Anatomy of head injury

The scalp has an extremely rich blood and nerve supply. It comprises five layers – skin, connective tissue, aponeurosis, loose areolar tissue and periosteum. The blood vessels lie within the tough fibrous septa of the connective tissue layer and cannot retract when divided – hence the copious bleeding from a scalp laceration. The loose areolar tissue beneath the aponeurosis is the plane in which the scalp is avulsed in trauma and in which the surgeon mobilizes a scalp flap. The periosteum adheres to the suture lines of the skull and a haematoma in this plane outlines the affected skull bone (cephalohaematoma).     

The use of Zenker's solution in linear craniectomy for craniosynostosis: Technical modification and reappraisal

Summary Regrowth of bone after craniectomy for craniosynostosis is still a problem, despite the advent of newer and extensive surgical techniques. A clinical study on 25 consecutive patients was undertaken to determine whether a modification of previous routines could retain the advantages of a tissue fixative, Zenker's solution, while eliminating the drawback of convulsive activity. After brief coagulation, Zenker's solution was sparingly applied to the durai surface for maximally one minute followed by copious irrigation of the surgical field. The results were satisfactory and postoperative complications unrelated to the fixative. The present procedure seems safe, effective, and easy to use.     

The role of CT in evaluation of the effectiveness of embolisation of spinal dural arteriovenous fistulae with N -butyl cyanoacrylate

A failed embolisation of a spinal dural arteriovenous fistula (AVF), because a pedicular injection has not reached the initial venous compartment, must be identified immediately, to allow prompt surgery and thus avoid clinical deterioration. The purpose of our study was to determine the role of CT in confirming a complete cure just after embolisation with N -butyl cyanoacrylate (NBCA). Seven patients embolised for spinal dural AVFs with perimedullary venous drainage had an immediate postembolisation CT scan. In six patients a complete cure was achieved, with a normal postembolisation angiogram in five cases. Just after injection of NBCA, we were unable to determine on plain films whether or not the glue had reached the draining vein in six of seven cases. The postembolisation CT showed various patterns: in two cured patients, the glue was visible in the inner surface of the dura mater and therefore on the venous side. In five cases, the glue was approaching the dura mater around the cord or seemed to reach its surface: in the four patients cured, the glue column was 7–18 mm high, whereas it was less than 2 mm high in the patient with angiographic proof of recurrent fistula. The follow-up angiogram remains the only way to confirm a durable cure. We suggest that immediate postembolisation CT may help in assessing endovascular treatment of spinal dural AVFs. Received: 27 May 1994 Accepted: 30 August 1995     

Puncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture

Background: This clinical study was conducted in order to investigate the effect of two different orientations of the bevel during dural puncture on development of postural postdural puncture headache (PPDPH).
Methods: Two hundred and eighteen patients aged 18 to 50 years scheduled lor minor non-obstetric surgery using spinal anaesthesia (SA) were included in this randomised, double-blind study. Dural puncture was performed using a 0.42 mm O.D. (27-g) Quincke spinal needle with the orientation of the bevel parallel or transverse relative to the longitudinal axis of the dural cylinder. All patients were blinded with regard to the puncture technique, and so was the anaesthesiologist performing a telephone interview 5 to 7 days postoperatively. The occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10.
Results: Two hundred and twelve patients with a mean age of 35.3 years completed the study, 106 in each group. The two groups were comparable with regard to mean age, sex, local anaesthetics used and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 4/106 patients (3.8%) in the parallel group and 24/106 (22.6%) in the transverse group ( P <0.0002). Postoperative backache occurred in 31 and 20 patients (parallel compared to transverse) (NS).
Conclusions: Dural puncture with the bevel of the needle transverse to the longitudinal axis of the dural cylinder gave significantly more cases of PPDPH than puncture with the bevel parallel to this axis even when using a 27-g Quincke needle. When using Quincke bevelled needles care must be taken to assure that the orientation of the bevel is parallel to the longitudinal axis of the dural sac.     

