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Louis Bathe Rawling. The Surgery of the Skull and Brain
The Surgery of the Skull and Brain
Table of Contents
PREFACE
CHAPTER I. CRANIO-CEREBRAL TOPOGRAPHY
The superior longitudinal sinus
The lateral sinus
The infratentorial region
The supratentorial region
(a) The external angular frontal process
(b) The malar tubercle
(c) The temporal crest
(d) The parietal prominence
(e) The zygoma
The middle meningeal artery
The lower limit of the cerebrum
The Sylvian point and fissure
The fissure of Rolando
The parieto-occipital and first temporo-sphenoidal fissures
The cortical motor and sensory areas
CHAPTER II. THE SPECIAL TECHNIQUE IN OPERATIONS ON THE SKULL AND BRAIN
Preparatory treatment
Precautions against the development of shock
The anæsthetic
The position of the patient
Preparation of the operative field
THE CONTROL OF HÆMORRHAGE
Hæmorrhage from vessels of the scalp
Hæmorrhage from the bone
Hæmorrhage from the dural vessels
Hæmorrhage from the superficial vessels of the brain
THE OPENING OF THE SKULL
Craniectomy
The enlargement of the trephine hole to the required size and shape
Keen-Hoffmann
Lane’s fulcrum forceps
Horsley’s nibbling or rongeur forceps
De Vilbiss’s forceps
Craniotomy
Opening the dura mater
Sewing up the dura mater
Replacement of the osteoplastic flap and sewing up
After-treatment
CHAPTER III. CEPHALOCELES. BIRTH-HÆMORRHAGES. BIRTH-FRACTURES. DERMOIDS. HYDROCEPHALUS
CEPHALOCELES
Congenital cephaloceles
Exencephaly
Cephaloceles
Position of the tumour
Size, structure, and contents
Treatment
Operation
TRAUMATIC CEPHALOCELES
Symptoms
Treatment
Fractures of the skull resulting from injuries received at or shortly after birth
FRACTURES OF THE VAULT
(a) Depressed fractures
Course and treatment
Operation
(b) Fissured fractures
Symptoms
Treatment
BIRTH-HÆMORRHAGES
Extracranial hæmorrhages
Subaponeurotic hæmatomata
Subpericranial hæmatomata
Treatment
Intracranial birth-hæmorrhages
Symptoms
Treatment
DERMOIDS
Treatment
HYDROCEPHALUS
Congenital internal hydrocephalus
Acquired hydrocephalus
Progress of the case
Treatment. Indications for operation
Lumbar puncture
Operation
Ventricular puncture
Through the anterior fontanelle
Through the frontal bone
Over the descending cornu of the lateral ventricle
Ventricular-subdural drainage
Ventriculo-abdominal drainage
CHAPTER IV. FRACTURES OF THE SKULL
General considerations
FRACTURES OF THE BASE OF THE SKULL
(a) Aran’s theory of irradiation
(b) The bursting and compression theories
(c) The contre-coup theories
Summary of theories
The influence of sutures on the line of the fracture
The influence of air-sinuses, &c., on the line of the fracture
The ethmoid cells
The auditory region
The influence of basic foramina
The probable line of basic fracture in any given case
Summary
SYMPTOMS RESULTING FROM FRACTURE OF THE BASE OF THE SKULL
Symptoms pointing to fracture of the Anterior Fossa. Hæmorrhages: (a) Subconjunctival hæmorrhage
(b) Palpebral and peri-palpebral hæmorrhage
(c) Orbital hæmorrhages
(d) Retinal hæmorrhages
(e) Hæmorrhage from the nose and mouth
Escape of cerebro-spinal fluid
Escape of brain-matter from the nose
Escape of air from the air-sinuses into the surrounding regions
The involvement of nerves
(a) The olfactory nerve
(b) The optic nerve
(c) The nerves passing through the sphenoidal fissure
SYMPTOMS POINTING TO FRACTURE OF THE MIDDLE FOSSA
External hæmorrhages (a) Hæmorrhage into the temporal region
Special points in prognosis and treatment
Escape of cerebro-spinal fluid
Special points in prognosis and treatment
Escape of brain-matter
Special points in treatment and prognosis
Involvement of nerves
The sixth nerve
