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Couldwell M, Chaiyamoon A, Cardona JJ, Iwanaga J, Ezra D, Suwannakhan A, Dumont AS, Tubbs RS. Twenty Intracranial Skull Base Variations in the Same Specimen. Cureus 2023; 15:e40096. [PMID: 37425550 PMCID: PMC10328379 DOI: 10.7759/cureus.40096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Anatomists and clinicians often encounter single bony anatomical variations in dry skulls and on imaging. However, a constellation of 20 such variants some that, to our knowledge, have not been previously described is noteworthy. Here, we describe an adult skull with multiple bony variations, and these are detailed and discussed. These included clival canals, an interclinoid bar with resultant foramen at the uppermost aspect of the clivus, middle clinoid process, posterior petroclinoid ligament, pterygoalar plate, septated hypoglossal canal, foramen through the anterior clinoid process, septated foramen ovale, shortened superior orbital fissure, and crista muscularis. Knowledge of individual differences in the structure of the skull may be of use to both anatomists and clinicians in the treatment of intracranial procedures as well as cranial imaging studies. Taken together, such a unique specimen is of archival value.
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Affiliation(s)
- Mitchell Couldwell
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, THA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - David Ezra
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Yaffo, ISR
| | | | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, USA
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
- Department of Surgery, Tulane University School of Medicine, New Orleans, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
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Yang H, Bai X, Huan X, Wang T. Paracondylar process combined with persistent first intersegmental vertebral artery: an anatomic case report and literature review. Br J Neurosurg 2020:1-5. [PMID: 32476483 DOI: 10.1080/02688697.2020.1772959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The paracondylar process (PCP) and the persistent first intersegmental vertebral artery (PFIA) are both rare variations at the craniovertebral junction. We report the above two variations coexisting in one cadaveric head during the training of far lateral approach in our skull base lab. The specimen simultaneously had a left occipitalized atlas associated with a PFIA and a right PCP. The previous reports, the embryogenesis, and the clinical implications of the two variations were also reviewed. Preoperative recognition of the rare variations is essential to a safe far lateral approach.
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Affiliation(s)
- Haigui Yang
- Department of Neurosurgery, Yan'an People's Hospital, Yan'an, China
| | - Xiaofei Bai
- Department of Neurosurgery, Yan'an People's Hospital, Yan'an, China
| | - Xiaoli Huan
- Department of Neurosurgery, Yan'an People's Hospital, Yan'an, China
| | - Tingzhong Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Shoja MM, Ramdhan R, Jensen CJ, Chern JJ, Oakes WJ, Tubbs RS. Embryology of the craniocervical junction and posterior cranial fossa, part I: Development of the upper vertebrae and skull. Clin Anat 2018; 31:466-487. [PMID: 29345006 DOI: 10.1002/ca.23049] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/15/2018] [Indexed: 01/29/2023]
Abstract
Although the embryology of the posterior cranial fossa can have life altering effects on a patient, a comprehensive review on this topic is difficult to find in the peer-reviewed medical literature. Therefore, this review article, using standard search engines, seemed timely. The embryology of the posterior cranial fossa is complex and relies on a unique timing of various neurovascular and bony elements. Derailment of these developmental processes can lead to a wide range of malformations such as the Chiari malformations. Therefore, a good working knowledge of this embryology as outlined in this review of its bony architecture is important for those treating patients with involvement of this region of the cranium. Clin. Anat. 31:466-487, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohammadali M Shoja
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rebecca Ramdhan
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada
| | - Chad J Jensen
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada
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Abstract
INTRODUCTION The skull base represents a central and complex bone structure of the skull and forms the floor of the cranial cavity on which the brain lies. Anatomical knowledge of this particular region is important for understanding several pathologic conditions as well as for planning surgical procedures. Embryology of the cranial base is of great interest due to its pronounced impact on the development of adjacent regions including the brain, neck, and craniofacial skeleton. MATERIALS AND METHODS Information from human and comparative anatomy, anthropology, embryology, surgery, and computed modelling was integrated to provide a perspective to interpret skull base formation and variability within the cranial functional and structural system. RESULTS AND CONCLUSIONS The skull base undergoes an elaborate sequence of development stages and represents a key player in skull, face and brain development. Furthering our holistic understanding of the embryology of the skull base promises to expand our knowledge and enhance our ability to treat associated anomalies.
