Premature closure of cranial sutures in children. Age-related transformations of the skull Extreme stenosis of the head in a child

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

At birth, the child'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 overlap 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 compression of the skull by the soft tissues of the vagina. An extreme decrease in the circumference of the child’s head as it passes through the birth canal, which occurs with disproportion, can lead to serious intracranial disorders in the form of rupture of the cerebellar tentorium or subdural hemorrhage.

The plates of a newborn's skull may overlap to 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.

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

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

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

Causes

There are many reasons for divergence of cranial sutures in a newborn. One of the most common factors causing the appearance of 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 diseases, Addison's disease).
Metabolic disorders (diabetes, hepatic encephalopathy, uremia, etc.).
Brain damage caused by other causes.
Intoxication.

The accumulation of excess cerebrospinal fluid in the lateral ventricles of the brain leads to an increase in pressure, first on the substance of the brain, and then on the bones of the skull. The bones of a newborn’s skull move apart, and the cranial sutures become wider. In newborns with severe and prolonged intracranial hypertension, the skull is usually subject to severe deformation.

Wide cranial sutures can occur with abnormal development of the skull or congenital deformations of the skull caused by genetic disorders or disembryogenesis.

Some vitamin and mineral deficiencies can cause seam separation. Your child may be malnourished and not receive the proper nutrients to maintain healthy connective tissue and bones. Dehydration (lack of fluid) can also cause sunken fontanelles, which resemble suture separation.

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

Symptoms

The clinic is determined by the underlying disease. Intracranial hypertension syndrome is characterized by a monotonous, high-pitched, so-called cerebral scream. The newborn is restless, sleeps poorly, and eats poorly.

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

In infectious conditions, fever, vomiting, increased heart rate, and convulsions are observed.

With a gradual increase in intracranial pressure (with hydrocephalus, brain tumors), the cranial sutures diverge slowly, and symptoms also increase over time. A sharp increase in intracranial pressure causes more 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. Anomalies of craniogenesis are usually accompanied by multiple malformations of other organs.

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

Diagnostics

The size of fontanelles in newborns, as a rule, varies. Diagnosis of the condition involves a comprehensive assessment of examination data, medical history, additional research methods and usually does not present any difficulties.

When questioning the mother, attention is paid to the obstetric history. The serial number of pregnancy, its course, and the characteristics of delivery are important. Heredity is clarified in detail (some diseases accompanied by defects of craniogenesis are hereditary, family in nature), and the presence of bad habits in the mother.

Upon examination, attention is drawn to the increase in the circumference of the child’s head and the asymmetry of the cerebral and facial parts of the skulls. The small and lateral fontanelles may be palpable. With advanced hydrocephalus, the newborn's head can be enlarged several times. The fibrous membrane between the bones of the skull is stretched, the large fontanel is dense, and upon percussion the clear sound of a cracked pot is heard.

Additionally, transillumination of the skull, computed tomography of the head, craniography, and 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.

Common to all types of diseases accompanied by dehiscence of cranial sutures are complications associated with compression of the brain (fluid or tumor). 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. Long-term compression of areas of the brain leads to infarction of the compressed area and its atrophy. This process is irreversible.

When the cerebrospinal fluid pressure increases above 30 mmHg. brain death occurs.

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

Forecast

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

Unfavorable prognostic factors include long-term intracranial hypertension, infections, tumors compressing the brain, and dislocation syndrome. Children with medullary atrophy experience a variety of neurological symptoms: convulsions, coma, focal symptoms - paralysis, paresis, strabismus, nystagmus. They are developmentally delayed, difficult to learn, and begin to sit up, walk, and talk later than other children.

Prevention of the condition is the mother’s refusal of bad habits, gentle 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 cannot be cured.

The soft spots may bulge when the baby lies on his back or cries. The soft spot should return to its normal position once your baby calms down, stands upright, or stops vomiting. Seek medical attention if the soft spot continues to protrude.

The decisive role in the formation and subsequent development of the skull belongs to the brain, teeth, chewing muscles and sensory organs. During the process of growth, the head undergoes significant changes. During development, they appear age, gender and individual characteristics of the skull. Let's look at some of them.

Newborns

The baby's skull has a specific structure. The spaces between the bone elements are filled with connective tissue. Newborns are completely absent sutures of the skull. Anatomy This part of the body is of particular interest. At the junction of several bones there are 6 fontanelles. They are covered with connective tissue plates. There are two unpaired (posterior and anterior) and two paired (mastoid, sphenoid) fontanelles. The largest is considered to be the frontal one. It has a diamond shape. It is located at the convergence of the left and right frontal and both parietal bones. Due to the fontanelles it is very elastic. As the fetal head passes through the birth canal, the edges of the roof overlap each other in a tiled manner. Due to this, it decreases. By the age of two, as a rule, they have formed sutures of the skull. Anatomy previously studied in a rather original way. Medieval doctors applied hot iron to the fontanel area for diseases of the eyes and brain. After the formation of a scar, doctors caused suppuration with various irritants. So they believed that they were opening the way for accumulating harmful substances. In the configuration of the stitches, doctors tried to discern symbols and letters. Doctors believed that they contained information about the fate of the patient.

