1. Whilst recognizing that internal hydrocephalus usually demands surgical interference, it is only in some few cases that material benefit results. Some recent successful cases point to the possibility of better results in the future.
2. The operation which promises the best results, combined with the least risk to the patient’s life, is that described as ventriculo-subdural drainage.
[4] _Der Hirnbruch und seine Behandlung._ Moscow, 1896.
[5] _De la céphalhydrocèle traumatique_ (_Travaux de Neur. Chir._, iii. 1898).
[6] _Archives Italiennes de Biologie_, vol. xxxviii, p. 444.
[7] _Der Hirnbruch und seine Behandlung._ Moscow, 1896.
[8] _Beitr. zur klin. Chir._, vol. iii, p. 228.
[9] _St. Bart. Hosp. Reports._ Lawrence Ward. May 5, 1896.
[10] _Beitr. zur klin. Chir._, vol. vii, p. 228.
[11] _American Practice of Surgery._ Bryant and Buck.
[12] _Tumours, Innocent and Malignant._ Bland Sutton.
[14] In estimating the size of the head, the following tables--after Bonnifay--will be useful:--
_Age._ _Circumference of head_ (average).
Birth to fifteenth day 343 millimetres (approximate). Fifteenth day to 2 months 368 „ „ At 3 months 388 „ „ Six months to 1 year 429 „ „ One year to 2 years 459 „ „
During the first 3 months 44 millimetres (approximate). During 3 to 6 months 41 „ „ From 6 months to 1 year 30 „ „ During second year 14 „ „
It should be noted that enlargement of the head can only take place during the years previous to synostosis of the skull bones. Leonard Guthrie (Harveian Lecture, March 17, 1910) writes, ‘I cannot find from any recorded cases of hydrocephalus acquired in later childhood and adult life that an increase in the size of the head has been any aid to diagnosis, and I believe it is true that internal hydrocephalus acquired after the sutures are set is hardly distinguishable from a non-localizable intracranial new growth giving rise to headache, vomiting, and optic neuritis.’
[15] The treatment for acquired hydrocephalus dependent on tumour formation is discussed elsewhere. This section deals with the congenital variety and with those cases of acquired hydrocephalus not due to obstruction by tumours.
[16] _Review of Neurology and Psychiatry_, vol. ix, No. 1, p. 1.