Plain radiographs of the skull, special styling. X-Ray Research Methods: Pediatric Neurology

Using this method, in brain tumors, both general and local changes skull bones.

General changes in the bones of the skull develop as a result of a prolonged increase in intracranial pressure, which is observed in brain tumors. The nature and degree of development of these changes mainly depend on the location of the tumor and its relationship to the CSF pathways and the great cerebral vein of Galen.

When a rapidly growing tumor is located along the CSF pathways (III ventricle, Sylvian aqueduct, IV ventricle), secondary occlusive dropsy gradually develops and, as a result, changes appear on the side of the vault and base of the skull. On a number of radiographs made in the same patient over several weeks or months, there is a gradually developing thinning of the bones of the cranial vault (general osteoporosis), flattening of its base, smoothing of the basal angle, as well as shortening and thinning of the back of the Turkish saddle, up to complete its destruction. The bottom of the Turkish saddle deepens, sometimes its destruction is observed. The sinus of the main bone is compressed. Along with these changes, osteoporosis is detected, and sometimes destruction of the anterior and posterior sphenoid processes.

With a slowly developing increase in intracranial pressure, a symmetrical expansion of the normally preformed openings of the skull base is determined for the most part, namely optic nerves, round, oval and torn holes, internal auditory canals. Often there is also a thinning of the edge of the large occipital foramen. In the advanced stage of the disease, especially with subtentorial tumors, osteoporosis of the tops of both pyramids is noted. The development of osteoporosis of the apex of only one pyramid on the side of the tumor is observed when it is located at the base temporal lobe brain.

With pronounced phenomena of increased intracranial pressure in young people and especially in children, a divergence of the cranial sutures is also detected; they are stretched and gaping. As a result of the increased pressure of the cerebral convolutions on the cranial vault, the pattern of digital impressions and ridges is enhanced. These changes are mostly found in subtentorial tumors. With large supratentorial tumors located along the midline, pronounced general signs of increased intracranial pressure from the bones of the fornix with signs of significant divergence of the cranial sutures are also often observed.

As a result of tumor-induced disturbances in the cerebral circulation in the skull, it is often noted diffuse expansion diploe vein channels. It is sometimes evenly expressed in both halves of the skull. Wide canals of diploic veins on radiographs are revealed in the form of slightly tortuous, short furrows heading towards one center. The pits of pachyon granulations and venous graduates also change their appearance in case of difficulty in blood circulation. They expand and deepen significantly.

Revealed in pictures general changes skull bones in case of suspected brain tumor confirm its presence, but do not give indications of localization.

For topical diagnostics It is important to identify local changes on radiographs caused by the contact of the tumor directly with the bones of the skull or the deposition of calcareous inclusions in it.

Local changes in the bones of the vault and base of the skull in brain tumors on radiographs are detected in the form of local hyperostosis, usuration, foci of pathological calcification inside the tumor or along its periphery, and increased development of vascular furrows involved in the blood supply to the tumor.

Local changes in the bones of the skull (hyperostoses, foci of destruction) are most often observed in arachnoid endotheliomas. The detection of these changes in the bones of the skull is important not only for determining the exact localization of the tumor; in some patients, these changes make it possible to judge its probable histological structure.

BG Egorov out of 508 patients with arachnoidendotheliomas in 50.2% of them revealed various local changes in the bones of the vault and base of the skull. KG Terian with arachnoid endotheliomas found the presence of hyperostoses directly at the site of contact of these tumors with the bones of the skull in 44% of patients. I. Ya. Razdolsky observed local changes in the bones of the skull in 46% of patients with arachnoid endotheliomas. Our data show that with a thorough X-ray examination of the skull, local changes in its bones are determined in 70-75% of patients with arachnoidendotheliomas, especially when they are localized at the base of the skull.

Hyperostoses of the skull bones (endostoses, exostoses) on radiographs are detected in the form various shapes and the size of limited seals. They are often determined in the small wings of the main bone, in the region of which arachnoidendotheliomas are often localized. Sometimes hyperostoses are also found in the region of the tubercle of the Turkish saddle and the olfactory fossa. Severe hyperostoses in the form of needle periostitis are detected mainly in arachnoidendotheliomas of the cranial vault and can spread to fairly large areas of the bone.

In the presence of hyperostosis and usuration in differential diagnosis, one should keep in mind not only arachnoid endotheliomas, but also diseases of the skull bones themselves, such as benign and malignant tumors, localized fibrous dysplasia, syphilis and tuberculosis.

Local bone changes are not detected on craniograms when arachnoidendotheliomas are located far from the vault and base of the skull. Local destructive changes in the bones of the skull are most often found in tumors of the brain appendage. We observed them in 97.3% of 355 patients with pituitary tumors. With intrasaddle tumors, these changes are expressed in a cup-shaped expansion of the Turkish saddle, destruction of its bottom, straightening of the back, its destruction, elevation and undermining of the anterior sphenoid processes. The presence of the bypass of the bottom of the Turkish saddle usually indicates uneven growth of the tumor.

The greater narrowing of one of the halves of the sphenoid sinus, which is detected on sighting images and tomograms of the sella turcica, indicates the predominant direction of tumor growth in this direction.

Detailed study of some features pathological changes the bone skeleton of the Turkish saddle makes it possible to presumably speak in favor of one or another histological structure intrasternal tumor.

In eosinophilic adenomas, which are mostly accompanied by acromegalic syndrome, the sella turcica is usually cupped, deepened, and enlarged in anteroposterior size. Its back is sharply straightened, deflected backwards and sharply sparse. Along with this, there is also a significant increase in the size sinuses skulls and their increased pneumatization. Such changes in the sella turcica and adnexal nasal cavities were observed by us in 82% of patients with eosinophilic pituitary adenomas. With chromophobic and basophilic adenomas, only destructive changes of the Turkish saddle, expressed to varying degrees, are determined.

Differential diagnosis between these two groups of tumors cannot be carried out without analysis clinical picture diseases and study of the fundus, field and visual acuity of the patient under study.

According to the nature of the destruction of the Turkish saddle, one can also presumably judge the suprasatella, near-saddle, behind-saddle, and anterior-saddle localization of the tumor.

With a suprasellar tumor, the back of the Turkish saddle is tilted anteriorly, destroyed and shortened. The anterior sphenoid processes are deflected downward and destroyed. The bottom of the Turkish saddle is compressed, the lumen of the sinus of the main bone is reduced.

With a perisedial tumor (tumor of the temporal lobe, tumor of the membranes), there is predominantly one-sided destruction of the Turkish saddle on the side where this tumor is located. In these cases, the destruction of the dorsum of the sella turcica is often determined on craniograms, which is sometimes combined with unilateral destruction of the anterior sphenoid process.

