Much information of value for the diagnosis may be expected from radiography and lumbar puncture. A good X-ray picture will sometimes reveal the presence of a basal tumor. On the whole, however, the method is not often applicable. Lumbar puncture is of value chiefly when the findings are negative, i.e., when the fluid obtained is under high press ure, clear like water, free from bacteria and coagulable, it points to meningitis. Very rarely particles of tumor are found in the fluid.
The treatment of brain tumor is still as hopeless as it ever was. Attempts at a casual therapeusis by operative removal of the tumor, made in recent years, while they reveal a high degree of acumen as well as accuracy in diagnosis, promise but little success in the case of children. This is partly because children tolerate the very bloody operation badly and partly—and this is more important—because the seat and variety of the tumors that are most common in childhood offer less favorable chances for successful operative removal. Tumors in the cerebellum, the basal ganglia and the pons, which are more frequent than any others, must still be regarded as practically inoperable, and brain tubercle, on the other hand, is frequently multiple and is the expression of a constitu tional disease so that the removal of one diseased spot does not insure the patient's recovery. Thus, among ft very large number of eases of brain tumors that have come under my observation in the course of years, I can call to mind only a single one in which I could advise operation. This was in a vigorous boy without any tuberculous taint, in whom a progressive monnparesis of one arm had developed along with charac teristic signs of tumor; but the parents could not bring themselves to consent to the operation. According to the local indications for opera
tive intervention set up by Bruns tumors in the following situations may be regarded as operable: (1) the central convolutions; (2) the speech regions; (3l the frontal lobes; (4) the occipital lobes; (5) the temporal lobes. These indications will have to be followed in the few operable cases that occur in childhood.
If there is no indication for the operable removal of a brain tutnor, a palliative operation still remains to be considered and should be employed symptomatically when the paroxysms of pain are very severe or there is beginning atrophy of the optic nerve. The procedures arc lumbar puncture and trephining of the skull, of which the former is the more important from the pediatrist's standpoint. 'Unfortunately lumbar puncture is not without danger in cases of brain tumor, because the sudden removal of pressure in the brain may induce haimorrhage. In any case the procedure must be terminated at once if a marked fall of pressure takes place or the general condition of the patient grows rapidly worse. Fortunately brain tumors in children develop very slowly and the child's skull is not very resistant, so that symptomatic operations of this kind are not often called for.
For the rest, the treatment of brain tumor is purely symptomatic. The most important indication is to relieve the headache, and for this purpose all the drugs at our command, particularly antipyrin and also morphine must be employed. In other respects we should apply the same treatment as in any acute process in the brain accompanied by increased pressure.