In the past the patients with fracture on the occipital bone involved the lateral sinus and/or the foramen magnum, were treated with the early exploratory burr hole trephination regardless of mental state. The 64 cases occipital bone fracture were evaluated used the computed tomography of the brain scan. The fracture lines involved both the transeverse sinus and the foramen magnum were 59.4%, only the transeverse sinus were 29.7% and only the foramen magnum were 10.9%. The findings of the computed tomography of the brain scan were normal 42 cases, brain edema 13 cases. The 5 cases had large hematoma on the computed tomography of the brain scan performed emergency operation. The other 59 cases were treated with only close observation and conservative treatment. The mortality rate was 20% in operative treatment and 8.5% in conservative treatment. So we concluded that the patients with significant fracture on the occipital bone but had no surgical indication on the computed tomography of the brain scan might be treated with close observation & conservative treatment and it would not be necessary to perform the exploratory craniotomy as was done in the past.
Brain ; Brain Edema ; Craniotomy ; Emergencies ; Foramen Magnum ; Hematoma ; Humans ; Mortality ; Occipital Bone* ; Transverse Sinuses ; Trephining

OBJECTIVE: Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. METHODS: Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. RESULTS: Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. CONCLUSION: The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.
Arthritis, Rheumatoid ; Asian Continental Ancestry Group ; Axis, Cervical Vertebra ; Decompression ; Follow-Up Studies ; Foramen Magnum ; Humans ; Male ; Occipital Bone ; Orthopedics ; Pneumonia ; Retrospective Studies ; Sepsis ; Spinal Cord Diseases ; Spine

OBJECTIVE: The purpose of this study is to compare landmark position between cephalometric radiography and midsagittal plane projected images from 3 dimensional (3D) CT. METHODS: Cephalometric radiographs and CT scans were taken from 20 patients for treatment of mandibular prognathism. After selection of landmarks, CT images were projected to the midsagittal plane and magnified to 110% according to the magnifying power of radiographs. These 2 images were superimposed with frontal and occipital bone. Common coordinate system was established on the base of FH plane. The coordinate value of each landmark was compared by paired t test and mean and standard deviation of difference was calculated. RESULTS: The difference was from -0.14 +/- 0.65 to -2.12 +/- 2.89 mm in X axis, from 0.34 +/- 0.78 to -2.36 +/- 2.55 mm (6.79 +/- 3.04 mm) in Y axis. There was no significant difference only 9 in X axis, and 7 in Y axis out of 20 landmarks. This might be caused by error from the difference of head positioning, by masking the subtle end structures, identification error from the superimposition and error from the different definition. CONCLUSIONS: This study revealed innate shortcomings of radiography. For the development of 3D cephalometry, more study was needed.
Axis, Cervical Vertebra ; Cephalometry ; Head ; Humans ; Masks ; Occipital Bone ; Prognathism

PURPOSE: The purpose of this study is to illustrate MR patterns of bone marrow of calvarium and vertebral body in normal subjects according the age distribution and to understand the course of the fatty replacement from red marrow. METHODS AND MATERIAL: We retrospectively evaluated MR examinations of the calvaria(n=71), cervical spine(n=71), thoracic spine(n=65), Imbar spine(n =68) in subjects without bone marrow abnormality whose age ranged 3 weeks to 74 years. Three distinctive patterns were categorized on Tl-weighted images of the skull. In pattern 1, uniformly low signal intensity with or without very small areas of high intensity in frontal and occipital bones is noted. In pattern 2, frontal and occipital bones have uniformly high signal intensity, and patchy area of high intensity appears in parietal bone. In pattern 3, the entire skull has uniformly high signal intensity. In the spine, four patterns were categorized on Tl-weighted MR images. In pattern 1, the vertebral body has uniformly low signal intensity except for linear areas of high intensity superior and inferior to basivertebral vein. In pattern 2, bandlike and triangular areas of high signal intensity are found in the periphery. Pattern 3 and 4 have diffusely distributed areas of high signal intensity; pattern 3 consist of numerous indistinct dots measuring a few millimeter or less, and pattern 4 consist of fairly well marginated areas ranging in size from 5 to 1.5cm. RESULT:In the calvaria, 73% of pattern 1 were younger than 20 years, pattern 2 were evenly distributed, and 86% of pattern 3 were older than 40 years. In the spine, 87% of pattern 1 were younger than 40 years, 72% of pattern 3 were in 40 to 50 years, and 87% of pattern 4 were older than 50 years. Pattern 2 were evenly distributed in the cervical and thoracic spine, but in the thoracic spine 62% were younger than 30 years. CONCLUSION:It is concluded that younger age group shows mainly pattern 1, whereas elderly group has pattern 3 or 4 in the calvarial and vertebral body marrow. This suggests that conversion to fatty marrow begin locally and progress diffusely with age.
Age Distribution* ; Aged ; Bone Marrow* ; Humans ; Occipital Bone ; Parietal Bone ; Retrospective Studies ; Skull* ; Spine ; Veins