With a posterior saddle tumor, the back of the Turkish saddle is pushed forward. The posterior sphenoid processes are shortened and destroyed. Sometimes there is destruction of the Blumenbach clivus. With further tumor growth, as a result of compression of the Sylvian aqueduct and the development of hydrocephalus, secondary changes Turkish saddle, characteristic of a chronic increase in intracranial pressure.

Anterior seat tumors cause destruction of the anterior sphenoid processes and destruction of the Turkish saddle of one kind or another. These tumors are detected on radiographs due to the presence of hyperostoses in the region of the olfactory fossa or the region of the small wings of the sphenoid bone.

In some cases, tumors develop in the sinus of the main bone and grow into the Turkish saddle from below. With this localization of tumors, the cavity of the sella turcica sharply narrows, its bottom either curves upwards or collapses. The lumen of the sinus of the sphenoid bone is not differentiated. Most often, craniopharyngiomas develop in this area - tumors emanating from Rathke's pocket, and malignant tumors of the base of the skull. Characteristic of craniopharyngiomas is the deposition of lime in the shell of the tumor or inside its cystic contents.

Lime deposition is one of the most important local radiographic features of brain tumors. The presence of this sign makes it possible not only to establish the localization of the tumor, but sometimes correctly determine its histological nature. It is known that such normally preformed formations as the pineal gland, choroid plexus lateral ventricles, large falciform process, dura mater, pachyon granulations, in some people they also calcify under physiological conditions. Especially often, at least in 50-80% of healthy people, calcification of the pineal gland is observed. Its displacement by a brain tumor is of great diagnostic value. Under the influence of tumor growth, the calcified pineal gland, as a rule, shifts from the midline in the opposite direction from the tumor.

Various physiological calcifications must be differentiated from lime deposits in brain tumors. Intratumoral deposits of lime may be homogeneous. Sometimes they come to light in the form of linear shadows, separate amorphous lumps or fine inclusions. In some tumors, for example, in arachnoid endotheliomas, lime is deposited only in their shell, which gives a certain idea of the size of these neoplasms. Sometimes, with prolonged observation of the patient, it is possible to see the growing calcification of the tumor on x-rays.

Most often, lime is deposited in arachnoidendotheliomas. It is defined in them in the form of linear calcifications, bordering their periphery, and sometimes in the form of dot inclusions located inside the tumor. Much less often, calcareous inclusions are determined in intracerebral tumors of neuroectodermal origin. Most often, we found them in oligodendrogliomas. Lime in these tumors is found in the form of linear, sometimes merging formations. The same form of calcification is occasionally observed in astrocytomas. Therefore, it is usually not possible to distinguish them by the nature of calcification from oligodendrogliomas.

A characteristic lime deposition is seen in craniopharyngiomas. Along the periphery of these tumors, lime is deposited in the form of linear or lamellar formations, and in the thickness of the tumor - in the form of various sizes of amorphous lumps. The presence of this kind of calcifications, taking into account their localization, allowed us to establish the correct diagnosis in 28 out of 32 patients with craniopharyngiomas. In differential diagnosis, it should be borne in mind that a similar nature of calcification can also be observed with cholesteatoma.

It should be borne in mind that the deposition of lime is determined not only in tumors, but also in pathological processes non-tumor nature, such as cysticerci of the brain, brain scars and long-term inflammatory foci. Differential diagnosis in these cases between tumor and non-tumor diseases of the brain on the basis of craniography data is difficult.

The deposition of lime, as a rule, is also observed in Sturge-Weber disease. The characteristic pattern of thin double strips of lime located on the surface of the brain, in its cortex, makes it easy to distinguish these calcifications from those observed during various tumors brain.

Strengthening of the vascular pattern of the bones of the skull in some cases is a pathognomonic sign of brain tumors. In arachnoidendotheliomas, crannograms often reveal a peculiar pattern of furrows of the branches of the meningeal arteries, characteristic of these tumors, that participate in their nutrition. In these cases, in a limited area of the cranial vault, unevenly expanded, short, intertwining vascular grooves are revealed. On technically well-executed radiographs in these cases, it is sometimes possible to trace the furrow of the arterial trunk that feeds the tumor into this tangle.

In intracerebral tumors, predominantly on the side of the tumor, diffuse expansion of the diploic veins of the skull bones is sometimes observed, resulting from venous stasis.

For tumors of the back cranial fossa(subtentorial) important radiographic features that contribute to their recognition is the expansion of the internal ear canal, osteoporosis, destruction of the top of the pyramid, as well as the detection of intratumoral calcifications. Uniform expansion of the internal auditory canal is most often observed with acoustic neuroma. When evaluating this symptom, it should be taken into account that the expansion of the auditory canal is also observed in non-tumor processes, for example, with internal dropsy and limited arachnoiditis.

The most characteristic craniographic sign of a tumor in the region of the cerebellopontine angle is the destruction of the apex of the pyramid. Its destruction is observed in both benign and malignant tumors of this area. At malignant neoplasms the destruction of the top of the pyramid occurs more quickly and is more pronounced than in benign tumors.

A valuable craniographic sign of cerebellar tumors is the thinning of the edge of the foramen magnum on the side of the tumor.

Topical diagnosis of subtentorial tumors is facilitated by calcifications sometimes detected in them on radiographs. Foci of lime are most often determined in cholesteatoma and glioma of the cerebellum.

In those patients in whom the data clinical examination and craniography data are insufficient for the diagnosis of a brain tumor and its localization, they resort to a contrast X-ray examination of the cerebrospinal fluid spaces of the brain and its vessels.

X-ray of the skull is one of the available and informative methods diagnostics. It can be used to check the status internal structures and bone elements. The value of the study is the ability to diagnose the patient's condition after detecting tumor process, the presence of pathological fluids.

What does a head x-ray show?

Craniography allows the doctor to detect the following points:

the presence of skull fractures, their nature, the development of complications;
congenital pathologies and birth traumatism;
primary tumor and the presence of metastases;
inflammatory processes of the paranasal sinuses;
the presence of cystic formations;
curvature of the nasal septum;
secondary changes in the bones of the skull;
the presence of pathological fluid in certain areas.

X-ray of the head allows you to get the data of the diagnostic field on the film, the monitor screen. If necessary, they are stored in the memory of the X-ray machine.

Surveillance and targeted scanning

During the survey x-ray, the condition of the brain as a whole is assessed. Sighting craniography allows you to verify the condition of a certain part of the head, to clarify its functionality in dynamics through several shots taken in a row.

A targeted x-ray of the head is performed to detect fractures in such bone elements:

lower jaw;
bone pyramid of the nose;
sphenoid bone;
eye sockets;
temporomandibular joints;
temporal bones.

