Thickness of the normal skull in the American Blacks and Whites

Traumatic brain injury graphing: A case study of Charles Whitman

Research has identified violent behavior (i.e., assault, murder, and suicide) as a possible sequela of moderate to severe traumatic brain injury (TBI) and repeated mild TBI (rmTBI). However, misconceptions about consciousness and its ability to control an injured brain, the diverse spectrum of potential outcomes, and the role genetics/environmental factors can play make proving TBI's influence on inciting violent behavior by a perpetrator extremely difficult. Though the cause and execution may be complex, multifaceted, and vary in each individual, violent behavior is often preceded and accompanied by other emotional, behavioral, cognitive, and/or physical consequences. This research examines the benefits of graphing, using data interpreted from in-depth, color-coded reverse chronology, as a visualization tool for analyzing/displaying the potential impacts of TBI injuries and aggravators on violent outcomes, especially in complex situations. The case of Charles J. Whitman (herein referred to as CW) was used to demonstrate this method. Results revealed that sequelae clusters appeared shortly after suspected TBI injuries, sequelae changed and progressed over time, and numerous TBI aggravators were present at the time of the tragedy, including: an extended period of excessively high ambient temperatures, sleep deprivation (SD), drug use, blood loss, and emotional stressors. TBI graphing (utilizing reverse chronology) served as a valuable tool for observing the potential TBI sequelae progression prior to the violent event.

Computed tomography study of cranial vault thickness in Malaysian subadult population

Cranial vault thickness (CVT) and its variations provide valuable insights into an individual's biological attributes such as age and sex. This paper aimed to assess the correlations of CVT with age and sex and develop a regression model for age estimation in Malaysian subadults using computed tomography (CT) images. A total of 521 CT images (male/female: 279/242; age range: 0-20 years; Malay/Chinese/Indian: 221/145/155) were included in the study. Correlations of CVT measurements with age and sex, including frontal bone thickness (FBT), occipital bone thickness (OBT), left parietal bone thickness (LPBT), and right parietal bone thickness (RPBT) were assessed and regression formulae were developed for age estimation in subadults. A significant correlation between CVT measurements and age was demonstrated (p < 0.001). Age estimation was most accurate in the younger age group (< 2 years) at frontal and occipital, and accuracy decreases in the older age groups. Additionally, sexual dimorphism was evident in the frontal and parietal bone thickness within the age range of 3-6 years and 16-20 years, respectively. In conclusion, the findings suggested CVT measurements could be used to corroborate other age estimation methods for subadults.

Multiple-Point Metamaterial-Inspired Microwave Sensors for Early-Stage Brain Tumor Diagnosis

Simple, instantaneous, contactless, multiple-point metamaterial-inspired microwave sensors, composed of multi-band, low-profile metamaterial-inspired antennas, were developed to detect and identify meningioma tumors, the most common primary brain tumors. Based on a typical meningioma tumor size of 5-20 mm, a higher operating frequency, where the wavelength is similar or smaller than the tumor target, is crucial. The sensors, designed for the microwave Ku band range (12-18 GHz), where the electromagnetic property values of tumors are available, were implemented in this study. A seven-layered head phantom, including the meningioma tumors, was defined using actual electromagnetic parametric values in the frequency range of interest to mimic the actual human head. The reflection coefficients can be recorded and analyzed instantaneously, reducing high electromagnetic radiation consumption. It has been shown that a single-band detection point is not adequate to classify the nonlinear tumor and head model parameters. On the other hand, dual-band and tri-band metamaterial-inspired antennas, with additional detecting points, create a continuous function solution for the nonlinear problem by adding extra observation points using multiple-band excitation. The point mapping values can be used to enhance the tumor detection capability. Two-point mapping showed a consistent trend between the S11 value order and the tumor size, while three-point mapping can also be used to demonstrate the correlation between the S11 value order and the tumor size. This proposed multi-detection point technique can be applied to a sensor for other nonlinear property targets. Moreover, a set of antennas with different polarizations, orientations, and arrangements in a network could help to obtain the highest sensitivity and accuracy of the whole system.

It's all in the timing: delayed feedback in autism may weaken predictive mechanisms during contour integration

Humans rely on predictive and integrative mechanisms during visual processing to efficiently resolve incomplete or ambiguous sensory signals. Although initial low-level sensory data are conveyed by feedforward connections, feedback connections are believed to shape sensory processing through automatic conveyance of statistical probabilities based on prior exposure to stimulus configurations. Individuals with autism spectrum disorder (ASD) show biases in stimulus processing toward parts rather than wholes, suggesting their sensory processing may be less shaped by statistical predictions acquired through prior exposure to global stimulus properties. Investigations of illusory contour (IC) processing in neurotypical (NT) adults have established a well-tested marker of contour integration characterized by a robust modulation of the visually evoked potential (VEP)-the IC-effect-that occurs over lateral occipital scalp during the timeframe of the visual N1 component. Converging evidence strongly supports the notion that this IC-effect indexes a signal with significant feedback contributions. Using high-density VEPs, we compared the IC-effect in 6- to 17-yr-old children with ASD (n = 32) or NT development (n = 53). Both groups of children generated an IC-effect that was equivalent in amplitude. However, the IC-effect notably onset 21 ms later in ASD, even though initial VEP afference was identical across groups. This suggests that feedforward information predominated during perceptual processing for 15% longer in ASD compared with NT children. This delay in the feedback-dependent IC-effect, in the context of known developmental differences between feedforward and feedback fibers, suggests a potential pathophysiological mechanism of visual processing in ASD, whereby ongoing stimulus processing is less shaped by visual feedback.NEW & NOTEWORTHY Children with autism often present with an atypical visual perceptual style that emphasizes parts or details over the whole. Using electroencephalography (EEG), this study identifies delays in the visual feedback from higher-order sensory brain areas to primary sensory regions. Because this type of visual feedback is thought to carry information about prior sensory experiences, individuals with autism may have difficulty efficiently using prior experience or putting together parts into a whole to help make sense of incoming new visual information. This provides empirical neural evidence to support theories of disrupted sensory perception mechanisms in autism.

New craniodental fossils of Paranthropus robustus from Kromdraai, South Africa (2014-2017 excavations)

Since the initial discovery of Paranthropus robustus at the site of Kromdraai in 1938, the hypodigm of this species has been expanded by subsequent work at the localities of Swartkrans and Drimolen, with a few fossils also known from Cooper's D, Gondolin and Sterkfontein Member 5. Beginning in 2014, systematic excavations at Kromdraai uncovered a large and previously unknown fossiliferous area, shedding light on Units O and P in the earliest part of the site's stratigraphic sequence. The aim of this paper is to provide detailed descriptions and illustrations of 30 P. robustus craniodental specimens recovered between 2014 and 2017 within the Unit P deposits at Kromdraai. This new sample predates all prior conspecific specimens found at this site (including the holotype of P. robustus from Kromdraai, TM 1517). Its basic dental morphology dimensions and cranial features are compared in a preliminary analysis with other P. robustus samples. The P. robustus sample from Kromdraai Unit P documents previously unknown portions of the P. robustus juvenile cranium. The new dental and cranial remains aid in the exploration of potential morphological distinctions between site-specific P. robustus samples and are compared favorably in size and morphology with the small P. robustus specimens from Drimolen (e.g., DNH 7). These findings do not support the hypothesis that the specimens from Drimolen belong to a different taxonomic group. Instead, they reinforce the presence of a significant degree of sexual dimorphism within P. robustus. The Kromdraai Unit P specimens also contribute to the biodemographic profile of P. robustus. The notable prevalence of infants (i.e., juvenile individuals before the emergence of their first permanent molars) mirrors the natural mortality profiles observed in wild chimpanzees. This suggests a closer resemblance in the processes of accumulation in Kromdraai Unit P and Drimolen than at Swartkrans.

