{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T03:15:45Z","timestamp":1769915745080,"version":"3.49.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2009,2]]},"abstract":"<jats:p>The odyssey leading to the discovery of herniation syndromes was prolonged due to a lack of early understanding of the underlying pathophysiology. In 1896, Leonard Hill documented transtentorial pressure gradients as the intervening phenomenon involved in uncal herniation. In 1904, James Collier became the first to describe cerebellar tonsillar herniation as a \u201cfalse localizing sign\u201d often associated with intracranial tumors. During the infancy of neurological surgery, management of increased intracranial pressure and an improved understanding of brain herniation syndromes were of the utmost importance in achieving a safe technique. Harvey Cushing provided seminal contributions in understanding the pathophysiology of increased intracranial pressure and resulting cardiopulmonary effects.<\/jats:p>\n<jats:p>Cushing believed that tonsillar herniation was a cause of acute cardiorespiratory compromise in patients with intracranial tumors. In this vignette, we describe the untold story of Cushing's heroic attempt to treat respiratory arrest operatively during supratentorial tumor surgery with an emergency suboccipital craniectomy to relieve the medullary dysfunction that he believed was caused by compression from tonsillar herniation. This case illustrates a surgeon's determination and courage in fighting for his patient's life in the most desperate of times.<\/jats:p>","DOI":"10.3171\/2008.8.jns08773","type":"journal-article","created":{"date-parts":[[2008,10,31]],"date-time":"2008-10-31T15:15:47Z","timestamp":1225466147000},"page":"391-394","source":"Crossref","is-referenced-by-count":5,"title":["Emergency suboccipital decompression for respiratory arrest during supratentorial surgery: the untold story of a surgeon's courage in times of despair"],"prefix":"10.3171","volume":"110","author":[{"given":"Beth Ann","family":"Shelton","sequence":"first","affiliation":[{"name":"Clarian Neuroscience Institute, Indianapolis Neurosurgical Group and Indiana University Department of Neurosurgery, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"O'Hara","sequence":"additional","affiliation":[{"name":"Clarian Neuroscience Institute, Indianapolis Neurosurgical Group and Indiana University Department of Neurosurgery, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery and Department of Cell Biology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammadli M.","family":"Shoja","sequence":"additional","affiliation":[{"name":"Clarian Neuroscience Institute, Indianapolis Neurosurgical Group and Indiana University Department of Neurosurgery, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred G.","family":"Barker","sequence":"additional","affiliation":[{"name":"Neurosurgical Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron A.","family":"Cohen-Gadol","sequence":"additional","affiliation":[{"name":"Clarian Neuroscience Institute, Indianapolis Neurosurgical Group and Indiana University Department of Neurosurgery, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-1100391","series-title":"Brain","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1093\/brain\/27.4.490","article-title":"The false localizing signs of intracranial tumour","volume":"27","author":"Collier","year":"1904"},{"key":"b2-1100391","series-title":"Am J Med Sci","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1097\/00000441-190306000-00006","article-title":"The blood pressure reaction of acute cerebral compression illustrated by cases of intracranial hemorrhage: a sequel to the Mutter lecture for 1901","volume":"125","author":"Cushing","year":"1903"},{"key":"b3-1100391","series-title":"Bull Johns Hopkins Hosp","first-page":"290","article-title":"Concerning a definite regulatory mechanism of the vasomotor center which controls blood pressure during cerebral compression","volume":"12","author":"Cushing","year":"1901"},{"key":"b4-1100391","series-title":"Mitteilungen aus den Grenzgebieten der Medizin und Chirurgie","first-page":"773","article-title":"[Physiological and anatomical observations of the influence of brain compression on intracranial blood circulation and some other related phenomenon.]","volume":"9","author":"Cushing","year":"1902"},{"key":"b5-1100391","series-title":"Am J Med Sci","first-page":"375","article-title":"Some experimental and clinical observations concerning states of increased intracranial tension. The Mutter lecture for 1901","volume":"124","author":"Cushing","year":"1902"},{"key":"b6-1100391","series-title":"Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontine Angle","author":"Cushing","year":"1917"},{"key":"b7-1100391","series-title":"Med Hist","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1017\/S0025727300017610","article-title":"The dilated pupil and head trauma 1517\u20131867","volume":"16","author":"Flamm","year":"1972"},{"key":"b8-1100391","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1227\/01.NEU.0000245582.08532.7C","article-title":"History of the cushing reflex","volume":"59","author":"Fodstad","year":"2006"},{"key":"b9-1100391","series-title":"The Physiology and Pathology of the Cerebral Circulation. An Experimental Research","author":"Hill","year":"1896"},{"key":"b10-1100391","series-title":"[Special Pathology and Therapy]","article-title":"Brain concussion, intracranial pressure, and surgical interventions in brain disease","author":"Kocher","year":"1901"},{"key":"b11-1100391","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.1001\/archneur.62.12.1932","article-title":"Uncal herniation","volume":"62","author":"Maramattom","year":"2005"},{"key":"b12-1100391","series-title":"Rev Neurol (Paris)","first-page":"252","article-title":"De l'engagement des amygdales cerebelleuses a l'interieur du trou occipital dans les cas ou la pression intracranienne se troube augmentee","volume":"8","author":"Marie","year":"1900"},{"key":"b13-1100391","series-title":"Comples rendus des seances et memoires de la Societe de Biologie et de ses Filiales","article-title":"Sur la compression du Cervelet par les foyers d'hemorrhagie cerebrale","author":"Marie","year":"1899"},{"key":"b14-1100391","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1136\/jnnp.2006.087544","article-title":"James Collier (1870\u20131935) and uncal herniation","volume":"77","author":"Pearce","year":"2006"},{"key":"b15-1100391","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1136\/jnnp.63.3.412","article-title":"About the original description of cerebellar tonsil herniation by Pierre Marie","volume":"63","author":"Simonetti","year":"1997"},{"key":"b16-1100391","series-title":"[The Surgical Treatment of Brain Disease, ed 3.]","author":"Von Bergmann","year":"1899"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/110\/2\/article-p391.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/110\/2\/article-p391.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/110\/2\/article-p391.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T04:56:26Z","timestamp":1664168186000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/110\/2\/article-p391.xml"}},"subtitle":["Historical vignette"],"short-title":[],"issued":{"date-parts":[[2009,2]]},"references-count":16,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2008.8.jns08773","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,2]]}}}