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9a. Operative Note by Dr. Cushing, August 10, 1932

OPERATIVE NOTE Right Transfrontal exploration of Large Size.

Aug. 10, 1932. Subtemporal Decompression. Exposure of Normal Chiasm. Puncture of Ventricle. Replacement of Dura without Suture. Replacement of Flap.

OPERATORS

  • Dr. Horrax

  • Dr. Cushing

  • Dr. Horrax. Had turned down the usual transfrontal flap in this case, the posterior leg being carried down to the temporal region. At this juncture I took over the exploration and exposed the chiasm finding some difficulty in doing this until I had tapped the ventricle and a large amount of air and fluid escaped. It was then possible to see the right optic nerve with an empty space behind it, and I also got a view of the left optic nerve, the chiasm being so far as I could see normal in position, neither prefixed nor postfixed. The frontal lobe was then allowed to fall back in position and I made a large subtemporal defect, opened the dura, reflecting it upward so as to permit of expansion if there actually is a third ventricle tumor. The lower part of the bone flap was also removed and the flap was then replaced and closed securely in the usual layers, with paracranial sutures along the lower leg. Dr. Horrax took over the latter part of this procedure. The program in this case therefore is to allow this woman's ventricles to dilate and in the course of 10 days or two weeks or possibly longer to make a transcortical exploration in case the suspicion of third ventricle defect should again be demonstrable by secondary ventriculograms.

(Dr. Cushing)

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