Cushing’s dogged struggle against death: the astonishing case of a patient under cardiac arrest surviving craniopharyngioma surgery

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The decisive role Dr. Harvey Cushing (1869–1939) played in medicine goes far beyond the development of neurosurgery. His scientific devotion and commitment to patient care made him an ethical model of strict professionalism. This paper seeks to analyze the decisions Cushing made with the challenging case of HW, an adolescent boy with a craniopharyngioma (CP) involving the third ventricle. Cushing’s earlier failure to successfully remove two similar lesions alerted him to the proximity of HW’s tumor and the hypothalamus. Consequently, he decided to use the chiasm-splitting technique for the first time, with the aim of dissecting the CP-hypothalamus boundaries under direct view. Unexpectedly, HW suffered cardiac arrest during the surgery, but Cushing did not give up. He continued with the operation while his assistants performed resuscitation maneuvers. Such determined and courageous action allowed Cushing to succeed in an apparently hopeless case. Cushing’s unwavering willingness to save patients’ lives, even under extreme circumstances, was a fundamental trait defining his identity as a neurosurgeon. Analyzing the way Cushing dealt with HW’s case provides valuable lessons for neurosurgeons today, particularly the importance of assuming proactive attitudes and, in certain cases, making painstaking efforts to overcome daunting situations to save a life.

ABBREVIATIONS BTR = Brain Tumor Registry; CP = craniopharyngioma; TSA = transsphenoidal approach.
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Contributor Notes

Correspondence Ruth Prieto: Puerta de Hierro University Hospital, Madrid, Spain. WHEN CITING Published online January 17, 2020; DOI: 10.3171/2019.11.JNS192487.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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