From Big Medical Encyclopedia

SKULL. Contents:

Comparative anatomy...... 292

Embryology of........... 293

Anatomy............. 293

Methods of inspection........ 298

Pathology............. 299

Operations............. 302

Skull [cranium (PNA, JNA, BNA)] — a skeleton of the head of vertebrata. Distinguish brain Ch. (cranium cerebrale, s. neurocranium) and visceral, or front (cranium viscerale, s. splanchnocranium). In brain Ch. allocate a roof, or the arch (calvaria), and the basis (basis cranii).

At the person the created Ch. consists, as a rule, of 23 bones.

Defines a shape of the head h. Brain Ch. forms a receptacle for a brain and olfactor organs, sight, balance and hearing; bones front Ch. create a bone basis for an initial part of digestive and respiratory systems (an oral cavity and a nasal cavity).

Comparative anatomy

of Brain and front Ch. have various phylogenetic origin. Brain Ch. is continuation of an axial skeleton of a trunk. At the lowest vertebrata it is constructed of cartilages, to-rye form a brain box, ear and nasal capsules. The brain box consists of chordal (back) and prechordal (lobby) of parts, as border between them serves the Turkish saddle. A chordal part develops from head sclerotomes and has signs of a segmented structure, in it allocate occipital and ear areas. A prechordal part of a nesegmenti-rovan, is subdivided into orbital and nasal areas. Evolutionary transformations brain Ch. are caused, first of all, by development of a brain and sense bodys.

To front Ch. it is presented at beschelyustny by several couples of branchiate arches which are metamericly located in walls of a front gut. At fishes front branchiate arches will be transformed to jaws, and at land vertebrata from them acoustical stones and the hypoglossal device develop, besides, (see. Visceral skeleton). Primary (primordialny) by cartilaginous Ch. it is most developed at cartilaginous fishes. Ancient amphipneustic fishes in Ch.'s basis have bones replacing a cartilage, and in Ch.'s arch cover bones as a result of merge skin che-shuy are formed. H bony fishes consists of bigger number of the small replacing and cover bones. With transition to a land way of life total number of bones of Ch. decreases, a part them merges among themselves, and a part disappears. The way of an attachment of jaws to a neurocranium changes. At reptiles forms secondary bone небо^ separating a nasal cavity from oral, temporal holes and temporal arches are formed. At fossil reptiles-terio-dontov the skeleton of the head is similar to Ch. of mammals.

Sharp increase in volume of a brain box (at subhuman primates it reaches 500 cm3) is characteristic of mammals. Ch.'s roof is constructed of not numerous large bones; in Ch.'s basis bone elements merge among themselves, forming occipital, wedge-shaped and temporal complexes. At mammals the joint between a mandible and a temporal bone is for the first time formed.

Transformations Ch. at stages of anthropogenesis (see) are caused by development of a brain, vertical position of a body at circulation, weakening of load

of the dentoalveolar device, chlenorazdel

ache the speech. The volume of a brain box increases from 450 — 700 cm3 at Australopithecuses up to 800 cm3 at the person of skillful (Homo habilis) and exceeds 1100 cm3 at the homo sapiens (Homo sapiens). Brain Ch.

is rounded and approaches on front so the front axis forms almost right angle with a longitudinal axis of brain

Fig. The diagrammatic representation of a ratio of a brain and facial skull at primacies and the person (lines designated a longitudinal axis of a neurocranium and a front axis): and — a semi-monkey (lemur) — the lowest uzkonosy monkey (monkey), in — an anthropomorphous monkey (chimpanzee) — the person; in the course of phylogenesis the corner between a longitudinal axis of a neurocranium and a front axis increases.

skulls (fig. 1). Ch.'s basis is bent in a middle part, forming a so-called basilar corner. A big (occipital) opening, and together with it and occipital condyles are displaced on Ch. Proiskhodit's basis smoothing of a muscular relief of bones, reduction of superciliary arches, shortening of jaws, a reduction of alveolar shoots, formation of an outside nose and a mental ledge.

Kostya's embryology brain Ch. develop from the mesenchyma which is located at the front end of a chord and surrounding a rudiment of a brain. Development of bones front Ch. is connected with laying of the branchiate device, in particular with the first and second visceral arches (see. Visceral skeleton, Jaws). Distinctiveness of development of Ch. is that one bones of Ch. form on the basis of a cartilage, others — from connecting fabric and according to it are subdivided on replacing a cartilage and cover. The first form Ch.'s basis and a part of a nasal skeleton, the second — bones of the arch and the majority of face bones. At the beginning of the 2nd month of pre-natal development in both parties of a chord there are parachordal cartilages merging in an occipital cartilage. Kperedi from a chord stuffs up trabecular and pituitary cartilages. In the same time the nasal capsule for an olfactor organ and the ear capsule — дл^я an inner ear is formed. Merging among themselves, these cartilaginous bookmarks create Ch.'s basis and extend to sidewalls Ch. Svod Ch. prior to ossification remains webby. Ossification centers appear on the 7th week of pre-natal development in connecting fabric (before everything in jaws), on the 8th week — in cartilaginous tissue (see fig. 2 to St. Skeleton, t. 23, p. 360). Many bones

of Ch. develop from two and more ossification centers merging among themselves in the pre-natal period or after the birth (see the Skeleton). In total in Ch. contain up to 120 ossification centers.

Brain Ch.'s anatomy (tsvetn. tab., Art. 176, fig. 1 and 2) make unpaired bones — occipital (os occipitale), wedge-shaped (os sphenoidale), frontal (os frontale) and steam rooms temporal (os temporale), parietal (os parieta-le). Partially the sievebone (os ethmoidale) enters it. Topographical carry acoustical stones to brain Ch. (see. Middle ear).

To front Ch. (tsvetn. the tab., Art. 176, fig. 1 and 2) belong pair bones — an upper jaw (maxilla), the lower nasal sink (concha nasalis inf.), nasal (os nasale), lacrimal (os lacrimale) of a bone, a palatal bone (os palatinum), a malar (os zygomaticum) and unpaired — a sievebone (partially), a share (vomer), a mandible (mandibula) and a hypoglossal bone (os hyoi-deum). The number of bones of Ch. can increase in cases when such bones as frontal, occipital, parietal and others, are divided by non-constant seams, and also at the expense of the non-constant bones developing from additional ossification centers on the course of seams — bones of seams (ossa suturarum) and in fontanels — rodnichkovy bones (ossa fonticulorum). On the other hand, the number of bones decreases at formation of age or abnormal synostoses.

Ch.'s bones have various, is more often wrong, a form, nek-ry of them pneumatic cavities or cells contain and belong to pneumatic bones (ossa pneumatica) — frontal, wedge-shaped, trellised, temporal bones and an upper jaw.

