Journal
JOURNAL OF NEUROSURGERY
Volume 133, Issue 6, Pages 1739-1752Publisher
AMER ASSOC NEUROLOGICAL SURGEONS
DOI: 10.3171/2019.8.JNS191508
Keywords
Charles Frazier; craniopharyngioma; hypothalamus; pituitary gland; Rathke's cleft cyst; subfrontal approach; third ventricle; radiotherapy; pituitary surgery; history
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Funding
- 2018 Wood Institute Travel Grants by The College of Physicians of Philadelphia
- Mutter Museum and Historical Medical Library of The College of Physicians of Philadelphia, Pennsylvania
- 2018 Wood Institute Travel Grant
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Charles H. Frazier (1870-1936), one of the pioneers of neurosurgery in the US, is known worldwide for devising surgical procedures to relieve trigeminal neuralgia and intractable pain. Less well-known are his substantial contributions to understanding and treating pituitary and parahypophyseal lesions. Along with Bernard Alpers, he defined Rathke's cleft tumors as a different pathological entity from adenomas and hypophyseal stalk tumors (craniopharyngiomas [CPs]). The surgical challenge posed by CPs piqued Frazier's interest in these lesions, although he never published a complete account of his CP series. An examination of the Charles Frazier papers at the College of Physicians of Philadelphia allowed the authors to identify 54 CPs that he had treated during his career. In the early 1910s, Frazier developed the subfrontal approach, which would become the primary surgical route to access these lesions, providing better control of the adjacent vital neurovascular structures than the transsphenoidal route hitherto used. Nevertheless, strong adhesions between CPs and the third ventricle floor, the major reason underlying Frazier's disappointing results, moved him to advocate incomplete tumor removal followed by radiotherapy to reduce both the risk of hypothalamic injury and CP recurrence. This conservative strategy remains a judicious treatment for CPs to this day.
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