Operative surgery, for students and practitioners . serves as a guide to the cutting this trunk, we then work a little farther inward,toward the middle line, until we meet the second division of thenerve. This is likewise isolated and followed backward from theforamen rotundum as far as the ganglion. The upper surface of theganglion is then gradually freed from the dura. While the workof isolating the ganglion is being accomplished the brain should bewell retracted: lifted away from the base of the skull. The ganglioncan be separated from the overlying dura with a blunt perios
Operative surgery, for students and practitioners . serves as a guide to the cutting this trunk, we then work a little farther inward,toward the middle line, until we meet the second division of thenerve. This is likewise isolated and followed backward from theforamen rotundum as far as the ganglion. The upper surface of theganglion is then gradually freed from the dura. While the workof isolating the ganglion is being accomplished the brain should bewell retracted: lifted away from the base of the skull. The ganglioncan be separated from the overlying dura with a blunt periosteum EXTIRPATION OF THE GASSERIAX GANGLION. 107 elevator. The third division of the nerve may be seized and pulledupon as a guide to the ganglion. It may be necessary- to cut a fewconnective-tissue bands, between the ganglion and the dura, withthe scissors, and in doing this the operator may accidentally cut intothe dura: this accident, however, is of no serious significance; somecerebro-spinal fluid will escape, but, according to Tiffany, this is. Fig. 66.—Hartley-Krause Operation. Brain within the dura lifted away fromfloor of middle fossa. The second and third division of the fifth nerveexposed. rather an advantage. There may be considerable hemorrhage oc-casioned in isolating and detaching the ganglion, but this may againbe controlled by pressure with the gauze pad or by shifting the re-tractor or allowing the brain to drop back in place upon the bonetemporarily. The ganglion should be freed as far back as the superiorborder of the petrous portion of the temporal bone, so that the oper-ator may be able to see the white trunk of the nerve showing beyondthe o-anglion. Care should be exercised in freeing the inner part of 108 HEAD AND FACE. the ganglion, on account of the proximity of this part of tlie cavernoussinus and the carotid artery. The operator should finally be ableto raise the detached ganglion away from the surface of the boneupon which it rests with the perioste
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