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The Lucite Calvarium—A Method for Direct Observation of the Brain

I. The Surgical and Lucite Processing Techniques

C. Hunter Shelden, Robert H. Pudenz, Joseph S. Restarski and Winchell McK. Craig

irrigation of this space proved unsatisfactory. Although the irrigation removed the xanthochromic fluid, it was followed in several instances by a mixed type of infection which ruined the preparation. The present model of the lucite plate, which has a 1 cm. flange and which is screwed, rather than wired, to the skull, permits a secure attachment. Moderately severe blows (velocity of 30 feet per second and energy of 6.6 foot pounds) delivered to the animals' heads have not resulted in a cerebrospinal fluid leak. Furthermore, no leak of cerebrospinal fluid occurred when

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silk. In two of these cases there was prompt linear healing of the skin wound. The third gaped in part, but subsequently healed. It is too early yet to assess the result on nerve healing. Spinal Cord Injuries . In two back wounds a missile penetrated the spinal canal. In the first of these there was a cerebrospinal fluid leak through a wound infected with Staphlococcus aureus and Proteus . During a course of sodium penicillin intramuscularly this wound was excised and closed in layers. The leak ceased and the wound healed, partly by granulation, without any

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Robert C. L. Robertson

normal on the fifth day. Lucid periods began on the third day and gradually increased in length. In spite of this he was somewhat confused and repeatedly removed his head dressings although he was restrained. A continuous cerebrospinal fluid leak was present from the cranial wound and on the eighth day was particularly profuse. He was transferred, by air, to Brooke General Hospital on the twelfth day, April 24, 1943. The granulating wound in the scalp appeared to be chiefly cerebral herniation, about 2.5 cm. in width, extending from the midline to below the right

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Subdural Hygroma

A Report of Seven Cases

Henry T. Wycis

distance of some ten feet. He was apparently not unconscious and was able to climb a ladder out of the pit without support. Vomiting immediately ensued. He was immediately taken to the emergency admission ward at Temple University Hospital. He was quite euphoric and insisted that he was well. At that time the pupils were equal and responded promptly to light. There were four lacerations about the right ear and occipital area. A bloody cerebrospinal fluid leak from the right ear was noted. Spinal puncture: pressure 10 mm. of Hg.; fluid bloody. Within half an hour the

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Stuart N. Rowe and Oscar A. Turner

must always be regarded as a greater potential source of infection than those entering the vault directly. In these cases meningitis may occur in the absence of an obvious cerebrospinal fluid leak. While it is not advisable to attempt the removal of all such missiles, these patients warrant prolonged and careful observation even when they appear to be symptom-free (Case 2). When rhinorrhea or otorrhea is associated with this type of wound the pathway for infection is enlarged. However, if adequate chemotherapy is maintained surgery may be delayed for a few days to

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J. E. Webster, R. C. Schneider and J. E. Lofstrom

cerebrospinal fluid leaking. A small communication with the ventricle closes readily by the early cerebral swelling in the area of the debridement. A large communication, however, closes after a period of delay as the brain fills the area of tissue loss. In this interval a dural covering controls the leaking. Frontal lobe abscesses communicating with the frontal or ethmoidal sinuses present the problem, particularly, of preventing rhinorrhea, accomplished by means of a graft which seals off the sinus orifices and the ventricular communication. CHEMOTHERAPEUTIC

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Penetrating Craniocerebral Injuries

Evaluation of the Late Results in a Group of 200 Consecutive Penetrating Cranial War Wounds

George L. Maltby

per cent) showed no evidence of wound infection at any time. Of the 15 remaining patients, 12 had major or deep infection, that is, brain abscess, meningitis, cerebral fungus and cerebrospinal fluid leaks. It seems probable that the superficial wound infection in the other 3 had little to do with the onset of convulsive seizures. In all but 3 of these cases the time of debridement was available. The average time was 25 hours or less than that for the whole series and essentially the same as in the group of 47 patients with infections. In the records of 23 of the

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Richard C. Schneider, Lloyd J. Lemmen and Basu K. Bagchi

end of the prodecure the brain pulsated well, and cerebrospinal fluid leaked out of the cistern. No attempt was made to close the dura mater and the wound was closed tightly without drainage. Burr holes were then made over the homologous left suboccipital area, over both occipital regions 3 cm. to either side of the midline, and over the right posterior parietal area 2.5 cm. above and behind the right ear. The dura mater was incised at all regions and no abnormality was found. Course . Twenty-four hours after operation the patient was much more responsive, obeying

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Aqueduct Stenosis

Clinical Aspects, and Results of Treatment by Ventriculo-Cisternostomy (Torkildsen's Operation)

Kenneth W. E. Paine and Wylie McKissock

if all proceeds well no special aftertreatment is necessary. On occasions it may appear that the tube has become blocked and then it may be necessary to aspirate the tube through the skin in the occipital region to re-establish drainage. If such is done then it is probably wise to perform daily lumbar punctures to encourage the flow of cerebrospinal fluid through the tube. If cerebrospinal fluid leaks around the tube it may be necessary to aspirate the subgaleal space, and should leakage continue a temporary ventricular drain in the opposite lateral ventricle may

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A. Earl Walker

quite approximate when an attempt was made to close them. The masseters, however, contracted well. The corneal sensation was good. The right ear was completely deaf. Otherwise the neurological findings including the gait were normal. The patient has written several times since her discharge stating that she has been quite well and has had no further complaints. DISCUSSION There seems little doubt that the cerebrospinal fluid leak in this case resulted from the extensive erosion of the tumor into and the subsequent operative opening of the mastoid air cells