, Ulverston, UK.
Acta Neurochir (Wien). 2023 Aug;165(8):2029-2034. doi: 10.1007/s00701-023-05661-z. Epub 2023 Jun 19.
Cranial fissures are not an indication for surgical intervention. It should be emphasised that the term fissure refers to linear skull fractures as defined in MESH. However, it was the universal term for this injury in the literature which forms the basis of this paper. Nonetheless, for over two millennia, their management was a major reason for opening the skull. The reasons for this deserve analysis, in particular taking into account the available technology and conceptual background.
The texts of significant surgical practitioners from Hippocrates to the eighteenth century were examined and analyzed.
The need for fissure surgery was based on Hippocrates' teaching. It was considered that extravasated blood would suppurate, and extracranial suppuration could leak inwards through a fracture. Trepanation to facilitate pus drainage and cleansing was considered vital. Avoiding surgical damage to the dura was also emphasized with a preference for operating only when the dura had separated from the cranium. The enlightenment with an increasing reliance on personal observation rather than the teachings of received authority enabled the accumulation of a more rational basis for treatment concerned with the effects of injury on brain function. This culminated in the teachings of Percivall Pott, who despite some minor errors, provided the framework on which modern treatments would develop.
Examination of the surgical management of cranial trauma from Hippocrates to the eighteenth century shows that cranial fissures were judged to be of great importance and required active treatment. This treatment was not aimed at improving the healing of the fracture but at avoiding deadly intracranial infection. It is worth noting that this sort of treatment persisted for over two millennia while modern management has only been practiced for just over a century. Who can say how it will change in the next hundred years.
颅缝不是手术干预的指征。应该强调的是，术语“裂缝”是指 MESH 中定义的线性颅骨骨折。然而，在文献中，这是这种损伤的通用术语，也是本文的基础。尽管如此，在过去的两千多年里，它们的处理一直是打开颅骨的主要原因。值得分析这种情况的原因，特别是考虑到现有的技术和概念背景。
检查和分析了从希波克拉底到 18 世纪的重要外科医生的文本。
进行裂缝手术的必要性基于希波克拉底的教义。人们认为，渗出的血液会化脓，而颅外化脓可以通过骨折向内漏。开颅以促进脓液引流和清洁被认为是至关重要的。避免对硬脑膜造成手术损伤也很重要，并且更喜欢仅在硬脑膜与颅骨分离时进行操作。启蒙运动越来越依赖于个人观察而不是权威的教义，这使得人们能够积累出更合理的治疗基础，关注损伤对大脑功能的影响。这最终导致了 Percivall Pott 的教义，尽管存在一些小错误，但为现代治疗方法的发展提供了框架。
从希波克拉底到 18 世纪，对颅骨创伤的手术治疗的检查表明，颅骨裂缝被认为非常重要，需要积极治疗。这种治疗不是旨在促进骨折愈合，而是旨在避免致命的颅内感染。值得注意的是，这种治疗方法已经持续了两千多年，而现代治疗方法仅实践了一个多世纪。谁能说在接下来的一百年里它会如何变化。
