Fig. 379
Prolapsus cerebri. (Bryant.)
Prognosis.
—The prognosis is generally unfavorable. There is always risk of edema or infection, either of which may prove fatal.
Infiltration, gangrene, suppuration, or repair by granulation may so disfigure and disguise the real brain substance as to lead to error of diagnosis. It by no means follows that every tumor presenting through an opening in the skull is of this character. When gangrene and spontaneous separation occur, spontaneous recovery may follow, the stump being covered by granulations and finally roofed over by connective tissue.
Treatment.
—Treatment in the primary cases should include the most rigid asepsis with removal of all foreign particles. Localized pressure does some good, especially in those cases where it can be tolerated. Signs of abscess should always be watched for, and deep exploration is often justified or indicated. While excision or cauterization are often heralded as successful, they are by no means without their dangers. Nevertheless in selected and suitable cases excision may be freely practised. Cases that admit of it should wear a protective shield properly molded to the part. Skin transplantation, or even osteoplastic repair of the defect, may give good results in favorable cases.
SEPTIC INFECTIONS WITHIN THE CRANIUM.
Under the general term septic infection are included: