BACKGROUND Supra-and infratentorial acute epidural hematoma(SIEDH)is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone(SOB).Traditionally,surgic...BACKGROUND Supra-and infratentorial acute epidural hematoma(SIEDH)is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone(SOB).Traditionally,surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.AIM To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.METHODS Skull computed tomography(CT)scan data from 32 adult patients were collected from January 1,2019 to January 31,2020.On the median sagittal plane of the CT scan,the angle of the SOB(ASOB)was defined by two lines:Line A was defined from the lambdoid suture(LambS)to the external occipital protuberance(EOP),while line B was defined from the EOP to the posterior edge of the foramen magnum(poFM).The operative angle for the SIEDH(OAS)from the supra-to infratentorial epidural space was determined by two lines:The first line passes from the midpoint between the EOP and the LambS to the poFM,while the second line passes from the EOP to the poFM.The ASOB and OAS were measured and analyzed.RESULTS Based on the anatomical study,a single supratentorial craniotomy was performed in 8 patients with SIEDH.The procedure and the results of the modified surgical method were demonstrated in detail.For males,the ASOB was 118.4±4.7 and the OAS was 15.1±1.8;for females,the ASOB was 130.4±5.1 and the OAS was 12.8±2.0.There were significant differences between males and females both in ASOB and OAS.The smaller the ASOB was,the larger the OAS was.The bone flaps in 8 patients were designed above the transverse sinus intraoperatively,and the SIEDH was completely removed without suboccipital craniotomy.The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines.The OAS was negatively correlated with the ASOB.CONCLUSION The single supratentorial craniotomy for SIEDH is reliable and effective.展开更多
Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma ...Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.展开更多
基金Supported by Key Research and Development Plan of Shaanxi Province,China,No.2021SF-298,and No.2018SF-137.
文摘BACKGROUND Supra-and infratentorial acute epidural hematoma(SIEDH)is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone(SOB).Traditionally,surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.AIM To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.METHODS Skull computed tomography(CT)scan data from 32 adult patients were collected from January 1,2019 to January 31,2020.On the median sagittal plane of the CT scan,the angle of the SOB(ASOB)was defined by two lines:Line A was defined from the lambdoid suture(LambS)to the external occipital protuberance(EOP),while line B was defined from the EOP to the posterior edge of the foramen magnum(poFM).The operative angle for the SIEDH(OAS)from the supra-to infratentorial epidural space was determined by two lines:The first line passes from the midpoint between the EOP and the LambS to the poFM,while the second line passes from the EOP to the poFM.The ASOB and OAS were measured and analyzed.RESULTS Based on the anatomical study,a single supratentorial craniotomy was performed in 8 patients with SIEDH.The procedure and the results of the modified surgical method were demonstrated in detail.For males,the ASOB was 118.4±4.7 and the OAS was 15.1±1.8;for females,the ASOB was 130.4±5.1 and the OAS was 12.8±2.0.There were significant differences between males and females both in ASOB and OAS.The smaller the ASOB was,the larger the OAS was.The bone flaps in 8 patients were designed above the transverse sinus intraoperatively,and the SIEDH was completely removed without suboccipital craniotomy.The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines.The OAS was negatively correlated with the ASOB.CONCLUSION The single supratentorial craniotomy for SIEDH is reliable and effective.
文摘Epithelioid hemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioid hemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.
