RU2653813C2 - Craniocorrector - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: invention relates to medical technology, in particular to devices, used in pediatric neurosurgery for partial / complete elimination of deformities of cranial vault in child with craniosynostosis (both mono- and polysynostosis after surgical treatment), hydrocephalus (any of its variants both before and after surgical treatment) used to correct pathological relief of cranial vault / prevent development of deformity of cranial vault in children with hydrocephalus and positional plagiocephaly. Craniocorrector contains shell with radial incisions in frontal and/or occipital and/or parietal-temporal region. At Dendi point, there are cuttings under pump of ventriculoperitoneal shunt and/or under pocket of ventriculosulbular shunt.

EFFECT: use of invention will allow craniocorrection of arch in early postoperative period and further for a long time, and also to ensure possibility of uniform impact on pathological relief of cranial vault without additional pressure on cranial vault bones.

1 cl, 3 dwg

Description

The invention relates to medical equipment, in particular to devices used in pediatric neurosurgery for partial / complete elimination of deformity of the cranial vault in a child with craniosynostosis (both mono-and polysynostoses after surgical treatment), hydrocephalus (any of its kind, both before and after surgical treatment, used to correct the pathological relief of the cranial vault / prevent the development of deformation of the cranial vault in children with hydrocephalus and positional plagiocephaly.

According to the international application for the invention WO 2014133091 a helmet for correction of cranial deformities is known, comprising a detachable rigid outer shell open at the top, equipped with ventilation holes and an inner liner.

Closest to the claimed technical solution is the craniocorrector known in the patent US 6154889, made in the form of a shell with radial cuts made in the frontal, occipital and parietal-temporal region.

A disadvantage of the known device is the lack of access to the Dandy point, as well as to the large and small fontanelles.

The technical result of the invention is: providing access to the Dandy point for the purpose of craniocorrection of the arch already in the early postoperative period, as well as access to the large and small fontanelles in order to monitor the condition of the patient, while the above actions are performed without the need to remove the device.

The technical result is achieved by the fact that in a craniocorrector containing a shell with radial incisions of the frontal, and / or occipital, and / or parietal-temporal region, according to the invention, clippings for a ventriculoperioneal shunt pump and / or for a pocket of a ventriculosubgaleal shunt are contained in the Dandy point.

Clippings at the point of the Dandy under the pump of the ventriculoperitoneal shunt and / or under the pocket of the ventriculosubgaleal shunt allow craniocorrection of the arch already in the early postoperative period without exerting pressure on the ICP pump (ventriculoperitoneal shunt); , these clippings allow you to track the condition of the VPSh pump and the VSSh pocket, without removing the structure if necessary.

Clippings for large and small fontanelles - allow you to visualize the condition of the fontanelles, large and small, if they are not closed taking into account age, to control the pulsation of the brain in the incision area, which makes it possible to control the level of ICP (intracranial pressure), the condition of the skin. These clippings make it possible to conduct USG (ultrasonography) of the brain through the large fontanel of the child, especially in the neonatal period.

Conservative correction of the cranial vault is carried out using a craniocorrector as a treatment and rehabilitation measure both before and after 1.5-4 weeks after surgical treatment.

Examples of specific applications of the invention.

Observation number 1. Patient A., 1.5 years. The main diagnosis: Non-syndromic isolated craniosynostosis of the coronary suture on the right. Anterior plagiocephaly. Surgical treatment: cranioplasty of metopic craniosynostosis. Cystic-gliotic posthemorrhagic changes in the temporal-occipital region on the left. Cyst of the left parietal-temporal region. Condition after endoscopic fenetration of a cyst of the left parietal-temporal region. In the postoperative period, the patient underwent MSCT of the head. Taking into account the MSCT data of the head in a child, severe deformity of the cranial vault according to the type of anterior plagiocephaly, there is no data for a relapse of craniosynostosis. Considering the mother’s complaints about the pronounced deformation of the cranial vault in the child and the data of objective examination, namely, the pronounced deformation of the cranial vault according to the type of anterior plagiocephaly, as well as the mother’s request for conservative craniocorrection, the child was taken under observation at the Department of Surgery at the Faculty of Surgery of the Faculty of Pediatric Surgical Surgery, Ural State Medical University for South Health using the method of conservative craniocorrection of the cranial vault in children using the “craniocorrector of the arch - a universal model for craniosynostosis (mono / polysynostosis after perativnogo treatment), hydrocephalus. " Given the MSCT data of the brain and cranial bones, there are no contraindications. Parental consent is obtained.

