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Gilbert Horrax

in penetrating gunshot wounds of the brain. 20 The radical operation of sensory root division or avulsion for trigeminal neuralgia had, during the first two decades of the twentieth century, become a fairly standardized procedure with an increasingly low mortality rate in the hands of skilled neurosurgeons. Among the best, however, this rate was somewhere between 1 and 2 per cent. In 1920, 22 Cushing published the statistics of his entire series of 322 ganglion or sensory root operations in which there had been but 2 deaths, a mortality of 0.6 per cent

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Claude C. Coleman

particularly difficult insofar as determining the extent or level of the neural damage. A traction lesion is most common in the brachial plexus around the shoulder joint, in the external popliteal, and in the musculospiral from fracture of the humerus with wide dislocation of the fragments. In civilian practice, injury to the brachial plexus from blows or falling on the shoulder is a frequent lesion. These lesions, unfortunately, are generally avulsion of the cords of the plexus from the spinal cord. The lower cords of the plexus often remain intact, enabling the patient to

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E. S. Gurdjian and H. M. Smathers

before Surgery Operation Result Ulnar nerve T.Z. M 10 1933 Fractured ulna middle third Primary 4 months Neurolysis, partial nerve suture Recovery A.Z. M 45 1934 Anterior dislocation of ulna, fractured lower third radius Primary Same day Release of nerve from end of ulna Recovery B.B. M 9 1935 Avulsion medial epicondyle of humerus Primary 5 weeks Neurolysis and transposition Recovery W.H. M 36 1936 Fractured trochlea and internal condyle Secondary 6 weeks Neurolysis and

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Edgar F. Fincher

a network for granulation tissue development. This theoretical venture might prove useful in plastic surgical efforts. In infra-orbital nerve avulsions, the introduction of suitably sized gelfoam has reduced the postoperative edema and ecchymosis of the cheek and eyelids. The placement of a large thin strip of foam outside the skull when the scalp has been dissected from off the skull, either in traumatic or elective undertakings, has certainly improved the physical healing of these wounds and has materially reduced the indications for so-called “flap aspirations

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Geniculate Neuralgia

Report of a Case Relieved by Intracranial Section of the Nerve of Wrisberg

Archer A. Wilson

stated that the pain had been so “fierce” that she hadn't been able to retain much food. She felt that there was a trigger zone in front of the right ear. Since she had gotten complete relief for 9 months through avulsion of the right 2nd division, it was felt that we were dealing with a major trigeminal neuralgia after all, and a selective retrogasserian neurectomy was carried out in October 1946. This gave complete and immediate relief and on her 3rd postoperative day she ate a good lunch with the comment that “this is my first good meal in 4 weeks,” and a few days

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Specific Treatment of Intracranial Aneurysms

Experiences with 143 Surgically Treated Patients

James L. Poppen

still alive 7 years after ligation, with no complaints. RELIEF OF SYMPTOMS FOLLOWING LIGATION In 3 patients the pain in the distribution of the 1st and 2nd divisions of the trigeminal nerve persisted following ligation. Two of these patients were completely relieved by division of the internal carotid artery, which had previously been ligated, and section of the sympathetic trunk immediately beneath the superior cervical ganglion. The 3rd patient was not relieved by this procedure and only after avulsion of the 1st and 2nd divisions of the trigeminal nerve was

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Charles Harrison Frazier

Tangibles and Intangibles

Francis C. Grant

importance of good teaching for young men over all other features of a Surgical Department. During these surgical years with Dr. Frazier, the sub-total avulsion of the sensory root was developed for preservation of corneal anesthesia and the avoidance of keratitis in the eye on the operated side. In 1924 he suggested bleeding a patient who had a cerebellar tumor and a high blood pressure prior to operation and giving him the blood back again at the end of the operation. The final steps were taken in working out the technique in cordotomy. At this time he worked on the

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The Lucite Calvarium

A Case Report

Gale Clark

The purpose of this report is to describe a situation which was benefited by the use of a lucite calvarium. This is probably the first use of the acrylic cap in a human where there was avulsion of the scalp, skull, dura and brain; it was applied in an effort to get the patient into such condition that he could be evacuated to a “rear” area from the “forward” area at Wonsan, Korea. The original work with the lucite calvarium, in a manner similar to that to be described, was done on monkeys by Shelden, Pudenz, Restarski and Craig 1, 3 at the Naval Medical

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Winchell McK. Craig

avulsion was not complete. Thus, it became necessary to operate again two months later. The patient's pain was relieved, but unfortunately, he was left with partial palsy in the distribution of the sixth nerve and temporary unilateral facial palsy. The third case was that of a girl who presented symptoms of increased intracranial pressure with signs suggestive of a lesion of the left frontal lobe, presumably a tumor. An osteoplastic flap was elevated on June 6, 1917, but instead of uncovering a tumor, an abscess of the left frontal lobe was encountered. This I drained

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Everett G. Grantham and Ludwig H. Segerberg

I t is generally understood that sensory root section by the temporal route is the operative procedure to give lasting relief from the pain of trigeminal neuralgia. Some writers, however, agree that there are indications for less radical or palliative procedures which must be considered in many instances. It is our purpose in this paper to give further consideration to the palliative procedures that are commonly employed: alcohol injection of branches of the trigeminal nerve; or avulsion of peripheral branches of the trigeminal nerve. It is felt that