PNEUMOENCEPHALOGRAPHY

From Big Medical Encyclopedia

PNEUMOENCEPHALOGRAPHY (grech, pneuma air + an encephalography) — a method of X-ray inspection of a brain by means of artificial contrasting by gas of its likvorny spaces: ventricles (pnevmoventrikulografiya), subarachnoid (subarachnoidal) tanks (pnevmotsisternografiya), subarachnoid space of a verkhnelateralny surface of a head hmozg.

By the item it is developed in 1918. U. The dandy, the term «pneumoencephalography» is offered in 1921 to Bingelem (And. Bingel). In a wedge, practice the method was implemented thanks to A. N. Bakulev (1923) researches, Videre (S. Wideroe, 1924), Liskholma (E. Lysholm, 1938), Ya. I. Geyni-smana (1953), etc. Development of new methods: a computer tomography (see. Tomography computer ), cerebral angiography (see), gamma stsintigrafii (see. Stsintigrafiya ) limited use of a pneumoencephalography.

Fig. 1. It is normal of a pneumoencephalogram: and — a back projection (1 — the left side ventricle, 2 — the right side ventricle, 3 — a transparent partition, 4 — the third ventricle); — a side projection (1 — a front horn of a side ventricle, 2 — the central part of a side ventricle, 3 — a back horn of a side ventricle, 4 — the lower horn of a side ventricle).

The item allows to establish topografo-anatomic relationship of various structures of a brain, situation, size, a form and rezorbtsionny function of its likvorny spaces (fig. 1, and, b). Define localization and character by P. intracranial patol, process, specify its extent, volume patol, the center, extent of deformation of subarachnoid space, prevalence of cicatricial and atrophic changes.

Fig. 2. A pneumoencephalogram in a front projection at a tumor of the right cerebral hemisphere: the right side ventricle is displaced by a tumor lateralno and deformed (it is specified by an arrow), on the party of defeat gas in subarachnoid space is absent.
Fig. 3. A pneumoencephalogram in a back projection at hydrocephaly: considerable expansion of cerebral cavities (it is specified by shooters) and furrows.

Item. apply for diagnosis of malformations, tumors (fig. 2), cysts, abscesses, traumatic injuries of a brain and their effects, hydrocephaly (fig. 3), disturbances of secretion and resorption of cerebrospinal liquid.

Item. it is contraindicated with a high intracranial pressure in case of the closed hydrocephaly, congestive nipples of optic nerves at supratentorialno the located tumor (in order to avoid strengthening of hypostasis of a brain and dislocation of its trunk departments), serious condition of the patient.

Items carry out later kraniografiya (see), in the conditions of an asepsis. In some cases, especially at children, P. make under anesthetic. Apply three ways of Item 1. In position of the patient sitting carry out spinal puncture (see) by means of two needles which enter into subarachnoid space of a spinal cord at different height. Through an upper needle slowly enter nitrous oxide, carbon dioxide gas or oxygen, through the lower needle in the graduated test tube cerebrospinal liquid follows. The volume of the entered gas and speed of its introduction depend on a research objective and reaction of the patient to administration of gas. In most cases the adult enter 30 — 80 cm 3 gas, newborn 5 — 8 cm 3 gas (it is 10 — 15% more than the volume of removed cerebrospinal liquid). 2. By a spinal puncture remove a small amount of cerebrospinal liquid (20 — 30 ml) and replace it 30 — 35 см^ gas. Gas is entered slowly, with a speed no more than 1 — 2 cm 3 in 1 min. that creates favorable conditions for its passing through a small opening of Marangdi (a median aperture of the fourth ventricle, T.; apertura mediana ventriculi quarti). For the direction of gas in ventricles of a brain to the patient in a sitting position suggest to incline the head forward. For preferential filling of subarachnoid space it is necessary to throw back the head, on the contrary. This method received the name slowed down and sent to Item 3. In subarachnoid space by means of spinal or suboktsipitalny puncture (see) enter 10 — 15 cm 3 gas without removal of cerebrospinal liquid.

The choice of a way P. is defined by a research objective and character patol, process. The first way P is more often used.

After administration of gas make rentgenol. Polyposition research (see). Change of position of the patient promotes movement of gas in likvorny spaces and by that to contrasting of different anatomical structures of a brain. The main consider survey roentgenograms of a skull in a lobby, back and side projections at horizontal position of the patient and a vertical nanravleniye of a bunch of x-ray emission. In addition make pictures in the same provisions of the patient, but at the horizontal direction of a bunch of radiation, and also semi-axial and axial roentgenograms and pictures at vertical position of the patient. At P. the X-ray television research was of particular importance (see. Television in medicine ), aim and layer-by-layer pictures since they allow to study in detail all departments of cerebral cavities, subarachnoid space of a verkhnelateralny surface of a brain, subarachnoid (subarachnoidal) tanks and all educations pressing in them.

Normal gas is evenly distributed on furrows of frontal and parietal lobes of a brain and gathers over front department of a corpus collosum. On a pneumoencephalogram each furrow is visible as a narrow tape-like enlightenment with equal parallel konturakhm. On the basis of a brain gas fills subarachnoid tanks: cerebellar and brain, intercrural, the tank of decussation covering the tank (cisterna ambiens, BNA, JNA), the tank of a big brain vein (cisterna venae magnae cerebri, BNA; cisterna venae cerebralis magnae, JNA), etc. On their background shadows of the bridge, legs of a brain, mastoidal bodies, visual decussation, sometimes are allocated to basilar Pi back brain arteries etc. By means of pictures in different projections it is possible to receive the image of all departments of cerebral cavities. At pathology note the general or local extension, narrowing, shift, deformation or lack of the image of the specified likvorny spaces.

At sick P.' most is followed by a headache, nausea or vomiting, a fever, cyanosis, change of pulse rate, a stiff neck. These phenomena disappear in several hours. Occasionally the state close to shock develops. Side reactions arise less often and are expressed more weakly at the slowed-down P.

See also Ventrikulografiya , Encephalography .



Bibliography: Bakulev A. N. Experience of use of an entsefalo-ventrikulografiya, Is new. hir. arkh., t. 5, book 3, page 471, 1924; Geynisman Ya. I. The slowed-down and directed pneumoencephalography, M., 1953; Kopylov M. B. Bases of radiodiagnosis of diseases of a brain. M, 1968; Di Chiro G. An atlas of detailed normal pneumencephalographic anatomy, Springfield, 1961; Grundriss der Neuroradiologie, hrsg. v. J. Neumann u. K. Seidel, Lpz., 1976; Robertson E. G. Pneumenzephalography, Springfield, 1957, Bibliogr.


L. D. Lindenbraten.

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