From Big Medical Encyclopedia

KRANIOTSEREBRALNY TOPOGRAPHY (grech, kranion skull + lat. cerebrum brain; grech, topos the place + grapho to write, represent) — a projection to the surfaces of a skull of shares of a brain, crinkles, furrows, border check-points between shares and convolutions of the brain, outlines of cerebral cavities, the direction of arteries and sine of a firm meninx and vessels of a brain, the place of an exit of cranial nerves and area of the separate centers of a brain. Method K. t., i.e. definition of location of educations (crinkles, furrows, arteries and venous collectors) on the surface of a brain according to skeletotopichesky data in connection with development of surgical accesses to the educations located in the depth of a brain it is added with other methods allowing to define more precisely a projection to a skull of the educations located not only to the surfaces of a brain but also in white matter of hemispheres, basal nodes, a thalamus and other departments of a brain trunk (see. Stereotaxic neurosurgery , Stereotaxic method ). However To. t. did not lose the value because does possible performance of osteoplastic operation on strictly chosen place. A certain stability of ratios of a skull and brain and a certain typical arrangement of brain furrows, appear, would have to make a lung establishment of a ratio between shares and furrows of a brain and bones of a skull. However actually this task very hard, and accuracy cannot be guaranteed.

The brain and its structures at the various movements keep generally a steady statics thanks to the arrangement in poles of a skull and in receptacles of a firm meninx with its educations, napr, the falx cerebri (falx cerebri), is mashed a cerebellum (tentorium cerebelli). Finger-shaped impressions (impressiones digitatae) are the proof of constancy of certain ratios between crinkles and the bone surface of a skull. The known role in sense of a statics of a brain in relation to a skull is played by cranial nerves, arterial and venous vessels; at last, the same role is carried out partly by granulations of an arachnoid membrane (a pakhionova of granulation). During the studying of position of a brain it is possible to see that the significant role belongs to cerebrospinal liquid. The brain not only is suspended by a number of the anatomic educations described above, he swims, according to Gyurtle and Plante (To. W. Hurtle, Plant). But if to take the specific weight of a brain (1,040) and cerebrospinal liquid (1,003 — 1,008) into account, then it is necessary to speak about swimming in exact sense of the word about a nek-swarm the reservation. At various specific weight it is possible to assume a possibility of shift of a brain at various provisions of the head, but the overweight of a brain as F. W. Muller considers, will be leveled thanks to pressure of liquid. Partly it is possible to see it from enormous material of suboktsipitalny punctures: corresponds to each position of a brain the special, causing stability provisions of a brain, pressure of cerebrospinal liquid. All this also creates base for a projection of these or those sites of a brain to the surfaces of a skull. It is necessary to specify that there is no compliance between the bones of a skull and shares of a brain carrying identical names: the frontal bone does not correspond to a frontal lobe of a brain; a temporal bone — a temporal share of a brain, an occipital bone — an occipital share of a brain.

However it is impossible to deny values of seams for creation of the projective scheme though seams in itself are subject to different aberrations.

The form of big hemispheres, separate shares is subject to big variability. Cases of uneven development of the right and left hemisphere with the shift of a falx cerebri are observed and it is sometimes mashed a cerebellum. Cases of uneven development of front and back departments of hemispheres are observed. Such asymmetries, of course, are not left without influence on an arrangement of the major furrows and crinkles as, e.g., the central furrow and crinkles delimited by it.

Though a technique of definition To. t. according to skeletotopichesky data it cannot be recognized perfect, nevertheless in practice use it widely. For a projection of sites of a brain to the surface of a skull of the head on bones of a skull it was offered many schemes constructed on the basis of careful studying of anatomy of a skull and a brain and also on the basis a wedge, observations.

Fig. 1. Identification points for skeletotopichesky definition of the main furrows of big parencephalons on Kokhera: 1 — a glabella; 2 — parietal point — border between a front and back half of the meridional (sagittal) line; 3 — the place of crossing of the temporal line and a back slanting meridian; 4 — a point at a top of a lambdoid seam; 5 — an outside occipital ledge; 6 — the place of crossing of the line of the equator with a back slanting meridian; 7 — the place of crossing of the line of the equator with a front slanting meridian; 8 — the place of crossing of the temporal line with a front slanting meridian.

Krenleyn, Kokher's methods enjoy the greatest popularity. At first determine the line of the equator between points of a glabella (nasion) and an outside occipital ledge by Kokher's method (protuberantia occipitalis ext.), then the meridional sagittal line, edges begins in a point of a glabella, passes through points of parietal point and a top of a lambdoid seam and comes to an end in a point of an outside occipital ledge (fig. 1). The meridional line is halved and thus find parietal point, from to-rogo postpone 2 meridians: front slanting and back braid. These two meridians postpone at an angle 60 ° to a lobby and the tail of the sagittal meridional line and stretch to the equatorial line. The front slanting meridian corresponds to an arrangement of a pretsentralny furrow. This meridian is divided into 3 equal parts. The received points of division correspond to the place of a confluence top and bottom frontal furrows in a pretsentralny furrow. T. Kokher called a back slanting meridian an ambit (linea limitans). This line divides two convolutions of the brain: supramarginal crinkle (gyrus supramarginalis) and angular crinkle (gyrus angularis); the first lies kpered from it, and the second kzad; in the lower site the ambit (a back slanting meridian) separates a temporal share from occipital. Between a point of a glabella to a top of a lambdoid seam there passes the line, to-ruyu T. Kokher called temporal. It evades from the course of a lateral furrow a little, goes on the first temporal crinkle and matches further an upper temporal furrow, as gave a reason to T. Kokher to call this line the temporal line.

