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✓ The authors describe the results of their recently reported computer-based stereotaxic surgical technique for the identification, enhancement, three-dimensional reconstruction, localization, and removal of small central nervous system lesions. This technique has been applied to patients with various types of central nervous system pathology, and representative cases are reported.

✓ The authors report a case of primary osteogenic sarcoma of the brain. Negative autopsy findings, complete bone radiographs, and bone-scanning techniques were consistent with a primary tumor focus in the right temporoparietal region of the brain. The authors suggest an origin from a primitive multipotential mesenchymal cell.

I NVOLUNTARY reflex spasm of the paralyzed muscles is present to some degree with most patients following permanent injury to the spinal cord. The etiology of these powerful muscular contractures remains a mystery. Likewise, the absence of this mass reflex in some patients is equally difficult to explain. Immediately after injury a period of so-called spinal shock exists, during which the paralysis is of a flaccid character. Some weeks later reflex activity reappears and may progress to marked hyperactivity and involuntary muscttlar spasms. At times the reflex spasm, evoked by simply touching the skin over the paralyzed area, may be so powerful that it is physically impossible for the examiner to overcome the strength of the muscular contractions. Why are these mass reflexes so important in the management of the paraplegic patient as to justify the injection of absolute alcohol in large amounts into the subarachnoid space? Every paraplegic patient's greatest desire is to walk, even though it may be only with the aid of braces and crutches. The mass reflexes serve as a formidable obstacle to this achievement. The patient cannot maintain an erect position even if he is physically able to handle crutches with his arms and shoulders. Flexion deformities are frequent, often with secondary structural contractures. These add to the patient's discomfort and increase the danger of trophic ulcers. Control of ulcerated areas, much less repair, is impossible if the deformities persist. Reflex spasm frequently involves the pelvis and abdomen. The urinary problem is increased because of reflex bladder spasm. If a urinal is used, violent spasms may result in more frequent wetting of the bed, thus adding to the patient's discomforts and the nursing problems. Abdominal spasms are a source of great annoyance to the patient, at times painful, and greatly interfering with his rest and sleep. Anterior rhizotomy has been used to relieve mass flexion reflexes with excellent results in selected cases. 11 The procedure consists in section of the anterior spinal nerve roots from the 10th thoracic through and including the 1st sacral nerve root bilaterally. Thus, the spastic paralysis of a spinal cord lesion is converted into the flaccid paralysis of a lower motor neuron lesion. Technically, this procedure is successful in overcoming the disabling

C ONSIDERABLE progress has been made during the past 4 years in the surgical management of major trigeminal neuralgia. However, very little has been added to our meager knowledge concerning the etiology of the pain. Woltman in 1951 suggested to us the possibility of controlling facial neuralgia by decompression of the peripheral branches of the trigeminal nerve at their points of exit from the skull. This suggestion was based upon the experience of Woltman and Williams 2 in treating facial tic by decompression of the seventh nerve. During the period from 1951 to 1953, 10 patients were surgically treated for trigeminal neuralgia by decompression of the peripheral branches of the trigeminal nerve at the foramen ovale and foramen rotundum. The surgical procedure consisted of temporal craniotomy, exposure of the foramen ovale and/or foramen rotundum, enlargement of the foramen by means of a motor-driven high-speed dental drill, neurolysis of peripheral branch or branches with saline followed by multiple linear incisions in the sheath of the nerve (Fig. 1). Every patient experienced complete relief of pain without significant objective impairment of facial sensation. Several patients noted mild subjective differences in tactile sensation, but this difference seldom could be demonstrated objectively for longer than a few days postoperatively. The results were gratifying but the mechanism of relief was difficult to explain. During this period it was learned that Taarnh~j in Copenhagen was accomplishing equally satisfactory results by decompression of the posterior root of the trigeminal nerve. His subsequent publication I verified the reports that we had obtained, but it was difficult to understand how the two procedures, both decompressing the fibers of the nerve, but at widely separated points, could accomplish the same results. Numerous observers concluded after Taarnhgj's report that the causative factor of trigeminal neuralgia was compression of the posterior root. If such were the ease, how could decompression of one or more branches peripheral to the ganglia afford complete relief of pain and no loss of facial sensation? The experience gained from our first 10 patients was presented in 195~

Despite satisfactory preoperative angiographic demonstration of intracranial aneurysms, the surgeon is often confronted at operation with lesions that are unsuitable for clipping or ligating. In the experience of the authors, a rapidhardening silicone rubber preparation has served to provide an immediately effective means of confining and reinforcing the walls of certain of these lesions. The plastic barrier formed by this material envelops the aneurysm without interfering with the patency of parent vessels, thus obviating the circulatory deficits imposed by trapping measures. Three cases are presented, illustrating the techniques and principles involved.