MICROCEPHALUS. — When a child is born with complete ossification of the skull, even at the fontanelles, or when ossification is completed soon after birth, microcephalus generally results. To remedy this condition and allow a more rapid expansion and growth of the brain Lannclongue has suggested that a groove, about a quarter of an inch wide, be exsectecl in the skull. This may be made on one side of the sagittal suture or on both sides, and may extend from the front line of the hair on the middle of the forehead well back into the occipital bone, and may have lateral branches. This operation should be done on only one side at a time, and is not devoid of danger, since the general vitality of such children is usually im paired. Keen, of Philadelphia, reduces the time of operation to not more than thirty minutes by using a rongeur for ceps which he has devised for the pur pose.
Tumors of the Skull.—Exostosis, or bony tumor, may occur as a result of in jury, but is usually a tertiary syphilitic manifestation, a result of a syphilitic gamma. If the growth is within the skull it is called an enostosis; if exter nal, exostosis.
The general treatment is that for syphilis of the bones. If the tumor is
external and gives annoyance, it may be removed. If internal, and it can be lo cated by its pressure effects upon the brain, the skull should be trephined and the tumor removed. Sometimes a growth upon the outside corresponds with a similar growth within the skull.
SARCOMA.—Round-, spindle-, and giant- celled sarcoma may affect the bones of the skull. The tumor may arise in the dura, the diploe, or in the periosteum. As the size of the tumor increases so does the danger and de formity. Sarcoma arising from the dura perforates the cranium and sometimes spreads underneath the scalp, finally breaking through the latter. The open ing in the bone, the pulsation of the mass, its partial or complete reducibility, generally accompanied with symptoms of pressure, and the presence of the optic neuritis which often results from it, en able one to diagnose this growth.
The growth may be removed, but re currence always follows. The operation itself involves such danger as often to be fatal, especially if the superior longi tudinal sinus be involved.