Complete overgrowth of the sutures of the skull occurs. Age-related transformations of the skull. Treatment without surgery

Craniostenosis - (from the Greek kranion - skull and stenosis - narrowing) premature closure of cranial sutures or their congenital absence.

The baby's skull consists of 6 bones of the skull: the frontal bone, the occipital bone, two parietal bones, two temporal bones. Normally, all these bones of the skull are not fused, the anterior and posterior fontanelles are open. The bones listed above are held together by strong, elastic tissues called sutures. Without the flexibility of these seams, a child's brain cannot grow properly. The brain grows and the baby's skull lid should expand as well. The stitches respond to brain growth by "stretching" and "producing" new bone, thereby allowing the skull to grow with the brain. The normal growth of the skull is perpendicular to each suture.

The posterior fontanelle closes by the end of the 2nd month, the anterior fontanelle closes during the 2nd year of life. By the end of the 6th month of life, the bones of the cranial vault are interconnected by a dense fibrous membrane. By the end of the 1st year of life, the size of the child's head is 90%, and by the age of 6 years it reaches 95% of the head size of an adult. Closing the sutures by connecting the jagged edges of the bones begins by the end of the 1st year of life and ends completely by the age of 12-14.

Premature and uneven overgrowing of fontanelles and cranial sutures in children - craniostenosis - interferes with the normal development of the brain and leads to the creation of conditions for cerebrospinal fluid disorders. Liquorodynamic disorders are usually called pathological conditions in which the secretion, resorption and circulation of cerebrospinal fluid are impaired. The incidence of craniostenosis is 1 per 1000 newborns. With craniostenosis, intracranial pressure is usually increased, in connection with this, hypertensive headache is characteristic, the development of stagnant discs of the optic nerves is possible, followed by their secondary atrophy and visual impairment, mental retardation.

Causes

Distinguish between primary (idiopathic) and secondary craniosynostosis. The development of secondary craniosynostosis can be due to various reasons. These may include vitamin D-deficient rickets, hypophosphatemia, thyroid hormone overdose in cases of treatment of congenital hypothyroid oligophrenia (cretinism).

What's happening?

The overgrowth of the sutures of the skull is not only premature, but also uneven, usually leads to deformation of the skull. In the process of monitoring the development of the shape of the cerebral skull, the so-called cranial index (CI) is taken into account - the ratio of the transverse size of the skull to its longitudinal size, multiplied by 100. With a normal (average) ratio of the transverse and longitudinal dimensions of the head (with mesocephaly), the cranial index in men is 76-80.9, for women - 77-81.9.

With premature overgrowth of the sagittal suture (sagittal synostosis) develops dolichocephaly, in which the skull increases in the anteroposterior direction and is reduced in transverse size. In such cases, the head is narrow and elongated. The CHI is less than 75.

A variant of dolichocephaly caused by premature overgrowth of the sagittal suture, in which there is a restriction of the growth of the skull in the transverse direction and its growth in length turns out to be excessive, may be scaphocephaly (from the Greek. skaphe - boat), cymbocephaly (scaphoid head, keeled head), in which a long narrow head with a prominent forehead and nape is formed, resembling a boat turned upside down. Saddle skull is a skull elongated in the longitudinal direction with an impression in the parietal region.

A variant of the skull deformity, in which the skull has an increased transverse size due to premature overgrowth of the coronary (coronal) sutures (coronary, or coronal, synostosis), is brachycephaly (from the Greek brachis - short and kephale - head), while the head is wide and shortened, the cranial index is over 81. In brachycephaly due to bilateral coronary synostosis, the face is flattened, often exophthalmos is manifested - anterior displacement of one or both eyeballs.

With premature overgrowth of the coronary suture on one side, plagiocephaly, or head-headedness (from the Greek plagios - oblique and kephale - head). In such cases, the skull is asymmetric, the frontal bone on the side of synostosis is flattened, on the same side exophthalmos and an increase in the middle and posterior cranial fossa are possible.

If there is a premature combined infection of the coronary and sagittal cranial sutures, the growth of the skull occurs mainly towards the anterior fontanelle and base, which leads to an increase in the height of the head while limiting its growth in the longitudinal and transverse directions. As a result, a tall, conical skull is formed, somewhat flattened in the anteroposterior direction (acroranium), it is often called a tower skull. A variant of the tower skull is oxycephaly, or a pointed head (from the Greek oxys - sharp, kephale - head), in which the early overgrowth of the cranial sutures leads to the formation of a high, tapering upward skull with a sloping forehead.

A variant of the skull deformity, characterized by a narrow frontal and wide occipital bones, is formed in connection with the premature overgrowth of the frontal suture. In this case, the frontal bones grow together at an angle (normally, overgrowth of the frontal suture occurs only by the end of the 2nd year of life) and a ridge is formed at the site of the frontal suture. If, in such cases, the posterior parts of the skull increase compensatory and its base deepens, trigonocranium or triangular skull occurs (from the Greek trigonon - triangle, kephale - head).

Isolated synostosis of the lambdoid suture is extremely rare and is accompanied by flattening of the occiput and compensatory expansion of the anterior part of the skull with an increase in the anterior fontanelle. Often it is combined with premature closure of the sagittal suture.

When secondary craniostenosis at an early stage of its development, conservative treatment of the underlying disease can be effective. With primary craniostenosis, as well as with secondary craniostenosis, in the case of already developed significant intracranial hypertension, decompression surgery is indicated: the formation of craniectomy passages up to 1 cm wide along the line of suture ossifications. Timely surgical treatment for craniostenosis can ensure normal brain development in the future.

Treatment

The most active period of brain growth is considered to be the age of up to two years. Thus, from a functional point of view, craniostenosis can be prevented by early surgical treatment. The optimal age for surgery for craniosynostosis can be considered the period from 3 to 9 months. The advantages of treatment at this age can be considered: ease of manipulation of the thin and soft bones of the skull; facilitating the final remodeling of the skull shape by a rapidly growing brain; more complete and faster healing of residual bone defects.

If the treatment is performed after five years, it is doubtful that it will lead to a significant improvement in brain function. To a greater extent, the operation will be aimed at eliminating the deformation of the head. The main feature of modern surgical treatment is not only an increase in the volume of the skull, but also the correction of its shape and combined deformity of the face during one operation.

What parents should pay attention to

• The unusual shape of the child's head
• Early closure of the large fontanelle (up to a year)
• Inconsistency of the growth rate of the child's head circumference with the age norm (see the boys 'head circumference and the girls' head circumference)
• Poor sleep, anxiety in the child, aggravation of the child when the weather changes, regurgitation, retardation in psychomotor development (see psychomotor development of the child)

If you find the above symptoms in a child, you should contact a specialist:

• Neurologist - assesses the presence of neurological symptoms, delayed development of the child
• To an ophthalmologist - assesses the signs of intracranial hypertension according to the results of an examination of the fundus (in advanced cases - a decrease in visual acuity)
• Pediatrician - assesses the presence of other anomalies in the development of organs and systems, somatic pathology
• Genetics - reveals the presence of the genetic nature of the disease, the likelihood of anomalies of other organs and systems and the prognosis of the recurrence of a similar pathology in the next child

Please note that it is better to play it safe and refer a child with a skull deformity to a specialist than to skip the pathology.

