Ulrich Batzdorf | University of California, Los Angeles (original) (raw)
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Papers by Ulrich Batzdorf
Journal of Neurosurgery: Spine, 2005
✓ In the present review the author describes the different types of syringomyelia that originate ... more ✓ In the present review the author describes the different types of syringomyelia that originate from abnormalities at the level of the spinal cord rather than at the craniovertebral junction. These include posttraumatic and postinflammatory syringomyelia, as well as syringomyelia associated with arachnoid cysts and spinal cord tumors. The diagnosis and the principles of managing these lesions are discussed, notably resection of the entity restricting cerebrospinal fluid flow. Placement of a shunt into the syrinx cavity is reserved for patients in whom other procedures have failed or who are not candidates for other procedures.
min - Minimally Invasive Neurosurgery, 2004
Anterior cervical foraminotomy (ACF) was developed under the concept of functional spine surgery,... more Anterior cervical foraminotomy (ACF) was developed under the concept of functional spine surgery, which directly eliminates compressive pathological factors while preserving functional anatomic features. The authors reviewed their results to determine the efficacy of the approach for unilateral cervical spondylotic radiculopathy (CSR). Nineteen patients were treated with the ACF with a follow-up from 12 to 36 months. There were 10 men and 9 women (mean age 49.8). Fourteen patients had a single ACF, and 5 had procedures at adjacent levels. The procedure involves microsurgical removal of the lateral portion of the uncinate process to identify the nerve root. Seventeen patients (89.5 %) were symptom-free or clearly improved, one (5.3 %) was unchanged and one patient (5.3 %) was worse in the visual analogue scale (VAS) score for radicular pain. One patient had developed contralateral foraminal stenosis at the level of the surgery and had undergone anterior discectomy and fusion. ACF provided good or excellent outcomes, with minimal morbidities, for patients with CSR. The advantages of ACF include direct decompression of the nerve root, and the preservation of the intervertebral disc and the motion segment. Thus, fusion-related sequelae, including graft-related complications, graft site complications and the adjacent level disease are avoided. The ACF procedure appears to be a good alternative for carefully selected patients with unilateral CSR.
Journal of Neurosurgery Spine, 2005
HE independent point prevalence of sciatica in the adult population is greater than 5% 32 and its... more HE independent point prevalence of sciatica in the adult population is greater than 5% 32 and its lifetime prevalence is as high as 40%. 28 The percentage of these cases of sciatica caused by lumbar disc herniations, however, remains unclear. Lumbar spine surgery is performed annually in only approximately 0.2% 6,60 of this population. Prior to 1934, sciatica was viewed primarily as the result of sciatic nerve entrapment in the pelvis, 27,43,63 but Mixter and Barr's widely respected publication 47 revealed the clinical importance of lumbar disc herniation. New diagnostic technology is now able to demonstrate that many cases of sciatica are in fact due to causes unrelated to disc lesions 49 such as piriformis syndrome and distal foraminal impingements. Because of methodological flaws, many of these diagnoses have not been adequately considered despite two decades of high-quality epidemiological and clinical work in this field. In one report written by a leading group of
Syringomyelia, 2001
The history of syringomyelia is considered from the original observation of the entity, the theor... more The history of syringomyelia is considered from the original observation of the entity, the theories of pathogenesis, and the history of the development of treatment modalities.
Neurosurgical Focus, 2000
In this paper the author summarizes currently available surgical approaches to spinal syringomyel... more In this paper the author summarizes currently available surgical approaches to spinal syringomyelia that is unrelated to Chiari I malformation or hindbrain descent. Primary spinal syringomyelia is most comonly associated with spinal trauma but is also encountered as a sequela to intradural inflammatory processes (infections or chemical), as a delayed response to surgical procedures, and in association with intra- and extradural neoplasms as well as disc protrusions. The advantages of placing a shunt are its technical simplicity and immediate reduction of syrinx size; its major disadvantages are the high rate of failure observed in long-term follow up and the difficulty in applying this technique in septated cysts. Expansion of the subarachnoid space with resection of scars has better long-term results. Patients in whom a syrinx cavity has caused a kyphotic spinal deformity may need to undergo a procedure in which the kyphotic deformity is corrected to expand the subarachnoid space. ...
