Exposure of cortex or of cerebellum after division of dura. (Marion.)
Fig. 389
Osteoplastic resection after Wagner. (Chipault.)
Drains and drainage are to be avoided when possible, and should be removed early, except in cases of abscess. They may be made of catgut, horse-hair, gauze, rubber, or even of glass, like those short ones which Kocher inserts after extensive operations, their outer ends flanged to prevent their slipping beyond control.
Opening the skull, or, in general terms, trephining, is at present resorted to for the following purposes:
1. For relief of compression—
- (a) By depressed bone, as in comminuted or gunshot fracture;
- (b) By removal of clot or ligation of vessels;
- (c) By evacuation of pus, either from the meningeal cavity or from a deeper abscess;
- (d) By the removal of serous effusions, either extraventricular or intraventricular.
2. For removal of foreign bodies.
3. For relief of intracranial irritation—e. g., epilepsy, the psychoses, etc.