Harvey Cushing's Influence on Norman Dott's Work on Acromegaly: Pituitary Research, Treatment Modalities, and Research Dissemination c.1900-c.1960.

OBJECTIVE: To review Dr. Harvey Cushing's influence on Mr. Norman Dott's work on acromegaly and other subjects surrounding the pituitary gland such as pituitary research, treatment modalities, and research dissemination. Dott was the first Professor of Neurosurgery in Scotland during 1947 and was considered a pioneer of the understanding and treatment modalities for pituitary disorders such as acromegaly. During 1923, he published an article regarding pituitary physiology that won him the award for the Rockefeller Fellowship Trust, to travel to Boston Massachusetts, giving him the opportunity to train under Cushing's supervision for the years of 1923-1924. However, similarities can be seen between Dott's physiology project that was completed before he ever met Cushing, as well as his treatment suggestions for acromegaly, after he had finished his training under Cushing's supervision. METHODS: This was a historical perspective based on literature review. We reviewed Norman Dott's archives held by University of Edinburgh Library or online sources and we compared these with the work Cushing had previously performed in a chronological fashion. Cushing's work on the pituitary gland and acromegaly can be largely found online, in biographical books, and in other secondary sources. The search included words such as "transsphenoidal surgery," "x-ray," "Harvey Cushing," "Norman Dott," "Acromegaly," "Annual Meetings," and "Pituitary physiology." We excluded any primary sources that were not published between 1900 and 1960 regarding either pituitary physiology or the treatments for acromegaly. CONCLUSIONS: Sir Norman Dott was the first Professor of Neurosurgery in Scotland during 1947 and is well known for his pioneering work on intracranial aneurysms. Although less well known for his contribution to pituitary pathologies, we would like to share his contribution in this regard and correlate it with Cushing's influence.

Sellar door: Harvey Cushing's entry into the pituitary gland, the unabridged Johns Hopkins experience 1896-1912.

OBJECTIVE: To review the original surgical records from the Johns Hopkins Hospital, and analyze the records of patients Cushing treated for pituitary disorders from 1896 to 1912. METHODS: Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the original surgical files from the Johns Hopkins Hospital. Patients presenting with pituitary-related symptoms, who underwent surgical treatment directed at the pituitary gland, were selected for further review. RESULTS: Thirty-seven patients who underwent surgical intervention for pituitary disorders were found. Of these patients, 12 were mentioned only briefly in Cushing's 1912 monograph, whereas 6 were not described at all. The remaining 19 were documented by Cushing in his 1912 monograph. Cushing used three main surgical approaches to the pituitary: transsphenoidal, transcranial, and the subfrontal "omega incision." There were 6 inpatient deaths. The mean time to last follow-up was 41.0 months. At follow-up, headache was the most common unresolved symptom. CONCLUSION: This review highlights Cushing's accomplishments in the surgical treatment of suspected pituitary pathology during his early career as a young attending at Johns Hopkins Hospital. It reveals new information about patients whom Cushing did not include in his publications detailing his surgical experience at the Johns Hopkins Hospital.

Pituitary surgery: legacies from the past.

Pituitary surgery is a recent development in neurosurgery and most of the surgical techniques concerned have been described within the last century. We provide a historical perspective by reviewing the major steps in the development of this neurosurgical subspecialty through the ages. We concentrate on the most important figures whose advances in the study of the physiology and anatomy of the pituitary are most significant. This journey into the past will demonstrate that our current knowledge is the summation of a long road of investigation.

Centenary of the first trans-sphenoidal surgery of the hypophysis (Hermann Schloffer 1907) and its echoes within Croatian neurosurgical practice.

In this paper we aim to reminisce the role of the Austrian surgeon Hermann Schloffer (1868-1937) as the pioneer of a trans-sphenoidal approach to the pituitary gland. On the 16th of March 1907 he operated a patient with pituitary tumor and published his report in the Wiener Klinische Wochenschrift on 23rd May 1907. This paper is to recall the 100th anniversary of this event. Schloffer's method was spread and modified worldwide, Croatia included, a country in which the interest in trans-sphenoidal approach to pituitary tumors has not diminished or been lost, but slowly modified. Today, almost a whole century after its introduction, it is still used to operate about 95% of sellar region tumors.

History of pituitary surgery from the technical aspect.

