. Text-book of operative surgery . s ofinterrupted loop sutures may also be inserted above the couAexity of the incisionin Order to control the ha^morrhage from above (Heidenhain and Hacker). Thebleeding from the edges of the flap can be easily arrested by compressing the flapbetAveen the fingers of the left hand and clamping the branches of the main artery(occipital) and vein A\üth forceps. The periosteum is now detached Avith a knife and elevator from the occipital bonealong Avith the attachments of the neck muscles as far down as the foramen magnum,after which the posterior fossa is opened
. Text-book of operative surgery . s ofinterrupted loop sutures may also be inserted above the couAexity of the incisionin Order to control the ha^morrhage from above (Heidenhain and Hacker). Thebleeding from the edges of the flap can be easily arrested by compressing the flapbetAveen the fingers of the left hand and clamping the branches of the main artery(occipital) and vein A\üth forceps. The periosteum is now detached Avith a knife and elevator from the occipital bonealong Avith the attachments of the neck muscles as far down as the foramen magnum,after which the posterior fossa is opened and the dura freely separated all round,which must be done carefully in the region of the sinuses, especially the occipitalsinus, although the bone covering the lateral sinus may be more freely removed. Theopening is then enlarged in all directions tili the dura covering the cerebellum isexposed in its whole extent (Fig. 89). The freer the exposure, the less Avill the brain be injured in looking for the 13 a iq6 OPERATIVE SURGERY. Fig. 89.—Exposure of both cerebellar lobes. The iigure also sliows , the ligatured ends of the occipital sinus ; the mastoid i^ro- cesses ; a large and constant sinus in the bona transmittiug a tributary of the lateral sinus ; the lateral sinus ; the exterual occipital protuberance. f tumour. The dm-a is not opened tili one is certain that a lai-ge part of botlicerebellar liemisplieres and the vermiform process can be directly examined. AAap incision, convex upwards, is then made with a fine knife and the edges of the dura are retractedwith small sharp hooks,after which the occipitalsinus is clamped with ourartery forceps and liga-tured above and below. If there is marked in-tracranial pressure, thecerebellum now bulgesprominently outwards,and if the tumour is notat once observed, the cere-bellum must be carefuUypalpated with gloved fin-gers. In one of the mostrecent cases on which weoperated we located (fromSymptoms of markedataxy and giddiness) t
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