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| EDITORIAL |
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| Year : 2006 | Volume
: 54
| Issue : 2 | Page : 143 |
The heuristics of craniospinal epidermoid tumors
Manu Kothari1, Atul Goel2
1 Department of Anatomy, King Edward Memorial Hospital & Seth G.S. Medical College, Parel, Mumbai - 400012, India
2 Department of Neurosurgery, King Edward Memorial Hospital & Seth G.S. Medical College, Parel, Mumbai - 400012, India
Correspondence Address:
Atul Goel
Department of Neurosurgery, King Edward Memorial Hospital & Seth G.S. Medical College, Parel, Mumbai - 400012
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 16804256 
How to cite this article:
Kothari M, Goel A. The heuristics of craniospinal epidermoid tumors. Neurol India 2006;54:143 |
'In nature's infinite book of secrecy/ A little I can read'. The characteristic humility of our dear Bard of Stratford-on-Avon can be heuristically put to use in the study of craniospinal epidermoid tumors (CET) that like any other tumors, continue to be a mystery inside an enigma with fore and backcovers of puzzle. Whitehead generalized that intelligent consciousness of one's ignorance spawns admiration, leading to a sense of wonder, culminating in reverence. CET merit our serious attention.
If beauty is skin-deep, the brain is no less. CET provide you a flashback that shows that the whole CNS is nothing but sunken skin. This is also the right moment to declare that one's brawn - posited in the muscles - is traceable to the ectoderm via the primitive streak, which is ectodermally derived. Entoderm too emanates from the ectoderm whose versatility thus is a glimpse of a cell's genius that, from its start 4.2 billion years ago, has refused to change. A 'stray' ectodermal cell, nestling in neuroectoderm, exemplifying - in Ardey's words - 'an ordered disorder', forms a nidus of slow, steady cellular accretion called epidermoid tumor. The wide array of elements that are housed in an epidermoid tumor are easily attributable to the versatility of the stray cell. It has been rightly generalized that every embryological 'anomaly' serves as a teacher, that wearing the garb of abnormality, points to the incomprehensible myriad processes that, unfailing by and large, fashion a normal tissue or a human being.
It is significant that the much-used terms normal and abnormal are as yet poorly defined. The Oxford companion to Medicine skips both the terms, for obvious reasons. Add to this the generalization that normality/abnormality concern a range and not an individual nor an average, and you realize that normality/abnormality, like beauty/ugliness lie in the eyes of the beholder, being mere opinions and therefore, nowhere a reality. CET are beyond medical judgmentalism, being as relevant, and 'normal' as the most beautiful face around. INNTOE is an acronym that loudly proclaims In Nature No Terror Of Error .
Every epidermoid tumor, then, occurs at the behest of the herd whereby an individual bears the cross so that all others are spared, a societal mechanism as common to cleft-palate as to ALL. It's the corporate genotype that orders the phenomenon to be expressed at an individual level. So, in a person with an epidermoid tumor, there is nothing abnormal, no genetical error, no punishment of some past Karma . CET's occurrence comes to underscore the Vedic truth that we all are united by a single soul. Each epidermoid tumor, like any other tumor, asserts its tritimensional uniqueness, being unlike any other epidermoid tumor in the total past, total present, and the infinite future. It does this by conversing with all that CET that were, are, and will be. An epidermoid tumor is a cosmic event that must evoke from the beholder the reverence of a witness and the gratitude that the beholder has been saved of an epidermoid tumor by its presence in the beheld.
The cells that spawn an epidermid tumor exhibit Januine ( Janus = double faced) allegiance- The ectodermal face overseas steady multiplication, and accretion leading to 'tumor' and differentiating versatility to beget a hair here, a nail there, sebaceous glands, and what have you. The wizardy and the artistry of an epidermoid tumor is best seen, even by your naked eye, as the mother of pearls , a truly versatile mother as it were. The other, neuroectodermal allegiance of epidermoid tumor sees to it that, despite ceaseless mitosis there is no inclination to invasive cancerousness. Little wonder that every epidermoid tumor exhibits, what Brooke poignantly called, a tumors' discreet silence', sustained over years. To this gentlemanly behaviour of the guest, the CNS itself plays an accommodating host ready to distort itself, even grossly, to give more room to the guest, trying at the same time not to encroach on the person' physiology or consciousness. This symphony between an epidermoid tumor and the CNS drives home the musical note that, as and when, an epidermoid tumor needs removal, discretion should be used to attack it dis-ease far and no further. If need be, leave behind bits and pieces of the epidermoid tumor, knowing that for years they were symbiotic with the CNS. Your discretion as a surgeon becomes the better part of your valour.
Operative enthusiasm often satisfies the intellectual soul of a surgeon, but at the cost of the patient's purse and persona. An epidermoid tumor is a formidable cosmic entity, to be treaded upon gently, softly, nay, reverentially.
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