From Big Medical Encyclopedia

CRANIOTOMY (Greek kranion a skull + tome a section, a section) — the fetaldestructive operation directed to reduction of volume of a head of a fruit for the purpose of delivery in natural patrimonial ways.

To. make more often on a dead or impractical fruit with anomalies of development (the last shall be authentically established) in that case when there is a need for acceleration of childbirth: in the presence at the woman in labor of the diseases complicating childbirth (severe forms of late toxicosis, dekompensirovanny heart diseases, etc.), at bleedings owing to placental presentation or her premature amotio at a usual arrangement; at threat of a hysterorrhesis; in case of discrepancy of the sizes of a basin of the woman in labor and a head of a fruit (anatomically a narrow basin, a large fruit, hydrocephaly); at weak patrimonial activity; at the wrong presentations; when the subsequent birth of a head is complicated, and its violent extraction can lead to an injury of patrimonial ways.

To. on a live fruit make exclusively seldom and only in that case when natural childbirth threatens life and health of the woman, and Cesarean section (see) for any reasons it is impossible to make.

Carrying out To. perhaps under certain conditions, from which extent of disclosure of a neck of uterus and the sizes of a parturient canal (the size of a true conjugate of a small pelvis) are most important. Perforation of a head is usually made at disclosure of a neck of uterus not less than on 4 — 6 cm; at the same time the size of a true conjugate shall make not less than 6 cm at flat and 6,5 cm at the all-narrowed basin since during the narrowing of a basin of the IV degree (a true conjugate less than 5 cm) to take a fruit even later To. in patrimonial ways it is almost impossible.

Operation is carried out in the presence of two assistants. Perforation of a head is made under control of sight by means of long and wide mirrors. During operation one assistant fixes a mobile head of a fruit hands through a front abdominal wall of the woman in labor, another delays a trunk of a fruit of a kzada. If it is difficult to fix a head through outside covers, it is recommended to take skin of a head of a fruit strong nippers after disclosure of a vagina mirrors.

To. make in two stages: the 1st stage — perforation of a head, the 2nd stage — excerebration (removal of a brain). The area of a back fontanel or arrow-shaped seam are most convenient for implementation of perforation of the prelying head at occipital presentation, at perednegolovny — area of a front fontanel, at frontal — area of a frontal seam or an eye-socket, at front — a mouth. For perforation of a head at a front type of head presentation it is reasonable to choose area of a front fontanel, at back — hypoglossal area. Perforation is made by means of the nozhnitsevidny perforator of Negele, the cylindrical perforator of Fenomenov or the lanceolated perforator of Blo (see. Obstetric and gynecologic tools ). Blo's perforator has a number of advantages: thanks to the acute lanceolated end it is entered with little effort as into the area of seams and fontanels, and directly into a bone; disclosure brashny with the subsequent rotary motions allows to increase a perforation opening to the size sufficient for carrying out excerebration. Also vacuum perforator - ekstserebrator, the offered I. A. Tsintsadze in 1965 is used; this tool is safer concerning traumatizing fabrics of patrimonial ways.

Fig. 1. The diagrammatic representation of a craniotomy (perforation of the prelying head of a fruit): 1 — using Fenomenov's perforator; 2 — using Negele's perforator. Sign of rotation of perforators is specified by an arrow.
Fig. 2. Diagrammatic representation of stages of a cranioclasia: 1 — introduction of a massive spoon to a head cavity (the assistant fixes hands a head of a fruit through an abdominal wall); 2 — introduction of a fenestrated spoon under control of the left hand (the head of a fruit is fixed through an abdominal wall); 3 — trial traction after fixing of spoons of a cranioclast (the direction is specified by an arrow).

The edge of the perforator is densely put to a bone of a skull, a fontanel or a seam so that its axis was strictly perpendicular the surfaces of a skull; having pressed the handle of the perforator and at the same time rotating it from left to right (in case of use of the perforator of Fenomenov) or in both parties (during the use of the nozhnitsevidny perforator of Negele or Blo's perforator), do an opening (fig. 1). Then by means of the curette delete a brain of a fruit. After removal of a brain the volume of a head decreases and at good patrimonial activity the woman can independently give rise.

At weak patrimonial activity for extraction of a fruit it is possible to use craniodermal nippers (see) with the suspended load in 200 — 300 g with simultaneous administration of the drugs reducing muscles of a uterus; extraction of a fruit is more often make by means of a cranioclast (cranioclasia). A necessary condition for a cranioclasia is full disclosure of a neck of uterus. Imposing of a cranioclast at incomplete disclosure of a neck of uterus can lead to damage not only soft tissues of a parturient canal, but also a basin. The massive (continuous) spoon of a cranioclast is entered under protection and control of the left hand through a perforation opening into a head cavity to its basis (fig. 2, 1). At the same time one of assistants fixes a hand a head of a fruit through an abdominal wall. After introduction the massive spoon is transferred to the assistant and enter a fenestrated spoon so that her lower edge leaned on a thumb of the left hand controlling its advance (fig. 2, 2); the spoon is put on a face. After that handles of both spoons fasten and, having checked a hand whether are taken by a cranioclast of tissue of uterus, make trial traction to be convinced of correctness of imposing of a cranioclast (fig. 2, 3). Then start extraction of a fruit. The direction of tractions the same, as at extraction of a fruit with the help obstetric nippers (see).

Complications (various damage rate of a parturient canal) are possible only at disturbance of conditions and technology of operation.

Forecast at To. for mother it is usually favorable.

See also Fetaldestructive operations .

Bibliography: Vashikhidze P. D., Chachava K. V. and N. A. Wa's Tsintsidze - a kuum-perforator-extractor, Akush, and ginek., No. 6, page 135, 1964; Ershikovag. M. Kraniotomiya in modern obstetrics, M., 1973, bibliogr.; Malinovsky M. S. Operational obstetrics, page 303, M., 1974.

G. M. Ershikova.