Acta Neurochirurgica

, Volume 153, Issue 5, pp 1043–1050

Harvey Cushing’s case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon’s quest to advance the treatment of the ‘suicide disease’

  • Hadie Adams
  • Courtney Pendleton
  • Katherine Latimer
  • Aaron A. Cohen-Gadol
  • Benjamin S. Carson
  • Alfredo Quinones-Hinojosa
Clinical Article

Abstract

Background

A review of Dr. Harvey Cushing’s surgical cases at the Johns Hopkins Hospital provided insight into his early work on trigeminal neuralgia (TN). There was perhaps no other affliction that captured his attention in the way that TN did, and he built a remarkable legacy of successful treatment. At the time, surgical interventions carried an operative mortality of 20%.

Methods

The Johns Hopkins Hospital surgical records from 1896–1912 were reviewed to contribute new cases to the 20 reports provided by Dr. Cushing in his early publications in 1900 and 1905. This review uncovered 123 TN cases, representing 168 interventions.

Results

At the start of his career, Cushing treated TN mainly through Gasserion ganglion extirpations and peripheral neurectomies; however, he nearly abandoned these methods in favor of sensory root avulsion after 1906 and did not perform alcohol injections until his later years at Hopkins. Overall, Cushing had a 0.6% mortality rate; additionally, 91% of patients were improved at the time of discharge. However, 26% of patients had a recurrence requiring further intervention by Cushing.

Conclusion

Modern day interventions of TN are reflective of the legacy left to us by Harvey Cushing, a pioneering forefather in neurosurgery. He pioneered the infra-arterial approach to excision of the Gasserion ganglion in face of problematic bleeding and later the use of sensory root avulsion to spare motor function. Through the evolution of his legacy and the refinement of original approaches, the quest to advance the treatment of TN took him along the trigeminal nerve from the periphery into the brain.

