Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
The _outer_ table is the most elastic layer of the calvarium, and it
varies greatly in thickness in different skulls and in different parts
of the same skull. It is nourished chiefly from the pericranium which
is firmly bound down along the lines of the sutures. The _inner_ or
vibreous table is thin and fragile, and its smooth internal surface is
grooved by the middle meningeal and other arteries of the dura mater,
and by the large venous sinuses. The intermediate layer--the
_diploë_--is highly vascular, branches of the meningeal vessels
anastomosing freely in its open porous substance with branches derived
from the pericranial vessels. Some of its veins open into the external
veins, and others into the intra-cranial sinuses, and they communicate
with the emissary veins as these pass through the bone, which explains
the spread of infective processes from the structures outside the
skull to those within. The possibility of withdrawing blood from the
interior of the skull by leeching, bleeding, or cupping depends on the
existence of the emissary veins.
_The Membranes of the Brain._--The _dura mater_ is a fibro-serous
membrane, the outer, fibrous layer constituting the endosteum of the
skull, the inner, serous layer forming one of the coverings of the
brain. Between the fibrous layer and the bone the meningeal vessels
ramify; and along certain lines the two layers split to form channels
in which run the cranial venous sinuses. Inside the dura, and
separated from it by a narrow space--the _sub-dural space_--lies the
_arachno-pial membrane_, consisting of an outer (_arachnoid_) layer
which envelops the brain but does not pass into the sulci, and a
highly vascular inner layer--the _pia mater_--which closely invests
the brain and lines its entire surface.
The space between these layers--the _sub-arachnoid space_--is
traversed by a network of fine fibrous strands, in the meshes of which
the cerebro-spinal fluid circulates. Each nerve-trunk as it leaves the
skull or spinal canal carries with it a prolongation of each of these
membranes and their intervening spaces. The membranes gradually become
lost in the fibrous sheaths of the nerves, and the sub-dural and
sub-arachnoid spaces become continuous with the lymph spaces of the
nerves.
The _cerebro-spinal fluid_ is secreted by the choroid plexuses and
fills the cerebral ventricles, the central canal of the cord, the
sub-dural and sub-arachnoid spaces, and the sheaths of the
intra-cerebral blood vessels. At the base of the brain, particularly
in the posterior fossa, the sub-arachnoid space is wider than
elsewhere, forming "cisterns" filled with cerebro-spinal fluid which
supports the cerebral structures. Through the foramen of Magendie in
the roof of the fourth ventricle the sub-arachnoid fluid of the
cranial cavity communicates with that of the vertebral canal.
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