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G. Vasudeva Iyer and Ammu Nayar

large depression visible above the forehead. Blood examination including white cell count and erythrocyte sedimentation rate, bone marrow, serum proteins, calcium, phosphate, and alkaline phosphatase were normal. Skull films showed complete destruction of both the tables subjacent to the depression ( Fig. 2 ), with partially lysed bone at the edges. The rest of the skull was normal. A skeletal survey did not reveal any other area of osteolysis. Fig. 2. Skull film, lateral view, showing disappearance of the inner and outer tables of the vault

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O. Saul Krivoy, Edgar A. Belfort, Alejandro Mondolfi, Irvin Walzer, Erwin Essenfeld and Tomás Landaeta

P aracoccidioidomycosis is a systemic infection endemic in an area extending from Mexico to Argentina. It was initially described in Brazil by Lutz in 1908. 14 Among the most frequent manifestations of the disease are lesions in the oral mucosa, lymph nodes, and lungs. Although lesions of the central nervous system and bone are less frequent, they have been observed more often in recent years. We are reporting a case of paracoccidioidomycosis of the skull. Case Report This 27-year-old woman was referred from a rural area on May 3, 1977, suffering from

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Milton D. Heifetz

T he automatic cranial drill was designed by Smith in 1950. 1 Occasionally, this rapidly rotating power drill point will not disengage and may plunge into the cranial cavity. This may be due to improper angulation during the drilling process, a broken part, faulty cleaning, or improper assembly of the mechanism. Such incidents, which may be catastrophic, can be avoided. Description of Device There are several features that should be part of all skull perforators: a variable-depth stop which should not interfere with the smooth drill action and which

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Elsie H. Froeschner

L et us go back about a thousand years. A wounded warrior with his skull fractured by a stone axe in the highlands of Peru is laid on a large stone block ( Fig. 1 ). None of the things we have today are present: no anesthesia as we know it, no antibiotics, no metal instruments, no sterilization of tools, and no electric lights. The cutting tools are stone: obsidian, flint, and quartz, chipped to produce sharp edges. Perhaps there are some coca leaves that can be chewed to produce some indifference to pain. Fig. 1. High in the Andes Mountains of Peru

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K. V. Chalapati Rao, B. Subba Rao, C. Pulla Reddy, B. Sundareshwar and C. R. R. M. Reddy

J affe and Lichtenstein 6 coined the term “aneurysmal bone cyst.” They proposed that it originates as a vascular disturbance giving the characteristic radiological picture of a “blow-out” of bone. These bone cysts generally occur throughout the skeleton but rarely in the skull. Recently we treated a patient with a giant aneurysmal bone cyst in the right half of the cranium. Case Report This 14-year-old boy was admitted to the neurosurgical unit on August 29, 1975. He had a swelling on the right side of the head that had been gradually increasing for the

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Jack E. McCallum, Edward Brand and Robert G. Selker

C hronic granulomatous disease of childhood, first described in 1957 by Berendes, et al. , 2 is a usually fatal, hereditary deficiency of leukocyte function. Patients with this disorder are subject to a number of infectious complications involving primarily the reticuloendothelial system, lungs, skin, mucous membranes, and bones. 1, 3, 6 We are presenting a case of osteomyelitis of the skull in a child with this disorder. Case Report This 20-month-old baby boy was first hospitalized in December, 1971, with fever, anorexia, vomiting, diarrhea, and

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Paul W. Detwiler, Randall W. Porter, Stephen W. Coons, Robert F. Spetzler, Carlos A. Carrion and Harold L. Rekate

T he management of osteolytic skull lesions in the pediatric population requires knowledge of various possible diagnoses because infectious, inflammatory, and neoplastic processes can manifest similar presentations. The patient's age at presentation, physical findings, concurrent physical disease, family medical history, and radiographic appearance of the lesion are needed to generate a differential diagnosis and to formulate a treatment plan. Case Report History This 3-year-old boy was referred to the neurosurgical service because he had a painful mass in the

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Georgios Tsermoulas, Asterios Aidonis and Graham Flint

T he use of skull trepanation in antiquity has been well documented, and archaeological research has revealed trepanned skulls that date back to the Mesolithic era, some of them bearing evidence of healing. 7 Prehistoric men clearly practiced the procedure, although their motivations in doing so were as likely to have been magico-ritual as they were medical. 18 The general belief is that, in ancient civilizations, trepanation was used as an intervention to treat both head injuries and diseases attributed to supernatural causes. 12 The earliest written

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Dominique Figarella-Branger, Miguelina Perez-Castillo, Louise Garbe, François Grisoli, Danielle Gambarelli and Jacques Hassoun

A benign osteoblastoma is an uncommon tumor and rarely occurs in the skull. 7, 9, 17 Moreover, the sarcomatous transformation is extremely rare: only six well-documented cases have been reported in the literature. Such cases are different from aggressive osteoblastomas and well-differentiated osteosarcomas. The diagnosis and management of these lesions are difficult for both neurosurgeons and neuropathologists who are not used to this pathology. We report here the spontaneous sarcomatous transformation of a benign osteoblastoma of the skull occurring 11

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Tuberculosis of the skull

Case illustration

Mohammed Al Wohaibi, Neville A. Russell, Matthew Omojola and Ahmed Al Ferayan

In recent years there has been an alarming resurgence of tuberculosis (TB) in North America, especially among immigrants, aboriginal people, and those with human immunodeficiency virus (HIV) infection. 2, 3 An increased incidence of extrapulmonary TB has also occurred, resulting in a reappearance of some of its rarer clinical manifestations. 4 We report a case of TB of the skull along with our computerized tomography (CT) and magnetic resonance (MR) imaging findings. This 61-year-old woman presented with an enlarging painless scalp swelling. She had no history