AMAarchives of neurology & psychiatry . n patients did not reply to our letter of is fair to assume that a few of these have improved, since patientswho have not improved are more likely to reply than patients who arewell and free from symptoms. Operation.—We employ no special technic in laminectomies for theremoval of tumors of the spinal cord, aside from precautionary 532 AliCHIlIlS OF NEUROLOGY A\D PSYCHIATRY measures against traumatizing the cord or permitting hemorrhagewithin the dura. The spines and laminae are removed; the musclesare closed in two planes with interrupted and
AMAarchives of neurology & psychiatry . n patients did not reply to our letter of is fair to assume that a few of these have improved, since patientswho have not improved are more likely to reply than patients who arewell and free from symptoms. Operation.—We employ no special technic in laminectomies for theremoval of tumors of the spinal cord, aside from precautionary 532 AliCHIlIlS OF NEUROLOGY A\D PSYCHIATRY measures against traumatizing the cord or permitting hemorrhagewithin the dura. The spines and laminae are removed; the musclesare closed in two planes with interrupted and ccmtinuous sutures ofcatgut, and the skin is closed by a subcuticular stitch of catgut, besidesa dermal suture. If the tumor is in the cervical region, a unilaterallaminectomy is performed, with the removal of the ojjposite laminaand the spine over the tumor. This ])recaution is taken because onepatient had a recurrence of symptoms owing to slipping of the bodiesof the cervical vertebrae, causing traction and pressure on the cervical. Fig. 9.—Tuberculoma (?) of the cauda equina, iniilatcral lesion. cord and resulting in paralysis. While we prefer the one-stagelaminectomy, we have found it necessary to perform a two-stage opera-tion in seven of our cases, and a three-stage operation in one, becauseof the extensiveness of the lesions. As a rule, we remove three spinesand laminae before we open the dura ; five or six can be removed withlittle difficulty. Ependymal gliomas of the cauda equina usually extendfrom the eleventh dorsal to the first or second sacral vertebra, and insuch cases trouble will be encountered if too much is attempted at oneoperation. Otherwise, the one-stage operation is very satisfactory,especially to the jiatient, and there is danger of infection in opening arecent wound for a second ojieration. ADSOX-OTT—SPIXAL CORD TUMOR 533 Ether anesthesia has been employed in the greater number of cases;however, we have foimd paravertebral anesthesia very satisfac
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