Aiming shots allow you to see:

the presence of calcifications, which caused the development of the pathology of the cranial bones;
the presence of calcification of parts of the tumor;
hemorrhages and hematomas;
consequences of increased intracranial pressure;
pathological fluid in paranasal sinuses nose
consequences of acromegaly (increase or expansion of bone elements);
osteodystrophy with deformation;
the presence of foreign bodies and inflammatory processes.

When appointed

An x-ray of the skull is done on the basis of the patient's complaints or those changes in the patient's condition that were noticed by the doctor himself during the examination. You need to be prepared if a specialist sends you for craniography in case of complaints of trembling in the limbs, cephalalgia, darkness or a veil before the eyes, nosebleeds, pain during chewing, decreased vision or hearing.

Indications may also be mechanical damage head, asymmetry of facial bones, fainting, suspicion of malignant tumors, pathologies endocrine apparatus and congenital anomalies.

Pregnant women and women during lactation do not have x-rays of the skull bones. The following specialists can send for the procedure:

traumatologist;
neurologist;
ophthalmologist;
surgeon;
endocrinologist;
oncologist.

Technique

This method of examination does not require special preparation. There are no restrictions (in drinking, food, medicines) before the procedure. Before the subject takes a place in the installation for x-ray diagnostics, he needs to remove metal things, dentures (if possible), glasses. Further, depending on the area under study, the patient lies down on the couch, sits down or stands.

A lead apron is put on the subject so that the body below the head does not receive excess radiation. The head is fixed with special fixators so that the examination area remains immobile for the entire period of diagnosis. Sometimes fasteners or bandages are used, sometimes ordinary sandbags.

If necessary, the radiologist can take not one, but several pictures. In addition, the position of the body can be changed in order to perform an x-ray of the skull in several projections.

Deciphering the results

The speed of obtaining results and the clarity of the image on them depends on the modernity of the X-ray apparatus used. In exceptional cases, the answer can be given to the subject immediately after the procedure, but in most cases it is required to wait up to half an hour. In state medical and preventive institutions, deciphering the results can take up to several days.

The decoding of the image contains data on the shape of the cranial bones, their condition, size, correctness of the anatomy, the contents of the paranasal sinuses, the state of the cranial sutures, and the bones of the nasal pyramid.

X-ray of the skull in 2 projections what does it show? For more informative results, the radiologist conducts a study in several projections (usually in the anterior and lateral). This allows you to more accurately determine the size of pathological formations, their localization, the condition of the bones, the presence of displacement.

How dangerous is research?

X-ray of the skull is accompanied by a low exposure of the patient's body (approximately 0.12 mSv). This figure is less than 5% of the dose that is allowed for a person to receive per year. For comparison, we can say that a person receives the same amount of radiation while relaxing under the sun on the beach in one hour of time.

However, an x-ray of the head (which this method shows, described above) is not recommended more than 7 times a year.

X-ray diagnostics is carried out exclusively according to indications and its purpose is to determine the presence deadly disease. That is why there are cases of more radiation from the patient than indicated in the medical literature. For example, a skull fracture is considered. When it is suspected, diagnostics are carried out even during pregnancy. Women carefully cover their chest and stomach with a lead apron.

Features of pediatric craniography

An x-ray of a child's skull is a procedure that requires a more thorough approach. In most cases, the specialist prefers ultrasound. X-ray diagnostics is used as a last resort, since the bone elements of the brain are still in the stage of their growth and formation, and excessive exposure can lead to negative consequences.

Frequent indications are head trauma, including birth trauma, and the procedure is similar to that of adults. The only problem- the need to be in one position during manipulation, which is very difficult for children. Parental presence or sedation may be required sleeping pills before diagnosis.

Head injury

One of the indications for craniography. Injuries can be scalped, torn, cut, chopped, blunt in nature, depending on the way they occur. The main reasons are:

accidents, catastrophes, domestic damage;
a fall;
the use of physical violence.

If only soft tissues are damaged, this condition is called a head contusion. In case of violation of the functionality of internal structures, we speak of a traumatic brain injury.

The victim feels pain at the site of injury and there are no other manifestations - this condition does not require the help of doctors. Cold is applied to the injury site. If there is bleeding, nausea and vomiting, neck pain, dizziness, hospitalization and specialist help are necessary.

An emergency requiring emergency assistance and calling the medical team to the place of injury, may be accompanied by the following manifestations:

blood or clear liquid flowing from the nose or ears;
hyperthermia;
convulsive seizures;
disturbance of consciousness;
the impossibility of fixing the gaze on a certain subject;
inability to move independently;
speech disorder;
deformation of the pupils, the difference in their diameter;
loss of consciousness;
feeling of lack of air.

Help and treatment

Awareness of what to do in case of a head injury can save the life of not only one of the strangers, but also close relatives. First of all, it is necessary to ensure that the victim is calm until the ambulance arrives. The person should be laid on a bed with the head end slightly raised, if possible in a dark room. There must be someone nearby.

If vomiting is present, do not allow the patient to stand up, but turn his head to the side and substitute a container for vomit. In the case of convulsive attacks, a person is turned on his side with his whole body, a solid, but not a metal object is thrust between the teeth, so that it does not happen

A bandage should be applied to the wound, pressed down with a hand if there is bleeding. If a fracture is suspected, pressure on the skull is not necessary. In parallel, you need to monitor the presence of pulse and breathing. If there are no signs of life, begin cardiopulmonary resuscitation.

No medicines, even painkillers, should be given to the victim until the ambulance arrives, as this can hide true picture states. It is necessary to clarify the state of a person’s memory by asking him a few questions about his name, relatives, the place where he is on this moment. Apply cold to the injury.

Even with a good knowledge of the possibility of first aid, you need to be calm and reasonable in order to leave panic aside and soberly assess the situation. And the best option, if possible, is to prevent injury than to restore the health of the victim later.

20.01.2017

The sulcus of the middle meningeal artery can be detected radiologically by the end of the 1st and at the beginning of the 2nd year of life

Age features. The sulcus of the middle meningeal artery can be detected radiologically by the end of the 1st and at the beginning of the 2nd year of life.

A slight increase in its diameter with age is difficult to take into account.

However, in the elderly and old age the diameter of the furrow can reach 3 mm, while in children and adults it does not exceed 1 - 2 mm.

In addition, with age, the tortuosity of the furrow of the anterior branch of the middle meningeal artery appears and intensifies at its exit to the roof of the skull, which, apparently, is due to atherosclerotic changes.

bracket shadow anterior section furrow internal carotid artery X-ray revealed after 20 years. Its age features have not been studied.

The venous sulci in the X-ray image, projecting orthogradely into the marginal part of the skull roof, form a clear bracket-like pressure on the inner plate.

Sometimes the edges of the furrows are slightly raised.