Neurologically, at the time the craniocorrection of the arch began (April 2015): In the mind, he is interested in a toy, plays with toys, the child is active, age-oriented. Pupils D = S. The reaction of the pupils to the light is alive. The corneal reflex is alive. Eye slots D = S. The face is symmetrical. Head in the midline. Tongue in the midline. There are no bulbar disorders. Passive and active movements in full. There are no paresis. SJR D = S, live. Abdominal reflexes are invoked, without a clear difference of sides. Convulsions, no hyperkinesis. Negative meningeal syndrome.

Locally: the skin flap in the projection of the postoperative bone defect is not strained, the pulsation is moderate, the postoperative scar is consistent, without inflammation, normotrophic.

After the patient has passed the period of adaptation to the craniocorrector of the arch, lasting for 1 month and reaching the 5th month of observation, the time interval from 4 to 16 hours, including daytime sleep, positive results were obtained in the form of a partial alignment of the relief of the cranial vault, the absence of recurrence of craniosynostosis, the absence of hypertensive syndrome and negative neurological symptoms. There are no trophic violations when using a craniocorrector of the arch. There are no complaints from the patient and his mother. Received a positive result. The goal is achieved.

Observation number 2. Patient B., 4.5 months. The main diagnosis: Occlusive hydrocephalus. Hypertensive hydrocephalic syndrome. ZPMR. VSGSh VPSh. In the postoperative period, the patient underwent MSCT of the head. Taking into account the MSCT data of the head, the patient has occlusal hydrocephalus, the state after HSS, CPS. Considering the mother’s complaints about the pronounced deformation of the cranial vault in the child and the data of objective examination, namely, the pronounced deformation of the cranial vault, as well as the mother’s request for conservative craniocorrection, the child was taken under observation at the Department of Surgery of the Faculty of Surgery of the Faculty of Pediatric and Occupational Health Care at South Ural State Medical University with the Conservative Method craniocorrection of the cranial vault in children using the “craniocorrector of the arch - a universal model for craniosynostosis (mono / polysynostosis after surgical treatment), hydroceph Leah. " Given the MSCT data of the brain and cranial bones, there are no contraindications. Parental consent is obtained.

Neurologically at the time the craniocorrection of the arch began (January 2015): In consciousness, ZPMR. Holds his head briefly, tries to roll over from his back to his stomach, holds the toy. Emotions saved, reacts calmly to the inspection. Pupils D = S, pupil photoreaction live. The corneal and conjunctival reflexes are living. The gaze fixes, monitors the subject. Gref's symptom is negative. The movements of the eyeballs in full. The response to the sound is saved. The face is symmetrical. Tongue in the oral cavity in the midline. The tongue does not deviate from the midline during phonation, the palatine curtain does not sag, the palatine and pharyngeal reflexes are alive. There are no bulbar disorders. Hypertonic muscle. Mixed tetraparesis. SJR from the upper extremities, knee and Achilles D = S, abdominal without a clear difference of sides. There are no violations of sensitivity. The functions of the pelvic organs are not impaired. Negative meningeal syndrome. There are no pathological reflexes, convulsions and hyperkinesis.

Locally: The head circumference is 43.5 cm, the large fontanel is not strained, its pulsation is moderate, diastasis between the bones of the skull is up to 0.5 cm, the HPS pump at the Dandy point is straightened, it is easily pumped and straightened, the HPS system works satisfactorily, the postoperative scar is normotrophic , linear in shape without signs of inflammation.

After the patient has passed the period of adaptation to the craniocorrector of the arch, lasting for 2 months and reaching the 8th month of observation, the time interval from 4 to 12-16 hours per day, including daytime sleep, a positive result is obtained in the form of a partial alignment of the relief of the cranial vault, confirmed after the passage of the MSCT of the head in dynamics 5 months after the start of the observation, the absence of hypertension syndrome with the use of craniocorrector arch and negative neurological symptoms.

After 8 months of observation, neurologically: in the mind, ZPMR. Holds his head, tries to roll over from his back to his stomach, holds a toy, sits with support, stands in a walker. Emotions are saved, reacts calmly to the inspection, plays and is interested in toys. Pupils D = S, pupil photoreaction live. The corneal and conjunctival reflexes are living. The gaze fixes, monitors the subject. Gref's symptom is negative. The movements of the eyeballs in full. The response to the sound is saved. The face is symmetrical. Tongue in the oral cavity in the midline. The tongue does not deviate from the midline during phonation, the palatine curtain does not sag, the palatine and pharyngeal reflexes are alive. There are no bulbar disorders. Muscle tone saved. Mixed tetraparesis. SJR from the upper extremities, knee and Achilles D = S, abdominal without a clear difference of sides. There are no violations of sensitivity. The functions of the pelvic organs are not impaired. Negative meningeal syndrome. There are no pathological reflexes, convulsions and hyperkinesis. Speech is syllables.

