Herbert Olivecrona: founder of Swedish neurosurgery

Harvey Cushing's international visitors

Harvey Cushing is considered the father of neurosurgery, not just for his work within the United States, but also for his global influence through international visitors and trainees. Starting in 1920, the neurosurgical clinic at the Peter Bent Brigham Hospital in Boston, led by Cushing, trained surgeons from all over the globe, many of whom returned home to establish neurosurgical departments and become neurosurgical pioneers themselves. The objective of this vignette is to highlight the importance of Cushing's international trainees, describe their contributions, and discuss how each had an impact on the development of the practice of neurosurgery worldwide. The authors demonstrate how Cushing provided the impetus for a movement that revolutionized neurology and neurosurgery worldwide. Even today, international cooperation continues to shape the success of our delicate specialty.

Origin and Use of Hydrogen Peroxide in Neurosurgery

Hydrogen peroxide (H2O2) is a chemical with a wide range of applications. This includes its use in the medical field, in which its use has been ubiquitous but is most useful as an antiseptic and in achieving hemostasis. Neurosurgeons have been using H2O2 for well over a century, primarily for its hemostatic and antiseptic effects. This is in spite of the fact that the actual effectiveness of H2O2 as an antiseptic is questionable, and its use, in general, may be more dangerous than it appears. We review the application of H2O2 in medicine generally and, more specifically, in neurosurgery. This review outlines the reasoning behind the use of H2O2 as an antiseptic and details why it may not be as effective as one might think. We also detail its use as a hemostatic agent in neurosurgery, reviewing a number of techniques in which it has been useful in this role. Finally, we review the documented cases of complications associated with the use of H2O2 in neurosurgery. Ultimately, we conclude that the use of H2O2 in neurosurgery be reconsidered because of its lack of effectiveness as an antiseptic and potentially fatal complications.

The evolution of stereotactic radiosurgery in neurosurgical practice

INTRODUCTION

Stereotactic radiosurgery (SRS) was born in an attempt to treat complex intracranial pathologies in a fashion whereby open surgery would create unnecessary or excessive risk. To create this innovation, it was necessary to harness advances in other fields such as engineering, physics, radiology, and computer science.

METHODS

We review the history of SRS to provide context to today's current state, as well as guide future advancement in the field.

RESULTS

Since time of Lars Leksell, the young Swedish neurosurgeon who pioneered the development of the SRS, the collegial and essential partnership between neurosurgeons, radiation oncologists and physicists has given rise to radiosurgery as a prominent and successful tool in neurosurgical practice.

CONCLUSION

We examine how neurosurgeons have helped foster the SRS evolution and how this evolution has impacted neurosurgical practice as well as that of radiation oncology and neuro-oncology.

Superior Sagittal Sinus: A Review of the History, Surgical Considerations, and Pathology

A systematic PubMed and Google Scholar search for studies related to the anatomy, history, surgical approaches, complications, and diseases of the superior sagittal sinus was performed. The purpose of this review is to elucidate some of the more recent advances of our understanding of this structure. One of the earliest anatomical landmarks to be described, the superior sagittal sinus (SSS, sinus sagittalis superior (Latin); "sagittalis" Latin for 'arrow' and "sinus" Latin for 'recess, bend, or bay') has been defined and redefined by the likes of Vesalius and Cushing. A review of the various methods of approaching pathology of the SSS is discussed, as well as the historical discovery of these methods. Disease states that were emphasized include invasion of the SSS by meningioma, as well as thrombosis and vascular malformations.

“Highly Qualified Loser”? Harvey Cushing and the Nobel Prize

Neurosurgery, in particular surgery of the brain, was recognized as one of the most spectacular transgressions of the traditional limits of surgical work. With their audacious, technically demanding, laboratory-based, and highly promising new interventions, prominent neurosurgeons were primary candidates for the Nobel Prize. Accordingly, neurosurgical pioneers such as Victor Horsley and, in particular, Harvey Cushing continued to be nominated for the prize. However, only António Egas Moniz was eventually awarded the prestigious award in 1949 for the introduction of frontal lobotomy, an intervention that would no longer be prize-worthy from today's perspective. Horsley and Cushing, who were arguably the most important proponents of early neurosurgery, remained “highly qualified losers,” as such cases have been called. This paper examines the nominations, reviews, and discussions kept in the Nobel Archives to understand the reasons for this remarkable choice. At a more general level, the authors use the example of neurosurgery to explore the mechanisms of scientific recognition and what could be called the enacting of excellence in science and medicine.