In the central and transitional parts of the skull, the venous sulci give a blurred, ribbon-like, uniform enlightenment that does not have branches.

Rice. 19. Schematic representation venous sinuses and out-of-graduates.

1 - internal jugular vein. Sinuses: 2 - Venous sulci in the x-ray image, projected orthograd-sigmoid; 3 - transverse; 4 - sinus drain; 5 - upper sagittal; 6 - lower to the edge-forming section of the skull roof, form a clear bracket-like sagittal; 7 - wedge-parietal; S - straight; 9 - cavernous; 10 - main foot impression on the inner plate. Sometimes the edges of the furrow are slightly intertwined. Graduate veins: 11 - mastoid-nab; 12 - occipital; 13 - parietal; 14 - frontal

The groove of the sagittal sinus is located in the median plane and is detected on radiographs in the direct anterior and posterior, nasolabial, naso-chin and posterior semi-axial (occipital) projections. In the edge-forming section, it gives a bracket-like impression on the inner plate, occasionally continuing downwards in the form of a ribbon-like enlightenment with a fairly clear contour, the width of which reaches 6-10 mm. On the roentgenogram of the skull in the lateral projection, the furrow is not differentiated, however, its edges and bottom can cause the multicontour of the inner plate.

The groove of the transverse sinus is detected on the radiograph in the posterior semi-axial (occipital) projection in the form of a distinct one- or two-sided ribbon-like enlightenment.

Unilateral enlightenment of the groove of the transverse sinus is due to its greater depth on the right, which is associated with a more significant blood flow through the right jugular vein.

The width of the groove of the transverse sinus reaches 8-12 mm. The transverse sinus sulcus and sinus drain may be seen on a lateral radiograph as a bracket-like depression on the internal occipital protuberance, usually continuing into a linear horizontal lucency

Rice. 21. Fragment of the radiograph of the skull in the lateral projection

You can see a ribbon-like enlightenment due to the groove of the transverse (single arrow) and sigmoid (double arrows) sinuses. In the edge-forming section, the triple arrow indicates an depression that reflects the flow of the sinuses.

The groove of the sigmoid sinus is a direct continuation of the groove of the transverse sinus. It is most clearly defined on the X-ray of the skull in the posterior semi-axial (occipital) and in the lateral projections as a ribbon-like S-shaped curved enlightenment located behind the petrous part of the temporal bone. The sulcus of the sigmoid sinus has a more distinct anterior and less distinct posterior contours, its width is 8-12 mm. In addition, the sulcus of the sigmoid sinus can be studied on an oblique x-ray of the temporal bone. The location of the sulcus in relation to the petrous part of the temporal bone will be considered when presenting the X-ray anatomy of the latter, since this is of particular importance in otolaryngological practice.

The sulcus of the sphenoid-parietal sinus is less constant, it can be one- or two-sided and is detected on the radiographs of the skull in frontal and lateral projections. This groove is located directly behind the coronal suture, parallel to it or slightly deviating backwards. IN lower section the roof of the skull in a limited area up to 1-2 cm long, it can coincide with the furrow of the anterior branch of the middle meningeal artery. In contrast to the arterial, the sulcus of the sphenoparietal sinus is a fairly uniform ribbon-like enlightenment. Its width towards the edge-forming section of the roof not only does not decrease, but can even increase.

Thus, the recognition of venous sulci and their differentiation from other anatomical formations

ny and traumatic injuries is not difficult.

The possibility of radiological detection of changes in the venous sulci in pathological intracranial
turnip processes is very limited; marked deepening of the venous grooves in craniostenosis.

Age features. Venous sulci can be detected radiographically, starting at
2nd year of life. With age, their width and depth slowly increase, reaching in adults, respectively
6-12 and 1-2 mm.

diploic channels. The canals of the diploe veins are best identified on survey radiographs skulls
in frontal and lateral projections. They are the most variable among all vascular formations of the skull and in
normally differ in asymmetry. There are linear and branching channels. The latter are most often localized in the region of the parietal tubercles.

The length of the linear channels varies from a few millimeters to several centimeters. A. E. Rubasheva
proposed to call linear canals up to 2 cm short, and more than 2 cm long - long. branching
diploe canals are also called stellate. Their width also varies considerably from 0.5 to 5 mm.

The characteristic features of the diploe channels in the X-ray image are the unevenness of their contour.
ditch and bay-like extensions of the lumen. Due to the location in the spongy substance and the absence of a dense wall, they give an unsharp, fairly homogeneous enlightenment. The bay-like and uneven contours are more pronounced, the wider the channel. This gave rise to the incorrect name of these channels of varicose veins.
nym. However, they are a variant of the norm. The disappearance of the bay shape in wide channels and the appearance of a clear, intense contour are observed in intracranial pathological processes and | caused by violation venous blood flow. Important feature wide diploe canals - the presence of bony islands along their course, which lead to a bifurcation of the main trunk. This feature of the diploe canals requires their differentiation from the symptom of bifurcation in linear fractures. Diploic canals differ from the fracture line by lesser transparency and uniformity of illumination, blurred and bay-shaped contours, and when the canal is bifurcated, by a significant width of the lumen (3-5 mm).

Age features. The canals of the diploe veins are formed after birth and are radiographically detected no earlier than the 2-3rd year of life. Their formation continues until the end of the 2nd or 3rd decade. With age, the width of the lumen of the diploe channels increases, and the bay shape of their contours increases.

The canals of the veins-graduates are radiologically detected in the form of ribbon-like enlightenments quite equal
numbered width with clear, intense contours due to the presence of a dense wall. One-
temporarily with the canal of the outlet vein, its internal or external opening can be determined in the form
oval or round enlightenment, surrounded by an intense rim. In some graduates,
only one of the foramina divides, and the canal is not differentiated. characteristic feature cana-
catching veins-graduates is their strict anatomical location. X-ray can be studied
cheny canals of the frontal, parietal, occipital and mastoid veins-graduates.

The channel of the frontal vein - the graduate is most clearly detected on radiographs in
direct anterior or naso-frontal projections. Starting from the groove of the sagittal sinus, its canal
forms an arcuate bend outward and ends with an opening in the region of the supraorbital margin.

Normally, a predominantly unilateral canal of the frontal outlet vein is found. Its length
reaches 30-70 mm, the width varies from 0.5 to 2 mm. The frequency of channel detection is small and amounts to
in adults, about 1%.

The canal of the parietal vein - the graduate radiological rarely detected due to unfavorable projection conditions.

The most optimal for its detection are the direct anterior and posterior, as well as the naso-chin
projections. A short canal that vertically perforates the parietal bone usually does not give an image and
therefore, only one of its holes is visible on radiographs. Paired or unpaired opening of the channel te-
The secondary vein-graduate has the appearance of an oval, clearly defined enlightenment with a diameter of 0.5-2 mm, located at a distance of up to 1 cm from the sagittal suture at the level of the parietal tubercles.

