Harvey Cushing's operative treatment of metastatic breast cancer to the central nervous system in the early 1900s

Background: A review of the surgical cases of Harvey Cushing, MD, at The Johns Hopkins Hospital provided insight into his early work treating breast cancer metastasis to the central nervous system (CNS). At the time, neurologic surgery was in its infancy. Metastases of breast carcinoma to the CNS were recognized; however, many surgeons of the era adhered to a general principle of not operating in these situations. Methods: The Johns Hopkins Hospital surgical records from 1896 to 1912 were reviewed. Four cases in which Cushing treated patients with a history of breast cancer who were diagnosed as having CNS metastasis were selected for further study. Results: Cushing performed surgery on 4 patients with suspected CNS metastasis in the early 1900s. For a spinal metastasis, Cushing performed a laminectomy and intradural exploratory surgery. His treatments in cerebral cases sought to relieve increased intracranial pressure through decompression. He resected the lesions when they could be located. Conclusions: From the start of his career as a neurosurgeon, Cushing chose to perform surgery on patients with suspected CNS metastasis in an attempt to palliate some of their symptoms. Although his patients did not survive long after the procedures, they did experience temporary relief of symptoms that likely encouraged Cushing's continued operations in such situations and laid the foundation for future therapies for these patients.