Almost all bones of Ch. form among themselves continuous connections (see the Synarthrosis) in the form of syndesmoses and synchondroses, to-rye provide almost motionless association of separate bones. At the same time borders of bones not always match borders anatomo-funktsional-nykh departments of H. A main type of syndesmoses of Ch. are seams (suturae cranii). In a form distinguish gear (sutura serrata), scaly (sutura squamosa) and flat (sutura plana) seams. Names of the majority of seams consist of names of bones, to-rye they connect, napr, a frontonasal seam (sutura frontonasalis) between frontal and nasal bones. In the field of the arch seams have special names: ve

a nechny seam (sutura coronalis) — between frontal and parietal bones, sagittal (sutura sagittalis) — between two parietal bones, lambdoid (sutura lambdoidea) — between occipital and parietal bones. Bones of the basis of Ch. are connected by synchondroses; wedge-shaped and stony (synchondrosis sphenopetrosa) and stony and occipital (synchondrosis petrooccipitalis) synchondroses are constants, and klinovidnozatylochny (synchondrosis sphenoo-ccipitalis) and wedge-shaped and trellised (synchondrosis sphenoethmoidalis) synchondroses remain only before the end of growth of the basis of H. Joints form only a mandible from a temporal kostyo (see. Temporal and mandibular joint) and acoustical stones among themselves.

In a cavity brain Ch. is located a brain with a meninx and blood vessels. Brain Ch. has the form of a dome with the flat basis. The sizes individually vary it, volume brain Ch. at adults makes from 1100 to 2000 cm3. The outer surface brain Ch. is covered with a periosteum (pericranium), and to an inner (brain) surface the firm cover of a brain directly prilezhit. The border between the arch and Ch.'s basis passes on a frontonasal seam and supraorbital edge (margo supraorbitalis) to a malar shoot (processus zygomaticus) of a frontal bone, further on wedge-shaped malar seam (sutura sphenozygomatica), an infratemporal crest (crista infratemporalis), the basis of a malar shoot of a temporal bone, the upper edge of an outside acoustical opening (porus acus-ticus ext.), to the basis of a mastoid (processus mastoideus) and upper nuchal line (linea nuchae sup.) to an outside occipital ledge (protuberantia occipitalis ext.).

The arch is formed: frontal scales

(squama frontalis), parietal bones, upper part of occipital scales (squama occipitalis), temporal scales (squama temporalis) and part of a big wing (ala magna) of a wedge-shaped bone. On the upper temporal line (linea temporalis sup.) there passes the border between unpaired lobnotemenno-occipital and pair temporal areas. Bones of the arch of Ch. belong to flat bones; in them distinguish outside and internal plates of compact substance (laminae ext. et int.) and spongy substance — diploe (diploe), to Krom there go diploichesky channels (canales diploici). Thickness of outside, internal plates and spongy substance is not identical in various parts of the arch, individually varies and changes with age. The form of the arch and structure of his bones define mechanical strength of a skull. Ultimate load at longitudinal compression of Ch., according to Eler (E. Eliler, 1976), makes apprx. 1100 kg - with, and at cross compression — 1450 kgfs. At the loading exceeding the specified figures at first spongy substance collapses; from compact plates of more fragile is internal in this connection it is called also glass (lamina vitrea). Outer surface of the arch of Ch. smooth. On an inner surface there are finger-shaped impressions (impressiones digitatae) reflecting a relief of cerebral hemispheres (hemicerebrums, T.), and dimples of granulations of an arachnoid membrane of a brain (foveolae granulares), or pakhionova of a pole (fig. 2); besides, on an inner surface of the arch pass a furrow of an upper sagittal sine (sulcus sinus sagittalis sup.) and arterial furrows (sulci arteriosi), the last correspond to meningeal arteries (see the Meninx).

Ch.'s basis has a difficult configuration, it is penetrated by a set of openings, through to-rye pass craniocereberal (cranial, T.) nerves and blood vessels, almost in the center of the basis the big (occipital) opening is located. For the internal basis of Ch. (basis cranii int.) alternation of speakers and profound parts is characteristic. In it allocate front, average and back cranial poles (tsvetn. tab., Art. 170, fig. 4). Front cranial pole (fossa cranii

of Fig. 2. Calvaria from within: 1 — a frontal bone; 2 — a coronal seam; 3 — an outside plate of compact substance; 4 — an internal plate of compact substance; 5 — spongy substance; 6 — a sagittal seam; 7 — arterial furrows; 8 — a furrow of an upper sagittal sine; 9 — a lambdoid seam; 10 — an occipital bone; 11 — bones of seams; 12 — a parietal bone; 13 — dimples of granulations of an arachnoid membrane of a brain.

ant.) makes a roof of an eye-socket and a part of an upper wall of a nasal cavity. It is formed by a frontal bone, a trellised plate (lamina cribrosa) of a sievebone bearing on itself a cock crest (crista galli), and also small wings (alae parvae) and a part of a body of a wedge-shaped bone. In a front cranial pole frontal lobes of cerebral hemispheres lie. Through openings of a trellised plate there pass olfactory nerves. Border of front and average cranial poles is the edge of small wings and a wedge-shaped eminence (jugum sphenoidale). The average cranial pole (fossa cranii media) is formed wedge-shaped and temporal bones. In its middle part there is the Turkish saddle (sella turcica), in Krom the hypophysis is located (see). Kperedi from the Turkish saddle opens the visual channel (canalis opticus) conducting in an eye-socket. Together with an optic nerve in the channel there passes the eye artery (a. oph-thalmica). Lateral, profound parts of an average cranial pole occupy temporal shares of cerebral hemispheres. Upper orbital crack (fissura orbitalis sup.) connects an average cranial pole to an eye-socket, in it there pass the oculomotor, block, taking-away nerves and the first branch of a trifacial (n. ophthalmicus). The round opening (foramen rotundum) conducts in a pterygopalatine pole and is the place of an exit of the second branch of a trifacial (item maxillaris). Through an oval opening (foramen ovale) there is the third branch of a trifacial (item mandibularis), through a foramen spinosum (foramen spinosum) the average meningeal artery (a. meningea media) enters. In an average cranial pole the sleepy channel (canalis caroticus) opens, to Krom there goes the internal carotid artery (a. carotis int.). The average cranial pole separates from a back cranial pole a dorsum sellae (dorsum sellae) and stony parts, or pyramids, temporal bones (pars petrosa, s. pyramis); in them it is put preddverno-ulitko-vy body (see. Inner ear, Middle ear). Back cranial pole (fossa cranii post.) form occipital, temporal bones and mastoidal corners of parietal bones. In a pole are located a myelencephalon, va-roliyev the bridge (the bridge of a brain, T.) and the cerebellum, is in its center a big (occipital) opening (foramen magnum), through a cut there pass the medulla, vertebral arteries (aa. vertebrales) and roots of an eleventh cranial nerve. A body wedge-shaped and a basilar part (pars basi-laris) occipital bones form a slope (clivus) — so-called blyumenba-Hove the slope which is going down to a big (occipital) opening. In a back cranial pole furrows of sine — cross (sulcus sinus transversi), sigmoid (sulcus sinus sigmoidei), top and bottom stony are well-marked (sulcus sinusum petrosorum sup. et inf.). Between occipital and temporal bones there is a jugular foramen (foramen jugulare) where the internal jugular vein begins (v. jugularis int.) also there are glossopalatine, wandering and additional nerves. On a back surface of a pyramid of a temporal bone the internal acoustical opening is located (porus acusticus int.), through a cut facial and preddverno-cochlear nerves enter internal acoustical pass. Sideways from a big (occipital) opening there is a hypoglossal channel (canalis hypo-glossalis) for the nerve of the same name.