The canal of the occipital vein - graduate is determined mainly on radiographs.

The frequency of X-ray detection of the canal of the parietal vein-graduate is about 8%.

The canal of the occipital vein - graduate is determined mainly on the radiograph of the sinuses, or external, located at the external occipital crest. The contour of the detected hole is clear, intense, its diameter varies within 0.5-2 mm. The detection rate is 22%.

The canal of the mastoid vein is clearly differentiated on radiographs in the lateral and posterior semi-axial (occipital) projections, as well as on the targeted radiograph of the petrous part of the temporal bone in an oblique projection, the radiological interpretation of which is given below.

On these radiographs, the canal of the mastoid outlet vein is determined, which has clear, intense contours. In some cases, it is possible to distinguish its internal opening, which opens at the bottom of the sulcus of the sigmoid sinus, less often - at the site of the transition of the transverse sulcus to the sulcus of the sigmoid sinus. Its external mastoid opening is also determined, which opens at the base of the mastoid process or in the region of the parietal mastoid suture.

The width of the canal of the mastoid outlet vein is the most variable and ranges from 0.5 to 5.0 mm, length ranges from 10-40 mm. The frequency of detection is the highest in comparison with other veins-graduates and on the radiograph in the lateral projection is about 30%.

The frequency of detection of channels of veins-graduates and their width increase with intracranial pathological processes. The width of the canal of the frontal, occipital and parietal outlet veins exceeding 2 mm, is a sign of impaired intracranial blood flow. In addition, with intracranial pathology, additional canals of the frontal canals and canals, and sometimes multiple openings of the occipital vein-graduate, become visible.

Age features. Canals of the veins of the graduates can be radiologically detected already in the first years of life (parietal and frontal - in the 2nd, occipital - in the 5th year), and the canal of the mastoid vein of the graduate - in the first months of life.

There was no distinct increase in the width of their lumen with age.

The frequency of X-ray detection of canals of the veins of graduates is slightly higher in the first decade of life than at an older age, which can be explained by better imaging conditions due to the smaller thickness of the skull bones in childhood.

Granulation (granular) dimples and lateral lacunae. Granulation dimples located in the roof and at the base of the skull. They are surrounded by a sharp or blunt edge, their walls, respectively, can be flat or sharp, sheer. With sharp edges, the contours of the dimples are clear, with gentle edges, they are fuzzy. The bottom of the dimples is often uneven due to additional impressions. The same impressions can be located along the edge of the dimples, which gives them a scalloped appearance.

When projected in the central region, granulation pits, which do not have additional impressions, give a uniform, round-shaped enlightenment with an even contour in the X-ray image. In the presence of additional impressions of the bottom and walls of the dimple, radiographs show cellular enlightenment with scalloped contours.

The bone structure around the deep granulation fossae is more finely looped than in the rest of the skull. Some dimples located in the frontal scales are surrounded by an intense rim of dense bone with a width of 0.5 to 5 mm.

Diploic canals usually approach the granulation fossae of the skull roof. The venous openings with which they open at the bottom or in the walls of the dimples give pinpoint enlightenments, which enhances the heterogeneity of the enlightenment caused by granulation dimples.

When the granulation dimples are located in the roof of the skull, they form an enlightenment bordered along one of the contours by an intense linear shadow of a bracket shape.

When depicting a granulation pit in the marginal part of the skull roof, it gives a niche-like impression of the inner plate with thinning of the diploic substance at this level. The outer plate above it is not changed.

The granulation pits of the skull roof are located asymmetrically, predominantly parasagittal in the frontal and parietal bones. On radiographs of the skull in direct anterior and naso-frontal projections, they are determined in the central and transitional sections of the roof at a distance of up to 3 cm from the midline of the skull

The sizes of granulation dimples of this localization are from 3 to 10 mm. The number of dimples detected by X-ray, in frontal bone does not exceed 6, and in the parietal - 4. On the x-ray of the skull in the lateral projection, the granulation fossae of the frontal and parietal bones are projected in the transitional section, occasionally go into the edge-forming section, and therefore their X-ray anatomical analysis is difficult.

Granulation dimples are occasionally determined in the occipital scales on the border of the roof and base of the skull along the groove of the transverse sinus. They give enlightenments of a rounded or polycyclic shape with sizes from 3 to 6 mm, their number normally does not exceed 2-3. The optimal projection for their detection is the posterior semi-axial (occipital).

The granulation fossae of the base of the skull are located in the greater wings. sphenoid bone and adjacent parts of the squamous part of the temporal bone (Fig. 256). Radiographically, they are rarely detected. Optimal for their study is the naso-chin projection. The granulation dimples of the greater wing of the sphenoid bone are projected in the outer part of the orbit, and the dimples of the squamous part of the temporal bone are projected outward from the orbit.

Rice. 22. Graphic representation of the increase in the number of granulation pits with age, taking into account sexual dimorphism.

Unlike the granulation fossae of the skull roof, no diploic canals are visible leading to the granulation fossae of the skull base.

With intracranial hypertension, the number and size of granulation pits increase, the zone of their localization in the frontal bone expands (from 3 to 5-6 cm on both sides of the midline), and in children there are more early dates their x-ray detection (earlier 3-5 years in the frontal bone and earlier 20 years - at the base of the skull). Large granulation dimples on x-ray can simulate foci of destruction.

From foci of destruction and other anatomical formations (finger-shaped impressions, openings of the canals of the veins of outlets), the granulation fossae of the roof and base of the skull differ in their regular localization, irregular rounded shape, the presence of a polycyclic, fairly clear contour, and heterogeneous cellular enlightenment. Lateral lacunae are clearly defined on radiographs in the direct anterior, naso-frontal and lateral projections. The number of lateral lacunae is small - up to 6.

Lateral lacunae are located in the roof of the skull mainly in the area of bregma. Often they are symmet-
rich. More often, lacunae occur only in the parietal bones, less often - in the frontal and parietal. In the presence of a groove of the sphenoid-parietal sinus, its confluence into the lateral lacunae is determined by one trunk or several
mi, disintegrating like branches of a river delta.

The dimensions of the lateral lacunae exceed the dimensions of the granulation pits. Their length is oriented in sagit-
in the tal direction and on the radiograph in the lateral projection reaches 1.5-3.0 cm.

