The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
Until quite recently, with the exception of these medicinal remedies,
the only other methods at our disposal in the treatment of trigeminal
neuralgia were Gasserian ganglion removal and other intracranial
operations on the three divisions of the fifth nerve. In 1906, however,
Schlösser[72] of Munich advocated the injection of alcohol into the
region of those foramina at the base of the skull through which the
nerve trunks emerged. As the result of these injections it was stated
that, although some slight degree of cutaneous anæsthesia frequently
resulted, yet that it was usually of an unimportant and transient
character, and that the pain subsided and finally ceased, remaining
absent for a variable period of time, usually about ten months. In the
event of recurrence the injection was repeated, each period of recurrent
pain being less intense and less prolonged, whilst the periods of
remission increased proportionately.
Whilst it is clear from the results obtained by those who have followed
in Schlösser’s footsteps, that alcohol injections are, as a rule,
reasonably satisfactory, yet it must be clearly understood that
beneficial results are not always observed, and that in the event of
failure the more radical intracranial operations must be carried out.
The technique of alcohol injections.
_Question of anæsthetic._ Freezing of the skin or other method of local
anæsthesia suffices to allow of the painless introduction of the needle.
A general anæsthetic should be avoided wherever possible, as the burning
sensation experienced by the patient when the nerve-trunk is encountered
greatly assists the accuracy of introduction.
_The needle._ The needle should be stout--10 cm. long, 1·5 cm. in
diameter, and graduated in centimetres up to 5 cm., and provided with a
blunt stilette.
_Introduction._ The skin is cleansed, the stilette slightly withdrawn,
and the needle introduced. After puncture of the skin the stilette is
pushed home, all further introduction being carried out with the blunt
advancing point. When in position, the stilette is withdrawn, and a
glass syringe, ready filled with alcohol, fitted to the needle and the
injection made.
_The solution._ Purves Stewart recommends the injection of 1-1·5 c.cm.
of the following solution:--
Beta eucaine, 2 grains
Absolute alcohol, 6 drs.
Distilled water to the ounce.
Wilfred Harris advises 90 per cent. alcohol, preceded by a 2 per cent.
solution eucaine. He urges that two or three drops should be injected
slowly, and if the needle be correctly placed a sharp burning pain will
instantly be felt over the area of the distribution of the nerve,
lasting fifteen seconds or so and then dying away. Two or three more
drops are then injected, and thus ‘a few drops at a time, from 1 to 1·5
c.cm. are injected, the pain produced with each succeeding push of the
syringe being less and less’.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account