Tumors of the skull bones. divided into primary and secondary (germinating or metastatic), characterized by benign or malignant growth. Among primary benign tumors of the calvarial bones, the most common are osteomas and hemangiomas. Osteoma develops from the deep layers of the periosteum. Its occurrence is associated with a violation embryonic development and brush formation. With growth, a compact osteoma is formed from the outer and inner plates of the kernel substance, and a spongy (spongy) or spongy osteoma is formed from the spongy substance. mixed form osteomas. It is also possible to develop osteoid osteoma. Osteomas, as a rule, are single, less often - multiple. In the bones of the skull. Compact osteomas predominate. They are characterized by slow growth, may not appear clinically for a long time, and are sometimes accidentally discovered during X-ray examination. Subject to availability clinical symptoms surgical treatment - removal of osteoma. The prognosis is favorable. Hemangioma of the skull bones is rare.

Localized in the spongy substance of the frontal and parietal (less often occipital) bones. In the bones of the cranial vault. Usually a capillary (spotted) hemangioma develops, less often a cavernous or racemotic form. Clinically, hemangioma is often asymptomatic and detected incidentally on an x-ray. At the same time, integrity bone plate, which is important for radiation or surgical treatment, is specified according to axial data computed tomography. Benign neoplasms V soft tissues heads can secondary locally destroy the bones of the cranial vault. Dermoid cysts are usually located at the outer and inner corner of the eye, in the area of ​​the mastoid process, along the sagittal and coronal sutures, etc. They are located under the aponeurosis, which causes the development of skull bone defects, saucer-shaped marginal defects, followed by complete destruction of all layers of the bone. In rare cases, a dermoid cyst develops as a diploe on cranial radiographs. a cavity with smooth walls is visible. Eosinophilic granuloma or Taratynov's disease is characterized by local bone destruction caused by the intraosseous development of granulomas consisting of histiocytic cells and eosinophils. Usually a solitary bone granuloma is detected, less often - several foci, and very rarely - multiple skeletal lesions. Most often these changes are localized in the flat bones of the skull and in femur.

The flat bones of the pelvis, ribs, vertebrae, and jaws may be affected. Treatment of benign tumors is surgical. The prognosis is favorable. Cholesteatoma can be located in the soft tissues of the head, most often under the aponeurosis. In this case, extensive defects outer bone plate and diploe with clear scalloped edges and a marginal band of osteosclerosis. Cholesteatoma located in the diploea is radiologically identical to a dermoid or teratoma. Treatment is surgical. The prognosis is favorable. To primary malignant tumors of the calvarial bones. include osteogenic sarcoma. However, secondary sarcoma is more common, developing from the periosteum, dura mater of the brain, aponeurosis and paranasal sinuses.

Sarcomas develop at a young age and differ large sizes and a slight tendency to decay, they quickly grow into the dura mater and give metastases. On the radiograph, the lesion has an uneven outline, with borderline osteosclerosis; When the tumor grows beyond the cortex, radiant periostitis appears in the form of fan-shaped diverging bone spicules. Since osteogenic sarcoma develops from primitive connective tissue, capable of forming bone and tumor osteoid, then the X-ray picture combines osteolytic and osteoblastic processes, which is clearly visible on computed tomograms. Antitumor drugs and radiation therapy are prescribed, and in some cases surgical treatment is indicated. The bones of the calvarium are affected in myeloma in the form of a solitary lesion (plasmocytoma); diffuse damage is less common.

At the same time, pathological foci can be detected in the ribs, pelvic bones, spine, tubular bones, sternum. A disorder of protein metabolism in the form of paraproteinemia is characteristic: a-, b- and g-plasmocytomas are differentiated by an increase in the amount of globulins. Sometimes the tumor grows into adjacent tissue (for example, hard shell brain). Main clinical symptom are pain in the affected bones. The diagnosis is established on the basis of clinical and laboratory data, the results of puncture examination bone marrow and x-ray picture. Treatment consists of prescribing antitumor drugs and conducting radiation therapy. Sometimes surgery is indicated.

The prognosis is unfavorable. Metastasis to the bones of the cranial vault is observed in primary cancer of the lung, breast, thyroid and parathyroid glands, kidney, prostate gland. Foci of bone destruction are localized in the cancellous bone and have a wide zone of sclerosis, which moves outward as the metastasis increases. Metastases of kidney adenocarcinoma are characterized by local bone destruction with the formation of intra- and extracranial nodes. Multiple lytic small-focal metastases of different configurations in the bones of the calvarium, reminiscent of multiple foci in myeloma, are observed in malignant chromaffinoma of the adrenal glands, mediastinum, and liver.

The occipital bone is considered the most massive in the skull, fixes the anatomical structures in the occipital area, protects from damage posterior sections brain

There are many reasons for pain in the back of the head. This may be a consequence nervous overstrain, overwork from excessive physical or mental stress, after a long stay in an uncomfortable position or intense training. Pain in the back of the head due to deformation of osteophytes in cervical spine spine, the appearance of growths on the bones due to salt deposition or degeneration of ligaments. The pain intensifies in the back of the head when turning the head, radiates to the neck, jaw, back of the head, eyes and ears when compacted neck muscles as a result of poor posture, severe nervous tension.

1. Neuralgia of the occipital nerve. With the development of pathology in the cervical spine: osteochondrosis or spondyloarthrosis, pain in the back of the head, dizziness, and a feeling of stiffness and tightness in the shoulders. With trigeminal neuralgia, the pain spreads to the lower jaw and ears, increases when turning the head, coughing, sneezing, pulsates at one point of the head, radiates to the back, jaw, temples, and pain in the back of the head.
2. Colds, hypothermia. Shooting pain appears when turning the head, sneezing, coughing.
3. Arterial hypertension, in which it compresses, stiffens the muscles, jaw and hurts in the back of the head.
4. Cervical migraine manifests itself sharp pain in the morning in the occipital and temporal parts, darkness in the eyes, noise in the ears, hearing deteriorates, dizziness. Migraine may be a genetic disorder and long time remain in a dormant state, activated only against the background of provoking factors. Begins to progress rapidly, manifesting itself in fits and starts blood pressure after taking hormonal drugs in large doses, a sudden change in weather, it radiates to the bones of the neck, jaw, back, overexertion after intense training or mental activity, excessive alcohol consumption.
5. Vertebrobasilar syndrome appears with osteochondrosis of the cervical spine, when there is noise in the ears, pain in the back of the head, and a veil covers the eyes. It seems, especially after intense training or taking large doses of alcohol, that everything around you is spinning, spinning, and doubles.

Many people experience constant pain in the back of their head. Many factors can provoke occipital pain, which is often painful, long-lasting, radiating to the jaw, and cannot be relieved even with pills. The pathology can be congenital, acquired or kinetic, when intracranial pressure jumps, which is often observed in women after 40 years.

Pain in the back of the head as a result of:

• hypertensive crisis;
• chronic stress;
• excessive muscle strain or staying toned for a long time;
• malocclusion;
• deformations of the temporomandibular joints, resulting in nausea, dizziness, impaired hearing and coordination of movements. Even analgesics do not help; there is a shooting pain that radiates to the bone in the neck and jaw;
• strains of the neck muscles after intense training, also in case of hypothermia, bruise, injury due to the accumulation of cerebrospinal fluid in a sore spot;
• post-traumatic intracranial pressure, concussion of the cerebellum, an acute, shooting pain appears in one point, localized to the jaw and occipital part, but the pain is well relieved by anesthetic tablets.
• smoking tobacco, drinking alcohol;
• constant stress;
• a sedentary lifestyle, staying in an uncomfortable position or prolonged exercise, which often happens while sleeping.