It's all in the timing: Delayed feedback in autism may weaken predictive mechanisms during contour integration

Humans rely on predictive mechanisms during visual processing to efficiently resolve incomplete or ambiguous sensory signals. While initial low-level sensory data are conveyed by feedforward connections, feedback connections are believed to shape sensory processing through conveyance of statistical predictions based on prior exposure to stimulus configurations. Individuals with autism spectrum disorder (ASD) show biases in stimulus processing toward parts rather than wholes, suggesting their sensory processing may be less shaped by statistical predictions acquired through prior exposure to global stimulus properties. Investigations of illusory contour (IC) processing in neurotypical (NT) adults have established a well-tested marker of contour integration characterized by a robust modulation of the visually evoked potential (VEP) - the IC-effect - that occurs over lateral occipital scalp during the timeframe of the N1 component. Converging evidence strongly supports the notion that this IC-effect indexes a signal with significant feedback contributions. Using high-density VEPs, we compared the IC-effect in 6-17-year-old children with ASD (n=32) or NT development (n=53). Both groups of children generated an IC-effect that was equivalent in amplitude. However, the IC-effect notably onset 21ms later in ASD, even though timing of initial VEP afference was identical across groups. This suggests that feedforward information predominated during perceptual processing for 15% longer in ASD compared to NT children. This delay in the feedback dependent IC-effect, in the context of known developmental differences between feedforward and feedback fibers, suggests a potential pathophysiological mechanism of visual processing in ASD, whereby ongoing stimulus processing is less shaped by statistical prediction mechanisms.

A study of the influence of genetic variance and sex on the density and thickness of the calvarial bone in collaborative cross mice

BACKGROUND

Bone microarchitecture is affected by multiple genes, each having a small effect on the external appearance. It is thus challenging to characterize the genes and their specific effect on bone thickness and porosity. The purpose of this study was to assess the heritability and the genetic variation effect, as well as the sex effect on the calvarial bone thickness (Ca.Th) and calvarial porosity (%PoV) using the Collaborative Cross (CC) mouse population.

METHODS

In the study we examined the parietal bones of 56 mice from 9 lines of CC mice. Morphometric parameters were evaluated using microcomputed tomography (μCT) and included Ca.Th and %PoV. We then evaluated heritability, genetic versus environmental variance and the sex effect for these parameters.

RESULTS

Our morphometric analysis showed that Ca.Th and %PoV are both significantly different among the CC lines with a broad sense heritability of 0.78 and 0.90, respectively. The sex effect within the lines was significant in line IL111 and showed higher values of Ca.Th and %PoV in females compared to males. In line IL19 there was a borderline sex effect in Ca.Th in which males showed higher values than females.

CONCLUSIONS

These results stress the complexity of sex and genotype interactions controlling Ca.Th and %PoV, as the skeletal sexual dimorphism was dependent on the genetic background. This study also shows that the CC population is a powerful tool for establishing the genetic effect on these traits.

Severely Attenuated Visual Feedback Processing in Children on the Autism Spectrum

Individuals on the autism spectrum often exhibit atypicality in their sensory perception, but the neural underpinnings of these perceptual differences remain incompletely understood. One proposed mechanism is an imbalance in higher-order feedback re-entrant inputs to early sensory cortices during sensory perception, leading to increased propensity to focus on local object features over global context. We explored this theory by measuring visual evoked potentials during contour integration as considerable work has revealed that these processes are largely driven by feedback inputs from higher-order ventral visual stream regions. We tested the hypothesis that autistic individuals would have attenuated evoked responses to illusory contours compared with neurotypical controls. Electrophysiology was acquired while 29 autistic and 31 neurotypical children (7-17 years old, inclusive of both males and females) passively viewed a random series of Kanizsa figure stimuli, each consisting of four inducers that were aligned either at random rotational angles or such that contour integration would form an illusory square. Autistic children demonstrated attenuated automatic contour integration over lateral occipital regions relative to neurotypical controls. The data are discussed in terms of the role of predictive feedback processes on perception of global stimulus features and the notion that weakened "priors" may play a role in the visual processing anomalies seen in autism.SIGNIFICANCE STATEMENT Children on the autism spectrum differ from typically developing children in many aspects of their processing of sensory stimuli. One proposed mechanism for these differences is an imbalance in higher-order feedback to primary sensory regions, leading to an increased focus on local object features rather than global context. However, systematic investigation of these feedback mechanisms remains limited. Using EEG and a visual illusion paradigm that is highly dependent on intact feedback processing, we demonstrated significant disruptions to visual feedback processing in children with autism. This provides much needed experimental evidence that advances our understanding of the contribution of feedback processing to visual perception in autism spectrum disorder.

Factors associated with bone thickness: Comparison of the cranium and humerus

Cortical bone thickness is important for the mechanical function of bone. Ontogeny, aging, sex, body size, hormone levels, diet, behavior, and genetics potentially cause variations in postcranial cortical robusticity. However, the factors associated with cranial cortical robusticity remain poorly understood. Few studies have examined cortical robusticity in both cranial and postcranial bones jointly. In the present study, we used computed tomography (CT) images to measure cortical bone thicknesses in the cranial vault and humeral diaphysis. This study clearly showed that females have a greater cranial vault thickness and greater age-related increase in cranial vault thickness than males. We found an age-related increase in the full thickness of the temporal cranial vault and the width of the humeral diaphysis, as well as an age-related decrease in the cortical thickness of the frontal cranial vault and the cortical thickness of the humeral diaphysis, suggesting that the mechanisms of bone modeling in cranial and long bones are similar. A positive correlation between cortical indices in the cranial vault and humeral diaphysis also suggested that common factors affect cortical robusticity. We also examined the association of polymorphisms in the WNT16 and TNFSF11 genes with bone thickness. However, no significant associations were observed. The present study provides fundamental knowledge about similarities and differences in the mechanisms of bone modeling between cranial and postcranial bones.

The influence of reduced foot dorsum cutaneous sensitivity on the vestibular control of balance

PURPOSE

Foot sole cooling increases vestibular-evoked balance responses, but less is known about foot dorsum temperature alterations. The purpose was to determine whether decreasing cutaneous receptor sensitivity via foot dorsum cooling modulates the vestibular control of balance.

