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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.25 no.4 São Paulo Dec. 1967

http://dx.doi.org/10.1590/S0004-282X1967000400001 

Neurological and physiological comments on the section of the pituitary stalk in humans (Mischotomy)

 

Comentários neurocirúrgicos e fisiológicos sobre a secção da haste pituitária em seres humanos (miscotomia)

 

 

J. Le Beau; J. F. Foncin; S. Nicolaidis

Laboratoire de Physiologie et de Psychologie Neuro-Chirurgicales de l'École Pratique des Hautes Études (Directeur: Prof. J. Le Beau), Service de Neurochirurgie de l'Hôpital de la Salpêtrière

 

 


SUMMARY

Our first hypophysectomy in a metastatic carcinoma of the breast was performed in November 1951 and the section of the pituitary stalk (mischotomy) for the same purpose was started in November 1955, the first results being published in 1956. When one succeeds in preventing the hypothalamohypophyseal vascular regeneration the general results of mischotomy are little different from those obtained with hypophysectomy. We adopt mischotomy when total pituitary removal seems to be a too great surgical risk.
Anatomo-physiological studies are being published since 1958, showing: (a) The variations of the anterior lobe necrosis which is neither total nor definite (pituitary regeneration) and the importance of the trabecular arteries in that respect; (b) The striking ability of vascular regeneration from the hypothalamus to the anterior lobe remnants thus creating a new anatomical and functional portal system; (c) After permanent pituitary isolation, the proliferation of prolactin (orangeophile) cells and the compensatory hypertrophy of pars tuberalis.
Removal of normal pituitary tissue obtained during the operation allowed us to describe for the first time in man the ACTH cells (1964) and the FSH cells (1966).


RESUMO

Nossa primeira hipofisectomia para tratamento de carcinoma metastático do seio foi feita em novembro de 1951 e a secção da haste pituitária (miscotomia) para o mesmo fim foi iniciada em novembro de 1956. Quando se consegue impedir a regeneração vascular hipotálamo-hipofisária os resultados gerais da miscotomia são pouco diferentes daqueles obtidos com a hipofisectomia. Empregamos a miscotomia sempre que, por condições locais ou gerais, a remoção total da hipófise parece constituir grande risco cirúrgico.
Temos publicado estudos anatomo-fisiológicos desde 1958 mostrando: (a) as variações da necrose do lobo anterior da hipófise que não são totais nem definitivas (regeneração pituitária) e a importância das artérias trabeculares a este respeito; b) a grande capacidade de regeneração vascular a partir do hipctálamo e dirigindo-se para a parte restante do lobo anterior da hipófise, o que constitui um novo sistema anatomo-funcional portal; c) após isolamento permanente da pituitária ocorre proliferação das células de prolactina (células orangeófilas) e hipertrofia compensadora da pars tuberalis.
A remoção cirúrgica de tecido hipofisário normal nos permitiu descrever, pela primeira vez no ser humano, as células ACTH (1964) e as células FSH (1966).


 

 

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