“Groans less, seems more comfortable:” Harvey Cushing's redefinition of success in the operative treatment of pediatric intracranial lesions
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Courtney Pendleton & George I. Jallo & Aaron A. Cohen-Gadol & Alfredo Quiٌones-Hinojosa
- چاپ و سال / کشور: 2010
Description
Background Challenges to diagnosing and localizing intracranial lesions in pediatric patients were immense during the advent of neurosurgery. For patients with suspected intracranial tumors, but with negative findings on operation, there were few options. The role of palliative surgical interventions, from decompressive craniectomies to lumbar and ventricular punctures, is not well-represented in the literature during this early stage. Objective To review Harvey Cushing's original surgical files and analyze his use of decompressive procedures in pediatric patients with suspected intracranial tumors, with negative findings during operative interventions. Methods Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912. Patients, .18 years old, presenting with suspected intracranial tumors, undergoing surgical intervention by Cushing, without discovery of intracranial pathology, were selected for further analysis. Results Of the 23 pediatric patients selected, 17 were male. The mean age was 10.6 years. Cushing used three main operative approaches: infratentorial/suboccipital, subtemporal, and hemisphere flaps. Post-operative condition was improved in 13 and unchanged in three patients. Seven patients died during their inpatient stay. The mean time to follow-up was 34.79 months; the mean time to death was 11.9 months. Conclusions These examples illustrate Cushing's commitment to improving quality of life in patients, offering decompressive procedures, including craniectomies as well as cerebrospinal fluid drainage in the operating room and at the bedside, when attempts at localizing and resecting of suspected tumors were unsuccessful.
Childs Nerv Syst (2011) 27:155–161 DOI 10.1007/s00381-010-1310-z Received: 29 August 2010 / Accepted: 11 October 2010 / Published online: 27 October 2010
