The Surgery of the Skull and Brain

by Louis Bathe Rawling

1. ‘Cases secondary to and part of the phenomena of tuberculous or any suppurative meningitis, comparable to pleural effusions due to tuberculous or any septic invasions of the pleura.

2. Cases resulting from the presence of tumours, &c., analogous to the pleuritic effusions accompanying tumours, &c., situated close to or involving the pleura.

3. Ordinary infantile or congenital hydrocephalus, which is, in some cases at least, due to intra-uterine meningitis.

4. Internal hydrocephalus supervening on the epidemic or sporadic type of posterior basic non-suppurative meningitis.

6. Simple idiopathic internal hydrocephalus of adults or older children due to serous ependymitis or ventricular meningitis.

7. Traumatic cases.’

This classification possibly includes all the various grades and degrees of internal hydrocephalus, but for all practical purposes the cases may be grouped into two classes, congenital and acquired, both of which may be either acute or chronic.

Congenital internal hydrocephalus.

The condition may be recognized soon after the birth of the child, or the enlargement of the head may only become apparent some weeks or months later. The slow development and the insidious nature of the enlargement, as observed in many cases, may lead to some confusion between the late congenital and the early acquired varieties. However, the absence of any symptoms pointing to meningeal inflammation between the time of the birth of the child and the hydrocephalic development usually allows of correct classification.

It is doubtful whether congenital internal hydrocephalus can be ascribed to malformation of the inter-ventricular channels and occlusion of the passages by means of which the cerebro-spinal fluid escapes into the cerebral subarachnoid space, or whether the development is dependent on hypersecretion from the ependyma and choroid plexuses. Virchow showed that occasionally there was an actual formation of small grey-red masses, about the size of a hemp-seed or cherry, in the walls of the ventricles, but other authorities deny the existence of such changes, and consider that the hydrocephalic condition is entirely dependent on congenital malformation.