British Journal of Neurosurgery (1991) 5, 525-526
Br J Neurosurg Downloaded from informahealthcare.com by Flinders University of South Australia on 01/04/15 For personal use only.
Letters to the Editors The Editors welcome all letters whether they are short case reports, preliminary reports of research, discussion or comments on papers published in the journal. Letters commenting on a paper may be sent to the authors of that paper so that their reply may appear in the same issue. There is no rigid limit to length but in general the shorter the letter the better the chance of publication. Authors should follow the same guidelines given for the preparation and submission of articles on the inside back covers of each issue, especially that regarding tables or illustrations. Letters should be signed by all authors.
Cranial tangential gunshot wounds SIR-I have read the paper ‘Cranial tangential Gunshot Wounds’ (British Journal of Neurosurgery 1991; 5(1):43) with interest. There have been some very interesting papers published on this subject, and one of the most interesting was by Peter Ashcroft who, I believe, published a paper in the British Journal of Surgery years ago just looking at scalp lacerations only. I think this was an autopsy series of patients in the war who had been shot but had only scalp lacerations and the amount of pathology he found intracranially was astonishing. A definitive paper was that by Dodge and Meirowsky, ‘Tangential wounds of the scalp and skull’ (Journal of Neurosurgery 1952; 9:472). EBENALEXANDER JR Department of Neurosurgery, The Bowman Gray School of Medicine, Wake Forest University, NC 27103, USA
Management of chronic subdural haematoma SIR-In the management of chronic subdural haematoma (SDH) craniotomy is rec-
ommended when sizeable solid clots are returned after irrigation, if the outer membrane is very thick, when there are multiple loculations in the haematoma cavity and in recurrent intractable haematoma formation.’ Thinking of recollection as a common postoperative complication, craniotomy has been modified in 12 patients with a mean age of 63 years to include durectomy, outer membranectomy and drainage. None of them needed subsequent tapping, mean post-operative hospitalization period was 16 days and brain C T 2 weeks post-operatively showed very satisfactory cerebral expansion. A standard craniotomy is employed to evacuate the haematoma. Dura is excised leaving a 1 cm margin which is diathermed, everted and stitched to the periosteum or galea. The outer membrane is excised and the remaining visible portion diathermed. The inner membrane is left intact to avoid any cerebral damage. Two soft catheters, one frontal and one parietal, are left under the bone flap connected to a closed non-suction drainage system. Bone flap is replaced without fixation. Post-operatively patients were kept flat and would assume the upright position gradually after removal of both drains. A drain was removed once the amount collected was less
525
Br J Neurosurg Downloaded from informahealthcare.com by Flinders University of South Australia on 01/04/15 For personal use only.
Letters to the Editors The Editors welcome all letters whether they are short case reports, preliminary reports of research, discussion or comments on papers published in the journal. Letters commenting on a paper may be sent to the authors of that paper so that their reply may appear in the same issue. There is no rigid limit to length but in general the shorter the letter the better the chance of publication. Authors should follow the same guidelines given for the preparation and submission of articles on the inside back covers of each issue, especially that regarding tables or illustrations. Letters should be signed by all authors.
Cranial tangential gunshot wounds SIR-I have read the paper ‘Cranial tangential Gunshot Wounds’ (British Journal of Neurosurgery 1991; 5(1):43) with interest. There have been some very interesting papers published on this subject, and one of the most interesting was by Peter Ashcroft who, I believe, published a paper in the British Journal of Surgery years ago just looking at scalp lacerations only. I think this was an autopsy series of patients in the war who had been shot but had only scalp lacerations and the amount of pathology he found intracranially was astonishing. A definitive paper was that by Dodge and Meirowsky, ‘Tangential wounds of the scalp and skull’ (Journal of Neurosurgery 1952; 9:472). EBENALEXANDER JR Department of Neurosurgery, The Bowman Gray School of Medicine, Wake Forest University, NC 27103, USA
Management of chronic subdural haematoma SIR-In the management of chronic subdural haematoma (SDH) craniotomy is rec-
ommended when sizeable solid clots are returned after irrigation, if the outer membrane is very thick, when there are multiple loculations in the haematoma cavity and in recurrent intractable haematoma formation.’ Thinking of recollection as a common postoperative complication, craniotomy has been modified in 12 patients with a mean age of 63 years to include durectomy, outer membranectomy and drainage. None of them needed subsequent tapping, mean post-operative hospitalization period was 16 days and brain C T 2 weeks post-operatively showed very satisfactory cerebral expansion. A standard craniotomy is employed to evacuate the haematoma. Dura is excised leaving a 1 cm margin which is diathermed, everted and stitched to the periosteum or galea. The outer membrane is excised and the remaining visible portion diathermed. The inner membrane is left intact to avoid any cerebral damage. Two soft catheters, one frontal and one parietal, are left under the bone flap connected to a closed non-suction drainage system. Bone flap is replaced without fixation. Post-operatively patients were kept flat and would assume the upright position gradually after removal of both drains. A drain was removed once the amount collected was less
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