On radiographs in the anterior and naso-frontal projections, the lateral lacunae are projected parasagittally but
one above the other in the form of enlightenments, bordered on top by a clear, intense bracket-shaped contour.
On the radiograph in the lateral projection, the lateral lacunae are located under the edge-forming section of the skull roof. With incomplete projection coincidence of the lateral lacunae of the right and left sides on radiographs
in the lateral projection, as well as in the direct anterior projection, they can be located one under the other. Staple-
a koobrazny contour is a display of the bottom, smoothly passing into the lateral sections of the lacunae.
Enlightenment due to lateral lacunae does not always differ in uniform transparency, since additional impressions of granulation pits can be located above it. They give her contour
scalloped, and enlightenment - a cellular structure

A rare variant of the lateral lacunae is their elevation in the form of an hour glass above the general
the level of the outer contour of the roof, due to a sharp thinning and protrusion
outer plate of the skull

The typical shape and localization make it possible to distinguish lacunae from foci of destruction.

Perforation of the skull roof in the area of granulation pits or lateral lacunae is not a normal variant (as noted in the literature), but indicates intracranial hypertension.

Age features. Granulation pits form after birth. Radiologically, they are detected in the frontal scales from the age of 4-6, in the occipital scales - from 15, and in the base of the skull - from 20 years.

With age, there is a slight increase in the number and size of granulation pits on the roof and base of the skull. More clearly identified age-related changes their relief and shape, which are reduced to an increase in scallopedness and clarity of contour, as well as to the appearance of cellular enlightenment.

In adults, better than in children, point enlightenments are determined against the background of a heterogeneous cellular structure, which are due to venous openings of diploic channels suitable for dimples.

Lateral lacunae radiographically differentiate in the region of bregma from the 1st-2nd year of life. Subsequently, they spread backwards. With age, along their contours and at the bottom, additional depressions appear due to granulation dimples, which gives their contour a scalloped appearance, and the bottom - a cellular structure.

Finger-like impressions and the surrounding cerebral eminences are located in the roof and at the base of the skull and are detected on radiographs in the direct, naso-chin and lateral projections.

Finger-like impressions, projected on radiographs in the central region, look like delicate, indistinctly defined enlightenments, and the shadows of cerebral eminences located between them have wrong angular shape. In the marginal region, finger-like depressions and cerebral eminences give a barely noticeable undulation to the inner surface of the roof and base of the skull.

Marked deepening and an increase in the number of finger-shaped impressions in intracranial hypertension. However, objective criteria have not been established to distinguish by counting an increased number of finger-shaped impressions in hypertension from those observed in the norm.

The deepening of the finger-like impressions is detected in the edge-forming section of the skull roof by a sharp difference in its thickness at the level of the finger-like impressions and cerebral eminences. Deepening of the finger-like impressions by more than 2-3 mm should be considered as a manifestation of intracranial hypertension.

The most significant deepening of the finger-like impressions is observed mainly in children with early craniostenosis, less distinct - with intracranial tumors.

The detection in adults of even shallow finger-like impressions over a significant extent of the frontal and occipital scales, as well as in the parietal bones, should be considered as a sign of an increase in the intracranial

foot pressure.

The presence of asymmetry in the location and depth of finger-like impressions should also be considered a sign of pathology.

Age features. Finger-like impressions form after birth. Radiologically, they are detected in the parietal-occipital region by the end of the 1st year of life, and in the frontal scales and orbital part of the frontal bone - by the end of the 2nd year. Finger-like impressions reach the greatest severity at the age of 4-5 to 10-14 years. The decrease in their number and depth begins at the age of 15-18. In adults, they remain in the bones of the skull roof for up to 20-25 years, and at the base on the inner surface of the orbital part of the frontal bone - throughout life.

As an individual feature, finger-like impressions can persist for up to 50-60 years in the lower part of the frontal scale, in the squamous part of the temporal bones and in the parietal bones adjacent to them.

Tags: furrows, frontal vein canal, parietal vein canal, images, changes
Start of activity (date): 20.01.2017 10:23:00
Created by (ID): 645
Keywords: furrows, frontal vein canal, parietal vein canal, images We did not find studies devoted to the study of the radiological features of the skull in children with natal spinal cord injuries, either in domestic or in the available foreign literature. Usually x-ray examination the skull is held only in isolated cases with birth injuries of newborns in case of suspected fracture of the bones of the cranial vault. So, E. D. Fastykovskaya (1970) elaborated in detail the issues of artificial contrasting of the vessels and sinuses of the brain during childbirth. intracranial injuries newborns. Interpretation of radiographs of the skull in children presents great difficulties. An interesting study in this direction was carried out by M. Kh. Fayzullin (1971) and his students.

The meaning of our research in this direction is that the presence of a natal spinal cord injury in a child does not exclude the possibility of simultaneous, albeit less severe, natal brain damage. Under these conditions, the cerebral focus can easily be viewed. That is why in those of our patients, where, along with spinal symptoms, some signs of craniocerebral inferiority were revealed, we considered a craniographic study to be obligatory.

In total, the skull was examined radiographically in 230 of our patients with birth injuries spinal cord. Radiography was carried out according to the generally accepted technique, taking into account the measures of radiation protection of the subjects. The study was ordered strictly clinical indications, took the minimum number of shots, as a rule, two shots in the lateral and frontal projections (Fig. 70, 71). A feature of the pictures taken in direct projection in newborns and children of the first years of life is that they had to be radiographed not in the fronto-nasal position, as in older children, but in the occipital position. Special styling was prescribed only after studying two radiographs and only if they did not solve diagnostic problems. On a normal lateral radiograph of the patient (Fig. 72, 73), one can only assume a fracture of the skull bones based on the superposition of the fragments (“plus” shadow) in the frontal brush. This served as an indication for the appointment of an X-ray of the skull with a tangent path of the beam, and then a significant depressed fracture of the frontal bone associated with the imposition of obstetric forceps became completely obvious.

Rice. 70. X-ray of the skull in the lateral projection of patient Sh., 9 months old.

Fig. 71. Roentgenogram of the skull in direct projection (occipital position) of the same patient Sh., 9 months old. In the occipital bone there is a transverse suture, "Inca bones".

Rice. 72. X-ray of the skull in the lateral projection of the newborn I., 13 days old. In the frontal bone, linear shading (“plus” shadow), overlapping of the parietal bone with the occipital bone, small shadows at the level of the lambda.

Rice. 73. Special radiograph of the skull of the same patient, produced by the "tangential" course of the x-ray beam. Depressed fracture of the scales of the frontal bone.

When evaluating skull radiographs in our patients, we Special attention on the following details: the configuration of the skull, the presence of digital impressions, the condition of the sutures, fontanelles, the existence of intercalary bones, diploic channels, sulci of the venous sinuses, the structure of the base of the skull, areas of restructuring of the bone structure. Of course, the results of x-ray studies were carefully compared with clinical data. These or other pathological findings on radiographs were found in 25% of patients.

