maintaining the planned thickness of the skull base and the anterior wall of the external auditory canal. Conclusion: Navigation guiding is a superior method for achieving predictable anatomical resection of the ankylotic mass. Full article

Background: The foramen of Arnold (FA) and foramen of Vesalius (FV) are two inconstant small openings through the greater wing of the sphenoid bone. When FA is present, the lesser petrosal nerve passes through it. FV usually contains an emissary vein that connects the cavernous sinus to the pterygoid plexus. Objectives: To assess the presence, unilaterally or bilaterally, of the aforementioned inconstant foramina in order to gain a better insight into the anatomic variability of the middle cranial fossa. Methods: We analyzed five hundred random unenhanced CT examinations of human dry skulls from the “Francisc I. Rainer” Craniological Collection of the Human Anthropological Institute in Bucharest, Romania. The collection holds substantial anthropological and radiological value, as dry skulls allow the use of higher spatial-resolution imaging parameters and thus better detection of the small osseous structures. All scans were performed on the same Multi-Detector Computed Tomography (MDCT) scanner (Canon Aquilion One 64 slice, Canon Medical Systems Corporation) in the Department of Radiology of the Bucharest Emergency University Hospital. After collecting data, appropriate statistical analysis was performed. Results: FA was absent in 355 (71%) skulls and present in 145 (29%) skulls, bilaterally in 33 (6.6%) skulls, and unilaterally in 112 (22.4%) skulls. FV was absent in 151 (30.2%) skulls and present in 349 (69.8%) skulls, bilaterally in 223 (44.6%) skulls, and unilaterally in 126 (25.2%) skulls. Conclusions: The great variability in the prevalence of these foramina may be partly explained by the different methods of analysis of the skull base, as well as the different population subgroups on which the research has been focused. Knowledge of this variability holds great importance for anatomists, anthropologists, as well as clinicians who interact with this complex area. Full article

Background: Vascular compression syndromes are increasingly recognized as underdiagnosed contributors to morbidity in patients exhibiting dysautonomia. Underlying vascular compression syndromes affecting the head and neck, abdomen, pelvis, and lower extremities may influence venous return, neurohormonal signaling, and autonomic regulation. There is considerable clinical overlap among these syndromes, as well as between hypermobility spectrum disorders (HSD) and dysautonomia, indicating possible shared or interacting pathophysiological mechanisms. Purpose/Aims: This hypothesis-generating narrative review synthesizes current evidence linking vascular compression syndromes with dysautonomia, highlights potential mechanistic pathways, identifies patterns of syndromic overlap, and emphasizes the importance of systematic evaluation in affected patient populations. Key Findings: Evidence from retrospective studies, case series, and clinical observations indicates that vascular compression syndromes may be prevalent among patients with dysautonomia, particularly postural orthostatic tachycardia syndrome (POTS) and HSD, yet are often unrecognized. Proposed mechanisms based on limited data include impaired venous capacitance and preload reserve, increased intracranial pressure, altered renin–aldosterone and cortisol signaling, underlying autoimmune and systemic diseases, and sympathetic ganglion irritation. Several compression syndromes show symptom overlap and frequent co-occurrence, especially in patients with connective tissue disorders. Emerging data suggest that targeted interventions, such as surgical decompression or venous stenting, may improve orthostatic intolerance and quality-of-life measures in selected patients, though high-quality prospective data remain limited. Conclusions: Vascular compression syndromes may be an important yet underappreciated contributor to dysautonomia. Increased clinical awareness and systematic screening may reduce diagnostic delays and morbidity in this underserved population. Prospective studies are needed to clarify prevalence, establish causal relationships, and determine the impact of targeted treatments on autonomic outcomes. Full article

