Читать книгу The Surgery of the Skull and Brain - Louis Bathe Rawling - Страница 51

In considering the question of treatment, the late Professor von Bergmann[10] divided the cases into two groups:—

1. Inoperable cases. When associated with premature synostosis and microcephaly.

When associated with hydrocephalus or marked deformity.

When the tumour is situated below the occipital protuberance.

2. Operable cases. Limited protrusions with none of the above defects and disadvantages.

This classification undoubtedly forms a practical basis on which to estimate the feasibility of operative measures, and it would appear that sincipital and small occipital cephaloceles are the only cases that come within the realms of operative treatment. In estimating the possibility of operation, however, due consideration must be paid to the fact that, in the very great majority of cases, the tumour tends to increase in size, the bones become further thinned, the margins of the gap more everted, and the development of the brain suffers correspondingly. Again, in spite of the fact that some few cases have survived to adult age, yet it is the general rule for the patient to die within a few weeks or months of birth. For desperate ills, corresponding measures must be undertaken, and in the consideration of the more serious cases the surgeon should be biased in favour of operation unless the general condition of the child shows clearly that no success is possible. The best results have been attained in cases of pure meningocele.