AMAarchives of neurology & psychiatry . ncision (Fig. 4) wasmade with its base between the external angular process and the tragus. Onreflecting the scalp and temporal muscle so as to expose the bony lesion, itwas found that the lower layer of muscle fibers were infiltrated by tumor overthe most prominent part of the bony protuberance. The skull at this point was CUSHIXG—CRAXIAL HYPEROSTOSES 143 considerably roughened, and the muscle was adherent to it. This small area ofobvious involvement of extracranial tissues was excised and an immediatefrozen section showed endothelioma. The area of hype
AMAarchives of neurology & psychiatry . ncision (Fig. 4) wasmade with its base between the external angular process and the tragus. Onreflecting the scalp and temporal muscle so as to expose the bony lesion, itwas found that the lower layer of muscle fibers were infiltrated by tumor overthe most prominent part of the bony protuberance. The skull at this point was CUSHIXG—CRAXIAL HYPEROSTOSES 143 considerably roughened, and the muscle was adherent to it. This small area ofobvious involvement of extracranial tissues was excised and an immediatefrozen section showed endothelioma. The area of hyperostosis, which was difficult of access, was then attacked bymaking a circle of perforations at its periphery. These perforations, made byusing a succession of motor-driven burrs of graduated size, were carried downthrough the dense bone to the dura. It would probably have been easier tohave burred away the entire hyperostosis in this fashion, but it was desired topreserve an intact portion of the thickened bone for subsequent Fig. 3.—Print of postoperative radiogram showing extent of bony removaland situation of clips outlining area of excised dura. The chief difficulty lay in the complete removal of the hyperostosis at itsanterior and lower periphery. In this situation it was necessary to carrj- theperforations obliquely through solid bone which proved to be 3 to 4 cm. inthickness, before the orbital cavity was reached. The remaining central andposterior mass of bone (Figs. 9-11) was then broken out in a single the view thus given it was possible, with the further use of burrs androngeurs, to enlarge the opening until all the thickened bone so far as couldbe told, was removed. In this procedure the entire outer side of the orbitalcontents, which had evidentlv been considerablv encroached on bv the growth, 144 . or xnrROLOcv A psychiatry
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Keywords: ., bookcentury1900, bookdecade1910, bookpublisherchica, bookyear1919
