Operative surgery . Pig. 274.—Anterior branch of middle menin-geal artery occupying a canal at anterior-inferior angle of parietal bone. vious location of the sinuses are indicated sufficiently, to avoid injury to them, under the heading of Dangers on page 244 and Precau- 238 OPERATIVE SURGERY. tions on page 239, and by Fig. 292, A, B. If a sinus be opened the woundis tied or sewed with catgut or closed by compression with aseptic gauze. The Results.—The nature of the injury, delay in the performance ofthe operation, and the inability to execute the proper technique are theimportan
Operative surgery . Pig. 274.—Anterior branch of middle menin-geal artery occupying a canal at anterior-inferior angle of parietal bone. vious location of the sinuses are indicated sufficiently, to avoid injury to them, under the heading of Dangers on page 244 and Precau- 238 OPERATIVE SURGERY. tions on page 239, and by Fig. 292, A, B. If a sinus be opened the woundis tied or sewed with catgut or closed by compression with aseptic gauze. The Results.—The nature of the injury, delay in the performance ofthe operation, and the inability to execute the proper technique are theimportant factors that modify the prognosis. A fatality of from four tofifteen per cent is a fair estimate of the results in civil practice. The deathrate from trephining alone is scarcely two per cent. Craniotomy for Meningeal Haemorrhage.—Meningeal haemorrhage maybe either epidural (Fig. 277) or subdural (Fig. 279). The former is easiertreatment and offers by far the better prognosis. Either variety is commonly. Fig. 275.—Anterior branch of middle meningeal artery occupying a groove on anterior-inferior angle of parietal bone. associated with severe injuries of the head, such as fracture of the skull,laceration of the brain, etc. In depressed fractures the blood often escapesexternally, or is easily removed coincident with elevation of the bone. Fis-sured fractures of the cranium are complicated frequently with extraduralhsemorrhage, especially when the fissure passes through the route of thebranches of the middle meningeal artery. This variety of hsemorrhage,although circumscribed, is frequently extensive. After the localization ofthe seat of the blood clot, the preparation of the patient is the same as intrephining for other purposes (page 231). The formation of the flap, thecontrol of the hemorrhage, and the general technique are similar. Theoperation should be done promptly—and with chloroform when practicable—if angesthesia is required. Tlie Oiieraiion.—Make a flap
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