Features of the structure of the skull

This part of the body in a newborn is distinguished by the small size of the facial bones. Another specific feature is the fontanelles mentioned above. In the skull of a newborn there are traces of all 3 unfinished stages of ossification. The fontanelles are remnants of the membranous period. Their presence is of practical importance. They allow the roof bones to move. The anterior fontanel is located in the midline at the junction of 4 sutures: 2 halves of the coronary, frontal and sagittal. It becomes overgrown in the second year of life. The posterior fontanel has a triangular shape. It is located between the two in front and the scales of the occipital bone in the back. It grows over in the second month. The lateral fontanels are distinguished between sphenoid and mastoid. The first is located at the convergence of the parietal, frontal, temporal scales and greater wing of the sphenoid bones. Overgrows in the second or third month. The mastoid fontanel is located between the parietal bone, the base of the pyramid in the temporal and the occipital squama.

Cartilaginous stage

At this stage, the following age-related features of the skull are noted. Cartilaginous layers are found between the individual, unfused elements of the bones of the base. The air sinuses are not yet developed. Due to muscle weakness, various muscle ridges, tubercles and lines are poorly defined. For the same reason, also associated with the lack of chewing function, the jaws are underdeveloped. Hardly ever. The lower jaw consists of two unfused halves. Because of this, the face extends little forward relative to the skull. It is only 1/8. Moreover, in an adult the ratio of face to skull is 1/4.

Bone displacement

Skulls after birth are manifested in active expansion of the cavities - nasal, cerebral, oral and nasopharynx. This leads to a displacement of the bones surrounding them in the direction of the growth vectors. The movement is accompanied by an increase in length and thickness. With marginal and superficial growth, the curvature of the bones begins to change.

Postnatal period

At this stage, they manifest themselves in uneven growth of the facial and brain regions. The linear dimensions of the latter increase by 0.5, and the former by 3 times. The volume of the brain region doubles in the first six months, and by the 2nd year it triples. From the age of 7, growth slows down and accelerates again during puberty. By the age of 16-18, the development of the arch stops. The base increases in length up to 18-20 years and ends when the spheno-occipital synchondrosis closes. The growth of the facial region is longer and more uniform. The bones around the mouth grow most actively. Age features of the skull in the process of growth, they manifest themselves in the fusion of parts of bones separated in newborns, differentiation in structure, and pneumatization. The relief of the internal and external surfaces becomes more defined. At an early age, smooth edges form on the seams; by the age of 20, jagged joints form.

Final stages

By the age of forty, obliteration of the sutures begins. It covers all or most connections. In old and senile age, osteoporosis of the cranial bones is observed. The thinning of the plates of the compact substance begins. In some cases, thickening of the bones is observed. Atrophy in the jaws becomes more pronounced in the facial region due to tooth loss. This causes an increase in the angle of the lower jaw. As a result, the chin comes forward.

Gender characteristics

There are several criteria by which a male skull differs from a female one. Such signs include the degree of severity of roughness and tubercles in the areas of muscle attachment, development of the occipital outer protuberance, protrusion of the upper jaw, etc. The male skull is more developed in comparison with the female. Its outlines are more angular due to the severity of roughness and tuberosity in the areas of attachment of the masticatory, temporal, occipital and cervical muscles. The frontal and parietal tubercles are more developed in women, while in men the glabella and brow ridges are more developed. the latter have a heavier and larger lower jaw. In the area of the lower edge and corners of the inner part of the chin, tuberosity is clearly expressed. This is caused by the attachment of the digastric, masticatory and pterygoid muscles. Depending on gender, the shape of the human skull also differs. Men have a sloping forehead, which turns into a rounded crown. An elevation is often observed in the direction of the sagittal suture. Women's foreheads are more vertical. It turns into a flat crown. Men have lower eye sockets. As a rule, they have a rectangular shape. Their upper edge is thickened. In women, the eye sockets are located higher. They are close to oval or round in shape with sharper and thinner upper edges. On the female skull, the alveolar process often protrudes forward. The nasofrontal angle in men is clearly expressed in most cases. On the female skull, the frontal bone transitions more smoothly to the nasal bones.

Additionally

The shape of a person's skull does not affect mental abilities. Based on the results of numerous studies by anthropologists, it can be concluded that there is no reason to believe that the size of the brain region predominates in any race. The Bushmen, Pygmies and some other tribes have slightly smaller heads than other people. This is due to their small stature. Often, a decrease in head size can be the result of poor nutrition over the centuries and the influence of other unfavorable factors.

