title: Sellar door: Harvey Cushing's entry into the pituitary gland, the unabridged Johns Hopkins experience 1896-1912.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Pendleton
authors.forename: Hadie
authors.initials: H
authors.lastname: Adams
authors.forename: Nestoras
authors.initials: N
authors.lastname: Mathioudakis
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore; D005260:Female; D049672:History, 19th Century; D049673:History, 20th Century; D006785:Hospitals, University / Q000266:history*; D006801:Humans; D007016:Hypophysectomy / Q000266:history*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000266:history*; D010900:Pituitary Diseases / Q000175:diagnosis / Q000266:history* / Q000601:surgery; D055815:Young Adult
references.citation: Neurosurgery. 2003 Apr;52(4):914-25; discussion 925-6
references.pmid: 12657189
references.citation: Pituitary. 2004;7(1):33-8
references.pmid: 15638296
references.citation: J Neurosurg. 2005 Dec;103(6):1096-104
references.pmid: 16381201
references.citation: JAMA. 1968 Jan 8;203(2):73-8
references.pmid: 5694073
references.citation: J Neurosurg. 2005 Sep;103(3):570-4
references.pmid: 16235694
references.citation: Ann Surg. 1909 Dec;50(6):1002-17
references.pmid: 17862444
references.citation: J Neurosurg. 1981 Apr;54(4):448-54
references.pmid: 7009800
references.citation: Nat Rev Endocrinol. 2010 Jan;6(1):48-52
references.pmid: 20010970
references.citation: Ann Otolaryngol Chir Cervicofac. 1966 Jun;83(6):466-71
references.pmid: 5944227
references.citation: Pituitary. 2010 Dec;13(4):324-8
references.pmid: 20607416
references.citation: Trans Am Acad Ophthalmol Otolaryngol. 1962 Jan-Feb;66:103-10
references.pmid: 13865720
references.citation: Ann Surg. 1913 Feb;57(2):145-50
references.pmid: 17862963
references.citation: Trans Pac Coast Otoophthalmol Soc Annu Meet. 1961;42:273-86
references.pmid: 13904062
references.citation: Br Med J. 1957 Apr 20;1(5024):903-10
references.pmid: 13413249
references.citation: J Physiol. 1902 Sep 12;28(5):325-53
references.pmid: 16992627
references.citation: Arch Otolaryngol. 1961 Jul;74:2-8
references.pmid: 13710960
references.citation: Br Med J. 1893 Dec 30;2(1722):1421-3
references.pmid: 20754579
references.citation: Pituitary. 2011 Mar;14(1):53-60
references.pmid: 20821269