Various operative techniques are available for the treatment of craniosynostosis. The patient's age at presentation is one of the most important factors in the determination of the surgical modality. Minimally invasive suturectomy and postoperative helmet therapy may be performed for relatively young infants, whose age is younger than 6 months. It relies upon the potential for rapid brain growth in this age group. Its minimal invasiveness is also advantageous. In this article, we review the advantages and limitations of minimally invasive suturectomy followed by helmet therapy for the treatment of craniosynostosis.
Brain ; Craniosynostoses ; Head Protective Devices* ; Humans ; Infant

OBJECTIVE: The authors developed a stereotactic device for irradiation of small animals with Leksell Gamma Knife(R) Model C. Development and verification procedures were described in this article. METHODS: The device was designed to satisfy three requirements. The mechanical accuracy in positioning was to be managed within 0.5 mm. The strength of the device and structure were to be compromised to provide enough strength to hold a small animal during irradiation and to interfere the gamma ray beam as little as possible. The device was to be used in combination with the Leksell G-frame(R) and KOPF(R) rat adaptor. The irradiation point was determined by separate imaging sequences such as plain X-ray images. RESULTS: The absolute dose rate with the device in a Leksell Gamma Knife was 3.7% less than the value calculated from Leksell Gamma Plan(R). The dose distributions measured with GAFCHROMIC(R) MD-55 film corresponded to those of Leksell Gamma Plan(R) within acceptable range. The device was used in a series of rat experiments with a 4 mm helmet of Leksell Gamma Knife. CONCLUSION: A stereotactic device for irradiation of small animals with Leksell Gamma Knife Model C has been developed so that it fulfilled above requirements. Absorbed dose and dose distribution at the center of a Gamma Knife helmet are in acceptable ranges. The device provides enough accuracy for stereotactic irradiation with acceptable practicality.
Animals ; Gamma Rays ; Head Protective Devices ; Rats

On the basis of extensive field investigation and a series of herbarium specimen identifications, we present and discuss the descriptions and distribution of 22 species of Ramalina found in the Hengduan Mountains of southwestern China. In this revisionary study, representatives of the Ramalina genus, including R. americana, R. confirmata, R. dendriscoides, R. obtusata, R. pacifica, R. pentecostii, R. peruviana, R. shinanoana, and R. subcomplanata are found for the first time in this area. In addition, R. holstii is reported for the first time China. Finally, a newly described species identified as Ramalina hengduanshanensis S. O. Oh & L. S. Wang is reported. It is characterized as growing from a narrow holdfast, solid, sparsely or richly and irregularly dichotomously branched, palmate and flattened lobes with distinctly dorsiventral appearance, surface rugose to reticulate, surface rugosely cracked, dense chondroid tissue, helmet shaped soralia at the tip. The species grows on rock and tree at the highest elevations in this area. Although very few lichen species belonging to the genus Ramalina have been collected above 4,000 m, this new species is found at this elevation. We present detailed morphological, anatomical, and chemical descriptions of this species along with molecular phylogenetic analysis of the internal transcribed spacer rDNA sequences.
China* ; DNA, Ribosomal ; Head Protective Devices ; Lichens* ; Trees

OBJECTIVE: To identify the effect of the 'disability prevention program' for elementary school students. METHOD: Our disability prevention program was a 60 minutes program composed of watching an education video for disability prevention and having a conversation with disabled speakers in wheelchairs. A questionnaire to measure the effect of the education was administered among 5,315 students in the 4th to 6th grades. The questionnaire was administered at 7 days before and after education. The questionnaire was to measure the changes in self-efficacy and in confidence to follow safety regulation. Also the questions on satisfaction about program were asked. RESULTS: The result showed that only 9.7% of bicycle owners, 18.9% of inline skate owners wore helmets, 9.3% of quick board (or skateboard) owners wore helmets, and only 47.6% of students fastened seat-belts in a car. After the program was conducted, there were significant improvements in self-efficacy and practice-confidence to wear protective device and to fasten seat belt in a car (p<0.01). The most impressive part of the program for students was 'conversation with disabled speaker' and the next was 'watching the video'. After program was conducted, 51.5% of students answered "I will keep safety regulations in mind and practice it" and 10.1% of students answered "I could learn a better understanding of the disabled and I also want to help them". CONCLUSION: The 'disability prevention program with disabled speakers in wheelchair' was effective in improving the self-efficacy and practice-confidence for safety regulation.
Disabled Persons ; Head Protective Devices ; Humans ; Protective Devices ; Surveys and Questionnaires ; Seat Belts ; Self Efficacy ; Social Control, Formal ; Wheelchairs