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Costa MA, Borzabadi-Farahani A, Lara-Sanchez PA, Schweitzer D, Jacobson L, Clarke N, Hammoudeh J, Urata MM, Magee WP. Partial craniofacial duplication: a review of the literature and case report. J Craniomaxillofac Surg 2013; 42:290-6. [PMID: 23969147 DOI: 10.1016/j.jcms.2013.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 11/25/2022] Open
Abstract
Diprosopus (Greek; di-, "two" + prosopon, "face"), or craniofacial duplication, is a rare craniofacial anomaly referring to the complete duplication of facial structures. Partial craniofacial duplication describes a broad spectrum of congenital anomalies, including duplications of the oral cavity. This paper describes a 15 month-old female with a duplicated oral cavity, mandible, and maxilla. A Tessier type 7 cleft, midline meningocele, and duplicated hypophysis were also present. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach was designed to preserve facial nerve innervation to the reconstructed cheek and mouth. The duplicated mandible and maxilla were excised and the remaining left maxilla was bone grafted. Soft tissue repair included closure of the Tessier type VII cleft. Craniofacial duplication remains a rare entity that is more common in females. The pathophysiology remains incompletely characterized, but is postulated to be due to duplication of the notochord, as well as duplication of mandibular growth centres. While diprosopus is a severe deformity often associated with anencephaly, patients with partial duplication typically benefit from surgical treatment. Managing craniofacial duplication requires a detailed preoperative evaluation as well as a comprehensive, staged treatment plan. Long-term follow up is needed appropriately to address ongoing craniofacial deformity.
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Affiliation(s)
- Melinda A Costa
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles (CHLA), Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Ali Borzabadi-Farahani
- Orthodontics, Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, UK; Formerly, Craniofacial Orthodontics, Division of Dentistry, CHLA, Center for Craniofacial Molecular Biology, USC, Los Angeles, CA, USA
| | - Pedro A Lara-Sanchez
- Department of Genetics, CHLA, Keck School of Medicine, USC, Los Angeles, CA, USA
| | - Daniela Schweitzer
- Department of Genetics, CHLA, Keck School of Medicine, USC, Los Angeles, CA, USA
| | - Lia Jacobson
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles (CHLA), Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Noreen Clarke
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles (CHLA), Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Jeffery Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles (CHLA), Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles (CHLA), Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - William P Magee
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles (CHLA), Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
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Natsis K, Piagkou M, Skotsimara G, Piagkos G, Skandalakis P. A morphometric anatomical and comparative study of the foramen magnum region in a Greek population. Surg Radiol Anat 2013; 35:925-34. [DOI: 10.1007/s00276-013-1119-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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Tubbs RS, Lingo PR, Mortazavi MM, Cohen-Gadol AA. Hypoplastic occipital condyle and third occipital condyle: review of their dysembryology. Clin Anat 2013; 26:928-32. [PMID: 23338989 DOI: 10.1002/ca.22205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/17/2012] [Accepted: 10/21/2012] [Indexed: 11/11/2022]
Abstract
Disruption or embryologic derailment of the normal bony architecture of the craniovertebral junction (CVJ) may result in symptoms. As studies of the embryology and pathology of hypoplasia of the occipital condyles and third occipital condyles are lacking in the literature, the present review was performed. Standard search engines were accessed and queried for publications regarding hypoplastic occipital condyles and third occipital condyles. The literature supports the notion that occipital condyle hypoplasia and a third occipital condyle are due to malformation or persistence of the proatlas, respectively. The Pax-1 gene is most likely involved in this process. Clinically, condylar hypoplasia may narrow the foramen magnum and lead to lateral medullary compression. Additionally, this maldevelopment can result in transient vertebral artery compression secondary to posterior subluxation of the occiput. Third occipital condyles have been associated with cervical canal stenosis, hypoplasia of the dens, transverse ligament laxity, and atlanto-axial instability causing acute and chronic spinal cord compression. Treatment goals are focused on craniovertebral stability. A better understanding of the embryology and pathology related to CVJ anomalies is useful to the clinician treating patients presenting with these entities.
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Affiliation(s)
- R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama
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The enigmatic clival canal: anatomy and clinical significance. Childs Nerv Syst 2010; 26:1207-10. [PMID: 20213190 DOI: 10.1007/s00381-010-1100-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE There is scant and conflicting literature regarding bony canals of the clivus. To date, only osteological observations of dry skulls have been made of such structures and multiple hypotheses exist regarding the etiology of these entities and whether or not they represent normal variations or pathology. The present study was performed to elucidate, specifically, clival canals of the occipital portion of the clivus. METHODS One hundred dry skulls (80 adult and 20 children) and 47 adult cadavers were included, and the superior and inferior surfaces of their clivus were inspected for bony defects/canals. When identified, the canals were measured and their potential contents removed. The contents of the canals in these cadaveric specimens were submitted for histological analysis. RESULTS A canal of the clivus was identified in 5% of dry specimens and in 6.4% of cadaveric specimens. One diagonal and five more or less vertical canals were found. One canal was observed to have a single opening and one canal was found to have three openings. For the cadaveric canals, histology of the contents revealed no pituitary or notochordal tissue with only vascular anatomy consistent with veins. These venous structures appeared to connect parts of the basilar venous plexus. CONCLUSIONS Based on our study, which is the first of its kind, such canals of the occipital portion of the clivus should not be mistaken for pathology and represent simple vascular channels.
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Tubbs RS, Salter EG, Oakes WJ. Reply to Kunicki and Ciszek. Clin Anat 2005. [DOI: 10.1002/ca.20209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kunicki J, Ciszek B. The clinical anatomy and the occipital condyle variants. Clin Anat 2005; 18:646-7; author reply 648. [PMID: 16187325 DOI: 10.1002/ca.20217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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