Unfortunately, painkillers do not always help with pain in the back of the head. Serious systemic physiological changes occur in the body, requiring identification of the main cause that provoked the pain in the back of the head, comprehensive diagnostics, and blood tests (general and biochemistry). Perhaps a malignant tumor has appeared in one of the brain structures, or the body is experiencing a pre-stroke state.

Pain in one point of the head is migrating, usually occurring suddenly and lasting no more than 1-3 seconds. Point pain is rare and, as a rule, does not pose a threat to human health. It hurts in the back of the head, has an exact location, you can point with one finger where it hurts: in the temporal part or on the back of the head. Pain is more common in women over 40 years of age who suffer from migraines and paroxysmal headaches in one point. As a rule, special treatment such pain is not required, it is enough to take painkillers: indomethacin, melatonin, nurofen, sedalgin, solpadeine.

With a migraine in the temporal part, the patient perceives pain as if at one point, which pulsates and swells. Before attacks there is:

• lacrimation;
• redness of the eyes;
• sagging lower eyelid;
• constriction of the pupil of the eye on the painful side;
• swelling of the nasal mucosa;
• difficulty breathing;
• copious discharge from the nasal cavity.

During attacks of pain in one part of the bone at the back of the head, intramuscular administration of triptan drugs is indicated. For prevention purposes, glucocorticoids are prescribed. In severe cases, radiofrequency ablation of the trigeminal ganglion to stimulate the occipital nerve in one of the rear parts hypothalamus in the neck.

Pain in the neck and back of the head can be different and the causes are also different. Patients often complain that pain lasts a long time and cannot be treated with painkillers; however, any pain is a symptom and is dangerous, regardless of the cause of its occurrence.

There may be a pinched nerve or nerve endings in the cervical spine, compression or displacement of the vertebrae. Pain in the back of the head and the right side of the head in the morning with arterial hypertension, compresses the temples and the head area, hearing and vision decrease. Antispasmodics usually help with cerebral vascular spasms. However, not all types of pain can be relieved even with the most powerful painkillers. Pain in the back of the head from overexertion, stress, poor diet, smoking, alcohol abuse, and pills do not always help. If unpleasant symptoms are not caused by a disease, then the best medicines are: relaxing acupressure, proper rest, normalization of nutrition, maintaining posture, placing a special cushion under the neck when sedentary work for a long time, for example, at the computer. This applies to office workers who often suffer from cervical migraines. You need to move more, sit less in one position for a long time, and after work do a neck massage in the back of the head.

For chronic pain, a head massage helps relieve attacks of headaches in the back of the head. For cervical osteochondrosis, some are effective folk remedies, homeopathic medicines.

You need the help of specialists if you experience pain in the back of your head. Self-medication is not recommended. Some folk remedies, warming ointments and gels can relieve unpleasant symptoms and alleviate the condition for a while, for example, after an intense and long workout, but this is not a way out. If the cause of pain is a disease, then it requires establishing the true root cause of the disease, comprehensive examination, CT, MRI, Dopplerography of the brain. The only exception, when the help of doctors is not really required, is the appearance of pain in the back of the head against the background of emotional or mental stress. It is advised to calm down, massage the neck area, carry out a relaxation procedure, and then take a contrast shower. You may be advised by your doctor to temporarily wear a neck bracing device to relieve stress and tension from the muscles at the back of your head.

It is necessary to ventilate the room more often, when constant pain apply to the back of the head warm compresses from infusions medicinal herbs, drink more hot tea, arrive at fresh air, avoid alcohol and smoking, dose sports loads, try to constantly keep your neck in the most relaxed state, do not overstrain the bone at the back of the head and neck muscles, place an orthopedic cushion under your head and jaw when working sedentarily.

Treatment of many diseases, if the pain in the back of the head does not go away for a long time, requires a serious and professional approach. The complex of necessary measures includes many processes and actions. For this reason, actions aimed at preventing the occurrence of illnesses are fundamental in the life processes of any person.

Head bones include malignant neoplasms in the brain and facial parts of the skull. The brain section consists of the roof (vault) and the base of the skull. It houses the brain, organs of smell, vision, balance and hearing. The facial region contains the bone base for the mouth and nose.

The brain section of the skull consists of unpaired bones (occipital, sphenoid and frontal) and paired bones (temporal and parietal, as seen in Fig. 1,2).

The ethmoid bone is partially included in brain section, and also the bones of the hearing organs (middle ear) are topographically located in it. The facial section consists of paired bones: the upper jaw, inferior nasal concha, nasal, lacrimal and zygomatic, as well as unpaired: parts of the ethmoid and hyoid bones, vomer, lower jaw.

The shape of the cranial bones is often irregular. The frontal, sphenoid, ethmoid, temporal and maxillary bones are called pneumatic because they have air cavities.

The skull consists largely of fixed joints, and they are held together by the cranial suture. The joints connect the temporal and auditory bones to each other and the lower jaw. The outside of the skull is covered with periosteum, the inside is covered with hard meninges With blood vessels. The cranial vault consists of flat bones with plates of compact and spongy substance (diploe), in which the channels of the diploic veins pass.

On the outside the fornix is ​​smooth, but on the inside it is covered with finger-like impressions, dimples, granulations of the arachnoid mater and venous grooves. At the base of the skull there are openings and canals for cranial nerves and blood vessels.

Cancer of the skull bones can be a consequence of mutation of primary benign formations:

• osteoma from the deep layers of the periostat. The outer and inner plates of the substance form a compact single or multiple osteoma, the spongy substance forms a spongy (spongy) osteoma or a mixed form.
• hemangiomas of the spongy substance of the parietal and frontal ossicles (less often occipital) of capillary (spotty), cavernous or racemose forms;
• enchondroma;
• osteoid osteomas (cortical osteomas);
• osteoblastoma;
• chondromyxoid fibromas.

A primary tumor of the bones of the skull and soft tissues of the head with benign growth can secondary grow into the bones of the vault and destroy them. They can be located at both corners of the eye in the form of dermoid cysts, next to the mastoid process, sagittal and coronal sutures.

Cholesteatomas of the soft tissues of the head form defects on the outer bone plate: scalloped edges and a band of osteosclerosis. Meningiomas grow into the bones along the osteon canals, and due to the proliferation of osteoblasts, the bone tissue is destroyed and thickened.

Types of malignant tumors of the skull bone

Skull bone cancer is represented by:

• chondrosarcoma with mutated elements of cartilage tissue;
• osteogenic sarcoma in the temple, occiput and forehead;
• myeloma at the cranial vault;
• Ewing's sarcoma in the tissues of the skull;
• malignant fibrous histiocytoma.

This malignant tumor of the skull, growing from cartilage cells, damages the skull, trachea and larynx. It is rare in children; people aged 20-75 years are more likely to get sick. This type of cancer appears in the form bony prominence, covered with cartilage. Chondrosarcoma can result from malignancy of benign tumor processes. This type is classified according to its degree, reflecting the speed of its development. With slow growth, the severity and prevalence will be lower and the survival prognosis will be higher. If the degree of malignancy is high (3 or 4), then the formation grows and spreads quickly.

