A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . xcision of brain tumors will become less unusual when all sur-geons are familiar with the principles of cerebral Infracture of the cranium trephining is sometimes demanded by theparalytic and other symptoms localizing the lesion under the seat offracture, when the amount of damage seen in the skull would lead oneto abstain from operation. Hence cognizance of the significance oflocal palsies and spasms is demanded
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . xcision of brain tumors will become less unusual when all sur-geons are familiar with the principles of cerebral Infracture of the cranium trephining is sometimes demanded by theparalytic and other symptoms localizing the lesion under the seat offracture, when the amount of damage seen in the skull would lead oneto abstain from operation. Hence cognizance of the significance oflocal palsies and spasms is demanded of the skilled surgeon. Trephining .—The term trephining is employed to designate oper-ative perforation of the cranium, whether done by means of a trephine,hammer and chisel, surgical engine or ribbon saw. After the initialperforation is made, the opening may be enlarged by gnawing forceps,saw or chisel. Osteoplastic resection, by which a trap door of softtissues and bone is raised and then restored to its original positionafter the intracranial manipulation is concluded, gives a good expo-sure and a satisfactory reconstruction of the cranial wall. Fig. Hopkinss gnawing forceps. Since the usual object in cases of fracture is to get an openingthrough which to insert an elevator to pry up the depressed frag-ments, a small trephine should be employed. Oue not over three-eighths of an inch in outside diameter at the cutting edge is largeenough. In operations for removing brain tumors a trephine of oneand a half to two inches in diameter may be used. After the induc-tion of anaesthesia, the incision in the scalp should be made of ahorseshoe shape, with its convexity downward when the patient isrecumbent, so that during the after-treatment the drainage may be 1 See Operative Surgery of the Human Brain, bv John B. Boberts. P. Blakiston,Son & Co., 1885. 394 FRACTURES. free. If a wound previously exists it may be enlarged. The knifeshould divide the scalp and periosteum at the
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