THE TREATMENT OF CHRONIC SUPPURATIVE OTITIS MEDIA
Authors: L. G. Brown
Journal: BMJ (1935)

INTRACRANIAL TUMOUR MTHE BRITDItCEncephalography is a procedure in which air is injected by the more convenient lumbar subarachnoid route.This method has been less extensively employed on the grounds that the air does not enter the ventricular system so satisfactorily, and that the attendant risk is greater, but it may be most informative and is practically free from danger if the correct technique is utilized.It should not be attempted if the intracranial pressure is increased.Arterial encephalography-radiography of the cerebral arteries after the injection of thorotrast into the internal carotid in the neck-was introduced in 1931 by Moniz, who affirms that the abnormalities in the course and distribution of the arteries so demonstrated afford as useful information as does ventriculography, and that the procedure is quite free from risk. The Present PositionA comparison of the operative results of to-day with those of the past necessitates a consideration of statistical data; and here we owe a special debt of gratitude to Harvey Cushing, the pioneer of the surgery of brain tumour, who has from time to time during the past three decades published his operative results.In his communication at the International Neurological Congress at Berne in 1931, entitled " The Surgical-Mortality Percentages pertaining to a Series of Two Thousand Verified Intracranial Tumours,"' Cushing analyses his unique experience.His figures are the more impressive since every death in hospital from any cause whatsoever, no matter how long the interval after operation, is regarded as a post-operative fatality.The facts, as the following table shows, are very striking.Comparison of Operative Mortality Percentages for Verified Tumours of Four Major Groups Divided in Three Periods Hopkirs Series Brigham Series July, 1928, to to 1912 to 1929 July, 1931 per cent.per cent.per cent.Gliomas (varia)... ... 30.9 17.8 11.0 Pituiitary adenomas ... 13.5 5.3 5.7 Meningiomas ... ... 21.0 10.3 7.7 Acoustic ttumours ... 25.0 11.5 4.4Cushing points out that the improvement in the results is not due to a selection of relatively favourable lesions, for " the proportion of patients admitted as ' forlorn hopes ' in the terminable stages of their malady, often after ill-judged procedures at the hands of surgeons with little or no neuro-surgical training, is as large as ever it was."The principal steps to which the more favourable results are to be attributed he enumerates chronologically as follows: (1) the generally accepted methods of decom- pression to relieve tension ; (2) such irreproachable wound- healing that secondary infections are practically unknown (3) the separate closure of the galea by buried fine black silk sutures, which has caused the once dreaded fungus cerebri to be well-nigh forgotten; (4) the introduction by de Martel, in place of ether inhalation, of local anaesthesia, now supplemented, when necessary, by the rectal admilnis- tration of tribromethanol ; (5) the more precise tumour localization which in obscure cases Dandy's ventriculo- graphy permits us to make; (6) the use of a motor- driven suction apparatus as an indispensable adjunct to every operation ; and (7) the successive improvements in methods of haemostasis which since 1927 have been most advantageously supplemented by the introduction of electro-surgical devices.But the operation, he adds, is by no means the whole story.After-care is equally important, for unsuspected complications may arise.