Features of some chondrosarcomas:

• differentiated - aggressive behavior, they can change and acquire features of fibrosarcomas or osteosarcomas;
• clear cell - slow growth, frequent local recurrence in the area of ​​the initial oncological process;
• mesenchymal - fast growth, but good sensitivity to chemicals and radiation.

This osteogenic tumor of the skull bones is rarely primary and is formed from bone cells. Affects the temporal, occipital and frontal regions. More often, secondary sarcoma is diagnosed in the periosteum, dura mater, aponeurosis and paranasal sinuses. The formations reach large sizes, are prone to decay and rapid germination into the dura mater of the brain.

Metastases in cancer of the skull bones (osteosarcoma) occur early, the formation forms quickly and grows aggressively. When examining the x-ray, a lesion with uneven outlines and the presence of borderline osteosclerosis is noticed. If the lesion extends beyond the cortex, this leads to the appearance of radiant periostitis. In this case, the bone spicules diverge fan-shaped.

Primitive connective tissue, which gives rise to osteogenic sarcoma of the skull, is capable of forming tumor osteoid. Then CT scans record a combination of osteological and osteoblastic processes.

Children, due to mutation of bone tissue during growth, and young people 10-30 years old are most often affected. Elderly people get sick in 10% of cases. Treatment is carried out surgically, antitumor agents (Vincristine, Cisplatin and others) and radiation therapy.

The growth of this sarcoma of the skull in bone and soft tissues occurs from malignant neoplasms of other zones. The tumor mass contains uniform round large cells with small nuclei; necrosis and hemorrhage may be present. Ewing's sarcoma of the head actively affects the human condition from the first months of development. Patients complain of high temperature, pain, their leukocyte level increases (up to 15,000), and secondary anemia develops. Children, adolescents and young adults are more likely to get sick. Ewing's sarcoma can be treated with radiation and Sarcolysin. X-ray therapy can prolong the life of patients up to 9 years or more.

A malignant tumor of the skull bone of these types initially originates in ligaments, tendons, fatty and muscle tissue. It then spreads to the bones, especially the jaws, and metastasizes to lymph nodes and important vital organs. Elderly and middle-aged people are more often affected.

Myeloma at the calvarium

Myeloma occurs in the flat cranial bones and ossicles facial area. It is characterized by a pronounced destructive process in the area of ​​the cranial vault. The clinical and radiological type of myeloma (according to S. A. Reinberg) is:

• multifocal;
• diffuse-porotic;
• isolated.

X-ray changes in bone in myeloma (according to A.A. Lemberg):

• focal;
• knotty;
• osteolytic;
• mesh;
• osteoporotic;
• mixed.

In the works of G.I. Volodina identified focal, osteoporotic, small-cell and mixed radiological variants of changes in bone tissue in myeloma. Focal changes include bone destruction: round or irregular in shape. The diameter of the area can be 2-5 cm.

Chordoma at the base of the skull

Oncology of the skull bones is also represented by chordoma at its base. She's dangerous rapid spread into the nasopharynx and damage to nerve bundles. The location of the chordoma leads to high frequency mortality of patients, among whom there are more men after 30 years. With residual chordoma cells after surgery, local recurrence occurs.

Classification of bone cancer also includes:

• giant cell primary tumor of benign and malignant forms without characteristic metastasis. Giant cell occurs as a local relapse after surgical excision bone tumor formation;
• non-Hodgkin's lymphoma in the bones or lymph nodes;
• plasmacytoma on the bones or bone marrow.

From the lymph nodes, cells can penetrate into the bones of the head and other organs. The tumor behaves like any other primary non-Hodgkin's tumor with the same subtype and stage. Therefore, treatment is carried out the same as for primary lymph nodes. The therapeutic regimen, as for osteogenic sarcoma of the skull, is not used.

Giant cell tumor of the skull (osteoblastoclastoma or osteoclastoma)

May occur due to hereditary predisposition in the population, from infancy to old age. The peak of the oncological process occurs at 20-30 years of age, due to the growth of the skeletal system. Benign tumors can transform into malignant ones. Osteoclastoma progresses slowly, pain and swelling of the bone appear on late stages diseases. Metastases reach surrounding and distant venous vessels.

In lytic forms of giant cell tumor, its cellular-trabecular structure is noticeable on the radiograph or the bone completely disappears under the influence of the oncological process. Pregnant women with this disease should terminate the pregnancy or begin treatment after childbirth if it is detected late.

Causes of skull bone cancer

The etiology and causes of cranial bone cancer have not yet been fully studied. It is believed that cancer formations in the lungs, mammary glands, sternum and other areas of the body during metastasis spread their cells through the blood and lymph vessels. When they reach the head, secondary cancer of the skull bones occurs. The formation of tumors, for example, at the base of the skull occurs when tumors grow from the neck and soft tissues. from the nasopharynx in later stages can also grow into the bones of the skull.

Risk factors or causes of skull tumors:

• genetic predisposition;
• related benign diseases(eg, retinoblastoma of the eye);
• bone marrow transplant;
• exostoses (bumps due to ossification of cartilage tissue) with chondrosarcoma;
• ionizing radiation, exposure to radiation for therapeutic purposes;
• diseases and conditions that reduce immunity;
• frequent bone injuries.

Skull bone cancer: symptoms and manifestations

Clinical symptoms of cranial bone cancer are divided into three groups. The first general infectious group includes:

• increase in body temperature with chills and/or excessive sweating;
• intermittent fever: a sharp rise in temperature above 40° and a fleeting decline to normal and subnormal levels, then a repetition of temperature jumps after 1-3 days;
• increased leukocytes in the blood, ESR;
• sudden weight loss, increasing weakness, appearance of pale skin on the face and body.

Symptoms of cranial bone cancer of the general cerebral group:

• headaches with increased intracranial pressure, with nausea and vomiting, as well as changes in the fundus (this includes congestive discs, neuritis optic nerve etc.);
• epileptic seizures (appear due to intracranial hypertension);
• periodic (orthostatic) bradycardia up to 40-50 beats/min;
• mental disorders;
• slowness of thinking;
• inertia, lethargy, “stupefaction”, drowsiness, even coma.

Focal (third group) symptoms and signs of cancer of the skull bones depend on the location pathological process. in some cases they do not appear for a long time.

Focal symptoms of skull bone tumors are complicated by edema and compression of brain tissue, meningeal symptoms with cerebellar abscesses. This is characterized by the manifestation of pleocytosis with lymphocytes and polynuclear cells (multinuclear cells) in the cerebrospinal fluid. It increases the protein concentration (0.75-3 g/l) and pressure. But often such changes may not occur.

Osteogenic sarcoma of the skull bone is characterized by immobile subcutaneous seal and pain when the skin above it moves. The lymph nodes of the head and neck are enlarged. With metastases, hypercalcemia develops, accompanied by nausea, vomiting, dryness of the oral mucosa, excessive urination, and impaired consciousness.

With Ewing's sarcoma, patients have increased white blood cell levels and temperature, headaches, and anemia. With myeloma, patients sharply weaken, they develop secondary anemia, and excruciating pain aggravates their life.

Multiple myeloma can affect 40% of the bone tissue of the cranial vault. Moreover, all detected lesions are considered primary with multifocal growth and do not belong to metastatic tumors.

Stages of skull cancer

Primary cancer of the skull bone is divided into stages of the malignant process, which is necessary to determine the extent of tumor spread, prescribe treatment and predict survival after it.