Craniosynostosis is characterized by premature fusion of one or more cranial sutures, often resulting in an abnormal head shape. This may be the result of primary abnormal ossification (primary craniosynostosis) or, more commonly, a growth disorder of the brain (secondary craniosynostosis).

The disease often occurs in utero or at a very early age. It can only be treated surgically, although a positive outcome is not possible in all cases.

Classification of craniosynostosis and causes of its development

Normal ossification of the cranial vault begins in the central region of each bone of the skull and extends outward to the cranial sutures. What indicates normal?

When the coronal suture separates the two frontal bones from the parietal bones.
The metopic suture separates the frontal bones.
The sagittal suture separates the two parietal bones.
The lambdoid suture separates the occipital bone from the two parietal bones.

The main factor that inhibits untimely fusion of the skull bones is the continued growth of the brain. It is worth emphasizing that the normal growth of each cranial bone occurs perpendicular to each suture.

Simple craniosynostosis is the term used in situations where only one suture fuses prematurely.
The term complex or junctional craniosynostosis is used to describe the premature fusion of multiple sutures.
When children showing symptoms of craniosynostosis also suffer from other body deformities, it is called syndromic craniosynostosis.

Primary craniosynostosis

If one or more sutures undergo premature fusion, skull growth may be limited by the perpendicular sutures. If multiple sutures are fused while the brain is still changing in size, intracranial pressure may increase. And this often ends in a number of complex symptoms, even death.

Types of primary craniosynostosis (premature fusion)

Scaphocephaly is a sagittal suture.
Anterior plagiocephaly is the first coronal suture.
Brachycephaly is a bilateral coronal suture.
Posterior plagiocephaly is early closure of one lambdoid suture.
Trigonocephaly is premature fusion of the metopic suture.

Secondary craniosynostosis

More often than with the primary type, this type of pathology can lead to early fusion of the sutures due to primary failure of brain growth. Since the growth of the brain controls the distance of the bone plates from each other, a disorder of its growth is the main reason for the premature fusion of all sutures.

With this type of pathology, intracranial pressure is usually normal, and there is rarely a need for surgery. Typically, lack of brain growth leads to microcephaly. Premature closure of the suture, which does not pose a threat to brain growth, also does not require surgical intervention.

Intrauterine spatial restrictions may play a role in premature fusion of the fetal skull sutures. This has been demonstrated in cases of coronal craniosynostosis. Other secondary causes include systemic disorders affecting bone metabolism such as rickets and hypercalcemia.

Causes and consequences of early craniosynostosis

Several theories have been proposed for the etiology of primary craniosynostosis. But the most widespread option is the one with the etiology of a primary defect in the mesenchymal layers of the bones of the skull.

Secondary craniosynostosis usually develops along with systemic disorders

These are endocrine disorders (hyperthyroidism, hypophosphatemia, vitamin D deficiency, renal osteodystrophy, hypercalcemia and rickets).
Hematological diseases that cause bone marrow hyperplasia, for example, sickle cell disease, thalassemia.
Low rates of brain growth, including microcephaly and its underlying causes, such as hydrocephalus.

The causes of syndromic craniosynostosis are genetic mutations responsible for fibroblast growth factor receptors of the second and third classes.

Other important factors to consider when studying the etiology of the disease

Differentiating plagiocephaly, which is often the result of positional fusion (which does not require surgery and is quite common) from lambdoid suture fusion, is an extremely important aspect.
The presence of multiple adhesions is suggestive of a craniofacial syndrome, which often requires diagnostic evaluation in pediatric genetics.

Symptoms of craniosynostosis and diagnostic methods

Craniosynostosis in all cases is characterized by an irregular shape of the skull, which in a child is determined by the type of craniosynostosis.

Main features

A rigid bone ridge, easily palpable along the pathological suture.
The soft spot (fontanelle) disappears, the child's head changes shape, and sensitivity in these areas is usually altered.
The baby's head does not grow in proportion to the rest of the body.
Increased intracranial pressure.

In some cases, craniosynostosis may not be noticeable until several months after birth.

Increased intracranial pressure is a common feature of all types of craniosynostosis, with the exception of some secondary pathologies. When only one suture fuses prematurely, increased intracranial pressure occurs in less than 15% of children. However, in syndromic craniosynostosis, where multiple sutures are involved, increased pressure can be observed in 60% of cases.

If a child suffers from a mild form of craniosynostosis, the disease may not be noticed until patients begin to experience problems due to increased intracranial pressure. This usually occurs between the ages of four and eight years.

Symptoms of increased intracranial pressure

They begin with persistent headaches, usually worse in the morning and at night.
Problems with vision - double vision, blurred vision or impaired color vision.
Unexplained decline in the child's mental abilities.

If your child complains of any of the above symptoms, you should contact your pediatrician as soon as possible. In most cases, these symptoms will not be caused by increased intracranial pressure, but they should definitely be investigated.

