title: Harvey Cushing's early treatment of meningiomas: the untold story.
abstract: BACKGROUND
  In his 1938 monograph, Cushing tabulated 313 meningioma cases treated throughout his career at the Johns Hopkins and the Peter Bent Brigham Hospitals. Of these, 18 patients were treated at the Johns Hopkins Hospital. Cushing provided basic demographic, perioperative, and outcomes data in his tables, but the operative details for many of his early meningioma cases have not been previously described.
  
  
  METHODS
  After institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical files for the Johns Hopkins Hospital from the period 1896 to 1912 were reviewed. Cases diagnosed as endothelioma or dural endothelioma were selected for further analysis.
  
  
  RESULTS
  Of the 14 patients with available records, 1 were male. The mean age was 34.4 years. Nine patients (64.3%) died during their inpatient stay. Cushing used staged resections in an attempt to minimize blood loss, morbidity, and mortality, albeit with limited success.
  
  
  CONCLUSIONS
  The operative details demonstrate Cushing's early attention to hemostasis, and use of staged resections in patients with large, highly vascular meningiomas. Cushing's first 18 cases of meningiomas, treated while a young attending physician at the Johns Hopkins Hospital, are not the most elegant operations in his lengthy series, but serve as an illustration of his ability to transform clinical challenges into opportunities for improvement.
authors: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors: Courtney
authors: C
authors: Pendleton
authors: Alessandro
authors: A
authors: Olivi
authors: Henry
authors: H
authors: Brem
authors: Alfredo
authors: A
authors: Quiñones-Hinojosa
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003399:Craniotomy; D017809:Fatal Outcome; D005260:Female; D006261:Headache / Q000209:etiology; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008579:Meningioma / Q000266:history* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009493:Neurosurgery / Q000266:history*; D019635:Neurosurgical Procedures / Q000401:mortality; D012640:Seizures / Q000209:etiology; D013524:Surgical Flaps; D055815:Young Adult