. Some points in the surgery of the brain and its membranes . Fig. 22.— I. Traumatic meningocele before operation. (Dembowski, Saivickis Essay in Chipault.) z. Same case after , aged i6 months. Three months before being seen fell on head. Tumourappeared and grew rapidly, so as to occupy right half of skull. Operation.—Part offrontal and most of parietal bone depressed and almost detached. The posterior partof parietal displaced backwards and outwards. Through the gap in the. parietalbone the hernia cerebri protruded. Bone replaced. Gap closed by periosteal recovered.
. Some points in the surgery of the brain and its membranes . Fig. 22.— I. Traumatic meningocele before operation. (Dembowski, Saivickis Essay in Chipault.) z. Same case after , aged i6 months. Three months before being seen fell on head. Tumourappeared and grew rapidly, so as to occupy right half of skull. Operation.—Part offrontal and most of parietal bone depressed and almost detached. The posterior partof parietal displaced backwards and outwards. Through the gap in the. parietalbone the hernia cerebri protruded. Bone replaced. Gap closed by periosteal recovered. bone behind the fracture was removed. It wasthen seen that the hernial mass of cerebral tissueprotruded between the sharp edges of a rent in 38 SOME POINTS IN THE SURGERY the dura corresponding in position and extent tothe fracture in the bone. The opening in thedura was enlarged by incisions made at rightangles to the tear, to the size of the aperturemade in the skull. Pulsation in the extra-cranial mass at once recommenced. No further. Fig. 23.—Diagram of fracture of skull in Dr. Bastians case of traumaticencephalocele. The bone enclosed by the dotted lines and by the frontal and sagittal sutures wasremoved at the operation. nipping of the junction of brain and hernia couldthen take place. The brain had been damagedto the depth of an inch along the line of scalp flap was replaced. The patient madea good recovery ; the hernia soon years later Dr. Saunders of Pembroke Dockwrote to Dr. Bastian : Speech gradually im-proved and now almost perfect except for some OF THE CEREBRAL MEMBRANES 39 slurring when excited. Power over left legalmost completely restored, of arm only partially—no use of hand. Lumbar Puncture in Injury to Brain and inApoplexy. This seems a fitting place to point out thegreat value of lumbar puncture in traumaticlacerations of the cerebral substance when thepatient passes into the stage of cerebral irrita-tion. A jockey, twe
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