A historical case study of early neurosurgery in Ireland: posterior fossa decompression for a skull base tumour in 1922

The 1920s was a formative period in the development of neurosurgery in Ireland. This study examines a 1922 brain tumour case treated by Adams McConnell, father of Irish neurosurgery, that illustrates the clinical limitations and defining practices of early neurosurgical interventions. A 19-year-old female was admitted with progressive neurological symptoms, including paraesthesias, diplopia, worsening vision, persistent vomiting, and gait imbalance. On clinical examination, signs of severe raised intracranial pressure and brainstem involvement were present, including papilledema and ataxia. Following diagnostic ventriculography, the patient then underwent two surgeries, including attempts at posterior decompression and posterior fossa exploration. Her condition rapidly declined postoperatively, marked by escalating fever and tachycardia, resulting in her death. Autopsy revealed a right-sided skull base tumour originating from the Gasserian ganglion. The tumour had eroded the middle cranial fossa and extended posteriorly to compress the pons, so it was not visible to the surgeons during craniotomy. Without modern medical technology and imaging, careful history taking, meticulous clinical observations, and the neurological examination were relied on to formulate a diagnosis. This study offers a snapshot of early neurosurgery amid diagnostic constraints; through which we can appreciate the remarkable advancements in the field over the past century.