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Peripheral Nerve Surgery

The Two-Stage Operation

Claude Pollard Jr. and Everett G. Grantham

Peroneal 10 6 4 5.3 6.4 10.1 5 0 Tibial 13 13 0 6.4 4.3 10.6 3 2 Brachial Plexus 1 1 0 Total 92 77 15 5.9 5.0 10.6 17 13 CONCLUSIONS 1. A method of performing a two-stage operation in cases of extensive peripheral nerve defects which will result in minimal traction injury to the adjacent and normal nerve substance is described and illustrated. 2. The two-stage operation is a last-resort procedure and should be used only in preference to a nerve graft when

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William S. Ogle, Lyle A. French and William T. Peyton

instituted in this clinic, only those patients with intractable pain in the upper thorax, brachial plexus, and upper extremity were subjected to this procedure. However, over a period of years it has been felt more and more strongly that high cervical cordotomy was the operation of choice for patients with intractable pain in the trunk, pelvis, and lower extremities and because of this, many patients with pain in these locations have been subjected to high cervical cordotomy and are included in this study. Initially, the selection of these cases for surgery was not based

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Henry G. Schwartz

T he distribution of subjective pain and objective sensory disturbance caused by cervical root involvement frequently has been noted to deviate from the “normal” dermatome pattern. Although variation from the normal may be explained on the basis of pre- or post-fixation of the brachial plexus and by peripheral overlap, recent experience has led us to consider another possibility. In the course of performing posterior rhizotomy for relief of limited pain in the hand we have had a patient in whom slender anastomotic branches were found running from the dural

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Henry W. Dodge Jr., J. Grafton Love and Cornelius M. Gottlieb

on many of these patients before they were examined at the clinic, was multiple sclerosis syringomyelia, amyotrophic lateral sclerosis, chronic encephalomyelitis or primary lateral sclerosis. An additional group of diagnoses attached to patients afflicted with benign neoplasms of the foramen magnum, but less common, were: subluxation of the upper cervical vertebrae, brachial plexus neuritis, platybasia, protrusion of an upper cervical disk, cervical cord tumor and posterior fossa tumor. 1, 5 The pitfalls to early diagnosis are many, and at times it is difficult

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1957 14 1 61 67 10.3171/jns.1957.14.1.0061 A Note on the Treatment of Involuntary Movements of the Arm by Resection of the Brachial Plexus Carl J. Bridge Gilbert Horrax January 1957 14 1 68 73 10.3171/jns.1957.14.1.0068 Fatal Brain-Stem Shift Following Hemispherectomy Fernando Cabieses Raúl Jerí Rodolfo Landa January 1957 14 1 74 91 10.3171/jns.1957.14.1.0074 “Central Pain” from Cerebral Arteriovenous Aneurysm Maurice L. Silver January 1957 14 1 92 96 10.3171/jns.1957.14.1.0092 Myelopathy Caused by Atlanto

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Carl J. Bridge and Gilbert Horrax

tightly over the flexed thumb. The patient was unable to open the right hand except by forcing the fingers open with the left hand. From time to time the arm would be thrown into violent athetoid and uncontrollable movements, as described by the patient. Fig. 1., Fig. 2., Fig. 3. Usual position of right arm. From this position it would make involuntary, purposeless, violent, uncontrollable movements. Hypertrophy of the upper arm is evident. After brachial plexus resection. The arm is paralyzed but the wrist is sharply flexed and has some athetoid movement

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William P. Tice

positioned for the epidural injection and operation at the same time. He is able to assume a comfortable posture under his own power, and the possibility of brachial plexus or peripheral nerve injury is reduced. Having the patient awake in the prone position obviates the necessity of an endotracheal tube. The single injection technic of lumbar epidural anesthesia is relatively simple, and when supplemented with local infiltration of the skin, permits one to start the operation without delay. The advantages of doing an operation under local anesthesia bear emphasis. In

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A. Chiasserini Jr.

, the patient may die in a very short time, and the acute and menacing symptoms are apt to obscure the neurological defects. Incidentally the latter might explain, at least partially, the considerable difference in frequency of injuries of the lumbosacral and the brachial plexuses. It is rather difficult to understand how the femoral nerve came to be injured in the course of an appendectomy, when one considers that the nerve is not only retroperitoneal, but is also protected by the iliac fascia, and the nerve itself is fairly thick. Possibly there were very

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Henry M. Cuneo

roots. On transverse section near the center was a gray mass which was of the size and shape of the spinal cord. Lateral to this were two white, roughly crescent-shaped masses of soft and friable tissue, presumably nervous, which almost met. On one side, gray tumor was found peripherally and laterally, so that one crescent-shaped white mass was completely embedded within tumor ( Fig. 1 ). At one end of the mass the tumor was reduced in amount and the spinal cord was intact and round, although extremely soft and friable. Brachial Plexus In the right brachial plexus a

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Robert C. Hardy, George Perret and Russell Meyers

components of the brachial plexus, to our knowledge these are the first reported cases of phrenicofacial anastomosis. The present data suggest that clinical evidence of regeneration of fibres within the facial nerve is as satisfactory following phrenicofacial as that following spinofacial and hypoglossofacial neurorrhaphy. If our impression in this regard should be supported as additional cases are accumulated in this and other clinics, there would appear to be reasons for preferring the phrenicofaciaf to the more conventional procedures. In the instance of spinofacial