CONGENITAL HYDROCEPHALUS (For the clinical aspect, fee Zappert, vol. iv.) Congenital hydrocephalus is nearly always present in the form of hydrocephalus interims, a cystic distention of the ventricles of the brain, which may be so extensive that the medullary substance forms but a thin cortex for the enormously enlarged cavities. The fontanelles increase in size and the cranial bones separate from each other, so that the head may assume a monstrous shape in which the rest of the body looks like a mere appendage.
The treatment which up to the present has been perfectly hopeless begins to promise a better outlook for the future through surgical inter ference. Starting from the fact that lumbar puncture causes a tem porary disappearance of the pressure symptoms, attempts have been made to obtain relief by drainage of the excessive accumulation of fluid in the internal spaces. Various methods were instituted: insertion of threads and strips from subdural space into the ventricle in order to effect drainage from the interior (v. Mikulicz); also placing rubber drain age tubes from the interior of the ventricle into the peritoneum (Senn).
These attempts have been failures so far as final success was con cerned, partly because of the great liability to infection of the organs involved, and partly because of the obscurity which still surrounds the real cause of the condition.
Payr's method may perhaps be attended with better results. Pieces of vein are inserted through the cerebral substance, from which the ventricular fluid is conducted to the large venous spaces. Further details may be seen from the Central!)fall f. Chirurgie, INS, and the original description in the Archir f. kiinische Chirurgie, vol. S7, No. 4. The future alone can show whether permanent drainage of the lumbar spinal canal into the peritoneal cavity after a transperitoneal opening Bill be attended with better results. (See Spina bifida.)
The puncture of the corpus callosum, after the method of Anton and v. Bramann, is attractive by its simplicity, and has already been successfnlly applied in eight cases of cerebral overpressure. It is described as follows: "A small aperture is made by trephining in the skull behind the coronary suture, generally on the right side near the sagittal suture, or an oval opening is drilled with Doyen's burr. After slight cleavage of the Jura a cannula is inserted near the edge formed by the union of the external and menial surfaces of the hemispheres to the fats cerebri, and continued along the latter to the corpus callosum, which is perforated to gain admittance to the anterior horn of the ventricle.
" The fluid, which is under more or less pressure; having been evacu ated, the aperture in the corpus callosum is widened by means of the cannula, so that the cavities are in intercommunication, which means that the ventricle is in communication with the entire subdural space.
"This serves to equalize the local pressure conditions, and at the same time there arc new and wider spaces with more intact walls pro vided for the disturbed resorption of the fluid." The other congenital affections of the central nervous system, including mierocephaly, the diminutive cranium, or the premature clos ure of the cranial cavity have no surgical interest. The endeavors to create space for the growing brain by means of eraniectomy must be considered failures. "At best," says Broca, "a complete idiot would be converted into a half idiot, which would hardly be a gain."