Pollock Jonathan R, Akinwunmi James, Scaravilli Francesco, Powell Michael P
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
Neurosurgery. 2003 Apr;52(4):914-25; discussion 925-6. doi: 10.1227/01.neu.0000053148.34310.bb.
To describe the clinical details and the operative method used in pituitary tumors by Sir Victor Horsley (1857-1916), which represent the earliest attempts at pituitary surgery.
Horsley's case books and postmortem records, archived at the National Hospital, Queen Square, London, were studied for patients with a primary diagnosis of a pituitary tumor admitted during the period 1886 to 1916 who were treated surgically. Contemporary records of nonpituitary cases were also examined to study aspects of Horsley's operative method.
Four patients (three men and one woman) underwent craniectomy for removal of a pituitary tumor via the subtemporal approach between 1904 and 1907. All four patients experienced significant impairments of visual fields or visual acuity; one patient had severe trigeminal neuralgia. Evidence of acutely raised intracranial pressure was present in one patient. All patients underwent craniectomy under chloroform anesthesia. One patient died on the day of surgery, and the postmortem findings are presented. In the other three patients, neurological morbidity was recorded in the postoperative period in the form of new cranial nerve deficits, monoparesis with dysphasia, and seizures. The patient with trigeminal neuralgia experienced partial relief and was readmitted later for reexploration and Gasserian ganglionectomy via the same route. Four contemporary nonoperative cases of pituitary tumor are also presented.
These cases provide insight into the presentation and operative treatment of pituitary tumors during the pre-Halsted era.
描述维克托·霍斯利爵士（1857 - 1916）对垂体肿瘤采用的临床细节及手术方法，这些代表了垂体手术的早期尝试。
研究存于伦敦女王广场国家医院档案中的霍斯利的病例簿和尸检记录，对象为1886年至1916年间因原发性垂体肿瘤入院并接受手术治疗的患者。还检查了同期非垂体病例的记录，以研究霍斯利手术方法的相关方面。
1904年至1907年间，4例患者（3男1女）经颞下入路行颅骨切除术以切除垂体肿瘤。所有4例患者均有明显的视野或视力损害；1例患者有严重的三叉神经痛。1例患者有急性颅内压升高的证据。所有患者均在氯仿麻醉下接受颅骨切除术。1例患者在手术当天死亡，并展示了尸检结果。在其他3例患者中，术后记录到神经功能障碍，表现为新的颅神经缺损、伴有言语困难的单瘫和癫痫发作。患有三叉神经痛的患者疼痛部分缓解，后来再次入院，通过相同路径进行再次探查和半月神经节切除术。还展示了4例同期垂体肿瘤非手术病例。
这些病例为了解霍尔斯特德时代之前垂体肿瘤的表现和手术治疗提供了见解。