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The local pediatrician should be able to create a head examination in the newborn and as an orthopedist. An orthopedic examination of a newborn begins with an examination and study of the head, the ability to hold it, then an examination of the face (its symmetry is noted) and the neck. Particular attention is paid to the condition of the sternocleidomastoid muscles (whether there are seals, shortening of one of their legs).

When examining the head of a newborn, you need to pay attention to:

The condition of the cranial sutures;

Inspection of the head should be combined with its palpation, and where necessary, percussion should also be directed. If there are features, they should be marked.

The position of the head of a healthy newborn is due to presentation during labor and the presence of physiological hypertonicity of the flexors (the head is easily brought to the chest).

Traumatic injuries in childbirth of the sternoclavicular muscle or the lower cervical and upper thoracic segments of the spinal cord lead to a deviation of the head to the right or left. In any situation, consultation with an orthopedist and a neurologist is required.

In a newborn child, the cerebral skull prevails over the facial one. The frontal and parietal tubercles clearly stand out. Quite often, in the back of the head, on the border of the scalp, there are red spots with vague boundaries that do not rise above the surface of the skin. Their borders are irregular. Under the pressure of the finger, the redness disappears, but then reappears. Better by crying. These spots (telangiectasias) are caused by local expansion of the rudimentary remnants of embryonic vessels. They disappear on their own within 1-1.5 years and are only a cosmetic defect that does not require treatment. They do not need to be confused with genuine vascular nevi. which have a blacker, more saturated color and do not disappear when pressed. They do not go away at the end of 1.5 years of life, but on the contrary, from time to time they increase in size.

On the scalp, there may be silvery-shiny or dull gray scales (gneiss) - a manifestation of seborrheic dermatitis.

The shape and size of the head are very personal and can be a manifestation of both constitutional raisins and a consequence of generic deformities (depressions, protrusions). Various hereditary and infectious diseases in the neonatal period (rubella, measles, mumps, influenza, cytomegalovirus infection, toxoplasmosis, etc.), and endocrine pathology can lead to transformations of the shape of the head or to the transformation of its size.

Variants of the usual head shape in a newborn are:

Bracheocephalic (head with a relatively weak development of longitudinal diameter and a relatively huge diameter);

Tower (the skull is extended vertically). Rarely seen.

In addition, wedge-shaped deformation to the right or left is likely.

In a premature newborn, the shape of the skull resembles that of hydrocephalus. This is explained by the relatively earlier maturation of the brain substance. A similar huge head occurs in a healthy, full-term baby, who has large heads in the family (dominantly or recessively inherited indicator) in the absence of other stigmas of dysembryogenesis and usual indicators of neurological status. These cases are not considered pathological.

Transformations of the shape of the newborn's head can also be caused by its injuries during childbirth, which are clinically manifested in the form of:

Transformations brought about by a vacuum extractor or by forceps.

Birth swelling is a congestive edema that appears on the presenting part of the fetus during childbirth (occiput, crown, face, etc.). It is localized, in most cases, over two or moreover three bones and is characterized by the absence of clear boundaries and doughy consistency. Its color is possibly cyanotic, turning into ordinary fabric. In the area of \u200b\u200bthe generic tumor, there are hemorrhages in the skin and subcutaneous tissue at almost any time. This is especially noticeable when the edema is localized in the forehead and face. It dissolves on its own by 1-2 weeks of life.

Cephalohematoma is a subperiosteal hemorrhage that appears as a result of a ruptured blood vessel during childbirth, as a result of birth trauma (forceps, vacuum extractor, bone formations of the mother's small pelvis). It is quite often localized in the parietal or occipital region and is limited to only one bone, without going beyond the borders of the suture. It has a lightly dense and fluctuating consistency. From the 7-10th day, the cephalohematoma begins to slowly decrease. It dissolves very slowly and completely disappears in most cases at the end of the first month of life.

Transformations reduced to a vacuum extractor. resemble a generic tumor in combination with a hematoma under the aponeurosis.

Transformations caused by the application of forceps. appear as an impression in the temporal or parietal regions (the phenomenon of a ping-pong ball).

Acrocephaly ("tower skull", large conical skull, pair flattened anteroposteriorly). Appears as a result of premature suture overgrowth. It is seen with syndromes: Cruson, Aper, Vanderburg;

The size of the head expresses its circumference. It is measured with a centimeter tape, which must pass through the most protruding supraorbital and occipital points. The head circumference should be measured at the first and subsequent patronages, and its indicators should be compared with the initial ones (the usual head circumference at birth ranges from 34 to 36 cm). Head circumference at birth below 34 cm in a premature baby or with a configuration of the head during childbirth (restored in most cases after 2-3 weeks) is not considered a pathology.

Macrocephaly - head circumference more than 36 cm (megacephaly, huge head). Such a head is not uncommon in hydrocephalus as a manifestation of an independent disease. In addition, hydrocephalus is possibly one of the manifestations of some syndromes: Holter-Müller-Wiedemann, Beckwith, Alexander, Canavan, Pile, Paget, etc .;

Microcephaly - head circumference less than 34 cm (small head). With microcephaly, excess skin on the head and an increased density of its bones are noted. It is seen with: alcoholic embryopathy, toxoplasmosis, Greg and Bloch-Sulzberger syndromes, Patau, Wolf-Hirschhorn, Edwars, etc.

By the end of the first month of life, the head circumference increases by an average of 1.5-2 cm. A delay in the rate of head growth is possibly a constitutional indicator, which is indirectly evidenced by the small size of the head in one or both of their parents, or a symptom of a delay in brain development. The accelerated growth of the head circumference during the neonatal period, if this is not a constitutional feature, speaks of hydrocephalus.

The skull of a newborn is represented by a solid number of bones (Fig. 2), the density of which, the size of fontanelles and cranial sutures are determined and assessed by palpation.

1 - scales of the occipital bone; 2 - a small fontanelle;

The bones of the skull of a healthy newborn are quite dense, with the exception of the places where they join - future sutures. A decrease in the density of the bones of the head indicates either prematurity or a violation of intrauterine ossification. The latter is possible in the form of lacunar osteoporosis (soft skull) or osteogenesis imperfecta, at a time when there is no ossification of all the bones of the skull (membranous skull). Ossification of the parietal and occipital bones is more often delayed. In contrast to a simple delay in ossification and lacunar osteoporosis, at a time when the affected bones feel uniformly soft to the touch and seem to spring easily when pressed, with the so-called lacunar skull, the bones are palpably felt like honeycombs, because with this form of lesion the areas softening is divided by narrow bony septa. The prognosis for isolated lacunar osteoporosis is favorable. At the age of 2-3 months, the foci of osteoporosis disappear. But the lacunar skull is quite often combined with other malformations of the skeleton and internal organs, with hydrocephalus.

