Article

"Fulfilling the chief of his duties as a physician": Harvey Cushing, selective dorsal rhizotomy and elective spine surgery for quality of life. Historical vignette

The Johns Hopkins University School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland 21287, USA.
Journal of neurosurgery. Spine (Impact Factor: 2.38). 03/2011; 14(3):421-7. DOI: 10.3171/2010.10.SPINE10152
Source: PubMed

ABSTRACT

At the beginning of the 20th century, the development of safer anesthesia, antiseptic techniques, and meticulous surgical dissection led to a substantial decrease in operative risk. In turn, the scope of surgery expanded to include elective procedures performed with the intention of improving the quality of life of patients. Between 1908 and 1912, Harvey Cushing performed 3 dorsal rhizotomies to improve the quality of life of 3 patients with debilitating neuralgia: a 54-year-old man with "lightning" radicular pain from tabes dorsalis, a 12-year-old boy cutaneous hyperesthesia and spasticity in his hemiplegic arm, and a 61-year-old man with postamputation neuropathic pain. Symptomatic improvement was seen postoperatively in the first 2 cases, although the third patient continued to have severe pain. Cushing also removed a prominent spinous process from each of 2 patients with debilitating headaches; both patients, however, experienced only minimal postoperative improvement. These cases, which have not been previously published, highlight Cushing's views on the role of surgery and illustrate the broader movement that occurred in surgery at the time, whereby elective procedures for quality of life became performed and accepted.

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    ABSTRACT: 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. 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. 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. 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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    ABSTRACT: Although Harvey Cushing was mostly known for his contributions to brain tumor surgery, he was also a pioneer in the development of spinal cord surgery. This lesser known facet of Cushing's career can provide a fresh and unique perspective into how the founders of neurosurgery surmounted early challenges in the field. The authors bring to light and examine for the first time Cushing's unpublished writing "Technique of Laminectomy" along with his first 3 documented intramedullary spinal cord tumor (IMSCT) cases at the Johns Hopkins Hospital. The authors draw lessons from the challenges in pathological classification, preoperative diagnosis, tumor localization, and surgical technique ofthat time. Although Cushing's attempts at exploration and resection of IMSCT as described here were of limited success, his ability to adapt his clinical and surgical technique to the challenges of the time, as well as develop skills to successfully manipulate the spinal cord during these exploratory procedures without the patients incurring neurological damage, postoperative infection, or complications, is a testament to his determination to advance the field and his meticulous operative technique. In spite of the limitations imposed on the pioneer neurosurgeons, Harvey Cushing and his contemporaries persevered through many of the challenges and built an essential part of neurosurgery's common story.
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