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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

Subdural hematoma 7 Herniated nucleus pulposus 3 Miscellaneous 10 __  Total 95 The use of foam was then extended to simple types of bleeding, for example, oozing from the surface of the brain or the outer surface of the dura ( Figs. 5 and 6 ). Under such circumstances, the application of a very small piece of the material stopped oozing instantly and thus saved an appreciable amount of time. During closure of the dura at the end of an extensive operation the all too familiar venous bleeding which may start up from the

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Edgar F. Fincher

operation may well be the only justification for this publication. In the initial trephine exposure the dura is likely to be thickened in comparison with the dura in cases of tumor or in traumatic craniotomies in babies. Free cerebral pulsations are not grossly obvious. When the dura is opened one encounters a greenish or purple-tinged membrane, in direct contact with the inner dural surface. Its appearance is very much that of an older chronic subdural hematoma membrane, and its adherence to the dura is identical. Using a small grooved director or a small dissecting

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Histologic Studies of the Brain Following Head Trauma

IV. Late Changes: Atrophic Sclerosis of the White Matter

Joseph P. Evans and I. Mark Scheinker

-old colored male, was admitted to the hospital about two hours after being struck in the left parietal region with a blunt object. Seventeen years earlier he had sustained a head injury in the treatment of which a large parietal decompression was made. On admission he was unconscious. In the old decompression area were found two superficial abrasions and a large subgaleal hematoma. There was a right-sided flaccid hemiplegia. Because of the hemiplegia, exploratory burr holes were made on the first hospital day in search of a possible subdural hematoma. None was found. On

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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

situation is observed after evacuation of large chronic subdural hematomas (in adults) and after surgical intervention on large hydrocephalus. The clinical syndrome associated with this type of hypotension may be frankly alarming and resemble a state of increased intracranial pressure. Failure to recognize the condition and consequent faulty therapeutic procedures may be responsible for avoidable postoperative fatalities. The correct management of such cases consists of placing the patient in shock position with the head lowered, intravenous infusion of large amounts of

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Arthur D. Ecker and Eugene W. Anthony

to be due to amblyopia exanopsia rather than to involvement of the optic nerve. What was apparently a large central scotoma on the confrontation test was actually a small central scotoma associated with marked blurring of near vision due to the marked degree of farsightedness. Therefore, the diagnosis was revised to: increased intracranial pressure due to right supratentorial lesion, probably subdural hematoma. An extracerebral process, subdural hematoma, was considered likely because of the relatively great lateral displacement of the pineal body in the absence

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Orville T. Bailey and Franc D. Ingraham

similar to that forming the outer wall. The underlying arachnoid was smooth and glistening without infiltration by the neoplasm. The situation and gross appearance of each tumor had many resemblances to a subdural hematoma. In making a diagnostic tap to determine whether or not that lesion was present, the operator might be misled by finding fluid in the precise location that it would be expected to occupy in a subdural hematoma. However, the fluid in both fibrosarcomas of the dura was brown and semigelatinous in character, whereas the fluid of a subdural hematoma is

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Mark Albert Glaser and Frederick P. Shafer

the remaining six patients, in addition to severe brain damage, had an associated subdural hematoma. Two of these were operated upon, and the hematoma removed. Of the remaining three, two died of a meningitis fourteen and twenty days after injury respectively. In both of these the fractures involved the accessory nasal sinuses; the depressions were elevated. In one of them a pneumatocephalus was present. The third patient was rendered unconscious and remained so for a few hours. He had a minor depression and there were no objective neurological findings. The second

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Subdural Hygroma

A Report of Seven Cases

Henry T. Wycis

recovery. Abbott, Due & Nosik 1943 25 cases Case 7 38 M Dazed several days − − 0 − Syncope, ataxia, impaired hearing, irritability, inability to concentrate. − Protein, 35 mgm. % Large rt. subdural hematoma, large lt. subdural effusion — Bilateral trephines. Good recovery. Wycis 1944 7 cases Case 1 45 M 1½ hrs. 60–80 120/80 + Equal Headache, hemiparesis, irritability. None Slightly xanthochromic, pressure 8 mm, Hg., protein 100 mgm. % 3 ozs. xanthochromic fluid on rt., 1 oz. on lt. Protein 4000 mgm

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Walter G. Haynes

combinations. Types of Wounds Depressed skull fractures are not included in this series. It is startling, however, to find that in the majority of those instances there is, under an intact dura, a subdural hematoma and a shallow area of brain maceration. This finding has been almost constant, and was at variance with previous conceptions of depressed skull fractures in the acute stage. Those wounds causing brain maceration are included here. Consequently, the dura is now opened in all such cases and the brain wound treated according to the above principles. Small

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Richard U. Light and Hazel R. Prentice

above all others here: the repair of torn venous sinuses and the control of dural ooze, especially that from hidden areas beneath the cranium. Analysis of the operative notes shows that rents in the superior sagittal or the transverse sinuses were repaired in 3 cases, ooze from the dura halted in all 6, the copious bleeding of pacchionian bodies in 2, and bleeding from a small cortical artery in the motor area in 1. Subtemporal Craniectomies (3). These cases need to be considered singly. The first was a newborn baby of 2 days, with a subdural hematoma complete with