Harvey Cushing's treatment of skull base infections: The Johns Hopkins experience

Objectives: In this report, we review Dr. Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his early operative approaches to infections of the skull base. Design: Following institutional review board (IRB) approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912. Setting: The Johns Hopkins Hospital, 1896 to 1912. Participants: Eleven patients underwent operative treatment for suspected infections of the skull base. Main Outcome Measures: The main outcome measure was operative approach, postoperative mortality, and condition recorded at the time of discharge. Results: Eleven patients underwent operative intervention for infections of the skull base. The mean age was 30 years (range: 9 to 63). Of these patients, seven (64%) were female. The mean length of stay was 16.5 days (range: 4 to 34). Postoperatively eight patients were discharged in " well" or "good " condition, one patient remained " unimproved," and two patients died during their admission. Conclusion: Cushing's careful preoperative observation of patients, meticulous operative technique, and judicious use of postoperative drainage catheters contributed to a remarkably low mortality rate in his series of skull base infections.