The hemispheres are now separated until the corpus callosum comes
into view. The left hemisphere is then held by the left hand, with
the thumb on the median surface and the fingers on the outer and
under sides, so that the hemisphere is turned outward and yet raised
slightly at the same time, thus stretching the corpus callosum over
the cavity of the left lateral ventricle. The point of the narrow
brain-knife (Fig. 3) with cutting edge upward is then introduced
with great care through the corpus callosum about midway between the
genu and splenium and close to the gyrus cinguli (gyr. forn., Fig.
28). The corpus callosum at this point is about 2 to 3 mm. thick and
it is gently nicked with the point of the knife until an opening is
made into the cavity of the ventricle. The knife-point must not be
allowed to slip through to damage the basal ganglia beneath. Into the
small opening thus made the brain-knife, held nearly horizontal,
with cutting edge upward, is introduced and the corpus callosum cut
forward until the anterior horn of the ventricle is reached. The
point of the knife is then passed into the horn and the knife-handle
raised and turned over forward, cutting slightly outward through
the frontal lobe to its apex and disclosing the anterior horn. The
knife is then reversed, held horizontally, with cutting edge upward,
and the corpus callosum cut posteriorly from the beginning of the
first cut, until the posterior horn is reached, when the point of
the knife is inserted into the horn and the knife turned over toward
the operator, cutting backward and somewhat outward through the
occipital lobe to its apex and opening up the posterior horn. (See
Fig. 28.) By this method the lateral ventricle is opened first at the
highest point of its cavity, and the fluid contents collect in the
anterior and posterior horns so that the amount and character can be
easily noted.
[Illustration: FIG. 29.—Section of brain. Ventricles opened.
Lines show direction of large longitudinal incisions through
brain-substance. (After Nauwerck.)]
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