U T. Kokhera places of crossing of the temporal line with lines pretsentralny (a front slanting meridian) and boundary (a back slanting meridian) will correspond: the first — to the beginning of a lateral furrow, and the second — to the back end of an upper and temporal crinkle. The final site of the temporal line corresponds to border between occipital and parietal shares.

If to know the direction of the main furrows, approximate orientation during other furrows and the centers is considerably facilitated, at least in approximate scales. The arrangement and the course of a cross sine are determined by an outer surface of an occipital part of a skull, an outside occipital ledge and the upper nuchal line (linea nuchae sup.), if it is probed; if she does not manage to be probed, then the upper edge of occipital muscles can be the identification line, and it is considered the rule that the upper nuchal line corresponds to bottom edge of a cross sine. Establishment of the line of passing of a cross sine at the same time characterizes and an attachment is mashed a cerebellum, and a back cross crack of a great brain (fissura transversa cerebri).

Fig. 2. Identification points for skeletotopichesky definition of the main furrows of big parencephalons according to Egorov: 1 — a glabella; 2 — frontal; z — pretsentralny; 4 — central; 5 — Postcentral; 6 — lambdoid; 7 — a point of an outside occipital ledge; 8 — orbital.

B. G. Egorov suggested to carry out skeletotopichesky definition of the main furrows according to the scheme provided on the figure 2.

The equator line (linea nasooccipitaiis horizontalis) is drawn on a circle of the head, crosses in front a point of nasion and behind a point of inion — protuberantia occipitalis ext.

The sagittal line (linea nasooccipitalis sagittalis) connects the same points on the average sagittal line. This line is measured and divided into 4 equal pieces on 25% in everyone. The distance from a point of a glabella (nasion) for 25% of a kzada defines a frontal point. Further on the middle of an extent of the line the parietal point is noted, edges is the top of a pretsentralny crinkle. Moving ahead kzad, the lambdoid point corresponding to 75% of length of the sagittal line is defined. The point is located slightly above a lambdoid seam and defines the back end of a projection of a lateral furrow. At last, the point of inion (a point of intersection of the upper nuchal line with the median plane of the head) corresponds to an outside occipital ledge.

A projection of a lateral furrow is the line connecting the orbital point located at the outside upper edge of an eye-socket to a lambdoid point on the sagittal line.

The projection of a pretsentralny furrow is defined by the line drawn from a pretsentralny point from top to bottom at an angle, turned kpered on 60 ° to the sagittal line. This line is drawn down camber of the head so that it crossed the equator line perpendicularly — at an angle 90 °.

The line of the central (rolandovy) furrow passes parallel to the pretsentralny line, otstupya from it a kzada on 1,5 cm and in a rolandovy point crosses the sagittal line.

A line of a postcentral furrow is drawn parallel to the line of the central furrow, otstupya kzad on 1,5 pieces and crosses the sagittal line in a postcentral point.

See also Furrows and crinkles of a cerebral cortex , Brain , Skull .

Bibliography: Egorov B. G. Anatomo-fiziologichesky justification of quick accesses to tumors of a brain through a parietal lobe, in book: Probl, sovr, neyrokhir., under the editorship of B. G. Egorov, t. 3, page 5, M., 1959; Kramer V. V. The doctrine about localizations, M. — L., 1931; D e 1-mas A. et PertuisetS. Topometrie cranio-encephalique chez l’homme, P., 1959; Frori ep A. Zur Kenntniss der Lage-beziehungen zwischen Grosshirn und Scha-deldach bei Menschen verschiedener Kopf-form, Lpz., 1897; Kocher E. Th. Chi-rurgische Operationslehre, Jena, 1907; K r o n 1 e i n, Zur cranio-cerebralen To-pographie, Bruns’ Beitr. klin. Chir., Bd 22, Hft 2, S. 364, 1898; it, Ein einfacher Kraniometer, Zbl. Chir., S. 1, 1899; Muller F. W. Cranio-cerebrale Topographie, in book: Allg. Chir. d. Gehirnkrankh., hrsg. v. F. Krause, Bd 12, S. 379, Stuttgart, 1 914, Bibliogr.; S a 1 a m o n J. Huang Y. P. Radiologic anatomy of the brain, V. a. o., 1976; Tandler J. u. R a n z i E. Chirurgische Anatomie und Operationstechnik des Zentralnervensystems, B., 1920.

H. H. Burdenko, S. M. Blinkov.