. Text-book of operative surgery . Fig. 98. SURGERY OF NERVE-ROOTS 209 pterygoid plexus of veins is arrested by forcible depression of the soft tissues witha blunt liook covered with ganze and by tlie application of pressure, when theforamen ovale tlirough which the third division of the nerve passes can be either seenor feit. The skull is then opened a thumbs-breadth above the infratemporal crest with achisel or Doyens burr, and the opening is enlarged in front and behind with gougeforceps, the dura at the sanie time being raised oif the bone as far as the foramen. Fig. 99.—Exposure of the Ga
. Text-book of operative surgery . Fig. 98. SURGERY OF NERVE-ROOTS 209 pterygoid plexus of veins is arrested by forcible depression of the soft tissues witha blunt liook covered with ganze and by tlie application of pressure, when theforamen ovale tlirough which the third division of the nerve passes can be either seenor feit. The skull is then opened a thumbs-breadth above the infratemporal crest with achisel or Doyens burr, and the opening is enlarged in front and behind with gougeforceps, the dura at the sanie time being raised oif the bone as far as the foramen. Fig. 99.—Exposure of the Gasserian gauglion by the temporo-spheiioidal route. The Lexer-Cushiiigincisiou has beeii made, and the zygoma divided. The base of the skull has been chiselledaway to expose tlie third division at the foramen ovale. The middle raeuingeal artery is seenou the dura, which has not yet been incised. ovale and foramen rotundum. The low position and limited size of the openingrequired have, according to Cushing, the advantage over Krauses higher method thatthe groove (often a canal) in the parietal bone, in which the middle meningeal arterylies, is avoided; the bleeding from the injured artery in this position is verydifficult to control. 14 OPERA riVE SURGER V With tlae low temporal opening (reacliing at niost 3 cm. in height) there is, fiirther,less Chance of ihe brain being injured wben it is held out of the way by means of aretractor. According to Cusbing, Krause, who employs the higher opening, hasreported superficial bruising of the brain at eight autopsies
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