At the time, when they talk about the seams of the bones of the roof of the skull of a newborn, they mean the connective tissue layers at the junction of the bones, at the sites of future sutures - metopic, frontal, coronal, sagittal and lambdoid. The metopic suture between the frontal bones at birth is partially already formed, so that only that part of it is palpable, which is adjacent to the huge fontanelle (anterior, frontal), located at the junction of the metopic suture with the sagittal and coronary. The rest of the sutures are palpable throughout. At the junction of the sagittal and lambdoid sutures, there is a small fontanelle (posterior, occipital). In the places of convergence of the frontal bones with the parietal and temporal, there are two anterior lateral fontanelles (antero-lateral), and between the parietal, temporal and occipital - two posterior lateral (mastoid). The bones of the skull adjacent to the sutures are less dense.

Lateral fontanelles (antero-lateral and mastoid) have an irregular shape. They can be closed already before birth or closed during the neonatal period. The small posterior fontanelle (occipital) is possibly open. Its shape is triangular. The large fontanelle is diamond-shaped. Its dimensions more correctly characterize the oblique diameters, which are measured between the edges of the frontal and parietal bones, which protrude most into the fontanelle and denote the border of the latter (Fig. 2). Separately go to measure the size of the fontanelle between the right frontal and left parietal bones and the left frontal and right parietal. This parameter in a newborn should not be more than 2.5 × 3.0 cm, i.e. the width of one or two fingers.

An increase in fontanelles and the distance between the bones of the skull roof is possible as a result of:

Any increase in the size of the head by 1-2 cm and a huge fontanelle over 3.0 cm when compared with the norm with an open sagittal suture more than 0.5 cm in combination with the usual bracheocephalic head shape with enlarged frontal tubercles or dolichocephalic shape with the occiput hanging behind is characteristic an indicator of hypertensive-hydrocephalic syndrome.

Complete closure of the lateral and small fontanelles for birth, combined with the small size of the huge, and sometimes flattening of the edges of the bones up to the complete overgrowth of the sutures, is an indicator of congenital microcephaly or craniostenosis. More often it is not uncommon for one suture to become infected.

In the first month of life, the rate of transformation of the sizes of sutures and fontanelles is of practical importance. A rapid, steadily progressive increase in fontanelles and suture divergence is an indicator of an increase in intracranial pressure. Accelerated closure of fontanelles and sutures is noted with damage to the central nervous system.

When palpating a huge fontanel, not only its size is determined, but also the degree of tension of the connective tissue membrane covering it. Along with this, the child should be in a relaxed state, not screaming or straining. Its position should be vertical. In most cases, both visually and palpably, the fontanelle is flat and sinks easily when compared with the surrounding surface of the skull. The fingers (index and ring) determine the degree of resistance in response to light pressure and the degree of bulging of the connective tissue membrane. Bulging of a huge fontanelle or its increased resistance to pressure indicates an increase in intracranial pressure.

The retraction of the huge fontanelle and the excessive compliance of the membrane in most cases indicates dehydration of the body (exsicosis).

Through palpation of the fontanel, it is also possible to take information about the nature of blood circulation. In case of circulatory failure, accompanied by an increase in venous pressure, the fontanelle is tense, its pulsation is increased.

By means of percussion, it is possible to recognize hydrocephalus or subdural hematoma.

In a healthy child, the percussion sound is evenly dull over the entire surface of the head. A change in percussion sound like the sound of a "cracked pot" is one of the signs of hydrocephalus. Along with this, the sound is possibly changed on one side or locally, which may indicate a subdural hematoma.

The combined asymmetry of the bones of the skull and face is a reflection of intrauterine disorders, much more often than the embryonic period.

Three in the morning. The spouse and wife are napping. Suddenly the doorbell rings. The husband, swearing, goes to open it. There is a man on the doorstep, of course screwed up:

Buddy, come with me, next to me, help me push me.

Are you fucking crazy, man? Three in the morning. Go ask someone else.

The husband goes to bed again. The spouse asks who came.

Yes, some goat got stuck, asked to push it. I sent it.

You are just some kind of beast. don't you forget how our engine stalled, but in the rain, and some young man pushed us for an hour? Can't you help a person out?

The husband, swearing again, gets out of bed, dresses up. Out into the yard in complete darkness. Shouts:

Here I am! Go here!

Well, here on the swing!

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Children's fontanelle: the size of the fontanelles in children, the timing of when the fontanelle overgrows

Parents of a newborn, as a rule, know that the baby has a fontanelle on the head or, as it is often called, a soft crown. Many of them are convinced that the fontanelle in babies is a weak and vulnerable spot that should not be touched once again. Is it really so? Does newborns have one fontanelle? What is it for? Let's figure it out.

Table of contents: Features of the structure of the skull of the fetus and the newborn Functions and sizes of fontanelles When the fontanelle overgrows The fontanelle is a signal beacon How the fontanelle helps diagnostics

FEATURES OF THE STRUCTURE OF THE SKULL OF THE FETAL AND THE NEWBORN

The fontanelles of a newborn, and there are several of them, can be safely called "adaptations" given by nature to facilitate the process of giving birth to a baby. During the passage of the fetus through the birth canal of the mother, its head can be deformed (in the good sense of the word) and take the form corresponding to the birth canal. This makes childbirth easier for both the baby and the mother.

Such anatomical "understanding" is possible due to the structural features of the fetal skull. It consists of the same bones as the skull of an adult. But the bones of the baby's cranial vault are highly elastic and are interconnected by a kind of shock absorbers - non-ossified connective tissue areas.

These are the seams and fontanelles:

• frontal or metopic suture - between the frontal bones;
• coronal or coronary suture - between the parietal and frontal bones;
• sagittal or sagittal suture - between the parietal bones;
• occipital or lambdoid suture - between the occipital and parietal bones;
• left and right scaly sutures - between the parietal and temporal bones;

• anterior or large fontanel - a rhomboid membranous plate, from the corners of which the frontal and sagittal sutures, the left and right parts of the coronal suture depart;
• posterior or small fontanel in children - a triangular depression at the intersection of the occipital and sagittal sutures;
• left and right wedge-shaped fontanelles - at the junction of the coronal and scaly sutures;
• left and right mastoid fontanelles - at the junction of the lambdoid and scaly sutures.

In a healthy full-term newborn, of all the listed membranous structures, the skulls remain open and only the large fontanelle (anterior) and, in rare cases, the posterior small fontanelle are determined. And all the seams and other fontanelles are closed. In premature newborns, some of the seams between the bones of the skull and the lateral fontanelles may remain partially open.

