Treatment of Ewing's sarcoma with concurrent radiotherapy and chemotherapy

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The volume of intracranial contents can be fairly accurately computed from measurements on plain skull films. Using the formula of Gordon and associates, 7 we estimated the intracranial volume in our patient to have been, prior to the craniotomies, approximately 660 ml., which is below the fifth percentile for age and is in the microcephalic range. Inasmuch as 200 to 300 ml. of subdural fluid was subsequently removed, it would seem that the patient 's brain must have been reduced to approximately one third of the size expected for her age. This may offer some explanation for the failure of mental or neurologic improvement following decompression. I t is not clear why the cranial volume was small despite such large subdural effusions. I t may be that brain growth was restricted by the thick inner membrane or that post t raumatic atrophy had occurred. I t is also possible that the brain was small prior to the t rauma at age 5 months. The fact that the vault was not thickened at that time would suggest that brain growth was not previously grossly retarded. I t is, however, impossible to make any definite conclusions regarding this factor since we have no reliable information as to neurological development or head size between birth and 5 months. Whatever the pathophysiology, it is important to remember that, al though infants with chronic subdural effusions generally have heads larger than normal, microcephaly does not preclude chronic subdural fluid coIlections.