Various parts of the reasons of Ch. are had unequal durability. Stronger sites form system of the longitudinal crossbeams meeting to a body of a wedge-shaped bone; they are fastened by cross crossbeams according to borders between cranial poles. Deepenings of cranial poles are «weak» places, in to-rykh there are typical changes of the basis of H.

Outside basis of Ch. (basis cranii ext.) divide into three departments — front, average and back (tsvetn. tab., Art. 176, fig. 3). The front department is formed by a bony palate (palatum osseum) and alveolar shoots of upper jaws (see the Sky). The average department is located between the rear edge of the sky and the line connecting a first line of a big (occipital) opening to tops of mastoids (see the Mastoid). From sides it is limited by an infratemporal crest, a zygoma (arcus zygomaticus) and an outside acoustical opening. The bony palate is adjoined behind by alate shoots of a wedge-shaped bone (processus pterygoideus), having limitedthe postnaris, ayushchy from sides, (choa-share) conducting in a nasal cavity. Both postnaris on the centerline are divided by a share. In the central part of average department of the outside basis

of Ch., on a basilar part of an occipital bone, the pharyngeal hillock (tuberculum pharyngeum) acts. Intermediate part of average department of the outside basis of Ch. is formed by a lower surface of a pyramid of a temporal bone and a big wing of a wedge-shaped bone. There are an awl-shaped shoot and a number of openings — a shilosoyetsevidny, jugular, awned, oval, outside foramen of the sleepy channel. The majority of openings of the outside basis of Ch. lies on the line connecting an incisive foramen (foramen incisivum) of the sky to a stylomastoid opening (foramen stylomastoideum) which is the place of an exit of a facial nerve. In a lateral part of average department of the outside basis of Ch. the joint hillock (tuberculum articulare), a mandibular pole (fossa mandibularis), an outside acoustical opening and a stony and drum crack (fissura petrotympanica) are located. Anterolateral part of average department of the basis

of Ch. is a part of an infratemporal pole (fossa infratemporalis), edges is limited to a big wing of a wedge-shaped bone, a scaly part of a temporal bone, an alate shoot and an upper jaw. Contents of a pole are made by medial and lateral alate muscles (m. pterygoideus med. et lat.), vessels and nerves. Through the lower orbital crack (fissura orbitalis inf.) the infratemporal pole is reported with an eye-socket, and medially it goes deep into a pterygopalatine pole (see).

The back department of the outside basis of Ch. stretches from a big (occipital) opening to the upper nuchal line; it is formed by occipital scales, lateral parts of an occipital bone and a stony part of a temporal bone with the mastoid located on it. Occipital scales are the place of an attachment of the occipital muscles creating its relief. On both parties of a big (occipital) opening occipital condyles (condyli occipita-les) which are jointed with the Atlas are located.

Bones front Ch. create eye-sockets, a nasal cavity and an oral cavity (see the Eye-socket; Nose; Mouth, oral cavity). Eye-sockets are in an upper part front Ch., on border with brain Ch. Vkhod in an eye-socket (aditus orbitae) is limited by orbital edge (margo orbitalis), below to-rogo the infraorbital foramen (foramen infraorbitale) opens. Pass through this opening of the same name a nerve and vessels. In a middle part front Ch. is available an unpaired pear-shaped aperture (apertura piriformis) conducting in a nasal cavity. Sideways from it there is a klykovy pole (fossa canina). The lower part front Ch. is presented by a mandible (mandibula). In a lateral part front Ch. acts a malar, edges connecting to a shoot of a temporal bone, forms a zygoma.

The structure front Ch. to a large extent is defined by function of the dentoalveolar device, on to-ry the main mechanical loading during the chewing falls. Strong sites front Ch. received the name of buttresses. Allocate front (frontonasal), side (alveolar and malar), pterygopalatine and palatal the buttresses connected among themselves by cross crossbeams. On buttresses tension is transferred to strong sites of the basis and Ch. V arch of the lower jaw is also available a certain orientation of bone crossbeams according to pressure and draft of muscles (see Jaws).

The form and Ch.'s structure of the person have individual and group distinctions (e.g., racial, sexual). The main forms Ch. are brakhitsefalny, or brakhikranny, dolikhotsefalny, or dolikhokranny, and mezotsefalny, ily meso-krannaya (see the Brachycephaly, the Dolichocephalia, Mezotsefaliya). Sexual distinctions of Ch. concern the sizes and a form of both all Ch., and its separate parts. In brain and front Ch. is, as a rule, observed right left-side asymmetry. Form, 4. and its parts study with the help of both descriptive, and measuring methods (see Kraniometriya).

Rentgenol. the research Ch. and the skialogichesky analysis kraniogramm present a number of the difficulties caused by complexity of a structure of a skull. The main projections at rentgenol, a research Ch. are side, direct and axial, corresponding to three mutually perpendicular planes (sagittal, frontal and horizontal). Pictures in each of the main projections can be executed in two options depending on from what party the film to a skull at a X-ray analysis prilezhit. So,

the side projection can be right and left; direct and axial — front and back. Each of direct and axial projections can have nek-ry additional. So, the direct front projection is supplemented nasofrontal and nosopodborodochny, a straight line back — back parietal and back occipital, a lobby axial — lobbies on-luaksialnymi with different tilt angles of the head. Depending on research objectives use those projections, to-rye give the greatest information. However the research is begun always with two survey pictures — side and direct front (at the patients who are in a serious condition — with direct back).

The survey roentgenogram of Ch. in a side projection is made at the direction of the central beam of x-ray emission in the biaurikulyarny (frontal) plane of the head, above the Frankfurt (ushnoglaznichny) horizontal, with centralization on area of the Turkish saddle. Side kraniogramma are designated left or right depending on from what party the cartridge (film) prilezhit to the head. The picture in a side projection gives a survey picture of all Ch. in general. In this picture the arch brain Ch. and its basis, contours of three cranial poles is presented that allows to make a kraniometriya and to calculate nek-ry kraniologichesky coefficients (indexes), napr, the cranial and saddle coefficient (a ratio of the sizes Ch. and the Turkish saddle) having a certain value in diagnosis of pathology of the Turkish saddle. zo

ny a calvaria (fig. 3) are presented to Krayeobrazuyushchiye frontal, parietal and occipital by bones, to-rye give the image in the form of two striolas — equal outside and a little twisting and places doubled internal, displaying outside and internal plates of compact substance Ch. with the close-meshed drawing of spongy substance between them. Clearly gear seams of a skull — coronal and lambdoid, an arrangement to-rykh strictly constant come to light. The sagittal arrow-shaped seam connecting parietal bones on a midline in a side picture does not come to light, scaly seams are not always differentiated.

