Mareen Nee TF over) , te Pneumoencephalography_ Pneumoencephalography is introduced by the Dandy-Walker in 1919. Pneumoencephalography was based upon the principle of gaseous replacement of the cerebrospinal fluid within the ventricles and the arachnoids space. After draining the CSF and filling filter air gives a great contrast, and it distinctly outlines the brain structures so their shapes and anatomical location can be examined easily. In the Pneumoencephalography the CSF was drained by the Iumbar puncture technique then an equal amount of air or the Carbon dioxide is introduced. 1 Equipment- e X-ray machine with the cassette e Somersault chair -(the special chair that can rotate 360 degrees it allows patient entire body would rotate into different position so the air moves easily in the ventricular system.) e Lumbar puncture needle -2 with a three-way stopcock e Contrast media carbon dioxide e Antiseptic solution e Local anesthesia e Syringe e Gloves © Sterile towel e Gauzeay =f © Detection of mass tumors in the brain © Determination of hydrocephalus ¢ Evaluation of ventricles Patient preparation- e The patient should not eat or drink after midnight. ¢ An intravenous line is inserted into the patient arm and sedative medication is given through the line to make the patient relax Procedure- 1. The patient is placed in somersault chair in sitting position, with fully flexed lumbar spine and resting his head and chin on the suitable support 2. The antiseptic solution applies to the skin of the Lumbar spine region 3. Local anesthesia is given at the examination site. 4. The first lower lumbar puncture needle is introduced slowly in the spinal canal into the subarachnoid space. 5. Then the upper needle is introduced slowly in the spinal canal. When the CSF comes out from the lower needle, simultaneously the same amount of air or Carbon dioxide is injected very slowly through the upper needle 6. The flow rate of the CSF and the injected air should be same, to maintain intracranial pressure. 7. After completion of contrast media, Injection patient was shifted to the x- ray table. 8. The first lateral film of the Skull was taken to access the gas in the central nervous system. 9. Then in an upright position head fully dorsiflexed, the lateral and the axial views will be taken to check the air in the ventricles. After the visualization of the air in the ventricles, the needles are removed and dressing is applied on the puncture site. Then the patient is transferred to the X-ray room and the following radiographs are taken in the supine position.-e Anterioposterior view of Skull e Lateral view of Skull Afterthen the patient is placed in the prone position and the following radiographs are taken- ¢ Skull Posterior Anterior Position to visualize air contrast in the occipital horns © Skull lateral projection for viewing the air contrast in the lateral ventricles ¢ Head flex position to visualize temporal homs of the ventricles Complication- © The procedure is extremely painful e A severe headache e Severe vomiting e High fever e Time-consuming Procedure The Ventriculography and the Pneumoencephalography methods are no longer is used. It was replaced by less invasive modern techniques, like MRI and CT sean but these studies made the beginning of a contrast study, an evaluation of the central nervous system abnormalities