An analysis of the obstetric anamnesis and the history of childbirth in our patients with changes identified on craniograms reveals a greater frequency of births in breech presentation, as well as in the front and transverse. All researchers note an unfavorable course of labor in breech presentations, a large percentage birth injuries in these children, and a combination of spinal and cerebral injuries is typical. The frequency of delivery operations also deserves attention. So, manual assistance was provided in 15 out of 56 births, vacuum extraction - in 10, exit forceps were applied in three births, two births ended caesarean section. There were twins in two births, protracted births were noted in four women in labor, rapid births in five, narrow pelvis was with one woman.

Behind Lately in all countries of the world, the proportion of childbirth is growing large fruit, fraught with the threat of complications associated with a discrepancy between the size of the fetus and the mother's pelvis. Among our patients with pronounced changes on craniograms, delivery with a large fetus (over 4500 g) was noted in 20 out of 56 cases. All this shows that there were many reasons for the occurrence of cranial complications in this group of newborns.

The greatest difficulty in assessing craniograms in our patients was caused by the severity of digital impressions, since an increase in the pattern of digital impressions can be both a sign of pathology, for example, with an increase in intracranial pressure, and a reflection of the normal anatomical and physiological state in children and adolescents. The pattern of finger impressions as a sign of pathology was regarded by us only in comparison with other signs of increased intracranial pressure (divergence of sutures, an increase in the size of the skull, thinning of the diploe, tension of the fontanelles, details of the saddle, flattening of the base of the skull, increased pattern of vascular sulci).

Naturally, we always evaluated radiographic data in comparison with the results clinical research. Taking into account all the above, in 34 patients radiological changes in the skull were regarded as signs of increased intracranial pressure. At the same time, we did not focus only on strengthening the pattern of digital impressions, for the reason that the pattern of the skull bones can be poorly traced (“blurred” pattern) with external or mixed dropsy, when the fluid in the outer parts of the brain retains X-rays and creates a false impression of the absence of signs of intracranial pressure (Fig. 74).

Rice. 74. X-ray of the skull of patient K., 3 years old. brain skull prevails over the front, a large fontanel is not fused, continues along the metopic suture. The bones of the skull are thinned, there are intercalary bones in the lambdoid suture, a large fontanel. The base of the skull, including the Turkish saddle, is flattened.

In addition, digital impressions were pronounced in 7 more patients without other signs of increased intracranial pressure, which made it possible to interpret them as a sign age norm. The appearance of a pattern of finger impressions depends on periods of intensive brain growth and, according to I. R. Khabibullin and A. M. Faizullin, can be expressed at the age of 4 to 13 years (moreover, in children from 4 to 7 years old - mainly in the parietal -temporal region, and in children from 7 to 13 years old - in all departments). We fully agree with the opinion of these authors that during the growth of the brain and skull, digital impressions can have different localization and intensity.

When the fetal head passes through the birth canal, the skull is temporarily deformed due to the displacement of individual bones in relation to each other. X-ray at the same time, the occurrence of the parietal bones on the occipital, frontal or protrusion of the parietal bones is noted. These changes in most cases undergo reverse development, without consequences for the fetus. According to E. D. Fastykovskaya, “the displacement of the parietal bones relative to each other is more alarming,” since such a configuration of the fetal head may be accompanied by damage to the meningeal vessels, up to the upper longitudinal sinus. On our material, the overlapping of the parietal bones on the frontal or occipital was noted in 6 patients and only in the first 2-3 months of life (Fig. 75).

Rice. 75. Fragment of the X-ray of the skull of V., 2 months old. The occurrence of the parietal bones on the occipital in the region of the lambda.

One of the indirect signs of a birth injury of the central nervous system may be cephalohematoma. Usually cephalohematoma persists up to 2 - 3 weeks after birth, and then undergoes reverse development. With a complicated course, the reverse development does not occur in the usual time frame. According to E. D. Fastykovskaya (1970), in such cases, an additional sclerotic rim is revealed at the base of the cephalohematoma due to the deposition of calcium salts in the hematoma capsule. Flattening of the underlying bone may also occur. We've been watching long-term preservation cephalohematoma in 5 patients (Fig. 76). In some children, the course of cephalohematoma was complicated by trophic disorders due to detachment of the periosteum and its possible rupture (in all these cases, exit forceps were used during childbirth). Radiographically, uneven thinning of the skull bones in the form of small islands of osteoporosis at the site of cephalohematoma was noted (Fig. 77).

Rice. 76. X-ray of the skull of patient N., 25 days old. Unresolved cephalohematoma in the parietal region.

Rice. 77. Fragment of an X-ray of the skull of patient K., 5 months old. In the posterior-upper square of the parietal bone, there are small areas of enlightenment - "trophic osteolysis".

The etiology and pathogenesis of the formation of defects in the bones of the skull in children after trauma has not yet been studied. There are isolated reports in the literature (Zedgenidze OA, 1954; Polyanker 3. N., 1967). According to O. A. Zedgenidze, osteolysis of bone tissue and restructuring of the bone structure are trophic in nature and result from a fracture with damage to the hard meninges. 3. N. Polyanker believes that the features of the reaction of bones are most clearly found in remote periods traumatic brain injury. The occurrence of trophic changes in the bones of the skull in children is associated with the peculiar structure of the bones of the vault. With cephalohematomas, after the use of forceps and a vacuum extractor, there is a high possibility of damage and detachment of the periosteum, which leads to trophic changes.

Restructuring of the bone structure in the form of thinning and resorption of bone elements was revealed by us in six patients. In addition to the thinning of the bones, in five other cases, on the contrary, limited areas of thickening of individual bones of the skull, more often the parietal ones, were revealed. When studying the history of these 11 births, it turned out that in three cases exit forceps were applied, in the remaining eight cases there was a vacuum extraction of the fetus, followed by the development of cephalohematoma. The relationship between these obstetric manipulations and the changes found on the craniograms is beyond doubt.

Skull asymmetry was noted by us on craniograms in nine newborns. Given the nature of the injury, the obstetric interventions used, the typical x-ray picture, these changes are regarded by us as post-traumatic.

It should be remembered that clinical manifestations asymmetries of the skull in children injured in childbirth are even more common. At the same time, only one child had a linear fissure (Fig. 78).

Rice. 78. Fragment of an X-ray of the skull of patient M., 7 months old. Linear crack of the parietal bone with transition to the opposite side.