In a picture in a side projection in Ch.'s arch furrows of average meningeal arteries well come to light. Diploichesky channels in a form, the sizes and an arrangement are very variable and can form various ring, looped and star-shaped figures of an enlightenment. Often the furrow of a wedge-shaped and parietal sine going along a coronal seam to a sagittal sine comes to light; sometimes forking in the conjunction. Here side lacunas of an upper sagittal sine in the form of enough large impressions of an internal plate with narrowing of a layer of spongy substance come to light. Sometimes the frontal graduate comes to light. The print of a surface of a brain in the form of the finger-shaped impressions alternating with twisting, more dense sites — brain eminences joins the general background of the drawing of bones of the arch of Ch. Granulations of an arachnoid membrane (pakhionova gra-

Fig. 3. The roentgenogram of a skull in a side projection (a) and the scheme of the educations seen on it: 1 — an outside plate of compact substance; 2 — an internal plate of compact substance; 3 — spongy substance; 4 — a nasal bone; 5 — frontal sinuses; 6 — a coronal seam; 7 — a furrow of a wedge-shaped and parietal sine; 8 — a furrow of a front branch of an average shell artery; 9 — diploichesky channels; 10 — a furrow of a back branch of an average shell artery; 11 — a lambdoid seam; 12 — a furrow of a drain of sine; 13 — a furrow of a cross sine; 14 — an auricle; 15 — the Turkish saddle; 16 — an eye-socket; 17 — outside acoustical pass; 18 — internal acoustical pass; 19 — a malar shoot of an upper jaw; 20 — a hard palate; 21 — a Highmore's bosom; 22 — an alate bosom; 23 — a head of a mandible; 24 — a coronal shoot of a mandible; 2 5 — tooth of an axial vertebra.

nulyation) are presented in the form of the small roundish single or collected in groups sites of an enlightenment which are localized but to all arch, but a thicket along sine of a firm meninx.

Ch.'s basis in a picture in a side projection has a difficult configuration. In it front, average and back cranial poles with all bone anatomic educations which are their part are separately projected.

To front Ch. in a picture in a side projection it is presented by the summary image of all anatomic details that allows to create only idea of its configuration, the sizes, a form and a ratio of components.

The direct front survey picture is the basic for Ch.'s studying in the frontal plane. Kraniogramma in a direct projection are made in the sagittal plane, at the same time direct the central beam of x-ray emission above a glabella, parallel to the Frankfurt horizontal passing through bottom edge of an eye-socket and the upper edge of outside acoustical pass. On the front roentgenogram the symmetric image of the right and left half brain and front Ch. turns out, a cut in a picture in a side projection it is summed up. In a picture in a direct projection (fig. 4) krayeobrazuyushchy Ch. in the arch are the parietal bones occupying all central department where the structure of spongy substance is well traced, a cut has the greatest thickness here. Lat rat no, according to a scaly part of temporal bones, a layer of spongy substance much thinner. Here the strip of an enlightenment of a scaly seam going slantwise from top to down is traced (that can be accepted for a crack). Sometimes nearby the second strip of an enlightenment of a wedge-shaped and scaly seam comes to light. In a calvaria the arc-shaped gear lines coronal below lambdoid seams are traced. Proyek-tsionno they can closely approach and partially match. The sagittal seam is traced on a small extent from a bregma to an inner edge of the arch where skobkoobrazny deepening of a furrow of a sagittal sine comes to light, on the parties to-rogo side venous lacunas are located. In a picture in a direct projection a side part of an eye-socket is crossed from top to down and several obliquely by the dense line displaying border of cranial poles. The lower half of an eye-socket is blocked by a shadow of pyramids of temporal bones. Between tops of pyramids the body of a wedge-shaped bone with an enlightenment of a wedge-shaped nazukha is located. Clearly the lower bound of a body of a wedge-shaped bone is traced in the form of the intensive line. In a direct picture cranial poles proyektsionno block each other. In the center of a picture the nasal cavity where nasal sinks and the nasal courses well come to light konturirutsya. On the parties from a nasal cavity below eye-sockets enlightenments of Highmore's bosoms come to light. On their background small enlightenments of round openings are defined, through to-rye there pass the second branches of trifacials (maxillary nerves). In frontal scales frontal sinuses kontu-rirutsya. The trellised labyrinth blocks an upper part of a nasal cavity. Thus, two survey pictures (side and direct), mutually supplementing each other, allow to study Ch. in general and its many anatomic details and to reveal anomalies of development and bone Natal. changes.

Fig. 4. The roentgenogram of a skull in a direct front projection {and) and the scheme of the educations seen on it (6): 1 — an outside plate of compact substance; 2 — spongy substance; z — an internal plate of compact substance; 4 — a sagittal seam; 5 — a coronal seam; 6 — a lambdoid seam; 7 — venous lacunas; 8 — the upper edge of an eye-socket; 9 — a frontal sinus; 10 — small wings of a wedge-shaped bone; 11 — - a klinovid-but-scaly seam; 12 — an upper orbital crack; 13 — the anonymous line; 14 — wedge-shaped bosoms; 15 — the nasal course; 16 — a round opening; 17 — a nasal crest; 18 — a hard palate; 19 — a Highmore's bosom; 20 — a branch of a mandible; 21 —

a body of the mandible.

Kraniometrichesky measurements in a front and side projection of Ch. allow to calculate the poperechnoprodolny index, to-ry a thicket designate as cranial, or head, an index (the head index) representing percentage of cross diameter of Ch. (its width) to the longitudinal diameter (its length). Depending on the size of a head index distinguish three main forms Ch.: dolikhotsefalny (a head index less than 75), brakhitsefalny (a head index 81 above) and mezotse-falny (a head index at men — 76 — 80,9, at women — 77 — 81,9). Except these main the abnormal forms Ch. most often caused premature behind a rashcheniye of one of seams quite often come to light.

In addition to a direct survey picture additional are used. So, for studying of a trellised labyrinth and adnexal bosoms of a nose the nosopodborodochny picture is optimum. The nasofrontal picture is applied to studying front by Ch. and supplement with aim pictures of nasal bones, a mandible and a zygoma.

In all direct pictures the occipital bone is almost not differentiated, edges it is blocked by images of other departments of H. Meanwhile in occipital area the changes, e.g., arising at damages and demanding diagnostic specification are often localized.

This area is visible on a kraniogramma in a back semi-axial (occipital) projection, to-ruyu make in position of the patient on spin with the chin pressed to a breast. The central beam is directed at an angle 35 ° from a coronal seam to a first line of a big (occipital) opening. In this projection all departments of occipital scales (fig. 5), edge of a big opening, the upper edges of pyramids of temporal bones, a lambdoid seam with inserted (vormiyevy) stones, a back or occipital fontanel are presented. Non-constant fontanels — parietal and cerebellar, located over a big occipital opening, and also additional (non-constant) seams can remain: horizontal (cross) upper, average and lower. The lower cross seam creates an interparietal bone — a so-called bone of Inca (os interparietale, s. incae). Non-constant bones of Ch. subdivide depending on localization into sutural (ossa suturalia) and insular bones (ossa insularia), located vnutrikostno, and also bones of fontanels (ossa fonticulorum). Occipital scales have an uneven structure and cross going occipital crest; outside and internal occipital ledges give intensive consolidation. On their background the enlightenment of a furrow of a cross sine and a drain of sine are traced, the furrow of an upper sagittal sine up departs. In a lower part of an occipital bone the condylar channel, and also a mastoidal opening of a temporal bone where there pass emissarny veins can come to light. A big (occipital) opening, and also openings of cranial nerves in the listed pictures almost do not come to light.

