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THE SURGICAL ASPECTS OF MAJOR NEURALGIA OF THE TRIGEMINAL NERVE.A REPORT OF TWENTY CASES OF OPERATION ON THE GASSERIAN GANGLION, WITH ANATOMIC AND PHYSIOLOGIC NOTES ON THE CONSEQUENCES OF ITS REMOVAL

HARVEY CUSHING, M.D.
JAMA. 1905;XLIV(11):860-865. doi:10.1001/jama.1905.92500380024001c.
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Liberation and Extraction of the Ganglion and Its Branches.  We now come to the method of dealing with the ganglion, and here, no matter what the approach has been, difficulties in a certain percentage of cases are invariably encountered. Hemorrhage is the chief bugbear, and I confess to have dwelt too lightly on it in my earlier paper. My first two cases were fortunately, or unfortunately, unusually bloodless ones. Not uncommonly, I think in more than one-half of my cases, has it. been possible, with almost no loss of blood, to arrive at this stage of the operation. Sometimes it may be completed and the ganglion removed without any difficulties whatever arising from bleeding, and this has been my good fortune on six occasions, but at other times the structure is "below water" much of the time.23There are certain advantages, I think, which come from working in a small hole and under the artery, provided that there is a good overhead light, for with the manipulations necessary

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