IL ENCEPHALOCELE.
Larger defines encephalocele as a congenital tumor of the cranium and face, with concomitant lesions more or less pronounced of the brain, and consisting in a larger or smaller diverticulum of the meninges and the brain, rarely the former alone, with or without serous fluid. He unites under this name the four varieties described by Spring, meningocele (Fig. 171), encephalocele (Fig. 172), hydrencephalocele, synencephalocele.
He admits three degrees: 1. Tumors in which the bones of the vault of the skull are almost ossified, and where there is simply a hole in the skull. These are the true surgical tumors. 2. Tumors in which almost all the bones of the vault are ossified. 3. Where the skull is almost entirely membranous.
According to the site of the tumor, he gives the following names: 1st. degree. No special name for each region.
2d. " Fronto-facial region . Proencophalocole.
,e Occipital . Notencephalocele.
Interparietal " Podenceplialocele.
3d. " Complete exencephalocele.
rare, Larger has been able to collect 98 cases.
In 5000 labors, and over, Vines noted 1 exencephalocele; in 12,900 Trelat noted 3.
Girls are more subject to the lesion than boys: Larger in 28 cases Boys, 11.
Spring in 59 cases Boys, 24.
Seat. —Wallmann in 44 cases found 24 posterior, and 20 anterior. Larger in 85 cases found 41 posterior, and 44 anterior.
Anteriorly the site of election is the root of the nose; posteriorly it is sub-occipital. Encephaloceles are most frequent anteriorly, and hydren cephaloceles and meningoceles posteriorly.
Pathological case of exencephalocele the cavity in the bone is round or oval, more or less regular iv border, always smooth. The dura mater is adherent to the walls of the sac, and, according to the majority of writers, the fluid is cephalo-rachidian. Larger, however, con tends that since exencephaloceles are irreducible, it is difficult to admit that the fluid contents are in communication with the cephalo-rachidian fluid. These exencephaloceles may be accompanied by serous congenital cysts of the neck, by angiomata, liponiata, and other abnormalities of the body. While Spring and others attribute the lesion to hydrocephalus, Larger believes that the production is intimately connected with the de velopment of the skull and the brain.
Synzptotn8.—The tumor is always constricted at its base, and varies in size from a lentil to the foetal head at term. It is usually single, at times bi-lobed, is always irreducible, painless on pressure, and only accompanied by reflex action, cries, and convulsions, when it is complicated by me ningo-encephalitis. It is translucent or opaque, according to the thick ness of the tissues covering it; either solid or fluctuating.
These tumors only complicate labor when voluminous, as in the cases of Ruysch, Deslandes, Tarnier. Labor is speedier when the head rather .. than when the pelvic extremity presents. If the obstacle to delivery is great, it suffices to puncture the tumor.