If left untreated, other symptoms of increased intracranial pressure may include:

vomiting;
irritability;
lethargy and lack of response;
swollen eyes or difficulty seeing a moving object.
hearing impairment;
labored breathing.

Upon closer examination of the skull, it becomes clear that its shape does not always confirm the diagnosis of craniosynostosis. In such cases, a number of visual examination methods are used, for example, a skull x-ray.

X-rays are performed in several projections - anterior, posterior, lateral and superior. Prematurely fused sutures are easily identified by the absence of connected lines and the presence of bone ridges along the suture line. The sutures themselves are either not visible, or their location shows evidence of sclerosis.

A 3D cranial CT scan is usually not needed for most infants. The technique is sometimes performed when surgery is being considered as the next step in treatment or when X-ray results are equivocal.

Pathology correction methods, possible complications and consequences

Over the past 30 years, modern medicine has developed a greater understanding of the pathophysiology and treatment of craniosynostosis. Currently, surgery generally remains the main type of treatment for the correction of cranial deformities in children with fusions of 1-2 sutures, resulting in a malformed head. For children with microcephaly, which is often seen with mild craniosynostosis, surgery is usually not required.

When drawing up a therapeutic regimen, specialists must take into account a number of points.

Patients with microcephaly should have the cause of this disease has been studied.
When you first contact head circumference is measured in the longitudinal direction and further changes are monitored. The doctor should verify normal brain growth in patients with primary craniosynostosis.
Should be carried out regularly monitoring for signs and symptoms of increased intracranial pressure.
If there is a suspicion of increased intracranial pressure, then it is very appropriate neurosurgical consultation.
To preserve visual function in patients with increased intracranial pressure, it is necessary to carry out additional ophthalmological consultations.

Surgery is usually planned for elevated intracranial pressure or to correct cranial deformity. The operation is usually performed in the first year of life.

Conditions for surgery

If the shape of the head does not change for the better at the age of two months, then the anomaly is unlikely to change with age. Early intervention is indicated if children may be candidates for minimally invasive surgery. It is worth noting that the deformity is more noticeable in the thoracic period, and it may become less obvious with age.
As the child grows and develops more hair, the visible signs of the abnormality may decrease.
Indications for surgical correction of craniosynostosis depend on the age, general condition of the child and the number of prematurely fused sutures.
Surgical treatment of cranial or craniofacial deformity is performed in children aged 3–6 months, although approaches vary among surgeons.

Surgery in infants can result in relatively large losses of blood volume. Accordingly, minimally invasive surgical techniques should be considered. One promising option is the use of intraoperative tranexamic acid. Patients with indications for surgical correction of craniosynostosis were pretreated with erythropoietin and tranexamic acid, which allowed them to maintain lower amounts of blood loss.

Other features of surgery

Surgery in infants over 8 months of age may be associated with slower skull growth.
Infants diagnosed with syndromic craniosynostosis should have surgery as soon as possible.
The results of the operation are better if it is performed on infants under 6 months of age.

The local pediatrician should be able to perform a head examination in a newborn as well 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 neck. Particular attention is paid to the condition of the sternocleidomastoid muscle (is there any compaction or shortening of one of its legs).

When examining a newborn's head, you need to pay attention to:

Condition of cranial sutures;

Examination of the head should be combined with its palpation, and where necessary, percussion should be performed. If there are any features, please note them.

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

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

In a newborn baby, the cerebral skull predominates over the facial skull. The frontal and parietal tubercles clearly protrude. Quite often, in the back of the head, at the border of the scalp, there are red spots with blurry boundaries that do not rise above the surface of the skin. Their borders have irregular outlines. Under finger pressure, the redness disappears, but after that it appears again. Better by crying. These spots (telangiectasia) are caused by local expansion of the vestigial remains 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 after 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 features and a consequence of birth deformities (depression, protrusion). Various hereditary and infectious diseases in the neonatal period (rubella, measles, mumps, influenza, cytomegalovirus infection, toxoplasmosis, etc.), and endocrine pathology can lead to transformations in the shape of the head or to transformations in its size.

Variants of the usual head shape in a newborn are:

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

Tower (skull extended vertically). Rarely seen.

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

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

Transformations in the shape of a newborn’s head can also be caused by trauma during childbirth, which clinically manifests itself in the form of:

Transformations brought about by a vacuum extractor or the application of forceps.

Birth tumor is a congestive edema that appears on the presenting part of the fetal body during childbirth (occiput, crown, face, etc.). It is localized, in most cases, over two or even three bones and is characterized by the absence of clear boundaries and a pasty consistency. Its color may be bluish, turning into ordinary fabric. In the area of the birth tumor, there are hemorrhages in the skin and subcutaneous tissue at almost any time. This is especially noticeable when swelling is localized in the forehead and face. Dissolves on its own by 1-2 weeks of life.

