Intracranial tumours : notes upon a series of two thousand verified cases with surgical-mortality percentges pertaining thereto / by Harvey Cushing.

  • Cushing, Harvey, 1869-1939.
Date:
[1932]
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Licence: In copyright

Credit: Intracranial tumours : notes upon a series of two thousand verified cases with surgical-mortality percentges pertaining thereto / by Harvey Cushing. Source: Wellcome Collection.

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    standpoint of longevity were more favourable than the other types and in 1923 Paul Martin13 made a report upon 9b examples in which this fact was duly emphasized. It however became apparent in the course of his studies that many of the supposedly favourable gliomatous cysts, ascribed to degenerative tendencies on the part of the tumour, had actually been replaced, as time passed, by a solid growth. Meanwhile, with the improvement of cranial roentgenograms, made possible since 1920 by the Potter-Bucky grille, the tendency of certain gliomas to show spotty shadows of calcification began to be recognized, and a study of them to May 192b was made by Arthur Van Dessel,14 who estimated that some 14 per cent of all our verified gliomas could have been detected in this way. What is more, this tendency to form lime de¬ posits was looked upon as an indication of slow growth, and might there¬ fore be useful in distinguishing malignant from benign lesions. At about this same time, moreover, the treatment of brain tumours by radiothera- peutic rather than by surgical measures was widely advocated and ap¬ parently favourable results were occasionally observed.15 However, without more definite knowledge of the cellular composition of a given lesion and of its life history and prognosis when unradiated, the beneficial effects ascribed to radiation were necessarily highly impressionistic. Wholly dissatisfied with this state of affairs, it was at this juncture that Dr. Bailey was encouraged to undertake the unpromising task of seeing what could be done toward a more definite subdivision of the gli¬ omas in the Brigham collection based on a combined study of their ap¬ parent histogenesis and their clinical longevity.16,17 The custom of leaving a non-cystic glioma pretty much alone when surgically exposed, and the tendency to be satisfied with the evacuation of gliomatous cysts without securing tissue to determine their precise nature, proved disadvantageous to the furtherance of these studies; and as my chief contribution toward them was to provide an ample supply of fresh material for investigation, our surgical procedures tended to become more radical than they pre¬ viously had been. One highly important outcome of this was the early disclosure that cysts, from which the mural tumour-nodule had been and we have had one essentially cystic oligoglioma. But the chief error lay, as we now know, in the probable inclusion of a number of cystic angioblastomas which do not belong in the glioma series. Fortunately the percentage of these histologi¬ cally undifferentiated “gliomatous cysts” is diminishing from year to year as cases so diagnosed have returned because of symptomatic recurrence. Needless to say we now routinely search for and remove the mural nodule from the cyst wall. 13 Le traitement chirurgical des gliomes cavitaires de l’encephale. Arch. Franco-Beiges de Chir., 1923, xxvi, 807-847. 14 L’incidence et le processus de calcification dans les gliomes du cerveau. Arch. Franco-Beiges, 1925, xxviii, 845-874. 15 Bailey, P. The results of Roentgen therapy on brain tumors. Am. J. Roent¬ genol., 1925, xiii, 48-53. 16 Bailey, P. A new principle applied to the staining of the fibrillary neuroglia. J. Med. Research, 1923, xliv, 73-77. 17 Bailey and Cushing. Microchemical color reactions as an aid to the identifi¬ cation and classification of brain tumors. Proc. Nat. Acad. Sc., 1925, xi, 82-84.