The connective tissue membrane that forms the fontanelle in children is similar in density to a tarp. Therefore, it is extremely difficult to violate its integrity. Calmly bathe your baby, if necessary, use a comb, play with your baby, give him a massage and do not be afraid to damage the fontanel.

FUNCTIONS AND SPRING DIMENSIONS

The anterior fontanelle of the child is shaped like a rhombus. The doctor measures the size of the fontanel not along the diagonals of the rhombus, but along the lines connecting the midpoints of its opposite sides.

The size of the large fontanelle in babies born on time varies from 2x2 cm to 3x3 cm. In premature babies, not only the fontanelle is larger, but also the areas of the skull sutures adjacent to it remain open.

Normally, the anterior fontanelle of the child is at the same level with the surrounding frontal and parietal bones or sinks quite a bit. Looking closely, you can see how the fontanel pulsates. With strong crying and anxiety, the baby may swell a little.

In the first year of a child's life, the brain quickly increases in size. Due to the elasticity and pliability of the fontanelle, the cranium does not interfere with brain growth.

In addition, the fontanelle in the baby performs the function of thermoregulation. When the child's body temperature rises through the large fontanelle, excess heat is returned by the membranes of the brain, that is, they are cooled naturally. Therefore, never swaddle a feverish baby with his head and do not wrap his head in hats and scarves.

In a full-term baby, the size of the fontanel, located at the back, provided that it is not completely closed, is so small that the tip of a finger can hardly fit into the triangular depression.

WHEN THE SPRING GROWS

In a healthy baby born at term, only the anterior large fontanelle remains unclosed. But as the bones of the skull grow, its size gradually decreases, and it closes.

For the age at which the anterior fontanelle closes completely, the norms are not strictly defined. In most newborns, this occurs by 12 and sometimes by 18 months. But even if the fontanelle is overgrown, and the child is not one year old, you should not worry. In a healthy baby, this may be a variant of the norm, which the pediatrician will certainly tell you about.

The posterior fontanelle is usually not even detected at the time of delivery. If you managed to find it, do not worry. It usually happens like this: by the time the anterior fontanelle overgrows, not a trace remains of the posterior one. It closes by 1.5-2 months.

SPRING - SIGNAL BEACON

As a parent of a newborn baby, you should monitor the condition of the fontanelle and tell your local pediatrician about any changes. If you notice that your baby's fontanel is strongly pulsating, or it seems to you that he has a very small fontanel (you, for example, know the norms of its size), do not be silent, but share your observations with the doctor.

For neonatologists and pediatricians, the fontanelle in the baby is a kind of signal beacon. He is the first to react to any trouble in the head of a newborn. By too early or very late overgrowth of the fontanel, the pediatrician may suspect a serious illness.

If at birth the anterior fontanelle is very small or completely absent in an infant, first of all, doctors exclude microcephaly and craniostenosis. In the first case, the child has all parts of the body of normal size, and the head (cerebral skull and brain) is significantly behind in development. Microcephaly is often a manifestation of severe chromosomal diseases such as Patau syndrome, Edwards syndrome, etc.

With craniostenosis, the seams between the bones of the skull overgrow early and the fontanelles close. Because of this, the head is deformed, the brain cannot grow normally, intracranial pressure rises with all the symptoms that follow from this.

The pressure inside the skull can be so high that the fused bones begin to separate again.

If a woman, while pregnant, ate a lot of foods containing calcium (cheese, milk, cottage cheese, etc.) and was fond of multivitamins, her child's fontanelle may close early. A lack of calcium in the body can cause late overgrowth of the fontanelle.

If a full-term baby has a very large anterior fontanelle and an open posterior fontanelle, it is examined for hydrocephalus (dropsy of the brain) and congenital hypothyroidism (thyroid insufficiency). Doctors exclude or confirm intrauterine hypoxia, birth trauma and intrauterine infections, in which the size of the fontanelle may also be above average.

The fontanelle in children reacts to an increase in intracranial pressure (ICP) with tension and bulging.

ICP in infants increases with the following diseases and conditions:

• congenital diseases (hydrocephalus, etc.);
• brain infections (purulent meningitis, etc.);
• volumetric formations in the cranial cavity (hematomas, tumors, etc.);
• perinatal encephalopathy;
• thrombosis of the sinuses and veins of the brain in severe infections, blood diseases, etc.

Important: if a bulging fontanelle appears immediately after the child receives an injury (head and not only), immediately contact a medical facility or call ambulance on house.

Be sure to pay attention not only to the bulging, but also to the sunken fontanel, which serves as an indicator of the degree of dehydration of the body. With intestinal infections due to vomiting and diarrhea, with neuroinfections due to repeated vomiting, dehydration develops very quickly. A child in such a situation requires urgent medical attention.

Please note: with meningitis, the fontanelle first swells due to an increase in ICP, and then, due to the loss of fluid by the baby's body, it sinks.

If a pediatrician or neurologist directs your baby to measure intracranial pressure, do not refuse this study. The procedure is absolutely safe and painless, but its results are quite informative. They will help the doctor make the correct diagnosis and prescribe treatment for the baby in a timely manner, if necessary.

HOW THE SPRING HELPS DIAGNOSTICS

The fontanelle in babies is a kind of "window" through which you can "look" into the baby's skull and brain.

Therefore, infants with access through the fontanelle perform some diagnostic and therapeutic manipulations, such as:

• subdural puncture under local anesthesia;
• puncture of the ventricles of the brain to measure the pressure of the cerebrospinal fluid, study its composition and subsequent ventriculography;
• non-functional measurement of ICP using special tonometers;
• two-dimensional echoencephalography and sonography - ultrasound studies;

• radioisotope scintigraphy.

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Newborn head examination

The local pediatrician should be able to examine the head of a newborn and as an orthopedist. Orthopedic examination of a newborn begins with examination and examination of the head, the ability to hold it, then examination of the face (its symmetry is noted) and neck. Particular attention is paid to the condition of the sternocleidomastoid muscle (whether there are seals, shortening of one of their legs).

When examining the head of a newborn, you need to pay attention to:

Position in relation to the body;

Dimensions;

The proportions of the brain and facial skull;

The size of the fontanelles;

The condition of the cranial sutures;

Density of bones.

Examination of the head should be combined with its palpation, and where necessary, percussion should be performed. If there are features, they should be noted.

The position of the head of a healthy newborn is due to presentation during labor and the presence of physiological hypertonicity of the flexors (the head is slightly brought to the chest).

Traumatic injuries in childbirth of the sternoclavicular muscle or the lower cervical and upper thoracic segments of the spinal cord lead to a deviation of the head to the right or left. In all cases, consultation with an orthopedist and a neurologist is required.