METHODS

Eighteen participants (9 males; 9 females) stood quietly on a force plate with feet together, eyes closed, and head rotated leftward during 4, 90-s trials (2 control; 2 cooled) of continuous electrical vestibular stimulation (EVS). Icepacks placed on the dorsum of both feet for 15 min induced cooling and remained throughout the EVS trials. Monofilament testing was performed at multiple locations before and after cooling to determine tactile detection thresholds. T-type thermocouples monitored skin temperature over the tibialis anterior, soleus, foot dorsum and arch of the right leg. Vestibular-evoked balance responses were characterized using time (cumulant density) and frequency (coherence and gain) domain analyses to determine the relationship between the EVS input and motor output (anteroposterior force-AP force; right medial gastrocnemius electromyography-MG EMG).

RESULTS

Skin temperature of the foot dorsum and arch decreased ~ 70 and 15%, respectively during cooling (p < 0.05), but was unaltered at other locations (p ≥ 0.10). Detection thresholds for the foot dorsum increased following cooling (p < 0.05). Surprisingly, cooling reduced EVS-AP force and EVS-MG EMG coherence and gain at multiple frequencies, and peak-to-peak amplitude compared to control (p < 0.05).

CONCLUSION

Our results indicate that vestibular-driven balance responses are reduced following foot dorsum cooling, likely owing to alterations in cutaneous mechanoreceptor sensitivity and subsequent alterations in the transformation of vestibular cues for balance control.

Fatal non-accidental pediatric cranial fracture risk and three-layered cranial architecture development

This study examines the influence of three-layered cranial architecture development upon blunt force trauma (BFT) cranial outcomes associated with pediatric non-accidental injury (NAI). Macroscopic and microscopic metric and morphological comparisons of subadult crania ranging from perinatal to 17 years of age chronicle the ontogenetic development and spatial and temporal variability in the emergence of a mature cranial architecture. Cranial vault thickness increases with subadult age, accelerating in the first 2 years of life due to rapid brain growth during this period. Three-layer differentiation of the cranial tables and diploë initiates by 3-6 months but is not consistently observed until 18 months to 2 years; diploë formation is not well developed until after age 4 and does not manifest a mature appearance until after age 8. These results allow topographic documentation of cortical and diploic development and temporal and spatial variability across the growing cranium. The lateral cranial vault is identified as expressing delayed development and reduced expression of the three-layer architecture, a pattern that continues into adulthood. Comparison of fracture locations from known BFT pediatric cases with identified cranial fracture high-risk impact regions shows a concordance and suggests the presence of a higher fracture risk associated with non-accidental BFT in the lateral vault region in subadults below the age of 2. The absence or lesser development of a three-layered architecture in subadults leaves their cranial bones, particularly in the lateral vault, thin and vulnerable to the effects of BFT.

Average thickness of the bones of the human neurocranium: development of reference measurements to assist with blunt force trauma interpretations

The accurate interpretation of a blunt force head injury relies on an understanding of the case circumstances (extrinsic variables) and anatomical details of the individual (intrinsic variables). Whilst it is often possible to account for many of these variables, the intrinsic variable of neurocranial thickness is difficult to account for as data for what constitutes 'normal' thickness is limited. The aim of this study was to investigate the effects of age, sex and ancestry on neurocranial thickness, and develop reference ranges for average neurocranial thickness in the context of those biological variables. Thickness (mm) was measured at 20 points across the frontal, left and right parietals, left and right temporals and occipital bones. Measurements were taken from post-mortem computed tomography scans of 604 individuals. Inferential statistics assessed how age, sex and ancestry affected thickness and descriptive statistics established thickness means. Mean thickness ranged from 2.11 mm (temporal squama) to 19.19 mm (petrous portion). Significant differences were noted in thickness of the frontal and temporal bones when age was considered, all bones when sex was considered and the, right parietal, left and right temporal and occipital bones when ancestry was considered. Furthermore, significant interactions in thickness were seen between age and sex in the frontal bone, ancestry and age in the temporal bone, ancestry and sex in the temporal bone, and age, sex and ancestry in the occipital bone. Given the assorted influence of the biological variables, reference measurement ranges for average thickness incorporated these variables. Such reference measurements allow forensic practitioners to identify when a neurocranial bone is of normal, or abnormal, thickness.

Influence of source-detector separation on diffuse correlation spectroscopy measurements of cerebral blood flow with a multilayered analytical model

Significance: Diffuse correlation spectroscopy (DCS) is an emerging noninvasive optical technology for bedside monitoring of cerebral blood flow. However, extracerebral hemodynamics can significantly influence DCS estimations of cerebral perfusion. Advanced analytical models can be used to remove the contribution of extracerebral hemodynamics; however, these models are highly sensitive to measurement noise. There is a need for an empirical determination of the optimal source-detector separation(s) (SDS) that improves the accuracy and reduces sensitivity to noise in the estimation of cerebral blood flow with these models. Aim: To determine the influence of SDS on solution uniqueness, measurement accuracy, and sensitivity to inaccuracies in model parameters when using the three-layer model to estimate cerebral blood flow with DCS. Approach: We performed a series of in silico simulations on samples spanning a wide range of physiologically-relevant layer optical properties, thicknesses, and flow. Data were simulated at SDS ranging from 0.5 to 3.0 cm using the three-layer solution to the correlation diffusion equation (with and without noise added) and using three-layer slab Monte Carlo simulations. We quantified the influence of SDS on uniqueness, accuracy, and sensitivity to inaccuracies in model parameters using the three-layer inverse model. Results: Two SDS are required to ensure a unique solution of cerebral blood flow index (CBFi). Combinations of 0.5/1.0/1.5 and 2.5 cm provide the optimal choice for balancing the depth penetration with signal-to-noise ratio to minimize the error in CBFi across a wide range of samples with varying optical properties, thicknesses, and dynamics. Conclusions: These results suggest that the choice of SDS is critical for minimizing the estimated error of cerebral blood flow when using the three-layer model to analyze DCS data.

Role of Cerebral Oximetry in Extracorporeal Membrane Oxygenation

Cerebral oximetry, which is based on near-infrared spectroscopy (NIRS) technology, is an optical technique that allows for noninvasive and continuous monitoring of brain oxygenation by determining cerebral tissue blood oxygen saturation. Many research and observational studies were performed with neonates using various types of NIRS/cerebral oximetry monitors. However, no food and drug administration (FDA) approved-cerebral oximeter is available for neonates. Successful validation of cerebral oximetry for the FDA has been done in human adult volunteer studies under protocols in which jugular bulb and arterial blood samples were obtained under different levels of fractional inspired oxygen levels.

