Surgical Procedures for Hydrocephalus
Apr 15, 2019 17:57:25 GMT -5
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Post by denadenise1963 on Apr 15, 2019 17:57:25 GMT -5
This has probably been considered at one time or another but I created a thread because I couldn’t find this topic being addressed specifically. I’ve been reading up on the subject of hydrocephalus. And the history of surgical interventions for hydrocephalus. The more successful surgeries to treat hydrocephalus were not really pioneered before the 1950’s. However I decided to look further and sure enough- surgeries to treat hydrocephalus were being attempted long before the 1950’s. It simply was not very successful. I have included (copied & pasted) the history of the techniques being used in the early part of the 20th century. What I am wondering is if it’s possible or has it been considered that possibly baby Charlie had already had some sort of surgical procedure done? And the surgery had left him with additional brain damage? I’m just thinking about the people who CAL had in his world and who he so admired. Like Alexis Carrel (don’t get me started). After an unsuccessful surgery (and surgical procedures for Hydrocephalus were simply not advanced enough then for it to be successful) was when CAL began to really consider applying the principles of Eugenics to his own baby? Perhaps even at the behest of Alexis Carrel. This is proof of nothing I realize. Possibly just another rabbit hole. But I started thinking about this today and I was wondering if anyone else had ever considered that the baby had already had some sort of surgery to treat hydrocephalus. This also could explain why he was kept out of view during certain time frames as well. Possibly this surgery would have also necessitated baby Charlie’s head being shaved. At least some parts of the head. And to be perfectly honest, I was looking at one photo of the baby last night and thinking about Annes passage in Hour of Gold Hour of Lead. Where she laments over not knowing how to brush (comb?) her baby’s hair.
Radoj~i}, Igor \. Meljnikov
ted in the classic work Observations on the Pathology of Hydrocephalus Dorothy Russell providedan ency- clopedic collection of hydrocephalic specimens (19). These descriptions were to have great influence onthe future therapeutic modalities for this disorder.
As the 20th century progressed, more defined in- vestigations into the physiology of CSF dynamics and hydrocephalus became possible. The introduction of radioactive tracers in the 1950st allowed for the detai- led analysis of the circulatory dynamics of CSF. Pa- penheimer’s perfusion method helped establish the ra- tes of CSF production and absorption, while elucidat- ing the extrachoroidal formationof CSF. Igor Klatzo (1916–2007) demonstrated that this movement was ca- used by bulk flow. In 1970, Thomas Herrick Milhorat illustrated the increase in periventricular permeabi- lityand the concept of transependymal absorption inex- perimental hydrocephalus (20). This was later found to correlate with periventricular low densities observed on computerized tomography scans obtained in pati- ents with untreated hydrocephalus.
A further milestone in understanding hydrocepha- lus came with the discovery that acute hydrocephalus could develop within hours in contrast to weeks or months, which was the prevailing paradigm. Effective therapy requires aseptic surgery as well as pathophysi- ological knowledge — both unavailable before the late nineteenth century. In 1881, Carl Wernicke (1848– –1905), a German physician, anatomist and neuropat- hologist, inaugurated sterile ventricular puncture and external CFS drainage. In parallel with the advances in the basic sciences understanding of hydrocephalus, ne- wer therapeutic interventions were initiated. This new knowledge provided impetus for more rational and substantive treatments.
Heinrich Irenaeus Quincke (1842–1922) first de- scribed the lumbar puncture as an effective treatment for hydrocephalus in 1891. William Williams Keen (1837–1932) is credited with the first description of continuous ventricular drainage. Johann von Miku- licz-Radecki (1850–1905) first attempted drainage from the lateral ventricle to the subgaleal, subdural and su- barachnoid spaces with the use of gold tubes and cat-gut strands. It was simultaneously a ventriculostomy and a drainage into an extrathecal low pressure compart- ment. Between 1898 and 1925, lumboperitoneal and ventriculo-peritoneal, -venous, -pleural and ureteral shunts were invented, but these had a high failure rate due to insufficient implant materals in most cases.
