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]
Catalogue details

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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    The tumours usually lie concealed beneath the cortex and may attain an enormous size. A favourite site for those of fibrillary type is deep in one of the frontal or temporal lobes; the latter are being studied by Dr. Benno Schlesinger and it would appear that their clinical syndrome is sufficiently definite to justify a reasonably precise preoperative diagnosis. It is our custom to attack these tumours—indeed, to attack all gli¬ omas—as radically as circumstances permit. Dr. Bailey has expressed the belief that certain gliomas are prone to become increasingly malignant if the attempt is made surgically to remove them; but even should such a change occasionally be demonstrable in a recurrent tumour (and I believe this is a matter still open to question), the relation of this to the operative Fig. 13. Supravital preparation during operation showing two well isolated multinuclear fibrillary astrocytes with numerous processes (X850). intervention is still something that awaits proof. As a matter of fact, it is a continual source of surprise to find that successive operations, over pe¬ riods of many years for gliomas of whatsoever type, reveal each time a tumour so closely resembling the original specimen that were the dates removed from the sections they could not possibly be told apart, much less chronologically arranged. In short, there is a surprising degree of constancy from start to finish in the histological character of an intra¬ cranial tumour of given primary cytology. What is more, with the excep¬ tion of certain meningiomas and of the medulloblastomas, whose cellular elements may grow by implantation when “seeded” in places remote from their primary seat of origin, most brain tumours only recur locally and expand by direct extension. Not only for these reasons but because I strongly believe that the op¬ erative mortality is higher in the case of gliomas treated merely by de¬ compression than it is when the growth, once exposed, is removed as com-