The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
7 cases in the first week.
11 cases in the second week.
4 cases in the third week.
4 cases between 2 and 18 months.
In the remainder, date uncertain.
=Fractures of the skull resulting from injuries received at or shortly
after birth.= In the consideration of injuries to the skull and brain in
babies the following points should be noted:--
1. The bones of the skull are elastic and pliable, and consequently a
blow may lead to a ‘bending-in’, either temporary or permanent. Slight
depressions may exist without any associated fracture, but all major
depressions are accompanied by a fracture of the bone, especially
evident on examination of the internal table.
2. The fibrous tissue intervening between the component parts of the
vault tends to cause a limitation of the fracture to the particular bone
affected. Downward extension to the base is of infrequent occurrence,
but, when that region is involved, the fracture usually follows the
transbasic lines described in the section dealing with fracture of the
base of the skull (p. 82).
3. The dura is said to be more adherent to the inner table of the skull
than in adults. The relative infrequency in the young of extra-dural
hæmorrhage has been ascribed to this peculiarity. It would appear,
however, more probable that the rarity of such hæmorrhages results from
the bending-in, _without splintering_, of the bone.
4. The brain of the infant is equally--if not more--liable to bruising
and laceration, but the results are far less definite than in adults.
There can be no question that extensive cerebral injury may exist in the
child without leading to the development of any definite localizing
symptoms.
FRACTURES OF THE VAULT
(_a_) =Depressed fractures.= Depressed fractures either result from
injury received during the birth of the child--whether from forceps
delivery or from the pressure exerted on the head by a contracted
pelvis--or from blows received shortly after birth.
[Illustration: FIG. 23. A DEPRESSED BIRTH-FRACTURE.]
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