A case of tumour of the spinal cord : removal, recovery / by W.R. Gowers and Victor Horsley.

  • William Richard Gowers
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A case of tumour of the spinal cord : removal, recovery / by W.R. Gowers and Victor Horsley. 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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    The fourth, fifth, and sixth dorsal spines were then cut off close to their bases with powerful bone forceps, the laminal arch of the fifth vertebra was then trephined with a three quarters of an inch trephine, the pin being placed in the middle line. The bone was very hard and tough and one sixteenth of an inch thick. The rest of the lamime were then removed with a bone forceps and knife, the ligamenta subflava giving much trouble owing to their toughness. The laminal arches of the fourth, fifth, and sixth vertebrae being thus cleared away, the dura mater was easily exposed by an incision in the middle line through the fat covering it. This fat, being pressed aside, shrank and showed the dura mater of a normal appearance, colour, and tension. Nothing very abnormal was then observed, save that on the left side the dura mater was distinctly pressed nearer to the bony wall of the neural canal. This, of course, was due to the fact that the tumour lay on the left side of the cord, and consequently pressed the dura mater on that side closer to the vertebrae. The wound being practically bloodless, the dura mater was slit open in the middle line with a knife and dissecting forceps. The cerebro-spinal fluid escaped freely, but not with any undue pressure to signify pathological tension. The spinal cord was now exposed for about two inches and appeared to be perfectly natural in colour and density; moreover, the vessels cours- ing on its surface were in every respect normal. It will now be readily understood that the upper part of the roots of the sixth nerve and the whole course of the fifth nerve on each side from the spinal cord to the intra- vertebral foramen was completely exposed. Examination of the spinal cord on all sides with the finger and cautiously with an aneurism needle failed to reveal anything abnormal. Another lamina was removed at each end of the wound, the dura mater as before slit up, and the cord still further exposed, but still nothing pathological was discovered. At this juncture it appeared as if sufficient had been done, but I was very unwilling to leave the matter undecided, and my friend Mr. Ballance being strongly of the opinion that
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