Locally: the large fontanel is closed, the HPS pump is in a straightened state, the HPS system is functioning satisfactorily, the postoperative scar is linear in shape without inflammation, normotrophic. There are also no trophic violations when using the craniocorrector of the arch, as in the first case. There are no complaints from the patient and his mother. Received a positive result. The goal is achieved.

Thus, the given clinical observations show the high efficiency of the method of conservative craniocorrection of the cranial vault in children using the "craniocorrector of the arch - a universal model for craniosynostosis (mono / polysynostosis after surgical treatment), hydrocephalus" in the form of partial alignment of the relief of the cranial arch even in such short observation periods (up to 5-12 months). With a longer observation period, a more complete alignment of the relief during arch deformation is possible until it is almost completely eliminated.

Observation number 3. Patient S., 2.5 months. The main diagnosis: Occlusal hydrocephalus as a result of posthypoxic-posthemorrhagic lesions of the central nervous system. Positional plagiocephaly. Surgical treatment - EPS on the right.

Complaints: the mother of the child complains about the deformation of the cranial vault in the child.

Neurologically: In a clear mind, responds calmly to the examination, lively emotions, is interested in a toy. The child is behaving actively. Crying is loud. Pupils D = S. The reaction of the pupils to the light is alive. The corneal and conjunctival reflexes are living. Fixes the gaze, traces the subject. Eye slots D = S. The exit points of the trigeminal nerve branches during palpation and percussion are painless. The face is symmetrical. Head in the midline. Tongue in the oral cavity in the midline. The palatine and pharyngeal reflexes are live. There are no bulbar disorders. Passive movements in full. Mixed tetraparesis is preserved. SJR D = S, live. Abdominal reflexes are invoked, without a clear difference of sides. Negative meningeal syndrome. Convulsions, no hyperkinesis. Physiological reflexes are triggered. Muscle tone is sufficient. Babinsky's reflex is unstable from 2 sides.

Locally: Head of hydrocephalic form, severe deformation of the cranial vault. The subcutaneous vasculature is moderately expressed. Large fontanel 3.5 × 3.5 cm, within the bone margin, moderate ripple. The VPSh pump in the expanded state, the VPSh system functions satisfactorily.

After the patient passed the period of adaptation to the craniocorrector of the arch, lasting for 2 months and reaching the 8th month of observation, the time interval from 4 to 22 hours per day, including the period of day and night sleep, a positive result was obtained in the form of almost complete alignment of the relief of the cranial vault , confirmed after passing the MSCT of the head in dynamics 10 months after the start of the observation, the absence of hypertension syndrome with the use of craniocorrector arch and negative neurological symptoms. After 10 months of observation, neurologically: without cerebral and focal symptoms, the development of the child is age-appropriate. Locally: the large fontanel is closed, the HPS pump is in a straightened state, the HPS system is functioning satisfactorily, the postoperative scar is linear in shape without inflammation, normotrophic. There are no trophic violations when using a craniocorrector of the arch. There are no complaints from the patient and his mother. Received a positive result. The goal is achieved.

Observation No. 4. Patient D., 1 year. The main diagnosis: Non-syndromic isolated craniosynostosis of the coronary suture on the right. Anterior plagiocephaly. Surgical treatment: endoscopic cranioplasty of craniosynostosis.

Complaints: the mother of the child complains about the deformation of the cranial vault in the child.

Neurologically: In a clear mind, he is interested in toys, plays with toys, the child is active, age-oriented. Pupils D = S. The reaction of the pupils to the light is alive. The corneal reflex is alive. Eye slots D = S. The face is symmetrical. Head in the midline. Tongue in the midline. There are no bulbar disorders. Passive and active movements in full. There are no paresis. SJR D = S, live. Abdominal reflexes are invoked, without a clear difference of sides. Convulsions, no hyperkinesis. Negative meningeal syndrome.

Locally: The skin flap in the projection of the postoperative bone defect is not strained, the pulsation is moderate. The postoperative scar is consistent, without inflammation, normotrophic.