For a research of the basis of Ch. do pictures in the third plane — horizontal (axial). On axial (front or back) pictures the image of the basis of Ch. in expanded form turns out. The picture of the basis of Ch. in a back axial projection is used for specification of a condition of a bottom of average and back cranial poles (fig. 6). This picture allows to study a condition of bone structure of the basis of Ch., size, a configuration of oval, awned, fragmentary, jugular openings, and also tops of pyramids of temporal bones, a slope, an inner edge of a big (occipital) opening, front and back arches of the Atlas, departments of a trellised labyrinth and wedge-shaped bosoms. Also arches, condylar (joint) and coronal shoots of a mandible, outside and internal occipital ledges are differentiated.

Fig. 5. The roentgenogram of a skull in a back gyuluaksialny (occipital) projection (a) and the scheme of the educations seen on it: 1 — a big (occipital) opening; 2 — a lambdoid seam; 3 — an occipital and mastoidal seam; 4 — a parietomastoid seam; 5 — a scaly seam; 6 — a coronal seam; 7 — a sagittal seam; 8 — a pyramid of a temporal bone; 9 — a furrow of a cross sine; 10 — a drain of sine; 11 — a sagittal sine.

Fig. 0. The roentgenogram of a skull in a back axial projection («■) and the scheme of the educations seen on it (6): 1 — a frontal sinus; 2, 3 — branches of a mandible; 4 — a sidewall of an eye-socket; 5 — zygomas; 6 — wedge-shaped paseszukh; 7 — blyumenbakh a slope; 8 — an oval opening; 9 — a foramen spinosum; 10 — acoustical pass; 11 — a big (occipital) opening.

For studying of such difficult anatomic educations as the eye-socket and a temporal bone, use special projections. Special laying is developed for a research of top and bottom orbital cracks, visual channels, pyramids of temporal bones, temporal and mandibular joints. Departments of a temporal bone study most often in three projections: a braid (according to Schueller), cross (across Stenver-su) and axial (axial) according to Maier (see. Middle ear).

Age features. At the newborn the weight (weight) of Ch. averages 42,5% of weight of a skeleton (the adult has 13,1%). Ch.'s volume is equal on average at newborn boys 375 smd, at girls — 350 sm6. The newborn has a size brain Ch. considerably exceeds the size front, and the area of the arch — the area of the basis (fig. 7, a).

H the newborn from above has outlines of a pentagon at the expense of strongly acting frontal and parietal hillocks (fig. 7, b).

The number of bones of Ch. at the newborn are more, than at the adult; the surface their smooth, structure is poorly differentiated. There are no mastoidal and alveolar shoots. Paranasal sinuses are in embryo. Seams are not created, in intervals between bones of the arch connecting fabric lies, and bones of a base of skull are divided by layers of a cartilage. Thanks to it bones of the arch can be displaced that is important at childbirth. In certain places between Ch.'s bones there are expansions — the fontanels executed by connecting fabric. Front (frontal) fontanel (fonticulus

of Fig. 7. A skull of the newborn (and — sideways; — from above): 1 — a frontal hillock; 2 — an upper jaw; 3 — a mandible;

4 — a big wing of a wedge-shaped bone;

5 — a wedge-shaped fontanel; 6 — a scaly part of a temporal bone; 7 — a lateral part of an occipital bone; 8 — a mastoidal fontanel; 9 — occipital scales; 10 — a back (occipital) fontanel; 11 — a parietal hillock; 12 — a front (frontal) fontanel; 13 — a coronal seam; 14 — a sagittal seam.

ant., s. frontalis) — the biggest; it is located between frontal and parietal bones, is closed at the end of the first or at the beginning of the second year of life. Back (occipital) fontanel (fonticulus post., s. occipitalis) is between occipital and parietal bones; it is closed in the first months of life. Side fontanels — wedge-shaped (fonticulus sphenoidalis) and mastoidal (fonticulus mastoideus) — steam rooms; they are closed before the birth and are available only for premature children. Besides, non-constant fontanels — glabellar (nasofrontal), metopic (srednelobny), parietal (sagittal) and cerebellar are observed; they can serve as the place of formation of craniocereberal hernias (see the Brain, hernias of a brain).

After the birth Ch.'s growth and formation of its parts continues. Expansion of brain, nasal, oral cavities and a nasopharynx leads to movement of the bones surrounding these cavities in the direction of vectors of growth. Movement of bones is followed by regional and superficial growth owing to what their extent and thickness increase; curvature of bones changes. Zones of an osteogenesis are seams and synchondroses of a skull.

Growth brain and front Ch. in the post-natal period is carried out unevenly. The linear sizes brain Ch. for the entire period of growth increase in 1V2 of time, and front Ch. — by 3 times. Brain

Ch. especially strongly increases in the first years of life: the volume of a medullary cavity in the first months would double, and by 2 years — trebles. After 7 years Ch.'s growth is slowed down, and in the pubertal period accelerates again. Growth of the arch of Ch. stops by 16 — 18 years, Ch.'s basis grows in length up to 18 — 20 years when there is a closing of a klinovidnozatylochny synchondrosis. Growth front Ch. more uniform and long, than brain. Most intensively bones grow in a circle of a mouth. Changes of separate bones of Ch. in the course of growth are expressed in accretion of their parts divided at the newborn (halves of a frontal bone, a mandible, parts of occipital and temporal bones, etc.), formation of a relief of outside and internal surfaces, a structural differentiation, a pnevmatization. Ch.'s seams at early age have smooth edges, and by 20 years gear seams form.

The obliteration of seams of Ch. begins at the end of the third decade of life and in a certain sequence covers everything or the majority of seams. At advanced and senile age osteoporosis is observed (see) Ch.'s bones, plates of compact substance become thinner, in nek-ry cases the thickening of bones is observed. In front department the atrophy of alveolar shoots of jaws in connection with loss of teeth is most expressed; as a result the corner of a mandible increases, the chin acts forward.

At nek-ry types of pathology of Ch. a certain diagnostic value its survey, a palpation, percussion has methods of inspection, with the help to-rykh it is possible to reveal new growths, sites of destruction of a bone, changes, to define local morbidity. E.g., at inborn hydrocephaly the palpation allows to define increase, protrusion and tension of fontanels, thinning of bones, at percussion of a skull characteristic «noise of the burst pot» is listened.

Complex the wedge, inspection includes neurologic, ophthalmologic, otonevro logical

researches, and also survey of the psychiatrist. Use also a number of additional methods, in particular an electroencephalography (see), a rheoencephalography (see). The basic among additional methods of a research is the X-ray analysis of a skull in standard and special projections (see Kraniografiya).

In a neuroradiology it is accepted to allocate primary radiological symptoms (e.g., calcification of a tumor and adjacent departments of a brain and a meninx) and secondary radiological symptoms, to-rye subdivide into the general and local. The general symptoms — change of a form and the sizes Ch. in general; strengthening of a relief of an internal plate of compact substance (finger-shaped impressions and venous sine, and also eminences between finger-shaped impressions); overgrowing or discrepancy of cranial seams; atrophy and thinning of bones as reflection of a generalized disease and involute changes in a skeleton; increase in lightness of pneumatic bones; strengthening of the vascular drawing. Local symptoms — destructive defect of a bone; different types of limited destruction of the drawing of bone substance (focal, linear, striate, landkartoobrazny, etc.); limited thickening of bones (hyperostosis); fragmentary consolidation of a bone tissue (osteosclerosis), different types of deformations of certain sites Ch.; thinning of bones in certain places as reflection of process of the general atrophy of a bone tissue (the arch, the Turkish saddle); atrophy from pressure patol. fabrics on the subject bone with regional deepening in it; expansion or narrowing of Ch.'s basis, any of anatomic openings; blackout of pneumatic cavities, calcifications, sequesters.

