CHAPTER XI

TUMOURS OF THE SKULL-BONES 325

INDEX 335

LIST OF ILLUSTRATIONS

FIGS. PAGES 1 and 2. Cranio-cerebral topography 2, 3 3. The cortical motor and sensory areas 8 4 and 5. The scalp-tourniquet 14, 15 6. Cushing’s ‘clips’ 18 7. Hudson’s trephine 20 8. The hand-trephine 21 9 and 10. The technique of trephining 22 11-16. Instruments used in trephining 23, 24 17-19. The formation of an osteoplastic flap 26, 27 20. An occipital cephalocele 33 21. A cephalocele over the anterior fontanelle 35 22. An occipital cephalocele 37 23. A depressed birth-fracture 45 24 A and B. A case of depressed birth-fracture, before and after operation 47 25. To illustrate the effects and position of a birth-hæmorrhage 53 26. The author’s operation for Hydrocephalus internus 64 27. The conversion of Hydrocephalus internus into cephalocele 65 28. Illustrating the lines along which forces received on the vault are transmitted to the base 69 29 A and B. The base of the skull and the base as seen on transillumination 70, 71 30. Plan of the base of the skull 77 31. To illustrate the relation of basic fractures to cranial nerves 81 32-37. The lines pursued by basic fractures 83-8 38 A and B. To illustrate the probable source of profuse hæmorrhage from the ear 97 39. To show the relation of a typical basic fracture to the middle ear and its adjuncts 103 40 and 41. To show the relation of basic fractures to the petrous bone 104, 105 42. A comminuted fracture of the skull 112 43 A and B. An explosive fracture of the vault of the skull 113 44. A temperature chart illustrating the changes in temperature observed in head-injuries 117 45-48. Intermusculo-temporal cerebral decompression 122, 123 49 A and B. The elevation of a depressed fracture of the vault 131 50 A and B. The inner aspect of the skull and the same seen on transillumination 137 51. To illustrate compression of the brain as produced by an extra-dural hæmorrhage from the middle meningeal artery 141 52 A and B. The operative treatment of middle meningeal hæmorrhage 144, 145 53. A basic fracture with laceration of both carotid arteries 148 54. A basic fracture with laceration of the cavernous sinus 149 55. A basic fracture with laceration of both lateral sinuses 151 56 A and B. The operative treatment of subdural hæmorrhage 156, 157 57. The areas concerned in speech expression 163 58. The cortical motor and sensory areas 165 59. The König-Müller osteoplastic flap 197 60. The author’s method of covering in a gap in the skull 199 61. A case of traumatic orbital aneurysm 207 62. A glioma of the brain 211 63. A sarcoma of the brain 211 64. An endothelioma of the dura mater 212 65. A fibroma of the dura mater 212 66. An acoustic tumour 213 67. Symmetrical tuberculomata 214 68. The cortical motor and sensory areas 220 69. The visual paths 223 70. A pituitary tumour 226 71 A, B and C. The exposure of a tumour by osteoplastic flap 230, 231 72. Combined flap formation and decompression 235 73 A, B, C and D. The exposure of a cerebellar tumour by craniectomy 239-41 74 A and B. To illustrate the extension of disease from the tympanic cavity and the surgical anatomy of that region (after Hunter Tod) 251 75. A large right-sided temporo-sphenoidal abscess 256 76. To illustrate the pressure effects of a temporo-sphenoidal abscess 257 77. A cerebellar abscess 259 78. To illustrate diagrammatically the symptoms observed in cerebellar abscess formation (after Luciani) 261 79. The exposure of a temporo-sphenoidal abscess 265 80. The ‘radical’ mastoid operation (after Hunter Tod) 269 81. Exploration for a temporo-sphenoidal abscess (after Hunter Tod) 270 82. Exploration for a cerebellar abscess (after Hunter Tod) 271 83. A fracture of the anterior fossa which was followed by the development of meningitis 275 84. Basal meningitis secondary to temporo-sphenoidal abscess 277 85 A and B. To illustrate the exposure of the lateral sinus (after Hunter Tod) 285 86. A case of Hernia cerebri and the abscess after removal 292 87. Diagrammatic illustration of the three forms of ‘gutter’ fracture 297 88. Diagrammatic representation of the effects produced on bone and brain by a perforating bullet-wound 299 89 A and B. Sheen’s bullet probe, forceps, and telephone bullet-detector 302, 303 90. To illustrate the operations on the Gasserian ganglion 317 91. To illustrate the operations for exposure of the Gasserian ganglion 321 92. Ivory exostoses of the skull 326 93. The development of the frontal bone 327 94. An exostosis of the orbit 330 95. An extrinsic sarcoma of the skull 331 96. An intrinsic sarcoma of the skull 333

THE SURGERY OF THE SKULL AND BRAIN