. Medical and surgical reports . ai is practice! by nearly all surgeons is thatoriginated by Hartley, of New York, and later employedindependently by Prof. F. Krause. As this is the methodthat has been chosen in the past by most surgeons, itstechnique will be considered somewhal in detail. The steps of the operation are as follows: 1. A horseshoe-shaped skin incision having its base atthe zygoma,, tin greatesi distance between the two armsbeing aboul three inches and the vertical measurementsfrom the lop of the arch to the base aboul the -;ime. 2. Resecting an osteoplastic flap, the hone at th
. Medical and surgical reports . ai is practice! by nearly all surgeons is thatoriginated by Hartley, of New York, and later employedindependently by Prof. F. Krause. As this is the methodthat has been chosen in the past by most surgeons, itstechnique will be considered somewhal in detail. The steps of the operation are as follows: 1. A horseshoe-shaped skin incision having its base atthe zygoma,, tin greatesi distance between the two armsbeing aboul three inches and the vertical measurementsfrom the lop of the arch to the base aboul the -;ime. 2. Resecting an osteoplastic flap, the hone at the base otthis flap being broken well down below the zygoma. ... Separation of the dura from the floor of the middlefossa. I. Exposure of the second and third divisions of thefifth nerve ;i- they enter the foramina rotundum and ovale. 5. This step in Hartleys operation consisted in resecting the second and third divisions between their foraminaof exit and the Gasserian ganglion. He made no attemptio rem. ive i lie ganglii m, . Fig. Operation. After Hartlej loo. 6. Recognition and extirpation of the ganglion. ToKrause belongs the credil of perfecting the technique ofthis step of the operation and of firsl removing the gang-lion by this route. As soon as the brain bas been lifted from the middlefossa and the hemorrhage checked, the second and thirddivisions can be readily recognized by the folds producedli\ elevation of the dura. The ganglion lies al the Junetion of the axes of the second and third divisions. Thetwo branches are uncovered, the dissection being carriedupward until the ganglion which rests between two layersof the dura is completely exposed. The ganglion i- thenseized with a pair of artery forceps, the second and thirddivisions are divided close to the base of the skull, andthe ganglion removed by twisting the forceps. Difficulties encountered in the course of the discussing in detail the different steps, as above oullined, the firsl thai
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