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Carl J. Graf

decidedly less than with rhizotomy (done for multiple-division pain), although corneal hypalgesia is seen frequently. In patients with “tic” of the 1st division, when alcohol block and avulsion of nerve are no longer effective or desirable, “compression” we feel is preferable to section of the root. In no instance has the motor root been injured functionally when Shelden's operation has been employed. A chief objection to temporal rhizotomy has been, of course, destruction of the motor root and total sensory loss with the risk of an anesthetic cornea and danger of

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Robert H. Wilkins

too cumbersome. The “clips” have been found useful for the occlusion of inaccessible vessels divided in the dural incisions of decompressive operations ( Fig. B ), for the occlusion of the meningeal at the foramen spinosum if its division is advisable during the operation for trigeminal root avulsion, and, as has been stated, during the enucleation of cerebral tumors for the occlusion of the vessels passing from cortex to tumor—vessels the position and delicacy of which often make ligation well-nigh impossible ( Fig. C ). Fig. B. X-ray of a patient's head

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Richard C. Schneider, Kenneth E. Livingston, A. J. E. Cave and Gilbert Hamilton

T raffic accidents occasionally produce a distinctive variety of fracture (or fracture-dislocation) of the upper cervical spine, characterized by a bilateral avulsion-fracture through the neural arch of the axis without injury to the odontoid process and with or without fracture-dislocation of the 2nd cervical vertebral body upon the 3rd. The similarity of this lesion to that effected by the modern technique of judicial hanging justifies its description as “hangman's fracture” of the cervical spine. Some years ago one of us (R.C.S. 5 ) published a radiograph

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Charles L. Goodell

were seen. The sciatic nerve can, of course, be stretched or lacerated by acetabular fracture-dislocations, but these more peripheral injuries are usually recognized as such and classified separately. Traction injuries of the brachial plexus have been frequently described 1, 2 and are well understood. Violent stretching of the brachial plexus can cause either disruption of the spinal nerves distal to their foramina or avulsion of radicular elements from the spinal cord. In the latter instance, myelographic examination has usually demonstrated a cyst

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Peter J. Jannetta

satisfactory evidence that the lateral division of dorsal roots conveys selective “noxious” impulses. A reduction of total volume of input may be relevant to the surgical result, but avulsion of rootlets by the subtemporal approach may fail to provide relief, even when a large proportion has been destroyed. In these cases it is likely that involved fibers have been spared. * This work was done in collaboration with Dr. R. W. Rand at U.C.L.A.

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Frederick W. L. Kerr

mildly or moderately atypical (absence of a trigger point at the time of examination, interval pain between paroxysms, pain not characteristic, or previous alcohol injections of the infraorbital or supraorbital nerves), we divided our material into two groups. 96 Group 1 included only cases of typical trigeminal neuralgia with no prior surgical procedures or alcohol injections. Group 2 included cases which had had mildly atypical symptoms or which had had alcohol injections, peripheral neurectomies, or avulsions. No case of injection of the divisions at the cranial

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Total Removal of Large Acoustic Neuromas

A Modification of the McKenzie Operation with Special Emphasis on Saving the Facial Nerve

Charles G. Drake

varies depending on whether the porus is enlarged and thin-walled or small and thick-walled. Enlarged Porus Erosion of the internal auditory meatus simplifies this stage. Not infrequently, because of the natural slant of the opening, the tumor can be teased out with a blunt hook or a small retractor to show its origin from the acoustic nerve (G). Division or avulsion of this nerve then allows the tumor to be lifted out of the meatus to expose the flattened facial nerve lying along the anterior wall (H). When magnification is used, identification of this nerve by

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Albert L. Rhoton Jr., Jack L. Pulec, George M. Hall and Allen S. Boyd Jr.

petrosal nerve, for which it may be mistaken. When such a bony defect is viewed from the side, as in the usual extradural subtemporal approach for trigeminal neuralgia, the irregularities of the floor of the middle fossa could hide it or make it barely perceptible. Because bleeding may result from elevation of the dura and avulsion of the petrosal branch of the middle meningeal artery from its entrance into the facial hiatus, 4 it is easy to understand why electrocoagulation might be used in close proximity to the exposed facial nerve. This vessel usually bleeds when

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Donald P. Becker and Frank E. Nulsen

( left ) and lateral ( right ) ventriculograms in a 6-day-old infant with myelomeningocele. Frontal cerebral mantle measures 2.5 cm. Fig. 8. Anteroposterior ( left ) and lateral ( right ) ventriculograms in the same patient at age 4 months. The frontal mantle now measures 4.5 cm. At original placement the catheter crossed the septum pellucidum, and the tip lay in left frontal horn. The size of this ventricle appears to be smaller than normal. Fig. 9. Avulsion of the choroid plexus. This ventricular catheter, placed at age 2 days, had come to lie

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H. Verbiest

upper brachial plexus paralysis have been thought to be due to forceful shoulder-head separation while the patient's arm is at his side. It has been shown experimentally that this mechanism produces greatest stress on the upper nerve roots, 19 which results either in root avulsion from the cord or rupture of the extraspinal portion at or near Erb's point. It is important to distinguish between these two lesions because only the rupture is apt to be treated surgically. There are two major problems in surgical repair: 1. After resection of the damaged area, the