ACKOMEGALY 855 



the roof of the sinus, which is also the floor of the sella, is similarly re- 

 moved piecemeal and the dural capsule of the hypophysis comes into view 

 This is incised, and the conditions encountered will then decide the further 

 procedure. A cyst may be incised, or a hypophyseal tumor removed piece- 

 meal, or nothing further done, the operation in the latter instance con- 

 stituting a "sellar decompression." 



Temp oral artery 



Fig. 24. Adson's incision for approach to hypophysis through anterior fossa. 

 (After A. W. Adson, J. Am. M. Assn,, 1918.) 



During the period in which the transsphenoidal methods were perfect- 

 ed other surgeons sought a safe and practicable intracranial route of ap- 

 proach. The temporal route having proved too difficult Krause (1905) 

 proposed a frontal one, through the anterior fossa. The method was suc- 

 cessively improved by Me Arthur, Bogojawlensky, and Frazier, and brought 

 to the highest perfection by Adson. While Frazier carried his incision as 

 far forward as the median line of the forehead and resected the orbital 

 roof (Fig. 23) Adson makes his flap farther backward (Fig. 24), and 



