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
Injuries of the #venous sinuses# may occur apart from gross lesions of
the skull, but as a rule they accompany fractures and penetrating
wounds. The transverse (lateral), superior sagittal (longitudinal),
and cavernous sinuses are those most frequently damaged. On account of
the low pressure in the sinuses, spontaneous arrest of extra-dural
hæmorrhage usually takes place, and recovery ensues. In some cases,
however, the amount of blood extravasated is sufficient to cause
compression. If the dura mater is torn, and the blood passes into the
sub-arachnoid space, it may spread over the whole surface of the
brain. Sometimes the bleeding only commences after a depressed
fracture has been elevated.
In the presence of an open wound, the venous source of the bleeding is
recognised by the dark colour of the blood and the continuous
character of the stream. It may be arrested by pressure with gauze
pads or by packing a strand of catgut into the sinus (Lister), or, if
this fails, by grasping the sinus with forceps and leaving these in
position for twenty-four or forty-eight hours. A small puncture in the
outer wall of the sinus may be closed with sutures. Signs of
increasing compression call for trephining and opening of the dura if
this is necessary to admit of the clot being removed.
#Intra-cranial Hæmorrhage in the Newly-Born.#--An extravasation of
blood into the arachno-pial space frequently occurs during birth. The
observations of Cushing seem to show that this is usually due to
tearing of the delicate cerebral veins which pass from the cortex to
the superior sagittal sinus, from the strain put upon them by the
overlapping of the parietal bones, in the moulding of the head. It may
sometimes be due to an excessive degree of asphyxia during birth. The
extravasation is usually most marked over the central area of the
cortex near the middle line, and it is often bilateral.
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