In a newborn child, the cerebral skull prevails over the facial one. The frontal and parietal tubercles are distinctly prominent. Quite often, in the back of the head at the border of the scalp, there are red spots with vague boundaries that do not rise above the surface of the skin. Their borders have irregular outlines. Under the pressure of the finger, the redness disappears, but then reappears. Aggravated by crying. These spots (telangiectasias) are caused by local expansion of the rudimentary remnants of embryonic vessels. They disappear on their own within 1-1.5 years and are only a cosmetic defect that does not require treatment. They should not be confused with true vascular nevi, which are darker, richer in color and do not disappear with pressure. They do not go away after 1.5 years of life, but, on the contrary, sometimes increase in size.

On the scalp, there may be silvery-shiny or dull gray scales (gneiss) - a manifestation of seborrheic dermatitis.

The shape and size of the head are very individual and can be a manifestation of both constitutional features and a consequence of generic deformities (depression, protrusion). Various hereditary and infectious diseases in the neonatal period (rubella, measles, mumps, influenza, cytomegalovirus infection, toxoplasmosis, etc.), as well as endocrine pathology can lead to changes in the shape of the head or to a change in its size.

Variants of a normal head shape in a newborn are:

Bracheocephalic (head with relatively weak development of longitudinal diameter and relatively large diameter);

Dolichocephalic (the skull is extended in the anteroposterior direction);

Tower (the skull is extended vertically). It is rare.

A wedge-shaped deformation to the right or left is also possible.

In a premature newborn, the shape of the skull resembles that of hydrocephalus. This is due to the relatively earlier maturation of the brain substance. A similar large head occurs in a healthy, full-term baby, who has large heads in the family (dominantly or recessively inherited trait) in the absence of other stigmas of dysembryogenesis and normal indicators of neurological status. These cases are not considered pathological.

Changes in the shape of the newborn's head can also be caused by its injuries during childbirth, which are clinically manifested in the form of:

Generic tumor;

Cephalohematomas;

Changes caused by a vacuum extractor or forceps.

A birth tumor is a congestive edema that occurs on the presenting part of the fetus during childbirth (occiput, crown, face, etc.). It is localized, as a rule, over two or even three bones and is characterized by the absence of clear boundaries and doughy consistency. Its color can be bluish, turning into normal tissue. In the area of \u200b\u200ba generic tumor, there are almost always hemorrhages in the skin and subcutaneous tissue. This is especially noticeable when the edema is localized in the forehead and face. It dissolves on its own by 1-2 weeks of life.

Cephalohematoma is a subperiosteal hemorrhage resulting from rupture of a blood vessel during childbirth, as a result of birth trauma (forceps, vacuum extractor, bone formations of the mother's small pelvis). It is often localized in the parietal or occipital region and is limited to only one bone, without going beyond the borders of the suture. It has a slightly dense and fluctuating texture. From the 7-10th day, the cephalohematoma begins to gradually decrease. It dissolves very slowly and usually disappears completely after the first month of life.

The changes caused by the vacuum extractor resemble a birth tumor in combination with a hematoma under the aponeurosis.

Changes caused by the application of forceps appear as an indentation in the temporal or parietal regions (ping-pong ball phenomenon).

Pathological forms of the head include:

Acrocephaly ("tower skull", a high conical skull, somewhat flattened in the anteroposterior direction). It occurs as a result of premature overgrowth of the seams. Occurs in syndromes: Cruson, Aper, Vanderburg;

Scaphocephaly (scaphoid elongated skull, elongated skull with a protruding ridge in place of a prematurely overgrown sagittal suture) - Aper's syndrome;

Plagiocephaly (oblique head, oblique skull). Skull asymmetry due to premature ossification of a part of the coronary suture.

The size of the head expresses its circumference. It is measured with a centimeter tape, which should pass through the most prominent supraorbital and occipital points. Head circumference should be measured during the first and subsequent patronages, and its indicators should be compared with the baseline (normal head circumference at birth ranges from 34 to 36 cm). Head circumference at birth below 34 cm in a premature baby or with a configuration of the head during childbirth (usually restored after 2-3 weeks) is not considered a pathology.

Pathological head sizes include:

Macrocephaly - a head circumference greater than 36 cm (megacephaly, large head). A similar head occurs with hydrocephalus as a manifestation of an independent disease. In addition, hydrocephalus can be one of the manifestations of some syndromes: Holter-Muller-Wiedemann, Beckwith, Alexander, Canavan, Pile, Paget, etc .;

Microcephaly - head circumference less than 34 cm (small head). With microcephaly, there is an excess of skin on the head and an increased density of its bones. It occurs with: alcoholic embryopathy, toxoplasmosis, Greg and Bloch-Sulzberger syndromes, Patau, Wolf-Hirschhorn, Edwars, etc.

By the end of the first month of life, the head circumference increases by an average of 1.5-2 cm. A delay in the rate of head growth may be a constitutional sign, which is indirectly evidenced by the small size of the head in one or both parents, or a symptom of delayed brain development. The accelerated growth of the head circumference during the neonatal period, if this is not a constitutional feature, indicates hydrocephalus.

The skull of a newborn is represented by a large number of bones (Fig. 2), the density of which, the size of fontanelles and cranial sutures are determined and assessed by palpation.

Figure 2. Bones of the skull and fontanelles in a newborn

1 - scales of the occipital bone; 2 - small fontanelle;

3 - parietal bone; 4 - a large fontanelle; 5 - frontal bone.

The bones of the skull of a healthy newborn are quite dense, with the exception of their joints - future sutures. A decrease in the density of the bones of the head indicates either prematurity or a violation of intrauterine ossification. The latter can be in the form of lacunar osteoporosis (soft skull) or osteogenesis imperfecta, when there is no ossification of all the bones of the skull (membranous skull). Ossification of the parietal and occipital bones is more often delayed. Unlike the usual delay in ossification and lacunar osteoporosis, when the affected bones feel uniformly soft to the touch and seem to be slightly springy when pressed, with the so-called lacunar skull, the bones are palpably felt like honeycombs, since with this form of lesion, the softened areas are separated by thin bone septa. The prognosis for isolated lacunar osteoporosis is favorable. At the age of 2-3 months, the foci of osteoporosis disappear. However, the lacunar skull is often combined with other malformations of the skeleton and internal organs, with hydrocephalus.

When they talk about the seams of the bones of the roof of the skull of a newborn, they mean the connective tissue layers at the junction of the bones, at the sites of future sutures - metopic, frontal, coronal, sagittal and lambdoid. The metopic suture between the frontal bones at birth is partially already formed, so that only that part of it is palpable, which is adjacent to the large fontanelle (anterior, frontal), located at the junction of the metopic suture with the sagittal and coronary sutures. The rest of the sutures are palpable throughout. At the junction of the sagittal and lambdoid sutures, there is a small fontanelle (posterior, occipital). In the places of convergence of the frontal bones with the parietal and temporal, there are two anterior lateral fontanelles (antero-lateral), and between the parietal, temporal and occipital - two posterior lateral (mastoid). The bones of the skull adjacent to the sutures are less dense.

