Search Results

You are looking at 1 - 10 of 26 items for

  • Author or Editor: Richard Ellenbogen x
Clear All Modify Search
Full access

Richard G. Ellenbogen

Object

Tumors of the lateral ventricle can be removed via two major approaches: the transcallosal or the transcortical route. The purpose of this study is to discuss the techniques and outcomes in transcortical surgery of tumors located in the lateral ventricle.

Methods

An experience with 29 consecutive lateral ventricular tumors resected via the transcortical route, over a 5-year period, is presented. The risks, complications, and outcomes of this surgical series, as well as those reported in the literature, are discussed. Surgical approaches to all five regions of the lateral ventricle are described. Neuropsychological, functional, and neurological outcomes are evaluated.

Conclusions

The transcortical technique makes it possible to resect lesions in each of the five regions of the lateral ventricle. It provides superior microsurgical working space and flexibility for maneuvering within the lateral ventricle. The key to a successful transcortical approach is an understanding of the functional anatomy of eloquent cortex to be broached, the location of the lesion, and its vascular supply. A clear understanding of the advantages and limitations of the transcortical approach makes performing this procedure for resection of large lesions in the ventricle both safe and effective. The majority of the patients in this series (86%) had a good outcome, returning to baseline functional status and suffering minimal morbidity. In the microsurgical era, transcortical surgery–related postoperative morbidity and outcome are dependent more on tumor histological type and site of origin than on approach.

Free access

Richard G. Ellenbogen

Full access

Diana Barrett Wiseman, Richard Ellenbogen and Christopher I. Shaffrey

Triage for the neurosurgeon is a misnomer. The neurosurgeon's role within a mass-casualty situation is one of a subspecialist surgeon instead of a triage officer. Unfortunately because of the events of September 11, 2001, civilian neurosurgeons and other medical specialists have been questioning their role within a mass-casualty situation or, worse, a situation created by biological, chemical, or nuclear weapons. There is no single triage system used exclusively within the United States, and different systems have differing sensitivities, specificities, and labeling methods. The purpose of this article is to discuss varying aspects of triage for both military personnel and civilians and suggest how the neurosurgeon may help shape this process within his or her community. Furthermore, the effects of biological, chemical, and nuclear weapons will be discussed in relation to the triage system.

Restricted access

Marcelo D. Vilela, Richard J. Bransford, Carlo Bellabarba and Richard G. Ellenbogen

Object

Horizontal fractures of the anterior arch of the atlas not associated with odontoid fractures have been regarded as stable fractures that can be simply treated with a cervical collar. The authors report that C-1 horizontal fractures also occur in association with severe distraction injuries of the craniocervical junction.

Methods

The authors retrospectively reviewed imaging studies obtained in all surviving patients in whom unstable distraction injuries of the craniocervical junction were diagnosed and in whom surgery was performed at their institution between 1995 and 2009. All patients who also had a C-1 horizontal fracture as a component of their spinal injury were included in the study.

Results

Of 47 patients with unstable craniocervical distraction injuries, 5 patients had a horizontal fracture through the anterior ring of C-1: 1 patient had a primarily C1–2 distractive injury whereas 4 others had a grossly unstable injury across the occipitoatlantal junction (occipitoatlantal dissociation).

Conclusions

The finding of a C-1 horizontal fracture does not always reflect a benign injury and its presence should heighten the concern of a more severe and unstable injury at the craniocervical junction.

Free access

E. Sander Connolly Jr. and Richard G. Ellenbogen

Restricted access

Michael R. Levitt, Toba N. Niazi, Richard A. Hopper, Richard G. Ellenbogen and Jeffrey G. Ojemann

Chiari malformation Type I (CM-I) is associated with syndromic and nonsyndromic craniosynostosis in pediatric patients, and the surgical management of CM-I in such cases is controversial. Previous guidelines have recommended simultaneous cranial vault expansion and suboccipital decompression. However, spontaneous resolution of CM-I has been observed, and the combined procedure carries additional surgical risks. The authors report the case of a 6-month-old boy with Crouzon syndrome, CM-I, and a cervical syrinx who underwent posterior cranial vault release without suboccipital decompression. Imaging at the 3-month follow-up visit demonstrated complete resolution of the CM-I, improvement in CSF flow, and reduction in the size of the syrinx. This case suggests that up-front suboccipital decompression may not be necessary in patients with craniosynostosis and CM-I. A strategy of initial cranial vault release, followed by watchful waiting and radiographic surveillance, is proposed.

