Fig. 408
Sympathectomy. Exposure and removal of middle and upper ganglia. (Marion.)
Fig. 409
Sympathectomy. Seizure and removal of inferior ganglion. (Marion.)
It is rarely necessary to provide for drainage after the operation, unless the retraction and laceration of tissues have been very great. My own preference is to make one long incision along the posterior border of the sternomastoid, by which the dissection is facilitated and the operation made less complicated and difficult. When done for glaucoma on one side it will be sufficient to attack one nerve, but when for epilepsy or for exophthalmic goitre the operation should be bilateral. When for epilepsy or glaucoma it is not so necessary to remove the lower cervical ganglion; this is indicated rather in those cases where it is desirable to control the accelerator nerves to the heart. The operation has given good results in all three affections named, yet it is one of considerable difficulty. It would be made extremely difficult by the presence of a large goitre, and in such case it would probably be better to extirpate the thyroid rather than to attack the nerve. (See [Glaucoma], [Epilepsy], and [Exophthalmic Goitre].)
CHAPTER XXXVIII.
THE SPINE, THE SPINAL CORD, AND THE PERIPHERAL NERVES.
SYRINGOMYELIA.
The term syringomyelia implies irregular dilatation of the central canal of the spinal cord, having a congenital origin, tending to relative increase later in life, with corresponding disturbance of function, the latter including paresthesiæ, loss of sensibility to heat and cold, more or less motor impairment and disturbances of nutrition, more noticeable in the region of the joints than elsewhere, the latter having been already considered in the chapter on the Joints. The dilatation is by no means regular, may occur in various regions of the cord, and attain a size permitting encroachment upon, and even atrophy of, the structures of the cord itself. When functional disturbance, especially paralytic, has become very pronounced a few surgeons have ventured to expose the cord by a laminectomy, and endeavored to make a more or less permanent opening with drainage of the dural cavity. Thus Keen has operated twice, Abbe once, and Munro three times, including twice on the same patient. Only in this last instance was any permanent relief obtained, and this was at the expense of a second operation. It is doubtful if any of the peculiar joint lesions of this disease will be in any way affected by operation for this purpose.