gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Meningioma surgery 1912 – a glimpse into historical textbooks

Meeting Abstract

Suche in Medline nach

  • H. Collmann - Archiv für Geschichte der Deutschen Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 070

DOI: 10.3205/12dgnc457, URN: urn:nbn:de:0183-12dgnc4571

Veröffentlicht: 4. Juni 2012

© 2012 Collmann.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Demonstration of possibilities and limitations of neurosurgical techniques at a time when many technical aids were still unavailable: neuroradiology, intubation anesthesia, microsurgery, suction devices, diathermia and blood transfusion.

Methods: Analysis of neurosurgical techniques as outlined in the textbooks by Krause published in 1908 and 1911, and by Krause and Heymann published in 1912 and 1914.

Results: Tumor diagnosis and localization was usually based on clinical findings only. General anesthesia was achieved by means of a chloroform mask. Heidenhain running sutures were applied against bleeding from the scalp. Craniotomy was then performed according to the technique of Wagner, leaving the bone flap attached to the periosteum and scalp, and was accomplished using the Doyen drill, a ball point burr and the Dahlgren cutting forceps. Bleeding from the bone was controlled by various techniques aiming at crushing the diploe. After craniotomy the wound was closed. The intradurally part of the procedure was delayed for about a week in order to allow the patient to recover. In a second session, after opening the dura the arachnoid membrane was cut at the tumor margins as identified by vision, palpation or probing. The tumor was rapidly delivered mainly by digital dissection. Diffuse bleeding from the tumor bed was stopped by gentle compression with gauze bandage, which usually had to be left in place for some days, or by applying squeezed pieces of muscle. According to the degree of the consecutive brain swelling the dura was left open and the scalp flap with the bone attached repositioned. The authors report on a number of patients successfully treated, amongst them a young woman with a huge meningioma of the posterior fossa and a patient with a large (malignant) meningioma of the middle cranial fossa. The latter tolerated first tumor removal not only, but also recovered from surgery for two even larger recurrences before she died from grotesque tumor re-growth.

Conclusions: Although the authors do not provide statistical data, these examples demonstrate that their exceeding surgical skills allowed extensive brain surgery even without technical tools, which were considered essential today. Their surgical technique appeared to be optimally adjusted to the facilities available at that time.