The Surgery of the Skull and Brain

by Louis Bathe Rawling

Fig. 94. An Exostosis of the Orbit.

SARCOMATA, PRIMARY AND TRAUMATIC

Primary sarcomata of the skull, when compared to sarcomata developing in other situations, is undoubtedly a rare disease. Still, many cases have been recorded, and four have come under my own personal care, one of which is depicted in the [figure].

The disease is equally prevalent in the two sexes, and, excluding chloromata (see [p. 334]), usually develops at or after middle life. The growth may originate in the diploic tissue (as a myelogenous tumour), or may spring from the pericranium. The cellular structure varies accordingly. More commonly the cells are of the large round or spindle type, and are proportionately malignant.

As regards site of development, the temporal bone (squamous portion) is most commonly involved, next to which comes the frontal bone.

In considering the ætiology of sarcoma in general, trauma must always be taken into account, for it is an undoubted fact that it plays an important part in the development of this dire disease. With respect to the skull similar factors come into play. For instance, Fröhlking,[79] after collecting 48 cases of sarcoma of the skull, found a definite history of trauma in 9-21 per cent.

Fig. 95. An Extrinsic Sarcoma of the Skull.

Ziegler[80] lays down the following essentials in establishing the traumatic origin of the tumour: It must develop directly after the trauma on the basis of the swelling or directly in the scar of the wound.