SPINA BIFTDA.
Tapping and the injection of Morton's Iodine Fluid are now abandoned. Unless when the tumour is ruptured during delivery of the child or shows signs of spontaneous rupture or causes paralysis, no attempt should he made to deal with it by operation until the infant has lived for a few years. The presence of hydrocephalus is a distinct contra-indication to operation in all cases. The tumour should be protected by a layer of cotton-wool or collodion, and a large shield of gutta-percha moulded to the part. Skilful nursing and feeding having tided the patient over the early period of life, the operation of excision may be undertaken with a fair hope of success by the age of 4 or 5 years. The operation should be performed with the child lying on its face over a pillow, so as to elevate the spine and prevent loss of spinal fluid. The neck of the sac should be exposed by an elliptical incision, which will provide skin flaps. When the type of tumour known as a " spinal meningocele " is present, the sac is to he excised and the opening sutured or ligatured before closing the skin wound.
In operating on a meningo-myelocele, after opening the sac the nerves must be carefully separated from its walls and gently pushed back into the spinal canal before proceeding with the excision, after which the pedicle is to be ligatured or sutured. In some cases it may be found possible to strengthen the opening by procuring periosteal flaps from the surrounding bone. Bayer uses two lateral periosteal flaps dissected from the canal 57 of the sacrum to make a bony roof over the sewed sac. The wounds in the dura mater, muscles and skin should be each separately sutured.
Where the surface of a rapidly increasing tumour has already broken down and there is, therefore, no healthy material for the manufacture of the flaps, some surgeons still think that the sac should be tapped and about 3o mins. Morton's Fluid (Iodine to gr., iodide of Potassium 3o grs. in I oz. Glycerin) injected.
Hey Groves points out that the mortality is so great that operation should never be undertaken unless enlargement and ulceration of the tumour threaten rupture.