The understanding and operative treatment of cerebral palsy at the turn of the twentieth century: Harvey Cushing's early forays into pediatric neurosurgery

Introduction At the turn of the twentieth century, cerebral palsy and its treatment were not well understood, and a variety of treatment modalities were tested with only limited success. Material and methods Following IRB approval and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896-1912. Eight patients who received a diagnosis consistent with cerebral palsy and were treated surgically by Dr. Cushing were selected for further analysis and are described here. Results A total of eight patients underwent operative intervention for treatment of symptoms consistent with cerebral palsy. Of these, seven were male; the mean age was 4.9 years (range, 1.5 to 12). Five patients underwent decompressive craniotomies, one underwent tenotomies, one underwent transection of the spinal nerve roots, and one underwent primary transection of the spinal nerve roots with secondary tenotomies. Four representative cases are reported here. Conclusions Cushing's contributions to pediatric neurooncology have been previously described, but his endeavors in non-oncologic realms remain largely unknown. Although Cushing employed previously described operative approaches for the treatment of cerebral palsy, parents brought their children to him from across the nation, in an era when long distance travel was tedious, and a financial burden. These cases serve to emphasize Cushing's interest in improving patient quality of life, and his broad contributions to pediatric neurosurgery.