Where as it was surmised that surgical removal of an anatomical obstruction as a primary treatment for hydrocephalus would reestablish normal CSF flow dy- namics, permanent CSF diversionary procedures and the means to reduce CSF production were also investi-
gated. Gabriel Anton (1858–1933) and Friedrich Gu- stav von Bramann (1854–1913) introduced the suboc- cipital puncture and “Balkenstich Method” in 1908, a procedure in which the corpus callosum was perforated with resultant drainage of CSF into the subdural spa- ces. Bramann was known for his use of minimal invasi- ve surgical practices and his pioneer work in neurosur- gery. The procedure fell into disfavor because of high surgery-related mortality and low cure rates (14).
Parkin and Glynn explored the effects of lysis of posterior fossa adhesions and achieved mixed success (21, 22). Attempts to drain CSF via the orbital roof (ventriculo-orbitotomy approach) and from the tempo- ral horn into the cheek fat pad were also explored but without resolution of the hydrocephalic process. In 1908 Erwin Payr (1871–1946) introduced drainage in- to the vascular system by using vein grafts from the ventricle directly into the sagittal sinus and jugular ve- ins. In this same year, Walther Kausch (1867–1928) Kausch used a rubber conduit to drain the lateral ven- tricle into the peritoneal cavity (23).
This concept, however, did not receive much ini- tial enthusiasm. During this time, Heile attempted to perform spinal CSF drainage into the peritoneum by sewing the serosa of the bowel to the dura mater, con- necting the subarachnoid space to the peritoneum by use of a silk suture, and by using other conduits such as veins or latex rubber tubes. He also was the first credi- ted with CSF diversion to the urinary system (24).
Harvey Williams Cushing (1869–1939), an Ameri- can neurosurgeon and a pioneer of brain surgery, paid tribute to this notable work, naming it the “third circula- tion”. Under the pioneering efforts of Cushing and his followers, neurosurgery emerged as a distinctive speci- alty. Cushing devised a technique in which the lumbar subarachnoid space was connected to the peritoneal ca- vity or retroperitoneum by using silver cannulas passed through apertures through the L-4 vertebral body. Cush- ing can also be credited with the innovative idea (for that time) that as the “third circulation”; the CSF had unique function greatly more complex than simply providing buoyancy for the brain. In 1914, Walter Edward Dandy (1886–1946) and Kenneth D. Blackfan (1883–1941) developed a technique of producing experimental ob- structive hydrocephalus in dogs by placing cotton pled- gets at the distal aqueduct of Sylvius, thereby causing proximal ventricular dilation (25). Dandy also reported that with unilateral choroid plexectomy and obstruction of the foramen of Monro, the plexectomized ventricle would collapse while the contralateral ventricle would dilate; he concluded that CSF was produced exclusively by the choroid plexus. This in turn led Dandy to introdu- ce, in 1918, bilateral choroid plexectomy as a means of reducing CSF
Radoj~i}, Igor \. Meljnikov
ted in the classic work Observations on the Pathology of Hydrocephalus Dorothy Russell providedan ency- clopedic collection of hydrocephalic specimens (19). These descriptions were to have great influence onthe future therapeutic modalities for this disorder.
As the 20th century progressed, more defined in- vestigations into the physiology of CSF dynamics and hydrocephalus became possible. The introduction of radioactive tracers in the 1950st allowed for the detai- led analysis of the circulatory dynamics of CSF. Pa- penheimer’s perfusion method helped establish the ra- tes of CSF production and absorption, while elucidat- ing the extrachoroidal formationof CSF. Igor Klatzo (1916–2007) demonstrated that this movement was ca- used by bulk flow. In 1970, Thomas Herrick Milhorat illustrated the increase in periventricular permeabi- lityand the concept of transependymal absorption inex- perimental hydrocephalus (20). This was later found to correlate with periventricular low densities observed on computerized tomography scans obtained in pati- ents with untreated hydrocephalus.
