The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
=The lateral sinus.= This sinus is represented by a line presenting a
slight upward convexity, which is drawn from the external occipital
protuberance to the upper and posterior part of the mastoid process of
the temporal bone.
[Illustration: FIG. 1. CRANIO-CEREBRAL TOPOGRAPHY. 1, The nasion; 2, The
inion; 3, The mid-point between nasion and inion; 4, The Rolandic
fissure; 5, The superior temporal crest; 6, The inferior temporal crest;
7, The Sylvian point; 8, The anterior horizontal limb of the Sylvian
fissure; 9, The vertical limb of the Sylvian fissure; 10, The posterior
horizontal limb of the Sylvian fissure; 11, The parietal prominence; 12,
The malar tubercle; 13, The lambda; 14, The first temporo-sphenoidal
sulcus; 15, The external parieto-occipital sulcus; 16, The lateral
sinus; 17, 17, 17, The level of the base of the cerebrum; 18, The
external auditory meatus; 19, 19, Reid’s base-line. (_Reproduced, by the
permission of Mr. H. K. Lewis, from the author’s work on ‘Landmarks and
Surface-markings’._)]
[Illustration: FIG. 2. CRANIO-CEREBRAL TOPOGRAPHY. 1, 1, Reid’s
base-line; 2, 2, A line parallel to the above at the level of the
supra-orbital margin; 3, The middle meningeal artery; 4, The anterior
branch; 5, 5, 5, The three sites for trephining; 6, The posterior
branch; 7, The site for trephining; 8, The point for trephining to reach
the descending horn of the lateral ventricle; 9, The lateral sinus; 10,
The inion; 11, The mastoid process; 12, Macewen’s suprameatal triangle;
12_a_, The mastoid antrum; 12_b_, The facial nerve; 13, The suprameatal
and supramastoid crests; 14, 14, The temporal crest; 15, The temporal
fossa; 16, The external angular frontal process; 17, The tendo-oculi
attachment; 18, The lachrymal groove. (_Reproduced, by the permission of
Mr. H. K. Lewis, from the author’s work on ‘Landmarks and
Surface-markings’._)]
=The infratentorial region.= The cerebellum lies wholly beneath the
tentorium cerebelli, and it is obvious that, in operations carried out
over this portion of the brain, the surgeon is limited in his field of
exposure, above by the line of the lateral sinus, and on either side by
the posterior border of the mastoid process. The division between the
halves of the cerebellum may be represented by a line drawn vertically
downwards from the external occipital protuberance to the nuchal region.
This line also represents the surface-marking of the occipital sinus and
falx cerebelli.
=The supratentorial region.= Brief allusion must be made to certain
landmarks that aid in the representation of structures situated in this
region:--
(_a_) _The external angular frontal process._ The suture between the
external angular frontal process and the corresponding process of the
malar bone lies immediately above the central point of the outer border
of the orbital cavity.
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