Neurosurgery
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Biography Historical Article
Phrenology in the science and culture of the 19th century.
In the last decade of the 18th century, Franz Joseph Gall of Vienna invented a combination of physiognomy and brain localization that he originally called "craniology" (the science of the head) and later called "organology" (the science of the organs of the brain). Between 1800 and 1812, he worked with Johann Christoph Spurzheim on a variety of important neuroanatomic studies to support this new science. By 1812, when they parted company in Paris, Spurzheim had become intrigued with the psychosocial potential of the undertaking, which he renamed "phrenology" (the science of the mind). ⋯ All forms of cerebral localization were lumped with phrenology and similarly repudiated. Nonetheless, Gall's organology was the first comprehensive, premodern statement of a theory of cerebral localization. The early pioneers of modern localization, especially Paul Broca and David Ferrier, were careful to define how their theories differed from phrenology, even as they provided the clinical and scientific data that confirmed some of its basic tenets.
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A detailed outcome analysis was performed on 40 children with intracranial ependymomas treated at our institution between 1975 and 1993 to identify those factors that were predictive of overall and progression-free survival. Three patients (7.5%) who were treated in the first 5 years of the study died within 3 months of surgery and were excluded from further outcome assessments. Eight (22%) of the 37 patients who survived the perioperative period had evidence of leptomeningeal dissemination at presentation, on the basis of either imaging (three children) and/or cytological (six children) results. ⋯ Neither the finding of evidence for dissemination at presentation nor the detection of anaplastic histological features (e.g., dense cellularity or high numbers of mitoses) were associated with a significantly worse outcome in this series. The combination of variables that had the strongest association with both favorable and unfavorable outcomes was the combination of the age of the patient and the resection extent. Only 2 of 17 patients older than 3 years with gross total resections have died, whereas 13 of 20 children who were either younger than 3 years or had radiologically incomplete resections have died (P < 0.0001).(ABSTRACT TRUNCATED AT 400 WORDS)