Report on Progress in Surgery

H. L. BURRELL, H. W. CUSHING
1886 Boston Medical and Surgical Journal  
In the past three years, Krönlein * has opened the cranial cavity for haemorrhage from the middle meningeal artery and resulting haematoma in four cases where neither wound of the skin, nor fracture of the skull existed. The diagnosis was correctly made in every case. In each instance there was found a marked supra-dural extravasation in the region of the arteria meníngea media. Two patients recovered. Cerebral haematoma may be (a) diffuse, or (b) circumscribed. Of the latter (b), Krönlein
more » ... (b), Krönlein makes the following classification, according to the seat of haemorrhage : First. Haematonia media, or tempero-parietale, of the middle cerebral fossa (a region supplied by the trunk and anterior or posterior division of the arteria meningia media) due to hiemorrhage from the anterior branch of the anterior division. Second. Haematonia posterius, or parieto-occipitale parietal eminencedue to haemorrhage from rupture of the posterior branch. Third. Haematoma anterius, or fronto-parietale frontal eminence. The tempero-parietal region is the mqpt common seat of injury (a) from the vulnerability of the region, (b) from the size and number of vessels, it being the seat of the trunk and the main branches. All haematoma are accessible at the anterior inferior angle of the parietal bone, with the exception of the circumscribed ones of the parieto-occipital region. If the haematoma is not found here, the parieto-occipital region must be explored, and the point for trephining is under the parietal eminence. Krönlein's indications for surgical interference are symptoms of cerebral compression, and his rule for locating the points for operation are as follows : (1) A line called the horizontal line of the skull, namely, one passing from the infra-orbital border to the external auditory meatus. (2) A horizontal line parallel with the above, and projected backward from the supra-orbital ridge. Both points of operation are in this line. (a) The anterior ; three to four cm. posterior to the zygomatic (ext. angular) process of the frontal bone.
doi:10.1056/nejm188608261150803 fatcat:5fqgv5bmcbh45g6qvey5tqoxka