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
CHAPTER I
CRANIO-CEREBRAL TOPOGRAPHY
The surgeon who is called upon to carry out operations on the skull and brain must possess an accurate knowledge of the anatomy of the parts involved. Added to this, he must have at his command some simple method of depicting on the surface of the skull the more important structures.
The more complicated systems of cranio-cerebral topography are of little practical value to the surgeon. Simplicity is essential, and the following outline will be found to furnish an adequate practical guide.
Firstly, the skull can be divided into two lateral halves by the surface-marking of the superior longitudinal venous sinus.