This report describes a case of diffuse neurofibroma(DNF) that presented with spontaneous intratumoral hemorrhage. A 31-year-old man with cutaneous manifestations typical of neurofibromatosis type 1(NF1) was referred to hospital with a progressively expanding scalp swelling. Magnetic resonance imaging(MRI) showed an acute hematoma surrounded by a dense mass on the parietooccipital scalp. Plain skull radiographs and a computed tomography(CT) scan revealed bony defects in the occipital bone around the lambdoid suture and the skull base, including the sphenoid and petrous bones. The tumor extended to the upper cervical region and infiltrated through the fascia of the musculature. The tumor and adjacent soft tissue were highly vascular, which made surgical resection difficult. We describe the clinical, radiological and pathological features of this patient and discuss the surgical methods used to avoid a life-threatening hemorrhage during surgery.
Adult ; Fascia ; Hematoma ; Hemorrhage* ; Humans ; Neurofibroma* ; Neurofibromatoses ; Occipital Bone ; Petrous Bone ; Scalp ; Skull ; Skull Base ; Sutures

A 33-month-old girl was admitted to the department of Neurosurgery, Seoul National University Hospital complaining of progressively growing suboccipital mass of 14 months' duration. A round, rubbery, child-fist sized mass was situated at the suboccipital area slightly on the right side from midline. The mass was not tender, pulsatile, and bruits were not audibl. There were no significant neurological abnormalities. Simple skull x-ray showed the huge, blown-out osteolytic lesion at suboccipital area and right retrograde brachial angiogram demonstrated no vascularity within the mass. The thick grayish white, well encapsulated cystic mass was firmly adhered to the adjacent bone and underlying dura, and contained about 30cc of chocolate-like deep brownish red, greasy fluid, and soft grumous brownish materials representing organizing blood clots, and consisted of spongy or honeycombed, coarsely trabeculated architecture. The mass was totally extirpated. The report of biopsy was a typical aneurismal bone cyst. She had uneventful postoperative course.
Aneurysm* ; Biopsy ; Bone Cysts ; Child, Preschool ; Female ; Humans ; Neurosurgery ; Occipital Bone* ; Seoul ; Skull

A 33-month-old girl was admitted to the department of Neurosurgery, Seoul National University Hospital complaining of progressively growing suboccipital mass of 14 months' duration. A round, rubbery, child-fist sized mass was situated at the suboccipital area slightly on the right side from midline. The mass was not tender, pulsatile, and bruits were not audibl. There were no significant neurological abnormalities. Simple skull x-ray showed the huge, blown-out osteolytic lesion at suboccipital area and right retrograde brachial angiogram demonstrated no vascularity within the mass. The thick grayish white, well encapsulated cystic mass was firmly adhered to the adjacent bone and underlying dura, and contained about 30cc of chocolate-like deep brownish red, greasy fluid, and soft grumous brownish materials representing organizing blood clots, and consisted of spongy or honeycombed, coarsely trabeculated architecture. The mass was totally extirpated. The report of biopsy was a typical aneurismal bone cyst. She had uneventful postoperative course.
Aneurysm* ; Biopsy ; Bone Cysts ; Child, Preschool ; Female ; Humans ; Neurosurgery ; Occipital Bone* ; Seoul ; Skull

A patients with atlantoaixial instability and osodontoideum underwent atlantoaixial fusion (Harms and Melcher technique) with demineralized bone matrix. But, unfortunately, the both pedicle screws in C2 were fractured within 9 weeks follow-up periods after several suspected episode of neck hyper-flexion. Fractured screws were not contact to occipital bone in several imaging studies, but it could irritate the occipital bone when neck extension because the relatively close distance between the occipital bone and C1 posterior arch. The patient underwent revision operation with translaminar screw fixation with autologus iliac bone graft. Postsurgical course were uneventful except donor site pain, but the bony fusion was not satisfied after 4 months follow-up. The patient re-underwent revision operation in other hospital. Continuous complication after atlantoaixial fusion is rare, but the clinical course could be unlucky to patients. Postoperative immobilization could be important to prevent the unintended clinical course of patients.
Bone Matrix ; Follow-Up Studies ; Humans ; Immobilization ; Neck ; Occipital Bone ; Tissue Donors ; Transplants

A pneumatocele is an air-filled cavity in the body. In the head and neck areas, the extensive hyperpneumatization of the temporal and occipital bones is typically associated with pneumatocele formation, which results in the spontaneous collection of gas, usually air, beneath the pericranium or within the skull. We herein report a case of stenosis of the external auditory canal caused by a left mastoid pneumatocele in a 12-year-old boy who was successfully treated with left simple mastoidectomy and canaloplasty.
Child ; Constriction, Pathologic ; Ear Canal* ; Head ; Humans ; Male ; Mastoid ; Neck ; Occipital Bone ; Skull ; Temporal Bone

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children's anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy.
Aged ; Cholesteatoma* ; Cranial Fossa, Posterior* ; Craniotomy ; Ear, Middle ; Epithelium ; Female ; Humans ; Mastoid* ; Occipital Bone ; Temporal Bone*