Neurosurgery involves the diagnosis and treatment of disorders related to the spinal column, spinal cord, brain, nervous system and peripheral nerves. The development of its practice at Stanford can be seen as part of the broader history of medicine in California.
Surgeons and physicians numbered among the thousands who arrived in California during the Gold Rush of the late 1840s and early 1850s. In the succeeding decades, The San Francisco Medical Press and The Pacific Medical & Surgical Journal reported trephination being used to treat railroad workers, soldiers, miners and others for epilepsy, cranial fractures and gunshot wounds.
Among the faculty of Cooper Medical College in San Francisco, which became Stanford University’s school of medicine in 1908, Dr. Levi Cooper Lane outlined trephination in his major textbook on surgery, and Dr. Henry Gibbons performed brain and spine operations on soldiers while serving in the Civil War.
On the East Coast, Dr. Henry Cushing inaugurated the modern field of neurosurgery in the early 20th century. His students transferred the nascent discipline to California — including Dr. Edward Towne, who brought Cushing’s teachings to Stanford. Within the first half of the 20th century, neurosurgeons established a national professional organization, a certifying board, and a journal.
Frederick Reichert joined the Stanford faculty in the late 1920s, further advancing Stanford’s training program in neurosurgery. John W. Hanbery joined the Stanford faculty in the 1950s, and oversaw the creation of a Division of Neurosurgery within the Department of Surgery. In 1990, the Division received Departmental Status.
In 1858, San Francisco surgeon Elias Samuel Cooper opened the first medical school in the western United States. After his early death, his nephew Levi Cooper Lane revived the school and named it “Cooper Medical College” in his uncle’s honor. After Stanford University took over the college in 1908, it became the Stanford University School of Medicine.
Like his uncle, Levi Cooper Lane was a surgeon; and he published a major textbook on head and neck surgery. Surgery was not highly specialized in the 19th century, however, and neurosurgery was undeveloped as a discipline. Brain surgery in Lane’s textbook largely amounted to trephination.
In 1895, Lane instituted a new special course of lectures to be delivered at the beginning of each term at Cooper Medical College. For the inaugural course, Lane selected Dr. William Macewen, Regius Professor of Surgery in the University of Glasgow, Scotland to offer presentations on brain surgery. Lane wrote:
"Professor Macewen delivered five masterly lectures on surgical anatomy in relation to neurological function, based almost entirely on his original research.
The lectures were models of excellence in every particular and were listened to with reverent attention by the students and faculty of Cooper Medical College, and by a large number of physicians, some of whom came from long distances, even from the states of Oregon and Nevada."
Harvey Cushing and his Legacy
Given Cushing’s interest in surgical neurology, Halstead sent Cushing to study under leading surgeons in Europe — though Cushing missed his opportunity to meet with William Macewen in Glasgow. Cushing devoted himself exclusively to the development of surgical neurology.
His efforts were recognized by 1919, when after Cushing’s address to the American College of Surgeons, William J. Mayo announced, "Gentlemen, we have this day witnessed the birth of a new specialty — neurological surgery."
- Howard Naffziger (University of California)
- Carl Rand (University of Southern California)
- Edward Bancroft Towne (Stanford University School of Medicine)
Edward Towne had received his MD from Harvard Medical
School in 1913. After studying under Cushing and serving in
World War I, he accepted the offer by Stanford for the position of Instructor in Surgery beginning in 1920.
He held the position of Visiting Surgeon not only at Stanford University
Hospital in San Francisco, but also at the San Francisco City and County
Hospital (now San Francisco
General Hospital) and the now-
defunct Southern Pacific Hospital.
Emergence of a Field
At the time that Edward Towne started teaching at Stanford in 1920, neurosurgery had begun to develop as a professional specialization — a trend that would continue over the next quarter century.
In 1920, the Society of Neurological Surgeons held its first meeting under the direction of Harvey Cushing at Brigham Hospital in Boston. Initially, the few members of the society met primarily to learn from one anothers’ surgical innovations. Edward Towne was a participant.
Also in 1920, another future Stanford faculty member, Frederick Reichert, was awarded his MD at Johns Hopkins. For two years at Hopkins, Dr. Reichert studied neurosurgery under Cushing’s successor, Walter Dandy. Dr. Reichert accepted the position of Associate Professor of Surgery at Stanford in 1926, and served as Professor of Surgery from 1930 until his retirement in 1960. During the years 1942–45, Dr. Reichert served as Department of Surgery Acting Executive while Dr. Emile Holman served in World War II.
Further professionalization of the field came with the founding of the Harvey Cushing Society (now the American Association of Neurological Surgeons) in 1931. Nearly a decade later, in 1940, the American Board of Neurological Surgery was approved as a new examining board by the Advisory Board for Medical Specialties and the American Medical Association’s Council on Medical Education
Within two years, the Harvey Cushing Society limited its membership those who were certified by the American Board of Neurological Surgeons. In 1944, the Journal of Neurosurgery was established, further consolidating the field.
John Hanbery and a New Division of Neurosurgery
John W. Hanbery received his MD from Stanford in 1945, after which he was accepted to do a neurosurgery residency at Johns Hopkins under Harvey Cushing’s protégé, Walter Dandy. Due to Dr. Dandy’s passing in 1946, however, Dr. Hanbery instead pursued a residency in neurosurgery at McGill University under Wilder Penfield and William Cone.
Dr. Hanbery’s concerted efforts resulted in the establishment of a residency training program in neurosurgery at Stanford in 1961. Three years later, the Department of Surgery created a new Division of Neurosurgery, and Dr. Hanbery served as the first Executive Head. Former residents who trained under Dr. Hanbery honored his mentorship in 1974 when they created the John W. Hanbery Society, which continues to meet annually for the presentation of research and clinical papers. Dr. Hanbery retired in 1989.
A New Department of Neurosurgery
In 1990, the Stanford University School of Medicine undertook the first major reorganization of the Department of Surgery in almost twenty years. Former Divisions and other programs within the Department of Surgery were reconfigured into new Departments, including new Departments of Urology, Cardiothoracic Surgery, and Functional Restoration.
The Division of Neurosurgery, inaugurated by Dr. John Hanbery in 1964, also received Departmental status in 1990. The faculty of the new Department of Neurosurgery included Dr. John Adler, Dr. Frances Conley, Dr. Lawrence Shuer, Dr. Gerald Silverberg, and Dr. Gary Steinberg. The Acting Chair of the new Department was Dr. Gerald Silverberg; the following year, Dr. Lawrence Shuer took over as Acting Chair.
Dr. Gary Steinberg has served as Chair of the Department since 1996. The Department has been particularly distinguished in terms of developing subspecialty expertise, both clinically and academically, and with regard to education of residents and postdoctoral fellows.
Areas of clinical and research focus include :
- cerebrovascular surgery and stroke
- brain tumors and neuro-oncology
- pituitary tumors and disease
- spine surgery
- pediatric neurosurgery
- functional neurosurgery (movement disorders, pain, epilepsy)
- traumatic brain and spinal cord injury
- stem cell research
- clinical outcomes research and non-invasive and minimally invasive surgery, including radiosurgery and endovascular surgery