William Osler and “the special field of neurological surgery”

1989 ◽  
Vol 70 (5) ◽  
pp. 759-766 ◽  
Author(s):  
D. J. Canale
Keyword(s):  
United States ◽  
The United States ◽  
Positive Influence ◽  
Johns Hopkins Hospital ◽  
Surgical Specialty ◽  
Content Type ◽  
Considerable Contribution ◽  
Neurological Surgery ◽  
William Osler ◽  
Fine Print

✓ Harvey Cushing's paper, “The special field of neurological surgery,” published in the Bulletin of The Johns Hopkins Hospital in 1905, constitutes a recognized milestone in the establishment of neurological surgery as a separate surgical specialty in the United States. The main point the author wishes to make here is that the very special friendship of Sir William Osler, influencing, encouraging, stimulating Cushing at the particular time that it did (1901 to 1905), was probably the primary positive influence that made it possible for Cushing to achieve specialization in neurological surgery and to make his considerable contribution in this field.

Residency training in neurological surgery, 1934–1984: evolution over 50 years of trial and tribulation

1984 ◽  
Vol 61 (6) ◽  
pp. 999-1004 ◽  
Author(s):  
Byron Cone Pevehouse
Keyword(s):  
United States ◽  
Socioeconomic Factors ◽  
Residency Training ◽  
American Association ◽  
The United States ◽  
Neurosurgical Training ◽  
Professional Liability ◽  
Content Type ◽  
Neurological Surgery ◽  
Fine Print

✓ The President of the American Association of Neurological Surgeons (AANS) reviews formal neurosurgical training in the United States from its inception with one program in 1934 to 1984, with 94 programs and 650 residents. He reports on the 1st year's experience with a national neurosurgical residency matching plan. He presents realistic remedies for today's professional liability dilemma and analyzes socioeconomic factors that have led to the complex challenges facing neurosurgeons in this decade, relating the importance of the AANS mission and goals in resolving these issues.

Neurological surgery in our changing times

1972 ◽  
Vol 37 (3) ◽  
pp. 255-268 ◽  
Author(s):  
Guy L. Odom
Keyword(s):  
United States ◽  
The United States ◽  
Curricular Change ◽  
Content Type ◽  
Federal Support ◽  
Complicated Process ◽  
Changing Times ◽  
Neurological Surgery ◽  
Specific Number ◽  
Fine Print

The President of the AANS evaluates the need for more neurosurgeons in the United States and concludes, on the basis of detailed surveys and analyses, that the field is nearing saturation. His evidence includes the effects of curricular change, the complicated process of accreditation, the shifting course of Federal support, the geographic distribution of neurosurgeons, the specific number of operations performed, and the effect of fragmentation within the specialty of neurosurgery.

The crucial decade: modern neurosurgery's definitive development in Harvey Cushing's early research and practice, 1900 to 1910

1997 ◽  
Vol 87 (6) ◽  
pp. 964-971 ◽  
Author(s):  
Samuel H. Greenblatt
Keyword(s):  
Clinical Success ◽  
Surgical Techniques ◽  
Scientific Work ◽  
The United States ◽  
Full Time ◽  
Content Type ◽  
Social Ability ◽  
Harvey Cushing ◽  
Neurological Surgery ◽  
Fine Print

✓ When Harvey Cushing announced his full-time commitment to neurological surgery in 1904, it was a discouraging and discouraged enterprise. Other surgeons' mortality rates for patients with brain tumors were 30 to 50%. By 1910 Cushing had operated on 180 tumors; he had a thriving practice, with a patient mortality rate of less than 13%. The three essential ingredients of his success were: 1) a new surgical conceptualization of intracranial pressure (ICP); 2) technical innovations for controlling ICP; and 3) establishment of a large referral base. In the years 1901 through 1905, the implications of his research on the “Cushing reflex” were quickly translated into surgical techniques for controlling ICP. In the period between 1906 and 1910, Cushing built up his referral practice by publishing widely, and especially by lecturing to medical audiences throughout the United States and Canada. His scientific work on ICP was essential to his clinical success, but without his professional and social ability to build a thriving practice, there would have been insufficient material for him to use to improve his approaches.

Mr. Jefferson's Rotunda

1992 ◽  
Vol 76 (5) ◽  
pp. 883-884
Author(s):  
Raymond C. Bice
Keyword(s):  
United States ◽  
Architectural Design ◽  
The United States ◽  
Thomas Jefferson ◽  
University Of Virginia ◽  
Content Type ◽  
The University ◽  
To Receive ◽  
Fine Print

✓ After retiring from the presidency of the United States, Thomas Jefferson concentrated his latter years on establishing The University of Virginia. He personally undertook the design of the buildings and directed the early days of the institution. The Rotunda, with its famous Dome Room and outside porticos, continues to receive critical acclaim for its architectural design.

