Induced deformation of the cranial vault is one form of permanent alteration of the body that has been performed by human beings from the beginning of history as a way of differentiating from others. These procedures have been observed in different cultures, but were particularly widespread in Mesoamerica. The authors examined and reviewed the historical and anthropological literature of intentional deformation practices in Mayan culture. The Mayans performed different types of cranial deformations and used different techniques and instruments to deform children's heads. The most remarkable morphological alteration is seen in the flattening of the frontal bone. Some archeological investigations link deformation types with specific periods. This article provides a glance at the cultural environment of the Mayans and demonstrates the heterogeneity of this interesting cultural phenomenon, which has changed over time.

Object. The object of this study was to determine the relationship between plasma taurine and subarachnoid hemorrhage (SAH) outcome.Methods. Forty patients with SAH and mild neurological deficits were included in this prospective, blinded cohort study. Plasma taurine levels were measured using high-performance liquid chromatography on admission and were correlated with patient outcomes at discharge.Results. Twenty-five percent of the patients ultimately had a poor outcome. Plasma taurine concentrations at admission were increased (2-fold) in SAH patients with a favorable outcome and were further increased (6-fold) in those who had a poor outcome. Increased taurine levels identified patients who would be discharged with a poor outcome, with sensitivity and specificity values of approximately 80% and 100%, respectively, and positive and negative predictive values of approximately 90%. Delayed cerebral vasospasm showed an OR of 27.9 (95% CI 1.090-714.9) for a poor outcome, whereas an increased taurine concentration had an OR of 105 for a poor outcome (95% CI 8.3-1328.0, p < 0.001).Conclusions. Increased plasma taurine concentrations on admission predict a poor outcome in SAH. J. Barges-Coll et al. 1022J Neurosurg / Volume 119 / October 2013 come predictor for Grades IV and V, but patients with a mild neurological deficit may unexpectedly have a poor outcome. 22 Up to 55% of patients with Fisher Grades 2 or 3 may have a poor outcome. 10,20 It is possible that the plasma taurine concentration may be elevated from the onset of SAH and may be associated with patient outcome, reflecting possible brain edema and explaining the unexpectedly poor outcome of patients with a mild neurological deficit after SAH. 17 Methods Study ParticipantsIn this prospective, blinded cohort study, approved by our institutional review board, we considered 211 consecutive patients who were admitted to the Emergency Department of our institute under the suspected diagnosis of a ruptured aneurysm (Fig. 1). Among these patients, only 41 fulfilled our study inclusion criteria: admission within the first 24 hours after SAH onset, HH Grade I-II, WFNS Grade I-II, 8 hours of fasting, not referred from another hospital, taking no medication during the previous 8 hours, and willingness to participate in the study and sign informed consent. One patient was excluded from the final analysis since taurine analysis was inconclusive. Data pertaining to demographic factors, comorbidities, Glasgow Coma Scale score, and HH grade were recorded on admission to the Emergency Department. Eighteen healthy volunteers were recruited as the control group.Routine blood analyses were performed (complete blood count, glucose, electrolytes, partial thromboplastin time, international normalized ratio). All patients underwent a 4-vessel digital angiography and CT study for the diagnosis of a ruptured aneurysm. Sample ProcessingA 20-ml blood sample was taken from every patient upon admission to the Emergency Department. Samples were labeled with a serial number and taken t...

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Falcotentorial meningiomas originate in the junction of the falx cerebri and the tentorium. Due to its anatomic vicinity, these tumors have a close relationship with important neurovascular structures surrounding the pineal region including the deep venous system. Surgical approaches would normally consider posterior midline corridors, but decision between supra or infratentorial access should be considered by the size, anatomic displacement of structures, and the infiltration of the dural attachment. This surgical video1,2 demonstrates the surgical technique and pearls to achieve a stepwise resection of a complex falcotentorial meningioma. We present a case of a 42-yr-old female patient, neurologically intact at presentation. A semi-sitting position was used. Appropriate management of cerebrospinal fluid was obtained with an external ventricular drainage which is kept closed until the dura is opened. A suprainfratentorial craniotomy was done with adequate exposure of the superior sagittal sinus and torcula. The supracerebellar infratentorial corridor was used for inferior internal debulking and arachnoidal dissection of the tumor while the exposure obtained in the posterior interhemispheric allowed a corridor which exposed widely the tumor with transtentorial transfalcine extension. Adequate management of adjacent structures was done while preserving the straight sinus and vein of Galen. A gross total removal of the tumor was achieved and the patient was discharged without complications. After this surgical video, the viewer will have learned the steps to safely achieve a surgical removal of a falcotentorial meningioma taking care of its relationship with the venous and neural adjacent structures.

We describe the case of a 42-yr-old female patient with a 2-yr history of headache that has progressively worsened. Physical examination revealed no neurological deficit. Magnetic resonance imaging showed a large tumor of the left lesser sphenoid wing that enhanced with gadolinium and produced displacement of the midline and the Sylvian fissure. A thorough analysis of the origin of the tumor was done to establish the surgical strategy. With the patient positioned supine with the head slightly turned to the right side, fixed in a 3-pin head clamp, a pterional craniotomy was performed. Since the origin of the tumor is in the lesser wing an early extradural devascularization of the tumor was done with drilling out all the hyperostotic bone of the lesser sphenoid wing, including the lateral base of the anterior clinoid process. Intradural debulking and resection showed the effect of extradural devascularization with an important decrease in bleeding, allowing the total resection of the tumor. An immediate postop magnetic resonance showed a complete removal of the tumor. The patient presented a paresis of the oculomotor nerve that completely resolved in the 3-mo follow-up. In the following video illustration, we narrate this operative case and highlight the nuances of this approach.1 The patient has given assent and written consent for videos, images, or clinical or genetic information to be published.