Transcranial and trans-sphenoidal pituitary surgery were developed independently with few exceptions by different groups of surgeons. The transcranial approaches, primarily the transfrontal-parasagittal and the frontotemporal along the sphenoid ridge, evolved without many variations within a short time span. The trans-sphenoidal exposures of the pituitary, on the contrary, underwent many modifications provoked by the fear of postoperative meningitis and the search for improved vision through the narrow alley leading to the target. Only Guiot in 1978 ended the extensive discussion by convincingly demonstrating that well-defined indications existed for each procedure. Improvement of diagnostic and surgical tools was a major factor for refining the surgical technique and improving the surgical results.

[History of pituitary surgery in humans and animals: from experiments with dogs to treatment of patients]. / Geschiedenis van de hypofysechirurgie bij mens en dier: van experimenten bij honden naar behandeling van patiënten.

At the end of the 19th century and the start of the 20th century experimental hypophysectomy was carried out on cats and dogs, by means of the lateral temporal approach, to investigate the physiological role of the pituitary gland because there was a debate as to whether the pituitary gland was essential for life. At the same time pioneering neurosurgeons such as Harvey Cushing used animal experiments to explore the different approaches to the neurocranium and the pituitary, thereby taking the first steps towards neurosurgery in humans. Eventually the transsphenoidal route was chosen for such an operation. Veterinary medicine has benefited from these developments in the medical field. For the past few decades, hypophysectomy has been used for the treatment of pituitary adenomas in dogs and cats that are kept as pets.

History of surgery for craniopharyngiomas.

Craniopharyngiomas, although histologically benign, are usually so intimately associated with the hypothalamus that total extirpation of these tumors was generally followed by death from hypotension and gross endocrine deficiencies. During the first half of the present century, those recording their tribulations include the famous names of Grant, Bailey, Bucy, Peet, Kahn, Olivecrona, Norlen, Sjöqvist, Rougerie and Northfield. Matson and Sweet were the first to achieve major reductions in mortality by giving massive doses of cortisone plus meticulous dissection, which took advantage of the reactive glial envelope which surrounds the great majority of these tumors.

Antecedentes históricos de la hipofisectomía / Historical antecedents of hypophysectomy

La cirugía hopofisaria comenzó a finales del siglo XIX, la aproximación del seno esfenoidal por la vía intranasal constituyó uno de los primeros métodos intracraneanos para la resección de los tumores hipofisarios, sin embargo, tuvo el inconveniente de comprometer la funcionalidad y la estética nasal; por lo que Killian introduce la técnica transesfenoidal por vía submucosa nasal, que sería mejorada por Hirschen 1909. Cushing en 1914 describe el abordaje transesfenoidal por la incisión sublabial para poder resecar el septum y permitir así una ruta transnasal media hacia el esfenoides y la glándula hipófisis, la cual tuvo gran aceptación por su baja morbi-mortalidad. Con el progreso de la medicina operatoria en los ultimos 30 años y con la introducción del microscopio quirúrgico por Hardy y Guiot. Se presenta el concepto de la resección selectiva de microadenomas hipofisarios por vía transesfenoidal. En las últimas 2 décadas, Kern ha demostrado la utilidad del abordaje transeptal-trasesfenoidal con el método de la vía maxila-premaxila. Por su parte, los doctores mexicanos: Gutiérrez Marcos, Azuara Pliego y Quezada González entre otros, destacan la vía transeptal-transesfenoidal como el método de elección para la resección de los microadenomas hipofisarios.

Antecedentes históricos de la hipofisectomía / Historical background of hypophysectomy

La cirugía hopofisaria comenzó a finales del siglo XIX, la aproximación del seno esfenoidal por la vía intranasal constituyó uno de los primeros métodos intracraneanos para la resección de los tumores hipofisarios, sin embargo, tuvo el inconveniente de comprometer la funcionalidad y la estética nasal; por lo que Killian introduce la técnica transesfenoidal por vía submucosa nasal, que sería mejorada por Hirschen 1909. Cushing en 1914 describe el abordaje transesfenoidal por la incisión sublabial para poder resecar el septum y permitir así una ruta transnasal media hacia el esfenoides y la glándula hipófisis, la cual tuvo gran aceptación por su baja morbi-mortalidad. Con el progreso de la medicina operatoria en los ultimos 30 años y con la introducción del microscopio quirúrgico por Hardy y Guiot. Se presenta el concepto de la resección selectiva de microadenomas hipofisarios por vía transesfenoidal. En las últimas 2 décadas, Kern ha demostrado la utilidad del abordaje transeptal-trasesfenoidal con el método de la vía maxila-premaxila. Por su parte, los doctores mexicanos: Gutiérrez Marcos, Azuara Pliego y Quezada González entre otros, destacan la vía transeptal-transesfenoidal como el método de elección para la resección de los microadenomas hipofisarios.(AU)