World Neurosurg
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Case Reports Biography Historical Article
Harvey Cushing's early treatment of meningiomas: the untold story.
In his 1938 monograph, Cushing tabulated 313 meningioma cases treated throughout his career at the Johns Hopkins and the Peter Bent Brigham Hospitals. Of these, 18 patients were treated at the Johns Hopkins Hospital. Cushing provided basic demographic, perioperative, and outcomes data in his tables, but the operative details for many of his early meningioma cases have not been previously described. ⋯ The operative details demonstrate Cushing's early attention to hemostasis, and use of staged resections in patients with large, highly vascular meningiomas. Cushing's first 18 cases of meningiomas, treated while a young attending physician at the Johns Hopkins Hospital, are not the most elegant operations in his lengthy series, but serve as an illustration of his ability to transform clinical challenges into opportunities for improvement.
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To investigate recent trends in surgical volume and associated patient outcomes in the treatment of acoustic neuromas. ⋯ A 41%, or 178 cases per year, reduction in surgical excision of acoustic neuroma cases was observed during the period 2001-2007. A possible explanation for this trend includes increased use of stereotactic radiosurgery. Nonroutine discharge and complications after surgical excision have increased perhaps because of surgery being used for larger tumors.
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Concerns over increased wound complication rates have been raised when bone morphogenic protein (BMP) is used as an adjunct for fusion in spinal surgery. This study evaluated 87 consecutive patients undergoing long-segment thoracolumbar spinal fusions with BMP to assess drain output and the rates of reoperation for infection or seroma. ⋯ Use of BMP for long-segment posterior thoracolumbar fusions may be associated with significant drain output, requiring multiple days of drainage. However, when drained adequately, infections and seromas occur infrequently.
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Biography Historical Article
Portrait of a life journey dedicated to neurosurgery.