Nanocrystalline Yttria-Stabilized Zirconia Ceramics for Cranial Window Applications

Transparent yttria-stabilized zirconia (YSZ) ceramics are promising for cranial window applications because of their good mechanical and optical properties as well as biocompatibility. YSZ discs with different yttria concentrations were either processed via current-activated pressure-assisted densification (CAPAD) using commercial nanoparticles or densified via spark plasma sintering (SPS) using pyrolysis-synthesized nanoparticles in-house. This study provided critical results to screen composition, processing, microstructure, and cytocompatibility of transparent YSZ discs for cranial window applications. CAPAD-processed YSZ discs with 6 or 8 mol % yttria (6YSZ and 8YSZ) and SPS-densified YSZ discs with 4 mol % yttria (4YSZ_P) showed 200-350 nm polycrystalline grains containing 20-30 nm crystallite domains. SPS-densified YSZ discs with 8 mol % yttria (8YSZ_P) showed larger polycrystalline grains of 819 ± 155 nm with 29 ± 5 nm crystallite domains. CAPAD-processed YSZ discs with 3 mol % yttria (3YSZ) showed 39 ± 9 nm grains. Bone-marrow-derived stem cells (BMSCs) on the polished YSZ discs showed statistically higher spreading areas than those on the unpolished YSZ discs of the same compositions. Generally, polished 8YSZ, 4YSZ_P, and 8YSZ_P discs and unpolished 8YSZ_R, 4YSZ_PR, and 8YSZ_PR discs had lower average cell adhesion densities than other YSZ discs under direct contact conditions. Under indirect contact conditions, all the YSZ disc groups showed similar average cell adhesion densities to the Cell-only control. The groups of polished 4YSZ_P and 8YSZ_P discs, unpolished 4YSZ_PR and 8YSZ_PR discs, and particle control of 8YSZ_Pnp showed higher Y³⁺ ion concentrations than other groups. No mineral deposition was detected on the polished YSZ discs after cell culture. Considering multiple factors such as cytocompatibility, cell adhesion density, Y³⁺ ion release, mineral deposition, and optical transparency collectively, 8YSZ may be the best candidate for the cranial window applications. Further studies are needed to evaluate the long-term transparency and biocompatibility of YSZ discs.

The effect of the presence or absence of skull fractures on intracranial lesion development in road traffic accidents

OBJECTIVE

The aim of this study was to investigate the effect of the presence or absence of skull fractures on the development of intracranial lesions in cases of head trauma associated with traffic accidents.

MATERIALS AND METHODS

A retrospective review was made of the medico-legal reports of 774 cases with injuries sustained in a traffic accident and which applied for expert examination as forensic cases at the Department of Forensic Medicine of our University between 1 January 2014 and 31 December 2019. A total of 162 cases (20.1%) were identified which were radiologically diagnosed with at least one skull fracture or intracranial lesion. These cases were evaluated in terms of age, gender, type of accident, and localization of skull fractures and/or intracranial lesions, and they were compared statistically to determine whether the presence or absence of skull fractures affected the development of intracranial lesions.

RESULTS

The 162 cases evaluated comprised 120 males and 42 females with a mean age of 25.1 ± 16.4 years. Intracranial lesions were accompanied by skull fractures in 77 cases, skull fracture alone was determined in 18 cases, and intracranial lesion alone in 67 cases. Skull fractures were mostly (64.5%) seen in the 1-20 years age group, and the intracranial lesions (90%) were mostly seen in the ≥41 years age group. Linear and diastatic fracture rates were highest in the temporal and frontal regions. The intracranial lesion/case ratio was 1.5/1 in cases without skull fracture, and 1.2/1 in cases with skull fracture.

CONCLUSION

The results of this study showed that the rate of linear or diastatic fractures was higher in females, which was associated with skull thickness. Skull fractures were found to occur most between the ages of 1 and 20 years, and the presence of skull fractures was determined to reduce the incidence of intracranial lesions by decreasing intracranial pressure.

Cerebral A1 adenosine receptor availability in female and male participants and its relationship to sleep

The neuromodulator adenosine and its receptors are mediators of sleep-wake regulation which is known to differ between sexes. We, therefore, investigated sex differences in A₁ adenosine receptor (A₁AR) availability in healthy human subjects under well-rested conditions using [¹⁸F]CPFPX and positron emission tomography (PET). [¹⁸F]CPFPX PET scans were acquired in 50 healthy human participants (20 females; mean age ± SD 28.0 ± 5.3 years). Mean binding potential (BP_ND; Logan's reference tissue model with cerebellum as reference region) and volume of distribution (V_T) values were calculated in 12 and 15 grey matter brain regions, respectively. [¹⁸F]CPFPX BP_ND was higher in females compared to males in all investigated brain regions (p < 0.025). The largest differences were found in the pallidum and anterior cingulate cortex, where mean BP_ND values were higher by 29% in females than in males. In females, sleep efficiency correlated positively and sleep latency negatively with BP_ND in most brain regions. V_T values did not differ between sexes. Sleep efficiency correlated positively with V_T in most brain regions in female participants. In conclusion, our analysis gives a first indication for potential sex differences in A₁AR availability even under well-rested conditions. A₁AR availability as measured by [¹⁸F]CPFPX BP_ND is higher in females compared to males. Considering the involvement of adenosine in sleep-wake control, this finding might partially explain the known sex differences in sleep efficiency and sleep latency.

Ultrasound for the Brain: A Review of Physical and Engineering Principles, and Clinical Applications

The emergence of new ultrasound technologies has improved our understanding of the brain functions and offered new opportunities for the treatment of brain diseases. Ultrasound has become a valuable tool in preclinical animal and clinical studies as it not only provides information about the structure and function of brain tissues but can also be used as a therapy alternative for brain diseases. High-resolution cerebral flow images with high sensitivity can be acquired using novel functional ultrasound and super-resolution ultrasound imaging techniques. The noninvasive treatment of essential tremors has been clinically approved and it has been demonstrated that the ultrasound technology can revolutionize the currently existing treatment methods. Microbubble-mediated ultrasound can remotely open the blood-brain barrier enabling targeted drug delivery in the brain. More recently, ultrasound neuromodulation received a great amount of attention due to its noninvasive and deep penetration features and potential therapeutic benefits. This review provides a thorough introduction to the current state-of-the-art research on brain ultrasound and also introduces basic knowledge of brain ultrasound including the acoustic properties of the brain/skull and engineering techniques for ultrasound. Ultrasound is expected to play an increasingly important role in the diagnosis and therapy of brain diseases.

Cross-sectional analysis of spatial distribution and total amount of harvestable calvarian split bone

BACKGROUND

Bone resorption of the jaw leads to challenging implant placement. Frequently, augmentation of the jaw is necessary. Is calvarian split bone an alternative to other extraoral donor sites and what volume of bone is harvestable? The aim was to evaluate the spatial distribution and the total amount of harvestable calvarian split bone.

MATERIAL AND METHODS

Computerized tomographies of 600 patients were divided into four groups (male and female: ≤45 years and >45 years). The skull was segmented and cut into the harvestable compartments (Os frontale, Ossa parietalia). The volume and thickness of the harvestable bone were calculated.

RESULTS

The overall harvestable bone was 110.644 ± 25.429 cm³. The bone from the Os frontale was significantly less than harvestable bone from the Os parietale (p < 0.001). More bone could be harvested from the right Os parietale. In younger males, significantly more bone could be harvested than in females (females ≤45 years: p = 0.001; females >45 years: p = 0.003). A weak negative correlation existed between the participants' age and the harvestable bone volume of the left Os parietale (r = -0.087; p = 0.033). The thickness of the harvestable bone from the Ossa parietalia is greater in females than in males.

CONCLUSION

A great amount of calvarian bone can be harvested to augment the jaw. Surgeons must acknowledge that more bone is harvestable from males than females while the female bone is thicker. Calculating the volume leads to accurate results of the available bone.

Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation

PURPOSE

To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age.

METHODS

270 children and adolescents (age: 0-17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL).

RESULTS

From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively.

