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R. Glen Spurling and Everett G. Grantham

of even the most enthusiastic advocates of the procedure—4 out of every 10 patients in this series who recovered completely as the result of a simple disc operation would have been submitted to a needless operation, with its attendant risks to life and with its prolonged period of postoperative disability. Unless a large series of long-term results can be published showing a higher percentage of cures and more satisfactory results with the fusion operation than were secured in this series by simple disc surgery, it seems fair to conclude that the best method of

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J. Le Beau

. This evolutional factor may explain, too, why long-term results are doubtful in cases of rapidly growing carcinoma . On the other hand, intermittent attacks of violent pain, as in Case 18 (tabes dorsalis) and Case 10 (causalgia with both permanent pain and paroxysm), were checked after bilateral topectomy. In any event, the problem of how a topectomized patient would react to a new and permanent cause of violent pain is not yet solved. It is possible to explain two other failures we observed, by the contention that in these cases neuralgia was associated with a

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George D. Zuidema and Solomon J. Cohen

the more severely ill patients, it would seem that the prognosis is good even in this group. TABLE 6 Types of treatment used and long-term results Number of Cases Treatment Used Results 2 Repeated lumbar punctures Excellent 8 No treatment Excellent 11 Subtemporal decompression Excellent in 6, good in 5 One patient (J.H.H. 106203) had a craniotomy elsewhere when her symptoms persisted. Thrombosis of the cerebral veins was found. She has done well for 15 years postoperatively. In

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Ira J. Jackson and S. R. Snodgrass

procedures. Only 2 patients in this group of successful shunts are not leading useful or relatively normal existences. The surgical technique and complications are presented. To fully evaluate any surgical operation for the treatment of hydrocephalus or increased intracranial pressure, a period of years must pass by. Our own experience with peritoneal shunts has shown us that the longer one follows these patients the poorer are the long-term results. However, we do feel that these shunts have a limited value in the neurosurgeon's armamentarium. REFERENCES 1

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Phillip Harris and George B. Udvarhelyi

is suitable when there is a good anastomotic circulation, if the aneurysm is large, and/or sessile. The direct procedure is required when the anastomotic circulation is poor, when there is a contralateral (or ipsilateral above the bifurcation of the internal carotid artery) aneurysm, if the aneurysm fills on testing the contralateral anastomotic circulation. A small aneurysm, with an inviting neck, is suitable for the intracranial operation. FOLLOW-UP STUDIES Much has to be learnt about the natural history, and also the long-term results of treatment in

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Intracranial Internal Carotid Artery Aneurysms

Results of Treatment by Cervical Carotid Artery Ligation

H. A. Shenkin, P. Polakoff and B. E. Finneson

suppress the image from this eye and consequently has no complaints of diplopia now, 4 years and 2 months after operation. It is further to be noted that this patient had multiple aneurysms of her internal carotid artery. Another patient is improving but follow-up is too short to be certain of the ultimate outcome of her 3rd nerve palsy. COMMENT Despite the great interest in this subject there is as yet a scarcity of reports giving long-term results of surgical treatment of intracranial aneurysms. Most articles deal with only immediate surgical results or do not

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Arterial Aneurysms of the Internal Carotid Artery and its Bifurcation

An Analysis of 69 Aneurysms Treated Mainly by Direct Surgical Attack

G. af Björkesten

aneurysm just as much as does a carotid ligature. A special problem is offered by the large sessile aneurysms at the carotid bifurcation, in which a ligature is not feasible and which are too large for any type of clips. We have wrapped these lesions with muscle, but it is uncertain whether the long-term results are reliable; in connection with other types of aneurysms we have seen secondary ruptures. Here Dutton's 4 method with acrylic plastic should perhaps be tried. The follow up shows that the fact that the patients had tolerated the operation well and been

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Daniel Ruge, Ruben Brochner and Loyal Davis

1920. The symptomatology of the entire group has been studied and the various forms of therapy have been evaluated. The immediate postoperative state has been reviewed in all instances and it has been possible to assess the long-term results in 513 patients. A total of 627 preganglionic sections of the trigeminal nerve were performed. The group of 637 patients included 373 females and 264 males. The preponderance of women sufferers, as compared to men, has been observed by others. In this series, the ratio of females to males would be even greater if the men who

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Hendrik J. Svien and J. Grafton Love

regard, that in our patients who sustained only subjective loss of sensation, the recurrence rate of 66.6 per cent, though high, is significantly less than the recurrence rate of 84.6 per cent for patients who did not experience sensory loss; and that the long-term results in patients who sustained objective sensory loss are remarkably superior to the results in patients in whom the nerve was not traumatized. When it is contemplated that the trauma engendered to the posterior root or ganglion in our cases was unintentional and random and that in the compression

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Rudolph Jaeger

of most individuals. However, the long-term results have been far from encouraging as the recurrence rate has been extremely high. It is our opinion that the beneficial results of this operation are ascribable to trauma of the nerve root rather than to the procedure of decompression. Actually, I believe this term is erroneous, as it is impossible to decompress structures that were not originally compressed. It is possible that as one performs more so-called decompression procedures, the technic improves, and as the technic improves the degree of trauma to the root