Successful operation for a case of pulsating tumour of the temporal region of eighteen years standing / by C. Yelverton Pearson.

  • Pearson, C. Yelverton (Charles Yelverton), 1857-1947.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Successful operation for a case of pulsating tumour of the temporal region of eighteen years standing / by C. Yelverton Pearson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    but is somewhat diminished by making pressure on the tumour itself. The pupils are equal, and respond normally to light. Ophthalmoscopic examination showed the existence of a choked disc and some optic neuritis on the left side, and increased vascu- larity of the right fundus. Differential diagnosis.—The possible pulsating tumours of this region are—Hernia of the brain or its membranes ; fungating tumour of the dura mater; pulsating tumour of the bones; malignant growths; and aneurysms. Malignant growths were excluded by the duration of the symptoms and the very gradual increase in size; hernia cerebri and meningocele by the absence of symptoms on pressure, and the very small extent of the fissure in the cranial wall; fungus of the dura mater by the slow progress, the well-defined boundaries of the swelling, and the firmness of the bones beneath ; hence the conclusion that the tumour was of tin aneurysmal character. The question, however, arose as to the precise nature of the aneurysm. Owing to the smooth surface and anatomically defined margin of the tumour, the absence of diminu- tion in pulsation and size on compressing the temporal and its anastomotic connections, and the existence of intra-cranial symp- toms, I formed the opinion that, in all probability, the tumour was a false aneurysm circumscribed by the temporal fascia and muscle with intra-cranial vascular connections, and. therefore, probably supplied by the middle meningeal or deep temporal arteries, or by both. Owing to the sufferings of the patient, his inability for work, and his own personal solicitations, an operation was determined upon, and was accordingly performed as follows :—The superficial temporal artery was exposed by a small incision immediately above the zygoma, and ligatured. A curved incision was made along the line of the temporal ridge, commencing a little in front of the coronal suture, and terminating below and behind at the posterior root of the zygoma. The integuments were reflected downwards and forwards and the temporal fascia was laid bare. The temporal fascia was then carefully divided over the centre of the tumour and reflected, when a highly vascular and convoluted mass was disclosed, bearing considerable resemblance to the living brain and its mem- branes when the dura mater is removed. On close inspection this mass was found to consist of very large and tortuous thin-walled vessels, which freely anastomosed. An attempt was made to ligature the larger vessels tit the circumference, but, after a few trials, this