Department of Neurosurgery, Puerta de Hierro University Hospital; and.
Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain.
J Neurosurg. 2017 Oct;127(4):927-940. doi: 10.3171/2016.9.JNS16702. Epub 2017 Jan 6.
Norman McOmish Dott (1897-1973) developed surgical neurology in Edinburgh, Scotland, and was a scholar of worldwide renown. One of Dott's most notable contributions to neurosurgery was his understanding of hypothalamic physiology, mostly acquired through the comprehensive study of patients with lesions involving this region of the diencephalon, particularly craniopharyngiomas (CPs). Recognition of symptoms caused by hypothalamic disturbances allowed him to predict the accurate anatomical relationships between CPs and the hypothalamus, despite the rudimentary radiological methods available during the 1930s. His sophisticated knowledge permitted Dott to perform radical removals of CPs originating within the third ventricle floor with acceptable success. Between 1934 and 1937, he operated on 4 CP cases originating in the hypothalamus, achieving a satisfactory postoperative outcome in 3 of the 4 patients. Aware of the strong attachment of hypothalamic CPs to the infundibulo-tuberal area, Dott used a double transbasal and transventricular approach to these lesions, a strategy providing an optimal view and control of the tumor boundaries. The decisive mentorship of several legendary figures of physiology and neurosurgery greatly influenced Dott's surgical evolution. The experimental pituitary gland work he performed with Sir Edward Sharpey-Schäfer at the beginning of his career stirred Dott's curiosity about the issue of hypothalamus-pituitary relationships. As a result, he decided to move to Peter Bent Brigham Hospital (Boston, Massachusetts) in 1923, to train in neurosurgery and neuropathology under the guidance of the leaders in these fields, Harvey Williams Cushing (1869-1939) and Percival Sylvester Bailey (1892-1973). They inspired the young Dott and shared with him their clinical and pathological expertise, in addition to their surgical strategies for best approaching and removing these challenging tumors. In time, Dott would come to surpass his mentors. This paper aims to credit Norman M. Dott for his decisive, modern contributions to hypothalamic CP surgery.
诺曼·麦克奥米什·多特（Norman McOmish Dott，1897-1973 年）在苏格兰爱丁堡发展了外科神经学，并成为享有国际声誉的学者。多特对神经外科的最重要贡献之一是他对下丘脑生理学的理解，这主要是通过对涉及间脑这一区域的患者（尤其是颅咽管瘤（CPs））进行全面研究获得的。对下丘脑紊乱引起的症状的认识使他能够预测 CPs 与下丘脑之间的准确解剖关系，尽管在 20 世纪 30 年代可用的放射学方法还很原始。他的精湛知识使多特能够对起源于第三脑室底部的 CPs 进行激进的切除，并取得了可接受的成功率。1934 年至 1937 年间，他对 4 例起源于下丘脑的 CP 病例进行了手术，其中 4 例患者中的 3 例术后结果令人满意。多特意识到下丘脑 CP 与漏斗管区域的强烈粘连，因此对这些病变采用了双基底和经脑室入路，这一策略为肿瘤边界提供了最佳的观察和控制。几位生理学和神经外科传奇人物的决定性指导对多特的手术发展产生了深远的影响。他在职业生涯早期与爱德华·沙尔皮-沙弗爵士（Sir Edward Sharpey-Schäfer）一起进行的实验性垂体腺工作激发了多特对下丘脑-垂体关系问题的好奇心。因此，他于 1923 年决定搬到马萨诸塞州波士顿的彼得·本特·布里格姆医院（Peter Bent Brigham Hospital），在神经外科和神经病理学领域的领导者哈维·威廉姆斯·库欣（Harvey Williams Cushing，1869-1939 年）和珀西瓦尔·西尔维斯特·贝利（Percival Sylvester Bailey，1892-1973 年）的指导下接受培训。他们激励了年轻的多特，并与他分享了他们的临床和病理专业知识，以及他们用于最佳接近和切除这些具有挑战性的肿瘤的手术策略。随着时间的推移，多特将超越他的导师。本文旨在表彰诺曼·M·多特（Norman M. Dott）对下丘脑 CP 手术的决定性、现代贡献。
