The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal

Aaron Cohen-Gadol, Edward R. Laws, Dennis D. Spencer, Antonio A F De Salles

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

The evolution of transsphenoidal surgery represents a special chapter in the progress of neurosurgery. Although Cushing initially advocated a transsphenoidal approach to pituitary tumors, he became disenchanted with this approach, ultimately favoring the subfrontal or "transfrontal" route late in his career. Other neurosurgeons followed Cushing's example, and the fate of transsphenoidal surgery entered a dark era in 1929. A review of Cushing's patients' records reveals that his abandonment of the transsphenoidal route was primarily related to the limitations of this approach in providing effective resection of large pituitary lesions - the symptomatic tumor recurrence rate after this procedure was substantial. Furthermore, given the preoperative uncertainty about the suprasellar extension of pituitary tumors prior to modern neuroimaging, the transfrontal route assured Cushing an adequate decompression of the optic chiasm. By 1927, Cushing's mastery of intracranial surgery was accompanied by the use of electrosurgical methods that enabled him to remove sellar lesions through the transfrontal route safely and with timely and effective restoration of visual loss. Transsphenoidal surgery remained relatively dormant, awaiting the efforts and enthusiasm of Norman Dott who bridged the gap between Cushing and Gerard Guiot, the surgeon who revitalized transsphenoidal adenomectomy for future generations of pituitary surgeons.

Original languageEnglish (US)
Pages (from-to)372-377
Number of pages6
JournalJournal of Neurosurgery
Volume103
Issue number2
DOIs
StatePublished - Aug 2005
Externally publishedYes

Fingerprint

Pituitary Neoplasms
Optic Chiasm
Social Responsibility
Neurosurgery
Decompression
Neuroimaging
Uncertainty
Recurrence
Neoplasms
Surgeons

Keywords

  • Harvey W. Cushing
  • History of neurosurgery
  • Pituitary tumor
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal. / Cohen-Gadol, Aaron; Laws, Edward R.; Spencer, Dennis D.; De Salles, Antonio A F.

In: Journal of Neurosurgery, Vol. 103, No. 2, 08.2005, p. 372-377.

Research output: Contribution to journalArticle

Cohen-Gadol, Aaron ; Laws, Edward R. ; Spencer, Dennis D. ; De Salles, Antonio A F. / The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal. In: Journal of Neurosurgery. 2005 ; Vol. 103, No. 2. pp. 372-377.
@article{8206e25a95044feb85029c4ea0101247,
title = "The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal",
abstract = "The evolution of transsphenoidal surgery represents a special chapter in the progress of neurosurgery. Although Cushing initially advocated a transsphenoidal approach to pituitary tumors, he became disenchanted with this approach, ultimately favoring the subfrontal or {"}transfrontal{"} route late in his career. Other neurosurgeons followed Cushing's example, and the fate of transsphenoidal surgery entered a dark era in 1929. A review of Cushing's patients' records reveals that his abandonment of the transsphenoidal route was primarily related to the limitations of this approach in providing effective resection of large pituitary lesions - the symptomatic tumor recurrence rate after this procedure was substantial. Furthermore, given the preoperative uncertainty about the suprasellar extension of pituitary tumors prior to modern neuroimaging, the transfrontal route assured Cushing an adequate decompression of the optic chiasm. By 1927, Cushing's mastery of intracranial surgery was accompanied by the use of electrosurgical methods that enabled him to remove sellar lesions through the transfrontal route safely and with timely and effective restoration of visual loss. Transsphenoidal surgery remained relatively dormant, awaiting the efforts and enthusiasm of Norman Dott who bridged the gap between Cushing and Gerard Guiot, the surgeon who revitalized transsphenoidal adenomectomy for future generations of pituitary surgeons.",
keywords = "Harvey W. Cushing, History of neurosurgery, Pituitary tumor, Transsphenoidal surgery",
author = "Aaron Cohen-Gadol and Laws, {Edward R.} and Spencer, {Dennis D.} and {De Salles}, {Antonio A F}",
year = "2005",
month = "8",
doi = "10.3171/jns.2005.103.2.0372",
language = "English (US)",
volume = "103",
pages = "372--377",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "2",

}

TY - JOUR

T1 - The evolution of Harvey Cushing's surgical approach to pituitary tumors from transsphenoidal to transfrontal

AU - Cohen-Gadol, Aaron

AU - Laws, Edward R.

AU - Spencer, Dennis D.

AU - De Salles, Antonio A F

PY - 2005/8

Y1 - 2005/8

N2 - The evolution of transsphenoidal surgery represents a special chapter in the progress of neurosurgery. Although Cushing initially advocated a transsphenoidal approach to pituitary tumors, he became disenchanted with this approach, ultimately favoring the subfrontal or "transfrontal" route late in his career. Other neurosurgeons followed Cushing's example, and the fate of transsphenoidal surgery entered a dark era in 1929. A review of Cushing's patients' records reveals that his abandonment of the transsphenoidal route was primarily related to the limitations of this approach in providing effective resection of large pituitary lesions - the symptomatic tumor recurrence rate after this procedure was substantial. Furthermore, given the preoperative uncertainty about the suprasellar extension of pituitary tumors prior to modern neuroimaging, the transfrontal route assured Cushing an adequate decompression of the optic chiasm. By 1927, Cushing's mastery of intracranial surgery was accompanied by the use of electrosurgical methods that enabled him to remove sellar lesions through the transfrontal route safely and with timely and effective restoration of visual loss. Transsphenoidal surgery remained relatively dormant, awaiting the efforts and enthusiasm of Norman Dott who bridged the gap between Cushing and Gerard Guiot, the surgeon who revitalized transsphenoidal adenomectomy for future generations of pituitary surgeons.

AB - The evolution of transsphenoidal surgery represents a special chapter in the progress of neurosurgery. Although Cushing initially advocated a transsphenoidal approach to pituitary tumors, he became disenchanted with this approach, ultimately favoring the subfrontal or "transfrontal" route late in his career. Other neurosurgeons followed Cushing's example, and the fate of transsphenoidal surgery entered a dark era in 1929. A review of Cushing's patients' records reveals that his abandonment of the transsphenoidal route was primarily related to the limitations of this approach in providing effective resection of large pituitary lesions - the symptomatic tumor recurrence rate after this procedure was substantial. Furthermore, given the preoperative uncertainty about the suprasellar extension of pituitary tumors prior to modern neuroimaging, the transfrontal route assured Cushing an adequate decompression of the optic chiasm. By 1927, Cushing's mastery of intracranial surgery was accompanied by the use of electrosurgical methods that enabled him to remove sellar lesions through the transfrontal route safely and with timely and effective restoration of visual loss. Transsphenoidal surgery remained relatively dormant, awaiting the efforts and enthusiasm of Norman Dott who bridged the gap between Cushing and Gerard Guiot, the surgeon who revitalized transsphenoidal adenomectomy for future generations of pituitary surgeons.

KW - Harvey W. Cushing

KW - History of neurosurgery

KW - Pituitary tumor

KW - Transsphenoidal surgery

UR - http://www.scopus.com/inward/record.url?scp=25444522650&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25444522650&partnerID=8YFLogxK

U2 - 10.3171/jns.2005.103.2.0372

DO - 10.3171/jns.2005.103.2.0372

M3 - Article

C2 - 16175871

AN - SCOPUS:25444522650

VL - 103

SP - 372

EP - 377

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 2

ER -