Subscribe to RSS
DOI: 10.1055/s-0031-1275631
© Thieme Medical Publishers
Transfacial Approaches to the Skull Base: The Early Contributions of Harvey Cushing
Publication History
Publication Date:
04 April 2011 (online)
![](https://www.thieme-connect.de/media/sbs/201104/lookinside/thumbnails/10.1055-s-0031-1275631-1.jpg)
ABSTRACT
In this report, we review Dr. Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his early use of craniofacial approaches for malignant pathology of the skull base. Following Institutional Review Board approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912, which included three patients who underwent surgical treatment of lesions involving the skull base through craniofacial approaches: two adults and one child (range 3 to 43 years). The main outcome measures were length of stay and condition recorded at the time of discharge. The indications for surgery included osteochondroma of the sphenoid sinus, sarcoma of the maxillary sinus and middle fossa, and osteoma of the frontal sinus. The mean length of stay was 24.5 days (range 7 to 45 days). Cushing employed craniofacial approaches for malignant pathology nearly 40 years before such techniques became widely used. He practiced the fundamentals of skull base surgery, including preferential removal of bone to achieving adequate exposure for resection. In addition, Cushing clearly understood the importance of proximal vascular control in approaching lesions with complex vascular involvement.
KEYWORDS
Harvey Cushing - skull base - transfacial - neuro-oncology
REFERENCES
- 1 Donald P J. History of skull base surgery. Skull Base Surg. 1991; 1 1-3
- 2 Pendleton C, Adams H, Salvatori R, Wand G, Quiñones-Hinojosa A. On the shoulders of giants: Harvey Cushing's experience with acromegaly and gigantism at the Johns Hopkins Hospital, 1896-1912. Pituitary. 2010; (September) 7 [Epub ahead of print]
- 3 Cushing H. Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontile Angle. Philadelphia, London: W.B. Saunders; 1917: viii
- 4 Dandy W. Results following the transcranial operative attack on orbital tumors. Arch Ophthalmol. 1941; 25 191-216
- 5 Cushing H. Meningiomas: Their Classification, Regional Behaviour, Life History, and Surgical End Results. New York: Hafner Pub.; 1962: 2 v. (xiv 785 p.)
- 6 Patel S G, Singh B, Polluri A et al.. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer. 2003; 98 1179-1187
- 7 Smith R R, Klopp C T, Williams J M. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer. 1954; 7 991-994
- 8 Ketcham A S, Wilkins R H, Vanburen J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses. Am J Surg. 1963; 106 698-703
- 9 Cushing H. The Pituitary Body and Its Disorders, Clinical States Produced by Disorders of the Hypophysis Cerebri. Philadelphia, London: J.B. Lippincott; 1912: x
- 10 Van Buren J M, Ommaya A K, Ketcham A S. Ten years' experience with radical combined craniofacial resection of malignant tumors of the paranasal sinuses. J Neurosurg. 1968; 28 341-350
- 11 Feiz-Erfan I, Han P P, Spetzler R F et al.. The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg. 2005; 103 485-490
- 12 Unterberger S. Care of frontobasal wounds. Arch Ohren Nasen Kehlkopfheilkd. 1958; 172 463-484
- 13 Knoener W, Schultheiss D. Johann Friedrich Dieffenbach (1792-1847) pioneer in oral maxillofacial surgery. J Hist Dent. 2002; 50 117-121
- 14 Rogers B O. Carl Ferdinand von Graefe (1787-1840). Plast Reconstr Surg. 1970; 46 554-563
- 15 Horton C E, Crawford H H, Adamson J E. John Peter METTAUER—America's first plastic surgeon. Plast Reconstr Surg Transplant Bull. 1961; 27 268-278
- 16 Davis J S. Scalping accidents. Bull Johns Hopkins Hosp. 1911; 16 257-262
- 17 Dorafshar A H, Pendleton C, Quinones-Hinojosa A, Redett R J. Cleft lip-cleft palate closure: the unknown contributions of Harvey Cushing. Plast Reconstr Surg. 2010; 126 1320-1324
- 18 Conway J E, Raza S M, Li K, McDermott M W, Quiñones-Hinojosa A. A surgical modification for performing orbitozygomatic osteotomies: technical note. Neurosurg Rev. 2010; 33 491-500
- 19 Raza S M, Conway J E, Li K W et al.. A modified frontal-nasal-orbital approach to midline lesions of the anterior cranial fossa and skull base: technical note with case illustrations. Neurosurg Rev. 2010; 33 63-70
- 20 Raza S M, Quinones-Hinojosa A. The extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification. Neurosurg Rev. 2011; 34 123-129
Alfredo Quiñones-HinojosaM.D.
1550 Orleans Street, Cancer Research Building II Room 253
Baltimore, MD 21231
Email: aquinon2@jhmi.edu