Abstract
Background:
In 1908, Anton and von Bramann proposed the Balkenstich method, a corpus callosum
puncture which created a communication between the ventricle and subarachnoid space.
This method offered the benefit of providing continuous CSF diversion without the
implantation of cannula or other shunting devices, yet it received only slight reference
in the literature of the time. It remained a novel and perhaps underutilized approach
at the time Cushing began expanding his neurosurgical practice at the Johns Hopkins
Hospital.
Materials and Methods:
Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives,
the surgical records of the Johns Hopkins Hospital for the period 1896–1912 were reviewed.
Patients operated upon by Harvey Cushing were selected.
Results:
7 patients underwent puncture of the corpus callosum for treatment of hydrocephalus.
6 patients were treated for obstructive hydrocephalus secondary to presumed intracranial
lesions. 1 patient was treated for congenital hydrocephalus.
Conclusion:
The series reported here documents Cushing’s early use of the corpus callosum puncture
to divert CSF in patients with obstructive hydrocephalus secondary to intracranial
tumors, as well as an attempt to use the procedure in a pediatric patient with congenital
hydrocephalus. Notably, 3 patients developed new onset left-sided weakness post-operatively,
possibly due to retraction injury upon the supplementary motor intra-operative manipulations.
Key words
callosal puncture - cushing - hydrocephalus
