title: "Colossal" breakthrough: the callosal puncture as a precursor to third ventriculostomy.
abstract: BACKGROUND
  In 1908, Anton and von Bramann proposed the Balkenstich method, a corpus callosum puncture which created a communication between the ventricle and subarachnoid space. This method offered the benefit of providing continuous CSF diversion without the implantation of cannula or other shunting devices, yet it received only slight reference in the literature of the time. It remained a novel and perhaps underutilized approach at the time Cushing began expanding his neurosurgical practice at the Johns Hopkins Hospital.
  
  
  METHODS
  Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records of the Johns Hopkins Hospital for the period 1896-1912 were reviewed. Patients operated upon by Harvey Cushing were selected.
  
  
  RESULTS
  7 patients underwent puncture of the corpus callosum for treatment of hydrocephalus. 6 patients were treated for obstructive hydrocephalus secondary to presumed intracranial lesions. 1 patient was treated for congenital hydrocephalus.
  
  
  CONCLUSIONS
  The series reported here documents Cushing's early use of the corpus callosum puncture to divert CSF in patients with obstructive hydrocephalus secondary to intracranial tumors, as well as an attempt to use the procedure in a pediatric patient with congenital hydrocephalus. Notably, 3 patients developed new onset left-sided weakness post-operatively, possibly due to retraction injury upon the supplementary motor intra-operative manipulations.
authors.affiliation: The Johns Hopkins University School of Medicine, Department of Neurosurgery and Oncology, Baltimore, MD, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Chesler
authors.forename: C
authors.initials: C
authors.lastname: Pendleton
authors.forename: G I
authors.initials: GI
authors.lastname: Jallo
authors.forename: A
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D000328:Adult; D003337:Corpus Callosum / Q000601:surgery*; D005260:Female; D049673:History, 20th Century; D006801:Humans; D006849:Hydrocephalus / Q000151:congenital / Q000209:etiology / Q000601:surgery; D007223:Infant; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000266:history / Q000379:methods*; D010871:Pinealoma / Q000150:complications; D011677:Punctures; D013346:Subarachnoid Space / Q000601:surgery; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000266:history / Q000379:methods*