The seventh and eighth nerves
SYMPTOMS POINTING TO FRACTURE OF THE POSTERIOR FOSSA
External hæmorrhages
Involvement of nerves
The twelfth nerve
FRACTURE OF THE MASTOID PORTION OF THE TEMPORAL BONE
Surgical emphysema and pneumatocele
Bleeding from the ear
Treatment
FRACTURES OF THE VAULT OF THE SKULL
Fractures of the external table alone
Fractures of the internal table alone
Fractures involving the whole thickness of the skull
Symptoms associated with fracture of the vault
Evidence supplied by local examination
The temperature in its relation to head-injuries
Group 1
Group 2
Group 3
Group 4
Treatment of Fracture of the Base of the Skull
Venesection
Lumbar puncture
‘Decompression’ operations
The operation
TREATMENT OF FRACTURES OF THE VAULT OF THE SKULL
Indications for operation
When the fracture is associated with mild concussion
When the fracture is associated with severe concussion
When the fracture is associated with general cerebral irritation
When the fracture is associated with compression
When the fracture is confined to the internal table
Treatment. When the fracture is associated with mild concussion
When the fracture is associated with severe concussion
When the fracture is associated with general cerebral irritation
The operative treatment of fractures of the vault
Fissured fractures
Depressed fractures
Punctured fractures
Fractures limited to the external table
Fractures limited to the internal table
THE MORTALITY FROM FRACTURE OF THE SKULL
CHAPTER V. INTRACRANIAL INJURIES: EXTRA- AND SUB-DURAL HÆMORRHAGES. INJURY TO THE BRAIN
HÆMORRHAGES
I. Extra-dural hæmorrhage
Middle meningeal hæmorrhage. General considerations
Symptomatology
General effects
Local effects
Pupillary changes
Treatment
Operation. For Hæmorrhage from the anterior branch
To secure the bleeding-points
For hæmorrhage from the posterior branch
Results
II. Subdural hæmorrhage
(A) Diffuse subdural hæmorrhage
Symptoms
Indications for operation
Operation
(B) Localized subdural hæmorrhage (subdural hæmatocele)
Operation
Results
Pia-arachnoid hæmorrhage
INJURY TO THE BRAIN
Symptoms
A. Localizing symptoms. Localizing to the frontal lobes
Localizing to those parts that minister to the function of speech
Word-deafness
Localizing to the temporo-sphenoidal lobe
Localizing to the pre- and post-central convolutions
Localizing of the occipital lobes
Localizing to the cerebellum
B. General symptoms. Concussion or cerebral shock
Its symptomatology
Cerebral Irritation
Compression
Treatment
Points in the differential diagnosis between traumatic and other forms of coma
CHAPTER VI. THE REMOTE EFFECTS OF HEAD-INJURY
General considerations
The effect of age
The effect of disposition
The effect of status
Traumatic neurasthenia
Treatment
Traumatic cephalalgia
Treatment
Traumatic epilepsy
The localizing symptoms of traumatic epilepsy
Pathology
The clinical course of the case
Operation
The formation of the scalp-flap
The examination of the bone
The treatment of the dura mater
The treatment of a cortical scar
The prevention of fresh adhesions between the dura and the brain and between the scalp and the dura or brain
The closure or protection of gaps in the skull
Methods
Results
Traumatic insanity
Treatment
MENINGEAL CYSTS
Cysts within the calvarium
TRAUMATIC ORBITAL ANEURYSM (Pulsating Exophthalmos)
Symptomatology. 1. Proptosis
2. Aneurysmal symptoms
3. Pressure symptoms
4. Subjective symptoms
Treatment
CHAPTER VII. TUMOURS OF THE BRAIN
Tumours of the brain
Pathology
Gliomata
Sarcomata
Endotheliomata
Fibromata
Tuberculomata
Syphilomata
Cysts
Carcinomata
Symptomatology
I. General Pressure Symptoms
Headache
Mental disturbances
Optic neuritis
Vomiting
