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Unlabelled: Patients with posthemorrhagic hydrocephalus (PHH) from germinal matrix hemorrhage of prematurity often require numerous early interventions, as well as long-term follow-up care from pediatric neurosurgeons, which continues to place high demands on the existing workforce and pediatric health care system. There are established correlations between premature birth and low socioeconomic status. The aim of this study is to characterize the demographic profile and follow-up patterns in this subpopulation of surgically treated infants with PHH from prematurity., Methods: A retrospective analysis of the electronic patient records for a single institution, from 2007 to 2010, was performed. All patients who underwent neurosurgical intervention for the treatment of PHH were selected for further analysis. Data elements available within the records included patient demographic features, inpatient treatments and procedures, inpatient mortality rates, length of stay, and postoperative follow-up at the institution. Socioeconomic status was assessed using the median household income for the patient's zip code, as reported in the United States Census for the year 2000., Results: A total of 40 patients who underwent neurosurgical intervention for PHH at a single institution were identified. More patients were female (52.5%); the majority of patients were Black (57.5%). No patients were uninsured; most patients had public insurance (62.5%), and 65% were below the Maryland State median household income (USD 52,868). There were trends toward more frequent emergency room visits among those covered by public insurance and those below the state and national median house income, although differences were not statistically significant., Conclusions: Our data indicate that the majority of patients fall within lower household income brackets, are born into households earning less than the statewide median household income, and are covered by public insurance. In light of the socioeconomic profile of the patient population reported here, these data may prove to be useful in preventative strategies aimed toward prematurity, PHH, and the ongoing treatment of hydrocephalus by pediatric neurosurgeons and other pediatric subspecialists., (Copyright © 2012 S. Karger AG, Basel.)

Of Harvey Cushing's many contributions to neurosurgery, one of the least documented is his early surgical intervention in children and his pioneering efforts to establish pediatric neurosurgery as a subspecialty. Between 1896 and 1912 Cushing conducted nearly 200 operations in children at The Johns Hopkins Hospital. A review of his records suggests that the advances he made in neurosurgery were significantly influenced by his experience with children. In this historical article, the authors describe Cushing's treatment of 6 children, in all of whom Cushing established a diagnosis of "birth hemorrhage." By reviewing Cushing's operative indications, techniques, and outcomes, the authors aim to understand the philosophy of his pediatric neurosurgical management and how this informed his development of neurosurgery as a new specialty.

As neurological surgery began developing into a surgical subspecialty in the US at the turn of the 20th century, with Harvey Cushing at the forefront, the operative treatment of spinal dysraphism was refined with attempts to minimize complications. Following institutional approval, and through the courtesy of the Alan Mason Chesney Archives, the authors reviewed the Johns Hopkins Hospital surgical files from 1896 to 1912. Patients presenting with spinal dysraphism who underwent surgical intervention by Dr. Harvey Cushing were selected for further analysis. Ten patients presented for surgical intervention for spinal dysraphism, and 7 of these had concurrent hydrocephalus. The mean age of these patients was 5.8 months (range 1-14 months). The mean length of stay was 20.4 days. There were 6 inpatient deaths. At the time of last follow-up, 2 patients were well, 1 patient remained unimproved, and 1 patient (for whom no discharge outcome was available) had died. The cases described in detail offer insight into the breadth of Cushing's practice and the varied approaches he employed. The use of Faradic stimulation to assess nerve root function, the use of complex multilayered closures, and the creation of operative tables for combined treatment of hydrocephalus and spinal dysraphism illustrate Cushing's contributions to developing the field of pediatric neurosurgery.