. Text-book of operative surgery . li afforcl excellent testimony to tlievalue of o^Deration in the above conditions. FoUowing our advice, Friedricli attacksthe bone and dura over the niotor area, while Cnshing devised an original method(intermuscular method) in which he provides for the expansion of the brain bytrephining over the temporal region. Both methods have their own a large portion of the skull is to be removed, a general ansesthetic isessential. At the same time a local anaesthetic may be also used, while all j^rophylacticmeasures for the arrest of haemorrhage m
. Text-book of operative surgery . li afforcl excellent testimony to tlievalue of o^Deration in the above conditions. FoUowing our advice, Friedricli attacksthe bone and dura over the niotor area, while Cnshing devised an original method(intermuscular method) in which he provides for the expansion of the brain bytrephining over the temporal region. Both methods have their own a large portion of the skull is to be removed, a general ansesthetic isessential. At the same time a local anaesthetic may be also used, while all j^rophylacticmeasures for the arrest of haemorrhage must be efficiently arranged so that theincision in the soft parts can be made without the Operator being encumbered byany bleeding. When a straight incision will suffice, it is the simpler method, buta curved or Aap incision must be made in cases where a considerable amount of boneis to be removed. Friedrich makes a large skin Aap similar to that adopted inWagners osteoplastic method. The skin incision must always be made 1 cm. or. Fig. 80.—Trephining for decompression (Cusliings temporal method). more outside the circumference of the bone to be removed, and this is still moreimportant when recourse is had to a curved incision (Cushing). The stitches in theskin must never be placed so as to lie over the edges of the bone. The incision is carried right down to the bone, and the soft parts are raised alongwith the periosteum with a sharp elevator down to the base of the Aap. The layerof muscle must not be injured in any Avay as it forms an excellent cushion Avhen thesoft parts are replaced. The preservation of the muscles is an important factor in the formation ofartificial cerebral hernice, and is the essence of Cushings temporal Operation (inter-muscular) for dealing with cerebral tumours (Fig. 80). In the latter Operation the curved incision only divides skin and fascia Avhich areturned down ofF the outer surface of the thin temporal fascia. The temporal muscleis incised par
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