TY - JOUR
T1 - Harvey Cushing's early management of hydrocephalus
T2 - An historical picture of the conundrum of hydrocephalus until modern shunts after WWII
AU - Chesler, David A.
AU - Pendleton, Courtney
AU - Ahn, Edward S.
AU - Quinones-Hinojosa, Alfredo
N1 - Funding Information:
DAC supported by an NIH T32 training grant. CP supported by an HHMI-Ivy Student Research Training Grant . AQH funded by an NIH K08 grant, and NIH R01 grant. Figures provided courtesy of the Alan Mason Chesney Archives.
PY - 2013/6
Y1 - 2013/6
N2 - Purpose: Throughout his early career, Cushing proposed a variety of methods for temporary and permanent drainage and diversion of CSF in his patients, and acknowledged that certain techniques were more suited to particular subsets of hydrocephalus. Methods: Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records of the Johns Hopkins Hospital, from 1896 to 1912, were reviewed. Patients operated upon by Harvey Cushing were selected for further analysis. Within this cohort, we recovered all available records for a single patient with hydrocephalus and spina bifida, who was treated with a ventriculosubgaleal shunt prior to repair of the spina bifida. Results: A 3 month-old infant presented with hydrocephalus associated with spina bifida. Cushing performed serial lumbar and ventricular punctures. Following this, Cushing took the patient to the operating room for placement of a ventriculosubgaleal shunt. The patient subsequently underwent excision of the myelomeningocele sac, with post-operative mortality due to unspecified causes. Conclusions: Cushing's publications document a preference for translumbar-peritoneal drainage in patients with congenital hydrocephalus, particularly those with spina bifida. Although the placement of ventriculosubgaleal shunts has become an accepted practice for contemporary neurosurgeons, this case illustrates the challenges that early neurosurgeons faced in developing operative approaches for the treatment of congenital hydrocephalus.
AB - Purpose: Throughout his early career, Cushing proposed a variety of methods for temporary and permanent drainage and diversion of CSF in his patients, and acknowledged that certain techniques were more suited to particular subsets of hydrocephalus. Methods: Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records of the Johns Hopkins Hospital, from 1896 to 1912, were reviewed. Patients operated upon by Harvey Cushing were selected for further analysis. Within this cohort, we recovered all available records for a single patient with hydrocephalus and spina bifida, who was treated with a ventriculosubgaleal shunt prior to repair of the spina bifida. Results: A 3 month-old infant presented with hydrocephalus associated with spina bifida. Cushing performed serial lumbar and ventricular punctures. Following this, Cushing took the patient to the operating room for placement of a ventriculosubgaleal shunt. The patient subsequently underwent excision of the myelomeningocele sac, with post-operative mortality due to unspecified causes. Conclusions: Cushing's publications document a preference for translumbar-peritoneal drainage in patients with congenital hydrocephalus, particularly those with spina bifida. Although the placement of ventriculosubgaleal shunts has become an accepted practice for contemporary neurosurgeons, this case illustrates the challenges that early neurosurgeons faced in developing operative approaches for the treatment of congenital hydrocephalus.
KW - Congenital hydrocephalus
KW - Cushing
KW - Spina bifida
KW - Ventriculosubgaleal shunt
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U2 - 10.1016/j.clineuro.2012.08.018
DO - 10.1016/j.clineuro.2012.08.018
M3 - Article
C2 - 22944467
AN - SCOPUS:84877639994
SN - 0303-8467
VL - 115
SP - 699
EP - 701
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
IS - 6
ER -