Finlayson, Duncan I. C.

2018-09-13T15:54:09Z

2018-09-13T15:54:09Z

1933

Considerable interest has been evinced in the past in tumours situated in the hypophysis cerebri and its immediate neighbourhood. The occurrence of these tumours is of sufficient rarity to have induced an interest in them if only on that account alone. In the case of the epidermoid tumours this interest has been centred largely on the pathological side of the problem which held much that was obscure in embryology, histology and classification. Such writings as were directed towards the clinical side of the subject concerned themselves almost wholly with questions of symptomatology and diagnosis. The treatment of these cases was regarded as well nigh hopeless, and either no surgical interference was undertaken, or else if an intracranial exploration were ventured upon the surgeon was content either to aspirate the contents of any cyst which might be encountered, or to accomplish a very partial removal. This inevitably led to a period of improvement of short duration, if indeed the case did not terminate fatally in the immediate postoperative period. The results achieved by surgical operative measures in the past have indeed been exceedingly melancholy. More recently, however, and especially during the past decade, the outlook has considerably altered. Advances in neurosurgical methods, the introduction and elaboration of electrical appliances, and a better understanding of the principles of intracranial manipulations have to a large e'tent widened the scope of the surgeon practising this branch of his art. The outlook for the patient is so absolutely hopeless without operation, and the improvement to be gained from the partial removals of tumours so relatively slight and of such short duration that one has come to look upon complete extirpation of the growth as the only reasonable surgical aim. A review of the subject is demanded at the present time as it has now become one of live clinical interest, both in the literal and metaphorical meaning of the phrase. There is still uncertainty regarding the etiology of these tumours and the views held on their origin have not been wholly satisfying. Especially in the writings concerning the histological structure of these tumours and the nomenclature adopted for their designation is there much that is uncertain or incorrect, and these failings have tended to be perpetuated by each succeeding author. The tumours were first given the name of hypophyseal duct tumours (Hypophysenganggeschvnulsten) by Erdheim. There is, however, little to support such a name, for the origin of the tumours from the hypophyseal duct is at best a doubtful one. They have also been termed craniopharyngiomas. This term is equally bad, merely pointing to the supposed embryological source of the growth, without defining its actual site and nature. So, too, the term tumour of the craniopharyngeal duct (Frazier and Alpers) is grossly inaccurate in the absence of any such structure at any stage of the human prenatal development. The term adamantinoma introduced by Onanoff is one which has become quite filled in the terminology. It was based on a mere structural resemblance of these tumours to the developing enamel organ - a resemblance which is a very superficial one - and has not since then been shown by any reasonable evidence to be more than a term coined through analogy. I shall hope to show that the name I here suggest - Pituitary Epidermoid Tumours - is a reasonable and simple one, designating sufficiently the site, origin, and essential nature of these growths without unnecessary reference to uncertain theories of their morphologic or embryologic relationships. There were available for investigation fourteen cases of tumours of this type with histological material from eleven of them. It was thought, in view of their very interesting pathology and the confusion arising out of so varied a terminology as that used in the literature, and particularly the vastly improved results attained by surgical methods which these case records bring to light, that it would be instructive to make a thorough survey of this material, especially at the present time when neuro-surgery is becoming more and core recognised as a live and progressive branch of the parent surgical art. It was because of all these facts then that the present stud;- was undertaken and is now presented.

http://hdl.handle.net/1842/32178

The University of Edinburgh

Annexe Thesis Digitisation Project 2018 Block 20

Epidermoid tumours of the pituitary body, a clinical and pathological study: written for the Syme Fellowship, 1933

The epidermoid tumours of the pituitary body, a clinical and pathological study: written for the Syme Fellowship, 1933

Thesis or Dissertation

Doctoral

PhD Doctor of Philosophy