The left hemisphere is now turned still more to the left, and with
the brain-knife a broad, smooth cut is made through it downward and
outward at an angle of 45°, reaching nearly to the cortical surface,
in a line connecting the cut through the frontal lobe with that
through the occipital and passing along the outer borders of the
corpus striatum. The left hemisphere is thus separated in the form of
a prism-shaped mass having a convex under surface. (See Fig. 29.) The
severed hemisphere falls back by the force of its own weight and the
flat cut-surface of the cerebrum is then bisected by a cut made at
right angles to it, from before backward, and extending nearly to the
cortical surface. (See Fig. 29.) In the case of both of these large
incisions of the hemisphere the severed parts are left connected by
a small portion of cortical tissue and the pia. The knife should be
perfectly dry and clean while making these cuts, and the cut surfaces
should not be touched with the fingers or knife-blade, or wet with
water, until they have been carefully inspected. Other straight
parallel cuts may be made through the brain substance toward the
cortex, the severed portions being left connected by the pia so as to
permit future orientation.
The right lateral ventricle is now opened. The four fingers of the
left hand are placed outside and beneath the right hemisphere with
the thumb on the median surface, gently raising the hemisphere toward
the left, taking care to see that the corpus callosum is not pulled
over to the right of the median line. The knife is held in the right
hand beneath the left one. The right ventricle is then opened in the
same way as the left, beginning in the middle of the corpus callosum
near to the gyrus cinguli, and opening first the anterior horn and
then the posterior. The operation is somewhat more difficult on the
right side than it is on the left, owing to the lack of tension
in the cut corpus callosum, so that greater care must be taken to
avoid injuring the floor of the ventricle. After the opening of the
ventricle the right hemisphere is cut by long parallel incisions made
in the same way as on the left side. (See Fig. 29.)
Some prosectors in opening the right ventricle prefer to turn the
board around so that the frontal lobe points to the operator.
The right hemisphere is then held in the left hand and the right
ventricle opened just as if it were the left ventricle, except
that the posterior horn is opened before the anterior. The method
given above can be just as easily learned, and time is saved by not
turning the board around twice, as is necessary in the latter case.
Public-domain text, read in full here on John Shaqi.
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