Wharton Sinkler

THE UNCERTAINTY OF CEREBRAL LOCALIZATION WITH REFERENCE TO OPERATION ESPECIALLY IN CONNECTION WITH GROWTHS IN SILENT REGIONS WITH INVASION SYMPTOMS

The accurate localization of a cerebral growth is never easy, and it should always be borne in mind that there are many cases in which tumors of the mid brain give rise to symptoms, which closely resemble those of a growth in the motor area. Even in cases which have been carefully studied for a long time, no tumor has been discovered on operation, although after death the growth has been found deep seated. Growths, which are most likely to cause errors of diagnosis are those, which begin in silent regions, like the frontal lobe, for example, and which encroach gradually upon the motor area. The writer referred to the statistics collected by Starr. Up to 1896 there were 162 cases, in which the operation of trephining was done for brain tumor; of these cases the tumor was successfully removed, and the patient recovered in 72, and 48 cases, that is in about 30% no tumor was found at the operation. In 35 patients the tumor was successfully located and removed, but the patient died. Out of several hundred cases of brain tumor, which have been studied post mortem by different ob servers, it was estimated, that but 7% could have been successfully removed had operations been attempted before death. The writer called attention to the great improvement in the results in brain surgery. In the past three years a much greater percentage of cases have recovered and this is probably owing to the fact that the operations have been done by more skilled surgeons. The writer quoted two cases, which illustrated the difficulty of locat-