At the first stage, tumor formations have a low level of malignancy and do not extend beyond the bone. At stage IA, the size of the node does not exceed 8 cm, at stage IB it is >8 cm.

At the second stage, the oncological process is still in the bone, but the degree of cell differentiation decreases.

At the third stage, several bones or areas of bone are affected, and the oncological process spreads throughout the skull and its soft tissues. Metastasis occurs to the lymph nodes, lungs and other distant organs at stage 4.

Diagnosis of a skull bone tumor

Diagnosis of cranial bone cancer includes:

• examination of the nasal cavity and ears using the endoscopic method;
• radiography of frontal and lateral projections of the head;
• CT and MRI with layer-by-layer radiological scanning of bone and soft tissue;
• PET – positron emission tomography with the introduction of glucose, containing a radioactive atom, to identify the oncological process in any area of ​​the body and distinguish between benign and malignant tumors;
• PET-CT – for more rapid detection of sarcoma of the skull bone and other formations;
• osteoscintigraphy – scanning bone skeleton using radionuclides;
• histological examination of biopsy material after radical surgery (biopsy, puncture and/or surgical biopsy);
• urine and blood tests, including a blood test.

Diagnosis of a tumor of the skull bones is supported by collecting anamnesis and examining patients to establish all the symptoms of the disease and general condition sick.

Skull bone cancer with metastases

Metastases in the bones of the skull appear mainly from a primary malignant process in the lungs, mammary, thyroid and prostate glands, as well as the kidneys. In 20% of patients, metastases from cancer of the skull bones spread from malignant melanoma mucous membranes of the nasopharynx and mouth, retina. Tumors spread to the brain through blood vessels. Metastasizes in adults with retinoblastoma and/or sympathoblastoma, in children - retinoblastoma and/or medulloblastoma. Destructive bone lesions damage the spongy substance. As the metastasis grows, a wide sclerotic zone moves outward from the bone.

With multiple lytic small-focal metastases, as in myeloma, their configuration may be different in the bones of the calvarium, and the process will resemble malignant chromaffin tumor of the adrenal glands, liver and mediastinum. Metastases also affect the base of the skull and facial bones. Therefore, when identifying signs of skull cancer on radiographs, it is necessary to examine not only the primary tumor, but also the metastatic lesion.

If even one metastasis appears in the skull, all other major organs are fully examined to exclude metastases in them. First of all, the lungs are checked with an X-ray. In addition to hematogenous metastasis, the following tumors can also penetrate into the vault and base of the skull as they grow:

• chordoma (it involves the bottom and back of the sella turcica, clivus and pyramidal apexes of the temple bones in the oncological process);
• cancer of the nasopharynx (the tumor mass grows into the sphenoid sinus and the bottom of the sella turcica).

Metastases from the kidneys, mammary glands, and adrenal glands reach the paranasal sinuses, upper and lower jaws, and orbits. Then a retrobulbar tumor is detected on an x-ray. With radionuclide scanning, metastases are detected faster than with radiography.
Treatment for metastatic cancer of the skull bones is the same as for primary tumors.

Treatment of skull bone cancer

Surgical treatment

Various pathological processes that develop in the cranial bones and in its cavities require surgical intervention: craniotomy.

Treatment of a tumor of the skull bones is carried out:

• resection trepanation with the formation of an unclosed bone defect;
• osteoplastic trephination, in which a part of the bone and soft tissue flaps are cut out, and after the operation they are placed in place. Sometimes alloplastic material (protacryl) is used to close the defect or preserved homogeneity.

Treatment of cancer of the skull bones, which is complicated by osteomyelitis, is carried out by wide resection of the affected bone to stop purulent process. Primary tumors (benign and malignant) are excised as much as possible within healthy tissue and treatment is supplemented with radiation therapy.

If osteodystrophic processes are detected, in which bone tissue grows significantly, apply cosmetic surgeries with removal of pathological foci and subsequent bone grafting. In the presence of craniostenosis, the bones of the calvaria are dissected into separate fragments or resection is carried out in areas of the cranial bones to ensure good decompression.

Chemotherapy

If the tumor is inoperable, then chemotherapy is used. Treatment of a tumor of the skull bones is carried out using:

1. Etoposide (VP-16).
2. Doxorubicin (Adriamycin).
3. Vincristina (Oncovin).
4. Ifosfamida (Ifosa).
5. Cyclophosphamide (Cytoxan).
6. Methotrexate.
7. Cisplatin or Carboplatin.

Cytostatic agents, when released into the blood, contribute to the disintegration of neoplasms into different stages. Courses, regimens, combinations of drugs and their dosage are selected individually for each patient. This determines how much it will be possible to minimize the development of complications (side effects) after chemotherapy.

Temporary health complications include nausea and vomiting, loss of appetite and hair, and the appearance of ulcerations on the mucous membranes of the mouth and nose. Chemicals damage bone marrow cells involved in hematopoiesis, as well as lymph nodes. At the same time, the number of blood cells decreases. If there is a blood disorder:

• the risk of infectious diseases increases (with a decrease in the level of leukocytes);
• bleeding or bruising occurs due to minor cuts or injuries (with a decrease in platelet levels);
• shortness of breath and weakness appear (with a decrease in red blood cells).

TO specific complications include hematuria (hemorrhagic cystitis - blood particles in the urine), which appears due to damage bladder Ifosfamide and Cyclophosphamide. To eliminate this pathology, the drug Mesna is used.

Cisplatin damages nerves, and neuropathy occurs: nerve function is impaired. Patients feel numbness, tingling and pain in the limbs. The drug can damage the kidneys, so the patient is given a lot of fluid before/after the Cisplatin infusion. Hearing is often impaired, especially not perceived high sounds, therefore, before prescribing chemotherapy and dosing medications, hearing is examined (an audiogram is performed).

Doxorubicin damages the heart muscle, especially when high doses drug. Before chemotherapy with Doxorubicin, heart function is examined to minimize the harm caused. About everyone side effects need to be reported to doctors and nurses so that corrective measures can be taken.

During the period of chemistry, blood and urine tests are examined in the laboratory to determine functional work liver, kidneys and bone marrow.

Radiotherapy

Some bone tumors may respond to radiotherapy only at high doses. This can cause damage to healthy structures and nearby nerves. This type of treatment is used as the main treatment for Ewing's sarcoma. In myeloma, ionizing radiation significantly improves the quality of life of patients. When the tumor mass is partially removed, the edges of the wound are irradiated to damage/destroy the remaining malignant cells.

Intensity modulated radiation therapy (IMRT)) is considered a modern type of external (local) radiological therapy, carried out by computer adjusting beams of rays to the volume of the tumor and changing their intensity. The rays are directed towards the epicenter under different angles, in order to reduce the dose of radiation that passes through healthy tissues. At the same time, the radiation dose to the site of the oncological process remains high.

A new type of radiotherapy includes proton beam therapy. Here protons are replaced x-rays. The proton beam slightly damages healthy tissue, but reaches and destroys cancer cells. This type of radiation is effective for treating the base of the skull in chordomas and chondrosarcomas.

In case of metastases, surgery is performed followed by radiation therapy, which reduces postoperative complications and relapse. Palliative therapy (symptomatic treatment) is carried out for metastatic and bone cancer of the skull: pain attacks are stopped and vital functions of the body are maintained.

Life prognosis for cancer of the skull bones

To assess the consequences of a diagnosis of skull bone cancer, oncologists use an indicator that includes the number of patients who lived 5 years from the date of confirmation of the diagnosis.

