ACROMEGALY 



857 



of the hypophysis, hence little or no relief is to be expected from a simple 

 subtemporal decompression. Sellar decompression with or without re- 

 moval of tumor tissue naturally suggests itself. If skiagraphic appear- 

 ances indicate that the tumor already is largely above the sella, an in- 

 tracranial approach such as that described by Adson would seem more 



Fig. 26. Placing the snare about the pedicle of the hypophysis tumor. (After A. 

 W. Adson, J. Am. M. Assn., 1918.) 



rational in that it enables the surgeon to survey the structures involved 

 and work more in the open than by any of the transsphenoidal methods. If 

 general brain tumor symptoms are marked and there are signs of pressure 

 on the motor nerves of the eyeballs or on the cavernous sinus, perhaps with 

 choked disc superimposed on the previous optic atrophy, a subtemporal 

 decompression or a callosal puncture may be the only procedure justified. 

 If this causes decided improvement in the general condition a radical oper- 

 ation, preferably by the intracranial route, may be performed later. 



