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Harvey Cushing's early treatment of meningiomas: the untold story
Courtney Pendleton1, Alessandro Olivi, Henry Brem
1Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Insights
Harvey Cushing’s early meningioma surgeries at Johns Hopkins Hospital showed his focus on hemostasis and staged resections for large tumors, though early outcomes were poor.
Area of Science:
- Neurosurgery
- Surgical History
- Oncology
Background:
- Review of Harvey Cushing's early meningioma cases (1896-1912) at Johns Hopkins Hospital.
- Analysis of 18 meningioma patients treated by Cushing, with detailed operative descriptions previously unavailable.
- Focus on cases diagnosed as endothelioma or dural endothelioma.
Discussion:
- Cushing's surgical techniques evolved, demonstrating early attention to hemostasis.
- Staged resections were employed for large, highly vascular meningiomas to mitigate risks.
- Limited success in reducing morbidity and mortality in these early cases.
Key Insights:
- Early meningioma surgeries by Cushing highlight his meticulous approach to hemostasis.
- Staged resection strategies were developed in response to challenging tumor characteristics.
- High inpatient mortality (64.3%) underscores the difficulties in treating meningiomas during this era.
Outlook:
- These early cases illustrate Cushing's adaptive surgical strategies and problem-solving abilities.
- Understanding Cushing's foundational techniques provides historical context for modern meningioma treatment.
- Further research could explore the long-term outcomes of these specific patient cohorts.
Background:
In his 1938 monograph, Cushing tabulated 313 meningioma cases treated throughout his career at the Johns Hopkins and the Peter Bent Brigham Hospitals. Of these, 18 patients were treated at the Johns Hopkins Hospital. Cushing provided basic demographic, perioperative, and outcomes data in his tables, but the operative details for many of his early meningioma cases have not been previously described.
Methods:
After institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical files for the Johns Hopkins Hospital from the period 1896 to 1912 were reviewed. Cases diagnosed as endothelioma or dural endothelioma were selected for further analysis.
Results:
Of the 14 patients with available records, 1 were male. The mean age was 34.4 years. Nine patients (64.3%) died during their inpatient stay. Cushing used staged resections in an attempt to minimize blood loss, morbidity, and mortality, albeit with limited success.
Conclusions:
The operative details demonstrate Cushing's early attention to hemostasis, and use of staged resections in patients with large, highly vascular meningiomas. Cushing's first 18 cases of meningiomas, treated while a young attending physician at the Johns Hopkins Hospital, are not the most elegant operations in his lengthy series, but serve as an illustration of his ability to transform clinical challenges into opportunities for improvement.
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