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  • By Author: Jallo, George I. x
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Vivek A. Mehta, Olindi Wijesekera, Courtney Pendleton, Alfredo Quiñones-Hinojosa, George I. Jallo and Edward S. Ahn

Of Harvey Cushing's many contributions to neurosurgery, one of the least documented is his early surgical intervention in children and his pioneering efforts to establish pediatric neurosurgery as a subspecialty. Between 1896 and 1912 Cushing conducted nearly 200 operations in children at The Johns Hopkins Hospital. A review of his records suggests that the advances he made in neurosurgery were significantly influenced by his experience with children. In this historical article, the authors describe Cushing's treatment of 6 children, in all of whom Cushing established a diagnosis of “birth hemorrhage.” By reviewing Cushing's operative indications, techniques, and outcomes, the authors aim to understand the philosophy of his pediatric neurosurgical management and how this informed his development of neurosurgery as a new specialty.

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Jennifer M. Dmetrichuk, Courtney Pendleton, George I. Jallo and Alfredo Quiñones-Hinojosa

Object

The early 20th century posed several challenges in the diagnosis and surgical treatment of intracranial tumors. However, this was a time in which more information was becoming more readily available based on pathological examination and surgical case reports. Such early work was crucial in shaping the current understanding of the nervous system and in developing modern treatment strategies. An early historical overview of the diagnosis and surgical interventions in pediatric patients with brainstem gliomas has not been described. Furthermore, Dr. Harvey Cushing's contributions to this field have not been reported.

Methods

Following institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the authors reviewed the Johns Hopkins Hospital surgical files dating from 1896 to 1912.

Results

The authors describe Cushing's early experience with a pediatric brainstem glioma during his time as a young attending physician at the Johns Hopkins Hospital. The case, presented in 1909, described the clinical events in a 15-year-old schoolgirl who presented with signs of a cerebellopontine lesion. A suboccipital exploration was performed by Cushing; his findings and surgical approach are described.

Conclusions

Harvey Cushing's early contributions to the field of pediatric neurosurgery, and to the operative treatment of pediatric brainstem gliomas have remained largely unknown. The case presented here represents the early work of the American “Father of Neurosurgery.”

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Courtney Pendleton, Edward S. Ahn, George I. Jallo and Alfredo Quiñones-Hinojosa

As neurological surgery began developing into a surgical subspecialty in the US at the turn of the 20th century, with Harvey Cushing at the forefront, the operative treatment of spinal dysraphism was refined with attempts to minimize complications. Following institutional approval, and through the courtesy of the Alan Mason Chesney Archives, the authors reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912. Patients presenting with spinal dysraphism who underwent surgical intervention by Dr. Harvey Cushing were selected for further analysis. Ten patients presented for surgical intervention for spinal dysraphism, and 7 of these had concurrent hydrocephalus. The mean age of these patients was 5.8 months (range 1–14 months). The mean length of stay was 20.4 days. There were 6 inpatient deaths. At the time of last follow-up, 2 patients were well, 1 patient remained unimproved, and 1 patient (for whom no discharge outcome was available) had died. The cases described in detail offer insight into the breadth of Cushing's practice and the varied approaches he employed. The use of Faradic stimulation to assess nerve root function, the use of complex multilayered closures, and the creation of operative tables for combined treatment of hydrocephalus and spinal dysraphism illustrate Cushing's contributions to developing the field of pediatric neurosurgery.