人蛛网膜绒毛的扫描电镜观察

用扫描电镜研究了正常人的蛛网膜绒毛的三维结构。观察到人的蛛网膜绒毛的上皮间存在着较宽的裂隙较小的孔洞。在上皮的表面可见微绒毛和球样突起。根据形态可把微绒毛分为两类：棒样微绒毛和末端有泡的微绒毛，策绒毛的分布不是均匀一致的，偶尔可见微绒毛聚信成花样结构。     

雪旺氏细胞植入硬脊膜管修复周围神经缺损的实验研究

本文报道两组10mm大鼠坐骨神经缺损,分别用含雪旺氏细胞和不含雪旺氏细胞的硬脊膜管桥接修复,术后2、4个月行光镜、电镜、神经电生理和计算机图像分析检测,证实植入雪旺氏细胞者,再生神经生长及成熟较早,肢体功能恢复较快,雪旺氏细胞和硬脊膜管结合,对周围神经再生有更大的促进作用。     

Cerebral dura mater and cephalalgia: relationships between mast cells and catecholaminergic nerve fibers in the rat

The aim of the present study was to examine whether mast cells have the same variations as the related catecholaminergic nerve fibers. Chemical sympathectomy or surgical removal of right superior cervical ganglion induced a rapid decrease of fluorescence in both nerve fibers and mast cells, as confirmed by quantitative analysis (nerve fibers 19±1.1 vs 1.3±0.6; mast cell 10.8±1.9 vs 2.1±0.3). The results of quantitative analysis after nerve fiber stimulation (electrical), however, showed an increase of the fluorescence in both the nerve fibers and the mast cells (nerve fibers 43.4±2.4; mast cells 18.6±1.6). Moreover, we found that the basal zone is more innervated (regarding catecholaminergic nerve fibers) than the apical one, and that the fluorescence level decreases passing from the vasal zone to the perivasal and intervasal zones, Further studies are needed in order to clarify the role of fluorescent nerve fibers and mast cells of cerebral dura mater in cephalalgia.     

Fibrosis of the dura mater. A cause of "failed back" syndrome

A patient is presented in which a persistent deformity of the dural sac was caused by fibrosis of the dura mater. Postmortem documentation is presented.     

Use of palatal mucosa and lyophilized dura mater to create attached gingiva

Gingival extension procedures using free palatal mucosal autografts or homologous lyophilized dura were compared clinically. Palatal mucosa was transplanted in 68 cases and lyophilized dura in 16 cases. The width of the zone of attached gingiva was measured before surgery and at regular intervals up to 2 years postoperatively. The width of the attached gingiva remained relatively constant in the mucosal transplant group from 1 month postoperatively, with an average relapse of about 20%. In the dura group the width of attached gingiva showed a marked decrease until 3 months after surgery with an average relapse of approximately 63%. If a preset minimal width of the attached gingiva is considered to be the criterion of success, the superiority of the palatal mucosa grafting procedure is demonstrated.     

Invasion of the rat ventral root L5 by putative sympathetic C-fibers after neonatal sciatic nerve crush

The present study examines the occurence of C-fibers in lumbar ventral roots after sciatic nerve crush in neonatal and adult rats. Electron microscopic analysis showed that the number of C-fibers in the ventral root L5 increased significantly on the lesion side after neonatal but not adult sciatic nerve crush and that the number of C-fibers was higher in the ventral root L5 on the unoperated side compared to this root in normal control rats. In order to determine whether the new C-fibers in the L5 root on the lesion side are sensory or sympathetic we made immunohistochemical studies on roots from neonatally crushed rats. We found that there was no obvious lesion side/contralateral side or operated rat/control rat difference with respect to the occurence and general configuration of axons with substance P-, calcitonin gene-related peptide- or vasoactive intestinal polypeptide-like immunoreactivity. However, the occurrence of axons with tyrosine hydroxylase-like immunoreactivity appeared clearly higher in the ventral root L5 on the lesion side compared to the unoperated side in neonatally crushed rats. Moreover, these axons seemed to be more numerous also in the ventral root L5 on the unoperated side compared to normal control rats. No lesion side/contralateral side or operated rat/control rat differences were seen in the ventral root L4. We propose that the ventral root L5 is invaded by putative sympathetic C-fibers after sciatic nerve crush lesions in newborn rats.