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.

    73/326 (page 55)
    studies have been more exact, particularly in regard to the Barany tests and X-ray studies. The surgical results also have been more promising, with only t wo deaths out of nineteen partial t, u m or re¬ in oval s—a 10.5 per cent mortality. The operative end results, moreover, have been increasingly better, though in the first case of the new series, like the last one (Case XI) of the old, pontile contusions resulting in an increase in local symptoms with dysphagia of a degree necessitating temporary nasal feeding, were produced by a too radical and a repeated effort to completely remove the lesion. Case XII P.B.B.H. Surg. No. 295. Right acoustic tumor giving an advanced cerebellopontile- angle syndrome. Partial intracapsular enucleation in two sessions. Recovery. Aug. 4-, 1913. Admission of Miss Caroline B., 50 years of age, referred by Dr. David Percy of Arlington Heights, Mass. Chronology of symptoms.—For twenty-one months increasing deafness of right ear: no tinnitus. For fourteen months unsteadiness of gait, first ob¬ served by others. For eight months occasional headaches and vertigo : also incoordination of right h a n d , with dropping of objects. For four months occasional periods of diplopia; blurred vision; numbness of right face. Positive neurological findings.—-(A) General pressure. Choked disc of 7 D. with hemor¬ rhages and much new tissue. X-ray shows evidences of increased tension and secondary absorption of dorsum sellae. (B) Localizing. (1) Cerebellar. Nystagmus variable: at times oscillatory movements: coarser to the right: rotary on looking up. Positive Romberg with falling to right and back. Gait very ataxic. Marked incoordination of right hand, with adiadococinesia, dysmetria, etc. Deep reflexes exaggerated, slightly greater on right. (2) Extracerebellar. Cerebral nerves. Vth = Considerable right hypsesthesia with corneal areflexa: also motor involvement, with deviation of jaw to right. VIth = Negative: his¬ tory of diplopia. VIIth = Slight asymmetry with flattening of nasolabial fold on right. Definite right ageusia. VIIIth = Complete right deafness, corroborated by caloric tests. No responses from right labyrinth. X-ray of porus inconclusive. IXth, Xth, XIth and XIIth = Considerable dysarthria and dysphagia. Sept. 3, 1913. Readmission. Increasing impairment of vision: choked disc subsiding with secondary atrophy. Condition otherwise much as on previous examination a month before. Sept. 6, 1913. Operation I.—It was impossible to dislocate the cerebellum sufficiently to expose the recess, so that a transverse incision in the hemisphere was made and carried down to the tumor, whose posterior pole was fully exposed. Intracapsular extirpation of possibly the lower half of the growth. Closure as usual in layers without drainage. Post-operative note.—Considerable post-operative deglutitory difficulty with increase of dysarthria. Temporary recourse to nasal feeding owing to fear of inhalation pneumonia. Healing per primam. Subsequent improvement in general condition. Neighborhood symptoms practically unchanged. It was unwisely decided to undertake a second and more radical procedure in the hope of completing the extirpation. Oct. 17, 1913. Operation II.—The wound was reopened, the tumor was again exposed, and about as much of the intracapsular contents as on the former occasion was removed from what seemed to be the posterior and inner portion of the growth. The tissue was cheesy and was easily peeled away from the capsule. Considerable twitching of the accessorius musculature produced during the manipulations. The impression was gained that the por-