Rudimentary meningocele of the scalp

A rudimentary meningocele, a variant of primary cutaneous meningioma, was seen on the scalp of a 9-month-old Japanese boy. Clinically, the lesion on the left parietal area was round, about 1.6 cm in diameter, alopecic, and slightly elevated. Histologically, the lesion, located from the dermis to the subcutis, consisted of scattered foci of meningothelial cells, an anastomosing network of empty spaces with psammoma bodies and collagen bodies, and small vessels. Immunohistochemically, the meningothelial cells were positive for vimentin and desmin. Ultrastructurally, they had elongated cytoplasmic processes, intermediate filaments in the cytoplasm, and desmosomal junctions.     

Undermining of the scalp: quantitative effects

The aim of the present study was to evaluate to what extent undermining affects the closing-tension of scalp defects to quantify the surgery-related benefits provided by this procedure. Data were collected by stepwise loading in 10 patients, 20 scalp flaps (obtained by a reversed Y scalp incision), and three different degrees of subgaleal undermining (1, 5, and 15 cm). The obtained data confirmed the value of undermining to diminish the tension on wound margins when closing a scalp defect. There was a progressive decrease in tension required to advance the wound edge when the amount of undermining was sequentially increased. Most of this reduction occurred with the 5-cm undermining, although statistically the 15-cm undermining also resulted in a significant decrease in the tension required to close the defect. Mean 83.3- and 92.2-percent reductions of the closing tension were obtained with 5 cm and 15 cm of undermining, respectively, compared with that achieved by the 1-cm undermining with the same width of defect.     

The management of extensive tumours of the scalp

Though tumours of the scalp and skull are not very common certain severe and extensive forms are associated frequently with intracranial propagation and therefore their reconstruction represents often a major problem requiring the use of a series of surgical methods. Their treatment requires the use of expanders, local flaps, pedicled cutaneous and musculocutaneous flaps, as well as free flaps. This report deals with 10 patients with localized extensive tumours larger than 120 cm2 within the region of the scalp and skull subjected to various reconstruction procedures. The applied surgical techniques are discussed and attention is devoted also to the involvement of bone in the above mentioned localization as well as to the problems associated with these lesions.     

Polarization of the human motor cortex through the scalp

Direct currents (DC) applied directly to central nervous system structures produce substantial and long-lasting effects in animal experiments. We tested the functional effects of very weak scalp DC (< 0.5 mA, 7 s) on the human motor cortex by assessing the changes in motor potentials evoked by transcranial magnetic brain stimulation. We performed four different experiments in 15 healthy volunteers. Our findings led to the conclusion that such weak (< 0.5 mA) anodal scalp DC, alternated with a cathodal DC, significantly depresses the excitability of the human motor cortex, providing evidence that a small electric field crosses the skull and influences the brain. A possible mechanism of action of scalp DC is the hyperpolarization of the superficial excitatory interneurones in the human motor cortex.     

Epidermoid cyst of the scalp containing human papillomavirus

Animal studies have indicated that plasma tetrafluoroethylene (TFE) may be a better prosthetic material than expanded polytetrafluoroethylene (ePTFE) for arteriovenous access in patients who require hemodialysis because it combines the advantages of both Dacron and Teflon. A randomized clinical trial to compare the two materials was conducted between May 1987 and January 1989. Forty-four patients were enrolled, 22 in each group. The status of the grafts was monitored for at least 18 months. The patency rate for plasma TFE was 59% and for ePTFE was 64%. Kaplan-Meier analysis and Wilcoxon testing revealed no statistical differences between the two groups. Four grafts became infected, two in each group, and one aneurysm developed. Despite its theoretical advantages, plasma TFE was found to be similar to ePTFE as a graft material for hemodialysis.     

