AMAarchives of neurology & psychiatry . 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 anesthesi
AMAarchives of neurology & psychiatry . 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 satisfactory inobese patients and in patients who are poor surgical risks. It is neces-sary to apply a 1 per cent, solution of procain to the dura, as it isexposed during laminectomy, since it is not desensitized in the para-vertebral anesthesia by procain. A few drops of 1 per cent, solution ofprocain can be injected into the dural canal above the tumor withoutdanger. Intraspinal anesthesia by procain can also be used in low. Fig. 10.—Intramedullary degenerating glioma of the dorsal cord. laminectomies of the lumbar and sacral regions, but should be usedcautiously, if at all. in middle dorsal or upper dorsal lesions. Postoperative Care.—The care of patients after laminectomy differslittle from general surgical care. We prefer to keep the patient on hisabdomen on three or four soft pillows, with the head slightly lower thanthe operative field, for three or four days, besides avoiding unduepressure on the bony prominences. He is then permitted to turn on hisside, and after ten or twelve days to lie on his back. About thefourteenth day he may sit up in a chair. We have found that he ismore comfortable in the prone position, that the wound heals more 534 ARCIIIlliS OF NEUROLOGY AND PSYCHIATRY rapidly, and there is less danjj;er of drainage of cerebrospinal fluid, espe-cially in cases of intramedullary tumors in which the dura is left the ])atient has not
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