At rentgenol. a research depending on a wedge, indications apply both a X-ray analysis in standard projections, and a purposeful X-ray analysis. For establishment of localization of foreign bodys, differentiation of options of seams, detection of incomplete fractures, etc. uses a stereo a X-ray analysis and a tomography (see) in all its options. For specification of local changes in bone plates of compact substance and spongy substance do tangent (tangential) and contact («adjacent») pictures, pictures with direct blowup, and also carry out a limit tomography. At suspicion of pathology of a hypophysis for the purpose of specification of the sizes and a form of the Turkish saddle, character and distribution of destruction in addition to a kraniografiya in a side projection do aim pictures of the Turkish saddle, and also sagittal and frontal tomograms. The anatomic options and anomalies which are often found in kraniovertebralny area and relating both to

Ch.'s basis, and to upper cervical vertebrae can be revealed on a survey side kraniogramma. For specification of their character resort to a tomography, and also conduct a functional research, at Krom carry out two side pictures — with the maximum bending of the head of a kpereda and the maximum extension of a kzada.

In some cases use rents-tenokontrastnoye a research.

E.g., for differentiation of brain and extra brain changes carry out a diploegrafiya or a dip-loesinusografiya — contrasting of diploichesky veins and dural sine (sine of a firm meninx) water-soluble radiopaque substances (like Verografinum, an amipak, gipa, a yoglyukomida) with the subsequent X-ray analysis. Apply also carotid and vertebralny angiography (see Vertebralnaya an angiography, the Carotid angiography), contrasting of adnexal bosoms of a nose, generally Highmore's (see Guy mo a horn a raffia).

Other beam methods of a research, such as thermovision (see Termografiya), ultrasonic investigation (see. Ultrasonic diagnosis), a laser research (see the Laser), nuclear magnetic resonance (see) and a computer tomography (see the Tomography computer), have limited use in diagnosis of bone pathology. Importance in establishment of morphological features patol. process has it is frayed - a biopsy (see).

At children of younger age sometimes apply transillumination (see) — the method based on raying patholologically of the thinned bones of a skull. It allows to reveal nek-ry volume educations, in particular intracranial cysts. The importance, especially for children chest and babyhood, has definition of a circle of the head and the sizes of fontanels that allows to reveal this or that pathology of a brain, napr, hydrocephaly in time. The circle of the head of children of chest age is presented in the table.

The table


At children is more senior than 1 year increase in a circle of the head happens as follows: from 1 to 2 years — approximately on 2 cm, from 2 to 3 years — to

1 cm, then approximately on 0,5 cm a year, after 7 years rate of a gain of a circle of the head becomes slower. Increase in the specified sizes not always is a symptom of pathology, especially if there are no other symptoms of intracranial hypertensia or focal damage of a brain.

The main method of a research Ch. — a X-ray analysis in standard and special projections (see Kraniografiya).


Distinguish anomalies and malformations of bones of Ch., injury of bones of a skull and brain, a disease of inflammatory character, parasitic damages, and also tumors of bones of a skull.

Anomalies and malformations of bones of a skull. A big variety of anomalies and Ch.'s defects is caused by complexity of its ontogenesis and phylogenesis. Distinguish Ch.'s anomalies which are not causing patol. changes in a brain, and the anomalies which are combined with malformations of a brain and its derivatives or creating conditions for development of pathology of c. N of page, among to-rykh mark out the anomalies connected with the sizes and

Ch. K configuration to the first group of anomalies and malformations of Ch. carry: non-constant (inserted, vormiyeva) bones of seams, bones of fontanels; non-constant seams (metopic, intra that-mennoy, false); big parietal foramens, thin parietal bone, perforated Ch., etc. As a rule, these anomalies clinically are not shown, found accidentally at rentgenol. a research also do not demand treatment.

The anomalies and malformations allocated in the second group can be connected with defects of development of a brain. In a case a nezakry-tiya of front department of a neurotubule in the embryonal period the brain and Ch. remain open from the dorsal party — kranioskhizis (see the Brain, malformations). Usually kranioskhizis is followed by an underdevelopment of a brain up to its almost total absence (anencephalia). Kranioskhizis leads to formation of hernias of a brain (see the Brain, hernias of a brain).

Rather often found malformation of a skull — the craniostenosis (see) which is a consequence of a premature synostosis of separate or all seams of H. At a craniostenosis various changes of a configuration of Ch. are observed (tower, carinate, wedge-shaped, slanted, etc.)> that is followed by various symptoms of damage of a brain. Carry a craniofacial dysostosis, or Kruzon's syndrome to kinds of a craniostenosis, at Krom the craniostenosis is combined with an underdevelopment of face bones, a short nose, shaped a hook («a beak of a parrot»), shortening of an upper jaw (see the Dysostosis), and also a disease, or a syndrome, Apera (see Aper a syndrome).

Change of the sizes Ch. is observed at the nanocephalia (see) which is characterized by reduction of the sizes brain Ch. and a brain at normally developed facial skeleton and the followed mental retardation and various nevrol. frustration. Sharp increase in the sizes of a neurocranium at normal front Ch. indicates hydrocephaly (see). Increase in the sizes Ch. is possible also at the expense of overdevelopment of substance of a brain without symptoms of hydrocephaly; in this case speak about a macrocephalia (see).

Anomalies front Ch. are more often connected with disturbance of development of teeth (see), the sky (see) and jaws (see), and also are expressed in its asymmetry which is shown the unequal size of eye-sockets, frontal and Highmore's sinuses, a slanting arrangement of a nose, a curvature of its partition. In nek-ry cases the bone is observed intermaxillary, or incisal.

Anomalies of development of bones of Ch. in combination with damage of other bones of a skeleton are characteristic of clavicular and cranial, maxillofacial and maxillary and cranial dysostoses (see the Dysostosis).

At the inborn and acquired perversion of osteoblastic braking and formation of a bone tissue the deformation of kra-niovertebralny area in general which is quite often combined with a prelum of a myelencephalon, cerebellum and upper parts of a spinal cord develops (see Kraniovertebralny anomalies). In a crust, time among kranioverteb-ralny anomalies distinguish a platybasia, a basilar impressiya and a konveksobaziya.

Treatment of anomalies and malformations of Ch. consists in operational elimination of defects of bones of Ch. leading to disturbance of functions of c. N of page or other vital functions, and also to a decompression of the squeezed departments of c. N of page. At deformations front Ch. operational treatment in nek-ry cases is directed to elimination of cosmetic defects. The forecast depends on weight of defeat. In nek-ry cases of anomaly of development of Ch. are incompatible with life.

Injuries of bones of a skull and a brain — see. Craniocereberal injury.

