The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
[Illustration: FIG. 28. DIAGRAM ILLUSTRATING THE LINES ALONG WHICH
FORCES RECEIVED ON THE VAULT ARE TRANSMITTED TO THE BASE. (For further
description, see text.)]
Further, not only does the skull vary in density in its several parts,
but it is also ribbed and strengthened by various bony bars and
buttresses that pass up from base to vault (see Fig. 28). These
‘ribbings’ are seen to extend upwards from the crista galli, from the
external angular frontal process, from the auditory region, and from the
occipital protuberance. Presumably, these ‘ribbings’ were so constituted
for a definite purpose; in any case, it is clear that they play an
important part in the reception and conduction of forces to the base of
the skull. It is apparent, moreover, that the parts intervening between
these ‘ribbings’ are liable to injury in direct proportion to their
general position and strength. The deep groovings of the bone for the
reception of the middle meningeal artery afford an additional source of
weakness to the bone in the squamo-temporal region. (See Fig. 50).
[Illustration: FIG. 29 A. THE BASE OF THE SKULL.]
[Illustration: FIG. 29 B. THE BASE OF THE SKULL AS SEEN ON
TRANSILLUMINATION.]
Further reference will be made to the relative strengths of the various
regions of the skull. Sufficient has been said to show that nature has
provided the skull with various paths by means of which forces applied
to the vault can be conducted and distributed to the base.
Before, however, proceeding to discuss the effects produced on the base
of the skull, it is necessary to add that nature provides other methods
by means of which the intensity of a blow, delivered over the vertex of
the skull, is diminished. The forces are broken up and distributed in
the following manner:--
1. Though the force tends to travel in the direction of the applied
force, yet the convexity of the skull allows of the dissemination of
that force over a large superficial area.
2. The intervention of cartilage or fibrous tissue between two or more
of the component bones of the vault tends to diminish the intensity of
the force, to break it up and to alter its direction.
3. The bony ridges, along which the forces tend to travel, themselves
terminate blindly (see Fig. 28). Thus,
(_a_) Forces passing from the frontal region converge, more or less, to
the crista galli.
(_b_) Forces from the external angular frontal process pass along the
wings of the sphenoid bone to the anterior clinoid process.
(_c_) Forces from the auditory region are projected along the summit of
the petrous bone towards the apex of that process and to the posterior
clinoid process.
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