CONCLUSION

We recommend that the tip of the pin should not exceed 2-3 mm in children aged < 4, and 4 mm in children aged 4-6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.

Investigation of the source-detector separation in near infrared spectroscopy for healthy and clinical applications

Understanding near infrared light propagation in tissue is vital for designing next generation optical brain imaging devices. Monte Carlo (MC) simulations provide a controlled mechanism to characterize and evaluate contributions of diverse near infrared spectroscopy (NIRS) sensor configurations and parameters. In this study, we developed a multilayer adult digital head model under both healthy and clinical settings and assessed light-tissue interaction through MC simulations in terms of partial differential pathlength, mean total optical pathlength, diffuse reflectance, detector light intensity and spatial sensitivity profile of optical measurements. The model incorporated four layers: scalp, skull, cerebrospinal-fluid and cerebral cortex with and without a customizable lesion for modeling hematoma of different sizes and depths. The effect of source-detector separation (SDS) on optical measurements' sensitivity to brain tissue was investigated. Results from 1330 separate simulations [(4 lesion volumes × 4 lesion depths for clinical +3 healthy settings) × 7 SDS × 10 simulation = 1330)] each with 100 million photons indicated that selection of SDS is critical to acquire optimal measurements from the brain and recommended SDS to be 25 to 35 mm depending on the wavelengths to obtain optical monitoring of the adult brain function. The findings here can guide the design of future NIRS probes for functional neuroimaging and clinical diagnostic systems.

Exploration of the Effect of Race on Cortical Current Flow Due to Transcranial Direct Current Stimulation: Comparison across Caucasian, Chinese, and Indian Standard Brains

It is well known that genetic and environmental factors amongst others make different ethnic populations dissimilar reflected by the difference in overall skull and brain volume, shape, and size. We sought to investigate in this study the effects of race related morphological changes by comparing across standard Caucasian, Chinese and Indian templates on brain current flow due to transcranial Direct Current Stimulation. Findings indicate up to 1.4 fold variation in induced electrical field magnitude in both target and non-target regions across the electrode montage and average heads considered. The observed variation is similar to the variation observed in adults of Caucasian race indicating that variation observed due to race are not significantly more than within race variation.

The response of the pediatric head to impacts onto a rigid surface

The study of pediatric head injury relies heavily on the use of finite element models and child anthropomorphic test devices (ATDs). However, these tools, in the context of pediatric head injury, have yet to be validated due to a paucity of pediatric head response data. The goal of this study is to investigate the response and injury tolerance of the pediatric head to impact. Twelve pediatric heads were impacted in a series of drop tests. The heads were dropped onto five impact locations (forehead, occiput, vertex and right and left parietal) from drop heights of 15 and 30 cm. The head could freely fall without rotation onto a flat 19 mm thick platen. The impact force was measured using a 3-axis piezoelectric load cell attached to the platen. Age and drop height were found to be significant factors in the impact response of the pediatric head. The head acceleration (14%-15 cm; 103-30 cm), Head Injury Criterion (HIC) (253%-15 cm; 154%-30 cm) and impact stiffness (5800%-15 cm; 3755%-30 cm) when averaged across all impact locations increased with age from 33 weeks gestation to 16 years, while the pulse duration (66%-15 cm; 53%-30 cm) decreased with age. Increases in head acceleration, HIC and impact stiffness were also observed with increased drop height, while pulse duration decreased with increased drop height. One important observation was that three of the four cadaveric heads between the ages of 5-months and 22-months sustained fractures from the 15 cm and 30 cm drop heights. The 5-month-old sustained a right parietal linear fracture while the 11- and 22-month-old sustained diastatic linear fractures.

Inducing therapeutic hypothermia via selective brain cooling: a finite element modeling analysis

Therapeutic hypothermia is a treatment method to reduce brain injuries after stroke, especially for cerebral ischemia. This study investigates in the temperature distribution of the head within selective brain cooling (SBC). Anatomically accurate geometries based on CT images of head and neck regions are used to develop the 3D geometry and physical model for the finite element modeling. Two cooling methods, the direct head surface cooling strategy and the combination cooling strategy of both head and neck, are evaluated to analyze the inducing hypothermia. The results show that for direct head surface cooling, the scalp and skull temperatures decrease significantly as the blood perfusion rate is constrained, but it is hard to affect the brain core temperature. To achieve a lower cerebral temperature, combination cooling strategy of both head and neck is an effective method in improving deep brain cooling. In normal condition, the cerebral temperature is reduced by about 0.12 °C in 60 min of hypothermia, while the temperature drop is approximately 0.98 °C in ischemic condition. Graphical abstract In this study, the 3D geometry of the head and carotid artery model based on the computed tomography (CT) were derived separately and the corresponding investigations were conducted to validate the reliability of the model. Direct head surface cooling strategy and the combination cooling strategy of both the head and neck were numerically researched.

Spinal instrumentation in infants, children, and adolescents: a review

OBJECTIVEThe evolution of pediatric spinal instrumentation has progressed in the last 70 years since the popularization of the Harrington rod showing the feasibility of placing spinal instrumentation into the pediatric spine. Although lacking in pediatric-specific spinal instrumentation, when possible, adult instrumentation techniques and tools have been adapted for the pediatric spine. A new generation of pediatric neurosurgeons with interest in complex spine disorder has pushed the field forward, while keeping the special nuances of the growing immature spine in mind. The authors sought to review their own experience with various types of spinal instrumentation in the pediatric spine and document the state of the art for pediatric spine surgery.METHODSThe authors retrospectively reviewed patients in their practice who underwent complex spine surgery. Patient demographics, operative data, and perioperative complications were recorded. At the same time, the authors surveyed the literature for spinal instrumentation techniques that have been utilized in the pediatric spine. The authors chronicle the past and present of pediatric spinal instrumentation, and speculate about its future.RESULTSThe medical records of the first 361 patients who underwent 384 procedures involving spinal instrumentation from July 1, 2007, to May 31, 2018, were analyzed. The mean age at surgery was 12 years and 6 months (range 3 months to 21 years and 4 months). The types of spinal instrumentation utilized included occipital screws (94 cases); C1 lateral mass screws (115 cases); C2 pars/translaminar screws (143 cases); subaxial cervical lateral mass screws (95 cases); thoracic and lumbar spine traditional-trajectory and cortical-trajectory pedicle screws (234 cases); thoracic and lumbar sublaminar, subtransverse, and subcostal polyester bands (65 cases); S1 pedicle screws (103 cases); and S2 alar-iliac/iliac screws (56 cases). Complications related to spinal instrumentation included hardware-related skin breakdown (1.8%), infection (1.8%), proximal junctional kyphosis (1.0%), pseudarthroses (1.0%), screw malpositioning (0.5%), CSF leak (0.5%), hardware failure (0.5%), graft migration (0.3%), nerve root injury (0.3%), and vertebral artery injury (0.3%).CONCLUSIONSPediatric neurosurgeons with an interest in complex spine disorders in children should develop a comprehensive armamentarium of safe techniques for placing rigid and nonrigid spinal instrumentation even in the smallest of children, with low complication rates. The authors' review provides some benchmarks and outcomes for comparison, and furnishes a historical perspective of the past and future of pediatric spine surgery.