Background: The foramen of Vesalius (FV; also known as the sphenoidal emissary foramen (SEF) or foramen venosum) is an inconstant skull-base foramen located near the foramen ovale. Its recognition may be relevant to percutaneous trigeminal procedures. Methods: This systematic review was registered in INPLASY (INOLASY2025100037; 11 October 2025) and conducted in accordance with PRISMA 2020. We searched PubMed, Scopus, and Web of Science from inception until December 2025 for English-language studies reporting the prevalence and/or morphometry of the foramen of Vesalius using cone-beam computed tomography (CBCT). Five reviewers screened and extracted data; prevalence studies were assessed for risk of bias using the Joanna Briggs Institute checklist. A random-effects meta-analysis of logit-transformed proportions was applied when ≥3 studies reported comparable prevalence outcomes. Results: Five retrospective CBCT studies (n = 1567) met the inclusion criteria. The prevalence of FV ranged from 28.1% (89/317; 95% CI 23.4–33.3) to 73.1% (190/260; 95% CI 67.4–78.1) throughout the cohorts. The total prevalence was 50.6% (95% CI 36.1–65.1), with significant variability (I² = 96.8%) and a broad 95% prediction interval (19.5–81.3). The documented FV–FO distances were typically a few millimeters (about 2–5 mm), whereas the FV–foramen spinosum (FS) distances varied from approximately 11 to 14 mm, contingent upon the cohort and measuring technique employed. Conclusions: FV is frequently observable on CBCT when the skull base is within the field of view; nevertheless, current prevalence estimates lack precision because of the limited number of five retrospective investigations, which are inconsistent and clinic-based. Standardized definitions and reporting for CBCT, together with population-based cohorts, are crucial for improving clinically applicable prevalence and morphometric reference data. Full article

Background/Objectives: The sphenoid sinus (SS) exhibits marked morphological variability, influencing the relationship of critical neurovascular skull base structures. This study aimed to characterize sphenoid sinus pneumatization (SSP) patterns and assess their impact on the course of the internal carotid artery (ICA), optic nerve (ON), Vidian nerve (VN), and maxillary nerve (MN) within a Greek adult population. Methods: A retrospective analysis of 253 adult skull base computed tomography (CT) scans was performed. The degree and direction of SSP were classified according to established radiological criteria. Anterior, lateral, and posterior extensions were evaluated. The course of adjacent neurovascular structures was categorized as typical, protruding, or dehiscent. Associations between pneumatization types and neurovascular variants were analyzed. Results: The sellar complete type was the predominant SS pattern (63.2%), followed by sellar incomplete (27.7%) and presellar (8.7%) types; agenesis was rare (0.4%). Posterior (63.6%) and lateral (46.6%) extensions were most common. Lateral and posterior pneumatization significantly correlated with protrusion and/or dehiscence of adjacent neurovascular structures, particularly the ICA, ON, and VN. LW extension was strongly associated with ON protrusion (96%), while PP and full-lateral extensions correlated with VN protrusion (56.1% and 79.9%, respectively). No significant sex- or side-related differences were identified. Conclusions: SSP demonstrates extensive morphological variability that significantly affects the anatomical course and osseous coverage of neighboring neurovascular structures. Comprehensive preoperative CT evaluation of SS anatomy is essential for planning endoscopic transsphenoidal and extended skull base procedures to minimize the risk of neurovascular injury. Full article

Background: Sinonasal mucosal melanoma is a rare and aggressive malignancy arising from the nasal cavity and paranasal sinuses, characterized by high local recurrence rates and poor survival. Skull-base and orbital progression can occur rapidly, particularly when preoperative imaging underestimates local extension. This paper reports a case of sinonasal mucosal epithelioid melanoma with fulminant postoperative skull-base breach and orbital invasion, highlighting its clinical course, management challenges, and histopathological features. Methods: A 60-year-old woman with progressive unilateral nasal obstruction, recurrent epistaxis, and headache underwent clinical evaluation, contrast-enhanced head MRI, CT, and PET-CT staging. Preoperative imaging demonstrated no intracranial or orbital invasion. Biopsy confirmed mucosal epithelioid melanoma with high proliferative activity (Ki-67 ~80–85%). The patient underwent extensive image-guided endoscopic resection with intraoperative cerebrospinal fluid leak repair. Results: Definitive histopathology confirmed pigmented epithelioid melanoma with extensive necrosis, bone invasion, and non-assessable resection margins due to specimen fragmentation (pT4a, Rx). Within two weeks postoperatively, CT and MRI demonstrated extensive local recurrence with cribriform plate destruction, anterior skull-base dural infiltration, and rapid orbital progression with optic nerve compression and loss of vision. Despite hemorrhage control and hypofractionated palliative radiotherapy (VMAT, 33 Gy in 11 fractions), the patient experienced progressive neurological decline, refractory pain, and recurrent tumour bleeding, and died approximately 4.5 months after initial presentation. Conclusions: In patients with sinonasal mucosal epithelioid melanoma, fulminant local progression with skull-base and orbital involvement may occur despite apparently limited preoperative imaging. When rapid vision loss, dural infiltration, and refractory nasal bleeding develop, structured palliation, hemorrhage control, and aggressive multimodal analgesia should be prioritized early alongside ongoing multidisciplinary decision-making. Full article

