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Article
April 1941

EXPERIENCES WITH INTRAMEDULLARY TRACTOTOMYI. RELIEF OF FACIAL PAIN AND SUMMARY OF OPERATIVE RESULTS

Author Affiliations

PHILADELPHIA
From the Neurosurgical Service of the Hospital of the University of Pennsylvania.

Arch Surg. 1941;42(4):681-692. doi:10.1001/archsurg.1941.01210100041004
Abstract

It has long been known from the study of pathologic conditions affecting the brain stem that there are an anatomic separation and a physiologic dissociation of the fibers of the trigeminal nerve immediately on their entry into the brain stem. The fibers conducting the modalities of pain and temperature turn downward and in company with the nucleus of the spinal tract of the fifth nerve run throughout the length of the medulla oblongata and into the upper cervical portion of the cord. During their course, they emerge from under cover of the restiform body and take a superficial position on the lateral surface of the medulla. In this situation they form a distinct elevation on the surface of the medulla—the tuberculum cinereum. In the closed portion of the medulla the tuberculum cinereum lies below the restiform body and above the olivary eminence. The fibers mediating touch sensation, on the other

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