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.”
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.
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