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

Courtney Pendleton, Alessandro Olivi, George I. Jallo, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

Abstract

Introduction: 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.

Original languageEnglish (US)
Pages (from-to)1145-1148
Number of pages4
JournalChild's Nervous System
Volume27
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

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Choroid Plexus Neoplasms
Lateral Ventricles
Pediatrics
History
Cerebellar Neoplasms
Cranial Nerves
Research Ethics Committees
Neurologic Examination
Blindness
Hydrocephalus
Diagnostic Errors
Neuroimaging
Physical Examination
Heart Ventricles
Headache
Early Diagnosis
Autopsy
Pathology
Population
Neurosurgeons

Keywords

  • Choroid plexus tumor
  • Harvey Cushing
  • Pediatric neurosurgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

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. / Pendleton, Courtney; Olivi, Alessandro; Jallo, George I.; Quinones-Hinojosa, Alfredo.

In: Child's Nervous System, Vol. 27, No. 7, 07.2011, p. 1145-1148.

Research output: Contribution to journalArticle

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