Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
Lesions of the frontal cortex anterior to the motor centres, even if
extensive, may produce few or no symptoms, and in consequence this
region has been called a "silent" area. Occasionally there results a
change in temperament or intelligence, and the region is on this
account supposed to be concerned with the higher psychical functions.
There is evidence that the pre-frontal cortex has a centre for the
conscious initiation of movements, and that lesions produce "apraxia,"
_i.e._, inability to perform, or clumsiness in voluntarily performing
fine movements such as touching the nose with the finger, though such
movements may be perfectly carried out unintentionally. This centre is
probably situated in the superior and middle left frontal convolutions
in right-handed people. The fibres from the centre to the right motor
area cross in the anterior part of the corpus callosum.
#Cerebral Localisation.#--The various parts of the brain can be
localised in relation to the surface by various methods. That devised
by Professor Chiene has been found reliable.
#Relation of Cerebral Centres to the Surface.#--Numerous attempts have
been made to formulate rules for locating the different parts of the
brain in relation to the surface of the head. The method devised by
Chiene is free from many of the difficulties and fallacies common to
most other methods, inasmuch as the results obtained do not depend
upon making definite measurements in inches, or determining particular
angles. Certain fixed and easily recognised bony landmarks--the
glabella, the external occipital protuberance, the lateral angular
process, and the root of the zygoma--are taken, and connected by
lines, which are further subdivided--_always being bisected_. Figs.
179 and 181 explain the method. The head being shaved, a line (GO) is
drawn along the vertex from the glabella (G) to the external occipital
protuberance (O). This line is bisected in M, which constitutes the
"mid-point." The posterior half of the line MO is bisected in T,
constituting the "three-quarters point," and the posterior half TO is
bisected in S--"the seven-eighths point." The lateral angular process
(E) is next connected to the root of the zygoma (P) by a line EP, and
the root of the zygoma with the seven-eighths point by PS; the line
EPS thus forms the base line. The lateral angular process is now
joined to the three-quarters point by ET. The two segments of the base
line EP and PS are bisected in N and R respectively, and these points
connected with the mid-point (M) by lines NM and RM. These lines cut
off a part of ET--AB, which is now bisected in C, and from C the line
CD is drawn parallel to AM.
[Illustration: FIG. 181.--Chiene's Method of Cerebral Localisation.]
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