The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
=Gliomata= occur with almost equal frequency in cerebrum and cerebellum.
They are generally primary and single, the boundaries but ill-defined,
and the tumour is seldom amenable to radical surgical procedures.
[Illustration: FIG. 64. AN ENDOTHELIOMA OF THE DURA MATER.]
[Illustration: FIG. 65. A FIBROMA OF THE DURA MATER. Indenting the
cortex and attached to the pia-arachnoid by fine filaments.]
=Sarcomata= grow from the meninges, periosteum of cranial bones, and
from the sheaths of nerves and vessels. They are either primary and then
single, or secondary and then multiple (sarcomatosis). Sarcomata are
often more or less encapsuled, tending in the first instance to exercise
a compression force, and only in the later stages to invade the
surrounding regions. It is during this early stage of development that
the tumour is capable of removal.
[Illustration: FIG. 66. AN ACOUSTIC TUMOUR. Attached loosely to the
seventh and eighth nerves.]
=Endotheliomata= grow from the meninges of the brain. They are hard,
nodular, and, in their early stages, definitely non-infiltrating, and,
when accessible, removable.
=Fibromata= are especially prone to originate in the cerebello-pontine
angle, usually possessing a narrow stalk representing an atrophied
nerve-trunk or vascular bundle. From the frequency with which these
cerebello-pontine tumours are attached to the eighth nerve they are
often designated _acoustic_ tumours. They may be as small as a pea or as
large as a hen’s egg. In their early stages they are probably pure
fibromata, appearing as pink-red lobulated tumours. They are of slow
growth, primarily compressing the brain-substance without invasion.
Later on degenerative changes are prone to occur, with invasion of the
cerebellar substance and extension into the internal auditory canal.
Whether growing in the cerebello-pontine angle or in other parts of the
skull, fibromata are often readily removed.
[Illustration: FIG. 67. SYMMETRICAL TUBERCULOMATA. Situated on either
side of the falx cerebri above the tentorium cerebelli.]
=Tuberculomata= are most commonly situated beneath the tentorium. They
are often multiple. They cannot be considered as favourable tumours from
the surgical point of view, insomuch as they are frequently associated
with tuberculous lesions in other parts of the body and complicated by a
tuberculous infiltration of the meninges.
=Syphilomata= occur with greater frequency in the cerebrum than in the
cerebellum. Sometimes they are totally unaffected by anti-syphilitic
remedies, and, under such conditions, appear as densely hard and
definitely encapsuled tumours. These more chronic gummata are usually
cortical or subcortical in position, and, when accessible, are readily
removable.
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