Lateral fontanelles (antero-lateral and mastoid) have an irregular shape. They may be closed at birth or close during the neonatal period. The small posterior fontanelle (occipital) may be open. Its shape is triangular. The large fontanelle is diamond-shaped. Its dimensions more accurately characterize the oblique diameters, which are measured between the edges of the frontal and parietal bones, which protrude most into the fontanelle and mark the border of the latter (Fig. 2). Separately, the size of the fontanel should be measured between the right frontal and left parietal bones and the left frontal and right parietal. This parameter in a newborn should not exceed 2.5x3.0 cm, i.e. the width of one or two fingers.

An increase in fontanelles and the distance between the bones of the roof of the skull can be a consequence of:

Prematurity;

Ossification disorders;

Congenital hydrocephalus.

Any increase in head size by 1-2 cm and a large fontanel over 3.0 cm compared to the norm with an open sagittal suture more than 0.5 cm in combination with a typical bracheocephalic head shape with enlarged frontal tubercles or a dolichocephalic shape with an overhanging occiput behind is characteristic feature hypertensive-hydrocephalic syndrome.

Complete closure of the lateral and small fontanelles for birth in combination with the small size of the large, and sometimes flattening of the edges of the bones up to complete overgrowth of the sutures is a sign of congenital microcephaly or craniostenosis. More often, one suture is infected.

In the first month of life, the rate of change in the size of the sutures and fontanelles is of practical importance. A rapid, steadily progressive increase in fontanelles and suture divergence is a sign of increased intracranial pressure. Accelerated closure of fontanelles and sutures is observed with damage to the central nervous system.

On palpation of the large fontanel, not only its size is determined, but also the degree of tension of the connective tissue membrane covering it. In this case, the child should be in a relaxed state, not screaming or straining. Its position should be vertical. Usually, both visually and palpably, the fontanelle is flat and slightly sinks in comparison with the surrounding surface of the skull. The fingers (index and ring) determine the degree of resistance in response to light pressure and the degree of bulging of the connective tissue membrane. Bulging of the large fontanelle or its increased resistance to pressure indicates an increase in intracranial pressure.

The retraction of the fontanelle and excessive compliance of the membrane usually indicates dehydration of the body (exsicosis).

With the help of palpation of the fontanel, you can also obtain information about the nature of the blood circulation. With circulatory failure, accompanied by an increase in venous pressure, the fontanelle is tense, its pulsation is increased.

Percussion can detect hydrocephalus or subdural hematoma.

In a healthy child, the percussion sound is evenly dull over the entire surface of the head. A change in percussion sound like the sound of a "cracked pot" is one of the symptoms of hydrocephalus. In this case, the sound can be changed on one side or locally, which may indicate a subdural hematoma.

The combined asymmetry of the bones of the skull and face is a reflection of intrauterine disorders, most often of the embryonic period.

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Newborn's head. Fontanelles of a child

The head of a newborn differs from an adult not only in size, but also in the presence of fontanelles. A detailed study of the size of the newborn's head is important for obstetrics, since in most cases the presentation of the fetus is cephalic and the most difficult is the birth of the head.

Nature has created the female pelvis in such a way that when the cervix is \u200b\u200bopened, the baby can move forward. For this, nature has endowed the fetal head with a number of such features so that it can shrink, deform during childbirth. The secret lies in the slit seams and fontanelles between the bones of the skull. The fetal skull bones are easy to bend and, if necessary, overlap.

The head of a newborn, or rather the skull, consists of two frontal, two parietal, two temporal and one occipital bones. There are so-called seams between them. The sagittal suture is located between the parietal bones. The frontal suture is located between the frontal bones. The coronal suture connects the frontal bones with the parietal bones. The lambdoid or occipital suture connects the occipital bone to the parietal.

The fontanelles are located at the intersection of these joints - the part of the head that is not protected by bone. The large fontanelle connects the frontal, coronal and sagittal sutures. The small fontanelle connects the sagittal and occipital sutures.

Cyst of the brain of the choroid plexus in a newborn

From the moment a child is born to the end of life, the skull undergoes great changes. These rearrangements are associated with those features of the reaction of connective tissue, in particular bones, which are observed in different age periods of a person's life. We are primarily interested not in changing the internal structure of the bones of the skull, but in transforming it external form, although it comes under the influence of the restructuring of bone architecture.

Changes in the skull can be conditionally divided into five age periods.

The first period covers the age from birth to 7 years. It is characterized by active growth of the skull. In the first 6 months after birth, the volume of the cerebral skull doubles, the cranial fossa deepens. In this regard, the occipital region protrudes. The nasal cavity also increases in height up to 22 mm due to the growth of the upper jaw. In the first year of life, the cartilage in the occipital bone and the membranous tissue of the cranial vault disappear. The formation of seams is planned.

From 1 year to 2 years, the volume of the cerebral skull triples, and up to 5 years it reaches 3/4 of the volume of the skull of an adult. There is a uniform growth of the brain and facial skull, the head becomes wider. The base of the skull reaches the size of an adult. The diameter of the foramen magnum is finally formed. Due to the growth of teeth and alveolar processes, the height of the upper and lower jaws increases, which is reflected in the shape of the face, oral and nasal cavities. An important point is the formation of sutures, which not only hold the individual bones of the skull together, but also serve as a place for their growth in width.

According to the shape, the seams of the skull are subdivided into: 1) a serrated seam (sutura serrata): on one bone there are depressions, and on the side of the second bone there are protrusions filling these depressions; this seam is the most durable; 2) scaly suture (sutura squamosa): the edges of two bones overlap each other; 3) flat seam (sutura plana): the contacting surfaces of the bone are even or slightly wavy. All seams are filled with fibrous connective tissue.

The following sutures are distinguished by their location in the skull.

The sagittal suture (sutura sagittalis) in a child is longer than in adults, since it starts from the frontal-nasal suture and reaches the upper corner of the occipital scales. The anterior part of the suture that connects the halves of the frontal bone is called the metopic suture (sutura metopica) and closes by age 5, while the posterior sagittal suture remains. Metopic suture occurs in adults in 8% of cases (Fig. 84).

The coronal suture (sutura coronalis) runs from right to left in the frontal plane at the junction of the frontal and parietal bones.

The lambdoid suture (sutura lambdoidea) is located in the frontal plane at the junction of the occipital scales and parietal bones.

Early closure of these three sutures results in a tapered head.

The scaly suture (sutura squamosa) is formed when the scales of the temporal and parietal bones join, when the edge of one bone is superimposed on the other.

The connection of the bones of the facial skull with each other and with the cerebral skull (except for the connection of the lower jaw with the temporal bone) occurs due to the flat seam, where the edges of the contacting bones are even or slightly wavy. The names of the sutures that have a flat shape are made up of the names of the bones that form them, for example: the frontal-maxillary suture (sutura frontomaxillaris), the temporomandibular suture (sutura temporozygomatica), etc. The connection of the palatine processes of the upper jaw is called sutura palatina mediana, and the connection of the horizontal plates of the palatine bones with the palatine processes of the bones of the upper jaw - sutura palatina transversa.