Infinite needs: finite resources

1986 ◽  
Vol 65 (4) ◽  
pp. 435-438 ◽  
Author(s):  
Richard D. Lamm
Keyword(s):  
United States ◽  
Health Care ◽  
Delivery Of Health Care ◽  
The United States ◽  
Careful Evaluation ◽  
Content Type ◽  
Constitutional Government ◽  
Basic Institution ◽  
Fine Print

✓ In this 199th year of constitutional government in the United States a careful evaluation of all our basic institutions is required if this country is to remain a great nation. The delivery of health care, a basic institution, must be included in the determination of how finite resources can be most effectively and efficiently used for what appears to be almost infinite needs.

AANS Presidential Address: The tradition of Harvey Cushing commemorated by a stamp in the Great American stamp series

1987 ◽  
Vol 67 (5) ◽  
pp. 631-642 ◽  
Author(s):  
Robert G. Ojemann
Keyword(s):  
United States ◽  
Presidential Address ◽  
The United States ◽  
Postal Service ◽  
Postage Stamp ◽  
United States Postal Service ◽  
Content Type ◽  
Harvey Cushing ◽  
Fine Print ◽  
United States Postal

✓ With the announcement that Harvey Cushing is to be honored by a United States postage stamp in the Great American stamp series, the qualities that this remarkable man possessed are reviewed — artist, author, bibliophile, scientist, soldier, physician, and teacher. The events that led to Cushing becoming a neurosurgeon are summarized. The recognition by the United States Postal Service of physicians and others who have appeared on stamps that had some relationship to Cushing's activities is discussed. Based on the tradition of Harvey Cushing, eight guidelines are presented.

Intracranial sparganosis: an uncommon infection

1984 ◽  
Vol 60 (6) ◽  
pp. 1282-1286 ◽  
Author(s):  
Karl Anders ◽  
Kevin Foley ◽  
W. Eugene Stern ◽  
W. Jann Brown
Keyword(s):  
United States ◽  
Lower Extremity ◽  
Parietal Lobe ◽  
The United States ◽  
Pathological Features ◽  
Content Type ◽  
First Case ◽  
The Right ◽  
Clinical And Pathological Features ◽  
Fine Print

✓ The first case of intracranial sparganosis to be reported from the United States is presented. The patient, a 27-year-old woman, complained of focal seizures involving the right lower extremity. A left parietal parasagittal craniotomy was performed, and a granuloma containing a sparganum was excised from the parietal lobe. The clinical and pathological features of sparganosis are reviewed. Only five cases of intracranial sparganosis have previously been described.

Workforce demand for neurosurgeons in the United States of America: a 13-year retrospective study

1999 ◽  
Vol 90 (6) ◽  
pp. 993-997 ◽  
Author(s):  
Daniel L. Friedlich ◽  
Paul J. Feustel ◽  
A. John Popp
Keyword(s):  
United States ◽  
Retrospective Study ◽  
United States Of America ◽  
Private Practice ◽  
The United States ◽  
Content Type ◽  
The Past ◽  
Practice Size ◽  
Group Practices ◽  
Fine Print

Object. The workforce demand for neurosurgeons was quantified by a review and an analysis of journal recruitment advertisements published over the past 13 years.Methods. A retrospective analysis of recruitment advertisements from July 1985 through June 1998 was performed by examining issues of the Journal of Neurosurgery and Neurosurgery. Advertisement information that appeared in each journal during the last 3 years was collected from alternating months (July to May); information that appeared prior to that time was collected from alternating recruitment years back to 1985. The authors examined the following workforce parameters: practice venue, subspecialization, and practice size.They found no significant decrease in neurosurgical recruitment advertisements. There was an average of 102.7 ± 22.4 (standard deviation) advertised positions per year during the most recent 3 years compared with 92.6 ± 17.9 advertised positions per year during the preceding decade. Similarly, there has been no decline in advertised positions either in academic (33 ± 6.1/year for the most recent 3 years compared with 32.8 ± 5.9/year for 1985–1995) or private practice (69.7 ± 21.6/year for the most recent 3 years compared with 59.8 ± 13.4/year for 1985–1995). A shift in demand toward subspecialty neurosurgery was observed. During the past 3 years, 31.2 ± 5.9% of advertised positions called for subspecialty expertise, compared with 18.5 ± 2.8% for the preceding decade (p < 0.05). The largest number of subspecialty advertisements designated positions for spine and pediatric neurosurgeons. Private practice advertisements increasingly sought to add neurosurgeons to group practices.Conclusions. Contrary to previous reports and a prevailing myth, our data show no decrease in workforce demand for neurosurgeons in the United States over the past 3 years compared with the prior decade. A shift toward subspecialist recruitment, particularly for spine neurosurgeons, has been demonstrated in both academic and private practice venues.