Cephalohematoma is a subperiosteal hemorrhage that appears as a result of 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 quite often localized in the parietal or occipital region and is limited to only one bone, without going beyond the boundaries of the suture. It has a slightly dense and fluctuating consistency. From the 7-10th day, the cephalohematoma begins to slowly decrease. It resolves very slowly and disappears completely in most cases after the end of the first month of life.

Transformations brought about by a vacuum extractor. resemble a birth tumor in combination with a hematoma under the aponeurosis.

Transformations caused by the application of forceps. manifest themselves as depressions in the temporal or parietal regions (ping-pong ball phenomenon).

Acrocephaly (“tower skull”, a large conical skull, a pair flattened in the anteroposterior direction). Appears as a result of premature fusion of sutures. Seen in syndromes: Crouzon, Apert, Vanderburg;

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

Macrocephaly - head circumference greater than 36 cm (megacephaly, huge head). A similar head is not uncommon with hydrocephalus as a manifestation of an independent disease. In addition, hydrocephalus may be one of the manifestations of some syndromes: Holter-Muller-Wiedemann, Beckwith, Alexander, Canavan, Pyle, Paget, etc.;

Microcephaly - head circumference less than 34 cm (small head). With microcephaly, there is redundancy of the skin on the head and increased bone density. Seen in: alcoholic embryopathy, toxoplasmosis, Greg and Bloch-Sulzberger, Patau, Wolf-Hirschhorn, Edwards syndromes, etc.

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

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

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

The skull bones of a healthy newborn are quite dense, with the exception of their junctions - 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 simple delayed ossification and lacunar osteoporosis, while the affected bones seem uniformly soft to the touch and seem to spring back easily when pressed, with the so-called lacunar skull the bones are palpated like honeycombs, because with this form of lesion the areas softenings are divided by narrow bone partitions. The prognosis for isolated lacunar osteoporosis is favorable. At the age of 2-3 months, foci of osteoporosis disappear. But the lacunar skull is quite often combined with other malformations of the skeleton and internal organs, with hydrocephalus.

When they talk about the sutures of the bones of the roof of the skull of a newborn, they mean the connective tissue layers at the junctions of the bones, at the sites of future sutures - metopic, frontal, coronal, sagittal and lambdoid. The metopic suture between the frontal bones is partially formed by birth, so that only that part of it that is adjacent to the huge fontanel (anterior, frontal), located at the junction of the metopic suture with the sagittal and coronal, is determined by palpation. The remaining seams are palpable throughout. At the junction of the sagittal and lambdoid sutures there is a small fontanel (posterior, occipital). At the convergence of the frontal bones with the parietal and temporal bones there are two anterior lateral fontanelles (anterolateral), and between the parietal, temporal and occipital bones there are two posterior lateral fontanelles (mastoid). The skull bones adjacent to the sutures are less dense.

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

Increased fontanelles and the distance between the bones of the skull roof may be a consequence of:

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

Complete closure of the lateral and small fontanelles at birth, combined with the small size of the huge fontanelle, and from time to time, flattening of the edges of the bones up to complete fusion of the sutures, is an indicator of congenital microcephaly or craniostenosis. More often it is not uncommon for one seam to close.

In the first month of life, the rate of transformation of the sizes of sutures and fontanelles is of practical importance. Rapid, steadily progressive increase in fontanelles and suture dehiscence are an indicator of increased intracranial pressure. Accelerated closure of fontanelles and sutures is observed 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 scream or tense. Its position should be vertical. In most cases, both visually and by palpation, the fontanel is flat and easily sinks when compared with the surrounding surface of the skull. Using the fingers (index and ring fingers) determine the degree of resistance in response to light pressure and the degree of bulging of the connective tissue membrane. The bulging of a large fontanel or its increased resistance to pressure indicates an increase in intracranial pressure.

Recession of a huge fontanelle and excessive compliance of the membrane in most cases indicate dehydration of the body (exicosis).

By palpation of the fontanel, it is also possible to obtain information about the nature of blood circulation. With circulatory failure, accompanied by an increase in venous pressure, the fontanel is tense and its pulsation is increased.

Through percussion it is possible to recognize hydrocephalus or subdural hematoma.

In a healthy child, the percussion sound is uniformly dull over the entire surface of the head. A change in percussion sound similar to the sound of a “cracked pot” is one of the signs of hydrocephalus. Along with this, the sound may 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, much more often in the embryonic period.

Three o'clock in the morning. The husband and wife are dozing. Suddenly the doorbell rings. The husband, swearing, goes to open it. There’s a guy standing on the threshold, of course a loser:

Buddy, come with me, here next to you, you can help me push.

Man, are you crazy, or what? Three o'clock in the morning. Go ask someone else.

The husband goes back to bed. The wife asks questions about who came.

Yes, some goat got stuck and asked to be pushed. I sent it.

You're just some kind of beast. Don’t you forget how our engine stalled, in the rain, and some young man pushed us for an hour? Can't you help someone out?

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

Here I am! Come here!

Well, here on the swing!

