CHAPTER 31 



OPERATIVE TECHNIQUE 



Although it is possible to operate on the pineal using local infiltration 

 of the scalp and some scopolamine and morphine, yet it is preferable, 

 in the author's opinion, to use rectal avertin, local infiltration of the scalp 

 with J per cent, novocain, and to follow with intratracheal gas and oxygen. 

 The reasons for using intratracheal gas and oxygen are that it is desirable 

 to have the patient completely quiet while the deep approach to the pineal 

 is proceeded with, and that if the patient stops breathing, oxygen or 



■ ■ 



Fig. 289. — Drawing showing the Skin Incision and Site for the Burr Holes 

 in the Bone so as to Expose the Posterior two-thirds of the Cerebral 

 Hemisphere. 



carbondioxide can be given, a very desirable precaution when operating 

 near the brain-stem, where slight deflections in either direction may press 

 or drag upon the respiratory centre. 



There are only two approaches to the pineal gland which are of any prac- 

 tical value, and both demand a large right occipito-parietal osteoplastic flap. 



1. Dandy's Operation. — This is the method of choice, and is based 

 on experimental operative procedure performed on dogs. After pre- 

 liminary infiltration of the scalp with novocain, a large occipito-parietal 

 scalp flap is fashioned (Fig. 289) and bleeding controlled. Some five 



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