Walter Dandy - Scientific and Clinical Contributions - Contributions To Pediatric Neurosurgery

Contributions To Pediatric Neurosurgery

Dandy's first scientific contribution was the detailed anatomical description of a 2 mm human embryo in Franklin P. Mall's collection. This paper was published in 1910, five months before he graduated from medical school. In 1911 and 1913, he described the blood supply and nerve supply, respectively, of the pituitary gland. In 1913 and 1914, Dandy and Kenneth D. Blackfan published two landmark papers on the production, circulation, and absorption of CSF in the brain and on the causes and potential treatments of hydrocephalus. Hydrocephalus is the buildup of CSF within the brain, an often lethal condition if left untreated. They described two forms of hydrocephalus, namely "obstructive" and "communicating," thus establishing a theoretical framework for the rational treatment of this condition. This work is regarded by many as one of the finest pieces of surgical research ever done. Indeed, Halsted reportedly told Edwards A. Park that "Dandy will never do anything equal to this again. Few men make more than one great contribution to medicine." (Fox 1984, p. 36) Dandy, however, would prove to be one of these "few men." Modern pediatric neurosurgeons devote most of their time to the management of hydrocephalus. Currently, the Walter E. Dandy Professor of Neurosurgery at the University of Pittsburgh, Ian F. Pollack, is a pediatric neurosurgeon and the chief of the Division of Pediatric Neurosurgery.

The Dandy-Walker malformation is a congenital malformation associated with hydrocephalus. In 1921 Dandy reported a case of hydrocephalus caused by obstruction of outflow of CSF from the fourth ventricle. In 1944 A. Earl Walker (who eventually became chairman of neurosurgery at Johns Hopkins) described a similar case of congenital closure of the outflow of the fourth ventricle. This congenital anomaly became known as the Dandy-Walker cyst. It is associated with closure of the foramina of Luschka and Magendie (the outflow openings of the fourth ventricle), atrophy of the cerebellum and cerebellar vermis, dilation of the fourth ventricle, hydrocephalus, and often atrophy of the corpus callosum.