Percival S. Bailey: eminent scholar of neurosciences who revealed the workings of the hypothalamus through clinicopathological research on craniopharyngiomas

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Percival S. Bailey (1892–1973) was a scholar, neuroscientist, neuropathologist, and neurosurgeon who made decisive contributions in the field of neuro-oncology. Far less known are his groundbreaking insights into understanding hypothalamic physiology through the study of craniopharyngiomas. As one of Harvey W. Cushing’s most talented trainees, Bailey was instrumental in developing Cushing’s project of a histologically based prognostic classification of brain tumors. He worked at Peter Bent Brigham Hospital on and off between 1919 and 1928, owing to frequent clashes with his mentor. A major cause of this long-term conflict was Bailey’s 1921 experimental demonstration of the hypothalamic origin of diabetes insipidus and Fröhlich’s syndrome. This finding challenged Cushing’s view that both alterations were due to pituitary gland insufficiency. In a seminal monograph written with John F. Fulton in 1929, both authors provided the first comprehensive account of the specific hypothalamic disturbances caused by tumors that originated within the infundibulum and third ventricle. The methodical study of Cushing’s craniopharyngioma specimens allowed Bailey to recognize the close contact between these lesions and hypothalamic nuclei, a key concept that Bailey originally advanced for proper surgical planning. This article aims to credit Bailey for his pioneering definition of craniopharyngiomas as tumors with a true intrahypothalamic position.

ABBREVIATIONS BTR = Brain Tumor Registry; CP = craniopharyngioma; DI = diabetes insipidus; PBBH = Peter Bent Brigham Hospital; 3V = third ventricle; 3VF = third ventricle floor.

Article Information

Correspondence Ruth Prieto: Puerta de Hierro University Hospital, Madrid, Spain. rprieto29@hotmail.com.

INCLUDE WHEN CITING Published online June 14, 2019; DOI: 10.3171/2019.3.JNS183145.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Percival Bailey’s craniopharyngioma collection at the Illinois Neuropsychiatric Institute. A: Photograph of Dr. Bailey taken in 1932. Image credit: 064–01.Bailey_P_01, Faculty and Alumni Biography Files, UIC Archives, University of Illinois at Chicago; used with the kind permission of the University of Illinois at Chicago Library. B: Plastic-encased brain specimen of an infundibulo-tuberal CP processed under the direction of Percival Bailey at the neuropathology laboratory of the 6th floor, North Tower of the Illinois Neuropsychiatric Institute. It corresponds to an 11-year-old boy with mental symptoms (memory loss, disorientation, anxiety attacks, and crying spells), gait ataxia, and temperature disturbances, who died after tumor biopsy. Note that the tumor has replaced the infundibulum and tuber cinereum, the mamillary bodies (MB) being the only recognizable area of the third ventricle floor. The optic chiasm (Ch) is compressed forward at the antero-inferior area of the tumor (t). Image credit: 016–06–20–02. PBBSC. NA 80/46, Percival Bailey Papers, University Archives, University of Illinois at Chicago; used with the kind permission of the University of Illinois at Chicago Library. C: Entrance to the Illinois Neuropsychiatric Institute cofounded by Percival Bailey in 1940–1941. The inscription above the door (close-up view in C2, indicated by yellow frame in C1) includes the founding fathers of modern neurosurgery (H. Cushing and V. Horsley), neuropathology (R. y Cajal), neurophysiology (C. Sherrington), neurology (A. Alzheimer, H. Jackson, and J. Charcot), and psychiatry (E. Bleuler, S. Freud, P. Janet, E. Kraepelin, H. Maudsley, A. Meyer, and P. Pinel). Figure is available in color online only.

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    Photomicrographs and diagrams of Bailey and Bremer’s experimental injuries at the base of the brain. A1–A3 correspond to dog 14, which was punctured through the sphenoid with a dental drill. Median sections of the hypophysis and hypothalamus (A1 and A2) and basal view (A3) showing a minute injury at the tuber cinereum extending upward and backward (indicated by x). B1–B3 correspond to dog 9, which was punctured through a subtemporal approach. The lesion (indicated by x) is located at the para-infundibular area behind the pituitary stalk (PS). Both dogs (9 and 14) had transitory polyuria, which was maximal on the 3rd day following surgery. Note that in both cases the pituitary gland (PG) is intact. From Bailey P, Bremer F: Experimental diabetes insipidus. Arch Intern Med 28:735–751, 1921. Public domain.

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    Craniopharyngioma case treated at Peter Bent Brigham Hospital demonstrating the hypothalamic origin of DI, hyperthermia, and cognitive disturbances. A: Case G.H.A. (Surgical No. 16889) of a histologically verified “pharyngeal pouch cyst.” B1 and B2: Surgical note written by Dr. Cushing on July 11, 1922, alluding to his fear that the patient may develop DI or hyperthermia due to the “great deal of trauma of the disclosed third ventricle” (B2). This thought demonstrates that he is accepting Bailey’s hypothalamic theory for the origin of DI. C1 and C2: Postoperative notes written by Percival Bailey (PB) making explicit reference to the symptoms of hypothalamic dysfunction. The day after surgery (C1) he wrote, “... patient is perfectly rational. No hyperthermia. No diabetes insipidus….” The following day (C2), he jotted down that the patient had developed “…his hyperthermia…” in addition to “…mental disturbance….” Courtesy of the Manuscript and Archives Department of the Sterling Memorial Library, Yale University. Public domain. Figure is available in color online only.