Otfrid Foerster, the great neurologist and neurosurgeon from Breslau (Wrocław): his influence on early neurosurgeons and legacy to present-day neurosurgery

As a result of the turbulences of World War II, Wrocław, Poland (formerly Breslau, Germany) lost its internationally acknowledged position in the field of neurosurgery, which it once had thanks to Otfrid Foerster. This innovative German doctor and scientist made a considerable contribution to the development of neurological and neurosurgical research worldwide. He also made Breslau a renowned center for scientific study, luring researchers from around the world. His achievements influenced many neurosurgeons during his lifetime, above all those from the US and England, including, for example, such well-known men as Fulton, Bucy, Bailey, and Penfield (who worked with Foerster in Breslau for quite a long time). Together Foerster and Penfield searched for the causes of epilepsy and the surgical methods to treat it. For young American neurosurgeons it was a very significant step in their careers to be able to train in Breslau under the guidance of Otfrid Foerster. In 1937 the British Association of Neurological Surgeons visited Breslau and awarded him with the honor of "Member Emeritus," which could be seen as the culmination of Foerster's career. In this paper the authors give an overview of Foerster's work and evaluate its significance. They also elucidate the difficult historical background during fascism in Germany using the sources of the Polish National Archives. Dr. Foerster's remaining traces in today's Wrocław are meticulously reported.

Evolution of vestibular schwannoma surgery: the long journey to current success

The extraordinary improvement of patient outcome after surgical treatment for vestibular schwannomas is relatively recent and has occurred mainly over the last 30 years. The introduction of microsurgical techniques has resulted in increasing degrees of precise anatomical and functional preservation of the facial and cochlear nerves. An expanded microsurgical technique accompanied by continuous electrophysiological monitoring has resulted in marked changes in the primary goals for this surgery. Whereas in the past the primary goal of vestibular schwannoma management was to preserve the patient's life, the objective in vestibular schwannoma treatment today is to preserve neurological function.

Long-term follow-up examinations show negligible recurrence rates, indicating that the aim of preservation of nerve function does not limit the completeness of tumor removal with modern neurosurgical techniques. Despite these advances in preserving the anatomical integrity of, for example, the cochlear nerve, losses of function and even deafness may occur postoperatively in some cases. Current biological and technical research in experimental and clinical settings addresses these problems. In this article, the authors report in detail the developments achieved in vestibular schwannoma surgery and the great clinicians to whom these results can be credited.

Harvey Cushing's Meningiomas text and the historical origin of resectability criteria for the anterior one third of the superior sagittal sinus

The search for the origin of the commonly held principle in current neurosurgery regarding the resectability of the anterior one third of the superior sagittal sinus unravels the many fascinating developments that occurred in neurosurgery during the early 20th century. All these occurrences can be traced back to, and are uniquely contextualized in, Harvey Cushing's seminal text, Meningiomas, Their Classification, Regional Behaviour, Life History, and Surgical End Results. Written with Louise Eisenhardt and published in 1938, Meningiomas is a monograph of incredible description and detail. The meticulous categorization of meningiomas, their presentation, clinical outcome, and surgical therapies are even further supplemented by Cushing's personal commentary, questions, and recollections. Cushing's genius was evident in his ability not only to make insightful clinical observations, but also to synthesize these ideas within the neurosurgical context of his era. As he says in Meningiomas, "Thus the pathological curiosity of one day becomes in its proper time a commonplace... most of which are one and the same disorder--had, for their interpretation, to await the advent of the Neurosurgeon."

Back to the roots of modern neurosurgery: neurosurgical pioneers in Halle an der Saale

At the end of the 19th and the beginning of the 20th centuries, German surgeons played a large role in the development of neurologic surgery. Many of them, however, have not been fully appreciated by the neurosurgical community until now. Pioneering personalities like F. Krause and F. von Bramann have contributed considerably to the early establishment of standard neurosurgical principles and operative techniques. Alexander Stieda was their successor and kept alive the neurosurgical tradition in Halle until the end of World War II. This middle-sized city in Central Germany, with an old university where Martin Luther once taught, was especially privileged to be one of the places where some of the best-qualified and restless surgeons have practiced neurologic surgery and done work in progress. This paper traces the biographies of the great old masters of German neurosurgery in search of the "Halle connection" to the progress of our field.

Hans Sølling: Danish pioneer neurosurgeon

Hans Adolf Sølling (1879-1945), working completely on his own in the small town of Horsens, was Denmark's first neurosurgeon. Sølling was an admirable and talented man who performed major intracranial operations on more than 130 patients suffering from trigeminal neuralgia, as well as treating epilepsy, craniotrauma, brain tumors, glossopharyngeal neuralgia, and myelomeningoceles. Although not in the same league as Harvey Cushing (1869-1939), Vilhelm Magnus in Norway (1871-1929), and Herbert Olivecrona in Sweden (1891-1980), Sølling was a true Danish pioneer.