Douglas W. C. Northfield (1902-1976): his crucial contribution to safer craniopharyngioma surgery.

Abstract

Douglas W. C. Northfield (1902-1976) was one of the pioneers of modern British neurosurgery. He trained under Sir Hugh Cairns (1896-1952) at The London Hospital, replacing him as director of the neurosurgical unit. Cairns was instrumental in transmitting Cushing's work methodology, including the painstaking upkeep of detailed clinical records with insightful reflections. Northfield's dismal surgical outcome record with craniopharyngiomas (CPs) tormented him. An examination of his records held by the Barts Health NHS Trust Archives allowed the authors to identify 52 CP patients, 38 of whom underwent surgery with a mortality rate as high as 26.3%. Like Cushing, Northfield gained insight through the CP brain specimens of his patients who had died. This served to illuminate the definitive correlation between poor surgical outcome and anatomical involvement of the tuber cinereum by the tumor. Northfield proposed a novel CP topographical classification based on the type of tumor relationship with the basal hypothalamus. Despite this scheme allowing for both predicting patient outcome and tailoring surgical strategy, it fell into oblivion. On the 100th anniversary of the Society of British Neurological Surgeons, this article highlights Northfield's legacy as a leading advocate for safer, hypothalamus-sparing CP surgery, a concept now widely accepted by internationally recognized experts.