. Postoperative treatment; an epitome of the general management of postoperative care and treatment of surgical cases as practised by prominent American and European surgeons. ved. After trephining, in case a fissure-fracture has traveled to the base of the skull, basilar meningitis is verylikely to follow, and, since many important cranial nerves are given offfrom this part of the brain, a disturbance of their functions will be , the inflammation is rarely limited to the base of the skull,but extends to the upper part of the spinal meninges and so retractionof the head and interf
. Postoperative treatment; an epitome of the general management of postoperative care and treatment of surgical cases as practised by prominent American and European surgeons. ved. After trephining, in case a fissure-fracture has traveled to the base of the skull, basilar meningitis is verylikely to follow, and, since many important cranial nerves are given offfrom this part of the brain, a disturbance of their functions will be , the inflammation is rarely limited to the base of the skull,but extends to the upper part of the spinal meninges and so retractionof the head and interference with, and disturbance of, the upper spinalmuscles are likely. When there has been any evidence of extension of the inflammation to OPERATIONS. 151 the spinal meninges, spinal puncture or laminectomy may be resorted to,with irrigation; but the results, up to present, of either of these pro-cedures do not warrant great hopes of recovery. (Abstract from Warren-Gould.) Postoperative Hernia Cerebri.—Postoperative hernia cerebri isan evidence of sepsis, local perhaps. The protruding mass, which isbrain-substance, at first is small; but subsequently may become large,. Fig. 35.—Postoperative Cerebral Hernia.(Reported by Cushing, S., G. & Obs., Vol. i, No. 4.) may slough, may suppurate, but always projects above the level of theskull. It will pulsate and is soft to the touch—not vascular, however;it is possible to cut away portions of the hernia, for brain-substance isinsensitive. When portions of the hernia are cut away, new portions areapt to protrude through the skull. As inflammation diminishes, thehernia will sink within the head and cicatrization take place, or thepatient may die of general sepsis. 152 POSTOPERATIVE TREATMENT. Treatment.—An attempt to force the brain back into the skull willgive rise to symptoms of compression not advantageous to the off pieces of the brain down to the level of the skull is not calledfor. A clean dressing, with a lig
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