Considering the data of an objective examination and MSCT data of the head, the child has a pronounced deformation of the cranial vault by the type of anterior plagiocephaly, a conservative craniocorrection of the arch is recommended.

After the patient has passed the period of adaptation to the craniocorrector of the arch, lasting for 1 month and reaching the time interval from 4 to 23 hours by the 11th month of observation, including the period of day and night sleep, positive results were obtained in the form of almost complete alignment of the relief of the cranial vault, confirmed with the passage of MSCT of the brain and bones of the skull, the absence of recurrence of craniosynostosis, the absence of hypertension syndrome and negative neurological symptoms. After 11 months of observation, neurologically: without cerebral and focal symptoms, the development of the child is age-appropriate. There are no trophic violations when using a craniocorrector of the arch. There are no complaints from the patient and his mother. Received a positive result. The goal is achieved.

Observation No. 5. Patient E., 7 months. The main diagnosis: PCNS. Occlusive internal hydrocephalus due to posthypoxic-posthemorrhagic lesions of the central nervous system. Surgical treatment: HSS, CPS, CM mixed tetraparesis. ZPR.

Complaints: the mother of the child complains about the deformation of the cranial vault in the child.

Neurologically (at the time the observation began): In a clear mind, he is interested in a toy, the child behaves actively. Pupils D = S. The reaction of the pupils to the light is alive. The corneal reflex is alive. Fixes the gaze, traces the subject. Eye slots D = S. The face is symmetrical. Head in the midline. Tongue in the oral cavity in the midline. There are no bulbar disorders. Passive movements in full. Mixed tetraparesis is preserved. SJR D = S, live. Abdominal reflexes are invoked, without a clear difference of sides. Babinsky's reflex is inconstant on both sides. Negative meningeal syndrome. Speech is booming. Holds his head independently, turns over.

Locally: Large fontanel 2 × 2 cm, made within the bone margin, its ripple is moderate. The pump is in a straightened state; the VPSh system is functioning satisfactorily. Marked deformation of the cranial vault.

Taking into account the existing pronounced deformation of the occipital region, frontal region, parietal regions, taking into account the brain MSCT data, a conservative correction of this pathological relief through the use of an individual craniocorrector of the arch is shown. Given the objective data, the neurological status of the child, the MSCT data of the brain, there are no contraindications for conservative craniocorrection. The term of treatment is 2 years. Parental consent is obtained.

7 months after the start of observation:

Neurologically: In a clear mind, he is interested in a toy, plays with toys, the child behaves actively. Pupils D = S. The reaction of the pupils to the light is alive. The corneal reflex is alive. Fixes the gaze, traces the subject. Eye slots D = S. The face is symmetrical. Head in the midline. Tongue in the oral cavity in the midline. There are no bulbar disorders. Passive movements in full. Mixed tetraparesis is preserved. SJR D = S, live. Abdominal reflexes are invoked, without a clear difference of sides. Convulsions, no hyperkinesis. Negative meningeal syndrome. Speech is syllables. He independently holds his head, turns over, sits independently, jumps in jumpers, stands with support, tries to stand on his own, walks with support.

Locally: Large fontanel 0.5 × 0.5 cm. The VPSh pump in the expanded state, the VPSh system functions satisfactorily. Marked deformation of the cranial vault, in dynamics much less (in the frontal and parietal regions). The cranial vault is immobilized in the craniocorrector of the arch; immobilization does not bother. There are no angioeurological disorders. The most pronounced deformity in the occipital region is preserved.

периода ночного сна в прежнем объеме. Лечение продолжать. Динамика положительная.The craniocorrector of the arch wears 2 hours with an interval of 15-20 minutes, including the period of daytime and partly night sleep. The total correction time is up to 14-16 hours per day. The VPSh is adapted to a semi-rigid model with a connector for a pump. Immobilization does not bother. Conservative craniocorrection to continue in the same volume for 1 month. Recommended: the craniocorrector of the arch should be used on

period of night sleep in the same volume. Continue treatment. The dynamics are positive.

Taking into account the data of MSCT control, the state with positive dynamics in the form of a persistent partial correction of the deformation of the cranial vault, the VPSh system functions satisfactorily, continue conservative craniocorrection.