Traumatic brain injury: sex, gender and intersecting vulnerabilities

Over the past decade, traumatic brain injury (TBI) has emerged as a major public health concern, attracting considerable interest from the scientific community, clinical and behavioural services and policymakers, owing to its rising prevalence, wide-ranging risk factors and substantial lifelong familial and societal impact. This increased attention to TBI has resulted in increased funding and advances in legislation. However, many questions surrounding TBI remain unanswered, including questions on sex and gender trends with respect to vulnerability to injury, presentation of injury, response to treatment, and outcomes. Here, we review recent research efforts aimed at advancing knowledge on the constructs of sex and gender and their respective influences in the context of TBI, and discuss methodological challenges in disentangling the differential impacts of these two constructs, particularly in marginalized populations.

Frontal sinus ontogeny and covariation with bone structures in a modern human population

In humans, the frontal sinus (FS) is located in the medial part of the supraorbital region, sometimes expanded throughout the frontal squama. It exhibits high morphological variability, but its general form appears to be constrained by surrounding structures. The goal of this study is to analyze FS growth and test for covariation between FS volume and the glabellar region, upper nasal region, bone thickness and endocranial size in a human sample from Argentina. The sample comprises 149 reconstructions derived from computed tomography images of individuals aged 0-31 years. Volume of the FS and measurements of the surrounding structures were recorded. The FS growth trajectory was assessed by parametric and nonparametric methods, and covariation was determined using correlations and partial correlations. The FS volume could be measured at an age of about 6 years and older; adults had no aplasia but hyperplasia was found in some cases. Since the most conspicuous characteristic found was variation among individuals, the nonparametric smoothing spline produced very poor fitting. The modified logistic function was the only parametric method providing significant parameters. Sexes differed in the age at which FS growth began and ended, with FS developing earlier but at a slower rate in females than in males. The FS volume did not correlate with either upper nasal width or endocranial volume, but it correlated with bone thickness measurements (mainly from the glabellar region), even when age was held constant. Expansion of the FS at the frontal poles also correlated with frontal bone thickness. Despite the difficulty in modeling and predicting the trajectory and morphology of FS, our results suggest that it is affected by its surrounding bony environment.

Novel Cranial Implants of Yttria-Stabilized Zirconia as Acoustic Windows for Ultrasonic Brain Therapy

Therapeutic ultrasound can induce changes in tissues by means of thermal and nonthermal effects. It is proposed for treatment of some brain pathologies such as Alzheimer's, Parkinson's, Huntington's diseases, and cancer. However, cranium highly absorbs ultrasound reducing transmission efficiency. There are clinical applications of transcranial focused ultrasound and implantable ultrasound transducers proposed to address this problem. In this paper, biocompatible materials are proposed for replacing part of the cranium (cranial implants) based on low porosity polycrystalline 8 mol% yttria-stabilized-zirconia (8YSZ) ceramics as acoustic windows for brain therapy. In order to assess the viability of 8YSZ implants to effectively transmit ultrasound, various 8YSZ ceramics with different porosity are tested; their acoustic properties are measured; and the results are validated using finite element models simulating wave propagation to brain tissue through 8YSZ windows. The ultrasound attenuation is found to be linearly dependent on ceramics' porosity. Results for the nearly pore-free case indicate that 8YSZ is highly effective in transmitting ultrasound, with overall maximum transmission efficiency of ≈81%, compared to near total absorption of cranial bone. These results suggest that 8YSZ polycrystals could be suitable acoustic windows for ultrasound brain therapy at 1 MHz.

A validation method for near-infrared spectroscopy based tissue oximeters for cerebral and somatic tissue oxygen saturation measurements

We describe the validation methodology for the NIRS based FORE-SIGHT ELITE^® (CAS Medical Systems, Inc., Branford, CT, USA) tissue oximeter for cerebral and somatic tissue oxygen saturation (StO₂) measurements for adult subjects submitted to the United States Food and Drug Administration (FDA) to obtain clearance for clinical use. This validation methodology evolved from a history of NIRS validations in the literature and FDA recommended use of Deming regression and bootstrapping statistical validation methods. For cerebral validation, forehead cerebral StO₂ measurements were compared to a weighted 70:30 reference (REF CX_B) of co-oximeter internal jugular venous and arterial blood saturation of healthy adult subjects during a controlled hypoxia sequence, with a sensor placed on the forehead. For somatic validation, somatic StO₂ measurements were compared to a weighted 70:30 reference (REF CX_S) of co-oximetry central venous and arterial saturation values following a similar protocol, with sensors place on the flank, quadriceps muscle, and calf muscle. With informed consent, 25 subjects successfully completed the cerebral validation study. The bias and precision (1 SD) of cerebral StO₂ compared to REF CX_B was −0.14 ± 3.07%. With informed consent, 24 subjects successfully completed the somatic validation study. The bias and precision of somatic StO₂ compared to REF CX_S was 0.04 ± 4.22% from the average of flank, quadriceps, and calf StO₂ measurements to best represent the global whole body REF CX_S. The NIRS validation methods presented potentially provide a reliable means to test NIRS monitors and qualify them for clinical use.

Attenuation Correction of PET/MR Imaging

PET/MR is a promising multimodality imaging approach. Attenuation is by far the largest correction required for quantitative PET imaging. MR-based attenuation correction have been extensively pursued, especially for brain imaging, in the past several years. In this article, we review atlas and direct imaging MR-based PET attenuation correction methods. The technical principles behind these methods are detailed and the advantages and disadvantages of these methods are discussed.

Human cranial vault thickness in a contemporary sample of 1097 autopsy cases: relation to body weight, stature, age, sex and ancestry

The relation between human cranial vault thickness (CVT) and various elements of the physical anthropological biological profile is subject of ongoing discussion. Some results seem to indicate no correlation between CVT and the biological profile of the individual, whereas other results suggest that CVT measurements might be useful for identification purposes. This study assesses the correlation between CVT and body weight, stature, age, sex, and ancestry by reviewing data of 1097 forensic autopsies performed at the Netherlands Forensic Institute (NFI). In subadults (younger than 19 years of age at the time of death), all frontal, temporal, and occipital CVT measurements correlated moderately to strongly with indicators of growth (body weight, stature, and age). Neither sex nor ancestry correlated significantly with cranial thickness. In adults, body weight correlated with all CVT measurements. No meaningful correlation was found between CVT and stature or age. Females showed to have thicker frontal bones, and the occipital region was thicker in the Negroid subsample. All correlation in the adult group was weak, with the distribution of cranial thickness overlapping for a great deal between the groups. Based on these results, it was concluded that CVT generally cannot be used as an indicator for any part of the biological profile.

Skull bone thickness versus malocclusion

Objective

The objectives of this study were to determine the thickness of skull bones, namely frontal, parietal, and occipital bones in Class I, Class II, and Class III patients.

Materials and Methods

Three hundred subjects who reported to the Department of Orthodontics requiring orthodontic treatment within the age group 17-35 were selected for the study. They were subdivided into three groups of 100 each according to the skeletal and dental relation. Profile radiographs were taken and the tracings were then scanned, and uploaded to the MATLAB 7.6.0 (R 2008a) software. The total surface areas of the individual bones were estimated by the software, which represented the thickness of each bone.

