Harvey Cushing's Treatment of Skull Base Infections: The Johns Hopkins Experience

Abstract

Objectives In this report, we review Dr. Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his early operative approaches to infections of the skull base.

Design Following institutional review board (IRB) approval, and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912.

Setting The Johns Hopkins Hospital, 1896 to 1912.

Participants Eleven patients underwent operative treatment for suspected infections of the skull base.

Main Outcome Measures The main outcome measure was operative approach, postoperative mortality, and condition recorded at the time of discharge.

Results Eleven patients underwent operative intervention for infections of the skull base. The mean age was 30 years (range: 9 to 63). Of these patients, seven (64%) were female. The mean length of stay was 16.5 days (range: 4 to 34). Postoperatively eight patients were discharged in “well” or “good” condition, one patient remained “unimproved,” and two patients died during their admission.

Conclusion Cushing's careful preoperative observation of patients, meticulous operative technique, and judicious use of postoperative drainage catheters contributed to a remarkably low mortality rate in his series of skull base infections.

Keywords

Harvey Cushing - skull base - intracranial infections

• References

• 1 Alexander JW. The contributions of infection control to a century of surgical progress. Ann Surg 1985; 201: 423-428
• 2 Clower WT, Finger S. Discovering trepanation: the contribution of Paul Broca. Neurosurgery 2001; 49: 1417-1425 , discussion 1425–1426
• 3 Miller JT, Rahimi SY, Lee M. History of infection control and its contributions to the development and success of brain tumor operations. Neurosurg Focus 2005; 18: e4
• 4 Stone JL. W. W. Keen: America's pioneer neurological surgeon. Neurosurgery 1985; 17: 997-1010
• 5 Laws Jr ER. Neurosurgery's man of the century: Harvey Cushing—the man and his legacy. Neurosurgery 1999; 45: 977-982
• 6 Cushing HW. Concerning the results of operations for brain tumor. JAMA 1915; LXIV: 189-195
• 7 Bliss M. Harvey Cushing: A Life in Surgery. New York: Oxford University Press; 2005
• 8 Cushing HW. Concerning the poisonous effect of pure sodium chloride solutions upon the nerve-muscle preparation. Am J Physiol 1901; 6: 77-90
• 9 Cushing HW. On routine determinations of arterial tension in operation room and clinic. Boston Med Surg J 1903; 148: 250-256
• 10 Cushing HW. Studies on the cerebro-spinal fluid: I. Introduction. J Med Res 1914; 31: 1-19
• 11 Voorhees JR, Cohen-Gadol AA, Spencer DD. Early evolution of neurological surgery: conquering increased intracranial pressure, infection, and blood loss. Neurosurg Focus 2005; 18: e2
• 12 Lehman RH. Frontal sinus surgery. Acta Otolaryngol Suppl 1970; 270: 1-21
• 13 Sanders SH. Is a permanent nasofrontal opening in surgery for chronic suppurative disease of the fronto-ethmosphenoid complex of sinuses really necessary?. Trans Am Acad Ophthalmol Otolaryngol 1965; 69: 725-739
• 14 Thomson EH. Harvey Cushing; Surgeon, Author, Artist. Yale University School of Medicine Yale Medical Library Historical Library Publication, vol no 24. Schuman, New York 1950
• 15 Cushing HW. Notes on the penetrating wounds of the brain. BMJ 1918; 1: 221-226