Three successful cases of cerebral surgery : including (1) the removal of a large intracranial fibroma (2) exsection of damaged brain tissue, and (3) exsection of the cerebral centre for the left hand : with remarks on the general technique of such operations / by W.W. Keen.

  • William Williams Keen
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Three successful cases of cerebral surgery : including (1) the removal of a large intracranial fibroma (2) exsection of damaged brain tissue, and (3) exsection of the cerebral centre for the left hand : with remarks on the general technique of such operations / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    44/46 page 42
    even now, in my mind, doubtful. The horsehair may be removed in three to five days. Everything should bend to the speediest possible healing of the wound, thus preventing hernia cerebri and favoring a quick recovery. 10. Replacement of the bone. This most interesting and valuable re- cent addition to our operative procedure receives further encourage- ment from the results of Cases II. and III. In the last the disk of bone (one and a half inches) was replaced with about fifteen fragments bitten out by the rongeur forceps. The skull is so completely restored that except for the scars and slight flattening one would not know that it had ever been trephined. Heretofore, when the dura mater has been removed, the bone has not been replaced, but Case II. shows that even then it may be done with ease by attaching it to the under surface of the flap by chromic catgut. Of course, the small pieces cannot be so utilized, so in Case III. I had a lamb in the adjoining room, and if the removal of the dura had been necessary and any large gap been made by the rongeur forceps I meant to replace the trephine button and fill up the remaining gap by another button from the lamb’s skull, trimmed by the rongeur to suit the opening. I find that the back of the lamb’s skull has nearly the same curve and thickness as man’s, and will give one good button from its centre or, at a pinch, two might be got from it. I had no trouble with the large disks, and do not think it at all needful to chop them up into small fragments as Macewen did. But if the bone is to be replaced, the most minute care must be given to it from the moment of its removal to that of its replacement by one of the assis- tants, whose sole care it should be. I have recently had to remove a similar one and one-half inch button from a case trephined by a friend. By accident the button escaped observation for perhaps twenty minutes or more after its removal, and so lost its heat, even if it did not become septic, which seems not probable. It gave no trouble for over two months, but then produced an abscess, headache, etc., which were quickly relieved by its removal. It was entirely necrosed. It is, how- ever, proper to say that the skull was unusually thick and almost all compact tissue, and that, soon after the primary operation, the wound had to be reopened for hemorrhage from the scalp. Even with the utmost care, disks of bone, if chiefly of compact tissue, cannot always be successfully replaced. I recently had to remove three such, much smaller (one-half inch) buttons from one of my cases of trephining of the lower jaw. Yet Dr. J. S. Miller (Medical News, liii. 136) has just reported a successful case of reimplantation of one such button in the same bone. 11. Rapidity of recovery. Case I., in consequence of the reopening of the wound and later complications, was long in getting well; but Cases II. and III. were out on the street on the seventh and eighth days, their
    digitised image 1
    digitised image 2
    digitised image 3