The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
The extent of anæsthesia resulting varies according to the nature of the
operation. Thus, if the upper part of the ganglion be spared or the
operation confined to the second and third divisions, the upper lid,
conjunctiva, cornea, and forehead escape. In any case, taste is but
little impaired, the posterior part of the tongue being supplied by the
glossopharyngeal and the tip and sides by the chorda tympani. In all
cases, except perhaps in Frazier’s operation, the motor fibres which
accompany the third division are almost always divided, with consequent
paralysis of the corresponding masseter, temporal, and pterygoid
muscles. The degree of discomfort and deformity resulting from such
anæsthesia and paralysis is, however, not very considerable, and in
contrast with the relief from the terrible pain, of very little import.
It is, as Jonathan Hutchinson says, the price which the patient has to
pay for the cure of the neuralgia.
With respect to recurrence of pain, there is every reason to believe
that the resection of the sensory root and the complete removal of the
ganglion are never followed by recurrence of pain. With respect to
Jonathan Hutchinson’s and Abbé’s operations, there is some divergence of
opinion. There would appear to be some cases recorded in which the
symptoms have recurred--often many years later. With regard to
Hutchinson’s operation I have no personal experience, but it is stated
that in some few cases the pain has recurred in the first division. I
believe, however, that I am correct in stating that this is denied by
Hutchinson from the experience based on his own cases. As regards Abbé’s
operation, recurrence may take place if the basal foramina are not
completely occluded, some few nerve fibres growing through the foramina
on either side of the occluding medium. Such complications have not
taken place in the cases in which I have carried out this operation.
Besides experiencing immediate and complete relief from pain, the
patients sleep well, eat well, and rapidly convalesce. For some two or
three days they may suffer from some headache, presumably due to the
necessary manipulations of the brain, but this, besides being relieved
by drugs, soon passes off. Frequently, the patients are up and about
within a few days.
Whatever the nature of the operation, the greatest care must be taken to
protect the eye on the affected side--the conjunctival sac is washed out
daily with a mild boracic solution and the cornea guarded from exposure
to air and dust by means of a glass covering fastened round the
forehead. This appliance should be worn for two or three weeks.
The =main difficulties and dangers of operation= are as follows:--
1. Hæmorrhage (from middle meningeal artery and cavernous sinus).
2. Infection.
3. Shock.
4. Ocular complications.
Public-domain text, read in full here on John Shaqi.
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