The History of Neurosurgery at The Mount Sinai Hospital

This information is primarily a condensation of an article by Jeffrey S. Oppenheim, M.D., published in the Journal of Neurosurgery in May 1994. For a more complete history, refer to that article. The book, The House of Noble Deeds: The Mount Sinai Hospital, 1852-2000 by Arthur H. Aufses, Jr., and Barbara J. Niss, provides further information.

Founded in 1852 as the first Jewish hospital in the United States, "The Jews' Hospital in New York" was renamed The Mount Sinai Hospital in 1866 to reflect the nonsectarian policy of patient care. Originally located on West 28th Street, the hospital moved to Lexington Avenue and 66th Street in 1872, and in need of more space, to its present location at 100th Street between Madison and Fifth Avenue in 1904. Although there was no designation for neurosurgery patients in the late 1880s, there were some neurosurgical procedures performed at Mount Sinai: in 1885, a urologist successfully extracted a "pistol ball" from a patient's brain; in 1895, there were three reported operations on brain tumors, and in 1896, a temporary skull resection. In the 1890s the improvement in antiseptic technique allowed more complex surgery including more frequent opening of the cranium. The practice by a surgeon of sharpening his dull knife on his shoe in the operating room gave way to the practice of antisepsis and asepsis. In fact, in 1888, general surgeon Dr. Arpad G. Gerster, a recent immigrant and the most active of the four surgical chiefs, published Rules of Aseptic and Antiseptic Surgery. Interested in neurosurgery, Dr. Gerster pioneered surgery for epilepsy. He was responsible for the early training of Dr. Charles Elsberg and Dr. Ernest Sachs who ultimately became the world's first professor of Neurological Surgery at Washington University Medical School.

In 1914, in a major reorganization of the Surgery Department, beds were designated for four surgical specialties, one of which was neurosurgery. Dr. Charles Elsberg, a general surgeon who has been called the "Father of Neurosurgery" at Mount Sinai, was the assigned specialist for Neurosurgery. As Chief of the Service, he instituted changes that included special instruments and drapes, nurses with specialized neurosurgical training, and a separate operating room for neurosurgical cases.

 

Elsberg
Charles Elsberg, M.D.

Dr. Elsberg's work and interest soon became synonymous with the growth of neurosurgery in New York. A native New Yorker, he did his internship at Mount Sinai after finishing medical school at Columbia, and held positions at Mount Sinai first as an associate surgeon and later as attending surgeon. In 1909, Dr. Elsberg helped to found the Neurological Institute of New York which later became part of Columbia University's College of Physicians and Surgeons. He resigned from Mount Sinai 20 years later to devote his time to that institute. In the interim, he co-founded the Society of Neurological Surgeons with Drs. Harvey Cushing and Charles Frasier in 1920, and served as the third president in 1923. His many inventions included several rongeurs for performing laminectomies and special cannulas and grooved directors for use in brain abscesses. Among his four major texts and more than 150 medical articles were reports on topics of interest in neurosurgery including cerebello-pontine angle tumors and laminectomies. His books, Diagnosis and Treatment of Surgical Diseases in the Spinal Cord and Its Membranes (1916) and Tumors of the Spinal Cord (1925), contributed to the advancement of surgery of the spinal cord.

 

Cohen
Ira S. Cohen, M.D.

Dr. Harold Neuhof, who succeeded Dr. Elsberg, became interested in thoracic surgery, and he assigned responsibilities for neurosurgery to Dr. Ira Cohen in 1932. Under Dr. Cohen's leadership, the Neurosurgical Service became a distinct department in 1932. Dr. Cohen believed that a separation from general surgery was warranted because the diagnostic and surgical needs of neurosurgical cases had become different from those of general surgery. Dr. Cohen received his medical degree from Columbia, interned at The Mount Sinai Hospital, worked as an adjunct surgeon from 1920 to 1932, and served as department head of Neurosurgery until 1950. During World War I, when he was a major in the army assigned to the Mount Sinai Unit, Base Hospital Number 3 in France, he assisted in surgery for his own head injury by looking in a mirror and instructing his colleagues as they debrided and repaired his wound. Dr. Cohen established the formal residency in Neurosurgery in 1946. He was able to appoint only two residents before his retirement in 1950. His first resident, Dr. Aron J. Beller, became Chairman of the Department of Neurosurgery at the Hadassah Hospital in Israel. Dr. Leonard Malis was the second resident appointed.

