Prognosis.—The prognosis is unfavor able, except in cases of small meningo cele amenable to operation, and in eases of small encephalocele, some of which live for many years. ITydrencephalocele is usually a fatal condition, death occur ring in from a day or two to several weeks.
Treatment.— Meningocele bas been frequently aspirated, and the injection of iodine into the sac in the form of 'Morton's solution bas been practiced. Many forms of operation have been tried in these cases, and successful operations have been reported from all of them, but, even in the successful cases, chronic hy drocephalus has often followed.
Attempts at the removal of encephalo cele by operation have been made by Lichtenberg, Czerny, and the author. Lichtenberg's patient died. from the op eration; Czerny's patient survived the operation, but died later from apparently independent causes.
Personal case in which the patient made a permanent recovery: that of a. Swede, in whom was found a tinnor filling the post-nasal space above the soft palate. On palpation the tumor seemed somewhat compressible, and would, upon pressure, appear to decrease in size so that it could be pushed up into the left half of the posterior nares. The pediele could be traced to the roof of the nose. Cerebral hernia suspected. Hypodermic needle twice inserted with negative results and diagnosis of ordi nary polypus and not basal hernia made. An attempt made to remove the growth in the usual way with the wire snare and the pedicle divided. After with drawal of the snare slight hmmorrhage occurred, but neither coughing nor sneezing brought forth the tiunor. The haemorrhage soon ceased, but was im mediately followed by dripping of a clear watery fluid, of which about a teaspoon ful was collected. The fluid was cere bro-spinal. The basis of the plan of op eration now was to secure the pedicle for transfixion and ligature as close to its exit from the cranium as possible. The operation of the osteoplastic or tem porary resection of the superior maxilla as devised by von Langenbeck was ac cordingly executed. Ten weeks after the operation the wound was so nearly closed that collodion dressing could be applied over thc fistula leading into the antrum, which remained open for about three months, but secreted little and did not interfere with the patient's work as coachman.
The microscopical examination showed distinctly that the tumor was a eysto encephalocele. Although no layer of white brain-substance was present, there was no doubt that this cavity was a continuation of a ventricle, probably the third ventricle. Its regular shape, and the fact of its being entirely surrounded by a layer of cortical brain-substance, made it distinctly different from the serous cavities which are found in her nias of the brain as well as of the spinal cold, developed from, or an exaggeration of, the subarachnoid lymph-spaces.
The distance between the eyes a point in diagnosis. It is possible that a basal cerebral hernia might cause a broaden ing of the root of the nose and a corre sponding increase in the distance be tween the inner walls of the orbits, just as occurs in sineipital hernias. Chris tian Fenger (Amer. Jour. Med. Sci., Jan., '95).
Treves operates in these eases only when rupture is threatened. Schatz (Berliner klin. Woch., No. 28, '85) gives statistics as follows: 3 recoveries in 24 occipital tumors not operated on, and 6 recoveries from 35 operated on by in jection, clamp or ligature, or excision. Six recovered out of 46 frontal tumors without operation, while 2 recovered out of 14 operated on. The tendency at present is to operate upon these cases, although the results are not very encour aging.
When the tumor is not small, it should be supported by gentle pressure,—or a collodion dressing may be applied over it, as advised by some surgeons.
In the case of a small encephalocele it is better to apply gentle pressure, and to wait in order to find out if it inclines to enlarge. In this form the patient may live many years and experience no dis comfort from the condition.
Cases of spontaneous cure of encepha loeele and meningocele have been re ported. This is effected by gradual growth of bone around the opening, with retraction of the sac. The opening in some cases becomes entirely closed. This is, however, of very infrequent occur rence.