scholarly journals Harvey Cushing’s management of neurogenic thoracic outlet syndrome

2019 ◽  
Vol 130 (3) ◽  
pp. 712-715
Author(s):  
Courtney Pendleton ◽  
Allan J. Belzberg ◽  
Robert J. Spinner ◽  
Alfredo Quinones-Hinojosa
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Johns Hopkins Hospital ◽  
Single Patient ◽  
Detailed Review ◽  
Cervical Rib ◽  
Harvey Cushing ◽  
Operative Report ◽  
Nerve Surgery

Harvey Cushing is widely regarded as one of the forefathers of neurosurgery, and is primarily associated with his work on intracranial pathology. However, he had a clinical and academic interest in peripheral nerve surgery. Through the courtesy of the Alan Mason Chesney Medical Archives, the surgical records of the Johns Hopkins Hospital from 1896 to 1912 were reviewed. The records of a single patient undergoing brachial plexus exploration and cervical rib resection were selected for detailed review. The operative report and accompanying illustrations demonstrate Cushing’s interest in adding approaches to the pathology of the brachial plexus to his operative armamentarium.

Reflections on the contributions of Harvey Cushing to the surgery of peripheral nerves

2011 ◽  
Vol 114 (5) ◽  
pp. 1442-1448 ◽  
Author(s):  
R. Shane Tubbs ◽  
Neal Patel ◽  
Brian Vala Nahed ◽  
Aaron A. Cohen-Gadol ◽  
Robert J. Spinner
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Johns Hopkins Hospital ◽  
Nerve Reconstruction ◽  
Surgical Resident ◽  
Nerve Blocks ◽  
Peripheral Nerve Surgery ◽  
Harvey Cushing ◽  
Operative Notes ◽  
Nerve Surgery

By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor.

scholarly journals Current Concept in Adult Peripheral Nerve and Brachial Plexus Surgery

2017 ◽  
Vol 12 (01) ◽  
pp. e7-e14 ◽  
Author(s):  
Lukas Rasulic
Keyword(s):  
Minimally Invasive ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Soft Tissue Injuries ◽  
Minimal Invasive ◽  
Peripheral Nerve Surgery ◽  
Nerve Conduits ◽  
Nerve Surgery ◽  
Brachial Plexus Surgery ◽  
New Generation

AbstractPeripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years—endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.

Posterior Subscapular Approach to the Brachial Plexus

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-377-ONS-381 ◽  
Author(s):  
Gabriel C. Tender ◽  
David G. Kline
Keyword(s):  
Morbid Obesity ◽  
Brachial Plexus ◽  
Operative Technique ◽  
Thoracic Outlet Syndrome ◽  
Transverse Process ◽  
Senior Author ◽  
Anterior Neck ◽  
Spinal Nerves ◽  
Cervical Rib ◽  
The Past

Abstract THE POSTERIOR SUBSCAPULAR APPROACH to the brachial plexus is commonly indicated in patients with neural entrapment (neurogenic thoracic outlet syndrome, especially when associated with a large C7 transverse process or cervical rib) and paraspinal tumors or lacerating injuries involving the spinal nerves close to the spine. This approach is also preferred in patients with previous anterior neck operations and/or morbid obesity. We describe the anatomy and operative technique of this approach, which has been used by the senior author (DGK) for the past 25 years.

scholarly journals Introduction: Peripheral Nerve Surgery—Biology, Entrapment, and Injuries

2009 ◽  
Vol 26 (2) ◽  
pp. E1 ◽  
Author(s):  
Allan H. Friedman ◽  
W. Jeffrey Elias ◽  
Rajiv Midha
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Nerve Repair ◽  
Peripheral Nerve Injuries ◽  
Significant Progress ◽  
Vital Function ◽  
Harvey Cushing ◽  
Nerve Transfers ◽  
Electrophysiological Technique ◽  
Nerve Surgery

Surgery aimed at repairing damaged peripheral nerves has a long history. Refuting the timehonored nihilism of Hippocrates and Galen that an injured nerve cannot regain function, a few adventurous medieval surgeons attempted to repair severed nerves.6,8 However, the ability of a peripheral nerve repair to restore function was not generally accepted until 1800.1,4 Neurosurgeons, beginning with Harvey Cushing, have had an interest in repairing damaged peripheral nerves.2 Significant progress in the treatment of peripheral nerve injuries resulted from experience with the numerous injuries that occurred during World Wars I and II.3,7,12 Surgeons steadily defined the anatomy of peripheral nerves and developed techniques for decompressing and repairing peripheral nerves.9,11 Kline and Dejonge5 developed an intraoperative electrophysiological technique for detecting axons regenerating across a damaged segment of nerve. In the second 2 decades of the 20th century, distal nerve transfers were rediscovered whereby the proximal end of a less essential nerve is used to reinnervate the distal end of a nerve, providing a more vital function.10

Histopathological basis for neurogenic thoracic outlet syndrome

2008 ◽  
Vol 8 (4) ◽  
pp. 347-351 ◽  
Author(s):  
R. Shane Tubbs ◽  
Robert G. Louis ◽  
Christopher T. Wartmann ◽  
Robert Lott ◽  
Gina D. Chua ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Thoracic Outlet Syndrome ◽  
Immunohistochemical Analysis ◽  
Histopathological Changes ◽  
Histological Findings ◽  
Histological Changes ◽  
Cervical Rib ◽  
Lower Trunk ◽  
Human Cadavers ◽  
Cervical Ribs