 

Davidoff
Leo Davidoff, M.D.

The next Director of the Department was Dr. Leo Davidoff, the only Jewish neurosurgeon trained by Dr. Cushing. After Harvard College, Harvard Medical School, and a residency at Peter Bent Brigham, Dr. Davidoff, who immigrated from Latvia as a child, traveled as a surgeon with the Byrd-MacMillan Antarctic Expedition. Dr. Davidoff was well known in his field, having published more than 200 papers and 12 books, including The Normal Encephalogram

and The Abnormal Pneumoencephalogram (1937). He held academic appointments at almost all the hospitals in New York and served as President of the Society of Neurological Surgeons in 1951.

In 1956, Dr. Sidney Gross was named Director of the Department. He had trained under Elsberg at the Neurological Institute and Ernest Sachs in St. Louis before further neuropathology training in Chicago. Among Dr. Gross's accomplishments was the introduction of Diodrast for cerebral arteriography in the United States. At the start of Dr. Gross's tenure, the AMA approved The Mount Sinai Hospital for a three-year residency training program, and in 1958 expanded the training to four years. In the early 1960s, the addition of the City Hospital Center at Elmhurst, with its busy trauma service, expanded the exposure of the residents' clinical experience. The residents also benefited from the differing approaches of the attendings: Dr. Gross, who drew from tried-and-true methods; Dr. Malis, who was an innovator; and Dr. Bruce Ralston, who never performed any operation the same way twice!

 

Malis
Leonard Malis, M.D.

Dr. Leonard Malis succeeded Dr. Gross who retired in 1970. As a Captain in the Medical Corps, Dr. Malis was head of his hospital's neurological unit (although he had no formal training) by the end of World War II. Following his discharge, he trained in neurology at Mount Sinai and then, as the last resident under Dr. Cohen, in neurosurgery. After a fellowship at Yale, Dr. Malis returned to the staff at Mount Sinai. Dr. Malis, recognized as a basic scientist and clinical investigator as well as a superb teacher and neurosurgeon, was a leader and an innovator who brought many firsts to The Mount Sinai Hospital: the first microneurosurgical operation in 1965; the first practical course on microneurosurgery in the United States in 1968; one of the earliest superficial temporal-middle cerebral artery bypass procedures in the United States in 1969; the first automatic angiographic cassette changer which he designed and constructed. The list goes on to include many techniques, instruments, and patents. Under his stewardship, the Department expanded dramatically with the opening of the surgical suite in the Annenberg building, an expansion of the residency program, and the addition of laboratory space. Dr. Malis, always the innovator, designed and implemented a unique operating room television network, still used today, that links the operating rooms, attending staff offices, laboratories, and neuroradiology suite.

 

Post
Kalmon Post, M.D.

