Tumors of the nervus acusticus and the syndrome of the cerebellopontile angle / by Harvey Cushing.

  • Harvey Williams Cushing
Date:
1917
Catalogue details

Licence: In copyright

Credit: Tumors of the nervus acusticus and the syndrome of the cerebellopontile angle / by Harvey Cushing. Source: Wellcome Collection.

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    tion after the clinical picture had become more or less confused. Today the opportunity is given of verifying the lesion in an increasing number of cases at a much more early stage than has heretofore been possible, and the operating room has largely supplanted the postmortem laboratory as the source of material for study. This is merely a repetition of the story concerning lesions in many other parts of the body. Our increasing familiarity with intracranial tumors in general has led to a better classification of them on a structural basis, so that in some instances it has become possible not only to localize a lesion with considerable accuracy but to foretell its histological character with reasonable certainty. No more striking illustration of this is afforded than by a review of the story of the tumors occurring in the so-called cerebellopontile angle, which in the brief period since the beginning of the present century have emerged from com¬ parative obscurity. Historical Review With the historical information concerning acoustic tumors, which Carl Gustav Lincke115 gathered in 1837 for his valuable and timely treatise on dis¬ eases of the ear, nearly all monographs on the subject have since been intro¬ duced. However, as was pointed out many years later by Virchow in his celebrated Vorlesungen, it is difficult enough to tell from the tissues at hand whether one is dealing with a true acoustic tumor, and these difficulties are greatly enhanced if one attempts to pass judgment on the incomplete case reports of the earlier writers. Doubtless isolated examples of these distinctive growths must have long been observed, but Sandifort’s presumptive case155 described in 1777 does not seem to be definitely antedated. Of this tumor, under the title De duro quodam corpuscido, nervo auditorio adhaerente, Sandifort wrote from Leyden as follows: “ * * * * As I examined the base of the brain, with the origins of the nerves, I discovered a small body clinging to the right auditory nerve, of such toughness that it was supposed surely to be cartilage. It was not so firmly attached to the inferior part of the said nerve, but it clung tightly to the proximal portion of the medulla oblongata, at that point where this nerve (the VIIIth), together with the VIIth, makes its exit, likewise insinuating itself into the foramen as an obstruction in the interior of the petrous portion of the temporal bone, which said nerve enters. The length of this small body was six lines, its width in its wider portion was five, and in its lesser, three lines. Its surface was exceedingly uneven, especially that part which was in relation with the base of the skull, and various larger and smaller nodules arose from its surface. It was not possible to separate the nerve from the lesion and neither was it pos¬ sible to free it entirely from the foramen which the nerve enters, but it was more easily separated from the part of the medulla to which, as stated before, it adhered. “Having cut into the body, it presented a tough cortex or exterior part: the interior, however, was somewhat softer, although in this also there were hard par¬ ticles interspersed. “The situation and firm lodging of this little body demonstrate without doubt that it compressed the auditory nerve. The depression seen at the point noted in the medulla and neighboring soft parts proves it, and the extension of the nodules into the foramen of the nerve still further confirms it. This lessened the nerve greatly in its capacity, as seen by a comparison of the right auditory nerve with the left.
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