The life expectancy for cancer of the skull bones at the first stage is 80%. With the further development of cancer, cell mutations and their spread beyond the lesion, the prognosis becomes less optimistic. In the second and third stages, up to 60% of patients survive. In the terminal phase and with metastasis, treatment of cranial tissue formations may have a negative result. The aggressive behavior of the tumor and damage to the central nervous system leads to death.

Life expectancy for tumors of the skull bones is late stages after treatment lasts 6-12 months. Most disappointing forecast with multiple metastatic lesions. Neurological disorders persist in 30% of patients after treatment.

Informative video

Bone pain or ossalgia is characteristic of some diseases and pathological conditions. It is important to differentiate the nature of the pain.

In some cases, pain in muscles, joints, ligaments and tendons is mistaken for ossalgia. Although often pain in these anatomical formations can be combined with bone pain. Depending on the causative factors, ossalgia can be felt in the long bones, ribs, bones of the skull and pelvis.

Intense and inadequate physical activity negatively affects musculoskeletal system. A syndrome called overtraining is formed. This syndrome, along with general weakness, decreased endurance and muscle strength, may be accompanied by painful sensations in the bones.

Growth period

Rapid growth of bones in length in childhood and adolescence is also sometimes manifested by ossalgia. Mostly the bones of the lower extremities hurt. Due to the increased consumption of calcium, along with pain, cramps in the lower extremities may be felt, mainly at night.

Injuries

Traumatic bone injuries - fractures, bruises, dislocations - all this is accompanied by pain of varying strength. Along with pain that increases with movement, other signs of injury will be noted - bleeding wounds, swelling and soft tissue hematomas.

Bone tumors

Malignant bone tumors (osteosarcoma, fibrosarcoma, Ewing's sarcoma, histiocytoma, etc.), in addition to progressive pain, are manifested by general exhaustion (cachexia), weakness, fever, and damage to other organs. Due to structural disorders of bone tissue, spontaneous fractures are not uncommon. Malignant bone tumors are not only primary, but also metastatic.

In these cases, the tumor initially forms in other organs, and then metastases develop in the bones. Not only malignant tumors themselves, but also their treatment with chemotherapy can cause bone pain. In rare cases, bone tumors can be benign. These tumors include osteomas, which mainly form in the humerus, femur, and skull bones. Osteomas grow slowly and do not immediately cause pain.

Hemoblastoses

Malignant tumors of the hematopoietic system or hemoblastosis affect the bone marrow and manifest as ossalgia. Hemoblastoses include myeloma, acute and chronic leukemia, various types of lymphomas.

Bone pain in these diseases is felt mainly in the sternum, ribs, bones of the spine and pelvis. Along with pain, progressive weakness, fever, enlargement of the liver, lymph nodes, spleen, and infectious complications are noted.

Osteomyelitis

This is a purulent inflammation of bone tissue and bone marrow. A purulent infection (staphylococcus, streptococcus, proteus) penetrates into the bone tissue when open injuries or brought from distant foci hematogenously (blood flow).

Osteomyelitis can affect any bone, but most often it develops in large bones - the humerus, femur and tibia.

Men and children are more susceptible to osteomyelitis. The disease, as a rule, proceeds violently with fever, chills, nausea, vomiting, and a progressive deterioration in the general condition of the patient.

The pathological process from the bone and periosteum spreads to nearby soft tissues. The skin turns red, swells, and often a fistulous defect forms on its surface, from which pus is released. Sharp pain in the bone it intensifies even more with the slightest load.

Specific infections

The causative agents of tuberculosis and syphilis (Koch bacillus, Treponema pallidum) over time can cause destructive changes in the bones, accompanied by pain.

Bone tuberculosis in most cases affects the spine, destroying the vertebrae and causing excruciating pain. Tubular bones are less frequently involved.

Syphilitic lesions usually affect the ribs, sternum, bones of the forearms and legs, as well as the nose and palate. It is noteworthy that bones are affected in the late, fourth stage of untreated syphilis.

Osteoporosis

This type of metabolic disorder is manifested by a decrease in bone density, and, as a result, painful sensations and pathological bone fractures. Osteoporosis mainly develops in the bones of the spine and in the long bones of the limbs. This is a polyetiological condition due to many reasons.

Among them are a deficiency of vitamins D and B1, a lack of calcium intake from food or a violation of its absorption in diseases of the gastrointestinal tract. Osteoporosis often occurs in old age, and in women after menopause.

This condition is caused by endocrine diseases, as well as some systematically taken medications - corticosteroids, anticoagulants, certain groups of antibiotics and anticonvulsants. A key role in the development of this condition is played by osteoclasts - specific cells that destroy bone tissue.

Diagnostics

Pathological changes in bone tissue are detected during radiography, which is carried out in 3 projections. However, conventional radiography is not very informative for diagnosing osteoporosis. To do this, densitometry is used - radiography or ultrasound of bones using a special technique using appropriate equipment.

To diagnose hemoblastoses, a puncture (puncture) of the lymph nodes or sternum (to obtain bone marrow) is performed, followed by a histological examination of the obtained material. To eliminate ossalgia, painkillers alone are not enough - the causative factor must be eliminated. Depending on the nature of this factor, treatment is carried out by a surgeon, orthopedic traumatologist, oncologist, endocrinologist, and hematologist.

Cancer is one of the most terrifying and unpredictable diseases known to medicine. There are many types of cancer pathologies, each of which poses a serious danger to human life. Bone cancer is one of the types of this pathological process that can affect the human body.

According to statistics, cancer bone structures is the rarest. At the same time, the disease is more often diagnosed in children and adolescents; people over 30 years of age suffer from this form of pathology extremely rarely, in only 2% of cases. Now we will understand what kind of disease this is, what are its causes and symptoms, types, and methods of control.

First of all, it is worth saying that the word cancer itself in medicine means a pathological process in which rapid and uncontrolled division of cells that form a tumor occurs. The neoplasm, wherever it appears, constantly increases in size, affecting nearby tissues. Doctors distinguish only two types of tumors:

1. Malignant – the development of a malignant tumor represents greatest threat human life, since this type of neoplasm can spread throughout the body and give metastases. In the final stages of metastasis, cancer cells malignant formation affect the entire body, the process ends in death.
2. Benign – the appearance of benign tumor neoplasms is considered a conditionally safe process. Such tumors grow extremely slowly and do not metastasize; they are removed surgically without further treatment. The neoplasm itself is called benign if it is surrounded by healthy tissue.

Cancer of the joints and skeletal system as a whole “submits” to the same gradation. In addition, there are two separate types of bone cancer:

1. Primary – the neoplasm originates directly in the bone tissue. If we're talking about about the back, this is the spine, if about the lower extremities, a certain area of ​​the leg, etc.
2. Secondary - cancer begins not in the bones, but in any affected organ in any part human body. Over time, at the metastasis stage, metastases appear in the bones, spreading throughout the body from the mentioned organ. The secondary type of bone cancer is more common than the primary one.

It is important to understand that cancer cells can develop in any bone structure. It doesn’t have to be bones; oncology begins in the joints, cartilage, and periosteum.

As mentioned earlier, the disease most often affects people under 30 years of age. At this age, as well as in children, oncology is more often localized in the bones of the lower extremities; in older people, the bones of the skull are more likely to be affected.