The second period of changes in the skull occurs from 8 to 13-14 years and is characterized by a relative slowdown in the growth of the bones of the skull, although there is a significant increase in the nasal cavity, upper jaw and orbit.

The third period lasts from the onset of puberty (14-16 years old) to 20-25 years, when the growth of the skeleton ends. At this age, the development of the skull is completed completely. The facial skull relative to the cerebral skull grows more intensively (Fig. 76), especially in men. The base of the skull increases, not only in the transverse, but also in the anteroposterior directions (Fig. 77). The airways are formed (see individual bones of the skull), tubercles, protrusions, glabella and grooves.

76. Age-related changes in facial indicators in humans (according to Welcker). Age in years is indicated by numbers.
A - the line of height (chin - the base of the nose) in a newborn is half the distance between the front surface of the zygomatic bones. The face indicator (the ratio of height to width x 100) is 62.8 in a newborn, 78.0 in a one-year-old, 89.6 in a six-year-old, and 90 in an adult.

77. Development of parts of the skull in terms of age.
1 - newborn; 2-1 years old; 3-7 years old; 4 - adult (according to Andronescu).

The fourth period (26-45 years) is the most stable, when there is no change in the size of the skull. Usually during this period, ossification of the seams occurs. In men, the posterior part of the sagittal suture is first mist-melted, in women - the coronal suture. Then the masto-occipital and lambdoid sutures are closed. The last to disappear is the scaly seam. In dolichocephalic sutures obliteration occurs earlier than in brachycephals. Rarely, the seams persist throughout life, for example, the philosopher Kant - up to 80 years.

The fifth period lasts from the moment of suture closure (45 years) to old age. It is characterized by a noticeable transformation of the facial skull associated with the loss of teeth. The absence of part or all of the teeth leads to atrophy of the bone substance of the alveolar processes of the upper and lower jaws. In this case, the shape of the face is somewhat similar to that of a newborn. Atrophy of the alveolar bone processes is reflected in the reconstruction of the hard palate, the lower and upper jaws, the glenoid fossa and the tubercle of the temporal bone, the zygomatic process and the zygomatic bone. In old people, the thickness of the compact plate and cancellous bone decreases, the skull becomes light, in many bones (lacrimal, ethmoid, large wings of the sphenoid bone, the tympanic part of the temporal bones) additional cavities are revealed due to resorption of bone matter. On the contrary, the scales of the frontal bone against the background of atrophy of other bones of the skull are often preserved and are thicker. In terms of chemical composition, the bone tissue in the elderly is significantly different in comparison with the young. With significant resorption of organic substances, restructuring of the architectonics and an increase in the content of mineral salts in the bones, they acquire greater fragility, break and crack with less effort than the bones of a young man.

Wide cranial sutures in a newborn can be a symptom of diseases caused both by anomalies in the development of the skull and brain, and by an increase in intracranial pressure as a result of brain tumors, infections, etc.

At birth, the baby's skull is in a state of incomplete ossification. The bones of the skull are fastened together by a dense fibrous membrane, which, when the child passes through the birth canal, allows them to go behind each other. Reducing the head circumference in this way allows the baby's head to pass through the birth canal faster and minimizes the traumatic effect of squeezing the skull by the soft tissues of the vagina. An extreme decrease in the head circumference of a child during passage through the birth canal, which occurs with imbalance, can lead to serious intracranial disorders in the form of a rupture of the cerebellar sign or subdural hemorrhage.

The skull plates of a newborn can overlap and form a ridge. In such cases, the ridge usually goes away after a few days, allowing the skull to return to its normal shape.

With age, the bones of the skull grow together, becoming immobile.

Distinguish between sagittal, coronal and lambdoid dentate cranial sutures. A newborn is characterized by the presence of fontanelles on the skull - the places of convergence of three or more bones of the skull (respectively, these are the places where the cranial sutures begin and end).

The small (occipital) fontanelle in full-term newborns is usually closed. The large (frontal) fontanelle closes by one year of life. These fontanelles can be palpated. The fontanelles present on the lateral surfaces of the skull at the point of convergence of the parietal, temporal and occipital bones (posterior) and the frontal, temporal, parietal and sphenoid bones (anterior) in a healthy newborn are not palpable.

Wide cranial sutures in a newborn cannot be interpreted in isolation from the symptoms and data of additional research methods.

Causes

There are many reasons for the divergence of the cranial sutures in a newborn. One of the most common factors causing this symptom is intracranial hypertension syndrome. It occurs in conditions such as:

• Meningitis and other brain infections.
• Hydrocephalus.
• Volumetric formations of the skull.
• Endocrine pathologies (thyroid disease, Addison's disease).
• Metabolic disorders (diabetes, hepatic encephalopathy, uremia, etc.).
• Brain damage caused by other causes.
• Intoxication.

The accumulation of an excess amount of cerebrospinal fluid in the lateral ventricles of the brain leads to an increase in pressure, first on the brain substance, and then on the skull bone. The bones of the skull of the newborn diverge, the cranial sutures become wider. In newborns with severe and prolonged intracranial hypertension, the skull is usually severely deformed.

Wide cranial sutures can occur with abnormalities in the development of the skull or congenital deformities of the skull due to genetic disorders or dysembryogenesis.

Certain vitamin and mineral deficiencies can cause seams to separate. Your baby may be malnourished and not getting the proper nutrients to maintain healthy connective tissues and bones. Dehydration (lack of fluid) can also cause sunken fontanelles that resemble a split suture.

Trauma, such as non-accidental child abuse, can cause seam separation as well as a bulging soft patch. A blow to the head can cause internal bleeding in the brain or an accumulation of blood on the surface of the brain known as a subdural hematoma. Infant head injury is emergency and requires immediate medical attention.

Symptoms

The clinic is determined by the underlying disease. In the syndrome of intracranial hypertension, a monotonous, piercing, so-called cerebral cry is characteristic. The newborn is restless, does not sleep well, and does not eat well.

The fontanelles are tense, the large fontanelle has bone density by palpation, in a calm state the seal does not disappear. With a pronounced divergence of the cranial sutures, the small and lateral fontanelles can be palpated. The veins of the skull are swollen, pulsating, the venous network is expressed. There is a symptom of the setting sun - when looking down, a white stripe of the sclera is visible.

In infectious conditions, there is an increase in temperature, vomiting, increased heart rate, convulsions.

With a gradual increase in intracranial pressure (with hydrocephalus, brain tumors), the cranial sutures diverge slowly, the symptoms also increase over time. A sharp increase in intracranial pressure gives more pronounced severe symptoms. As a rule, with intracranial hypertension against the background of hydrocephalus, the width of the sagittal and coronal sutures of the skull increases after 2 weeks.