Razryd2000.ru

Children's fontanel: the size of the fontanel in children, the time when the fontanel overgrows

Parents of a newborn, as a rule, know that on the baby’s head there is a fontanel or, as it is often called, a soft crown. Many of them are convinced that the fontanel in infants is a weak and vulnerable place that should not be touched again. Is this really true? Do newborns have one fontanel? What is it for? Let's figure it out.

Contents: Features of the structure of the skull of the fetus and newborn Functions and sizes of the fontanel When the fontanel overgrows The fontanel is a signal beacon How the fontanel helps in diagnosis

STRUCTURE FEATURES OF THE SKULL OF THE FETAL AND NEWBORN

A newborn’s fontanelles, and there are several of them, can safely be called “devices” given by nature to facilitate the process of bringing a baby into the world. During the passage of the fetus through the mother's birth canal, its head can become deformed (in the good sense of the word) and take on shapes corresponding to the birth canal. This makes labor easier for both the baby and the mother.

Such anatomical “mutual understanding” is possible due to the structural features of the fetal skull. It consists of the same bones as the adult skull. But the bones of the baby’s cranial vault are highly elastic and are connected to each other by peculiar shock absorbers - non-ossified connective tissue areas.

These are the sutures and fontanelles:

frontal or metopic suture - between the frontal bones;
coronal or coronal 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;

the anterior or greater fontanel is a diamond-shaped membranous plate, from the corners of which the frontal and sagittal sutures, the left and right parts of the coronal suture extend;
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 squamosal sutures.

In a healthy full-term newborn, of all the membranous structures of the skull listed above, only the large fontanelle (anterior) and, in rare cases, the posterior small fontanelle remain open and are identified. And all the seams and other fontanelles are closed. In premature newborns, some sutures 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 tarpaulin. Therefore, it is extremely difficult to violate its integrity. Calmly bathe your baby, use a comb if necessary, play with the baby, give him a massage, and don’t be afraid to damage the fontanelle.

FUNCTIONS AND SIZES OF FONTANELLAS

The anterior fontanel is shaped like a diamond. The doctor measures the size of the fontanel not along the diagonals of the diamond, but along the lines connecting the middles of its opposite sides.

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

Normally, the anterior fontanel is at the same level with the surrounding frontal and parietal bones or sinks very slightly. If you look closely, you can see how the fontanelle pulsates. If the baby cries a lot and is restless, he may bulge a little.

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

In addition, the fontanel in an infant performs the function of thermoregulation. When the child’s body temperature rises, excess heat is released from the membranes of the brain through the large fontanelle, that is, they are cooled naturally. Therefore, never swaddle a feverish baby's head or wrap his head in hats and scarves.

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

WHEN DOES THE FOUNTAIN OVERGROW?

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

For the age at which the anterior fontanel closes completely, the standards are not strictly defined. In most newborns this occurs by 12 and sometimes by 18 months. But even if the fontanel is overgrown and the child is not one year old, there is no need to worry. In a healthy baby, this may be a variant of the norm, as your pediatrician will certainly tell you.

The posterior fontanel is usually not even detected at the time of birth. If you manage to find it, don't worry. It usually happens like this: by the time the anterior fontanel is overgrown, not a trace remains of the posterior one long ago. It closes by 1.5–2 months.

FANTANNA – SIGNAL BEACON

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

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

If at birth the baby's anterior fontanelle is very small or absent altogether, doctors first rule out microcephaly and craniostenosis. In the first case, the child has all parts of the body of normal size, but the head (cranium and brain) is significantly delayed in development. Microcephaly is often a manifestation of severe chromosomal diseases, such as Patau syndrome, Edwards syndrome, etc.

With craniostenosis, the sutures between the bones of the skull close early and the fontanelles close. Because of this, the head becomes deformed, the brain cannot grow normally, and intracranial pressure increases with all the ensuing symptoms.

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 took multivitamin medications, her baby’s fontanel may close early. A lack of calcium in the body can cause late overgrowth of the fontanel.

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

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

ICP in infants increases with the following diseases and conditions:

congenital diseases (hydrocephalus, etc.);
brain infections (purulent meningitis, etc.);
space-occupying 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 fontanel appears immediately after the child has received an injury (to the head and not only), immediately contact a medical facility or call an ambulance at home.

Be sure to pay attention not only to a bulging fontanel, but also to a sunken fontanelle, 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 emergency medical care.

Please note: with meningitis, the fontanel first bulges due to increased ICP, and then, due to the loss of fluid from the baby’s body, it sinks.

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

HOW THE FENTANELLE HELPES DIAGNOSIS

The fontanel in infants is a kind of “window” through which you can “look” inside the baby’s skull and brain.

Therefore, infants with access through the fontanelle undergo some diagnostic and therapeutic procedures, 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;
puncture-free measurement of ICP using special tonometers;
two-dimensional echoencephalography and sonography - ultrasound examinations;

radioisotope scintigraphy.