Result

Frontal bone was the thickest in Class III malocclusion group and the thinnest in Class II malocclusion group. But the parietal and occipital bone thickness were not significant. During gender differentiation in Class I, malocclusion group frontal bone thickness was more in males than females, In Class II, malocclusion parietal bone thickness was more in males than females. No statistically significant difference exists between genders, in Class III malocclusion group. During inter-comparison, the frontal bone thickness was significant when compared with Class I and Class II malocclusion groups and Class II and Class III malocclusion groups.

Conclusion

The differences in skull thickness in various malocclusions can be used as an adjunct in diagnosis and treatment planning for orthodontic patients. It was found that the new method (MATLAB 7.6.0 [R 2008a] software) of measuring skull thickness was easier, faster, precise, and accurate.

Determination of head conductivity frequency response in vivo with optimized EIT-EEG

Electroencephalography (EEG) benefits from accurate head models. Dipole source modelling errors can be reduced from over 1cm to a few millimetres by replacing generic head geometry and conductivity with tailored ones. When adequate head geometry is available, electrical impedance tomography (EIT) can be used to infer the conductivities of head tissues. In this study, the boundary element method (BEM) is applied with three-compartment (scalp, skull and brain) subject-specific head models. The optimal injection of small currents to the head with a modular EIT current injector, and voltage measurement by an EEG amplifier is first sought by simulations. The measurement with a 64-electrode EEG layout is studied with respect to three noise sources affecting EIT: background EEG, deviations from the fitting assumption of equal scalp and brain conductivities, and smooth model geometry deviations from the true head geometry. The noise source effects were investigated depending on the positioning of the injection and extraction electrode and the number of their combinations used sequentially. The deviation from equal scalp and brain conductivities produces rather deterministic errors in the three conductivities irrespective of the current injection locations. With a realistic measurement of around 2 min and around 8 distant distinct current injection pairs, the error from the other noise sources is reduced to around 10% or less in the skull conductivity. The analysis of subsequent real measurements, however, suggests that there could be subject-specific local thinnings in the skull, which could amplify the conductivity fitting errors. With proper analysis of multiplexed sinusoidal EIT current injections, the measurements on average yielded conductivities of 340 mS/m (scalp and brain) and 6.6 mS/m (skull) at 2 Hz. From 11 to 127 Hz, the conductivities increased by 1.6% (scalp and brain) and 6.7% (skull) on the average. The proper analysis was ensured by using recombination of the current injections into virtual ones, avoiding problems in location-specific skull morphology variations. The observed large intersubject variations support the need for in vivo measurement of skull conductivity, resulting in calibrated subject-specific head models.

Evaluation of Atlas-Based Attenuation Correction for Integrated PET/MR in Human Brain: Application of a Head Atlas and Comparison to True CT-Based Attenuation Correction

Attenuation correction (AC) for integrated PET/MR imaging in the human brain is still an open problem. In this study, we evaluated a simplified atlas-based AC (Atlas-AC) by comparing (18)F-FDG PET data corrected using either Atlas-AC or true CT data (CT-AC).

METHODS

We enrolled 8 patients (median age, 63 y). All patients underwent clinically indicated whole-body (18)F-FDG PET/CT for staging, restaging, or follow-up of malignant disease. All patients volunteered for an additional PET/MR of the head (additional tracer was not injected). For each patient, 2 AC maps were generated: an Atlas-AC map registered to a patient-specific liver accelerated volume acquisition-Flex MR sequence and using a vendor-provided head atlas generated from multiple CT head images and a CT-based AC map. For comparative AC, the CT-AC map generated from PET/CT was superimposed on the Atlas-AC map. PET images were reconstructed from the list-mode raw data from the PET/MR imaging scanner using each AC map. All PET images were normalized to the SPM5 PET template, and (18)F-FDG accumulation was quantified in 67 volumes of interest (VOIs; automated anatomic labeling atlas). Relative difference (%diff) between images based on Atlas-AC and CT-AC was calculated, and averaged difference images were generated. (18)F-FDG uptake in all VOIs was compared using Bland-Altman analysis.

RESULTS

The range of error in all 536 VOIs was -3.0%-7.3%. Whole-brain (18)F-FDG uptake based on Atlas-AC was slightly underestimated (%diff = 2.19% ± 1.40%). The underestimation was most pronounced in the regions below the anterior/posterior commissure line, such as the cerebellum, temporal lobe, and central structures (%diff = 3.69% ± 1.43%, 3.25% ± 1.42%, and 3.05% ± 1.18%), suggesting that Atlas-AC tends to underestimate the attenuation values of the skull base bone.

CONCLUSION

When compared with the gold-standard CT-AC, errors introduced using Atlas-AC did not exceed 8% in any brain region investigated. Underestimation of (18)F-FDG uptake was minor (<4%) but significant in regions near the skull base.

Variation of bone layer thicknesses and trabecular volume fraction in the adult male human calvarium

The human calvarium is a sandwich structure with two dense layers of cortical bone separated by porous cancellous bone. The variation of the three dimensional geometry, including the layer thicknesses and the volume fraction of the cancellous layer across the population, is unavailable in the current literature. This information is of particular importance to mathematical models of the human head used to simulate mechanical response. Although the target geometry for these models is the median geometry of the population, the best attempt so far has been the scaling of a unique geometry based on a few median anthropometric measurements of the head. However, this method does not represent the median geometry. This paper reports the average three dimensional geometry of the calvarium from X-ray computed tomography (CT) imaging and layer thickness and trabecular volume fraction from micro CT (μCT) imaging of ten adult male post-mortem human surrogates (PMHS). Skull bone samples have been obtained and μCT imaging was done at a resolution of 30 μm. Monte Carlo simulation was done to estimate the variance in these measurements due to the uncertainty in image segmentation. The layer thickness data has been averaged over areas of 5mm(2). The outer cortical layer was found to be significantly (p < 0.01; Student's t test) thicker than the inner layer (median of thickness ratio 1.68). Although there was significant location to location difference in all the layer thicknesses and volume fraction measurements, there was no trend. Average distribution and the variance of these metrics on the calvarium have been shown. The findings have been reported as colormaps on a 2D projection of the cranial vault.

The effort to close the gap: tracking the development of illusory contour processing from childhood to adulthood with high-density electrical mapping

The adult human visual system can efficiently fill-in missing object boundaries when low-level information from the retina is incomplete, but little is known about how these processes develop across childhood. A decade of visual-evoked potential (VEP) studies has produced a theoretical model identifying distinct phases of contour completion in adults. The first, termed a perceptual phase, occurs from approximately 100-200 ms and is associated with automatic boundary completion. The second is termed a conceptual phase occurring between 230 and 400 ms. The latter has been associated with the analysis of ambiguous objects which seem to require more effort to complete. The electrophysiological markers of these phases have both been localized to the lateral occipital complex, a cluster of ventral visual stream brain regions associated with object-processing. We presented Kanizsa-type illusory contour stimuli, often used for exploring contour completion processes, to neurotypical persons ages 6-31 (N=63), while parametrically varying the spatial extent of these induced contours, in order to better understand how filling-in processes develop across childhood and adolescence. Our results suggest that, while adults complete contour boundaries in a single discrete period during the automatic perceptual phase, children display an immature response pattern-engaging in more protracted processing across both timeframes and appearing to recruit more widely distributed regions which resemble those evoked during adult processing of higher-order ambiguous figures. However, children older than 5years of age were remarkably like adults in that the effects of contour processing were invariant to manipulation of contour extent.

