The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
One must acknowledge that this mode of treatment has--except in a few
isolated cases--not produced very satisfactory results. Still, since an
open operation is usually out of the question, no other course remains.
The after-history of these cases is not very encouraging. In one of
Weinlecher’s cases the child was living 5 years later, but pulsation was
still present. In Lucas’s case the patient died 21 months later from
meningitis. In Sir T. Smith’s case, pulsation was present 3 years after
the accident, and in Silcock’s there was no marked change for the better
after 11 years. On the other hand, a case reported by Golding Bird
steadily improved, and a second case reported by the same writer gave
every promise of a permanent cure. The two following cases have come
under my own observation:--
1. A female child, 11 months old, was knocked down by a van, and, on
admission, a large hæmatoma was seen situated over the right
temporo-parietal region. The child was semi-comatose, but recovered
consciousness next day. The hæmatoma softening, a gap in the bone was
felt, one-third of an inch wide, and extending from the occipital
bone upwards and inwards to the middle line. The swelling increased in
size when the child cried. Pulsation was present and translucency was
obtained. The tumour increased in size for some days, but no untoward
symptoms developed. For over one month pressure was applied, but
without much benefit, though the general condition of the child was
good. The edges of the gap became thickened. The child was then
removed from the hospital.
2. A male child fell 19 feet on to his head. He was concussed, and, on
admission, presented a hæmatoma over the right fronto-parietal region,
and subconjunctival hæmorrhage in the left orbit. Four days later he
was apathetic and there was some paresis of the left arm and leg. As
the hæmatoma became softer, pulsation was noticed over a small area,
and, in this situation, the swelling increased in size on straining. A
fracture was detected later, one-third of an inch in diameter, and
extending across the left frontal bone to the right temporal region.
Pressure was applied, the tumour steadily decreased in size, and
eventually the gap was completely closed.
=Synopsis of 38 cases of traumatic cephalocele.=
_Sex._ Males, 16. Females, 13. Sex not stated, 9.
_Age at time of accident._
2 cases at birth.
9 in the first 6 months.
9 in the second 6 months.
14 between 1 and 2 years of age.
1 between 3 and 10.
1 between 10 and 15.
1 between 15 and 20.
1 between 20 and 30.
_Region affected._
Right parietal, 17 cases.
Left parietal, 4 cases.
Other bones, right and left, 8 cases.
Parietal with others, 9 cases.
Parietal bone involved in 30 out of 38 cases.
Right side involved in 27 out of 38 cases.
_Date of appearance of tumour._
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