Background and Clinical Significance: Traumatic brain injuries (TBI), most frequently caused by falls, represent a major source of morbidity and mortality and pose significant challenges in forensic investigations, especially when events are unwitnessed or testimonies conflict. Despite advances in imaging and autopsy, reconstructing the mechanism of head trauma often remains impossible. The objective of this study is to assess how biomechanical modeling can support forensic practitioners by narrowing the range of plausible scenarios and strengthening evidence-based interpretation in complex medico-legal contexts, without seeking to establish legal causality or certainty. Case Presentation: This case report investigates forensic biomechanics as a decision-support tool using a combined multibody and finite element (FE) modeling approach. An initial set of twenty-five scenarios, derived from witness statements and investigative data, was reconstructed to simulate potential fall- and assault-related mechanisms. Multibody simulations with the human facet model were first performed to estimate head impact velocities and orientations. These parameters were then applied to an FE head model to evaluate tissue response. Conclusions: Skull fracture patterns and intracerebral von Mises stress distributions were analyzed and systematically compared with clinical, radiological, and autopsy findings. Although simulated stress magnitudes were generally lower than injury thresholds reported in the literature, several scenarios reproduced fracture propagation and intracerebral stress patterns consistent with the documented lesions, including corpus callosum involvement. This multidisciplinary approach highlights the growing role of biomechanics in forensic investigations and forensic anthropology. Full article

Background/Objectives: Skull base osteomyelitis and necrotising otitis externa require prolonged antibiotic therapy, yet determining optimal treatment cessation timing remains challenging. Conventional imaging modalities demonstrate persistent abnormalities beyond infection resolution, confounding treatment decisions. This systematic review evaluated the diagnostic test accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) for treatment response monitoring in skull base osteomyelitis and necrotising otitis externa. Methods: We conducted a systematic review following PRISMA-DTA guidelines, searching MEDLINE, Embase, CENTRAL, CINAHL, Scopus, and Web of Science from inception to November 2025. Studies evaluating ¹⁸F-FDG PET diagnostic accuracy for treatment response assessment in confirmed skull base osteomyelitis or necrotising otitis externa were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using QUADAS-2. Bivariate random-effects meta-analysis was performed using MetaBayesDTA to obtain pooled sensitivity and specificity. Results: Eight studies comprising 154 lesions contributed to the primary analysis. Pooled sensitivity was 95.2% (95% credible interval 85.6–99.0%) and pooled specificity was 89.1% (95% credible interval 70.7–96.7%). The positive likelihood ratio was 8.7 (95% credible interval 3.2–28.4) and negative likelihood ratio was 0.05 (95% credible interval 0.01–0.17), with a diagnostic odds ratio of 172.0. Seven studies evaluating detection rate at initial presentation yielded a pooled rate of 96.1% (95% confidence interval 91.3–98.3%). SUVmax was the most frequently used metabolic parameter. Conclusions: ¹⁸F-FDG PET, specifically using SUVmax, demonstrates high sensitivity and good specificity for treatment response monitoring, with excellent capacity to rule out persistent infection. However, evidence quality is limited by retrospective designs and substantial heterogeneity. Prospective studies with standardised thresholds are needed to validate clinical utility. Full article

