Chesler David A, Pendleton Courtney, Ahn Edward S, Quinones-Hinojosa Alfredo
The Johns Hopkins University School of Medicine, Department of Neurosurgery and Oncology, Baltimore, MD, United States.
Clin Neurol Neurosurg. 2013 Jun;115(6):699-701. doi: 10.1016/j.clineuro.2012.08.018. Epub 2012 Sep 1.
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.
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.
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.
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.
在其早期职业生涯中，库欣提出了多种用于临时和永久性脑脊液引流及分流的方法，并承认某些技术更适用于特定类型的脑积水。
经机构审查委员会（IRB）批准，并承蒙艾伦·梅森·切斯尼档案馆的好意，对约翰·霍普金斯医院1896年至1912年的手术记录进行了回顾。选择由哈维·库欣进行手术的患者进行进一步分析。在该队列中，我们找到了一名患有脑积水和脊柱裂患者的所有可用记录，该患者在脊柱裂修复术前接受了脑室-帽状腱膜下分流术。
一名3个月大的婴儿出现与脊柱裂相关的脑积水。库欣进行了系列腰椎穿刺和脑室穿刺。在此之后，库欣将患者带入手术室进行脑室-帽状腱膜下分流术的置入。患者随后接受脊髓脊膜膨出囊切除术，术后因不明原因死亡。
库欣的出版物表明，他倾向于对先天性脑积水患者，尤其是脊柱裂患者采用经腰-腹腔引流。尽管脑室-帽状腱膜下分流术的置入已成为当代神经外科医生认可的做法，但该病例说明了早期神经外科医生在开发先天性脑积水治疗手术方法时所面临的挑战。