If the divergence of the skull is caused by abnormalities in the development of the bones of the skull and brain, a variety of neurological symptoms occur. Abnormalities of craniogenesis, as a rule, are accompanied by multiple malformations of other organs.

Important! The divergence of the cranial sutures noticeable to the naked eye against the background of the hypertensive-hydrocephalic syndrome appears after a while. In the vast majority of cases, the symptoms of the underlying disease are primary.

Diagnostics

The sizes of fontanelles in newborns, as a rule, vary. Diagnosis of the condition involves comprehensive assessment examination data, anamnesis, additional research methods and usually does not present difficulties.

When questioning the mother, attention is paid to the obstetric history. What matters is the ordinal number of pregnancy, its course, especially delivery. Heredity is being investigated in detail (some diseases accompanied by defects of craniogenesis are hereditary, family in nature), the presence of bad habits in the mother.

On examination, attention is drawn to the increase in the child's head circumference, the asymmetry of the cerebral and facial sections of the skulls. The small and lateral fontanelles can be palpated. With advanced hydrocephalus, the head of a newborn can be increased several times. The fibrous membrane between the bones of the skull is stretched, the large fontanelle is dense, with percussion, a clear sound of a cracked pot is heard.

Additionally, transillumination of the skull, computed tomography of the head, craniography, echo-EG are prescribed.

If an infectious disease is suspected, a cerebrospinal fluid analysis is prescribed.

Complications

Complications with wide cranial sutures are associated primarily with the underlying disease.

Complications associated with compression of the brain (fluid or tumor) are common to all types of diseases accompanied by divergence of the cranial sutures. Dislocation syndromes develop, associated with the movement of parts of the brain in the cranial cavity relative to each other. Compression of the medulla oblongata leads to cessation of breathing and heartbeat, and death. Prolonged compression of parts of the brain leads to infarction of the compressed area and its atrophy. This process is irreversible.

With an increase in cerebrospinal fluid pressure over 30 mm Hg. brain death occurs.

The main complications associated with uncorrected craniosynostosis (a condition in which one or more fibrous sutures in the skull fuse prematurely to become bone) are increased intracranial pressure, facial asymmetry, and malocclusion. Asymmetry of the orbits leads to strabismus

Forecast

With early diagnosis and treatment of the underlying disease, the prognosis is favorable. The decrease in intracranial pressure allows the cranial sutures to return to normal over time.

Long-term intracranial hypertension, infections, tumors that compress the brain, and dislocation syndrome are unfavorable in prognostic terms. Children with atrophy of the medulla have a variety of neurological symptoms: convulsions, coma, focal symptoms - paralysis, paresis, strabismus, nystagmus. They are lagging behind in development, are difficult to learn, later than other children they begin to sit down, walk, talk.

Prevention of the condition is the refusal of the mother from bad habits, sparing management of childbirth, prevention of intrauterine hypoxia, early correction of metabolic disorders, early detection of infections of the nervous system and tumors of the cranial cavity. Hereditary diseases are not cured.

Soft spots may bulge when the baby is lying on its back or crying. The soft spot should return to its normal position as soon as your baby calms down, stands upright, or stops vomiting. Seek medical attention if soft spot continues to protrude.

There is a definite connection between the growth of the cerebral skull and the appearance of digital impressions on the inner surface of his bones, although the mechanism of their occurrence is still not fully understood. They are first detected at the age of 1.5-2 years in the region of the parietal bones, then in the occipital zone and only by 7-8 years in the frontal. Digital impressions reach their maximum severity in puberty, they do not change until 35-40 years old, and after 40 years they gradually smooth out. After 15 years, the severity of these anatomical formations in various parts of the cerebral skull is as follows: occipital, temporal, parietal, frontal; respectively as 10: 7: 7.

Some observations testify that digital impressions are more pronounced in children with delayed mental development, and their absence is an important symptom of impaired osteogenesis processes and is usually accompanied by cortical atrophy. In persons over 50, digital impressions persist only in 2-2.5% of cases, which reflects a decrease in the level of bone transformation processes.

Large fontanelles close during the first 1.5-2 years of postnatal period... Their longer existence may be a sign of such a common childhood disease as rickets, and in more serious cases, an increase in intracranial pressure.

Sutures of the cerebral skull They gradually narrow - in a newborn, their diameter is 10-11 mm, and in a child of 7 years old - about 2 mm. However, bone-forming activity at the edges of the seams continues for a very long time - up to 25-30 years on average, gradually decreasing in intensity after 20 years. Therefore, although by the end of the second year of a child's life, his cerebral skull is formed in principle the same way as the skull of an adult, the growth of the skull continues.

Complete closure of the gap cranial sutures marks the end of the physiological growth phase of the skull bones. On the inner surface of the skull, the sutures are closed earlier than on the outer, sometimes with a difference of 7 to S years. In this case, calcification of the edges of the seam is not an indicator of its obliteration. Submitted by G. Friedman, R. Shapiro and A. Janzen, the closure of the suture occurs in several of its sites and does not always correspond to age. It is only known that in men the sutures are obliterated earlier and more evenly.

Closing the sutures of the cerebral skull, according to R. Shapiro and A. Janzen, occurs at the following age: sagittal suture - at 22-26 years old, coronary - at 29-30 years old, lambdoid - at 26-45 years old, parietomastoidal - at 30-40 years old, sphenotemporal - even by the age of 60. Individual mild fluctuations in the level of bone formation and the duration of the existence of the sutures create different shapes of the skull, and the premature closure of all sutures can lead to the development of pathological forms of the brachycephalic type of skull.

Unlike the rest of the bones the facial and cerebral parts of the skull, its base is formed by bones of cartilaginous origin. Ossification of the latter begins as early as the 3rd month of the prenatal period from two growth centers in the basisphenoidal and occipital regions and later the emerging third center in the presphenoidal zone. Synchondroses are formed near the centers of ossification, which are homologues of the epiphyseal growth zones and represent the last rudiments of primordial cartilage in the human skeleton. Before the birth of a child, the indicated ossification zones merge and only layers of synchondrosis remain between them.

To the moment birth the main growth occurs in the basephenoidal and baseoccipital areas. During the first year of life, another growth center appears in the nasal septum - the mesoetmoidal one. With the beginning of its function, the crista galli and the upper half of the nasal septum ossify. The duration of this growth center is not exactly known. As pointed out by N. Ford, filed by various anatomists, the fusion of the specified growth center with the center located in the main bone occurs at the age of 12-25 years. The cartilaginous layers between the mesozmoidal growth center and the surrounding bones of the facial and cerebral skull (frontal, lateral ethmoid masses) begin to gradually ossify at 2-6 years of age.

Thus, a small child at the base of the skull there are four growth centers: spheno-occipital and sphenomesoetmoidal synchondrosis and cartilaginous layers between the ethmoid and frontal bones and in the frontal bone itself.