Outlines of practical surgery / by Walter G. Spencer.

  • Spencer, Walter G. (Walter George)
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of practical surgery / by Walter G. Spencer. Source: Wellcome Collection.

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    inflammation from the exterior through this hollow process, or by the growth of the tumour within the spinal canal. A spina bifida occulta should, therefore, be treated by ex- cision ; the base of the process of the meninges must be most carefully ligatured before any of the distal portion is cut away, and the cauda equina cleared of all fibrous, fatty, or scar tissue. If the meninges are not closed by ligature, then this must be done by suture, or fatal septic inflammation is likely to spread from the wound inwards. If the removal be done early in life, improvement in the paralysis may be hopefully looked for. 2. Spinal Meningocele.—It forms a globular swelling in the middle line, generally of the lumbo-sacral region. The skin is seldom quite normal over it. At the posterior pole there may be one of the conditions described as spina bifida occulta, or the skin may be thinned so that the tumour is diaphanous, or may be absent in part or wholly from the pro- jecting tumour. When viewed by transmitted light, no bands are seen in the tumour. When the fluid is gently expressed, the unclosed fontanelle of the child bulges, and the child becomes drowsy. On relaxing the pressure the tumour refills. The tumour shows cardiac and respiratory pulsations, and an impulse on coughing or crying. It is made more tense by elevating the child's head, and the tension becomes less when the head is lowered below the trunk. By gently expressing some of the fluid, the size of the opening in the spinal column can be made out. It is liable to be complicated by hydro- cephalus and wasting, which progress. Other deformities may be present, such as hare-lip. Paralysis of the legs and incontinence of urine may be absent, or may gradually develop, indicating an extension of pressure on the spinal cord. Excision of the sac and suture may be demanded, on account of rupture, or threatened rupture, whether at birth or later. If possible, the tumour is protected from inflam- matory complications by good nursing, and an operation is delayed until the child is a year or more, to see whether hydrocephalus will supervene. Increasing hydrocephalus contra-indicates the operation ; increasing signs of pressure