854 



PETEE BASSOE 



ries, hopes and expectations but with positive results which cannot he 

 challenged on the ground of coincidences and optimism. There is no 

 more inspiring chapter in surgery than the history of the conception and 

 perfection of the methods by which the exposure and removal of hypophy- 

 seal tumors are now accomplished with an operative mortality of less than 

 10 per cent though with a small proportion of cures or of decided or rapid 

 improvement. The idea of reaching the hypophysis surgically originated 

 with Horsley, who first performed the operation on animals (1886). Caton 

 and Paul (1893) and later Horsley attempted unsuccessfully to remove 

 tumors through the middle fossa of the skull. Kapid strides 



airline 





' f /f r fl7fff> 



Fig. 23. Line of incision in fronto-orbital approach to hypophysis. 

 Frazier, Surg. Gyn. & Obst., 1913.) 



(After C. H. 



were made after Schloffer(a) in 1906 devised a superior nasal approach by 

 which the nose was turned aside and extensive bone resections made so as 

 to open a path to the sphenoidal sinus and thence to the sella. This method, 

 although improved by Ilochenegg(fr) and v. Eiselberg, has been practically 

 discarded as unnecessarily mutilating, in favor of the inferior nasal 

 method proposed by Kanavel and modified by Hirsch(&), Halstead, and 

 Cushing(e). (Fig. 22.) In its perfected form, as described by the last 

 named author (1914), the main steps are as follows: The upper 

 lip is drawn up, and a transverse incision about 2 cm. long is made across 

 the frenum down to the bone. When the septum is reached the mucous 

 membrane is separated on each side, the septum resected, and after enlarg- 

 ing the passage thus procured, by means of dilating plugs, a bivalve 

 speculum is introduced. A headlight is now used and by means of rongeur 

 forceps the anterior wall of the sphenoidal sinus is bitten through. Next, 