After Dr. Malis stepped down in 1991, Dr. Kalmon D. Post succeeded him as Chairman. Dr. Post, who had trained under Dr. Joseph Ransohoff at New York University, came to Mount Sinai from Columbia where he had been Vice Chairman of the Department of Neurological Surgery. During his tenure, Dr. Post significantly expanded the Department, in personnel, aeras of clinical, academic and research expertise, resources and physical space. Under his leadership, the faculty grew to 12 full-time and 13 voluntary neurosurgeons, four basic scientists, and seven more faculty with joint appointments in Neurology, Radiology, Endocrinology and Anesthesia. Dr. Post added specialists in Functional, Skull Base, Endovascular and Spine. This more specialized faculty pioneered advances in frameless stereotactic cranial surgery, computer-assisted image-guided minimally invasive surgery, endoscopic neurosurgery, microsurgery, physiologic monitoring in the operating room, spinal disease, management of neurovascular abnormalities and tumors of the nervous system, and the surgery of epilepsy. The number of operations performed in microvascular neurosurgery, pituitary and acoustic surgery, epilepsy and movement disorder surgery, and spine surgery dramatically increased. He recruited two neurointensivists, neurologists with a joint appointment in Neurosurgery, to work with the neurosurgeons in the ICU. In terms of its physical resources, the Department remodeled the eighth floor of Annenberg to accommodate 19 academic offices, four operating rooms, an additional waiting room, and a neurosurgical ICU that was expanded from 12 to 16 beds. Dr. Post created a Clinical Center for Skull Base Surgery at Mount Sinai in conjunction with the Department of Otolaryngology and recruited a scientist who organized the department's intraoperative neurophysiological monitoring team. He also facilitated the purchase of the Novalis system, at the time one of the most sophisticated approaches to stereotactic radiosurgery and radiotherapy. Under his leadership, in 2002, Dr. Joshua Bederson was appointed Vice Chairman and Residency Program Director, and in 2003, Dr. H. Richard Winn joined the faculty as Director of Research. The number of NIH grants increased to 2 RO1s and one RO3. Under Dr. Post's Chairmanship, the Department created the Leonard. I. Malis, MD/Corinne and Joseph Graber Endowed Chair in Neurosurgery, as well as four annual lectureships: The Sidney A. Hollin, MD, Endowed Lecture; the Jeannette and Bernard S. Post, MD, Endowed Lecture; The Ved P. Sachdev, MD, Endowed Lecture; and the Leonard I. Malis, MD, Endowed Lecture. The Kalmon D. Post Resident Research Prize, which acknowledges and promotes excellence in scholarship, was established to be awarded annually for the best peer-reviewed manuscript by a resident that has been published or accepted for publication during the preceding year. Dr. Post trained 38 residents, including more women neurosurgeons than have been trained in any other department in the country. He built one of the country's largest neurosurgical practices, specializing in acoustics with hearing preservation, pituitary and other skull base tumors. Dr. Post inherited a strong department with robust potential, continued the tradition of excellence and vision, and left an extraordinary legacy at The Mount Sinai Hospital.

 

Bederson
Joshua Bederson, M.D.

Dr. Joshua B. Bederson, who succeeded Dr. Post on July 1, 2008, was familiar with the department, having joined the faculty in 1992 and having been Vice-Chairman since 2002. He earned his medical degree and completed a residency in neurosurgery at the University of California in San Francisco. While a resident, he did advanced study programs in neuropathology at the University of Torino in Italy, and in microvascular and skull-base neurosurgery at the University Hospitals of Zurich, Switzerland, and the University Medical Center in Ljubljana, Slovenia. He also completed a fellowship in cerebrovascular surgery at the Barrow Neurological Institute. At Mount Sinai, he was the Director of the Cerebrovascular Surgery Program and established the first basic science laboratory in the Department of Neurosurgery, developing models of stroke and subarachnoid hemorrhage. An advocate of collaboration with other accomplished physicians and scientists at Mount Sinai, Dr. Bederson developed one of the first interdisciplinary clinical programs with the Department of Neurology Stroke Program, and fostered collaborative efforts with the Department of Otolaryngology, the Cancer Institute, and the Translational Neuroscience Center. He is building on the strong legacy left to him by the distinguished former chairs. Dr. Bederson continues to develop the department by recruiting outstanding young faculty who trained at distinguished institutions. In 2008, both Sathish Subbaiah, MD, and Hongyan (Jenny) Zou, MD, joined the faculty.