[Tomodensitometry in exploring the orbit].
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Biomedical subjects
Publications and source records attributed to H Ammerich.
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There now exist protocols for specific scanning which make it possible to obtain tranverse sections of a few millimetres in thickness of the orbits and their contents, with minimum sweep and with a very low dose of radiation for the lens. Normal scanner anatomical findings in the orbit may thus be defined for the eyeball (outer coats, vitreous, lens) as well as retrobulbar structures (optic nerve, oculomotor muscles in particular). Intraocular tumours (e.g. retinoblastoma) are visible on enlarged scan films. The value of scannings lies above all in the determination of the site, size and shape of orbital lesions and, where applicable, their relations with neighbouring extra- and intra-cerebral structures. In addition, certain conditions such as exophthalmos during hyperthyroidism have characteristic scan findings. It nevertheless remains difficult to attempt to predict a histological diagnosis on the basis of scan findings, the risk of a false positive being particularly significant. Particular emphasis must be placed upon the contribution of techniques of treatment of the films obtained (enlargement, contrast media, histograms, lateral views) as well as the complementary use of other methods of radiological investigation (in particular arteriography and phlebography) which scanning cannot replace but which it should usually precede since it is atraumatic and non-invase.
The value of scanning lies above all in the determination of the site, size and shape of orbital lesions and, where applicable, their relations with neighbouring extra or intra cerebral structures. But certain conditions such as exophthalmos during hyperthyroïdosis have characteristic scan findings. Even intra-ocular tumors are visible on elarged scanfilms. It nevertheless remains difficult to attempt to predict a histological diagnosis on the only basis of scan findings. Particular emphasis must be placed upon the contribution of techniques of treatment of the films obtained (enlargement, contrast media, histograms, lateral views) as well as the complementary use of phlebography and ultrasonography.
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The location of the choroid arterial point as well as of the copular venous point with reference to a line, dealing with the anatomical structure at the level of the cervicooccipital joint, was found to be a quick and accurate method for the diagnosis of tonsillar herniation. The application of this method has the advantage of giving the location of the choroid arterial point, and a control of the venous time of arteriography by the location of the copular point.
The lumbar epidural veins are opacified by injection of the lateral sacral and ascending lumbar veins with abdominal compression. This technique provides a good opacification of the entire lumbar epidural venous system. Some anatomical points are discussed and clarified. The interest of the technique in the diagnosis of discal herniations is emphasized.
Venous anastomoses at the base of the brain are represented by the anterior and posterior communicating veins. The anterior communicating vein anastomoses with the anterior communicating vein anastomoses with the anterior cerebral veins. The posterior communicating veins join the basal veins through the interpenduncular veins. The functional value of these venous anastomoses is less important than that of the arterial polygon of Willis. This anastomotic function depends on anatomical constancy and on the calibre of these transverse veins. Under certain pathological conditions the variations of intracranial pressure result in contralateral venous drainage through these anterior and posterior anastomotic veins.
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