Volume 14

The American encyclopedia and dictionary of ophthalmology / edited by Casey A. Wood, assisted by a large staff of collaborators.

Date:
1913-1921
Catalogue details

Licence: In copyright

Credit: The American encyclopedia and dictionary of ophthalmology / edited by Casey A. Wood, assisted by a large staff of collaborators. Source: Wellcome Collection.

    145/822 (page 10541)
    maiient drainage of the ventricles in internal hydrocephalus, acute and chronic, whatever the origin; (2) evacuation of pus and blood; (3) evacuation of fluid from meningeal spaces and lateral ventricles to diminish pressure before decompression or exploratory operations. Dangers of hram pimcture. 1. The chief danger is from h&mm-- rhage, which is naturally very much less when the puncture is done in connection with a resection of the cranium, so that large veins can be avoided and any bleeding promptly seen and checked. In the use of the puncture through a small trephine opening by the method of Neisser and Pollock, the chief danger is from injury to the pial veins by the point of the exploratory needle. Though nor- mally small, in diseased conditions they are often greatly dilated and the walls are at all times very fragile and delicate. The dural veins are injured less easily, but may give rise to very severe hemorrhage at times. The branches of the middle meningeal artery may be injured during the trephining, but they are more easily seen and the hemor- rhage controlled by ligation. Vascular tumors on the surface and in the tissue of the brain are still more dangerous to puncture; e. g., angiomata, angiosarcomata, etc., may exist, which may easily give rise to fatal and unrecognized hemorrhage. 2. Septic infectian is rarely likely to be carried in from without, but may easily infect the meninges from a punctured abscess if the Neisser and Pollock puncture is done without walling off the meningeal space. 3. Tuntior infectimi may easily be carried .into the healthy parts of the brain by the exploring needle when the tumor lies superficially and the needle, as often happens, is inserted through and beyond it. 4. Focal symptoms from destruction of nerve centers are avoided by not putting in the needle too deeply (four inches is the limit in any direction, and five to six centimeters is usually far enough). Pons, medulla and basal ganglia lie so deeply that there is rarely danger of striking them. Puncture in the motor area may have dis- agreeable after-effects, as in a case of P. Krause’s, which was followed by temporary arm paralysis and severe general prostration and shock. 5. Sudden collapse from diminution of intravenous pressure may occur with the larger collections of blood and pus, but is especially apt to occur in the evacuation of an internal hydrocephalus. If this happens the head is lowered and the veins filled with salt solution and adrenalin. The best means of preventing this complication is to slowly evacuate the fluid. 6. Acute and fatal edema of the brain associated with great in-