12 months later

Neurologically: In a clear mind, emotions are lively, he is interested in a toy, plays with toys, the child behaves actively. Speech is single words. Pupils D = S. The reaction of the pupils to the light is alive. The corneal reflex is alive. Fixes the gaze, traces the subject. Eye slots D = S. The face is symmetrical. Head in the midline. Tongue in the oral cavity in the midline. There are no bulbar disorders. Passive movements in full. There are no paresis. SJR D = S, live. Abdominal reflexes are invoked, without a clear difference of sides. Convulsions, no hyperkinesis. Negative meningeal syndrome. Speech - single words and syllables. He independently holds his head, turns over, sits independently, stands independently, walks.

Locally: The large fontanel is closed. The VPSh pump in the expanded state, the VPSh system functions satisfactorily. Severe deformation of the cranial vault, in dynamics is much less (in the frontal and parietal regions, almost complete elimination of deformation, taking into account the MSCT of the brain and bones of the skull). Deformation in the occipital region is maintained. The cranial vault is immobilized in the craniocorrector of the arch; immobilization does not bother. There are no angioeurological disorders.

The operation performed during the observation period was the removal of the HSS.

The craniocorrector of the arch wears 2 hours with an interval of 15-20 minutes, including the period of day and night sleep. The total correction time is up to 20-22 hours per day. The child is adapted to the rigid model with a connector for the HPS pump; after removing the HSS, the additional notch for the HSS pocket is closed. Immobilization does not bother. Conservative craniocorrection to continue in the same volume for 3 months. Recommended: the craniocorrector of the arch should be used for the period of day and night sleep in the same volume. Continue treatment. The dynamics are positive.

Taking into account the MSCT control, the dynamics are positive in the form of stable alignment of the deformed areas of the cranial vault, there is no data for VPS dysfunction, the state after VPS, continue correction.

After the patient passed the period of adaptation to the craniocorrector of the arch, lasting for 1 month and reaching the time interval from 4 to 22 hours, including the daytime sleep period, by the 11th month of observation, positive results were obtained in the form of almost complete alignment of the relief of the cranial vault, confirmed by passage MSCT of the brain and bones of the skull, the absence of hypertension syndrome and negative neurological symptoms. After 12 months of observation, neurologically: without cerebral and focal symptoms, the development of the child is age-appropriate. There are no trophic violations when using a craniocorrector of the arch. There are no complaints from the patient and his mother. Received a positive result. The goal is achieved.

The material widely used in orthopedics is used. The outer shell of the “craniocorrector” is made of a polymer bandage, for example, INTRARICHCASTSOFT semi-rigid fixation, is used for hydrocephalus and positional plagiocephaly, craniosynostosis for children under 6 months, because softer skin and open fontanelles, for example, INTRARICHCAST rigid fixation or polyurethane bandage ORTHOFORMACAST, also tight fixation, is used for craniosynostosis and hydrocephalus, positional plagiocephaly after 6 months, because fontanelles already have a tendency to partial closure, the bones of the cranial vault are more dense in structure, and skin integuments are adapted to the rigid frame through the use of a primarily semi-rigid structure or from POLIFIX polymer material.

The invention is illustrated by drawings.

In FIG. 1 shows a rear view of the craniocorrector with a cut and a carabiner.

In FIG. 2 shows a top view of the craniocorrector with a notch at the Dandy point, notches under the large and small fontanelles, and a cut in the back of the head.

In FIG. Figure 3 shows a side view of the craniocorrector with cuts at the Dandy point, tenderloin under the large fontanel and soft stitches on the notches at the Dandy point.

The craniocorrector contains a shell 1, radial incisions 2 are made in the frontal and / or occipital and / or parieto-temporal region, while the cuts 3, 4 are made for large and small fontanelles in the shell, the shell 1 is covered with a soft cloth on the inside, and the lower edge is covered by elastic material 5, at the Dandy point there is a notch 6 under the ventriculoperitoneal shunt pump, radial sections are made with edges reinforced with elastic frame 7, on radial sections 2 in the frontal and / or temporal-parietal and / or occipital parts, and also on The dandy clipping has light plastic carabiners 8.

The material widely used in orthopedics is used. The outer shell of the “craniocorrector” is made of a polymer bandage, for example, INTRARICHCASTSOFT semi-rigid fixation, is used for hydrocephalus and positional plagiocephaly, craniosynostosis for children under 6 months, because softer skin and open fontanelles, for example, INTRARICHCAST rigid fixation or polyurethane bandage ORTHOFORMACAST, also tight fixation, is used for craniosynostosis and hydrocephalus, positional plagiocephaly after 6 months, because fontanelles already have a tendency to partial closure, the bones of the cranial vault are more dense in structure, and skin integuments are adapted to the rigid frame through the use of a primarily semi-rigid structure or from POLIFIX polymer material. Instead of plastic carabiners on cuts and clippings, soft ties on the clippings can be used.