Background: In the last few decades, endoscopic endonasal approaches (EEA) have revolutionized surgical access to the sellar region and anterior cranial fossa (ACF). One technique, the endoscopic endonasal transethmoidal transcribriform approach (EETTA), offers distinct advantages over traditional open transcranial approaches, such as reduced morbidity, shorter hospital stays, faster recovery, and a reduced risk of neurological deficit due to less brain tissue manipulation. Methods: We present a comprehensive step-by-step description of the EETTA surgical technique, illustrated through four representative cases of varying pathologies treated at our institution. The anatomical boundaries—including the lamina papyracea, anterior and posterior ethmoidal arteries, and frontal sinus—and the surgical corridor are detailed alongside indications, technical nuances, limitations, and operative recommendations. Results: Four cases demonstrate the versatility of EETTA across diverse pathologies: two olfactory groove meningiomas (including one WHO grade 2 and one recurrent case with invasive skull base involvement), an esthesioneuroblastoma (ENB), and a recurrent inverted papilloma requiring combined transcranial and endoscopic resection. Near-total or gross-total resection was achieved in all cases. The indications, nuances, and limitations of this approach are discussed, along with tips for successful surgery. Conclusions: The EETTA represents an important minimally invasive option for ACF tumors extending into the nasal cavity, with midline involvement limited medially by the lamina papyracea. Success requires a thorough understanding of skull base anatomy, meticulous multilayer reconstruction techniques, and appropriate patient selection, based on the tumor location and lateral extension. While cerebrospinal fluid (CSF) leak remains the primary concern, contemporary techniques have substantially reduced this complication rate. Full article

Primary parapharyngeal space (PPS) tumors are rare neoplasms comprising 0.5% of head and neck tumors. Their complex anatomical location and proximity to critical neurovascular structures pose significant surgical challenges. While transcervical and transcervical-combined approaches represent the primary surgical techniques, no comprehensive systematic comparison exists. This systematic review compared surgical success, complications, functional outcomes, and recurrence rates between these approaches. Following PROSPERO registration (CRD420251037201), we searched PubMed, Cochrane, Web of Science, Google Scholar, and ScienceDirect without date restrictions. Independent dual screening identified retrospective cohort studies and case series comparing both approaches. Data extraction and risk of bias assessment employed standardized tools, with synthesis conducted per PRISMA 2020 guidelines using narrative analysis. Ten studies encompassing 505 patients with 508 tumors met inclusion criteria. Both approaches achieved excellent complete resection rates (95–100%). Transcervical approaches demonstrated lower overall complication rates (4.8–52.6%) versus transcervical-combined approaches (7.7–100%), though rates varied substantially by tumor type, and differences likely reflect case selection rather than approach-specific effects. Cranial nerve injuries (VII, X, XII) constituted predominant complications. Infratemporal fossa approaches showed the highest morbidity. Recurrence rates ranged from 0–30.3% without consistent patterns favoring either approach. Transcervical-combined approaches were essential for superior compartment extension and for skull base involvement. Both transcervical and transcervical-combined approaches achieve excellent tumor resection with acceptable morbidity when appropriately selected. For most benign PPS tumors, a transcervical approach may be preferred. Combined approaches may be considered in specific anatomic scenarios that require enhanced exposure, particularly when the superior compartment and skull base are involved, although the decision is always highly individual. Full article

Objective: To evaluate the three-dimensional (3D) angular displacement (Roll, Yaw, and Pitch) of the upper cervical vertebrae (C1, C2, and C3) in patients with severe mandibular deviation (MD) due to condylar hyperplasia (CH), utilizing a computed tomography (CT)-based segmentation approach. Methods: This retrospective cross-sectional study included 50 patients with MD ≥ 6 mm caused by hemimandibular elongation (HE) or a hybrid form (HF) of CH. The skull, mandible, and cervical vertebrae (C1–C3) were segmented using 3D Slicer software. Angular deviations (Pitch, Yaw, Roll) were measured relative to the Frankfurt plane. Patients were categorized by the side of CH (right or left), and intergroup comparisons were performed using Kruskal–Wallis and Mann–Whitney U tests. Spearman’s correlation analyses assessed associations between MD magnitude and cervical angles. Results: CH was significantly more prevalent in females (58%; p = 0.021). C2 and C3 exhibited significantly increased lateral Roll inclination toward the side of deviation (p = 0.006 and p = 0.045, respectively). C2 Pitch negatively correlated with MD severity bilaterally (r ≈ −0.51, p = 0.02 right; r ≈ −0.50, p = 0.02 left). Strong intra-vertebral correlations between Pitch and Yaw were observed in C1 and C2, indicating synchronized vertical and rotational motion. No significant intergroup differences were found in Yaw angles (p > 0.05). Conclusions: Patients with CH and severe MD exhibit consistent patterns of 3D cervical displacement, particularly in lateral inclination and vertical movement, suggesting compensatory postural adaptations in the upper cervical spine. Full article