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