Reasons

Despite the fairly high level modern medicine and the active study of bone cancer by scientists, the true causes of the development of tumor formations, as well as bone cancer, have not yet been established. Despite this, doctors identify a number of reasons that, in their opinion, predispose or at least precede the development of the disease.

Causes of bone cancer:

• Bone marrow transplant.
• Exposure of the body to ion radiation, prolonged or repeated exposure to ionizing rays.
• Related genetic diseases, among which the most dangerous are retinoblastoma, Li-Fraumeni or Rothmund-Thompson syndrome.
• Paget's disease, in which disturbances in the regenerative abilities of bone tissue occur, followed by the occurrence of disorders in bone structures.
• The development of primary clinical cancer is facilitated by injuries, mainly bone fractures. In this case, the injury may even be ten years old.

All of the above points relate directly to bone tumors, that is, the primary type of oncology. As for the secondary type of pathology, it is preceded by neoplasms of a different localization. In most cases, we are talking about the most common types of cancer, that is, lung, breast, and prostate cancer metastasizes.

Spine cancer

Despite the fact that spinal cancer has no differences with everything said earlier, it is worth talking about it separately. This is explained severe course tumor formation in spinal column, because the spinal cord is located here, and the spine itself plays a colossal role in the human body.

In addition, for example, cancer thoracic spine will be symptomatically different from the same neoplasm in another region.

But first of all, it is worth saying that doctors distinguish three separate types of spinal cancer, depending on the location of the tumor:

• Extradural - the tumor is localized outside the dura mater of the spinal cord. Such a tumor often gives metastases, but they do not affect the functions of the central nervous system.
• Intradural – tumor growth occurs directly into the structure of the dura mater. The main danger is compression of the spinal cord, which only aggravates the pathological process.
• Intramedullary - the neoplasm is localized in the very spinal cord, its increase is accompanied by the loss of certain functions. In this case, it all depends on in which part the tumor grows, for example, oncology lumbar region spine, among other things, threatens paralysis of the lower extremities.

Symptoms of the disease

The development of bone cancer is accompanied by certain symptoms, which become more varied as bone cancer develops and the tumor increases in size.

If we talk about the general clinical picture, the symptoms and manifestations are as follows:

• Pain is the main one cancer symptom. Painful sensations have a clear localization at the site of growth of the malignant tumor. Pain syndrome permanent, does not disappear depending on body position. Pain increases with any physical activity, movements, and also at night, when the muscles relax.
• Edema – also forms at the site of tumor growth, for example, in one of the lower extremities. The swelling is encircling; it surrounds the tumor, but is clearly visible only when the tumor reaches a significant size. When it comes to defeat internal bones in the pelvic area or other hard-to-reach area, swelling may not be visible.
• Deformation of the affected area, which should not be confused with edema, and this is difficult to do. This clinical sign is characterized by protrusion, swelling, swelling of the skin on the affected area of ​​the body. The deformation has the shape of a tubercle, sometimes uneven, its size depends on the size of the growing tumor.
• Impaired motor functions are not always observed, mainly in cases where the tumor is localized near movable joints or structures on which motor functions, innervation of the limbs, etc. depend. A striking example would be hip cancer closer to knee joint. As the tumor grows, it will become more difficult to move your knee, and your leg may become numb or tingly.
• TO general symptoms Oncology also includes signs of causeless weight loss, the appearance of fever (often low-grade), systematic lethargy, loss of appetite, and excessive sweating.

In addition to the general clinical picture, we can identify characteristic symptoms inherent in certain types of bone cancer:

In most cases, the clinical picture of bone cancer is obvious, but only in the later stages. As for the onset of the disease, you should be concerned about any deterioration in your general condition that lasts more than one week.

Types of tumors

As mentioned earlier, doctors distinguish between benign and malignant neoplasms in bone cancer. Besides, oncological process characterized depending on the location of the tumor, the characteristics of the course, which affect the principles of treatment. For these reasons, it is worth talking about each type of tumor separately.

Ewing's sarcoma

This type of neoplasm belongs to malignant ones; it affects mainly tubular bones. It is more common in the lower extremities, spine, pelvis, ribs, collarbone, and shoulder blades.

Ewing's sarcoma is diagnosed primarily in people between 10 and 15 years of age. In most cases, the tumor directly affects bone structures, since doctors associate its development with injuries. Extraosseous cases of tissue damage are extremely rare.

Even at the beginning of its development, Ewing's sarcoma can already metastasize, affecting soft tissues, organs, bone marrow, central nervous system. For this reason, this type of tumor is considered one of the most aggressive and dangerous.

Osteosarcoma

Osteogenic sarcoma is one of the most common types of bone cancer. The formation of a neoplasm begins with changes in bone structures, develops quickly and gives metastases in the early stages.

In most cases, bone tissue damage occurs in the legs, but there are also known cases of localization in the area shoulder girdle and pelvic bones. If we talk about the limbs in general, most often this type of oncology affects the knee or elbow joints in a child's body.

According to statistics, this type of oncology is more often diagnosed in males. The disease mainly affects people from 10 to 30 years old, but it is likely to occur at any age. The peak incidence and rate of tumor development occurs during the period of bone growth (adolescence), and is more often diagnosed in tall, tall people.

Chondrosarcoma

It grows predominantly in cartilaginous tissues or flat bone structures; it has rarely been diagnosed in other bones. The “favorite” location is the area of ​​the larynx and trachea, since small bones are located here.

There are two scenarios for tumor development:

• Favorable – slow growth with a late stage of metastasis.
• Unfavorable – rapid growth with metastases in the early stages.

It is more often diagnosed in people over 40 years of age, but exceptions are possible.

Fibrosarcoma

It is formed mainly in connective tissues, muscles and tendons, located deep. Only after this the tumor spreads and affects bone tissue. The main place of damage is the legs.

Hondarma

A rare type of cancer, according to some data, developing from embryonic tissues and their residual mass. Localized in the sacrum or bone structures of the base of the skull.

By its structure, this tumor is considered benign. But due to the specifics of its localization, as well as high probability compression of vital nerve branches and organs due to tumor growth, it is regarded as malignant.

Histiocytoma

Malignant neoplasm affecting the upper and lower limbs, trunk, especially the bones in the peritoneal area. Growth occurs in tubular bones of small and large sizes. The neoplasm quickly passes into the stage of metastasis; in most cases, metastases affect the lung tissue.

Parosteal sarcoma

A subtype of osteosarcoma, much rarer and less different aggressive course. The site of development is the surface of the bone, the growth of the tumor is slow, it is less malignant, so to speak.

In most cases it affects the femoral or tibia, in less than 30% of cases it is localized on the bones of the skull, spine, pelvis, hands or feet.

Eosinophilic granuloma

The nature of the development of this type of neoplasm is unknown. According to statistics, this type tumors most often affect children preschool age. The pathology is characterized by numerous foci that “attack” hollow and tubular bones.

The tumors themselves are granulomas, that is, infiltrates, the structure of which contains high concentration eosinophilic leukocytes. This type of neoplasm is considered benign.

Chondroblastoma

Perhaps the most controversial type of neoplasm, as it can be benign or malignant. It is formed from cartilage tissue and is formed in different parts skeleton in tubular long bones.

Diagnosed in patients over 20 years of age, it is localized in the pelvis, hips, and feet. However, it can develop in the ribs, spine, collarbones, shoulder blades, etc. There is a possibility that after surgery, during which the tumor was not completely removed, it may degenerate into malignant.