Reconstruction of the scalp, calvarium, and frontal sinus

Scalp and cranial deformities are common after trauma or ablative surgery. Local flaps and free flaps may be used in reconstruction of soft tissue defects, and autogenous bone or alloplastic bone substitutes may be used for cranioplasty procedures. Injuries to the frontal sinus, particularly when complicated by leak of cerebrospinal fluid or obstruction of the nasofrontal outflow tract, represent special challenges. Further studies are recommended to improve the multidisciplinary management of these complex, debilitating conditions, in anticipation of enhanced function and cosmesis, reduced donor site morbidity, and improved surgical outcomes.

Safety of cranial fixation in endoscopic brow lifts

INTRODUCTION

The endoscopic brow lift technique relies on brow mobilization and often soft fixation to the underlying calvarium. While the endoscopic brow lift has been used safely, there are anecdotal reports of cerebrospinal fluid leak. We sought to measure calvarial thickness to improve the safety of cranial fixation.

METHODS

A retrospective review was performed of T2 weighted MRIs of the face of 28 patients. Calvarial thickness was measured on 10 coronal planes, from 3 centimeters (cm) anterior to 6 cm posterior to coronal suture. Fifteen points were measured on each coronal plane, starting in the midline and extending laterally for 7 cm. There were a total of 150 calvarial measurements per patient, covering the surface area used in endoscopic brow lifts. Statistical comparison was performed using analysis of variance.

RESULTS

Cranial thickness ranged from 1.1 to 13.6mm, with a mean of 6.1mm. The skull was thickest 2-4 cm posterior to the coronal suture, and thinnest 1cm anterior to the coronal suture. The cranium thins as it extends laterally, with an average thickness of 5.0mm at seven centimeters from midline. Average skull thickness for males was 5.96 versus 6.16 in females. There was no relationship between age and skull thickness.

CONCLUSION

Cranial thickness increases medially and posteriorly, and is larger for females compared with their male counterparts. Given the risk of CSF leak, surgeons need to be aware of how cranial thickness varies by location along the skull.

3D ultrasound system to investigate intraventricular hemorrhage in preterm neonates

Intraventricular hemorrhage (IVH) is a common disorder among preterm neonates that is routinely diagnosed and monitored by 2D cranial ultrasound (US). The cerebral ventricles of patients with IVH often have a period of ventricular dilation (ventriculomegaly). This initial increase in ventricle size can either spontaneously resolve, which often shows clinically as a period of stabilization in ventricle size and eventual decline back towards a more normal size, or progressive ventricular dilation that does not stabilize and which may require interventional therapy to reduce symptoms relating to increased intracranial pressure. To improve the characterization of ventricle dilation, we developed a 3D US imaging system that can be used with a conventional clinical US scanner to image the ventricular system of preterm neonates at risk of ventriculomegaly. A motorized transducer housing was designed specifically for hand-held use inside an incubator using a transducer commonly used for cranial 2D US scans. This system was validated using geometric phantoms, US/MRI compatible ventricle volume phantoms, and patient images to determine 3D reconstruction accuracy and inter- and intra-observer volume estimation variability. 3D US geometric reconstruction was found to be accurate with an error of <0.2%. Measured volumes of a US/MRI compatible ventricle-like phantom were within 5% of gold standard water displacement measurements. Intra-class correlation for the three observers was 0.97, showing very high agreement between observers. The coefficient of variation was between 1.8-6.3% for repeated segmentations of the same patient. The minimum detectable difference was calculated to be 0.63 cm(3) for a single observer. Results from ANOVA for three observers segmenting three patients of IVH grade II did not show any significant differences (p > 0.05) for the measured ventricle volumes between observers. This 3D US system can reliably produce 3D US images of the neonatal ventricular system. There is the potential to use this system to monitor the progression of ventriculomegaly over time in patients with IVH.

Dosage considerations for transcranial direct current stimulation in children: a computational modeling study

Transcranial direct current stimulation (tDCS) is being widely investigated in adults as a therapeutic modality for brain disorders involving abnormal cortical excitability or disordered network activity. Interest is also growing in studying tDCS in children. Limited empirical studies in children suggest that tDCS is well tolerated and may have a similar safety profile as in adults. However, in electrotherapy as in pharmacotherapy, dose selection in children requires special attention, and simple extrapolation from adult studies may be inadequate. Critical aspects of dose adjustment include 1) differences in neurophysiology and disease, and 2) variation in brain electric fields for a specified dose due to gross anatomical differences between children and adults. In this study, we used high-resolution MRI derived finite element modeling simulations of two healthy children, ages 8 years and 12 years, and three healthy adults with varying head size to compare differences in electric field intensity and distribution. Multiple conventional and high-definition tDCS montages were tested. Our results suggest that on average, children will be exposed to higher peak electrical fields for a given applied current intensity than adults, but there is likely to be overlap between adults with smaller head size and children. In addition, exposure is montage specific. Variations in peak electrical fields were seen between the two pediatric models, despite comparable head size, suggesting that the relationship between neuroanatomic factors and bioavailable current dose is not trivial. In conclusion, caution is advised in using higher tDCS doses in children until 1) further modeling studies in a larger group shed light on the range of exposure possible by applied dose and age and 2) further studies correlate bioavailable dose estimates from modeling studies with empirically tested physiologic effects, such as modulation of motor evoked potentials after stimulation.

Depth sensitivity and source-detector separations for near infrared spectroscopy based on the Colin27 brain template

Understanding the spatial and depth sensitivity of non-invasive near-infrared spectroscopy (NIRS) measurements to brain tissue–i.e., near-infrared neuromonitoring (NIN) – is essential for designing experiments as well as interpreting research findings. However, a thorough characterization of such sensitivity in realistic head models has remained unavailable. In this study, we conducted 3,555 Monte Carlo (MC) simulations to densely cover the scalp of a well-characterized, adult male template brain (Colin27). We sought to evaluate: (i) the spatial sensitivity profile of NIRS to brain tissue as a function of source-detector separation, (ii) the NIRS sensitivity to brain tissue as a function of depth in this realistic and complex head model, and (iii) the effect of NIRS instrument sensitivity on detecting brain activation. We found that increasing the source-detector (SD) separation from 20 to 65 mm provides monotonic increases in sensitivity to brain tissue. For every 10 mm increase in SD separation (up to ∼45 mm), sensitivity to gray matter increased an additional 4%. Our analyses also demonstrate that sensitivity in depth (S) decreases exponentially, with a “rule-of-thumb” formula S = 0.75*0.85^depth. Thus, while the depth sensitivity of NIRS is not strictly limited, NIN signals in adult humans are strongly biased towards the outermost 10–15 mm of intracranial space. These general results, along with the detailed quantitation of sensitivity estimates around the head, can provide detailed guidance for interpreting the likely sources of NIRS signals, as well as help NIRS investigators design and plan better NIRS experiments, head probes and instruments.