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Harvey Gass and William P. van Wagenen

O ccasionally , after performing what one considers to be an adequate section of the posterior sensory root of the trigeminal ganglion for tic douloureux by the temporal route, he is surprised that the postoperative examination shows the area of anesthesia on the face to be considerably less than was anticipated. In 1932 van Nouhuys, 3 on the basis of anatomical dissections, concluded that “the sensory root of the fifth nerve is not composed of the three parts that correspond to the three peripheral branches from the gasserian ganglion” and that because of

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Palle Taarnhøj

, and that bleeding is less and more easily controlled. However, he has only seen the extradural approach used by others and has never tried it himself. The temporal-extradural approach in many clinics has been the method of choice, but in this series it was used in only one patient. As in the Frazier 4 operation, the dura mater was stripped from the base of the skull to the middle meningeal artery, which was cut. The dura mater covering the trigeminal ganglion and the root was incised to the superior petrosal sinus, which was divided between clips. The dura mater

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R. A. Money and G. K. Vanderfield

regaining consciousness 17 M 45 25 yrs. earlier, “tic douloureux” successfully treated by alcohol injection of trigeminal ganglion. 6 yrs. frontal headaches. Recently biliousness, nervousness. Hypertension. Normal vision Grossly enlarged pituitary fossa “Stretching” of ant. cerebrals indicating int. hydrocephalus. Fig. 10 Old hydrocephalus with cerebral atrophy Ventriculography showed gross symmetrical hydrocephalus without high intracranial pressure. No indication for operation Fits 3 days later Died. Autopsy: adhesive basal hydrocephalus 18

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Delayed Action Potentials in the Trigeminal System of Cats

Discussion of their Possible Relationship to Tic Douloureux

Benjamin L. Crue Jr. and Jerome Sutin

artery. Others, such as Dandy, 36 preferred a posterior fossa approach, which is still used by some today. 160 Other methods of permanent destruction of the trigeminal ganglion or root have been advocated, including electrocoagulation, 92 and injection of alcohol 67 and boiling water. 86 In an attempt to obviate the undesired postoperative facial anesthesia, Sjöqvist 134 in 1938 reported his technique of trigeminal medullary tractotomy and made a major contribution to the understanding of the central connections of the trigeminal system. Walker described

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George S. Baker and Frederick W. L. Kerr

Clinic on the results of this operation in 100 patients after more than 4 years, wrote that in cases in which recheck examination revealed that sensation in the face was normal, the recurrence of pain was as high as 84.6 per cent. Interestingly, among cases in which an objective sensory loss could be demonstrated after surgery, pain recurred in only 36.4 per cent. These data gave support to the prediction of Shelden and co-workers 3 that to obtain lasting satisfactory results in trigeminal neuralgia it would be necessary to apply enough trauma to the trigeminal

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Robert H. Wilkins

accurate closure of wounds, accompanied by as painstaking haemostasis as possible, should be observed during the more difficult intracranial procedures. Neighborhood oozing obscures the clear view essential to the safety of such delicate manipulations as are required for the removal of, let us say, a lateral recess tumor or the trigeminal ganglion; whereas a more general loss of blood with the consequent lowering of arterial tension is a cordial invitation to its near relative shock, favors the onset of respiratory paralysis in cases associated with medullary pressure

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Neurinoma of the Gasserian Ganglion

Report of a Case and Review of the Literature

Philip D. Gordy

atrophy. 2. It is re-emphasized that objective sensory and/or motor loss in the trigeminal distribution should arouse the suspicion of a neoplasm involving the trigeminal ganglion or root. 3. Attention is called to the fact that the absence of pain does not preclude the presence of a tumor located in the middle fossa with ganglionic involvement. 4. A brief review of the literature is presented. Grateful acknowledgment is made to Dr. A. Earl Walker for helpful technical suggestions during the operative procedure. References 1. Cohen , I

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Binoy Chakravorty

. She was free from symptoms for about 10 days then the pain returned. A trigeminal ganglion injection was given on the right side. In this case we used a mixture phenol and myodil as the ganglion blocking agent. Hartel's approach was used and 1 cc. of 1 in 9 phenol in myodil was injected after a preliminary test with 2 per cent novocaine. Immediately following the injection she developed a fixed dilated right pupil and diplopia. There was no light reflex in the right pupil and complete 3rd, 4th, and 6th nerve palsy. Within 2 to 3 minutes she complained that she

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Frederick W. L. Kerr

N umerous studies of sensory ganglia using light microscopy had been reported by the turn of the century. Cajal summarized much of that information in his treatise of 1909; 12 since then this technique has added only minor details. Electron microscopic studies of the trigeminal ganglion, however, have now added substantially to our knowledge of the fine structure of the trigeminal ganglion and have permitted a more accurate evaluation of normal variants. One of the major problems inherent in the study of materials suspected of harboring lesions is to

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David L. Beaver

belief has been that there are no pathological changes in the trigeminal ganglion itself. Some of this legend, at least, is based upon a single ganglion removed by Victor Horsely and examined by Henry Head, who finally donated the ganglion to anatomy to be used for normal histology instruction. 169 Although other investigators have found a variety of pathological changes in the trigeminal ganglion, 65, 113, 143 their findings have never been widely accepted, due in part to the fact that even by light microscopy the normal histology of the ganglion has never been