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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

. Hydrocolloids are sterilizable and workable at temperatures tolerated by the intracranial tissues. Before taking an impression, it is necessary to construct a well-fitting impression tray. Sheet copper or aluminum, 1 mm. in thickness, is excellent for this purpose. A tray made from either metal may be contoured and reshaped for use in subsequent operations. A stout wire loop attached to the outer surface of the tray aids in removing the impression from the skull. The value of a properly constructed impression tray cannot be overemphasized. Unless the hydrocolloid is

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Gilbert Horrax

had ever emphasized the importance of decompressing at a distance from the growth as a preliminary measure should the brain prove to be under great tension. * The value of this type of palliative decompression in those early days hardly can be overemphasized. It relieved an infinite amount of suffering, preserved vision, and allowed many patients to get back to active and useful work, sometimes for years. Indeed, in not a few persons the tumors later became localizable and were removed successfully, whereas if they had not been decompressed death or blindness

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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

. Another field in which the fibrin foams have proved of great value is in the control of bleeding from large venous channels. When there is oozing from large superficial cerebral veins, especially those entering the mid-portion of the superior longitudinal sinus, ligation is apt to be followed by cerebral softening. Such oozing may be controlled by the use of foam. It is also possible to stop bleeding from the superior longitudinal sinus or other dural sinuses by the use of a good sized piece of foam placed firmly against the sinus. The foam has also proved invaluable in

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Claude C. Coleman

distance peripherally from the site of the injury and gently tapping the skin upward over the course of the nerve toward the injury, a tingling or formication was produced as soon as the down-growing regenerating fibers were percussed. It was thought by this method one could determine whether the lesion was recovering spontaneously and, if so, the level reached by regenerating axones from the central stump. However, the value of the test was considerably discounted in many cases in which the Tinel's sign showed favorable progress of the nerve and later exploration

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R. Glen Spurling

responses even with five times the minimal stimulus, it may be assumed that anatomical continuity is lost, providing the nerve has been liberated from its extrinsic scar prior to the test. If the operation is conducted under local anesthesia and no procaine has been infiltrated into the proximal segment of nerve, information of great value can be obtained from the sensory responses. Stimulation of the scar or neuroma is always painful, more so than stimulation of normal nerve above the scar. Stimulation distal to the scar without sensory response indicates disruption of

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Burton M. Shinners and Wallace B. Hamby

protruded intervertebral discs. In 140 patients 116 disc protrusions were found at the first operation, 8 recurrences later occurred at the same level and 3 at new levels. Twenty-four patients were explored without finding disc protrusions. An analysis was made of the value in diagnosis of 100 spinograms of various types. The rôle and results of spinal fusion are discussed. Listed are the results obtained after simple removal of disc protrusions, after spinal fusion and after exploration without disclosing a protrusion. A comparison is made of results in private

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A. H. S. Holbourn

“intracranial pressure,” having the same value throughout the brain does not adequately describe conditions in the brain where expanding tumours are present. It often appears somewhat as if the hydrostatic pressure were higher near the tumour than elsewhere. It is not sufficiently realised, however, that different hydrostatic pressures could not coexist at two points in the brain unless there also existed non-hydrostatic stresses at other points. It is convenient to divide the six components of stress into two sets of three which are of different types. Three consist of

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Franc D. Ingraham, Orville T. Bailey and Frank E. Nulsen

hemostatic agent in 1911 by Cushing 5 was a definite advance in neurosurgery. Muscle has proved of great value in controlling ooze from vessels unsuited to ligation and is often very useful in dealing with bleeding from the dural sinuses and other large venous channels. Its greatest value lies in the fact that it is absorbed and therefore may be left in place at the end of operation. Similar types of bleeding are often well controlled with moist cotton but in many instances the removal of the pattie may pull away the clot and the bleeding then begins anew. Fibrin foam

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Jurgen Ruesch

, attention was called to a number of visual functions which were shown to be sensitive indicators of changes in brain physiology. 23 In view of these reports it seemed of interest to inquire into the value of visual functions as indicators of structural brain damage. Thus dark adaptation, onset of negative after images, apperception and comprehension following tachistoscopic exposure and reaction time were investigated in 57 patients with head injuries. The diagnostic value of gross alterations of the visual fields following craniocerebral injuries is well established

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J. Grafton Love

; yet eleven patients had pain in only one lower extremity and, what is even more interesting and important, is the fact that five of the patients had backache only, in spite of the fact that they came to operation for relief of incapacitating symptoms and, in each case, an intraspinal neoplasm involving the cauda equina was found and removed. These five cases, it seems to me, are excellent evidence of the value of diagnostic lumbar puncture and also of the fact that, clinically and neurologically, at times it is impossible to make accurate diagnosis of, and to