Arthur Roland Elvidge (1899–1985): contributions to the diagnosis of brain tumors and cerebrovascular disease

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✓ The contributions of Arthur Elvidge (1899–1985), Wilder Penfield's first neurosurgical recruit, to the development of neurosurgery have been relatively neglected, although his work in brain tumors extended the previous work of Percival Bailey and Harvey Cushing. He published rigorous correlations of clinical and histological information and formulated a revised, modern nosology for neuroepithelial tumors, including a modern histological definition of glioblastoma multiforme. Well ahead of his time, he believed that glioblastoma was not strictly localized and was the first to comment that the tumor frequently showed “satellitosis.” He was the first neurosurgeon in North America to use angiography as a radiographic aid in the diagnosis of cerebrovascular disease. Having studied with Egas Moniz, he was the first to detail the use of angiographic examinations specifically for demonstrating cerebrovascular disorders, believing that it would make possible routine surgery of the intracranial blood vessels. Seeking to visualize all phases of angiography, he was the impetus behind the design of one of the first semi-automatic film changers. Elvidge and Egas Moniz made the first observations on thrombosis of the carotid vessels independently of each other. Elvidge elucidated the significance of embolic stroke and commented on the ischemic sequelae of subarachnoid hemorrhage. Besides his contributions to neurosurgery, he codiscovered the mode of transmission of poliomyelitis. Elvidge's soft-spoken manner, his dry wit and candor, mastery of the understatement, love of exotic travel, and consummate dedication to neurosurgery made him a favorite of patients, neurosurgery residents, nurses, and other hospital staff. His accomplishments and example as teacher and physician have become part of neurosurgery's growing legacy.

Article Information

Address reprint requests to: William Feindel, M.D., Department of Neurology and Neurosurgery, Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, H3A 2B4 Canada.

© AANS, except where prohibited by US copyright law.

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Figures

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    An intraoperative sketch made by Elvidge during resection depicting a low-grade astrocytoma in the lower motor strip that had caused frequent seizures The border of the excision is marked by a dotted line and the area where the tumor could be seen at the cortical surface is labeled. Note that several motor responses were obtained within the tumor boundaries during cortical mapping.

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    Upper: Angiogram obtained by Elvidge demonstrating an AVM of the right central cortex. Lower: Photograph taken during the excision of the AVM by Wilder Penfield showing the location of the lesion just behind the motor strip. Note the numbered tickets that mark locations of motor responses obtained by electrical stimulation. This may be the first example ever published of the use of the technique of angiographic examination together with intraoperative cortical mapping.

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    Preoperative angiogram (upper) showing a right anterior cerebral aneurysm in a 13-year-old boy treated in 1946 and postoperative plain x-ray films (lower) showing the position of aneurysm clips.

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    Left: Photograph showing Elvidge, with the help of his residents, examining a young boy after a successful operation for a head trauma—related injury. Center and Right: Photographs showing a patient with an external fixation system in place that was developed in 1944 by Elvidge, with the help of a colleague in plastic surgery, for the treatment of complicated facial and skull fractures.39

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    Catching a towel and off to the showers. Photograph showing Arthur Elvidge as a Major with the 6th Canadian Field Ambulance during World War II.

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    Left: Photograph showing Elvidge, posing with three nurses. He was a favorite of the staff because of his gentle manner and his dry wit. Right: A sketch of Elvidge in surgical garb by nurse Mary Filer. In the operating room his ritual of focusing his headlamp was avoided by the nurses.

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    Photograph showing Elvidge astride a fine mount at Giza in Egypt. Intensely interested in wildlife and the environment, he was an active member of the National Geographic Society, the Canadian Geographic Society, the New York Zoological Society, and the American Polar Society.

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    A portrait photograph taken by Youssef Karsh of Elvidge around the time of his retirement in the early 1960s.

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    Photograph showing (left to right) Arthur Elvidge, Gilles Bertrand, Wilder Penfield, William Cone, Lamar Roberts, and Theodore Rasmussen at Elvidge's 60th birthday party, on which occasion he was presented with a fine white, western Stetson hat inside a large suitcase, and a painting of a monkey made by his grandfather. Elvidge's journeys were the subject of much levity at the Institute.

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