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

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.