A further milestone in understanding hydrocepha- lus came with the discovery that acute hydrocephalus could develop within hours in contrast to weeks or months, which was the prevailing paradigm. Effective therapy requires aseptic surgery as well as pathophysi- ological knowledge — both unavailable before the late nineteenth century. In 1881, Carl Wernicke (1848– –1905), a German physician, anatomist and neuropat- hologist, inaugurated sterile ventricular puncture and external CFS drainage. In parallel with the advances in the basic sciences understanding of hydrocephalus, ne- wer therapeutic interventions were initiated. This new knowledge provided impetus for more rational and substantive treatments.
Heinrich Irenaeus Quincke (1842–1922) first de- scribed the lumbar puncture as an effective treatment for hydrocephalus in 1891. William Williams Keen (1837–1932) is credited with the first description of continuous ventricular drainage. Johann von Miku- licz-Radecki (1850–1905) first attempted drainage from the lateral ventricle to the subgaleal, subdural and su- barachnoid spaces with the use of gold tubes and cat-gut strands. It was simultaneously a ventriculostomy and a drainage into an extrathecal low pressure compart- ment. Between 1898 and 1925, lumboperitoneal and ventriculo-peritoneal, -venous, -pleural and ureteral shunts were invented, but these had a high failure rate due to insufficient implant materals in most cases.
Where as it was surmised that surgical removal of an anatomical obstruction as a primary treatment for hydrocephalus would reestablish normal CSF flow dy- namics, permanent CSF diversionary procedures and the means to reduce CSF production were also investi-
gated. Gabriel Anton (1858–1933) and Friedrich Gu- stav von Bramann (1854–1913) introduced the suboc- cipital puncture and “Balkenstich Method” in 1908, a procedure in which the corpus callosum was perforated with resultant drainage of CSF into the subdural spa- ces. Bramann was known for his use of minimal invasi- ve surgical practices and his pioneer work in neurosur- gery. The procedure fell into disfavor because of high surgery-related mortality and low cure rates (14).
Parkin and Glynn explored the effects of lysis of posterior fossa adhesions and achieved mixed success (21, 22). Attempts to drain CSF via the orbital roof (ventriculo-orbitotomy approach) and from the tempo- ral horn into the cheek fat pad were also explored but without resolution of the hydrocephalic process. In 1908 Erwin Payr (1871–1946) introduced drainage in- to the vascular system by using vein grafts from the ventricle directly into the sagittal sinus and jugular ve- ins. In this same year, Walther Kausch (1867–1928) Kausch used a rubber conduit to drain the lateral ven- tricle into the peritoneal cavity (23).
This concept, however, did not receive much ini- tial enthusiasm. During this time, Heile attempted to perform spinal CSF drainage into the peritoneum by sewing the serosa of the bowel to the dura mater, con- necting the subarachnoid space to the peritoneum by use of a silk suture, and by using other conduits such as veins or latex rubber tubes. He also was the first credi- ted with CSF diversion to the urinary system (24).
Harvey Williams Cushing (1869–1939), an Ameri- can neurosurgeon and a pioneer of brain surgery, paid tribute to this notable work, naming it the “third circula- tion”. Under the pioneering efforts of Cushing and his followers, neurosurgery emerged as a distinctive speci- alty. Cushing devised a technique in which the lumbar subarachnoid space was connected to the peritoneal ca- vity or retroperitoneum by using silver cannulas passed through apertures through the L-4 vertebral body. Cush- ing can also be credited with the innovative idea (for that time) that as the “third circulation”; the CSF had unique function greatly more complex than simply providing buoyancy for the brain. In 1914, Walter Edward Dandy (1886–1946) and Kenneth D. Blackfan (1883–1941) developed a technique of producing experimental ob- structive hydrocephalus in dogs by placing cotton pled- gets at the distal aqueduct of Sylvius, thereby causing proximal ventricular dilation (25). Dandy also reported that with unilateral choroid plexectomy and obstruction of the foramen of Monro, the plexectomized ventricle would collapse while the contralateral ventricle would dilate; he concluded that CSF was produced exclusively by the choroid plexus. This in turn led Dandy to introdu- ce, in 1918, bilateral choroid plexectomy as a means of reducing CSF