title: Harvey Cushing's early management of hydrocephalus: an historical picture of the conundrum of hydrocephalus until modern shunts after WWII.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Johns Hopkins University School of Medicine, Department of Neurosurgery and Oncology, Baltimore, MD, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Chesler
authors.forename: Courtney
authors.initials: C
authors.lastname: Pendleton
authors.forename: Edward S
authors.initials: ES
authors.lastname: Ahn
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones-Hinojosa
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000266:history; D004322:Drainage; D017809:Fatal Outcome; D049673:History, 20th Century; D006801:Humans; D006849:Hydrocephalus / Q000266:history* / Q000601:surgery*; D007223:Infant; D008297:Male; D009493:Neurosurgery / Q000266:history*; D016135:Spinal Dysraphism / Q000150:complications / Q000601:surgery