Crane corrector is used as follows. Take the product and push apart all its parts and halves, formed by a cut / ami-notch / s, gently put the frame on the child’s head and fasten it with soft ties or plastic carabiners (head mounts). With hydrocephalus, the localization of the VPSh pump, the VSGS pocket, the condition of the large and small fontanelles (if they are not closed) are monitored - these areas should be open. With hydrocephalus and / or craniostenosis with a tendency to relapse, pressure is not exerted on the cranial vault, and the fastenings are tied / fastened so tightly that the “craniocorrector of the arch” was sufficiently tightly held on the child’s head without the formation of additional pressure, and the therapeutic effect was achieved due to the constant keeping fit.

It should be noted that the main support and fixation points for the monolithic skeleton are formed individually taking into account the initially pathological corrected smooth surface (frontal, and / or parietal, and / or occipital tubercles, depending on the type of deformation with mono / polysynostosis and hydrocephalus and all their varieties ), taking into account the presence and localization of the VPSh pump, VSGS pocket, the presence / absence of the fontanel.

The child gradually adapts to the “craniocorrector of the arch” from 1-2 to 22 hours a day for 1.5-3 months.

Along the incisions in the frontal (s) and / or temporoparietal (s) and / or occipital (s) parts, there are soft sashes and / or light plastic carabiners for regulating the pressure of the “craniocorrector fornix” on the bones of the patient’s fornix (after adaptation of the patient to the “craniocorrector of the arch” up to 12-22 hours per day), the monolithic frame is fixed with ties and / or carabiners more tightly and adheres to the most pronounced areas of the cranial vault, they are the fulcrum, mechanically preventing their further growth and contributing to further remodeling of uneven bone structure in a flat space under a monolithic frame over time from 6 to 18 months of regular use. The growth and remodeling of the bones of the arch occurs in the direction of the flat inner surface of the monolithic skeleton, thus, a gradual partial / complete alignment of the pathological relief of the cranial vault in the child occurs.

With craniostenosis without a tendency to relapse, fastenings fasten more tightly, with craniostenoses with a tendency to relapse and / or any variant of hydrocephalus fasteners fasten less tightly, only maintaining the correct symmetrical shape, as well as taking into account the size of the head circumference of the child, and correction of the shape of the cranial vault in the data cases and conditions is achieved due to prolonged natural growth and remodeling towards the inner even layer of the monolithic frame, and not due to the pressure exerted on spine of the cranial vault. The recesses for the large and small fontanelles, the VPSh pump and the VGSh pocket allow to constantly monitor their condition and exclude the impact on them and their traumatization, exclude trophic disturbances, and do not provoke craniosynostosis relapse and the development of hypertension syndrome in various forms of hydrocephalus in children.

Recesses for the auricle and mastoid process, for the HPS pump at the Kocher / Dendi point and / or the HSSS pocket, for the large and small fontanelles (if they are not closed) are formed within the monolithic frame without violating its integrity. It is permissible to form a large connector for the VPSh pump with the formation of soft ties that do not exert pressure on the delicate skin of the child, which are tightly tied with the condition of observing an even diameter of the monolithic frame.

It is possible to form asymmetric / symmetrical warm knitted or “fluffy” faux fur ears, removable on additional mounts, in order to protect them from the wind and protect the VPSh pump and VSGS pocket while walking in the summer. In winter, during walks, do not use this design.

A shell made of semi-rigid or rigid material should include at least 4-6 layers of polymer bandage for sufficient fixation.

Soft ties or plastic carabiners, as the head circumference grows, make it easy to adjust the size of the structure, while they are convenient for the child, do not contain metal and allow you to undergo MSCT (multispiral computed tomography) and MRI (magnetic resonance imaging) of the brain in this design.

The implementation of the lower edge of the covered soft-elastic material allows to increase the convenience for the patient with adaptation and constant use.

Claims (2)

1. Craniocorrector containing a shell with radial sections of the frontal, and / or occipital, and / or parietal-temporal region, characterized in that at the Dandy point contains cuttings for the pump of the ventriculoperitoneal shunt and / or for the pocket of the ventriculosubgaleal shunt. 2. The crane adjuster according to claim 1, characterized in that the shell contains cuttings for large and small fontanelles.

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