Neurosurgical Classic—XIII

Harvey Cushing's Wanderjahr (1900-1901)

Harvey Cushing's 14-month Wanderjahr had a profound effect on his subsequent personal career, which in turn ushered in the modern age of American neurosurgery. From July 1900 to August 1901, he traveled to European neurosurgical centers in England, France, Switzerland, Italy, and Germany. His excursion happened at a crucial moment in his trajectory; it was built on his existing foundation of Halstedian surgical training and occurred at a time when interest in the special field of neurological surgery was emerging. The research and clinical experiences on his journey-good and bad-undoubtedly informed his fledgling neurosurgical practice. We present a concise account of Harvey Cushing's time in Europe that consolidates accounts from Cushing's travel journals, biographers, and other neurosurgeons. This article highlights tensions in prior works and reveals new insights into the transformative nature of his Wanderjahr. Furthermore, we contextualize his travels and achievements within the broader transformation of American medical education at the turn of the 20th century to elucidate how Europe influenced American medicine. We briefly consider parallel benefits of Harvey Cushing's Wanderjahr and modern domestic or international training opportunities and present potential areas of implementation.

Impact of radiosurgery on the surgical treatment of trigeminal neuralgia

BACKGROUND

The history of the development of current available techniques to treat TN was reviewed.

METHODS

The largest peer-reviewed publications on the surgical treatment of refractory TN were analyzed, considering the pros and cons of each technique. Results of modern peer-reviewed radiosurgery series were presented, taking into consideration the approach of each research article. Radiation doses and targets for radiosurgery were discussed to maximize the understanding of this technique.

RESULTS

It is concluded that radiosurgery is the least invasive modality with the fewest side effects, although, to match the results of the competing techniques, a substantial number of patients still need some medication intake.

CONCLUSION

Further studies determining the ideal target and radiation dose may bring radiosurgery results to the level of the ones achieved with microvascular decompression, currently considered the gold-standard method.

An anatomical study of the laterotrigeminal venous system

The middle cranial fossa of 100 cadavers were dissected under stereoscopic loupe in order to identify and systematize the venous vessels located along the lateral margin of the trigeminal cave. The author found that at the sensitive root and trigeminal ganglion level a dural venous canal was present in most individuals examined and that the upper side of this canal communicated with the superior petrosal sinus. However, at the level of the lateral border of the intracranial segment of the mandibular nerve, venous lacunae were found to prevail, and these lacunae communicated with several other venous formations in the peritrigeminal region. The author concludes that the venous vascularization of this area constitutes a major risk in surgical interventions made in the middle cranial fossa. In addition, it is a relevant factor in the hemodynamics of the intracranial circulation.

[Anatomic relationships of the emissary sinus of the foramen ovale and their clinico-surgical implications]

Após dissecar a fossa média da base do crânio de 50 cadáveres de indivíduos brasileiros, leuco e melanodermas, cujas idades variaram de 25 a 80 anos, o autor sistematizou as relações anatômicas do seio emissário do forame oval com os elementos nervosos e durais circunjacentes. Concluiu ser o referido seio emissário um elemento anatômico de considerável importância do ponto de vista clínico-cirúrgico, devendo ser lembrado sobretudo na terapêutica cirúrgica do gânglio trigeminal e do segmento intracraniano dos nervos maxilar e mandibular.