The surgical treatment of intracranial tumors / by William W. Keen.

  • William Williams Keen
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of intracranial tumors / by William W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    4/10 (page 2)
    benefit). In fact, he claims that in future cerebral localization is useless in surgery and has only a physiological interest. Whether so extensive a temporary resection will stand the test of time and experience is somewhat doubtful, but should it do so, it will greatly simplify the treatment of tumors. The mode of access to the tumor, if Doyen's method is not fol- lowed, is either by the ordinary method of trephining, using not less than an inch-and-a-half trephine, and making either a single or mul- tiple trephine openings, which may be later connected by sawing or gnawing away the intervening bridges of bone, or by various methods for making the usual temporary osteoplastic resection. Last summer, Mr. Horsley told me that he had returned to the use of an ordinary straight saw, cutting by means of this either three sides of a square and breaking the fourth, or sawing the fourth if the bone is to be removed entirely. Krause, instead of this, uses a cir- cular saw (which is actuated by the surgical engine, like that which is used by the dentists), with this difference, that the handle of the saw is prolonged on the farther side, so that the saw can be held firmly by both hands. Others use the chisel in one of two ways. If an osteoplastic resection is to be done, the margins of the flap are cut through by such chisels as have been devised by Hartley, of New York, and by Pyle, of Canton, Ohio, or, secondly, by simply chiselling away all the bone over an area such as we wish to uncover. P'or this method Krause's gouge is the best. Another method is by such drills as those devised by Dr. Cryer, of this city, which are useful and effective, but require an expensive and not easily obtained extra heavy surgical engine. Whichever one of these processes is used requires a considerable amount of time, varying usually from fifteen to twenty- five minutes, and involves a moderate and sometimes a considerable loss of blood both from the scalp and the bone. Operation in One or Two Stages.—The skull being opened, we may follow one of two courses. First, especially if the tumor is small, we may proceed with its extirpation and the closure of the wound, or, secondly (and this is especially applicable to tumors of large size), the first part of the operation may be terminated so soon as the brain is exposed and the hemorrhage checked. The wound is then temporarily closed, and the remainder of the operation is com- pleted after the lapse of from three to six days. In other words, the tumor is attacked either by an operation in a single stage or an operation in two stages, as may be thought best. In large tumors I should certainly advise that the operation should be divided into two stages. Hemorrhage and shock, the two principal dangers in connec- tion with the removal of cerebral tumors are thus minimized. It has, however, the disadvantage of a possible infection. Two operations