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SUMMARY The development of a facial flush during thermocoagulation of the Gasserian ganglion was monitored in 16 patients with pulse recording techniques and in a further 17 patients with thermography. There was a close association between the development of the facial flush in the distribution of one or more divisions of the trigeminal nerve and the subsequent demonstration of postoperative analgesia. In regions where significant changes took place, vascular pulsations increased 25-233% (mean 96%) and facial temperature rose 0*5-2-0°C. The response persisted for up to an hour postoperatively, and was not diminished in patients with pre-operative analgesia from a previous procedure. Possible mechanisms for the facial flush, including stimulation of an active vasodilator system, the antidromic release of vasoactive substances from trigeminal nerve terminals and the release of tonic vasoconstriction are discussed. A practical application of the pulse recording technique used in the present investigation would be to monitor the distribution of vasodilatation at operation to avoid unwanted first division sensory loss.Flushing on one side of the face may follow an attack of trigeminal neuralgia' and has been observed after injection of alcohol into the ipsilateral trigeminal (Gasserian) ganglion.2 Rowbotham2 commented that facial temperature and skin colour did not alter after tractotomy, root section or intracranial neurectomy, and attributed the rise in skin temperature after alcohol injection of the ganglion to involvement of sympathetic fibres either in the ganglion or adjacent to it. Oka3 reported that temperature increased on one or both sides of the face following injection of alcohol into the Gasserian ganglion, the response reaching its peak 10-30 minutes after injection and persisting for 40-120 minutes.Similar

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A double blind controlled trial was carried out on 100 neurosurgical patients. Ornipressin 0•2 IU Iml was compared with adrenaline 1 : 250,000. Ornipressin proved to be as effective as the control agent, and had little systemic effect. It is concluded that absence of arrhythmigenicity makes ornipressin preferable to adrenaline.

The management of 40 intracranial aneurysms using profound hypothermia and cardiac arrest are reviewed. The technique is described and the reasons for using this procedure are discussed. It is suggested that this technique is of value in the treatment of giant aneurysms, aneurysms which could not be treated by conventional methods, multiple aneurysms, aneurysms in difficulat sites and aneurysms complicated by other hazards. such as vascular anomalies.