It is important to distinguish deformational plagiocephaly from craniosynostosis, the two conditions are different with respect to clinical progression and treatment options. Deformational plagiocephaly is diagnosed based on the patient's medical history and physical examination. Until recently, there has been no standardized method of evaluation. Visual assessment, anthropometric assessment, digital scanning, and radiologic evaluation are mostly commonly used modalities for diagnosis and assessment. Treatment of deformational plagiocephaly requires an understanding of natural progression of the disease. Deformational plagiocephaly should be classified according to its severity before the proper method and time for treatment are determined. Treatment includes repositioning, physiotherapy and remodeling with the use of orthotic devices. In general, repositioning is preferred for patients younger than six months old while treatment with the use of orthotic devices such as helmet is preferred for patients over six months old. Moreover, treatment with the use of orthotic devices is also favored for severe plagiocephaly. There is continuing research on the relation between deformational plagiocephaly and developmental delay.
Craniosynostoses ; Head Protective Devices ; Humans ; Orthotic Devices ; Physical Examination ; Plagiocephaly ; Plagiocephaly, Nonsynostotic*

Cutaneous angiosarcomas are uncommon malignancies which account about 1% of sarcomas. They are found most commonly in the head and neck regions, frequently on the scalp. Although preferred treatment has been combined surgery and postoperative radiation therapy, the extensiveness and multiplicity of the lesions set limits to such an approach and the patient is often referred for radiotherapy without surgery. As the entire scalp usually needs to be treated, radiation therapy is a challenging problem to radiation oncology staffs. We report a case of angiosarcoma of the scalp, which was treated successfully by radiation therapy with a simple and repeatable method using mixed photon and electron beam technique. Using a bolus to increase the surface dose of the scalp and to minimize dose to the normal tissues of the brain desirable but difficult technically to be well conformed o the three dimensional curved surface such as vertex of the head. A helmet made of thermoplastics filled with paraffin was elaborated and used for the treatment, resulting of the relatively uniform surface doses along the several points measured on the scalp, the difference among the points not exceeding 7% of the prescribed dose by TLD readings.
Brain ; Head ; Head Protective Devices ; Hemangiosarcoma* ; Humans ; Neck ; Paraffin ; Radiation Oncology ; Radiotherapy* ; Reading ; Sarcoma ; Scalp*

OBJECTIVE: To compare effectiveness on correcting cranial and ear asymmetry between helmet therapy and counter positioning for deformational plagiocephaly (DP). METHODS: Retrospective data of children diagnosed with DP who visited our clinic from November 2010 to October 2012 were reviewed. Subjects < or =10 months of age who showed > or =10 mm of diagonal difference were included for analysis. For DP treatment, information on both helmet therapy and counter positioning was given and either of the two was chosen by each family. Head circumference, cranial asymmetry measurements including diagonal difference, cranial vault asymmetry index, radial symmetry index, and ear shift were obtained by 3-dimensional head-surface laser scan at the time of initiation and termination of therapy. RESULTS: Twenty-seven subjects were included: 21 had helmet therapy and 6 underwent counter positioning. There was no significant difference of baseline characteristics, head circumferences and cranial asymmetry measurements at the initiation of therapy. The mean duration of therapy was 4.30+/-1.27 months in the helmet therapy group and 4.08+/-0.95 months in the counter positioning group (p=0.770). While cranial asymmetry measurements improved in both groups, significantly more improvement was observed with helmet therapy. There was no significant difference of the head circumference growth between the two groups at the end of therapy. CONCLUSION: Helmet therapy resulted in more favorable outcomes in correcting cranial and ear asymmetry than counter positioning on moderate to severe DP without compromising head growth.
Cephalometry ; Child ; Ear ; Facial Asymmetry ; Head ; Head Protective Devices* ; Humans ; Patient Positioning ; Plagiocephaly, Nonsynostotic* ; Retrospective Studies

