Studies in intracranial physiology & surgery : the third circulation, the hypophysis, the gliomas / by Harvey Cushing.

  • Harvey Williams Cushing
Date:
1926
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Licence: In copyright

Credit: Studies in intracranial physiology & surgery : the third circulation, the hypophysis, the gliomas / by Harvey Cushing. Source: Wellcome Collection.

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    a peripheral rim of eosinophilic granules still persists about the cell; and he and Mr. Dott feel confident that this particular type of adenoma serves to explain those mixed clinical syndromes in which traces of acromegaly are seen commingled with the clinical evidences of hypopituitarism.* It is our custom and preference to approach these glandular tumours by a method called trans-sphenoidal.23 A small incision is made under the lip ; the mucous mem¬ brane is separated on each side so that the operative approach is by way of the nose, but does not actually enter the nasal cavities. A speculum is inserted, the anterior wall of the sphenoidal cells removed, the thin bulging floor of the sella chipped away, the dural encasement incised, and such an amount of the gland as is thought sufficient to relieve pressure is then spooned or sucked away. | It sounds simple and in a favourable case may be so. What is more, the * Personally I am not very clear in mind as to whether the pituitary adenomas arise from a definite focus within the gland, as do the so-called ‘ foetal5 adenomas of the thyroid, or whether the entire epithelial lobe becomes involved in the process at the outset. Embryologists have shown [e. g. Baumgarten (1916)] that the pars intermedia and the pars distalis (anterior lobe) are ontogenetically and phylogenetically distinct, and that generally speaking the former may be considered to be the chief chromophobic and the latter the chief chromophilic portion of the gland. But we have no reason to assume that the typical chromophobe adenomas arise from the pars intermedia, indeed a very definite reason to believe that they do not, for otherwise we would frequently run across evidences of a compressed pars distalis in the ordinary trans-sphenoidal operation for adenoma. As a matter of fact, the histological examination in all of our cases shows the same kind of tissue throughout, with never any areas of normal-appearing glandular tissue. | There is nothing wholly original in using a ‘ sucker which is the most satisfactory agent for this purpose. If I am correctly informed, the ancient Egyptian embalmers used the trans-sphenoidal and sellar route to suck out the entire brain. Children, moreover, use the same principle in preserving birds’ eggs. H
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