Diseases. Acute inflammatory process in Ch.'s bones can proceed in the form of a periostitis (see), osteomyelitis (see) and inflammations of veins of bones of the arch (thrombophlebitis).

The periostitis most often is a consequence of an injury, less often it develops as a result of distribution on Ch.'s bone of inflammatory process of soft tissues and adnexal bosoms of a nose. Locally the picture of abscess (see) or phlegmons develops (see). The expressed hypostasis of soft tissues which however is not extending for borders of an attachment of a tendinous helmet is usually observed. The treatment combined: the operational vmeshatelrzstvo (a section with counteropenings at the level of an attachment of a tendinous helmet) is supplemented with conservative actions (prescription of antibiotics, streptocides, fortifying means). Forecast favorable.

Osteomyelitis of bones of Ch. can be a hematogenous or not hematogenous origin. Hematogenous osteomyelitis meets seldom at distribution of contagiums (stafilokokk, streptococci, etc.) from a suppurative focus another of localizations. Not hematogenous osteomyelitis arises upon direct transition of contagiums to Ch.'s bones from an abscess in soft tissues of Ch., adnexal bosoms of a nose, abscesses of a brain, and also at the getting gunshot wounds (wound osteomyelitis).

In a bone tissue the necrosis of the site of a bone with the subsequent its sequestration is observed (see the Sequester). Sometimes inflammatory process is not limited, proceeds chronically, sequestration is not observed. Treatment complex using antibacterial and symptomatic agents. At inefficiency of a konservatavny treatment and formation of sequesters make removal of sequesters or a resection of an affected area of a bone of a skull, with a bathing of the wound antiseptic solutions and the investigating drainage. The forecast at timely treatment, as a rule, favorable. Through — 12 months after an operative measure in the absence of signs of an inflammation the cranioplasty is shown (see).

The inflammation of digshoichesky veins of bones Ch. (thrombophlebitis) arises at suppuration of soft tissues of Ch. or fibrinferment of sine of a firm meninx with suppuration (see Thrombosis of vessels of a brain). Clinically proceeds with the phenomena of sepsis which are combined with symptoms of damage of a brain. Treatment consists in prescription of antibiotics and symptomatic means. Forecast serious.

Tuberculosis of bones of Ch. usually develops for the second time (see Tuberculosis extra pulmonary, a tuberculosis of bones and joints). Distinguish the limited (perforating) and progressively infiltriruyushchy forms. In the first case the painless swelling is formed (more often in frontal or parietal areas), edges it increases gradually and softened, forming cold abscess. Then fistula with purulent separated opens.

At progressively infiltriruyushchy form the sizes of a swelling quickly increase. In a bone tissue the tubercular granulomas with a caseous necrosis in the center and nonspecific granulyatsionny fabric extending in a bone and destroying it are formed. Diagnosis is based on kliniko-rents-genol. data with use gistol. and immunobiol. methods of a research. Treatment is specific, during the formation of cold abscess and fistulas — operational (see Tuberculosis extra pulmonary, a tuberculosis of bones and joints). The forecast depends on the course of basic process.

Syphilis of bones of Ch. meets seldom. Defeats are observed in the secondary and tertiary periods of a disease. In the secondary period there are local periostites. A basic element of damage of a bone in the tertiary period of syphilis is specific inf. a granuloma — a gumma. Distinguish solitary, subperiosteal, central (marrowy) and multiple small gummas. The Granulyatsionny fabric which is a part of a gumma causes destructive and osteoplastic processes in a bone. The diagnosis is based on clinicoradiological yielded and results of serological tests. Treatment specific (see Syphilis). The forecast is generally favorable.

The actinomycosis of bones of a skull meets seldom (see the Actinomycosis). Signs of chronically proceeding inflammatory damage of bones of Ch. with existence in soft tissues of the head of characteristic actinomycotic infiltrate, fistulas with typical separated are noted. In diagnosis identification of the activator is important. Treatment complex: the basis with

is stavlyat by an immunotherapy, in addition apply antibacterial and fortifying agents. At inefficiency of conservative treatment resort to excision of the center of defeat. Forecast, as a rule, favorable.

Damage of bones of Ch. an echinococcus is observed seldom. The echinococcus in a frontal bone, an eye-socket is localized, is more rare — in parietal, temporal bones and bones of a base of skull.

Initially the parasite is in spongy substance of a bone, is more rare — in paranasal sinuses. At destruction of plates of compact substance sotovidny defects of a bone tissue are formed, through to-rye bubbles of an echinococcus get into soft covers of Ch., into an eye-socket, a nasal cavity, are located epidu-ralno and subduralno, for the second time squeezing a brain. The break of an echinococcal cyst outside is followed by burrowing. In diagnosis are of great importance immunobiol. reactions (see the Echinococcus). Treatment — operational: Uda

leniye of all cysts of an echinococcus. The forecast during radical removal of all bubbles of an echinococcus favorable.

Tumors of bones of Ch. divide on primary and secondary (burgeoning, or metastatic), characterized by high-quality or malignant growth. Development of bones of the arch and base of skull from different embryonal bookmarks (see above the section Embryology) causes various nature of tumoral processes in them.

Tumors of bones of a calvaria. Most often occur among primary benign tumors of bones of the arch of Ch. an osteoma and a hemangioma. An osteoma (see) develops from deep layers of a periosteum where osteoblasts are located. Its emergence is connected with disturbance of embryonic development and formation of a bone. With

a growth from outside and internal plates of bone substance the compact osteoma, and is formed of spongy substance — the spongy

(spongy) or mixed form of an osteoma. Perhaps also development of an osteoid osteoma (see). An osteoma, as a rule, happen single, is more rare — multiple. They are characterized by slow growth, clinically can long not be shown, sometimes accidentally find them at rentgenol. research (fig. 8). In the presence a wedge, symptoms treatment operational — removal

of an osteoma. Forecast favorable.

The hemangioma of bones of a skull meets seldom (see the Hemangioma). The hemangioma is localized in spongy substance frontal and parietal (is more rare occipital) bones. In bones of the arch of Ch. the capillary hemangioma usually develops. Clinically the hemangioma often proceeds asymptomatically and is accidental rentgenol. find (fig. 9).

Secondary benign tumors of bones of the arch are presented me-

to Fig. 8. The roentgenogram of a skull (a side projection) at a compact osteoma of a parietal bone: shooters specified the site of consolidation of a bone tissue caused by an osteoma.

Fig. 9. The roentgenogram of a skull (a side projection) at a capillary hemangioma of a parietal bone: shooters specified the roundish center of destruction with the typical radiant grubotrabekulyarny drawing surrounded with a sclerous rim.

ningiomy (arakhnoidendoteliomy), growing into a bone from covers of a brain. A meningioma (see) sprouts bones of the arch of Ch. on the course of gaversovy channels, forming sites of a thickening of a bone tissue owing to active proliferation of osteoblasts. In rare instances the phenomena of destruction of a bone and substitution by her tumor prevail that causes detection of defect of a bone on kraniogramma. Wedge, current of meningiomas long. Treatment — operational. The forecast after timely operational treatment, as a rule, favorable.

