Stereotaxic treatment of pain.

bookbinders. A further series of photographs was then shown of dissections of the upper brain-stem showing the 5th nerves and the structures in the vicinity of the apex of the petrous bone. Serial photographs and radio-graphs had been taken while the crushing was in progress and again at the end of each procedure when the crushing force had been released. An attempt was then made to correlate the findings in theseexperiments with the clinical features of six patients with clinical and radiological evidence of petrous dislocation. It was concluded that, because of certain types of deformation of the base of the skull, the petrous bone might be dislodged in a postero-medial direction from its normal position due to opening of the petrosphenoid and petrosquamous sutures. As a result of this bony displacement, the 5th and 6th nerves might be damaged by stretching or by involvement in the fracture line. Extension of the fractures laterally into the middle ear produced deafness and facial weakness and the function of the temporomandibular joint might be disturbed by disruption of the petrosquamous fissure in the glenoid fossa. Medially the displaced petrous apex might damage the carotid artery and cause a carotid cavernous fistula. It was suggested that this syndrome and its variants might occur more frequently than had been hitherto suspected. R. BRAAKMAN (Rotterdam) had undertaken a retrospective study of cases of depressed fracture of the skull who had been admitted to his department during thepast 10 years. He included only those patients admitted within 48 hours of the accident and assessed their present condition in relation to the injury. The 225 cases under review were also compared with the 400 Glasgow cases reported by Miller and Jennett in 1968. As in the Glasgow series 85 % of the cases were male and of the 196 survivors information was available about 177; 44% were under 16 years of age. Only 14% of fractures were classified as closed, whereas Lewin had found closed and compound fractures in equal numbers. In this, and also regarding dural penetration, the Rotterdam and Glasgow figures were similar. The incidence of epilepsy, both early and late, was less than in the Glasgow series, although the mortality rate was significantly higher. In relation to practical management , as a result of this study, they felt that bone fragments should usually be replaced. There were five infections in 109 cases with replacement …