OkeyDoc.ru

Examination of the newborn's head

The local pediatrician must be able to examine the head of a newborn and as an orthopedist. An orthopedic examination of a newborn begins with an examination and examination of the head, the ability to hold it, then an examination of the face (its symmetry is noted) and neck. Particular attention is paid to the condition of the sternocleidomastoid muscle (is there any compaction or shortening of one of its legs).

When examining a newborn's head, you need to pay attention to:

Position in relation to the body;

Dimensions;

Proportions of the brain and facial skull;

Sizes of fontanelles;

Condition of cranial sutures;

Bone density.

Examination of the head should be combined with 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 determined by the presentation during labor and the presence of physiological hypertonicity of the flexors (the head is slightly adducted to the chest).

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

In a newborn baby, the cerebral skull predominates over the facial skull. The frontal and parietal tubercles protrude clearly. Quite often, in the back of the head, at the border of the scalp, there are red spots with blurry boundaries that do not rise above the surface of the skin. Their borders have irregular outlines. Under finger pressure, the redness disappears, but then appears again. Worsened by crying. These spots (telangiectasia) are caused by local expansion of the vestigial remains 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 have a darker, more saturated 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 characteristics and a consequence of birth 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 changes in its size.

Variants of the normal head shape in a newborn are:

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

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

Tower (skull extended vertically). Rarely seen.

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

In a premature newborn, the shape of the skull resembles that of hydrocephalus. This is explained by the relatively earlier maturation of brain matter. A similar large head can also occur in a healthy full-term child whose family has large heads (dominantly or recessively inherited trait) in the absence of other stigmas of disembryogenesis and normal neurological status. These cases are not considered pathological.

Changes in the shape of a newborn’s head can also result from trauma during childbirth, which clinically manifests itself in the form of:

Birth tumor;

Cephalohematomas;

Changes caused by a vacuum extractor or forceps.

Birth tumor is a congestive swelling that occurs on the presenting part of the fetal body 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 may be bluish, turning into normal tissue. In the area of the birth tumor there are almost always hemorrhages in the skin and subcutaneous tissue. This is especially noticeable when swelling is localized in the forehead and face. 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 consequence 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 boundaries of the suture. It has a slightly dense and fluctuating consistency. From the 7-10th day, the cephalohematoma begins to gradually decrease. It resolves 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 depressions 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). Occurs as a result of premature fusion of sutures. Occurs in syndromes: Crouzon, Apert, Vanderburg;

Scaphocephaly (scaphoform elongated skull, elongated skull with a protruding ridge at the site of a prematurely overgrown sagittal suture) - Apert syndrome;

Plagiocephaly (oblique head, oblique skull). Asymmetry of the skull caused by premature ossification of part of the coronal suture.

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

Pathological head sizes include:

Macrocephaly - 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, Pyle, Paget, etc.;

Microcephaly - head circumference less than 34 cm (small head). With microcephaly, there is redundancy of the skin on the head and increased bone density. Occurs in: alcoholic embryopathy, toxoplasmosis, Greg and Bloch-Sulzberger, Patau, Wolf-Hirschhorn, Edwards syndromes, etc.

By the end of the first month of life, head circumference increases by an average of 1.5-2 cm. A delay in the rate of head growth can be a constitutional sign, as indirectly evidenced by the small size of the head in one or both parents, or a symptom of delayed brain development. Accelerated growth of 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 the 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 fontanel;

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

The skull bones of a healthy newborn are quite dense, with the exception of their junctions - 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. In contrast to the usual delayed ossification and lacunar osteoporosis, when the affected bones seem uniformly soft to the touch and seem to spring slightly when pressed, with the so-called lacunar skull the bones palpably feel like honeycombs, since with this form of lesion the areas of softening are separated by thin bone partitions. The prognosis for isolated lacunar osteoporosis is favorable. At the age of 2-3 months, foci of osteoporosis disappear. However, a lacunar skull is often combined with other malformations of the skeleton and internal organs, with hydrocephalus.

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

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

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

Prematurity;

Ossification disorders;

Congenital hydrocephalus.

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

Complete closure of the lateral and small fontanelles at birth, combined with the small size of the large fontanelle, and sometimes flattening of the edges of the bones up to complete fusion of the sutures, is a sign of congenital microcephaly or craniostenosis. More often there is fusion of one seam.

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

When palpating a 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 scream or tense. Its position should be vertical. Usually, both visually and by palpation, the fontanel is flat and slightly sunken in comparison with the surrounding surface of the skull. Using the fingers (index and ring fingers) determine the degree of resistance in response to light pressure and the degree of bulging of the connective tissue membrane. Bulging of a large fontanel or its increased resistance to pressure indicates increased intracranial pressure.

Retraction of the large fontanelle and excessive compliance of the membrane usually indicate dehydration of the body (exicosis).

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

Percussion can reveal hydrocephalus or subdural hematoma.