Treatment of scalp arteriovenous malformation

We report seven patients with scalp arteriovenous malformations, including two patients with lesions > 10 cm in diameter, who were successfully treated. The principal complaint of each patient was a deforming mass. Each of four patients had a history of blunt traumatic injury. The lesions, each consisting of the nidus, feeders, and draining veins, evolved in all patients. The nidus consisted of fistulae, which exhibited various angioarchitectures as revealed by angiography. A hemangiomatous component was histologically recognized in one patient. In five patients, in whom the lesions were relatively small and whose nidi included only large fistulae, the malformations were remedied by surgical intervention alone or were cured with embolization alone using liquid adhesives. In the two patients with lesions > 10 cm, the nidi consisted of numerous large fistulae and plexiform fistulae in one patient and plexiform fistulae and a hemangiomatous component in the other patient. These patients were treated with a combination of transarterial embolization and surgical intervention. Preoperative embolization greatly reduced blood loss during resection. Total excision and scalp reconstruction using a soft tissue expander were performed in both patients. The cosmetic results were excellent in all of the patients, and no recurrence has been recognized during the follow-up period, which ranges from 31 to 99 months. The treatment of scalp arteriovenous malformations should strive to improve deforming features and to attain a permanent cure. Because each nidus includes a variety of anomalous angioarchitectural features, there should be different means and a combination of treatments for each patient. Embolization alone could be adequate treatment in relatively small lesions, the nidi of which consist only of several large fistulae. For malformations with more extensive, large fistulae or with anomalous components other than large fistulae, a combined endovascular and surgical approach and scalp reconstruction seems to be the best treatment.     

"Windmill-plasty" for coverage of large defects of the scalp

The closure of large circular defects on the scalp is technically difficult and cosmetically often not satisfying, if a free transplant is necessary. Following the technique of Tillmann described first in 1908, several flaps shaped like a windmill can be combined. We report on 14 patients (ages 41-88 years) where large defects resulting from the excision of various tumors (5 melanomas, 5 basal cell carcinomas, 1 keratoacanthoma, 1 trichilemmal cyst, 1 squamous cell carcinoma, 1 skin metastasis) were successfully closed by this method. The diameter of the defect ranged between 4 and 8 cm (mean 5.7 cm). Size and number of the rotating flaps (3 or 4) was varied according to the size of the defect and the mobility of the surrounding tissue. The procedure was performed with local anesthesia in all cases. Wound healing occurred without complications except in 3 cases. 2 patients (63 years, 70 years) developed small necrotic areas on the tips of the flaps. In a 74 year old man with a very large defect of 8 cm diameter, one flap of four underwent total necrosis. The cosmetic result was rated "very good" in 71.4% and "good" in 14.3%. The preservation of the terminal hair turned out to be of special advantage. The "windmill procedure" is an important addition to the surgical approaches for closure of large defects on the scalp, particularly in young patients.     

Concepts in scalp and forehead reconstruction

Reconstruction of forehead and scalp defects are challenging. A thorough understanding of the anatomy and dissection planes of the scalp is essential. The ability to use a variety of techniques allows the facial plastic surgeon to maximize functional and aesthetic results. Techniques such as tissue expansion, free tissue transfer, and flaps used for covering exposed bone are useful adjuncts for optimal results.     

Shaving of the scalp may increase the rate of infection in CSF shunt surgery

Most surgeons use metal clips in laparoscopic cholecystectomy. The aim of this prospective randomized controlled study was to evaluate the efficacy of absorbable clips in elective laparoscopic cholecystectomy. One hundred consecutive patients with symptomatic gallstones without complications were randomized into groups; group T had two metal clips (titan clip ETHICONR), group R (laproclipR Davis and Geck) had one absorbable clip applied on the cystic duct and cystic artery. The patients were followed for one year. There was no difference between the two groups concerning operative time, hospital stay and postoperative complications. The absorbable clips seem to be as effective as metal clips in providing hemostasis in cystic artery and in cystic duct ligation.     

Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans

Tufted folliculitis is an uncommon folliculitis of the scalp that resolves with patches of scarring alopecia within which multiple hair tufts emerge from dilated follicular orifices. The clinicohistological data from a group of 15 patients with tufted folliculitis were reviewed and compared with those of seven patients with folliculitis decalvans, five with acne keloidalis nuchae, four with dissecting cellulitis of the scalp, three with kerion celsi and 20 with follicular lichen planus. It was found that tufted folliculitis could be differentiated from folliculitis decalvans only by finding several hair tufts scattered within patches of scarring alopecia. Histologically, a single tuft consisted of peculiar clustering of adjacent follicular units opening at the bottom of an epidermal depression. Conversely, the presence of keloidal plaques in acne keloidalis nuchae, coalescing nodules discharging purulent material in dissecting cellulitis of the scalp, erythematous plaques covered by pustules replete with fungal elements in kerion celsi, and the absence of follicular pustules in follicular lichen planus distinguished these diseases from tufted folliculitis. On the basis of these findings, it is suggested that tufted folliculitis should be considered as a distinctive clinicohistological variant of folliculitis decalvans. Tufting of hair is caused by clustering of adjacent follicular units due to a fibrosing process and to retention of telogen hairs within the involved follicular units.     

Method of superimposing the angiographically located supratentorial lesion on the scalp prior to craniotomy

One of the important points in operation of the intracranial supratentorial lesion is appropriate site and size of bony window made by craniotomy and this matter is also important first step in procedure of craniotomy. On the other hand, the site and size of bony window made in craniotomy for supratentorial lesion has relationship with perfectibility of operation. The detail intracranial situation and extent of supratentorial lesion is decided from the datas of various examinations and the findings in cerebral angiogram give a most important and valuable information to the neurosurgeon at present. The neurosurgeons used to decide the area of craniotomy from the findings of cerebral angiogram but there are some difficulty in transfer of findings related with situation of supratentorial lesion in angiogram to the patient's scalp, because the film of cerebral angiography is a projected picture of spheric head by X-ray to the plane. The author devised the planning method of site and size of bony window in craniotomy by transfer the location and extent of supratentorial lesion in cerebral angiogram to the patient's scalp and the author have been recognized for the past five years that this method is simple one and has clinical accuracy. The principle of the author's method are as follows. The film of cerebral angiography in lateral projection and the patient's scalp are divided into nine parts by same manner and the relation of the site and extent of lesion in cerebral angiogram with divided parts transfer to the division of the patient's scalp under special care to make minimize errors due to use the cerebral angiogram which is picture made by projection in a plane from spheric intracranial supratentorial space. Five points and seven lines are used to divide the film of cerebral angiography and the patient's scalp. Five divide points are most upper part of margin of external acoustic meatus, most posterior edge of auricle, upper, lower and lateral edge of orbit. The following divide lines are drawn by use of these five divide points. Two horizontal lines are eye-ear horizontal line and superior eye horizontal line. Three vertical line are external acoustic meatus vertical line, auricular vertical line and temporal orbital margine vertical line. Two oblique lines are anterior and posterior oblique lines. The film of lateral cerebral angiography and patient's scalp are divided into nine parts by these seven divide lines. In the areas above the superior eye horizontal line, following procedure for correction of error due to transfer the point of X-ray film to the patient's scalp is needed because of strong curved brain surface. One end of celluloid or steel scale place closely with the scalp below the superior eye horizontal line and the other end of scale make freely from curved scalp surface. The point of lesion on the divide line of X-ray film marks at correspond point on the scale...     

Localizing the development of covert attention in infants with scalp event-related potentials.

This study examined covert shifts of attention in infants aged 14, 20, and 26 weeks of age with scalp-recorded event-related potentials (ERPs). The infants were tested in a spatial cuing procedure. The reaction time (RT) to localize the target showed covert attention shifts (e.g., response facilitation or inhibition of return depending on cue–target stimulus onset asynchrony). There was a larger P1 ERP component on the valid trials than on the invalid trials or on the no-cue control trials. Presaccadic ERP potentials in response to the target were larger when it was in the cued location than when it was in uncued locations. There were increases from 14 to 26 weeks of age in the amount of inhibition of return, in the post-target-onset P1 effect. and in the presaccadic ERP potentials. These results suggest that cortical development parallels the development of covert orienting of attention and saccade planning in infants in this age range. (PsycINFO Database Record (c) 2010 APA, all rights reserved)