The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
Many cases have been recorded in which a cephalocele developed after an
injury to the skull. In such conditions it is necessary that a
comminuted or fissured fracture of the vault should be present, that the
underlying dura mater should be torn, and that the adjacent brain
substance should be severely contused or lacerated. Cerebro-spinal fluid
may alone escape through the gap in the skull to the subaponeurotic and
subcutaneous regions, leading to the formation of a _false traumatic
meningocele_. When the brain shares in the outward protrusion the
condition is known as _false traumatic meningo-encephalocele_. This
protrusion of the brain is dependent on the fact that the
injury--necessarily a severe one--leads to considerable brain lesion,
with subsequent œdema and localized or general increase in the
intracranial pressure.
Occasionally, the external accumulation of cerebro-spinal fluid
communicates with one of the horns of the lateral ventricle. A
meningo-encephalocele, having such connexions, is produced in the
following manner:--the protruded brain includes that part of the
cerebral substance which bounds one of the horns of the lateral
ventricle, usually the descending cornu. The ventricular channel becomes
elongated in the outward direction, towards and through the gap in the
skull, whilst the increased intraventricular tension gradually dilates
up the new channel, and, in course of time, still further spreads out
and thins that part of its cerebral boundary which lies external to the
skull deficiency.
There can be no question that after the patient has reached the age of
three years traumatic cephaloceles are of exceedingly rare occurrence.
This special liability in quite young children has been ascribed to the
greater elasticity of the infant skull, and to the supposed greater
adherence of the dura mater. Though these factors may exercise some
influence on the production of the tumour, it seems more probable that
the development of a cephalocele is dependent to a greater degree on the
general vitality of the child. Thus, a blow that produces in the adult a
comminuted or widely fissured fracture of the skull, with laceration of
the dura mater and injury to the underlying brain, frequently leads to a
fatal result, whilst the child often recovers. Again, in the adult, the
force required to produce such a lesion usually suffices to lacerate the
integument. Consequently a compound comminuted fracture of the vault
with hernia cerebri is relatively more common in the adult than in the
infant.
The right side of the head is more frequently affected than the left,
and, of all bones in the skull, the parietal is the one most constantly
involved.
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