OBJECTIVE: A review of Harvey Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early work using nerve xenografts to repair peripheral nerve injuries. METHODS: The Johns Hopkins Hospital surgical records from 1896 to 1912 were reviewed. A single case in which Cushing used a xenograft to repair a peripheral nerve defect was selected for further study. RESULTS: In August 1902, a 23-year-old woman presented with tingling and numbness in her left foot and focal tenderness in the popliteal region. Cushing performed an exploratory operation, revealing an encapsulated tumor originating from the internal popliteal nerve. After resecting the segment of involved nerve, Cushing harvested the spinal cord from a rabbit and used it to span the 18-cm defect. At a 5-month postoperative follow-up, according to Cushing's clinical notes, the patient had partially regained some sensation in her leg and foot. Seven months later, the patient presented with a local tumor recurrence, and her leg was amputated. An examination of the amputated specimen demonstrated that the xenograft was still intact without gross evidence of xenograft rejection. CONCLUSION: Despite its questionable functional success, we report a previously unpublished operative case by Harvey Cushing in which a rabbit spinal cord was transplanted into a human to bridge a sciatic nerve gap. This sheds light on the potential for animal tissue as a source for the treatment of neurological disease in humans.
OBJECTIVE: A review of Harvey Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early work using nerve xenografts to repair peripheral nerve injuries. METHODS: The Johns Hopkins Hospital surgical records from 1896 to 1912 were reviewed. A single case in which Cushing used a xenograft to repair a peripheral nerve defect was selected for further study. RESULTS: In August 1902, a 23-year-old woman presented with tingling and numbness in her left foot and focal tenderness in the popliteal region. Cushing performed an exploratory operation, revealing an encapsulated tumor originating from the internal popliteal nerve. After resecting the segment of involved nerve, Cushing harvested the spinal cord from a rabbit and used it to span the 18-cm defect. At a 5-month postoperative follow-up, according to Cushing's clinical notes, the patient had partially regained some sensation in her leg and foot. Seven months later, the patient presented with a local tumor recurrence, and her leg was amputated. An examination of the amputated specimen demonstrated that the xenograft was still intact without gross evidence of xenograft rejection. CONCLUSION: Despite its questionable functional success, we report a previously unpublished operative case by Harvey Cushing in which a rabbit spinal cord was transplanted into a human to bridge a sciatic nerve gap. This sheds light on the potential for animal tissue as a source for the treatment of neurological disease in humans.
Authors: Courtney Pendleton; Richard J Redett; Alfredo Quinones-Hinojosa; John Gearhart; Amir H Dorafshar Journal: World J Urol Date: 2012-05-31 Impact factor: 4.226