Alterations in pulse, respiration, and blood-pressure
Alterations in temperature
II. Localizing Symptoms (A) To the non-excito-motor frontal region (anterior frontal)
(B) To the excito-motor frontal region
(C) To the post-central, angular, and marginal convolutions
(D) To the temporo-sphenoidal lobe
(E) To the occipital lobe
(F) To the subtentorial region
(G) To the pituitary region
Lumbar puncture
X-ray examination
Treatment. Indications for operation
For the radical operation
For the palliative operation
Radical operation for cerebral tumours
Examination of the dura mater
Opening the dura mater
Examination of the brain
Extirpation of the tumour
Closure of the dura and reposition of the flap
Radical operation for cerebellar tumours
Unilateral cerebellar exposure
Bilateral cerebellar exposure
Palliative operations for cerebral and cerebellar tumours
Operations for tumours of the pituitary body
Results of operation on brain tumours
Mortality
The mortality according to the region affected
The mortality according as to whether the tumour is found or not
CHAPTER VIII. THE INFECTIVE DISEASES OF THE BRAIN AND MENINGES: ABSCESS OF THE BRAIN, MENINGITIS, LATERAL AND CAVERNOUS SINUS THROMBOSIS, HERNIA CEREBRI
ABSCESS OF THE BRAIN
Multiple abscess
Acute traumatic abscess
Symptomatology
Prognosis and treatment
Chronic abscess
Pathology
The wall of the abscess
Contents of the abscess
The size of the abscess
The neck of the abscess
Course pursued by an untreated brain abscess
Mode of healing after successful operation
Symptomatology
The INITIAL stage
The LATENT stage
The MANIFEST stage
The TERMINAL stage
Treatment
1. The two-stage operation
2. The one-stage operation
MENINGITIS
Serous meningitis
Pachymeningitis externa
Pachymeningitis interna and pachymeningitis interna hæmorrhagica
Acute lepto-meningitis
1.Meningitis of traumatic origin
2.Meningitis secondary to disease of neighbouring regions
3.Meningitis secondary to disease of more distant regions
Some anatomical considerations of meningitis
Symptomatology
Intellectual symptoms
Motor symptoms
Sensory and other phenomena
The period of depression
Treatment
SINUS THROMBOSIS
Lateral sinus thrombosis
Treatment
Cavernous sinus thrombosis
Symptomatology (a) Symptoms dependent on the formation of the thrombus and its extension to neighbouring venous and lymphatic channels
(b) Symptoms dependent on toxic absorption or resulting from the transference of infected particles to other parts of the body
Treatment
The prognosis in brain abscess, meningitis, and sinus thrombosis
HERNIA CEREBRI
Treatment
CHAPTER IX. BULLET-WOUNDS OF THE SKULL AND BRAIN
Injury to the bone
Fractures limited to the external table
Fractures limited to the internal table
Gutter fractures
The complete fractures produced by penetrating and perforating wounds
Injury to the brain
Symptomatology
Indications for operation
Operation
The exploration of the wounds of entry and exit
The search for and removal of the bullet
Complications
Results
CHAPTER X. TRIGEMINAL NEURALGIA
NEURALGIA MINOR
Treatment
Neurectomy of the inferior dental nerve
Exposure of the infra-orbital nerve
Exposure of the supra-orbital nerve
NEURALGIA MAJOR
Symptomatology. Pain
Vaso-motor and trophic changes
General decline in health
Treatment
The technique of alcohol injections
Results
Operative procedures
Modifications of the Hartley-Krause operation
Operations on the sensory root (Frazier’s operation)
Frazier’s operation[76] on the sensory root
Choice of operation
The results obtained by operation
CHAPTER XI. TUMOURS OF THE SKULL-BONES
Tumours of the skull-bones
OSTEOMATA
Clinical characteristics
Treatment
SARCOMATA, PRIMARY AND TRAUMATIC
Treatment
Chloromata
Carcinoma
INDEX
