title: Unique challenges faced by pediatric neurosurgeon Harvey Cushing in 1909 at Johns Hopkins: a choroid plexus tumor of the lateral ventricle mimicking a cerebellar lesion.
abstract: BACKGROUND
  At the turn of the twentieth century, diagnosis of pediatric intracranial lesions frequently relied exclusively on the subtle, nonspecific signs associated with these pathologies. In absence of detailed neuroimaging, erroneous diagnoses and misdirected operative explorations were common within pediatric populations.
  
  
  METHODS
  Following institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the surgical files from the Johns Hopkins Hospital for the years 1896-1912. Harvey Cushing's neurosurgical cases were collected and further analyzed.
  
  
  RESULTS
  A 9-year-old boy presented with a year-long history of headaches and blindness. His neurological examination was remarkable for focal cranial nerve deficits and cerebellar signs. Cushing diagnosed a cerebellar tumor with hydrocephalus and performed two suboccipital explorations with negative results. The patient died prior to further operative intervention, and the postmortem examination revealed a large choroid plexus tumor within the left lateral ventricle.
  
  
  CONCLUSIONS
  Early neurosurgical diagnosis and operative planning was fraught with difficulties, and surgeons relied solely on history and physical examination for localization of intracranial lesions. Here we report a case of a choroid plexus tumor of the lateral ventricle, which was misdiagnosed by Cushing. This case serves to emphasize the unique challenges faced by pediatric neurosurgeons at the turn of the twentieth century, who relied solely on history and examination to localize intracranial lesions.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Pendleton
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000266:history* / Q000601:surgery; D002648:Child; D016545:Choroid Plexus Neoplasms / Q000175:diagnosis / Q000266:history*; D003951:Diagnostic Errors / Q000266:history*; D049673:History, 20th Century; D006801:Humans; D020547:Lateral Ventricles / Q000473:pathology*; D008297:Male; D008487:Medical History Taking; D009493:Neurosurgery / Q000266:history*; D010372:Pediatrics / Q000266:history; D010808:Physical Examination / Q000266:history