The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
In addition, allusion should be made to Dana’s symptom--‘cerebellar
fits’--said to be almost pathognomonic of an extra-cerebellar tumour (or
abscess) situated in the cerebello-pontine angle. In such cases, there
may be sudden attacks of tinnitus, vertigo, and apparent loss of
consciousness, during which the patient falls to the ground as if struck
with lightning. The final stage of falling is said to be dependent, not
so much on actual loss of consciousness, as from the absence of
cerebellar innervation and a total loss of equilibrium. These attacks
are brought about by sudden alterations in position.
(_G_) =To the pituitary region.= Considerable research has recently been
carried out, and much knowledge obtained as to the functions of the
pituitary body and the symptoms that result from lesions of the
gland.[44] As is well known, the pituitary body consists of two
portions, an anterior (derived from upgrowth of buccal epiblast) and a
posterior (formed from neural epiblastic downgrowth).
Complete removal of the body in animals invariably terminates fatally,
the patient exhibiting a definite train of symptoms--cachexia
hypophyseopriva--and dying within a few days or weeks, the younger
animals living longer than the older. The symptoms of apituitarism are
as follows: fall of body temperature, lowering of blood-pressure,
increasing feebleness, muscular tremors, a curious attitude resembling
that of defæcation, coma, and death.
On further investigation it was proved that all these symptoms were
observed when the anterior portion of the gland was alone removed,
whilst, on the other hand, extirpation of the posterior half created no
great change in the animal’s general health.
[Illustration: FIG. 70. A PITUITARY TUMOUR.]
In the human being it would appear that the symptoms resulting from the
development of pituitary tumour formation may be classified into two
groups, those of hyper-pituitarism and those of hypo-pituitarism.
In the former case the secretion being superabundant, acromegaly and
giantism are observed. Keith[45] considers that one of the substances
secreted by the gland is of the nature of a hormone, rendering the
osteoblasts hypersensitive to the various stresses that fall upon the
human skeleton during life, and that the osteoblasts, at the origins and
insertions of muscles, become increasingly sensitive to the traction of
muscles. Muscular impressions and processes of the skeleton become
exaggerated by the new bony matter, and if the epiphyseal lines be
still open, the osteoblasts of which appear to be specially affected,
giantism is produced. The skull and skeleton of the giant O’Brien are
regarded as typical examples of the results due to over-secretion of the
gland.
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