Introduction: The field of neurosurgery has a rich and fascinating history. The development of the specialty in Hawaii has been particularly unique, given the state’s remote location, indigenous population, and military presence. The life of Dr. Cloward, Hawaii’s most noted neurosurgeon, has received some attention in the literature. However, a comprehensive review of this history, including the pre-Cloward and post-Cloward era, is lacking.

Methods: This study will review and chronicle the development of neurosurgery in Hawaii with special attention to three topics: the traveling neurosurgeons of the early 20th century, such as Dr. Frederick Reichert; Hawaii’s first full time neurosurgeon, Dr. Cloward; and finally, the current state of neurosurgery in Hawaii.

Results: The field first came to Hawaii in the form of traveling surgeons from California, such as Dr. Reichert, Chair at Stanford. Then, in the 1920s, Dr. Cloward became the first full time surgeon in the islands. Dr. Cloward made substantial contributions to the field and worked in many unique environments, including the leprosy colony and military base, while in Hawaii. Neurosurgery has continued to grow at the University of Hawaii and its associated training sites, making the state one of the Pacific’s a premier destinations for such services.

Conclusions: From its humble beginnings in the early 20th century to the present day, neurosurgery has a rich and fascinating history in the state of Hawaii.

Patient Care: A thorough understanding of the past may translate to more effective patient care in the present.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of Dr. Reichert and Dr. Cloward to the development of neurosurgery in the Hawaiian Islands 2) Discuss, in small groups, the past and present state of neurosurgery in Hawaii.

References: 1. Canale DJ, Watridge CB, Fuehrer TS, Robertson JH. The history of neurosurgery in Memphis: the Semmes-Murphey Clinic and the Department of Neurosurgery at the University of Tennessee College of Medicine. J Neurosurg. 2010;112(1):189-98. 2. Kimmell KT, Petraglia AL, Bakos R, Rodenhouse T, Maurer PK, Pilcher WH. The history of neurosurgery at the University of Rochester. J Neurosurg. 2014;121(4):989-94. 3. Krishna V, Rauf Y, Patel S, Glazier S, Perot P, Ellegala DB. History and current state of neurosurgery at the Medical University of South Carolina. Neurosurgery. 2011;69(1):145-52. 4. McClelland S. The Montreal Neurological Institute: training of the first African-American neurosurgeons. J Natl Med Assoc. 2007;99(9):1071-3. 5. Lanzino G, Jane JA. Neurosurgery at the University of Virginia. Neurosurgery. 1998;43(1):133-41. 6. Rosenfeld JV, Kaye AH. Neurosurgery at the Royal Melbourne Hospital. Neurosurgery. 2000;46(4):978-85. 7. Ikezaki K, Fukui M. Origin and evolution of the Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyushu University. Neurosurgery. 2000;46(2):471-7. 8. Cloward RB. Neurology and neurosurgery in Hawaii over 45 years--a personal reminiscence. Hawaii Med J. 1984;43(12):444-8. 9. “Department History.” Stanford Neurosurgery. 2016. https://med.stanford.edu/neurosurgery/about-us/history.html. 10. “The Development of Neurosurgery in Northern California.” Neurological Surgery at UCSF. 2016. http://neurosurgery.medschool.ucsf.edu/general_information/neurosurgery_history_ca.html. 11. Haas LF. Harvey Williams Cushing (1869–1939). Journal of Neurology, Neurosurgery & Psychiatry 2002;73:596. 12. Cloward RB. The anterior surgical approach to the cervical spine: the Cloward Procedure: past, present, and future. The presidential guest lecture, Cervical Spine Research Society. Spine (Phila Pa 1976). 1988;13(7):823-7. 13. Cloward RB. Diaphragm paralysis from cervical disc lesions. Br J Neurosurg. 1988;2(3):395-9. 14. Cloward RB. History of the anterior cervical fusion technique. J Neurosurg. 1985;63(5):817-9. 15. Cloward RB. Posterior lumbar interbody fusion updated. Clin Orthop Relat Res. 1985;(193):16-9. 16. Cloward RB. Progressive idiopathic anterior dislocation of the upper cervical spine with severe myelopathy. Surg Neurol. 1984;22(6):579-87. 17. Cloward RB. Spondylolisthesis: treatment by laminectomy and posterior interbody fusion. Clin Orthop Relat Res. 1981;(154):74-82. 18. Cloward RB. Acute cervical spine injuries. Clin Symp. 1980;32(1):1-32. 19. Cloward RB. Gas-sterilized cadaver bone grafts for spinal fusion operations. A simplified bone bank. Spine (Phila Pa 1976). 1980;5(1):4-10. 20. Cloward RB. A neurosurgeon remembers Pearl Harbor. Surg Neurol. 1976;6(6):319-22. 21. Cloward RB. War Injuries to the head; treatment of penetrating wounds. JAMA. 1942;118:267-270. 22. Cloward RB. Spinal Extradural Cysts. Ann Surg. 1937;105(3):401-7. 23. “Cloward Award.” Western Neurosurgical Society. 2016. http://www.westnsurg.org/clowardaward.asp. 24. “Queen’s Neuroscience Institute.” The Queen’s Medical Center. 2016. http://queensmedicalcenter.org/neuroscience-institute.