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    Craniopharyngiomas centered on the hypothalamus with confounding cerebellar symptoms. A1–A4: Case J.P. (Surgical No. 10563). A1: Note written by Cushing on July 30, 1922. A2: Document header of the autopsy performed by Bailey on September 7, 1922. A3: Midsagittal brain autopsy section showing a mixed solid-cystic tumor (t) that is growing in the third ventricle and has replaced the third ventricle floor. A4: Photomicrograph showing a calcified nodule surrounded by an intense reactive gliosis (×300). B1–B3: Case D.E.H. (Surgical No. 17015). B1: Note written by Percival Bailey (PB) on July 25, 1922. “Here is another case which poses again the problem of diagnosis between suprasellar and cerebellar tumor. Again from the clinical syndrome I was obliged to conclude midline cerebellar tumor.” B2 and B3: Bailey’s description of the brain autopsy performed on July 30, 1922. He noted that the tumor had a “broad base of attachment to brain in the region of the tuber cinereum” (B2, red frame) and “filled practically the entire third ventricle” (B3, red frame), pathological features that demonstrate an infundibulo-tuberal topography. Courtesy of the Manuscript and Archives Department of the Sterling Memorial Library, Yale University. Public domain. Figure is available in color online only.

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    Letter written by Harvey Cushing on April 30, 1929, after he had reviewed the draft about third ventricle tumors written by Bailey and John Fulton (underlined sentence). The red frame indicates the fragment in which Cushing expressed that he considered craniopharyngiomas as the best examples of hypothalamic syndrome. Courtesy of the Manuscript and Archives Department of the Sterling Memorial Library, Yale University. Public domain. Figure is available in color online only.

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    Bailey’s 3 monographs on craniopharyngiomas. A1: Front page of the book Intracranial Tumors, published in 1933. A2: Chapter title: Craniopharyngiomas—Syndrome of the Hypothalamus. A3: Scheme of an infundibulo-tuberal craniopharyngioma (t) occupying the third ventricle. Note the pituitary gland (PG) is intact below the tumor, the pituitary stalk (PS) is amputated by the tumor, and the chiasm (Ch) is compressed forward. A4: Picture of a 16-year-old patient showing the typical Fröhlich’s habitus (infantilism and obesity). A5: Scheme of the hypothalamus made and signed by Percival Bailey (PB). A1–A5, from Bailey P: Craniopharyngiomas. Syndrome of the hypothalamus, in Intracranial Tumors. Springfield, IL: Charles C. Thomas, Publisher, 1933. Public domain. B1: Front page of the book Intracranial Tumors of Infancy and Childhood, published in 1939. B2: Title of the eighth chapter. B3: Basal view of the brain autopsy of Bailey’s craniopharyngioma case 89. Note that the solid (ts) and cystic (tc) portions of the tumor have replaced the infundibulum and tuber cinereum. B4: Radiograph from Bailey’s case 86 showing suprasellar calcifications (*). Note that the cyst, filled with air, is positioned at the 3V cavity. B5: Photomicrograph from case 87 showing finger-like tumor protrusions (*) in the surrounding brain tissue. H & E, original magnification ×80. B6: Photomicrograph from case 89 displays the typical adamantinomatous histological features. Note the loose microcystic areas (*) and aggregates of epithelial cells forming a whorl-like array (arrow). H & E, original magnification ×300. B7: Photomicrograph from Bailey’s craniopharyngioma case 90 showing calcified squamous epithelium (*) and anucleate nests of ghost cells (arrowhead). Original magnification ×150. B8: Photomicrograph from Bailey’s case 89 showing cholesterol clefts. Original magnification ×60. B9: Photomicrograph from Bailey’s case 88 showing fibroblastic layer (*) between tumor epithelium and brain gliosis. Original magnification ×150. B1–B9 reproduced from Bailey P: Craniopharyngiomas, in Bailey P, Buchanan DN, Bucy PC (eds): Intracranial Tumors of Infancy and Childhood. Chicago, IL: The University of Chicago Press, 1939. Copyright 1939 by the University of Chicago. Published with permission from University of Chicago Press. C1: First page of the book The Hypothalamus and Central Levels of Autonomic Function, published in 1940. C2: Title: Tumors Involving the Hypothalamus and Their Clinical Manifestations. The first group of tumors discussed by Bailey is craniopharyngiomas. C3: Photograph of a boy with adiposogenital dystrophy. C4: Photograph of a girl with precocious puberty. C5: Midsagittal section from the brain autopsy displayed in B3, showing a mixed solid-cystic infundibulo-tuberal craniopharyngioma. The PG is intact but flattened below the tumor. C1–C5, from Bailey P: Tumors involving the hypothalamus and their clinical manifestations, in Fulton JF, Ranson SW, Frantz AM (eds): The Hypothalamus and Central Levels of Autonomic Function. Proceedings of the Association for Research in Nervous and Mental Disease, December 20 and 21, 1939. New York, Baltimore: Williams & Wilkins, 1940.

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