In a healthy child, the percussion sound is uniformly dull over the entire surface of the head. A change in percussion sound similar to the sound of a “cracked pot” is one of the symptoms of hydrocephalus. In this case, the sound may 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 the embryonic period.

poznajvse.com

Newborn head. Child's fontanelles

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 a newborn’s head is important for obstetrics, since in most cases the fetus is cephalic and the most difficult birth is the head.

Nature created the female pelvis in such a way that when the cervix dilates, the baby can move forward. For this purpose, nature has endowed the fetal head with a number of features so that it can shrink and become deformed during childbirth. The secret lies in the slit-like sutures and fontanelles between the bones of the skull. The bones of the fetal skull bend easily and, if necessary, overlap each other.

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 to the parietal bones. The lambdoid or occipital suture connects the occipital bone to the parietal bone.

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

Cerebral choroid plexus cyst in a newborn

Malformations of the skull can manifest themselves in a discrepancy between the size of the skull and the volume of the brain and the presence of external deformities (craniosynostosis, hypertelorism); in incomplete closure of the bones of the skull and spinal canal with the formation of defects through which the contents of the skull and spinal canal can protrude (cerebral and spinal hernias); in deformation of the skull, leading to compression of important brain structures (platybasia, basilar impression).

Craniostenosis(from the Greek kranion - skull + Greek stenosis - narrowing) - a congenital pathology of the development of the skull, manifested in the early fusion of cranial sutures, resulting in deformation of the skull and a discrepancy between its volume and the size of the brain.

During the first years of a child's life, brain mass continues to increase and head volume increases. By one year, a child’s head size is 90%, and by 6 years, 95% of an adult’s head size. The cranial sutures close only at 12–14 years of age. If the process of closing the sutures is disrupted and their early ossification occurs, the child’s skull stops growing, which in cases of severe pathology can lead to severe brain damage. Premature closure of all skull sutures is possible. However, premature fusion of individual sutures is often observed: coronal, sagittal, etc., which leads to severe deformation of the skull. There are several forms of craniostenosis.

Scaphocephaly(from Greek skaphe - boat + Greek kephale - head), characterized by a peculiar elongated, laterally compressed shape of the skull.

This type of craniostenosis occurs due to prematurely overgrown sagittal suture. In this case, the increase in the size of the skull in the transverse direction stops and continues in the direction from front to back.

With premature ossification of the coronal suture, the enlargement of the skull in the anteroposterior direction stops, and the so-called brachycephaly(from Greek brachys - short).

Often, early fusion of the coronal suture is accompanied by underdevelopment of the orbits, sphenoid bone, and bones of the facial skull ( Crouzon syndrome, in which craniostenosis is combined with exophthalmos due to underdevelopment of the orbits and oral cavity). With a cranial anomaly close to this type Apert syndrome there is also syndactyly).

With unilateral premature closure of the coronal suture, flattening of the forehead, underdevelopment of the orbit and elevation of its orbital edge are noted - plagiocephaly (from the Greek plagios - oblique).

With pathology of the so-called metapic suture (between the frontal bones), the head takes on a triangular shape - trigonocephaly(from the Greek trigonon - triangle). Early fusion of several sutures leads to a general decrease in the volume of the skull, its deformation - a tower skull or acrocephaly(from the Greek akros - high) with underdevelopment of the sinuses and orbits.

With craniostenosis, in addition to the described types of cranial deformation, symptoms of brain damage may be observed. They are most pronounced with premature ossification of several sutures, when the discrepancy between the growing brain and the skull that has stopped developing can reach an extreme degree of severity.

In these cases, the symptoms of intracranial hypertension come to the fore: headache, vomiting, congestion in the fundus, leading to decreased vision, and general cerebral phenomena. A craniographic examination reveals characteristic signs of craniostenosis: fusion of sutures, absence of fontanelles and pronounced digital impressions.

Surgery. The most common type of treatment for craniostenosis is resection of the bone along the ossified sutures, which allows for an increase in the size of the skull.

In cases of severe deformations of the skull, reconstructive operations have recently been widely used, the nature of which is determined by the type of craniostenosis.

Thus, with brachycephaly caused by premature fusion of the coronal suture, the so-called Fronto-orbital advancement is carried out. For this purpose, two bone blocks are formed, consisting of the orbital edge and the frontal bone, which are mixed anteriorly and fixed with wire sutures or special metal plates.

Scaphocephaly and acrocephaly (“tower” skull) require more complex skull reconstruction. With Crouzon's disease, the most complex surgical correction of combined anomalies of the cerebral and facial skull is performed, including, in addition to fronto-orbital advancement, also movement of the upper jaw.

Performing the described reconstructive operations requires the use of special surgical instruments: pneumatic and electrocraniotomes, oscillating saws, special cutters. It is advisable to perform operations for craniostenosis in the first 3–4 months of life in order to prevent the development of severe deformation of the skull