The cartilage healed in smoothly. After three weeks the tumor was rapidly removed, turned inward and sewn over. During the opera tion there was an occasional arrest of respiration, as has been observed by other authors in operations at this place. A skin flap with a broad base was then detached from the roof of the skull which carried the healed-in cartilage at its frontal end. The transplanted cartilage was trimmed to a proper size and, so to speak, buttoned into the aperture, and the skin wound closed. On the second clay the child had recovered from the shock, and the sutures were removed on the sixth day, when the wound looked dry and apparently normal. The child suddenly collapsed on the ninth day with manifestations of cerebral pressure.
The autopsy showed the wound had healed normally at the place of operation. There were no signs of any kind of meningitis, but, On the other hand, the ventricles were enormously dilated and the cerebral cortex was so thin as to appear like the skin covering a cyst.
It is sufficient in slight cases to cover the defect with the skin. Simplicity and rapidity in these operations, aside, of course, from the most rigorous asepsis, are the principal factors. The fact that we are
operating on small children must always be borne in mind, and also that complicated plastic operations with badly nourished autogenic or even heterogenic material may easily impair the condition of the wound and increase the clanger of infection, which in these eases is especially great.
In the presence or suspected presence of hydrocephalus the chances for operation are very unfavorable. In many cases it would even appear as if the hydrocephalus increased after the removal or closing of the reservoir, which in view of the thin walls often presents an enlarged surface for evaporation. The exclusion from operation of these cases, as well as those associated with extensive malformations, is all the more indicated, as these children in any case are destined to early death.
The prognosis in operations on small cephaloceles is good.
The operation fur meningovele is considerably simpler and the prognosis is more favorable :nut does nut differ from the enuelention or removal of other cysts of the cranial vault.