The aim of this study is to review the protective effect of a bicycle helmet on each facial location systematically. PubMed was searched for articles published before December 12, 2014. The data were summarized, and the odds ratio (OR) between the locations of facial injury was calculated. A statistical analysis was performed with Review Manager (The Nordic Cochrane Centre). Bicycle helmets protect the upper and middle face from serious facial injury but do not protect the lower face. Non-wearers had significantly increased risks of upper facial injury (OR, 2.07; P<0.001) and of middle facial injury (OR, 1.97; P<0.001) as compared to helmet users. In the case of lower facial injury, however, only a slightly increased risk (OR, 1.42; 95% confidence interval (CI), 0.67-3.00, P=0.36) was observed. The abovementioned results can be attributed to the fact that a helmet covers the head and forehead but cannot cover the lower face. However, helmets having a chin cap might decrease the risk of lower facial injury.
Bicycling ; Chin ; Facial Injuries* ; Forehead ; Head ; Head Protective Devices* ; Odds Ratio

PURPOSE: A cranioremodeling helmet for correcting plagiocephaly was recently developed. However, no discrete objective methods to evaluate how the deformity is being corrected have been developed. We have established an easy and cost-effective method that can be used not only to show the correction process, but can also be used by physicians to assess the degree of plagiocephaly two-dimensionally. METHODS: For two-dimensional evaluation, a length of malleable memory wire (2 mm in diameter) resembling "Sun-Wukong's headband" was placed on the patient's head. The wire around the patient's head was positioned on a plane including points 1 cm above the eyebrow and 1 cm above the auricle. The wire was placed on a sheet of paper and the outline was marked using pens of various colors during each visit. The degree of plagiocephaly correction could then be shown to the patient's parents at every consultation. RESULTS: The method established by the present study easily shows the horizontal cross-section transformation of the head, illustrates plagiocephaly correction by the helmet, and shows the degree of correction in a two-dimensional manner. CONCLUSION: A soft-shell helmet is widely used for correcting plagiocephaly. However, evaluating the effectiveness of the helmet has been determined in a subjective manner, and a more objective method is now in demanded. Our study found that a "Sun-Wukong's headband" wire can accurately measure two-dimensional changes. Future studies will be required to identify landmarks needed for assessing plagiocephaly correction.
Congenital Abnormalities ; Eyebrows ; Head ; Head Protective Devices ; Humans ; Memory ; Parents ; Plagiocephaly ; Plagiocephaly, Nonsynostotic

OBJECTIVETo investigate the clinical effect of postural correction training and helmet therapy in the treatment of moderate-severe positional head deformity defined as asymmetric head shape in infants.

METHODSA total of 31 infants who were diagnosed with moderate-severe plagiocephaly and/or brachiocephaly were enrolled. According to the different treatment methods, the infants were divided into helmet therapy group with 11 infants and postural correction training group with 20 infants. The cranial vault asymmetry index (CVAI), cephalic ratio (CR), and head circumference growth were compared between the two groups before and after treatment.

RESULTSCompared with the postural correction training group, the helmet therapy group had significantly lower CVAI and CR after treatment. The helmet therapy group had significantly better improvements in CVAI and CR after treatment compared with the postural correction training group (CVAI difference: 6.0±1.9 vs 0.7±0.8, P=0.001; CR difference: 0.047±0.009 vs 0.008±0.005, P<0.001). There was no significant difference in head circumference growth between the two groups (P=0.55).

CONCLUSIONSHelmet therapy has a significantly better effect in the treatment of moderate-severe positional head deformity than postural correction training in infants. Helmet therapy does not limit head circumference growth.

Female ; Head ; abnormalities ; growth & development ; Head Protective Devices ; Humans ; Infant ; Infant, Newborn ; Male ; Posture