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The Use of Products Prepared from Human Fibrinogen and Human Thrombin in Neurosurgery

Fibrin Foams as Hemostatic Agents; Fibrin Films in Repair of Dural Defects and in Prevention of Meningocerebral Adhesions

Franc D. Ingraham and Orville T. Bailey

. Foam soaked in thrombin was placed on the intact cortex ( Fig. 1 ), on the cortex after it had been traumatized by multiple needle wounds (with hemorrhage) ( Fig. 2 ) and at other times pieces of foam roughly 4 × 4 × 6 mm. were implanted in the substance of the parietal lobe at a depth of 3 mm. beneath the surface of the arachnoid. In other instances a piece of cerebral cortex was removed ( Fig. 3 ) and replaced by foam ( Fig. 4 ). Each of the variants was repeated with the alteration that 50 mg. of sulfadiazine were sprinkled on the surface of the wound before

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Intracranial Dural Cyst

With Report of a Case

Webb Haymaker and Miles E. Foster Jr.

tissue lined by a single layer of mesothelial cells. In two such instances a delicate trabecular connective-tissue network spanned the cyst cavity; in only one of these, that of Roger, Arnaud, Poursines and Alliez, 6 was there a free communication between cyst and subarachnoid space. Another type of wall had the appearance of hyperplastic arachnoid in that it was composed of rather delicate loculated connective tissue, lined in places by flattened mesothelial cells. Certain of the epidural cysts would seem to have originated as dural diverticuli, others as a

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Abraham Kaplan

condition may be of interest. Cerebrospinal rhinorrhea with pneumocephalus may be due to various causes. It may occur spontaneously in a patient with congenital arachnoidal prolongations along the olfactory nerve after a severe sneezing spell. 12 Most often, however, pneumocephalus is secondary to a fracture of the skull involving the posterior wall of the frontal sinus or cribriform plate of the ethmoid bone. As the bone is fractured there is an accompanying tear of the dura which may extend through and communicate with the arachnoid, brain substance or ventricles

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Norman C. Delarue, Eric A. Linell and Kenneth G. McKenzie

cortical trauma, when tantalum was not placed in the sub-dural space. In 7 dogs the tantalum was found to be lying free in the sub-dural space when the animal was sacrificed. The best result was in one of these 7 which was killed 3½ months after operation and is shown in Figs. 2 and 3 . Fig. 2 shows the free tantalum in position over the left parietal lobe. The dura mater covering the tantalum has been turned to the right and is thickened over the area that covered the metal. On removal of the tantalum ( Fig. 3 ) the arachnoid underlying the foil shows

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Edgar F. Fincher

of chronic inflammatory changes… the dura was thickened and sometimes adherent to the pia arachnoid” microscopically… “the cerebral cortex showed a definite paucity of neurones; in the precentral gyrus for instance there were areas almost devoid of healthy pyramidal cells, etc.… Some brains under consideration showed definite evidence of a slight degree of atrophic sclerosis affecting both hemispheres.” Recalling the numerous instances in which dural-arachnoidal adherences in cases of tumor have been mistaken as the sole cause of the clinical symptoms of increased

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Edgar F. Fincher, Bronson S. Ray, Harold J. Stewart, Edgar F. Fincher, T. C. Erickson, L. W. Paul, Franc D. Ingraham, Orville T. Bailey, Frank E. Nulsen, James W. Watts, Walter Freeman, C. G. de Gutiérrez-Mahoney, Frank Turnbull, Carl F. List, William J. German, A. Earl Walker, J. Grafton Love, Francis C. Grant, I. M. Tarlov, Thomas I. Hoen and Rupert B. Raney

had bilateral membranes. As to Dr. Crawford's question, the sacrifice has been both dural and membranous, as extensively as a 2½ to 3 cm. exposure would permit. If the arachnoid is not ruptured during the operation, I don't think we have noted any ill effects from leaving the dura wide open. In the child shown with the bulging decompression, aspiration resulted in a goodly escape of fluid from beneath the scalp; it was some weeks before the bulge receded. This might give a false impression of bulging cortex. The others haven't had extensive collections of fluid. We

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Axel Olsen and Gilbert Horrax

April 8, 1937, a ventriculogram showed uniformly dilated lateral and third ventricles. On bilateral suboccipital exploration the same day, a left acoustic neuroma was exposed and removed completely. It was felt that the facial nerve was preserved during the removal and this has subsequently proved to be correct. The growth itself was of only moderate size, but there was a large arachnoid cyst overlying it. After an uneventful postoperative course, she was discharged on May 1 in good condition and with a little motion beginning to appear in the left side of the face

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Dean H. Echols

. The blood pressure was 120/85, pulse around 90 and respirations were normal. Course . The child died forty-eight hours after operation. Autopsy . Postmortem examination was made by Dr. L. S. Walsh. Only the part of his findings concerning the lesion will be given. The brain weighed 1300 grams. The basal arachnoid and vasculature were fixed to a mass which displaced cerebral tissue superiorly and indented the floor of the third ventricle and optic chiasm. Gross coronal sections of the forebrain revealed nothing unusual. Gross cross sections of the stem showed

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Orville T. Bailey and Franc D. Ingraham

from there they extend into the Virchow-Robin spaces. In most instances, the sarcoma lies beneath, and does not penetrate, the arachnoid surface layer. Hence it does not involve the dura primarily and very rarely becomes involved with this structure in the course of its progression. 3, 15 The most frequent tumor occurring in the dura proper is the meningioma. Studies of a series of these tumors 1 have indicated that the meningioma is not of pure fibroblastic origin but is a tumor with stroma. The meningioma arises from arachnoid cells, the source of arachnoid

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Michael Scott

fluid. 7 Van Wagenen and Aird suggest that embryonic rests of pia arachnoid in the inner walls of the septum might be the origin of the fluid, although they have not been able to show this histologically. 6 Wolf and Bamford state that, although this suggestion appears embryologically sound, the histological findings in their cases are against this theory. It is possible, they add, that mesodermal elements probably included in the embryological development of the cavi disappear. 7 Dandy also states that inclusions of choroid plexus in the cyst wall have been