Remarks on operations on the Gasserian ganglion : with a report of five additional cases / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on operations on the Gasserian ganglion : with a report of five additional cases / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    some fibrous tissue passed. I trephined at the same point and found the nerve reproduced and thickened to about the size of the median nerve. I removed au inch and a half of the nerve by avulsion and then removed the superior maxillary nerve, dividing it well back of the infra-orbital canal. This operation gave her relief for another eighteen months or two years, when the pain returned as bad as ever. Her physician, Dr. Moore, of Spartanburg, S. C., brought her to see me early in October, 1895. I recommended and she accepted au operation on the Gasserian ganglion. Third operation, October 6, 1895. The ordinary Hartley-Krause osteoplastic operation was done. In chiseling the lower part of the incision just in front of the ear, the posterior branch of the middle meningeal was divided, although I took every precaution not to go through the bone, as in a woman of her age and so thin as she, I judged that the bones of the skull were probably very thin. As soon as I turned down the flap of bone, I found that the anterior branch of the middle meningeal went through a canal and was torn, and the posterior went through a very deep groove, in which my chisel had divided it. In addition to this, there was a rent in the dura, which must have been made by the chisel penetrating, without its being per- ceived, into the interior of the skull cavity. I finally succeeded, with great difficulty, in securing the posterior branch ; the anterior was com- paratively easily controlled. I then carefully lifted the dura from the middle fossa, but in doing so the middle meningeal tore directly at the foramen spinosum, and a profuse hemorrhage followed. I was able, however, to arrest this by getting the curved end of the Allis blunt dis- sector into the canal and then substituted, first, the forefinger of the left hand and then a piece of iodoform gauze, by which I controlled the bleeding completely. I then exposed and cut the second and third divisions at their foramina, grasped them with forceps, and endeavored to avulse the ganglion with them. The two branches each tore off from the ganglion, but I was able to scoop out most of the ganglion with a curette. What I took to be the cavernous sinus was perfectly visible and avoidable. The small piece of gauze packed into the foramen spinosum was brought out through the wound and the wound closed with interrupted silkworm-gut sutures. Dr. Kyle reported on the tissue which was supposed to be the ganglion that it was undoubtedly portions of the ganglion, since he found nerve cells as well as tubules in the tissue. Three days after the operation, I very carefully removed the small bit of iodoform gauze which blocked up the middle meningeal artery, and no hemorrhage followed. The wound was healed in the course of a week. On the third day after the operation her eye became red and a cor- neal ulcer began to develop. I placed her in charge of Dr. de Schweinitz for the ulcer of the cornea. In spite of the utmost care, this broadened and deepened to a considerable extent, and at one time was very threatening, but by long-continued treatment by atropine, boric-acid solution, hot compresses, bandaging the eyes with the greatest care, etc., she finally went home, November 27, 1895, with a distinctly healing ulcer and without any pain.