The history of neurosurgery at the House Clinic in Los Angeles

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Although most widely known as the birthplace of neuro-otology, the House Clinic in Los Angeles has been the site of several major contributions to the field of neurosurgery. From the beginning of the formation of the Otologic Medical Group in 1958 (later renamed the House Ear Clinic), these contributions have been largely due to the innovative and collaborative work of neurosurgeon William E. Hitselberger, MD, and neuro-otologist William F. House, MD, DDS. Together they were responsible for the development and widespread adoption of the team approach to skull-base surgery. Specific neurosurgical advances accomplished at the House Clinic have included the first application of the operative microscope to neurosurgery, the application of middle fossa and translabyrinthine approaches for vestibular schwannoma, and the development of combined petrosal, retrolabyrinthine, and other alternative petrosal approaches and of hearing preservation surgery for vestibular schwannoma. The auditory brainstem implant, invented at the House Clinic in 1979, was the first ever successful application of central nervous system neuromodulation for restoration of function. Technological innovations at the House Clinic have also advanced neurosurgery. These include the first video transmission of microsurgery, the first suction irrigator, the first debulking instrument for tumors, and the House-Urban retractor for middle fossa surgery.

ABBREVIATIONS IAC = internal auditory canal.

Article Information

Correspondence Gautam U. Mehta: House Ear Institute, Los Angeles, CA. gmehta@houseclinic.com.

INCLUDE WHEN CITING Published online August 16, 2019; DOI: 10.3171/2019.5.JNS19602.

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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    William F. House, MD, DDS (1960s). Image courtesy of John W. House, MD.

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    Illustration of the middle fossa surgical approach to the internal auditory canal (patient’s right). The temporal lobe dura is retracted (bottom) exposing the temporal bone. Reprinted from House WF: Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa. Laryngoscope 71:1363–1385, 1961. © The American Laryngological, Rhinological and Otological Society, Inc. Used with permission granted by John Wiley & Sons.

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    William E. Hitselberger, MD, analyzing pathology slides (1960s). Dr. Hitselberger had completed a fellowship in neuropathology at the Mayo Clinic. Image courtesy of John W. House, MD.

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    William E. Hitselberger, MD (left), and William F. House, MD, DDS (right), with Professor Herbert Olivecrona (center) at a 1964 symposium on vestibular schwannoma surgery. Professor Olivecrona was an early supporter of the House Clinic’s approach to vestibular schwannomas. Photograph courtesy of the House Clinic.

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    An example of the polytome-pantopaque technique for identifying tumors of the IAC using a polytome x-ray (multidirectional tomogram) and iophendylate (pantopaque) dye. Left: Without obstruction, dye (white) fills the IAC past the level of the transverse crest. Right: An example of an IAC obstructed by tumor. Reprinted from Hitselberger WE, House WF: Polytome-pantopaque: a technique for the diagnosis of small acoustic tumors. Technical note. J Neurosurgery 29:214–217, 1968. Published with permission.

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    The first onlay auditory brainstem implant that was placed in 1981. Reprinted from Hitselberger WE, House WF, Edgerton BJ, Whitaker S: Cochlear nucleus implants. Otolaryngology—Head and Neck Surgery (92:52–54). © 1984 Sage Publications, Inc.; reprinted by permission.

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