The management of major injuries
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The skull is composed of the cranial vault and the base. The vault has an inner and outer table of bone and is particularly thin in the temporal regions, although protected by the temporalis muscle. The base of the skull is irregular, which may contribute to accelerative injuries. The floor of the cranial cavity has three distinct regions: the anterior, middle and posterior fossae. The meninges cover the brain and consist of three layers: Dura mater – a tough, fibrous layer, firmly adherent to the inner skullArachnoid mater – a thin, transparent layer, not adherent to the overlying dura and so presenting a potential space. Cerebrospinal fluid (CSF) is contained and circulates within this spacePia mater – a thin, transparent layer, firmly adherent to the underlying surface of the brain.
Neoplasia
C. Simon Herrington in Muir's Textbook of Pathology, 2020
Despite their name these are not always harmless. As they remain localized at their site of origin, the effects fall into three broad categories: The presence of a palpable lump, often painless, but occasionally causing discomfort.The effects of substances produced by a tumour. The cells of a benign tumour are well differentiated and often retain the function of the tissue of origin, such as production of hormones. This is usually outwith the normal feedback mechanisms and overactivity may result, e.g. a thyroid adenoma may lead to hyperthyroidism.The effects on adjacent tissues due to pressure from expansion of the tumour. This is seen particularly when the tumour arises in a confined area, e.g. within the cranial cavity. Thus, a pituitary adenoma may cause hypopituitarism by compressing the surrounding normal glandular tissue. The distortion of the uterine cavity by a fibroid (leiomyoma) often results in heavy menstrual blood loss, whereas a benign tumour may block a hollow viscus, e.g. by causing intussusception in the intestine (see Chapter 10).
Head, neck and vertebral column
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
In life the cranial cavity is lined by the dura mater (Fig. 3.1), the outermost and toughest of the three membranes or meninges that cover the brain (p. 50). The dura is firmly adherent to the periosteal (endocranial) lining of the cranial cavity, so there is normally no patent extradural space. This space is normally only created when bleeding occurs after a skull fracture, especially in the middle cranial fossa (see below). In places the dura forms partitions that help to keep the brain in place: the falx cerebri between the two cerebral hemispheres, and the tentorium cerebelli between the cerebral hemispheres above and the cerebellum below. The dura also forms the venous sinuses of the skull (see below).
Relationship between vertebral artery blood flow in different head positions and vertigo
Published in Acta Oto-Laryngologica, 2018
Ela Araz Server, Deniz Tuna Edizer, Özgür Yiğit, Ahmet Görkem Yasak, Çağrı Erdim
VA enters the cranial cavity through atlanto-axial region. Evaluation of the blood flow in this intracranial segment (V4) is especially important. Although V4 segment can be evaluated by transcranial Dopp-USG, it is not used widely due to some difficulties in clinical use [16]. Sultan et al. investigated 46 patients with suspected positional vertebrobasilar ischemia. They retrospectively evaluated the results of the transcranial and extracranial blood flow of the vertebral and posterior cerebral arteries and concluded that compression of the vertebral artery with head rotation was extremely rare [10]. Mitchell and Kramschuster, on the other hand, stated that head rotation would result in a significant decrease in ipsilateral vertebral artery blood flow and bilateral decrease in the diameter of the VA3 segment [17]. We also detected a decrease in blood flow of ipsilateral V2 segment caused by head rotation in symptomatic patients.
An innovative hippocratic cranial intervention for amaurosis in classical Greece
Published in Acta Chirurgica Belgica, 2021
Gregory Tsoucalas, Spyros N. Michaleas, Panagiotis Sideris, Marianna Karamanou
These interventions were particularly valuable to physicians and surgeons, because in Greek antiquity, internal organs were operated on only if access could be obtained through various cavities of the human body. Massive haemorrhages, such as those occurring during abdominal surgeries, often resulted in death, because surgeons could not control the bleeding. Thus, surgeons used bodily cavities (e.g. the ‘hepar,’ or abdominal cavity) as passages to access various visceral organs and protect against vessel dissection. Cranial trepanation usually involved minimal haemorrhaging. Still, these neurosurgical operations required skill and dexterity. As medico-philosophers, surgeons of ancient Greece had to understand all anatomical structures of the cranial cavity, including how organs and tissues related to each other and which injury could cause irreversible neurological problems or even death [17]. Although craniotomy procedures were already known in Greek Mythology (like the case of the birth of the goddess Athena from the head of Zeus) (Figure 4), the Hippocratic School of Medicine established them [18]. These cranial surgical procedures advanced surgical knowledge and the authority of ancient Greek physicians in the field of surgery. Furthermore, the procedures for treating amaurosis helped identify how the central nervous system, brain, and optic nerve connects with the senses [17].
Transient anisocoria after a traumatic cervical spinal cord injury: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Paul Overdorf, Gary J. Farkas, Natasha Romanoski
The sympathetic innervation to the eye is from the superior cervical ganglion (Fig. 1). The superior cervical ganglion lies anterior to the transverse processes of the second and third cervical vertebra. Anterior to the ganglion lies the carotid sheath with the internal carotid artery, internal jugular vein, and vagus nerve, while the longus capitis muscle is found posterior to the ganglion. Postganglionic sympathetic fibers from the superior cervical ganglion are distributed onto the internal carotid artery and help to form the internal carotid nerve plexus, which ascends on the internal carotid artery into the carotid canal to enter the cranial cavity (Fig. 1).11 Once in the cranial cavity, postganglionic fibers from the internal carotid nerve plexus travel on the nasociliary nerve of the ophthalmic division of the trigeminal nerve, while other fibers continue from the internal carotid nerve plexus as the sympathetic root of the ciliary ganglion.12 The sympathetic root of the ciliary ganglion traverses the ciliary ganglion without synapsing (Fig. 1). These nerves then travel on the short ciliary nerves of the ciliary ganglion to the eye where they innervate the dilator pupillae muscle. Some of these postganglionic sympathetic fibers also travel on the long ciliary nerve, a nerve branch of the nasociliary nerve, to reach the eye (Fig. 1). Sympathetic activation of the dilator pupillae muscle dilates the pupil.11,12
Related Knowledge Centers
- Cerebrospinal Fluid
- Mandible
- Meninges
- Parietal Bone
- Skull
- Calvaria
- Brain
- Neurocranium
- Facial Skeleton
- Head Injury