924 



HAEVEY G. BECK 



A review of the literature on surgery of the hypophysis emphasizes 

 two points the wide variation in operative mortality, which, of course, is 

 to be expected, and the relatively small group of cases in which surgery 

 offers anything worth while (Quick). The operative mortality depends 

 upon the experience of the operator in cranial surgery and upon the meth- 

 od or route of approach; ranging from 35 per cent to 10 per cent OT less. 



Indications for operation in pituitary growth or neighborhood lesions 

 are (a) symptoms due to increased general intracranial pressure, such as 

 headache; (b) symptoms due to local pressure, such as blindness, oculo- 

 motor palsy, and "pituitary headache" ; (c) symptoms due to disturbance 

 of the pituitary secretion producing acromegaly or dystrophia adiposo- 

 genitalis (Bell(fc)). 



The headache and visual disturbances are most markedly benefited by 

 operation. The visual symptoms do not improve if optic atrophy is com- 

 plete. The adiposity is ordinarily not influenced unless feeding of gland 

 substance is used in conjunction with operation. The skeletal changes, 

 which depend upon metabolic processes and trophic influences are as a rule 

 only slightly benefited. 



The following is a list of methods of approach employed by various 

 surgeons, taken from Cope's statistics: superior nasal (von Eiselsberg), 

 inferior nasal (Hirsch), inferior nasal submucous (Gushing), temporal 

 (Horsley, Gushing) , orbitof rental (Frazier, Gushing, Sargent, Cope), 

 orbitonasal (Kahler, Chiari), palatal (Preysing). Cushing(&) employed 

 the inferior nasal submucous method in one hundred and six cases with 

 only eight deaths. The various methods and their technique will be dis- 

 cussed in another chapter. 