For the second time bones of a calvaria can be surprised and in the presence in soft tissues of the head (under an aponeurosis) such high-quality new growths as a cholesteatoma, a dermoid cyst (see the Dermoid, the Cholesteatoma). Radiological at the same time the local destruction surrounded with a border area of a sclerosis is defined. Treatment — operational. Forecast favorable.

Carry an osteosarcoma to primary malignant tumors of bones of the arch (see). However the secondary sarcoma developing from a periosteum, a firm cover of a brain, an aponeurosis, etc. meets more often. Sarcomas develop at young age, differ in the big sizes and insignificant tendency to disintegration, quickly sprout a firm meninx and give metastasises. On the roentgenogram the center of defeat has uneven outlines, is sharply condensed; at germination of a tumor out of limits of cortical substance there is a so-called radiant periostitis in the form of (fig. 10) which are fanlikely dispersing bone sgsh-cool. The fibrosarcoma is conditionally malignant (see). Appoint antineoplastic

means and radiation therapy, in some cases operational treatment is shown.

Bones of a calvaria are surprised at a miyelozhny disease (see) in the form of the solitary center (plasmacytoma), diffusion defeat is less often observed. At the same time can come to light patol. the centers in edges, pelvic bones, a backbone, tubular bones, a breast. Disturbance of protein metabolism in the form of a paraproteinemia is characteristic (see P roteinemiya). Sometimes the tumor burgeons in adjacent fabrics (e.g., in a firm cover of a brain). The basic a wedge, a symptom are the affected bone pains. The diagnosis is established on the basis of clinical and datas of laboratory, results of a research of punctate of marrow and rentgenol. pictures. Treatment consists in purpose of antineoplastic means and performing radiation therapy. Operational treatment is sometimes shown (see. Multiple myeloma).

Forecast not benefit accepted.

Innidiation in a bone of a calvaria is observed at primary cancer of a lung, mammary gland, thyroid and epithelial bodies, a kidney, a prostate. Approximately in 20% of cases in Ch.'s bone metastasize malignant melanomas (see the Melanoma) a mucous membrane of a mouth and a nasopharynx, a retina, etc. The centers of destruction of a bone are localized in spongy substance and have a wide zone of a sclerosis, edges is removed knaruzh in process of increase in a metastasis (fig. 11). The multiple lytic melkoochagovy metastasises of a different configuration in bones of the arch of Ch. reminding the multiple centers at a multiple myeloma are observed at a malignant pheochromocytoma of adrenal glands, mediastinums, a liver (see Hromaffinom). Forecast adverse.

Tumors of bones of a base of skull. In bones osno-

Fig. 10. The roentgenogram of a skull (a side projection) at an osteosarcoma of a parietal bone: shooters specified

Nye's raft a shadow of a tumor with periosteal reaction in the form of fanlikely dispersing spicules.

Fig. 11. The roentgenogram of a skull (a direct projection) at a metastasis of cancer of epithelial body in scales of a frontal bone:

shooters specified the center of destruction surrounded with a wide zone of a sclerosis.

Ch.'s vaniye except described above ?opukholy development of fibroma (see), a chondroma (see), an osteoblast-klastomy (see), chordomas is possible (see).

Destruction of bones of the basis of Ch. is caused for the second time by tumors of intracranial educations. So, tumors pituitary sellyarnoy areas — adenomas of a hypophysis, a cranyopharyngioma (see the Hypophysis, the Cranyopharyngioma), are followed by increase in the sizes of the Turkish saddle, change of its configuration, structure and emergence of petrifikat. At a glioma, a meningioma of the channel of an optic nerve (see), and also a neurofibromatosis (see) the visual channel on the party of defeat with a moderate sclerosis or osteoporosis of edges of its opening extends. The tumor of a trigeminal node causes bone destruction of medial departments of an average cranial pole, the upper edge and a top of a pyramid of a temporal bone with expansion

of oval and (seldom) round openings. Intra orbital and parasellyarny tumors in some cases lead to expansion

of an upper orbital crack. At

neurinoma of an acoustical nerve the amount of internal acoustical pass increases and destruction of a top of a pyramid of a temporal bone is noted.

Usually primary and secondary

tumors of the basis of Ch. are followed similar a wedge, manifestations therefore in diagnosis are important rentgenol. given, and also a biopsy, the medical tactics and the forecast allowing to define. In definition of localization and the amount of process except a X-ray (tomographic) inspection are of great importance given to a cerebral angiography (see), a X-ray contrast research of likvorny system (see Ventrikulografiya, Pnevmoentsefalografiya), a computer tomography (see the Tomography computer) and nuclear magnetic resonance (see).

Treatment of tumors of bones of the basis of Ch. — operational in combination with radiation therapy. The forecast is always serious and depends on a look, localization of a tumor and a stage of process.


make Operative measures on Ch. at various patol. the processes developing both in Ch.'s bones, and in his cavities. A necessary stage overwhelming • the majority of operative measures at various intracranial pathology is the craniotrypesis (see). It is subdivided on resection when after operation in a skull open bone defect is formed, and osteoplastic with cutting out of rags of soft tissues and bones, to-rye later end of operation stack on the place (autoplasty), in some cases defect of a bone is closed hallo - plastic material (more often pro-tacryl) or a tinned gomokost (see the Cranioplasty). Most often operative measures on Ch. are undertaken concerning craniocereberal injuries (see. Craniocereberal injury). The purpose of operation is elimination of impressions of bones of Ch., removal of the bone fragments which were implemented into

Ch.'s cavity, achievement of a decompression at the accruing wet brain, etc. At osteomyelitis of bones of Ch. make a wide resection of the changed bone that provides the termination of purulent process. At primary tumors of bones of Ch. make their greatest possible removal within probably not changed bone tissue, a cut at malignant and X-ray sensitive benign tumors supplement with radiation therapy. In nek-ry cases, napr, at the osteo-dystrophic bone processes which are followed by considerable growths of a bone tissue, an operative measure is undertaken with the cosmetic purpose; it includes removal patol. centers and subsequent bone plastics. At a craniostenosis (see) make the operative measures on bones of a calvaria which are in their section on separate fragments or resections of sites of bones of Ch. that provides usually good decompression. On a skull to some extent treat surgical interventions: cherepnomozgovy hernias operations; operations at a nek-ry arteriovenous anastomosis when sites of a bone of a calvaria are resected, through to-rye drainage of an arterial blood in venous system is carried out; operations at a hypertelorism (see the Dysostosis) \interventions on paranasal sinuses (see); jaw operations (see).

Operations on Ch. depending on their look and volume make under local anesthesia (see Anesthesia local), an electroanaesthesia or under an endotracheal anesthesia (see). Operations on Ch. shall be provided with special tools and depending on a type of pathology are carried out by doctors of various profile: neurosurgeons, otorhinolaryngologists, specialists in maxillofacial surgery, etc.

Bibliography: Andronesku of A. Anato

a miya of the child, the lane from Romanians., page 81, Bucharest, 1970; Bunak V. V. A skull of the person and a stage of his formation at fossil people and modern races, M.,

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H. Ya. Vasin (hir.), I. G. Lagunova (radioanatomy), A. N. Lebedev (pathology, methods of inspection), V. S. Speransky (An., embr.).