The Surgery of the Skull and Brain
Louis Bathe Rawling
Library of Alexandria
This work on the Surgery of the Skull and Brain is based on experience derived, and on research carried out, during the past ten years. Cranio-Cerebral Surgery, though still in its infancy, has progressed with leaps and bounds during the past few years. This book represents the most modern aspects of the case and is brought up to date by means of a recent visit to some of the leading surgical clinics of the United States of America. I have realized to the full the difficulties of the task which I have undertaken, but have every confidence that they have been overcome and that a reasonable measure of success has been obtained. With this anticipation, this work on the Surgery of the Skull and Brain is offered to the Profession. The surgeon who is called upon to carry out operations on the skull and brain must possess an accurate knowledge of the anatomy of the parts involved. Added to this, he must have at his command some simple method of depicting on the surface of the skull the more important structures. The more complicated systems of cranio-cerebral topography are of little practical value to the surgeon. Simplicity is essential, and the following outline will be found to furnish an adequate practical guide. Firstly, the skull can be divided into two lateral halves by the surface-marking of the superior longitudinal venous sinus. This sinus originates at the crista galli and, passing backwards along the attached margin of the falx cerebri, terminates at the internal occipital protuberance. It may be represented by a line drawn from the base of the nose (the nasion), over the vertex of the skull, to the external occipital protuberance (the inion)—this line corresponding in its course to the occasionally persistent metopic suture between the two halves of the frontal bone, to the sagittal suture between the parietal bones, and to the middle line of the upper or tabular portion of the occipital bone. Secondly, each lateral half of the skull can be subdivided into supra- and infratentorial regions by a line which marks the external attachment of the tentorium cerebelli; in other words, by the line of the lateral sinus.