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Ossama Al-Mefty, Edward R. Laws, and A. John Popp

As it does periodically, the United States healthcare system is, yet again, undergoing a period of change on multiple fronts, including internal initiatives in education, quality, and the workforce, as well as external pressure responding to changes in reimbursement and oversight. In such times, looking back at the foundations of our specialty is helpful, allowing often-beleaguered neurosurgeons to reflect upon what it means to be a neurosurgeon, and how they can be assured that our specialty will continue to flourish in the future. Harvey Cushing envisioned, espoused, and developed neurological surgery as a “special field”—a comprehensive, encompassing, and distinct discipline that studies the nervous system and manages neurological disorders. It provides surgical intervention for the treatment of neurological disorders; it by no means was meant to be developed as a mere technical or procedural skill; it is neither a subspecialty of surgery nor a branch of neurology; it is a “special field” that has flourished to become a crown jewel in the realm of medicine. Herein is a perspective that brings the inception and future of this concept to light. A specialty that is to live and flourish should stand on and recognize its roots.

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Michael G. Z. Ghali, Visish M. Srinivasan, Andrew Jea, and Sandi Lam

posteriorly placed coronal incision at the vertex rather than the anterior hairline, techniques that are currently common practice in neurological and craniofacial surgery (personal communication, S. A. Wolfe, December 8, 2013). Legacy As the founding father of the specialty, Tessier's personal approach to craniofacial surgery came to define the philosophy of a whole new generation of surgeons. He emphasized the importance of learning from each case, the work ethic required to succeed in solving the challenges of the field, and the importance of collaboration within

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Kristopher T. Kimmell, Anthony L. Petraglia, Robert Bakos, Thomas Rodenhouse, Paul K. Maurer, and Webster H. Pilcher

A s the University of Rochester Medical Center (URMC) enters its 9th decade, the Department of Neurosurgery reflects on its legacy. With direct ties to the father of modern neurosurgery, Dr. Harvey Cushing, neurosurgery in Rochester has a long history of being at the forefront of advances in the neurosciences, which continues today ( Table 1 ). TABLE 1: Timeline for the Department of Neurosurgery at URMC Date Event 1921 University of Rochester Medical School founded 1926 Strong Memorial Hospital opens 1926 Dr

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Christopher M. Bonfield and Douglas Kondziolka

, Masterton was not wearing a helmet. He suffered severe head injuries as a direct result of the fall and immediately lost consciousness ( Fig. 1 ). He was taken directly to the hospital, where he died 2 days later at the age of 29 years. 1 His memory lives on through not only a trophy that bears his name, but also the legacy of bringing head safety to the forefront of a game that was both unready and unwilling to accept change. This paper explores the death of Bill Masterton and the long-lasting effects that it had on head injury and protection in sports. Fig. 1

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Erin J. Torell, Tyler S. Pistone, and Andrew P. Gard

I n July 2019, the Nebraska Board of Regents elevated the neurosurgery program at the University of Nebraska Medical Center (UNMC) to department status. The hard work and dedication of several committed faculty members built the foundation for the newly designated Department of Neurosurgery ( Table 1 ). This legacy of excellence extends into the present through the faculty, residency program, and patient care. TABLE 1. Timeline for the Department of Neurosurgery at UNMC Date Event 1854 The city of Omaha is established 1867 Nebraska becomes a state 1869

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Harold Rosegay

Cushing For the legacy of this experience, and for the line that stretches from Cushing to the present, we must go back to the clinic days of 1923 to 1924, when Norman Dott was his assistant. Dott saw both sides of the operative problem and came to his own conclusions, which were not different from Cushing's at that time: “It is essential … to form an opinion as to whether the tumour is or is not an adenoma, since from a surgical standpoint the correct differentiation of the adenomata from the various parahypophysial lesions is of the first importance.… Suprasellar

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Ilhan Elmaci and Naci Balak

be separate from general surgery. On the subject of the practice of neurosurgery, Dilek followed Cushing's legacy by stating in an article: … undoubtedly a general surgeon can perform neurosurgical procedures. Yet, more than the technique is necessary for successful outcomes in neurological surgery. The abilities to make the diagnosis and localize the lesion are also essential. Therefore, a neurosurgeon should have comprehensive knowledge of not only surgical techniques but also neurology and biology. [translation by the authors] 20 Dilek's efforts succeeded

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Smruti K. Patel, William T. Couldwell, and James K. Liu

: 199–207, 1925, with permission. Original art is #696 in the Walters Collection of the Max Brödel Archives in the Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Brödel's Legacy: A Training Program for Medical Illustrators With Brödel's work becoming increasingly popular, offers from other institutions began pouring in and he was tempted to go elsewhere; however, deeply rooted at the Johns Hopkins institution, he remained loyal and stayed there to continue his work. 1 Much as the physicians

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D. Ryan Ormond, Mohab Abozeid, Shekar Kurpad, and Stephen J. Haines

. 3 , 13 , 17 Many surgical specialties have implemented research fellowships during postgraduate training to support the development of surgeon scientists. 4 , 12 , 15 , 17 As a direct legacy of Harvey Cushing through William P. Van Wagenen, the Van Wagenen Fellowship was the first of such fellowships for the development of academic neurosurgeons. At the 50th anniversary of the William P. Van Wagenen Fellowship, it seems appropriate to assess the return on investment of the fellowship both for the awardees and for neurosurgery as a whole. To this end, this study

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Kurt R. Lehner and Michael Schulder

, lapsed into a coma, and died on July 16, 1916, at 60 years old. In a letter to his wife only a few months prior Horsley had written, “Don’t worry about me, I don’t matter, I can’t live forever, it’s the young that matter.” 37 Conclusions Although the legacy of Victor Horsley in America may have been muddied by Cushing and Fulton’s anecdote and Horsley’s strong personality, current neurosurgery has acknowledged the profound influence Sir Victor had on the development of the “special” field. Writings from and about prominent Americans during Horsley’s time reveal that he