J. E. Webster

The Mechanism of Skull Fracture

Deformation patterns of the skull due to blows of low velocity, as well as the mechanism of production of linear skull fracture, have been previously described (1–5). When the dry skull is coated inside and out with “stresscoat” brittle lacquer, and then subjected to a blow, the lacquer cracks in the areas of greatest tensile deformation. The cracks appear on the outside of the skull in the regions in which the bone bends outward and on the internal surface where the bone bends inward. A region of inbending—generally circular, oval, or star-shaped—always surrounds the point of application of a blow, no matter where it is struck. Where the skull curves sharply, however, the extent of the inbending is not so great as in a less curved region. By means of the “stresscoat” technic, it has been shown that outbending of bone may occur at a considerable distance from the point of application of the blow. In some specimens a contrecoup type of outbending has been observed approximately diagonally opposite the poin...

Angiography in the evaluation of intracranial trauma.

Angiography in the diagnosis of intracranial lesions is not a new procedure, having been developed in 1927 by Egas Moniz (2). The technic has not been widely applied, however, in the evaluation of intracranial mass lesions occurring as a result of trauma. Many surgeons have preferred to depend upon watchful waiting, with the employment of a trephine as indicated. Under this type of management the diagnostic error has been high (30 to 40 per cent). In an attempt to reduce this figure, we have been utilizing carotid arteriography with increasing frequency since 1949. Approximately 1,000 head injury patients are seen on the neurosurgical services of the Detroit Receiving, Detroit Memorial, and Grace Hospitals each year. About one-half of these present evidence of severe intracranial damage. It is in this latter group that angiography has been useful in determining the presence of intracranial hematoma, its extent, and its localization. In previous reports on this subject, 30 cases studied by angiography were...

Neurosurgical Aspects of Occlusive Cerebral Vascular Disease

The surgeons interest in cerebral vascular disease began in the last century with the concern for hemorrhagic collections on the surface of the brain-the epidural and subdural hematomas. In this century, with the development and use of cerebral angiography since the thirties, cerebral aneurysms and their intracranial complications have gained increasing attention. Of more than academic interest, many aneurysms are now amenable to surgical treatment. More recently, patients having a socalled “cerebral vascular accident,” or “stroke syndrome,” have been referred to the neurosurgeon for evaluation. By collaboration, the radiologist also is involved in seeking a physiologic explanation for the dysfunction associated with cerebral vascular insufficiency and/or failure. Such collaboration is based mainly upon the application of the radiologic technic of angiography. This revealing premortem pathophysiologic roentgen procedure is disclosing new and important information concerning the dynamics of cerebral blood...