. Modern surgery, general and operative. orbit. This fragment, too, is placed in warm salt rest of the orbital roof is cut away by a rongeur. The dura covering the g^o Diseases and Injuries of the Head inferior surface of the frontal lobe is separated from the bone, while the lobe israised and the orbital contents are held out of the way. Between the clinoidprocesses the dura is divided by Krauses hook-shaped knife. An enlargedhypophysis will now be accessible. At the conclusion of the operation on thehypophysis the bone-fragments are replaced, Frazier has modified McArthursoperat
. Modern surgery, general and operative. orbit. This fragment, too, is placed in warm salt rest of the orbital roof is cut away by a rongeur. The dura covering the g^o Diseases and Injuries of the Head inferior surface of the frontal lobe is separated from the bone, while the lobe israised and the orbital contents are held out of the way. Between the clinoidprocesses the dura is divided by Krauses hook-shaped knife. An enlargedhypophysis will now be accessible. At the conclusion of the operation on thehypophysis the bone-fragments are replaced, Frazier has modified McArthursoperation (Annals of Surgery, Feb., 1913). I have performed the operationonce for a cvst of the hypophysis. Gushing has had wonderful success withhis nasal method which involves resection of the septum (i death in 32 cases).To perform this one must be highly skilful in working in a very small most surgeons the fronto-orbital method will be easier. The operationcan be done aseptically and by aid of sight and the brain must be retracted. Fig. 602.—Horner B. Smitlib head- re-t lur iipi.;rcltinn> LU^un the liam J. Taylor). rebellura (modified by Wil- far less than in the temporal approach. A soHd tumor can be removed moresatisfactorily than by the nasal route. After the operation there may be edemaof the eye and the eyeball may not be quite on a level with the other eyeball. The Combined Method of Harvey Gushing (From Gushing s The Pitui-tary Body and Its Disorders).—This surgeon, whose experience is very large,operates as follows: Intratracheal anesthesia. Place the patient with theshoulders sUghtly raised so that the head drops back. Pack the posterior nareswith a sea-sponge. Insert cotton wet with adrenalin in each nostril. Liftthe upper Up. Make a transverse incision across the Irenum, and carry it downto the anterior nasal spine. By blunt dissection raise the soft parts on eachside from the inferior margin of the osseous nasal opening until the cartilaginousseptum Is
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