Fig. 199.—Nævus at Root of Nose, simulating Cephalocele.
(From a photograph lent by Sir George T. Beatson.)
Treatment.—Only small cephaloceles are amenable to surgical treatment; those that are large and contain brain substance are best left alone, being merely protected from irritation and infection.
While the immediate effects of operation are, on the whole, satisfactory, the ultimate results are disappointing, as the essential cause of the intra-cranial pressure persists, and the child develops hydrocephalus. The method of tapping the sac and injecting iodine has nothing to recommend it.
Traumatic Cephal-hydrocele.—Certain rare cases of simple fracture of the vault occurring in early childhood have been followed by the development beneath the scalp of a localised fluid swelling, which varies in size from time to time and is partly reducible by pressure. The swelling results from laceration of the membranes, and sometimes of the brain substance, so that the cerebro-spinal fluid of the sub-arachnoid space, or even of the lateral ventricle, escapes through the opening in the skull and bulges beneath the scalp. In a majority the swelling pulsates synchronously with the heart, and becomes tense on exertion. A distinct opening in the skull may sometimes be felt. When associated, as it frequently is, with mental deficiency or the occurrence of fits, the cyst may be tapped or its neck ligated (Hogarth Pringle). Otherwise it should be left alone.
Hydrocephalus
An excess of cerebro-spinal fluid may collect in the arachno-pial space surrounding the brain, or in the interior of the ventricles, constituting in the former case an external, and in the latter an internal hydrocephalus. Hydrocephalus may be acute or chronic.
Acute hydrocephalus is practically synonymous with tuberculous meningitis, although it may result from other forms of meningeal infection. The excess of fluid is found both in the arachno-pial space and in the ventricles. This condition only calls for mention here as attempts have been made to treat it by surgical measures, such as lumbar puncture, or drainage through the occipital fossa. The results, however, have not been encouraging.
Chronic Hydrocephalus.—Chronic external hydrocephalus is rare, and usually results from some definite intra-cranial lesion, such as meningitis, tumour, or cerebral atrophy. It is not amenable to surgical treatment.