More severe damage to the bones of the skull during childbirth is also possible. So, in one of our observations, a child was born from an urgent delivery, in a breech presentation with Tsovyanov's allowance. The condition was very heavy, the handles hung along the torso. Immediately, an X-ray examination of the cervical spine and skull was made, which revealed an avulsion fracture of the occipital bone (Fig. 79). as one of age features skull bones in children, sometimes simulating a violation of the integrity of the bones, it should be noted the presence of non-permanent sutures - metopic and wisdom suture (Sutura mendosa). Metopic suture in adults occurs in 1% of cases (M. Kh., Faizullin), and in the study of children, A. M. Faizullin found this suture in 7.6% of cases. Usually, the metopic suture fuses by the end of the 2nd year of a child's life, but may persist up to 5-7 years. We found a metopic suture in 7 patients, all of whom were older than 2.5 years. A distinctive feature of the metopic suture from the crack is the typical localization, serration, sclerosis, and the absence of other symptoms. linear fractures(symptoms of "lightning" and bifurcation).

Rice. 79. X-ray of the skull and cervical spine of a newborn G., 7 days old. Avulsion fracture occipital bone (explanation in text).

The transverse suture divides the scales of the occipital bone at the level of the occipital protrusions. By the time of birth, only the lateral sections are preserved, called the suture of wisdom (sutura mendosa). According to G. Yu. Koval (1975), this suture synostoses at the age of 1-4 years. We found the remains of a transverse suture in two patients, and in two more it was preserved throughout the scales of the occipital bone (Fig. 80), which is also evident from the presence of large interparietal bones (Inca bone). A rare variant of the parietal bone, when it is formed from two independent sources of ossification, was found in our patients only in one case.

Rice. 80. Fragment of the radiograph of the skull of patient K., 3 years 8 months. The preserved transverse occipital suture is the "wisdom" suture.

Traumatic injuries of the skull can be simulated by intercalated bones in the fontanels and sutures - we found them in 13 patients. Some researchers associate the occurrence and preservation of intercalated bones with the transferred birth trauma using forceps. So, according to A. M. Faizullin, forceps were used in 17 out of 39 children with found intercalary bones during childbirth. Among our 13 patients, vacuum extraction was applied to seven, obstetric forceps - in one case.

In children, x-rays of the skull along the edges of the sutures may show sclerotic edging. We detected sclerosis around the coronal suture in 6 children older than 7 years. According to M. B. Kopylov (1968), this may be one of the signs of stabilization of cranial hypertension. According to our data, in three cases sclerosis around the coronal suture was accompanied by moderate signs of intracranial hypertension.

When studying the vascular pattern of the skull, we paid attention to diploic canals, venous sulci, lacunae, emissaries, and pits of pachyon granulations. Diploic canals were found in 20 patients out of 56. Sphenoparietal and transverse sinuses are often found in healthy children. We identified these sinuses in four patients. Intensification of the pattern of diploic vessels and expansion (squeezing) of the venous sinuses, in our opinion, in isolation from other symptoms, cannot be considered as a sign of intracranial hypertension. They acquire meaning only in combination with other signs.

When studying the shapes and sizes of the Turkish saddle, measuring the basal angle in our patients with natal spinal cord injuries, no pathology was revealed.

Summarizing the data on the X-ray features of the skull in children with natal spinal cord injuries, it can be noted that changes were detected in a quarter of all examined and they manifested themselves most often. intracranial hypertension, x-ray symptoms of a former cephalohematoma, changes in the configuration of the skull. Often there are symptoms of pathological restructuring of the bone structure at the site of cephalohematoma, after the use of forceps and a vacuum extractor. We emphasize once again that only children with suspected cerebral pathology were examined craniographically. Skull fractures were found in isolated cases. In the group of patients with combined brain and spinal cord injury, craniographic findings were more common. An analysis of the obstetric anamnesis and birth histories showed that the births in all these cases took place with complications, with the use of obstetric benefits. Noteworthy is the frequency of births in breech presentation in the mothers of our patients, with more than half of the newborns born weighing more than 4.5 kg.

Thus, an X-ray examination of the skull in children with birth injuries of the spine and spinal cord, with the slightest suspicion of a combined skull injury, should be considered mandatory. In combination with neurological data, it makes it possible to judge the involvement of the skull in the process, to suspect a lesion cerebral structures and get a clearer and more complete picture of the sick child.

X-ray signs intracranial tumors can be of two kinds: 1) general, due to increased intracranial pressure, and 2) local. General signs, like congestive nipples, indicate only the presence of an intracranial process, but not its localization. Local symptoms become important not only for determining the location, but often for clarifying the nature of the tumor.

Influenced increased intracranial pressure digital depressions (impressiones digitatae) and juga cerebralia begin to stand out more clearly. Finger impressions are imprints of cerebral convolutions in the bones of the cranial vault and are already observed under physiological conditions, especially in childhood and adolescence. With a slow and gradually increasing increase in intracranial pressure, they deepen and give characteristic enlightenments in the bones of the cranial vault, which are not always evenly distributed. One should not draw a conclusion about the size of the tumor by the degree of development of digital impressions.

Sometimes a small tumor can lead to disconnection of communications between the ventricles and the subarachnoid space and cause a significant increase in intracranial pressure with corresponding changes in the bones of the vault and base of the skull. With a sharp and rapid increase in intracranial pressure, finger impressions may be absent.
Especially carefully one must draw conclusions when detecting finger impressions in the bones of the cranial vault in young subjects.

With a long and strong one, the opposite phenomenon can also be observed, when the inner surface of the bones of the cranial vault begins to smooth out and the finger impressions that were before completely disappear. This is due, as M. B. Kopylov points out, to the fact that as a result of a sharp increase in the ventricles, thinning of the brain tissue occurs, expansion of the cerebral gyri and smoothing of the surface cerebral cortex. Along with this, there is a significant increase in the size of the cranium.

At increased intracranial pressure special attention should be paid to the condition. The changes observed in this case are most pronounced in childhood, which is quite understandable, since at this age the ossification of the sutures has not yet set in, as a result of which they are much easier to be affected by increased intracranial pressure. Usually there is a more or less pronounced divergence of the seams, especially the coronal ones.

In a number of cases in hydrocephalic the skull is not a divergence, but a seal of the seams. This indicates, according to Kopylov and other authors, the stabilization or elimination of the process. The sealing of the sutures is due to hyperproduction of the bone along the suture.

Pattern enhancement vascular groove is also one of the signs of increased intracranial pressure. When diploe veins are found on radiographs, the conclusion must be made carefully, since they are normal, according to A. E. Rubasheva, are very diverse. A certain diagnostic value is the expansion of the sphenoparietal sinus, especially one-sided.

At increased intracranial pressure there may be changes in the bone walls of the orbit in the form of porosity of the large and small wings of the main bone, and in some cases, the expansion of the upper orbital fissure. We had to watch similar phenomenon only in one case.

Exclusively great importance acquire changes in the area of the Turkish saddle with increased intracranial pressure. These changes are sometimes so characteristic that on the basis of their analysis it is possible to establish the location of the tumor. We will return to this issue in other articles on our site.