Tumors of the nervus acusticus and the syndrome of the cerebellopontile angle / by Harvey Cushing.

  • Cushing, Harvey, 1869-1939.
Date:
1917
Catalogue details

Licence: In copyright

Credit: Tumors of the nervus acusticus and the syndrome of the cerebellopontile angle / by Harvey Cushing. Source: Wellcome Collection.

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    of the point of origin of these tumors. The cerebellar manifestations were fairly well marked, but the cerebral nerves showed merely an impaired func¬ tion of the VIIIth together with a definite corneal areflexa, the reverse, as can be seen, of Case XXVII, in which the cerebral nerves were extensively in¬ volved and the cerebellar signs inconspicuous. The syndrome, as may be noted, supports Oppenheim’s contention of the occasional great diagnostic value of a lost corneal reflex. The wide-spread post-operative palsies of the adjacent nerves provoked by the operative manipulations, largely intracapsular, gentle and bloodless as they were, serve to show how inevitable such nerve injuries must be when an attempted total extirpation by rougher methods is undertaken. One thing which should be noted is the fact that no dysarthria or dysphagia was produced by the damage to the IXth, Xth and XIth bundle, which sup¬ ports the view that these symptoms are due to pressure against the medulla Fig. 165 Fig. 166 Figs. 165, 166.—Case XXIX. Showing (left) fibrous area with fat cells: (right) reticular area. rather than to the pressure involvement of the third or fourth posterior nerves. The experience with the X-ray studies of the pori in this case is an illumi¬ nating one and served to cast considerable doubt on the interpretations of the cases which had been previously studied. In all probability it is unwise to attempt to interpret a condition of the porus interims from single plates, even though it is possible to study and compare the condition on the two sides. Not only are stereo-Rontgenograms necessary, but with our present inex¬ perience several sets may be required before a definite opinion can be ex¬ pressed. The following case completes the present series of verified cases. When this study was begun the patient, like Case XXVIII, was listed among the cerebellopontile-angle (acoustic) “suspects.” It was regarded,