Object To the best of the authors' knowledge, no report exists that has demonstrated the histopathological changes of neural elements within the brachial plexus as a result of cervical rib compression. Methods Four hundred seventy-five consecutive human cadavers were evaluated for the presence of cervical ribs. From this cohort, 2 male specimens (0.42%) were identified that harbored cervical ribs. One of the cadavers was found to have bilateral cervical ribs and the other a single right cervical rib. Following gross observations of the brachial plexus and, specifically, the lower trunk and its relationship to these anomalous ribs, the lower trunks were submitted for immunohistochemical analysis. Specimens were compared with two age-matched controls that did not have cervical ribs. Results The compressed plexus trunks were largely unremarkable proximal to the areas of compression by cervical ribs, where they demonstrated epi- and perineurial fibrosis, vascular hyalinization, mucinous degeneration, and frequent intraneural collagenous nodules. These histological findings were not seen in the nerve specimens in control cadavers. The epineurium was thickened with intersecting fibrous bands, and the perineurium appeared fibrotic. Many of the blood vessels were hyalinized. The nerve fascicles contained frequent intraneural collagenous nodules in this area, and focal mucinous degeneration was identified. Conclusions Cervical ribs found incidentally may cause histological changes in the lower trunk of the brachial plexus. The clinician may wish to observe or perform further evaluation in such patients.

George J. Heuer: forgotten pioneer neurosurgeon at The Johns Hopkins Hospital

2002 ◽  
Vol 96 (6) ◽  
pp. 1139-1146 ◽  
Author(s):  
William B. Borden ◽  
Rafael J. Tamargo
Keyword(s):  
World War I ◽  
Military Service ◽  
Clinical Work ◽  
Early Career ◽  
Johns Hopkins Hospital ◽  
Content Type ◽  
Harvey Cushing ◽  
Surgical Career ◽  
Nerve Surgery ◽  
Fine Print

✓ George J. Heuer was a pioneer in neurosurgery at The Johns Hopkins Hospital in the early 20th century; he trained under Harvey Cushing and acted as a mentor to Walter Dandy. In his early career, Heuer focused on research and clinical work in the field of neurosurgery and temporarily led the neurosurgery section at Johns Hopkins. One of his most important contributions to neurosurgery was the modern frontotemporal craniotomy. This elegant craniotomy, which initially was used to approach chiasmal tumors, developed into the modern frontosphenotemporal craniotomy, which neurosurgeons use to approach numerous tumors as well as most aneurysms. Although Dandy is frequently credited with inventing this operation, his article detailing the new approach clearly attributes its origin to Heuer, who was serving in World War I when the new technique was presented. Although he had hoped to lead the neurosurgical section at Johns Hopkins permanently, he returned from military service to find that Dandy had been appointed to this position. Heuer subsequently advanced to a distinguished career in general surgery as the chairman of surgery at two institutions, and was known for his contributions to surgical education. Throughout his academic years, Heuer continued to operate on the nervous system and to perform spinal cord and peripheral nerve surgery. He played an important role along with Cushing and Dandy in the creation of neurosurgery as a specialty, but he is rarely given credit for this accomplishment. The authors describe Heuer's contributions to neurosurgery as well as his distinguished surgical career.

Complication Avoidance in Peripheral Nerve Surgery: Preoperative Evaluation of Nerve Injuries and Brachial Plexus Exploration—part 1

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-441-ONS-448 ◽  
Author(s):  
Stephen M. Russell ◽  
David G. Kline
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Preoperative Evaluation ◽  
Nerve Injuries ◽  
Peripheral Nerve Surgery ◽  
Intraoperative Assessment ◽  
Nerve Surgery

Abstract Complication avoidance during peripheral nerve surgery has received little attention in the neurosurgical literature. The goal of our two-part review is to discuss these possible complications, with this initial article highlighting the pitfalls associated with pre- and intraoperative assessment of nerve injuries, as well as the operative nuances used during brachial plexus exploration to minimize complications.

scholarly journals Supraclavicular Resection of a Cervical Rib Causing Thoracic Outlet Syndrome: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (5) ◽  
pp. E520-E520
Author(s):  
Stephen Shelby Burks ◽  
Erin M Wolfe ◽  
Jang Won Yoon ◽  
Allan D Levi
Keyword(s):  
Brachial Plexus ◽  
Clinical Improvement ◽  
Anterior Approach ◽  
Thoracic Outlet Syndrome ◽  
Cervical Vertebrae ◽  
Cervical Rib ◽  
Rib Resection ◽  
Lower Trunk ◽  
Neurogenic Thoracic Outlet Syndrome

Abstract Presence of a cervical rib results from overdevelopment of the seventh cervical vertebrae.1-3 The cervical rib along with scalene muscles can cause neurogenic thoracic outlet syndrome.4,5 Rib resection is typically done via anterior approach, using either supraclavicular or transaxillary route.6,7 We present an operative video detailing supraclavicular resection of a cervical rib causing neurogenic thoracic outlet syndrome with direct decompression of the lower trunk of the brachial plexus. The patient presented with severe symptoms including hand atrophy. We were able to directly visualize the rib and resect it, along with scalene musculature. We present 3-mo follow-up data noting clinical improvement in neuropathic symptoms.

Sign in / Sign up

Export Citation Format

Share Document