Download rajiv gandhi university of health sciences karnataka, bangalore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE CANDIDATE
DR SHASHANKA M J
AND ADDRESS
S/O M V JAYADEVAIAH
NO: 104 ‘ANANYA’ MUTSANDRA ROAD
D-CROSS DODDABALLAPUR 561203
ADDRESS FOR
DR SHASHANKA M J
CORRESPONDANCE
PG IN ANATOMY
DEPT OF ANATOMY
M.S. RAMAIAH MEDICAL COLLEGE
BANGALORE 560054
2.
NAME OF THE INSTITUTION
M.S.RAMAIAH MEDICAL COLLEGE
BANGALORE 560054
3.
COURSE OF THE STUDY
M.D. ANATOMY
AND SUBJECT
4.
DATE OF ADMISSION TO
13 - 06 - 2008
THE COURSE
5.
TITLE OF THE TOPIC
STUDY OF THE THICKNESS OF CRANIAL
VAULT AND DIPLOEIC IN RELATION TO
AGE, SEX, HEAD CIRCUMFERENCE AND
BODY HABITUS IN PAEDIATRIC AGE
GROUP
6. Brief resume of intended work.
6.1 Introduction and need for the study:
Cranial vault is formed by frontal, occipital, pair of parietal and temporal bones. They are flat
bones which have an outer table, an inner table and in between are the spongy bone called as
diploe. These bones grow in breadth and thickness similar to long bones and thus, the growth is
maximum in the pediatric age group.
Study of the variation in thickness of these bones is very useful for the neurosurgeons while
performing craniotomy, burr hole surgeries and other procedures. The main implication of our
study is in cranial reconstructive surgeries.
Various parameters of the skull bones can determine the age and sex in 80% of individuals. The
thickness of bones can also be included as a parameter. Thus the study of thickness of these
bones has become an interesting venue in forensic medicine while ageing and sexing of a pieces
of skull bones and also in identifying cranial fractures.
It is also helpful for radiologists to develop a nomogram for skull vault thickness and its relation
to age and sex.
Diploeic and cranial thickness is important variable to be considered while carrying out
biomedical modelling of the skull. This has become an interesting field of research, in terms of
modelling cranial fractures as seen in forensic pathology and also in the cross-sectional
proportions of compact and cancellous bones.
All these factors made me undertake this study and thus to find out the anatomical relevance in
the growth pattern of the bones of cranial vault and also the diploe.
6.2 Review of literature:
Growth of the vault is rapid during the first year and then slower to the seventh, by which time it
reaches almost adult dimensions. For most of this period expansion is largely concentric. The
form is determined early in the first year, remaining thereafter largely unaltered. Shape of the
vault is not directly related to cerebral growth but to genetic factors and is supported by the great
range of cranial indices and shapes in racial groups. During the first and early second year’s
growth of the vault is mainly by ossification at opposed margins of bones – which possess an
osteogenic layer – accompanied by some accretion and absorption of bone at surfaces to adapt to
continually altering curvatures.
Growth in breadth occurs at the sagittal, sphenofrontal, sphenotemporal, occipitomastoid sutures
and petro-occipital cartilaginous joints.
Growth in height occurs at the frontozygomatic and squamosal sutures, pterion and asterion. At
birth the vault is unilaminar. Tables and intervening diploe appear about the fourth year, with
maximal differentiation at about 35 years, when diploeic veins are prominent in radiograms.
Until puberty there is little sexual difference in skulls. Adult males tend to be larger than
females in a number of features due to a combination of faster rates of growth during puberty
and longer period of growth. However, ranges of variation between sexes overlap considerably.
In general, the adult male cranium has 11%larger cranial capacity than females, mostly reflecting
larger male body mass. Because variation is greater within than between sexes, diagnosis of sex
is difficult or impossible for many crania, and is most accurately assessed using multivariate
statistical techniques such as discriminates function analysis.1
It is found that there is no statistically significant differences between males and females for the
diploeic thickness, except for the frontal bones, where there is statistically significant difference
with males having the thickest measures. It is noted that males overall has the thickest diploeic
bone layer.2
Considering that the mean thickness of the whole cranial vault from ten measurements does not
give a strong correlation to age and therefore there is no further advantage for determination of
age. Because of the weak correlation between the thickness of the os frontale and age in females,
it is not possible to estimate individual age from calvarial bone thickness within useful limits.3
6.3 Objective of the study:
1. To study the correlation between age, sex, height, weight, head circumference and
measurements of cranial vault thickness in paediatric age group (0 to 15 years).
