Just over one hundred years ago the very first surgery was performed here at Columbia University Medical Center‘s Department of Neurosurgery.  The surgeon was Dr. Charles Elsberg and he performed the removal of an intramedullary spinal cord tumor. His two step method was pioneering at the time but since then, medicine has advanced tremendously and the treatment of this condition has come a long way.

Charles Elsberg, the first chairman of the Department of Neurological Surgery at the Neurological Institute of New York, mastered and popularized surgical resection of intramedullary spinal cord tumors.

Prior to Elsberg’s work (c. 1910), surgery within the substance of the spinal cord was largely avoided due to excessively high morbidity.  Elsberg introduced the “two-stage method of extrusion” for resecting intramedullary tumors.

During the first stage of the surgery Elsberg exposed the region of the spinal cord known to harbor the tumor and proceeded to perform a myelotomy over the area. At this point Elsberg would close the wound and return for the second stage of the surgery after about 1 week.

During the second stage, Elsberg reopened the surgical wound and excised the tumor which had invariably begun the process of delivering itself from the surrounding spinal cord.  Elsberg is quoted as saying: “…no matter how markedly the tumor will seem to bulge, the surgeon must not attempt to remove the growth, for he will be sure to cause grave injury to the cord. He must leave it to nature to extrude the tumor.”

Dr. Charles Elsberg performed the first surgery at the Department of Neurosurgery 100 years ago

Elsberg’s pioneering two-stage method showed that surgery was a viable option for treating intramedullary tumors.  The advent of micro-neurosurgical techniques has precipitously advanced the surgical strategy used to treat intramedullary tumors.

Resection of intramedullary Spinal Tumors is now done in a single stage by specialists here at both the Brain Tumor Center and Spine Center.  Their techniques have come a long way since Elsberg’s time.  Now they use surgical microscopes, microsurgical tools, and often laser or ultrasonic aspiration instruments.

Today, many types of intramedullary tumors can be completely removed with low attendant morbidity. Needless to say, Elsberg did not have the benefit of such high-end technology in the operating room, making his surgical achievements that much more remarkable.

To learn more see our pages on Spinal Tumors and Neuro-Oncology.

H. Houston Merritt, MD is widely considered the father of Neurology, by now however, it may be more accurate to say he is the Grandfather of Neurology.  In the 12th edition of Merritt’s Neurology just published, the editors refer to the most recent bunch of contributors as his “intellectual children and grandchildren.” Among these are no less than ten from the Department of Neurosurgery.

Merritt’s Neurology was first published in 1955 with Merritt as the sole author.  He continued to write, revise and expand the text as the field of neurology grew, accepting contributions only for the fifth and sixth editions before he died in 1979.  In the preface of the newest edition the editors write:

The seventh edition, published and edited by Lewis P. Rowland in 1984, was prepared by seventy of Merritt’s students.  Thirty of them headed neurology departments and others had become distinguished clinicians, teachers and investigators.  That edition was a landmark in the history of neurology.  It documented the human legacy of a singular leader(.) 12th edition Merritt’s Neurology

Years earlier, in 1948, when Merritt joined the faculty of the Neurological Institute he was already well known for his accomplishments including the introduction (with his colleague Tracy Putnam) of the use of dilantin to control seizures in epileptics.

Over the course of his career, however, Merritt mentored hundreds of neurologists, and in the end that was probably his greatest achievement.  Just over 30 years have passed since his death and his proteges have themselves become mentors who’s students in turn are teaching a whole new generation of neurologists.

Merritt’s “intellectual children and grandchildren” from the Department of Neurosurgery include: Robert A. Solomon, MD; Peter D. Angevine, MD, MPH; Jeffrey N. Bruce, MD; Neil A. Feldstein, MD; Saadi Ghatan, MD; Steven R. Isaacson, MD; Michael G. Kaiser ,MD, FACS; Sean D. Lavine, MD; Paul C. McCormick, MD, MPH; and  Philip M. Meyers MD.

Look for future blogs that include information about their contributions to this 12th edition of  Merritt’s Neurology.

To learn more, see Merritt’s Neurology On-line for a fully search-able electronic version.

Dr. Charles A. Elsberg was one of the NI founders and their first Chair of Neurosurgery. He held this position until retirement in 1937. Elsberg has been called the “father of spinal surgery.” In his paper, Some Aspects of the Diagnosis and Surgical Treatment of Tumors of the Spinal Cord, published in 1925, he commented on the progress in the field, “we are now able, in many instances, to say with certainty that an individual has a spinal cord tumor, and it is possible to diagnosticate not only the level at which the spinal cord is compressed, but also the side of the cord… upon which the expanding lesion is exerting its pressure.” This was a remarkable achievement in his day especially since X-rays were the only imaging techniques and, as they were, didn’t actually pick up these tumors.

