The influence of Harvey Cushing on neuroradiologic therapy

Harvey Cushing was largely responsible for the establishment of neurosurgery as a separate discipline. He demonstrated how careful attention to technique could make surgery acceptably safe, established classifications and clinical-pathologic correlations of a wide variety of tumors, and trained dozens of future neurosurgical department heads. Less well known, however, is Cushing's contribution to the early clinical use of radiation therapy for a variety of intracranial disorders. With the aid of his meticulous clinical follow-up, large case volume, and willingness to try new treatment methods, he demonstrated the utility of therapeutic radiation in patients with pituitary tumor, medulloblastoma, and arteriovenous malformation. His less impressive results with the irradiation of patients with glioma are also worthy of note and include trials of brachytherapy. Neurosurgeons and radiation oncologists exploring new methods of delivering therapeutic radiation to the central nervous system should be aware of the lessons learned from Cushing's experience.