Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . e the tumor; for he willdo serious injury to the cord. It must be left to nature. Nature will slowly 342 SURGICAL TREATMENT extrude the tumor with the least amount of damage to the cord. The durashould not be sewed. The muscles and skin should be sewed over the cord,and the wound dressed. At the end of about a week the wound should beopened and the tumor will usually be found lying outside of the cord. Itsremoval requires only dividing a few adhesions. If any inju
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . e the tumor; for he willdo serious injury to the cord. It must be left to nature. Nature will slowly 342 SURGICAL TREATMENT extrude the tumor with the least amount of damage to the cord. The durashould not be sewed. The muscles and skin should be sewed over the cord,and the wound dressed. At the end of about a week the wound should beopened and the tumor will usually be found lying outside of the cord. Itsremoval requires only dividing a few adhesions. If any injury to the cordis required in removing the tumor, if it is benign, it is best to defer itsremoval. The pia should then be closed. The dura, muscles, and skinshould be sutured over all. Intramedullary tumors which extend the height of several vertebraemay be treated in this same manner, even though they infiltrate the cordsubstance. A small incision, made at the place where pressure seemsgreatest, or at the level of the most pronounced symptoms, may resultin extrusion sufficient to give relief. This method of treatment may also. Fig. 1040.—Laminectomy. Closing dura with continuous suture. be applied to blood clot in the cord, spinal gliosis, and syringomyelia. Acentral cavity may thus be drained into the subarachnoid space. Tn incising the cord, the utmost gentleness should be used. The incisionshould be made slowly with an exceeding fine knife. Sponging should be sogentle that no pressure is made on the cord. The cord should not be graspedwith forceps or anything else. If it is necessary to lift it from its bed, thedura or pia may be grasped. This treatment of intramedullary tumors,which Elsberg has named the method of extrusion, is the most im-portant modern advancement in the treatment of these lesions (see C. Surgery of the Spinal Cord, W. B. Saunders Co., 1916). For exposure for operation on a tumor the laminectomy should be THE SPINE 343 complete. Not less than
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