The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
In 10 cases compression was applied to the common carotid artery, with
the result that in 3 cases the conditions remained stationary whilst in
the remainder, either on account of the pain produced or from complete
failure to bring about any improvement, this mode of treatment was
abandoned in favour of ligature of the common carotid. In some cases the
carotid compression was carried out by means of tourniquets, in others
intermittent digital pressure was utilized by means of relays of
assistants.
In 18 cases the common carotid was ligatured, in 12 cases as a primary
measure, in 6 after failure of other methods. The immediate and remote
results were in all cases as satisfactory as could be anticipated.
Proptosis at once diminished, the globe receding in some cases to the
normal position, and the distressing subjective symptoms were almost
entirely relieved. In many cases the patients were enabled to return to
work.
Some defect in vision commonly persists, dependent on muscular paresis
(on account of the previous stretching), retinal thrombosis, or corneal
changes. The longer radical treatment was deferred the greater and more
distressing were the after-effects of the lesion.
According to Sattler, however, the results obtained by ligature of the
common carotid are less favourable than as stated above, and by no means
devoid of danger to life. Fifty-six cases were collected with results as
below:--
39 cases recovered and showed marked improvement.
11 cases experienced no benefit.
8 cases died.
It has been urged that ligature of the _internal_ carotid artery would
suffice to bring about equally satisfactory results, combined with less
danger to life and diminished risk of secondary cerebral degeneration.
Such, however, does not seem to be the case, for the anastomosis between
the angular arteries and between the terminal branches of the ophthalmic
is so free that the results obtained by ligature of the internal carotid
appear to be unsatisfactory. Indeed, even when the larger trunk was
tied, secondary operations have been occasionally required in order to
excise some large anastomotic channel in the region of the inner canthus
of the eye and over the bridge of the nose.
From these data, the following conclusions can be drawn:--
1. That by means of rest, careful dieting, and administration of
potassium iodide in large doses, the progress of the case can sometimes
be arrested, but that much patience is required and the ultimate result
is entirely problematical.
2. That compression--digital or instrumental, intermittent or
continuous--is painful, tedious, and usually quite inefficacious.
3. That ligature of the common carotid affords the best chance of cure
or alleviation.
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