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Mirza N. Baig, Faheem Chishty, Phillip Immesoete and Chris S. Karas

✓The seat of consciousness has not always been thought to reside in the brain. Its “source” is as varied as the cultures of those who have sought it. At present, although most may agree that the central nervous system is held to be the root of individualism in much of Western philosophy, this has not always been the case, and this viewpoint is certainly not unanimously accepted across all cultures today.

In this paper the authors undertook a literary review of ancient texts of both Eastern and Western societies as well as modern writings on the organic counterpart to the soul. The authors have studied both ancient Greek and Roman material as well as Islamic and Eastern philosophy.

Several specific aspects of the human body have often been proposed as the seat of consciousness, not only in medical texts, but also within historical documents, poetry, legal proceedings, and religious literature. Among the most prominently proposed have been the heart and breath, favoring a cardiopulmonary seat of individualism. This understanding was by no means stagnant, but evolved over time, as did the role of the brain in the definition of what it means to be human.

Even in the 21st century, no clear consensus exists between or within communities, scientific or otherwise, on the brain's capacity for making us who we are. Perhaps, by its nature, our consciousness—and our awareness of our surroundings and ourselves—is a function of what surrounds us, and must therefore change as the world changes and as we change.

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Chris S. Karas, Mirza N. Baig and Scott W. Elton

Object

The authors review all cases in which ventriculosubgaleal (VSG) shunts were placed at Columbus Children's Hospital for the treatment of posthemorrhagic hydrocephalus in order to assess the surgical procedure, effectiveness of surgery, and complications of cerebrospinal fluid diversion to the subgaleal space. The purpose of the review is to make a comparison between cases in which shunts were placed in the operating room (OR) and those in which they were placed in the neonatal intensive care unit (NICU). Considerations and complications specific to patient transport to the OR or surgical implantation in the NICU are discussed.

Methods

Seventeen infants with posthemorrhagic hydrocephalus were treated with VSG shunt placement over a period of 4 years. A retrospective analysis of these cases was performed to evaluate multiple aspects of the procedure. Specifically, the surgical procedure, duration of shunt function prior to shunt conversion, neuroimaging changes, operative complications, and risk of infection are discussed. The authors also performed a comparative analysis of shunt placement in the NICU and the OR.

Results

The length of the procedure was similar in the two locations. No differences in perioperative or intraoperative risks and no increased risk of infection were seen in either location in this pilot study. Interestingly, the mean lifespan of primary implants placed in the NICU (73 days) was longer than that of those placed in the OR (43 days).

Conclusions

Ventriculosubgaleal shunt placement offers a safe and effective temporary means of treating post-hemorrhagic hydrocephalus and can be reliably and safely performed at the bedside.