W. W. Keen and the dawn of American neurosurgery

Abstract

Before the turn of the century, W. W. Keen was the most celebrated neurosurgeon in the United States. During the Civil War he served as a surgeon in the Union Army. He collaborated with Mitchell and Morehouse in clinical studies that culminated in their publishing Gunshot Wounds and Other Injuries of Nerves. In 1887, he was the first surgeon in the Americas to remove a benign brain tumor. He perfected a technique for ventricular puncture, devised operations for spasmodic torticollis, microcephalus, and tic douloureaux, and introduced many European neurosurgical techniques to the United States. An astute clinician and excellent teacher, Keen had no research interests other than anatomical and pathological dissections. He published over 50 papers on neurosurgical topics, in addition to articles on numerous other subjects. Although recognized as a pioneer in neurosurgery, he is not usually considered a founder of neurosurgery in the United States because of his failure to develop the specialty further than his contemporaries in the remainder of the neurosurgical world. This failure related not to his abilities, but probably to the fact that he was elderly before it became technically possible to perform safe and effective intracranial procedures.

Evolution and Future of Skull Base Surgery: The Paradigm of Skull Base Meningiomas

“…The patient was discharged 4 months later, and remained recurrence-free for 30 months (149). Similarly, William Williams Keen performed the first successful removal of an intracranial meningioma in the United States in December 1887 (10).…”

Felix Platter and a historical perspective of the meningioma

“…After Dr. Platter reported his case of intracranial tumor in 1614 [11], French surgeon, Antoine Louis, in 1771 published a case series of meningioma entitled "Fungueuses de la dure-mere" or "Fungatting mass of the dura matter" [9]. In USA, Dr. William Keen successfully resected a case of meningioma in 1887 [3]. In 1863, Dr. Virchow identified the granules in meningioma and named the granular bodies as psammomas (sand-like).…”

Risk Factors for Malignant and Atypical Meningiomas

“…Keen described the first successful removal of a meningioma in the United States [12]. Nowadays the degree of surgical resection is the most important factor for recurrence especially for classical meningiomas, Simpson classified is clinical classification for meningioma resection as follows: Grade one, complete removal, including resection of dura and bone; Grade two, complete tumor removal with coagulation of dural attachment; Grade three, complete tumor removal without resection or coagulation of dural attachments; Grade four, subtotal removal; and Grade five, decompression.…”