Linear craniotomy (miscalled craniectomy) for microcephalus / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Linear craniotomy (miscalled craniectomy) for microcephalus / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The paralysis has almost disappeared, so that the left hand is used almost as readily as the right. In considering these cases one is struck by the fact that two of them were followed by speedily fatal results. I presume it is only to be ex- pected that children of such feeble cerebral development accompanied as in my own case (Case III.) with faulty circulation, should be less rugged and less able to stand the shock of an operation. The cause of death in my own case was very clearly, I think, heart-failure, and in Sach's and Gerster's case it was acute anaemia. This mortality, which is quite unusual, of course, in ordinary brain operations, should induce us to state the risk to the parents in stronger terms than we would were it an ordinary case of trephining. For myself I cannot but think it a very fortunate thing, for if such children cannot be helped it seems to me that death is preferable rather than to linger in this world in such a defective and helpless condition. It should, however, make us especially careful as to the administra- tion of the anaesthetic, and we should use all possible means to shorten the operation as much as possible. The forceps I devised for the opera- tion certainly answer the purpose very much better than those I first used, so that the time required for the last operation was only twenty minutes, instead of an hour and a quarter as in my first. In using them it is better to cut alternately a little to the right and left (as one turns his toes out in walking) to prevent their binding. It will be noticed that the upper blade is perforated. This perforation widens from the cutting edge upward, so that each piece of bone bitten out pushes its predecessor loose. In a recent case of spinal laminectomy I used the same forceps to remove the vertebral laminae, and I found them far supe- rior to any of the other instruments I had on hand, and tried in turn. I have not yet operated on both sides of the skull, and in view of our present experience I certainly would deprecate a simultaneous operation on both sides. Probably the additional shock would be very unwise and would add greatly to the mortality. Whether two lateral opera- tions done successively will improve the condition of such children more than one remains to be seen. The results as to mental condition in the six cases that have survived may be stated briefly as follows : Lannelongue's second case was reported almost immediately, too early to judge of any results. So, too, of McClintock's case. In the other four children there can be no question of the improvement, very rapid in Lannelongue's case, slower but sure in both of my own and in Wyeth's case. We have therefore, I think, sufficient reason to encourage us to operate in other cases, and it is this fact and the fatal result in two which has led me to report my cases so early, before the final results are obtained. This will require several years, and meantime we ought to make known the immediate results as a guide in other cases.