Paul Broca and the first craniotomy based on cerebral localization

1991 ◽  
Vol 75 (1) ◽  
pp. 154-159 ◽  
Author(s):  
James L. Stone
Keyword(s):  
Skull Fracture ◽  
Intracranial Abscess ◽  
Content Type ◽  
Nonfluent Aphasia ◽  
Cerebral Localization ◽  
Cortical Localization ◽  
Cortical Regions ◽  
French Surgeon ◽  
Scalp Laceration ◽  
Cerebral Convolutions

✓ Paul Broca (1824–1880) was a well-known French surgeon-anthropologist-neurologist. Best known for his work on cerebral cortical localization and speech mechanisms, Broca also carefully worked out skull and scalp localization for underlying cortical regions. In 1871, Broca treated a man who had sustained a scalp laceration from a blow to the head without loss of consciousness or skull fracture. The patient exhibited a nonfluent aphasia about 1 month after injury and became progressively obtunded and eventually comatose. Suspecting an intracranial abscess, Broca trephined at the region of the left third frontal convolution and drained an epidural abscess. The patient improved transiently but died a few days later. Autopsy showed a left-sided, predominantly frontal purulent meningoencephalitis. Broca's other neurosurgical contributions included various surgical cases, methods for scalp localization of the cerebral convolutions, extensive studies of skull and brain abnormalities, thermoencephalography, and the stimulation of younger surgical colleagues and neurologists to make practical use of cerebral localization.

Relief of facial pain after combined removal of precentral and postcentral cortex

1971 ◽  
Vol 34 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Richard A. Lende ◽  
Wolff M. Kirsch ◽  
Ralph Druckman
Keyword(s):  
Facial Pain ◽  
The Other ◽  
Precentral Gyrus ◽  
Nerve Section ◽  
Content Type ◽  
Burning Pain ◽  
Cortical Localization ◽  
The Brain ◽  
Fine Print ◽  
Frontal Lobotomy

✓ Cortical removals which included precentral and postcentral facial representations resulted in relief of facial pain in two patients. Because of known failures following only postcentral (SmI) ablations, these operations were designed to eliminate also the cutaneous afferent projection to the precentral gyrus (MsI) and the second somatic sensory area (SmII). In one case burning pain developed after a stroke involving the brain stem and was not improved by total fifth nerve section; prompt relief followed corticectomy and lasted until death from heart disease 20 months later. In the other case persistent steady pain that developed after fifth rhizotomy for trigeminal neuralgia proved refractory to frontal lobotomy; relief after corticectomy was immediate and has lasted 14 months. Cortical localization was established by stimulation under local anesthesia. Each removal extended up to the border of the arm representation and down to the upper border of the insula. Such a resection necessarily included SmII, and in one case responses presumably from SmII were obtained before removal. The suggestions of Biemond (1956) and Poggio and Mountcastle (1960) that SmII might be concerned with pain sensibility may be pertinent in these cases.

Cranioplasty with inner table of bone flap

1985 ◽  
Vol 62 (4) ◽  
pp. 607-609 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Hirohiko Gibo ◽  
Shigeaki Kobayashi ◽  
Kenichiro Sugita
Keyword(s):  
Foreign Body Reaction ◽  
Skull Fracture ◽  
Bone Defects ◽  
Skin Incision ◽  
The Body ◽  
Bone Flap ◽  
Growing Skull Fracture ◽  
Content Type ◽  
Additional Exposure ◽  
Fine Print

✓ A new method of cranioplasty is described in which the inner table of the bone flap obtained during craniotomy is used for grafting. The method was used in 10 cases to repair bone defects caused by a growing skull fracture in two, created during removal of an invasive skull tumor in two, during the approach to intraorbital tumors in two, and secondary to craniectomy for additional exposure in four. The method has the advantage that a piece of the inner table for grafting can be obtained from the craniotomy bone flap, without the need for an additional skin incision or taking a graft from another part of the body, and foreign-body reaction is minimal.

The management of “asymptomatic” epidural hematomas

1989 ◽  
Vol 70 (3) ◽  
pp. 392-396 ◽  
Author(s):  
Neville W. Knuckey ◽  
Steven Gelbard ◽  
Mel H. Epstein
Keyword(s):  
Risk Factors ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Management Protocol ◽  
Major Vessel ◽  
Low Incidence ◽  
A Prospective Study ◽  
Fine Print

✓ Standard neurosurgical management mandates prompt evacuation of all epidural hematomas to obtain a low incidence of mortality and morbidity. This dogma has recently been challenged. A number of authors have suggested that in selected cases small and moderate epidural hematomas may be managed conservatively with a normal outcome and without risk to the patient. The goal of this study was to define the clinical parameters that may aide in the management of patients with small epidural hematomas who were clinically asymptomatic at initial presentation because there was no clinical evidence of raised intracranial pressure or focal compression. A prospective study was conducted of 22 patients (17 males and five females) aged from 1 to 71 years, who had a small epidural hematoma diagnosed within 24 hours of trauma and were managed expectantly. Of these, 32% subsequently required evacuation of the epidural hematoma 1 to 10 days after the initial trauma. Analysis of the patients revealed that age, sex, Glasgow Coma Scale score, and initial size of the hematoma are not risk factors for deterioration. However, deterioration was seen in 55% of patients with a skull fracture transversing a meningeal artery, vein, or major sinus, and in 43% of those undergoing computerized tomography (CT) within 6 hours of trauma. In contrast, only 13% of patients in whom the diagnosis of a small epidural hematoma was delayed over 6 hours subsequently required evacuation of the epidural collection. Of patients with both risk factors, 71% required evacuation of the epidural hematoma. None of the patients suffered neurological sequelae attributable to this management protocol. It was concluded that patients with a small epidural hematoma, a fracture overlaying a major vessel or major sinus, and/or who are diagnosed less than 6 hours after trauma are at risk of subsequent deterioration and may require evacuation. Conversely, patients without these risk factors may be managed conservatively with repeat CT and careful neurological observation, because of the low risk of delayed deterioration.

Rapid resolution of acute epidural hematoma

1988 ◽  
Vol 68 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Epidural Hematoma ◽  
Clinical Course ◽  
Skull Fracture ◽  
Fracture Line ◽  
Concomitant Increase ◽  
Content Type ◽  
Rapid Resolution ◽  
Acute Epidural Hematoma ◽  
Fine Print

✓ Two cases of acute epidural hematoma with rapid resolution followed by a benign clinical course are reported. Because of the concomitant increase in the epicranial hematoma over a linear skull fracture in each case, the acute epidural hematoma was presumed to have been decompressed into the epicranial region through the fracture line.

Choroid plexus carcinoma presenting as an intraparenchymal mass

2001 ◽  
Vol 95 (6) ◽  
pp. 1040-1044 ◽  
Author(s):  
Alexis Byrne Carter ◽  
Donald L. Price ◽  
Keith A. Tucci ◽  
Gregory K. Lewis ◽  
Jeffrey Mewborne ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Skull Fracture ◽  
Ct Scanning ◽  
Cystic Mass ◽  
Choroid Plexus Carcinoma ◽  
Left Frontal Lobe ◽  
Content Type ◽  
Resected Tissue ◽  
History Of ◽  
The Brain

✓ A 6-year-old girl with a history of a nondisplaced skull fracture diagnosed with computerized tomography (CT) scanning 3 years previously presented with a 6-week history of headaches and decreased use of her right side. On admission CT scans, a large cystic mass was identified in the left frontal lobe region of the brain. A connection between the mass and the ventricular system was not seen on radiological examination or during surgery. Gross-total resection of the mass was achieved. The histological and immunohistochemical findings in the resected tissue confirmed a diagnosis of choroid plexus carcinoma (ChPC). This is the first reported case of a ChPC arising in an extraventricular location not associated with the choroid plexus.

Air in acute epidural hematomas

1986 ◽  
Vol 65 (4) ◽  
pp. 555-556 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Temporal Bone ◽  
Clinical Significance ◽  
Epidural Hematoma ◽  
Pediatric Patients ◽  
Skull Fracture ◽  
Air Bubbles ◽  
Content Type ◽  
Air Bubble ◽  
Acute Epidural Hematoma ◽  
Fine Print

✓ Two pediatric patients with acute epidural hematomas containing air bubble(s) are reported. A skull fracture was observed extending to the mastoid cells of the temporal bone in both patients. In one patient the hematoma and air bubbles subsequently increased in volume, requiring a craniotomy. The clinical significance of air in an acute epidural hematoma is discussed.

