Search Results

You are looking at 1 - 10 of 63 items for :

  • By Author: Cohen-Gadol, Aaron A. x
Clear All
Free access

Aaron A. Cohen-Gadol

Epidermoid tumors comprise about 1% of all intracranial tumors. They are congenital lesions that arise from paramedian cisterns within the posterior fossa. These tumors present as heterogeneous hyperintense lesions on FLAIR and homogenous hyperintense lesions on DWI. Surgical resection remains the most accepted form of therapy, but epidermoid tumors may recur. These tumors are well exposed through a traditional retrosigmoid approach. The tumor can be removed relatively easily as it is avascular. However, the propensity of this tumor type to fill the small spaces within basal cisterns and attach to cranial nerves may make its complete resection challenging. Tumors resection has to preserve the surrounding arachnoid membranes encasing the cranial nerves.

The author presents the case of a 42-year-old woman with a 1-year history of imbalance and nystagmus. An MRI revealed a large right-sided CP angle epidermoid tumor filling the ventral brainstem cistern and extending to the contralateral side, compressing the brainstem. The accompanying video illustrates resection of this mass through an extended (exposing the sigmoid sinus) retrosigmoid approach. The author removed the tumor piecemeal while protecting the cranial nerves. Small pieces of affected arachnoid covering the cranial nerves were not significantly manipulated. To excise the tumor along the contralateral paramedian cistern, the author used the space between the V and VII/VII cranial nerves to expose the space contralateral to the basilar artery and remove additional tumor. This maneuver allowed gross total resection of the tumor without a need to employ a more elaborate skull base approach such as petrosectomy. At 3-month follow-up visit after surgery, the patient's neurological exam returned to normal.

The video can be found here: http://youtu.be/CzRb-GUvhog.

Restricted access

Zachary A. Seymour and Aaron A. Cohen-Gadol

A bout the time Cushing was graduating from medical school, radiation therapy entered its infancy. In November 1895, Roentgen discovered x-rays. Even before the nature of the x-ray was understood, many hypothesized that it could be used as a potential treatment option. By January of 1896, x-ray therapy (or radiotherapy) had been used in the treatment of hirsutism and breast cancer. 18 These 2 applications were the most dominant use of early radiation therapy, and, along with radiation dermatitis, were documented within months of radiotherapy's conception

Restricted access

Aaron A. Cohen-Gadol and Dennis D. Spencer

✓ The temporal lobe is the most common site of partial epilepsy that is amenable to surgical therapy, and therefore ictal localization in this region is important. The authors describe the application of an anteromedial subdural strip electrode for the evaluation of epilepsy originating from the medial temporal lobe. This strip is advanced around the temporal pole and underneath the lesser wing of the sphenoid bone as it follows the medial temporal lobe contour. The advantages of this method of placement are the consistent path and reliable final position of the strip along the medial basal temporal lobe surface. This method allows adequate coverage of the parahippocampal gyrus along its long axis extending posterior to the level of the collicular plate. This technique has been used with no complications during intracranial monitoring of more than 100 patients with presumed temporal lobe epilepsy.

Free access

Jonathan Russin and Aaron A. Cohen-Gadol

Spetzler-Martin Grade I and II (Class A) AVMs can be managed with microsurgical resection alone, achieving good outcomes in 96% and 90% of patients, respectively. These results support microsurgical resection based on the ARUBA trial’s natural history data. Class B or Spetzler-Martin Grade III AVMs are a heterogeneous collection of malformations that require a case-by-case evaluation with special consideration for multimodal therapy. A conservative approach is warranted in patients with these AVMs when they present without a history of rupture. Conservative management is

Restricted access

Aaron A. Cohen-Gadol and Dennis D. Spencer

. One patient who was not included in the published series was among the 11 patients we collected from the database (Case 11, Table 1 ); he was treated after the publication of Cushing's series. TABLE 1 Patients' clinical features, operative findings, adjuvant therapies, and outcomes * Case No. Type of Lesion Date of Surgery Presenting Symptom Physical Exam Findings Imaging/Other Study Findings Surgical Approach Intraop Finding Intervention Immediate Outcome Long-Term Outcome Last FU 1

Free access

Roberto Rey-Dios and Aaron A. Cohen-Gadol

condition tends to be more refractory to medical therapy, especially in patients with vascular compression. 11 , 13 , 32 , 37 , 42 , 51 , 53 , 64 Pain refractory to medical therapy and poor tolerance of drug side effects are common indications for surgical intervention. Historical Perspectives Extracranial nerve ablation was one of the first procedures attempted for treatment of GPN. 43 , 57 This approach was abandoned due to its high morbidity and pain recurrence due to a lack of supraganglionic ablation. Dandy 10 performed some of the first intracranial

Restricted access

Aaron A. Cohen-Gadol and Dennis D. Spencer

Histogenetic Basis With a Correlated Study of Prognosis. Philadelphia: JB Lippincott Co, 1926 2. Bailey P , Sosman M , Van Dessel A : Roentgen therapy of gliomas of the brain. AJR Am J Roentgenol 19 : 203 – 264 , 1928 Bailey P, Sosman M, Van Dessel A: Roentgen therapy of gliomas of the brain. AJR Am J Roentgenol 19: 203–264, 1928 3. Black PM : Harvey Cushing at the Peter Bent Brigham Hospital. Neurosurgery 45 : 990 – 1001 , 1999 Black PM: Harvey Cushing at the Peter Bent Brigham Hospital

Restricted access

Aaron A. Cohen-Gadol and Bruce E. Pollock

median radiosurgery-based AVM score was 1.08 (range 0.36–4.08). TABLE 1 Patient characteristics Factor No. of Patients (%) age (yrs)  ≤ 8 3 (8)  9–15 19 (50)  16–18 16 (42) presenting symptom  hemorrhage 20 (53)  seizure 9 (24)  other 9 (24) prior treatment  partial resection 1 (3)  clot evacuation 3 (8)  proton beam therapy 1 (3) AVM location  deep * 16 (42)  lobar 22 (58) Spetzler–Martin grade  I & II 11 (29)  III 19 (50)  IV & V 8 (21

Restricted access

Michael Turner, Ha Son Nguyen and Aaron A. Cohen-Gadol

(malfunction, rotation), and wound complications (infection, dehiscence). 22 , 32 , 33 These issues necessitate additional surgical intervention, leading to multiple revisions. Recently, a few studies have reported the use of IVB in refractory spasticity or dystonia. Albright and Ferson 7 reported the use of IVB for dystonia with favorable results. 7 Haranhalli et al. 19 used IVB in 2 patients after multiple complications from ITB. In the present study, the authors report the outcomes of a series of 20 patients who were treated with IVB therapy after increasing

Free access

Benjamin K. Hendricks, Aaron A. Cohen-Gadol and James C. Miller

efficacious delivery of pharmaceutical therapy, and these barriers are discussed in this review. The relatively limited access of chemotherapy medications to the microenvironment of a malignant brain tumor is a major obstacle to their delivery. This limited access is due to 2 major structural barriers: the blood-brain barrier (BBB) and the blood–cerebrospinal fluid barrier (BCSFB). Both barriers provide biomechanical and cellular resistance to pharmaceutical extravasation and to the exposure of the parenchymal tissues of the central nervous system (CNS) to chemotherapy