7th March 2014, Volume 127 Number 1390

Excerpt from a case written by W. Fergus Paterson and published in NZMJ 1913 December;12(48):621–3.

Patient aet. 35 was thrown from his motor bicycle against a railing mischievously placed across a foot-bridge in 1907. He remained unconscious for several hours. After a period of some months during which he was in his usual health, he developed “petit mal,” which later assumed the graver form of major epilepsy. Fits occurred more frequently and latterly without aura, and patient would remain in status epilepticus for three or four days, and on one occasion for a week, without return to consciousness. Convulsions were extremely vigorous and cyanosis marked with stertorous respirations in the intervals.
Bromide administration was of little avail, and quickly nauseated patient. Injections hypodermically of morphine and atropine were also tried, and chloroforming proved a temporary palliative.
Eventually it was decided to attempt surgical measures. Localising symptoms were few, but comprised convulsive twitching of muscles of neck and shrugging of the left shoulder and grinding of teeth, which always preceded general convulsion. In addition to above, patient complained of a localised tenderness on the right side of the vault of the cranium, and a chronic headache. X-radiography failed to elicit anything in the way of depressed bone or thickening of the cranial vault.
Operation.–The head having been shaved, no external sign was found to indicate site of injury. Deducing from the above facts that the site of pressure was in all probability in the region of the rolandic fissure over the middle third of the ascending frontal convolution, and as the local tenderness and headache corresponded, craniotopographical measurements having been taken, the fissures of Rolando and Sylvius were outlined with lunar caustic.
Patient was anaesthetised and a liberal semicircular flap incised and reflected, The pericranium was also incised and the bone denuded sufficiently to admit of a trephine opening of one and a quarter inches in diameter. The dura mater was incised by a triradiate incision and reflected, bringing to view a traumatic cyst, the so-called "arachnoid cyst." This was incised and dissected out, two small dilated veins were ligatured with Van Horn size 0 catgut, and a hairpin shaped seton of silkworm gut inserted and the dura sutured. The free end of the seton was drawn through a puncture in the scalp flap, and the latter replaced and sutured.
The seton was removed three days later, and patient left the hospital a fortnight later, i.e., January 1st, 1912, and up to date of writing is in perfect health, has lost his migraine attacks, and has evinced no trace of his former epileptic attacks.