. Some points in the surgery of the brain and its membranes . stalk is in the regionof the fracture. Drainage through the stalk would, ifsuccessfully accomplished, remove all urgentsymptoms and obviate the tendency to some cases no doubt such an opening wouldnot be sufficient to effect a cure, and the surgeonwould be obliged to make a counter-opening, ashe would in other parts of the body. To dothis it is desirable to remove a considerablearea of bone, and then to open the dura andpack the wound with gauze, so as to get thearea of the brain through which an incisionis to be made isola
. Some points in the surgery of the brain and its membranes . stalk is in the regionof the fracture. Drainage through the stalk would, ifsuccessfully accomplished, remove all urgentsymptoms and obviate the tendency to some cases no doubt such an opening wouldnot be sufficient to effect a cure, and the surgeonwould be obliged to make a counter-opening, ashe would in other parts of the body. To dothis it is desirable to remove a considerablearea of bone, and then to open the dura andpack the wound with gauze, so as to get thearea of the brain through which an incisionis to be made isolated by adhesions, on theprinciple so long rendered familiar by colotomyand similar operations. By doing the operationin this way a new point of attachment of theabscess to the dura is formed, and the danger of 144 SOME POINTS IN THE SURGERY diffuse encephalitis avoided. The area of boneto be removed will be determined by the positionand size of the abscess, as ascertained by a probepassed through the open stalk. In some cases when, for example, respiration. Fig. 58.—Frontal lobe abscess secondary to frontal sinus disease.(Modified from Killian.) Note the stalk of the abscess springing from the cranial wall of the frontal an abscess is commonly situated in the white matter of the basal part of thefirst frontal convolution. As it extends backwards it tends to involve the coronaradiata and anterior end of the internal capsule, causing paresis of face, tongue, arm,and leg in the order named on the contralateral side. Killian says, In a veryinstructive case, in which recovery took place, I was able to observe motordisturbances arise and completely disappear after the operation. has ceased, the condition of the patient is so badthat there is no time to follow a possiblytortuous route through which the disease foundentrance to the brain. At all costs the abscessmust be evacuated quickly. The abscess mustthen be reached by the most direct route and by OF ABSCESS OF THE BRA
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