Harvey Cushing’s management of neurogenic thoracic outlet syndrome

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Harvey Cushing is widely regarded as one of the forefathers of neurosurgery, and is primarily associated with his work on intracranial pathology. However, he had a clinical and academic interest in peripheral nerve surgery. Through the courtesy of the Alan Mason Chesney Medical Archives, the surgical records of the Johns Hopkins Hospital from 1896 to 1912 were reviewed. The records of a single patient undergoing brachial plexus exploration and cervical rib resection were selected for detailed review. The operative report and accompanying illustrations demonstrate Cushing’s interest in adding approaches to the pathology of the brachial plexus to his operative armamentarium.

ABBREVIATIONS TOS = thoracic outlet syndrome.

Article Information

Correspondence Alfredo Quinones-Hinojosa: Mayo Clinic, Jacksonville, FL. quinones-hinojosa.alfredo@mayo.edu.

INCLUDE WHEN CITING Published online April 13, 2018; DOI: 10.3171/2017.9.JNS17173.

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.



  • View in gallery

    Cushing’s illustration of the exposure of the supraclavicular brachial plexus. Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

  • View in gallery

    Diagram of fascial band between cervical rib and scalenes compressing the lower trunk. Cushing’s legend reads “Fascial band under it on retracting plexus exposed.” Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

  • View in gallery

    Cushing’s legend reads “approx size and shape of rib as removed.” Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.



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