No definite prognosis can be laid down. Everything depends on the site of the tumor. In general, apart from surgical relief and from medical treatment of syphi lomata, the outlook is pessimistic. Sudden i death is not infrequent and lumbar puncture is an extremely dangerous procedure with brain tumor, often leading to sudden collapse and death, especially with tumors of the posterior fossa. Syphilomata and gummata of the brain have a fair prognosis. Better results are ob tained with mercury by inunction and by iodides than by salvarsan in the beginning treatment. Salvarsan may be used later to attempt to kill off all the spirochetes, but with well-advanced syphilomata, salvarsan is apt to set up a dangerous reaction. Round, hard gummata do not absorb, as a rule, and are best considered surgically.
Medical treatment, excepting for syphilomata, is useless, and involves a waste of valuable time. The chief objects to be attained are early diagnosis, immediate ex elusion of syphilis by serological tests, eye ground examination with particular study of the color fields, exact localization as soon as possible, and surgical removal or palliation (decompression) to save the eyesight or to gain time for a more exact localization.
The details for applying these principles have already been noted. The results to be
expected in any particular case are prob lematical, yet from 10 to 20 per cent of all brain tumors (seen in the large) have been removable, with at least in 10 per cent practical recovery. Even with such chances against him the patient should have the benefit of the doubt if a competent surgeon is available. Surgical skill is a very large factor in the results; a good abdominal surgeon is not necessarily a good brain surgeon. The brain is semi-fluid and an intricate switchboard of highly important structures; there are no unimportant areas in the brain; many surgeons have treated it in the past as though it were an abdominal viscus. The results have been disappointing. Most brain operations are best done in two stages. Decompression, usually subtemporal, alone is often the only possible procedure. It often relieves a recently acquired blindness. The situation referable to brain surgery for cerebral tumors is rapidly advancing, and better results are being obtained and regions hitherto im possible to reach (hypophysis, etc.) have been approached with results which a decade ago would have been impossible. Notwithstanding all this, the general attitude should be one of extreme caution. Consult Jelliffe and White, 'Diseases of the Nervous System' (1917).