2. To study the correlation between age, sex, height, weight, head circumference and
measurements of diploeic thickness in paediatric age group (0 to 15 years).
7. Materials and methods:
7.1 Source of data:
All children in the age group of 0 to 15 years referred to Radiology department of MS Ramaiah
teaching hospital and M.S.Ramaiah memorial hospital for CT Brain with no history of cranial
trauma.
Sample size:
300 cases in the age group of 0 to 15 years will be studied.
7.2 Method of collection of data:
Children referred to CT Brain will be scanned in Dual Slice Siemens Emotion Duo. The
measurements of skull vault and diploe will be taken at predetermined places, along with
patient’s demographics which include age, sex, height, weight and head circumference (which
are collected from the paediatric department of MSRTH and MSRMC).
Inclusion criteria:
Any child in the age group of 0 to 15 years referred to radiology for CT brain.
Exclusion criteria:
Children in the age group of 0 to 15 years with
1. History of cranial trauma.
2. Any metabolic disorder.
3. Structural neuroparenchymal disorders.
4. On any medications.
5. Anaemia with Hb% less than 11 gm/dl.
Statistical analysis:
Correlation co-efficient(r) between age, sex, height, weight, head circumference and
measurements of cranial vault and diploeic thickness will be analyzed and its significance will
be tested using ‘t’ – test.
7.3 Does the study require any investigations or interventions to be conducted on patients
or other humans or animals?
Yes, as mentioned in (7.2) i.e. CT Brain.
7.4 Has ethical clearance been obtained from your institution?
Yes
8. List of references;
1 .Susan standring et.Al. Gary’s Anatomy 39th Edition, Elsevier, Churchill Livingstone,
Edinburgh, 2005, 484 – 489pp.
2. Lynnerup N. et.al, 2005 “Thickness of the human cranial diploe in relation to age, sex and
general body build.”, Head and face medical,1 (1 ): 1-13
3. H.P.Schmitt, K.S.Saternus, 1973 ”Beitrage zur forensischen ostoelogie.ІІІ. Zur Frage der
Bestimmung des Individualalters an Hand der Dicke der Schadelkalotte.”, International Journal
of Legal Medicine, 72(1 ):40-49, English translation, Publisher - springer Berlin / Heidelberg.
9
SIGNATURE OF THE CANDIDATE
Study of thickness of cranial vault and diploe
in relation to the age, sex is the valuable aid for
anatomical studies. These measurements are
most widely used by neurosurgeons in cranial
10
REMARKS OF THE GUIDE
reconstructive
surgeries.
Study
of
these
parameters reduces the risk during various
cranial
procedures.
It
also
helps
in
determining the age and sex of cranial bones
by forensic experts. It thus becomes interesting
venue of research.
11
NAME AND DESIGNATION OF
Dr. JAYANTHI V.
11.1 GUIDE
ASSOCIATE PROFESSOR
DEPARTMENT OF ANATOMY
M.S.RAMAIAH MEDICAL COLLEGE
BANGALORE 560054.
11.2 SIGNATURE
Dr. GIRIDHAR A.G.
ASSOCIATE PROFESSOR
11.3 CO GUIDE
DEPARTMENT OF RADIOLOGY
M.S.RAMAIAH MEDICAL COLLEGE &
HOSPITAL, BANGALORE.
11.4 SIGNATURE
11.5
HEAD OF THE DEPARTMENT
Dr. ROOPA KULKARNI
SENIOR PROFESSOR AND HEAD
DEPARTMENT OF ANATOMY
M.S.RAMAIAH MEDICAL COLLEGE
BANGALORE.
11.6
SIGNATURE
12
12.1
REMARKS OF DEAN AND
PRINCIPAL
Dr S.KUMAR,
PRINCIPAL AND DEAN
M.S. RAMAIAH MEDICAL COLLEGE
BANGALORE.
12.2
SIGNATURE