Abstract
Craniotomy for brain tumor, with or without focal symptoms, not infrequently fails to disclose the neoplasm. The evidence of increased intracranial pressure will be manifest by various degrees of brain bulging, by a flattening out of the convolutions, by obliteration of the sulci and by diminished or absent brain pulsation. Inspection, palpation, and exploration by incision or aspirating needle all fail to locate or reveal the cause. The tumor may be so deep within the brain substances or at such a stage of development as to be inaccessible. The lesion may be an infiltrating glioma, which cannot be macroscopically differentiated from the normal brain, or the craniotomy may not have been formed at the proper site. The wound is closed, temporary benefit is conferred by the decompression, and in time the patient dies. Definite localizing information may develop after decompression in cases in which focal symptoms have been absent. In
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