The descriptive epidemiology of craniopharyngioma

1998 ◽  
Vol 89 (4) ◽  
pp. 547-551 ◽  
Author(s):  
Greta R. Bunin ◽  
Tanya S. Surawicz ◽  
Philip A. Witman ◽  
Susan Preston-Martin ◽  
Faith Davis ◽  
...  
Keyword(s):  
United States ◽  
Brain Tumor ◽  
Los Angeles ◽  
Los Angeles County ◽  
The United States ◽  
Cancer Surveillance ◽  
Tumor Registry ◽  
Content Type ◽  
Cancer Data ◽  
Fine Print

Object. In this report the authors describe the epidemiology of craniopharyngioma. Methods. The incidence of craniopharyngioma in the United States was estimated from two population-based cancer registries that include brain tumors of benign and borderline malignancy: the Central Brain Tumor Registry of the United States (CBTRUS) and the Los Angeles county Cancer Surveillance Program. Information on additional pediatric tumors was available from the Greater Delaware Valley Pediatric Tumor Registry (GDVPTR). The overall incidence of craniopharyngioma was 0.13 per 100,000 person years and did not vary by gender or race. A bimodal distribution by age was noted with peak incidence rates in children (aged 5–14 years) and among older adults (aged 65–74 years in CBTRUS and 50–74 years in Los Angeles county). Survival information was available from GDVPTR and the National Cancer Data Base (NCDB), a hospital-based reporting system. In the NCDB, the 5-year survival rate was 80% and decreased with older age at diagnosis. Survival is higher among children and has improved in recent years. Conclusions. Craniopharyngioma is a rare brain tumor of uncertain behavior that occurs at a rate of 1.3 per million person years. Approximately 338 cases of this disease are expected to occur annually in the United States, with 96 occurring in children from 0 to 14 years of age.

Cervical spine stenosis secondary to ossification of the posterior longitudinal ligament

1987 ◽  
Vol 67 (3) ◽  
pp. 349-357 ◽  
Author(s):  
Griffith R. Harsh ◽  
George W. Sypert ◽  
Philip R. Weinstein ◽  
Donald A. Ross ◽  
Charles B. Wilson
Keyword(s):  
United States ◽  
Cervical Spine ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Posterior Longitudinal Ligament ◽  
Japanese Patients ◽  
The United States ◽  
Content Type ◽  
Canal Diameter ◽  
Operative Planning ◽  
Fine Print

✓ Ossification of the posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Reports of OPLL in North Americans are rare. Choices of diagnostic method and treatment for this entity remain controversial. The authors report the results of management of 20 patients in the United States with symptomatic OPLL of the cervical spine. These represented 10% to 20% of patients operated on over the last 3 years for myelopathy secondary to structural spinal compression. Most of these OPLL patients were Caucasian (60%), male (male:female 4:1), and middle-aged (median age 47.5 years). Six had previously undergone laminectomy or discectomy. Cervical roentgenograms and standard myelography occasionally suggested the diagnosis. Axial computerized tomography (CT) metrizamide myelography with small interslice intervals proved invaluable for diagnosis and operative planning. Magnetic resonance imaging was not necessary for diagnosis. Retrovertebral calcification extended over one to five bodies (mean 2.75). The mass ranged in size from 5 to 16 mm in anteroposterior diameter and reduced the residual canal diameter to a mean (± standard deviation) caliber of 9.42 ± 2.41 mm (mean narrowing ratio 0.44 ± 0.12). Anterior cervical decompression by medial corpectomy and discectomy with fusion uniformly reduced preoperative myelopathy. Complications were limited to transient neurological deterioration in two patients, recurrent laryngeal nerve palsy in one, and halo device pin site infections in two. At a mean postoperative interval of 15 months, improvement was seen in each category of deficit: extremity weakness, hypesthesia, hypertonia, and urinary dysfunction. All fusions produced solid unions. It is concluded that OPLL of the cervical spine is an unexpectedly prevalent cause of myelopathy among patients treated in the United States. Thin-section axial CT metrizamide myelography with small interslice intervals is essential for the investigation of patients who may have OPLL. Anterior decompression and stabilization by medial corpectomy, discectomy, removal of the calcified mass, and fusion is a safe and effective method of treatment.

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