Full access

Richard G. Ellenbogen, Rocco A. Armonda, Dennis W. W. Shaw and H. Richard Winn

In patients with Chiari I malformation with and without associated syringomyelia, aberrant cerebrospinal fluid (CSF) dynamics and a spectrum of posterior fossa pathological findings are demonstrated. In this study, the authors test the validity of using prospective cardiac-gated phase-contrast cine-mode magnetic resonance (MR) imaging to define the malformation, delineate its pathophysiology, and assist in implementing a rational treatment plan.

Eighty-five cases were prospectively analyzed using cine MR imaging. Sixty-five patients, adults and children, with symptomatic Chiari malformation, with and without syringomyelia, were surgically treated from 1990 to 1999. All patients underwent pre- and postoperative cine MR evaluation. Ten patients were treated after a previous surgical procedure had failed. To establish CSF flow characteristics and normative CSF profiles, 20 healthy volunteers were examined.

Compared with normal volunteers, in Chiari I malformation patients with and without syringomyelia, uniformly abnormal craniocervical junction CSF flow profiles were revealed. After intradural exploration, nearly all patients with Chiari I malformation experienced clinical improvement and CSF flow profiles, paralleling those of normal volunteers, were shown. In all patients in whom treatment had failed, abnormal preoperative CSF flow profiles, which correlated with suspected physiological abnormalities and the pathological findings noted at reoperation, were demonstrated.

Symptomatic Chiari I malformation is a dynamic process characterized by the impaction of the hindbrain in an abnormal posterior fossa. This compression obstructs the normal venting of CSF in and out of the craniocervical sub-arachnoid space, throughout the cardiac cycle. Therefore, decompression or enlargement of the posterior fossa to establish normal CSF pathways should be the primary goal of surgical intervention. Aberrant CSF flow appears to be only one aspect of the pathological condition found in patients with Chiari I malformation. Arachnoid scarring in the posterior fossa and selective vulnerability of the spinal cord may also be factors in the pathogenesis and maintenance of associated syringomyelia. Phase-contrast cine MR imaging is a useful tool in defining physiological and anatomical problems in patients with Chiari I and syringomyelia, and it can help guide an appropriate primary or salvage surgical therapy.

Restricted access

Rohan Ramakrishna, Jeffrey C. Mai, Tanya Filardi, Samuel R. Browd and Richard G. Ellenbogen

This 18-year-old woman presented with symptoms of right upper-extremity ataxia and imaging evidence of syringomyelia and an acquired Chiari malformation after a previous suboccipital decompression for cerebellar hemorrhage. The patient underwent posterior fossa reexploration to detether any adhesions and release scar tissue in the fourth ventricular outlet. Her symptoms of syringomyelia resolved but she then developed symptoms of lethargy, confusion, and amnesia in addition to ataxia. Repeat neural axis imaging revealed resolution of the syrinx but prominent brainstem hypertrophy. Eventually, the placement of a ventriculoperitoneal shunt resulted in the resolution of both symptoms and brainstem hypertrophy. In the present article, the authors elaborate on this first reported case of a reversible brainstem hypertrophy responsive to CSF shunting.

Restricted access

Taylor J. Abel, Abhineet Chowdhary, Patrik Gabikian, Richard G. Ellenbogen and Anthony M. Avellino

✓ The authors report the case of a 3-year-old girl with a Chiari malformation Type I (CM-I) and concomitant fatty terminal filum. This child was examined prior to the onset of CM-I as well as after, and the authors present magnetic resonance (MR) images documenting that the malformation was acquired as the child grew in height. This case contributes to the literature describing an acquired CM-I associated with a fatty filum and is the first published account to include MR imaging obtained before and after the onset of the malformation.

Restricted access

Ali H. Mesiwala, Christopher I. Shaffrey, Joseph S. Gruss and Richard G. Ellenbogen

✓ The authors present the first known reported case of hemifacial microsomia associated with a Chiari I malformation and syrinx. A 14-year-old girl presented with progressive torticollis of 3 years' duration and headaches exacerbated by exercise. Computerized tomography scanning and magnetic resonance imaging revealed extensive craniofacial and vertebral abnormalities, including aplasia of the floor of the left middle fossa and posterior fossa cranium, articulation of the left mandibular condyle with the left temporal lobe, and progressive development of a Chiari I malformation with associated syringomyelia. The patient first underwent posterior fossa decompression, duraplasty, and occipitocervical fusion. This procedure was later followed by reconstruction of the floor of the left middle fossa and temporomandibular joint. The patient's outcome was excellent. In this case report the authors review the complex embryological development of craniofacial and craniovertebral structures, and emphasize the use of a staged approach to treat pathophysiological consequences of this congenital anomaly.