A successful case of removal of a large brain-tumor from the left frontal region : opening and packing of the lateral ventricle with iodoform-gauze / by H.M. Thomas and W.W. Keen.

  • Thomas, Henry M.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: A successful case of removal of a large brain-tumor from the left frontal region : opening and packing of the lateral ventricle with iodoform-gauze / by H.M. Thomas and W.W. Keen. 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.

    18/22 (page 16)
    1895, p. 900), who advocates and has practised the removal of one entire hemisphere of the skull. He even declares that cerebral localization in future is only of physiological interest and is not necessary to the sur- geon. I was, however, very much pleased with the extensive view of the brain which I got, a view which in this case was needful to the proper treatment. It was desirable that the orbital surface of the frontal lobe should be examined. This is the first case in which I ever had occasion to examine it, and I was very much struck with the ease of access and the extensive view that I had. Should it have been necessary to open the dura before lifting the frontal lobe, I think there would have been no difficulty in seeing the pituitary body and the vessels. At the best, manipulations here would have been, however, of course, much more dangerous than on the free surface, by reason of the relative inaccessi- bility. If in future I should have a case in which an extensive frontal operation is necessary, I should make, if needful, an osteoplastic resection of the whole forehead, either in one piece or bilaterally in two. There would be no difficulty, of course, in separating the superior longitudinal sinus from the skull after the first flap had been resected and drawn back. Kemoval of the Tumor. Fortunately, the tumor was not an infil- trating sarcoma, but well delimited. As in my case of the large fibroma above alluded to, I was able to scoop it out with perfect ease, because of its lying loose in its bed. The hemorrhage after the enucleation was very much lessened by the prior ligation of the vessels connecting the tumor with the cortex at the point where it had broken through the cortical layer. Prognosis. The apparently non-infiltrating character of the tumor, which was confirmed by Dr. Flexner's examination, would also lead us to take a much more hopeful view of the future of the patient, as to non-recurrence of the growth. As it may take, however, some years to determine these facts, it seemed desirable to report the case at once and then supplement it at a later period. It is encouraging to re- member that in Durante's well-known case a fibro-cellular sarcoma- tous tumor the size of an apple was removed from the left anterior lobe, and in spite of its character the patient was in good health four years later. Opening and Packing of the Lateral Ventricle. This is the first case in which I ever have actually looked into the lateral ventricle in the living, and, so far as I know, is the first in which the ventricle has ever been packed. The entire cavity was disclosed, so that I could see certainly into the cavity and possibly into the opening of the middle or posterior horn. In view of the free opening and, of course, of the grad- ual oozing of blood which would take place after the flap was replaced, I was fearful lest the blood might flow from the lateral into the third ventricle and then through the Sylvian aqueduct reach the fourth ven-