Hospital-acquired bacterial meningitis in neurosurgical patients

1977 ◽  
Vol 46 (4) ◽  
pp. 494-500 ◽  
Author(s):  
Frederick J. Buckwold ◽  
Roger Hand ◽  
Robert R. Hansebout
Keyword(s):  
Staphylococcus Epidermidis ◽  
Skull Fracture ◽  
Cerebrospinal Fluid Leak ◽  
Enteric Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Etiologic Agents ◽  
Neurosurgical Patients ◽  
Fluid Leak ◽  
Hospital Acquired

✓ The authors review 23 cases of hospital-acquired meningitis occurring over a 15-year period in neurosurgical patients. Factors associated with the development of meningitis include recent craniotomy, cerebrospinal fluid leak, the presence of ventricular or lumbar drainage tubes, and skull fracture. Four cases were caused by Staphylococcus epidermidis; one of these patients died. In 19 cases, Gram-negative enteric bacteria were the etiologic agents, most commonly members of the Klebsiella-Enterobacter-Serratia group. Eleven of these patients died. The particular antibiotic or group of antibiotics used and the route of administration made no difference in the outcome of Gram-negative bacillary meningitis.

Electrical recording with micro- and macroelectrodes from the cerebellum of man

1970 ◽  
Vol 33 (5) ◽  
pp. 524-528 ◽  
Author(s):  
D. Graham Slaughter ◽  
Blaine S. Nashold ◽  
George G. Somjen
Keyword(s):  
White Matter ◽  
Electrical Activity ◽  
Dentate Nucleus ◽  
Active Movement ◽  
Nuclear Region ◽  
Cerebellar White Matter ◽  
Evaluation Period ◽  
Content Type ◽  
Cortical Regions ◽  
Fine Print

✓ Recordings of electrical activity in the cerebellar cortex and deep nuclei were obtained from three patients with congenital athetosis, prior to therapeutic ablation of the dentate nucleus. Recordings from microelectrodes were carried out during the stereotaxic procedure with the patient under light fluthane anesthesia. Macroelectrodes were also implanted within the cerebellar nuclear and cortical regions; records from these electrodes were obtained with the patient fully awake during a 2-week evaluation period. Two major areas of electrical activity were defined in the cortical gray and nuclear gray, separated by an area of relative electrical silence corresponding to the cerebellar white matter. The electrical activity from the nuclear gray was characteristically of a higher frequency and voltage; thus, the limits of the nuclear region can be defined by contrast with the relatively silent white matter. The recorded electrical activity was not influenced by either sleep or active movement of the extremities.

Depressed skull fracture in the neonate

1979 ◽  
Vol 50 (4) ◽  
pp. 512-514 ◽  
Author(s):  
Brian S. Saunders ◽  
Stephen Lazoritz ◽  
Robert D. McArtor ◽  
Paul Marshall ◽  
William M. Bason
Keyword(s):  
Direct Observation ◽  
Skull Fracture ◽  
Skull Fractures ◽  
Content Type ◽  
Depressed Skull Fracture ◽  
Neurological Signs ◽  
Vacuum Extractor ◽  
Breast Pump ◽  
Fine Print

✓ The authors describe three cases of neonatal depressed skull fracture that were elevated by means of an obstetrical vacuum extractor. In one case, a transparent breast pump shield replaced the metal vacuum extractor cup, permitting direct observation as the depression was elevated. Neonatal depressed skull fractures not associated with neurological signs may be safely elevated without surgery using the obstetrical vacuum extractor.

Management of depressed skull fracture in the newborn

1976 ◽  
Vol 44 (1) ◽  
pp. 62-64 ◽  
Author(s):  
John D. Loeser ◽  
H. Lee Kilburn ◽  
Tim Jolley
Keyword(s):  
Surgical Therapy ◽  
Epileptiform Activity ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Skull Fractures ◽  
Content Type ◽  
Depressed Skull Fracture ◽  
Neurological Signs ◽  
The Absolute ◽  
Fine Print

✓ The authors describe three cases of neonatal depressed skull fracture subsequent to difficult delivery, treated without surgical elevation. None of the patients developed neurological deficits, cosmetic deformity or electroencephalographic signs of epileptiform activity. Neonatal depressed skull fractures not associated with focal neurological signs may not require surgical therapy; we are not certain what the absolute criteria for operation should be.

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