Osteoma

It is diagnosed mainly in children and young people under 20 years of age. This type of tumor is benign and is not prone to rapid growth, does not metastasize, and also does not grow into nearby organs and tissues.

Osteomas can form from bone and connective tissue on the humerus, tibia and femur, as well as the thin bones of the skull. Moreover, when osteomas appear, there are no symptoms. The only exceptions are those cases when the tumor reaches a large size and puts pressure on any organ.

Angioma

In most cases, angioma is a vascular formation that is formed from blood or lymphatic vessels. Angioma can also affect bone tissue, but these cases are rare.

Chondromyxoid fibroma

A benign neoplasm that mainly affects long tubular bones, but in rare cases exceptions are possible, with germination in other bone structures. The growth of the tumor is accompanied by painful sensations, and there is a possibility of its degeneration into malignancy.

Chondromyxoid fibroma is a very rare oncological manifestation; in the worst cases, it causes muscle atrophy in the area of ​​localization or limitation of joint mobility, if there is one nearby.

Giant cell tumor

A benign tumor that does not metastasize and is localized in the terminal areas of the bones. In this case, the tumor often grows into nearby tissues, and its main disadvantage is that even after surgical removal of the tumor, it can grow again.

Osteoid osteoma

Single benign education, not growing more than 1 centimeter in diameter. The tumor can develop in any bone structure of the human skeleton. Moreover, osteoid osteoma is rarely diagnosed, since it is small, and when it appears there are no symptoms.

Stages of bone cancer

Recognizing the stage of development of the pathological process plays a decisive role in setting up treatment, and sometimes predicting life. In total, there are 4 stages of bone cancer development:

1. Education does not leave the bone. Tumors at the first stage are divided by size, above and below 8 centimeters.
2. The tumor is still limited to the bone, but tests confirm signs of cellular malignancy.
3. The tumor spreads to several bone structures, and cancer cells penetrate into the area of ​​regional lymph nodes.
4. The fourth stage is characterized by the growth of the tumor beyond the bone, onto nearby tissues. With stage 4 bone cancer, the process of metastasis begins.

Diagnostics

Bone cancer always requires diagnosis. To do this, you need to consult a doctor, who will prescribe the necessary diagnostic measures. Diagnosis is necessary to identify cancer cells in principle, determine the stage of development of oncology, and prescribe treatment.

Diagnostic methods are as follows:

• The first thing to do is to take an x-ray of the bones at the suspected location of the tumor.
• The patient in mandatory You need to donate blood for a test that detects tumor markers for cancer.
• Isotope scanning - a special substance is injected into the bloodstream, which is absorbed by bone tissue. Then a special scanner is used to “highlight” the substance in the bones and detect even the smallest formations.
• Computed and magnetic resonance tomography.
• A biopsy of tumor tissue to determine the type of tumor (malignant or benign).

How to treat bone cancer

Treatment of any cancer– a complex and painstaking process, especially for bone cancer. Cancer should be treated only by contacting an oncologist, who will make a diagnosis and prescribe a treatment regimen based on the diagnostic data obtained.

It is important to understand that for each patient and specific case of the disease, treatment is prescribed individually. For some, this means radiation and chemotherapy, but in most cases they still resort to surgical removal tumors or parts of bone. In the second case, the bone is subsequently replaced by a special prosthesis. In particular difficult situations Together with the patient, a decision is made to amputate the affected limb.

How long do you live with bone cancer?

The life expectancy of people with bone cancer is, again, controversial and has a huge number of variables. It is necessary to take into account the location of the tumor, the stage of its development, the type of tumor, the presence or absence of metastases, the age of the patient, etc.

Of course, the most favorable prognosis will be if the cancer was detected at the first stage and the tumor was completely removed. After this, irradiation is carried out and the survival rate exceeds 80%. The higher the stage of cancer, the more unfavorable factors, the lower this figure.

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Skull bone tumors divided into primary and secondary (germinating or metastatic), characterized by benign or malignant growth. Among primary benign tumors of the calvarial bones, the most common are osteomas and hemangiomas. Osteoma develops from the deep layers of the periosteum. Its occurrence is associated with a violation of embryonic development and hand formation. With growth, a compact osteoma is formed from the outer and inner plates of the kernel substance, and a spongy (spongy) or mixed form of osteoma is formed from the spongy substance. It is also possible to develop osteoid osteoma. Osteomas, as a rule, are single, less often - multiple. In the bones of the skull... compact osteomas predominate. They are characterized by slow growth, may not appear clinically for a long time, and are sometimes accidentally discovered during X-ray examination. If clinical symptoms are present, surgical treatment is removal of the osteoma. The prognosis is favorable.

Hemangioma of the skull bones rarely occurs. Localized in the spongy substance of the frontal and parietal (less often occipital) bones. In the bones of the cranial vault. Usually a capillary (spotted) hemangioma develops, less often a cavernous or racemotic form. Clinically, hemangioma is often asymptomatic and detected incidentally on an x-ray. In this case, the integrity of the bone plate, which is important for radiation or surgical treatment, is clarified using axial computed tomography data.

Benign neoplasms in the soft tissues of the head can secondary locally destroy the bones of the cranial vault.

Dermoid cysts They are usually located at the outer and inner corners of the eye, in the area of ​​the mastoid process, along the sagittal and coronal sutures, etc. They are located under the aponeurosis, which causes the development of skull bone defects, saucer-shaped marginal defects, followed by complete destruction of all layers of the bone. In rare cases, a dermoid cyst develops into a diploe on radiographs of the skull... a cavity with smooth walls is visible.

Eosinophilic granuloma or Taratynov's disease characterized by local bone destruction caused by the intraosseous development of granulomas consisting of histiocytic cells and eosinophils. Usually a solitary bone granuloma is detected, less often - several foci, and very rarely - multiple skeletal lesions. Most often these changes are localized in the flat bones of the skull and the femur. The flat bones of the pelvis, ribs, vertebrae, and jaws may be affected. Treatment of benign tumors is surgical. The prognosis is favorable.

Cholesteatoma can be located in the soft tissues of the head, most often under the aponeurosis. In this case, extensive defects of the outer bone plate and diploe are formed with clear scalloped edges and a marginal band of osteosclerosis. Cholesteatoma located in the diploea is radiologically identical to a dermoid or teratoma. Treatment is surgical. The prognosis is favorable.

Primary malignant tumors of the bones of the cranial vault include... osteogenic sarcoma. However, secondary sarcoma is more common, developing from the periosteum, dura mater of the brain, aponeurosis and paranasal sinuses. Sarcomas develop at a young age, are large in size and have a slight tendency to decay, quickly grow into the dura mater and give metastases. On the radiograph, the lesion has an uneven outline, with borderline osteosclerosis; When the tumor grows beyond the cortex, radiant periostitis appears in the form of fan-shaped diverging bone spicules. Since osteogenic sarcoma develops from primitive connective tissue capable of forming bone and tumor osteoid, the X-ray picture combines osteolytic and osteoblastic processes, which is clearly visible on computed tomograms. Antitumor drugs and radiation therapy are prescribed, and in some cases surgical treatment is indicated.

