Читать книгу The Surgery of the Skull and Brain - Louis Bathe Rawling - Страница 31

This form of hæmorrhage, one of the most troublesome complications arising in head-operations, most commonly results from hasty or careless opening of the dura mater. Thus, when the dura is incised in a case of greatly increased intracranial pressure, the brain herniates suddenly outwards, and the incautious use of the knife will damage one of the dilated superficial cortical veins. The dura should always be opened with the greatest care, the knife being passed lightly over the membrane till the pia-arachnoid is exposed, when the dural margins are lifted up with small tenaculum forceps and the membrane slit up with blunt-pointed scissors or on a grooved director.

In the event of injury, the bleeding may often be controlled by light pressure with dry gauze, or wet gauze wrung out in hot saline solution as described above. If this fails, a very fine silk ligature may be passed beneath the vessel on either side of the site of bleeding. This procedure is not easy to accomplish, the tissues are so soft and friable. However, every effort must be made to arrest the bleeding, for not only does the hæmorrhage obscure the field of operation, but the presence of a blood-clot beneath the dura mater will lead at a later date to the formation of adhesions between the various membranes of the brain—a potent cause of headache, epilepsy, &c.