In his article, Elsberg, also details the surgical procedure of tumor removal. He says, “The attempt should always be made to do as wide a laminectomy as possible to reduce to a minimum the amount of handling of the cord.” This meant making as large an incision and removing as much bone as possible. In fact, because the damage was too great, Elsberg recommended not removing the entire tumor if the cord was involved. The problem was, he had to rely only on what he could see with his naked eye. This was a challenge to be tackled by the next generation of surgeons.

Enter Dr. J. Lawrence Pool. Pool was chairman of the Department of Neurological Surgery from 1949 to 1972. In 1937, he made strides in diagnosis when he first performed an exam using a myeloscope. In 1959, he presented A look Ahead at Technical and Training Developments in Neurosurgey in which he details advancement of other diagnostic techniques such as radioactive scanning and enzyme studies of the cerebrospinal fluid. But it was his introduction of the use of the microscope during surgery that lead to the development of the microsurgical techniques used today.

The torch was then passed to Dr. Paul McCormick, current director of the Spine Center at NI. He has dedicated his research to the study of the spine, and largely to the microsurgical management of spinal tumors. Microsurgery involves the use of microscopes and tiny instruments that can remove more of the tumor, more safely than ever before. Highly focused beams of radiation can also be used to target any remaining tumor. This together with advances in diagnostics such as MRIs and CAT scans have greatly improved patient outcomes. More information on Dr. McCormick’s and the Spine Centers’ work can be found here: Spinal Tumors and Spinal Tumor Resection Procedure.

Finally, in the words of Dr. J. Lawrence Pool, “Technical developments along these and other lines rest entirely on the ability and imagination of future neurosurgeons. Their predecessors have already demonstrated a remarkable degree of ingenuity in this regard,”

Learn more about the History of the Neurological Institute

To mark this occasion Columbia University’s College of Physicians and Surgeons hosted a Centennial Symposium in September.  The auditorium was filled with Neuroscientists and Neurosurgeons from all over the world who came to hear members of the Columbia University and NI teams speak. Two of the speakers were Nobel Prize winners, Dr. Eric R Kandel and Dr. Richard Axel .

Dr. Eric R Kandel won the Nobel Prize for Physiology/Medicine in 2000.  He is a University Professor and Kavli Professor of Brain Science at Columbia University and Senior Research Scientist at the Howard Hughes Medical Research Institute.  He is best known for the study of the physiology of memory. He has also recently published the book: Memory: From Mind to Molecules.

Dr. Richard Axel won the Nobel Prize for Physiology/Medicine in 2004.  He is also a University Professor at Columbia University and an Investigator at the Howard Hughes Medical Institute. His work is notable for paving the way to the genetic and molecular study of olfaction (that is our sense of smell).

The day long Centennial Symposium featured many other notable neuroscientists and neurosurgeons.  At the end of the day the Neurological Institute had been true to their long standing tradition as stated by Dr. Lee Goldman,  “The Neurological Institute is more than just a building- it is important to our medical center because of its stellar faculty who educate the next generation of neurologists and neurosurgeons, and who continue to lead developments in addressing some of the most devastating neurological diseases that affect our population.”

Axel  See Dr. Richard Axel’s Interview with Charlie Rose

Related basic science projects include an active collaboration with Dr. Carol Troy seeks to understand novel mechanisms of caspase-mediated post-ischemic neuronal cell death/survival.  In addition, recent laboratory studies are underway to study the role of the complement cascade, programmed cell death, and neurogenesis in spontaneous intracerebral hemorrhage, as well.

We have recently begun recruiting patients for an FDA-funded multicenter, phase II clinical trial aimed at assessing the safety of tiopronin in patients with aneurysmal subarachnoid hemorrhage(aSAH) and also to obtain preliminary data on the efficacy of tiopronin versus placebo in reducing serum and CSF 3AP levels in this stroke patient population. Collaborating principle investigators participating in this trial include Dr. Brian L. Hoh and Dr. J. Mocco from the Neurosurgery Department at the University of Florida, and also Dr. Louis J. Kim from the Neurosurgery Department at the University of Washington.

Other clinical research efforts include those concerning vascular re-activation of large and small cerebral vessels through the effects of subarachnoid hemorrhage and other trauma, and the auto-regulation of vessels in relation to arteriovenous malformations and other pathological vascular conditions.  In collaboration with Dr. Eric Heyer (Anesthesiology), the lab has also shown that possession of the ε4 allele of the ApoE gene (originally characterized in Alzheimer’s Diseases) is a risk factor for neurocognitive decline following carotid endarterectomy.  Researchers in the laboratory also play a pivotal role in the international effort to identify genes responsible for the formation of cerebral aneurysms.