TY - JOUR
T1 - Groans less, seems more comfortable
T2 - Harvey Cushing's redefinition of success in the operative treatment of pediatric intracranial lesions
AU - Pendleton, Courtney
AU - Jallo, George I.
AU - Cohen-Gadol, Aaron A.
AU - Quiñones-Hinojosa, Alfredo
N1 - Funding Information:
Acknowledgments CP was supported by an HHMI-Ivy Student Research Training Grant. AQH was funded by the KO8 NIH grant and an HHMI grant.
PY - 2011/1
Y1 - 2011/1
N2 - 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.
AB - 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.
KW - Brain tumor
KW - Cushing
KW - Palliation
KW - Pediatric
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U2 - 10.1007/s00381-010-1310-z
DO - 10.1007/s00381-010-1310-z
M3 - Article
C2 - 20978769
AN - SCOPUS:78951480668
SN - 0256-7040
VL - 27
SP - 155
EP - 161
JO - Child's Nervous System
JF - Child's Nervous System
IS - 1
ER -