The bones of the cranial vault are affected by multiple myeloma in the form of a solitary focus (plasmocytoma); diffuse damage is less common. At the same time, pathological foci can be detected in the ribs, pelvic bones, spine, tubular bones, and sternum. A disorder of protein metabolism in the form of paraproteinemia is characteristic: a-, b- and g-plasmocytomas are differentiated by an increase in the amount of globulins. Sometimes the tumor grows into adjacent tissue (for example, into the dura mater of the brain). The main clinical symptom is pain in the affected bones. The diagnosis is established on the basis of clinical and laboratory data, the results of a bone marrow punctate examination and an x-ray picture. Treatment consists of prescribing antitumor drugs and radiation therapy. Sometimes surgery is indicated. The prognosis is unfavorable.

Metastasis to bone of the cranial vault is observed in primary cancer of the lung, breast, thyroid and parathyroid glands, kidney, and prostate. Foci of bone destruction are localized in the cancellous bone and have a wide zone of sclerosis, which moves outward as the metastasis increases. Metastases of kidney adenocarcinoma are characterized by local bone destruction with the formation of intra- and extracranial nodes. Multiple lytic small-focal metastases of different configurations in the bones of the calvarium, reminiscent of multiple foci in myeloma, are observed in malignant chromaffinoma of the adrenal glands, mediastinum, and liver.

Of the benign tumors of the skull, the most common are atheromas, somewhat less frequently angiomas and dercoids, and very rarely fibromas, lipomas and neurofibromas.

Atheromas of the head more common in adulthood.

Clinically atheroma (retention cyst sebaceous gland) is a slowly growing painless tumor with a smooth surface, soft or tightly elastic to the touch. Large atheromas fluctuate. The size ranges from a pea to a potato. The tumor is covered with unchanged or somewhat thinned skin, with which it, as a skin derivative, is closely connected and with which it easily moves in relation to the underlying tissues.

Atheromas are often single, less often multiple. They are located mainly in the scalp, especially often in the parietal region. The course of the disease is sometimes complicated by suppuration or malignant degeneration. The tumor must be removed carefully; not a single piece of the membrane should be left, otherwise a relapse is inevitable.

Dermoids represent cysts formed from particles of the ectodermal layer included in the underlying tissue in the embryonic period of life. The wall of the cyst is lined with skin containing sebaceous and sweat glands and hair follicles. The contents of the cyst consist of a pasty mass formed from discharged skin glands and exfoliated epithelium, often mixed with hair.

Clinically, a dermoid is a slowly growing, painless, round, smooth, tight-elastic tumor ranging in size from a pea to a tangerine or larger. Dermoids, usually buried deep, are loosely connected to the skin. Unlike atheromas, the skin easily moves over the tumor. In the bone under the tumor, due to prolonged pressure, a depression is sometimes formed, the edges of which can be felt around the circumference of the tumor in the form of a hard ridge.

The depression in the bone sometimes turns into a hole, and the tumor comes into contact with the dura mater. Typical locations of dermoids: median canthus, temporal and occipital region, region mastoid process and the lateral end of the eyebrow. Clinically, dermoids are detected in childhood and adolescence.

Dermoids located at the inner canthus can be mistaken for a cerebral hernia. Distinctive features the latter is due to greater softness, compressibility (not always) and a defect in the cranial bone, ascertained by x-ray. Lipomas are distinguished by their lobulation and great softness.

Dermoids are removed surgically. To avoid relapse, the cyst shell should be bluntly isolated or completely cut out. During surgery, one must keep in mind the possibility of skull distortion and, consequently, damage to the dura mater.

Hemangioma of the skull found in all its characteristic forms.

Superficial capillary hemangioma looks like a more or less extensive spot with a smooth or slightly bumpy surface and is usually located on one side of the head. Capillary hemangioma involves only the skin and does not extend to the subcutaneous tissue. If arterial capillaries predominate, the spot is bright red; if venous capillaries are developed, it is blue-red. Superficial hemangioma is a congenital formation, therefore it is also called vascular birthmark(naevus vasculosus).

For therapeutic purposes, electrocoagulation, cauterization with a hot needle, x-ray therapy, radiotherapy, surgical removal of hemangioma with subsequent closure are used. significant defect large epithelial flaps obtained using a dermatome, or a lattice flap.

Cavernous cavernous hemangioma (haeman-gioma cavernosum) is a cluster of blood-filled cavities communicating with each other and with small blood vessels. The most common are cavernous hemangiomas, located in the subcutaneous tissue.

Clinically, cavernous hemangioma appears as a red spot or soft nodule that appears through thin skin or protrudes onto its surface. With pressure, the angiomatous node collapses.

The tumor may be congenital or may appear in early childhood, developing from an initially imperceptible congenital rudiment. Small cavernous hemangiomas sometimes disappear spontaneously, but more often they slowly enlarge. Often, the growth of a hemangioma is greatly accelerated, and the tumor in a short time engulfs a significant area of ​​neighboring tissues, growing over a long distance and even usurizing the bone.

Once ulcerated, the hemangioma can become a source of heavy bleeding. Rarely, cranial hemangiomas, especially those located in the midline, communicate with intracranial blood vessels, for example, with venous sinuses.

Due to the usually rapid growth and sometimes observed malignant degeneration, cavernous hemangiomas must be surgically removed. Bleeding during surgery is perfectly prevented, as the experience of our clinic has shown, by preliminary application around the tumor of a looped hemostatic suture used during craniotomy. Small superficial cavernous hemangiomas can also be successfully treated with electrocoagulation or radium rays.

Branched hemangioma (haemangioma racemosum), also called serpentine aneurysm (aneurysma cirsoides), is rare and is a flat, irregularly shaped, pulsating tumor consisting of elongated, tortuous and highly dilated vessels.

The essence of the disease is a broad communication arterial system with a vein. The veins are arterialized. The number and caliber of capillaries are extremely increased. On the tumor, a constant noise is heard that increases with systole, caused by numerous anastomoses between arteries and veins.

Anastomosis is sometimes single. Its presence and location are determined by arteriography. Most often, a serpentine aneurysm is observed in the area of ​​branches of the temporal artery, less often in the area of ​​other branches of the external carotid artery. Sometimes it spreads to the entire half of the head. The disease develops in connection with a head injury or from a cavernous hemangioma and tends to progress.

A radical cure can only be achieved complete removal tumors. To limit bleeding, which is sometimes dangerous, a preliminary ligation of the adductor artery is performed and the tumor is cut around the circumference with a hemostatic suture, and an elastic tourniquet is applied around the skull. In the case of a single anastomosis, the communication between the artery and vein is first closed.

Neurofibromas are very rare. These are multiple small, dense, painless tumors in the thickness of the skull, congenital or detected in early childhood. The starting point for the formation of tumors is the nerve sheath. Neurofibromas of the head can also be a manifestation of general neurofibromatosis. Surgical intervention is indicated for large single nodes or when there is a threat of malignant degeneration.

Malignant tumors of the skull

Of the malignant tumors of the skull, cancer is often encountered and sarcoma is much less common.

Cancer of the skin covering the skull originates from the skin epithelium or from the epithelium of the sebaceous or sweat glands and hair follicles and is seen almost exclusively in the more benign superficial basocellular form. The more malignant spinocellular form, which tends to spread early and metastasize to the lymph nodes, is rare. Treatment of skin cancer of the skull area is carried out according to the same rules as the treatment of facial skin cancer.

Sarcoma of the skull in the initial stage is a dense skin nodule, which quickly enlarges and soon ulcerates. Growing deeper, the tumor often grows into the underlying cranial bone. Surgical treatment gives better results in combination with x-ray or radiotherapy.