The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
Attempts have been made to classify the various forms of meningitis on a
bacterial basis. When, however, it is realized that almost any known
form of organism may be present in the exudate, and that the symptoms
dependent on these various infections closely resemble one another,
merely differing in their acuteness and intensity, it would appear that
some other form of classification is preferable.
The following method of classification will suffice:--
=1.= =Meningitis of traumatic origin.= The organisms either obtain
direct entrance to the meningeal space by means of a compound fracture
of the vault or base of the skull, or reach their destination along the
course of the numerous emissary and diploic veins that bring the extra-
and intra-cranial channels into communication.
=2.= =Meningitis secondary to disease of neighbouring regions.=
(1) The accessory sinuses of the nose and ear.
(2) The bones of the skull.
(3) The soft parts--scalp, orbit, nose, and face.
=3.= =Meningitis secondary to disease of more distant regions.= Through
the medium of the blood-stream bacteria may be carried to the meningeal
region in many acute infections--more especially in diseases of the
lung.
=Some anatomical considerations of meningitis.= The _pia_ is closely
applied to the surface of the brain, dipping down into all the fissures,
both major and minor. The _arachnoid_ is only reflected into the greater
fissures--the mesial longitudinal fissure, the fissure of Sylvius,
Rolando, &c. The pia and arachnoid are therefore separated from one
another by a potential space over the convolutions themselves, and by an
actual space in the region of many of the cortical fissures.
On the under aspect of the brain the two membranes are so disposed and
so separated from one another as to form three great basins or cisternæ,
three great spaces acting as a water-bed for the brain. These are the
_cisterna magna_, the arachnoid bridging over the wide interval between
the back part of the under surface of the cerebellum and the medulla,
the _cisterna pontis_, the angular space between the pons, medulla, and
cerebellum, and the _cisterna basalis_, the arachnoid there covering in
the structure situated in the interpeduncular space, including the
Circle of Willis.
The subarachnoid space, both cortical and basal, is traversed by
numerous trabeculæ which, passing from one membrane to the other, break
up the space into innumerable small compartments, all containing
cerebro-spinal fluid and all intercommunicating. The cerebral vessels
ramify in the space, the tributaries being supported by the framework
and bathed in the fluid.
All cranial nerves carry with them in their emergence from the skull a
process of both pia and arachnoid, variable in extent, but so arranged
that the nerve trunk is surrounded for some distance by a funnel-shaped
process of membrane, the cerebral cerebro-spinal fluid being thus
brought into connexion with the cervical lymphatic spaces.
Public-domain text, read in full here on John Shaqi.
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