The Frontal Lobe 11
In a case of "hydrancephaly," Dr. Firlik was forced to decide whether doing surgery to slow the abnormal growth of an infant's head was justified given the condition. Hydrancephaly occurs when the brain does not develop its cerebral portion and, instead, fills the void in the skull with cerebrospinal fluid. If the cerebrospinal fluid does not absorb properly the head will expand creating a weight the infant neck cannot support. Evacuating the fluid may decrease the head size but the lack of brain will not make the infant any more likely to survive. Other pediatric conditions include schizencephaly, pachygyria, holoprosencephaly, and tuberous sclerosis. Apert syndrome is a congenital condition including multiple craniofacial abnormalities and syndacity (fusion of the fingers). Holoprosencephaly, also known as arhinencephaly, is a developmental defect of the midline brain structures which causes midline facial abnormalities. All these rare pediatric conditions create disturbing features for the infant and their parents. So if the brain makes it through the initial stages of life, Dr. Firlik comments, it is still amazing that it goes on to develop "normally." And is "normalcy" measured by IQ? For centuries researchers have attempted to correlate brain volume and intelligence. Nevertheless, that simplistic general rule is peppered with exceptions. For instance, Einstein was said to have a below average sized brain. Other research describes the correlation between gray matter and intelligence. Still, better technology points to the function of the brain as the best indicator of intelligence. Dr. Firlik observes, "Clearly, in order for the fragmented community of brain injury specialists to come to any meaningful conclusions about the physical brain and intelligence, much more needs to happen: existing studies need to repeated or otherwise validated, the major questions need to be approached from multiple angles, and there needs to be communication across disciplines (the hard part)." 
Chapter 11 entitled "Disturbing Deviations" takes the reader through Dr. Firlik's experience and observations of Pediatric Neurology. As a resident and a practicing surgeon, Dr. Firlik grapples with clinical detachment, reality and horror of being unable to change the "randomness of nature."