Keywords

Harvey Cushing Trigeminal Neuralgia 

References

  1. 1.
    Andre M (1756) Practical observations on urethral diseases, and factual information on convulsive facial contortions with principles for cure of associated gangrenous and cancerous conditions by use of various solvents and caustics. College of the Royal Academy [in French], ParisGoogle Scholar
  2. 2.
    Bell C (1821) On the nerves; giving an account of some experiments on their structure and functions, which lead to a new arrangement of the system. Philo Trans R Soc 111:398–424CrossRefGoogle Scholar
  3. 3.
    Bliss M (2005) Harvey Cushing: a life in surgery. Oxford University Press, New YorkGoogle Scholar
  4. 4.
    Brown JA, Coursaget C, Preul MC, Sangvai D (1999) Mercury water and cauterizing stones: Nicolas Andre and tic douloureux. J Neurosurg 90:977–981PubMedCrossRefGoogle Scholar
  5. 5.
    Cole CD, Liu JK, Apfelbaum RI (2005) Historical perspectives on the diagnosis and treatment of trigeminal neuralgia. Neurosurg Focus 18:E4PubMedCrossRefGoogle Scholar
  6. 6.
    Cushing H (1906) I. On preservation of the nerve supply to the brow, in the operative approach to the Gasserian ganglion. Ann Surg 43:1–4PubMedGoogle Scholar
  7. 7.
    Cushing H (1983) Landmark article April 28, 1900: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia. By a route through the temporal fossa and beneath the middle meningeal artery. By Harvey Cushing. JAMA 250:519–528PubMedCrossRefGoogle Scholar
  8. 8.
    Cushing H (1920) The major trigeminal neuralgias and their surgical treatmetn based on experiences with 332 Gaserian operations. First paper. The varieties of facial neuralgia. Am J Med Sci 160:157–185CrossRefGoogle Scholar
  9. 9.
    Cushing H (1900) A Method of Total Extirpation of the Gasserian Ganglion for Trigeminal Neuralgia. JAMA:1035–1041Google Scholar
  10. 10.
    Cushing H (1920) The role of deep alcohol injections in the treatment of trigeminal neuralgia. JAMA 75:441–443Google Scholar
  11. 11.
    Cushing H (1905) The surgical aspects of major neuralgia of the trigeminal nerve. JAMA:773–779Google Scholar
  12. 12.
    Dandy WE (1934) Concerning the cause of Trigeminal Neuralgia. Am J Surg:447–455Google Scholar
  13. 13.
    Dandy WE (1929) An operation for the cure of tic douloureux: partial section of the sensory root at the pons. Arch Surg 18:687–734. doi:10.1001/archsurg.1929.04420030081005 Google Scholar
  14. 14.
    Dandy WE (1925) Section of the sensory root of the trigeminal nerve at the pons—preliminary report of the operative procedure. Bull Johns Hopkins Hosp 36:105–106Google Scholar
  15. 15.
    Eboli P, Stone JL, Aydin S, Slavin KV (2009) Historical characterization of trigeminal neuralgia. Neurosurgery 64:1183–1186, discussion 1186–1187PubMedCrossRefGoogle Scholar
  16. 16.
    Eller JL, Raslan AM, Burchiel KJ (2005) Trigeminal neuralgia: definition and classification. Neurosurg Focus 18:E3PubMedCrossRefGoogle Scholar
  17. 17.
    Frazier CH (1928) Operation for the radical cure of trigeminal neuralgia: analysis of five hundred cases. Ann Surg 88:534–547PubMedCrossRefGoogle Scholar
  18. 18.
    Hartley F (1893) I. Intracranial Neurectomy of the Fifth Nerve. Ann Surg 17:511–526Google Scholar
  19. 19.
    Horowitz N, Rizzoli H (1967) Postoperative complications in neurosurgical practice: recognition, prevention and management. Williams & Wilkins, BaltimoreGoogle Scholar
  20. 20.
    Horsley V (1891) Remarks on the various surgical procedures devised for the relief or cure of trigeminal neuralgia (tic douloureux). Br Med J 2:1249–1252PubMedCrossRefGoogle Scholar
  21. 21.
    Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26(Suppl):159–162PubMedGoogle Scholar
  22. 22.
    Jannetta PJ (1993) Vascular compression is the cause of trigeminal neuralgia. APS J 2:217–227CrossRefGoogle Scholar
  23. 23.
    Jannetta PJ, Tew JM Jr (1979) Treatment of trigeminal neuralgia. Neurosurgery 4:93–94PubMedCrossRefGoogle Scholar
  24. 24.
    Katusic S, Beard CM, Bergstralh E, Kurland LT (1990) Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984. Ann Neurol 27:89–95PubMedCrossRefGoogle Scholar
  25. 25.
    Kellogg R, Pendleton C, Quinones-Hinojosa A, Cohen-Gadol AA (2010) Surgical treatment of trigeminal neuralgia: a history of early strides toward curing a “cancerous acrimony”. Neurosurgery 67:1419–1425. doi:10.1227/NEU.0b013e3181f0ef13, discussion 1425PubMedCrossRefGoogle Scholar
  26. 26.
    Krause F (1893) The question of priority in devising a method for the performance of intra-cranial neurectomy of the fifth nerve. Ann Surg 18:362–364PubMedCrossRefGoogle Scholar
  27. 27.
    Lewy F (1938) The first authentic case of major trigeminal neuralgia and some comments on the history of this disease. Ann Med Hist 10:247–250Google Scholar
  28. 28.
    Prasad S, Galetta S (2009) Trigeminal neuralgia: historical notes and current concepts. Neurologist 15:87–94PubMedCrossRefGoogle Scholar
  29. 29.
    Spiller WG, Frazier CH (1901) The division of the sensory root of the trigeminus for relief of tic douloureux: an experimental, pathological, and clinical study with a preliminary report of one surgically successful case. Phila Med J:1039–1049Google Scholar
  30. 30.
    Steel T, Burchiel K (2002) Ablative neurosurgical techniques in the treatment of chronic pain: overview. In: Burchiel K (ed) Surgical management of pain. Thieme, New York, pp 633–643Google Scholar
  31. 31.
    Stookey B (1959) Historical background of the neurological institute and the neurological societies. Bull NY Acad Med 35:707–729Google Scholar
  32. 32.
    Sweet WH (1984) Deafferentation pain after posterior rhizotomy, trauma to a limb, and herpes zoster. Neurosurgery 15:928–932PubMedCrossRefGoogle Scholar
  33. 33.
    Thomson EH (1961) Harvey Cushing: surgeon, author, artist. Collier, New YorkGoogle Scholar
  34. 34.
    Wilkins R (2002) Trigeminal neuralgia: historical overview, with emphasis on surgical treatment. In: Burchiel K (ed) Surgical management of pain. Thieme, New York, pp 288–301Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hadie Adams
    • 1
  • Courtney Pendleton
    • 1
  • Katherine Latimer
    • 1
  • Aaron A. Cohen-Gadol
    • 2
  • Benjamin S. Carson
    • 1
  • Alfredo Quinones-Hinojosa
    • 1
    • 3
  1. 1.Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Goodman Campbell Brain and Spine & Indiana University Department of NeurosurgeryIndianapolisUSA
  3. 3.Department of Neurosurgery and Oncology, Brain Tumor Stem Cell LaboratoryCancer Research Building II RoomBaltimoreUSA

Personalised recommendations