Journal of Neurosurgery: Spine, 2008
Object The most commonly reported treatment of primary syringomyelia has been laminectomy with du... more Object The most commonly reported treatment of primary syringomyelia has been laminectomy with duraplasty or direct shunting from the syrinx cavity. Diversion of cerebrospinal fluid (CSF) from the spinal subarachnoid space to peritoneal, atrial, or pleural cavities has been described previously in only a few case reports. Shunting of the CSF from the subarachnoid space rostral to the level of myelographic blockage may reduce the filling force of the syrinx cavity and avoids myelotomy and manipulation of the spinal cord parenchyma. The authors report on 7 patients who underwent thecal shunt placement for primary spinal syringomyelia. Methods This study is a retrospective review of a consecutive series. The authors reviewed the medical records and neuroimaging studies of 7 adult patients with posttraumatic, postsurgical, or postinflammatory syringomyelia treated with thecoperitoneal, thecopleural, or thecoatrial shunt placement at the University of California Los Angeles Medical Cente...
Journal of Neurosurgery: Spine, 2002
Object. Syringomyelia is often linked to pathological lesions of the foramen magnum. The most com... more Object. Syringomyelia is often linked to pathological lesions of the foramen magnum. The most common cause is hindbrain herniation, usually referred to as Chiari I or II malformation. Foramen magnum arachnoiditis without either Chiari I or II malformation is a rare cause of syringomyelia. The authors undertook a retrospective analysis of 21 patients with foramen magnum arachnoiditis (FMA) and syringomyelia treated between 1978 and 2000 to determine clinical course and optimum management. Methods. In the review of records, 21 patients with FMA and syringomyelia were documented. A stable clinical course was demonstrated in three patients in whom surgery was not performed, and one patient refused surgical intervention. Seventeen patients underwent 23 operations to treat progressive neurological disease. Of these 23 operations, 18 involved opening of the foramen magnum, arachnoid dissection, and placement of a large dural graft. One patient underwent insertion of a ventriculoperitoneal ...
Journal of Neurosurgery: Spine, 2006
Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) fo... more Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resectio...
Journal of Neurosurgery: Spine, 2006
Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) fo... more Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resectio...
Spine, 1991
Twenty-two patients who underwent a surgical decompressive procedure for cervical spondylotic mye... more Twenty-two patients who underwent a surgical decompressive procedure for cervical spondylotic myelopathy were studied with magnetic resonance imaging to evaluate the effectiveness of their decompressive procedures. Twelve patients were judged as adequately decompressed by magnetic resonance imaging criteria. Ten patients exhibited evidence of residual cord indentation. This along with cord atrophy, gliosis, and abnormal spine curvature presumably contributed to residual deficit in several patients. One patient underwent a second decompressive procedure for residual cord indentation, which subsequently improved, as seen on his second postoperative magnetic resonance image. Magnetic resonance imaging was useful in distinguishing mechanical problems from intrinsic cord damage or atrophy. Magnetic resonance imaging should be used after operation in patients with residual deficit to detect patients who may be considered for a second decompressive procedure.
Recent work-hour restrictions and the constantly evolving body of knowledge are challenging the c... more Recent work-hour restrictions and the constantly evolving body of knowledge are challenging the current ways of teaching neurosurgery residents. To develop a curriculum-based digital library of multimedia content to face the challenges in neurosurgery education. We used the residency program curriculum developed by the Congress of Neurological Surgeons to structure the library and Microsoft Sharepoint as the user interface. This project led to the creation of a user-friendly and searchable digital library that could be accessed remotely and throughout the hospital, including the operating rooms. The electronic format allows standardization of the content and transformation of the operating room into a classroom. This in turn facilitates the implementation of a curriculum within the training program and improves teaching efficiency. Future work will focus on evaluating the efficacy of the library as a teaching tool for residents.
Journal of Neurosurgery: Spine, 2005
✓ In the present review the author describes the different types of syringomyelia that originate ... more ✓ In the present review the author describes the different types of syringomyelia that originate from abnormalities at the level of the spinal cord rather than at the craniovertebral junction. These include posttraumatic and postinflammatory syringomyelia, as well as syringomyelia associated with arachnoid cysts and spinal cord tumors. The diagnosis and the principles of managing these lesions are discussed, notably resection of the entity restricting cerebrospinal fluid flow. Placement of a shunt into the syrinx cavity is reserved for patients in whom other procedures have failed or who are not candidates for other procedures.
min - Minimally Invasive Neurosurgery, 2004
Anterior cervical foraminotomy (ACF) was developed under the concept of functional spine surgery,... more Anterior cervical foraminotomy (ACF) was developed under the concept of functional spine surgery, which directly eliminates compressive pathological factors while preserving functional anatomic features. The authors reviewed their results to determine the efficacy of the approach for unilateral cervical spondylotic radiculopathy (CSR). Nineteen patients were treated with the ACF with a follow-up from 12 to 36 months. There were 10 men and 9 women (mean age 49.8). Fourteen patients had a single ACF, and 5 had procedures at adjacent levels. The procedure involves microsurgical removal of the lateral portion of the uncinate process to identify the nerve root. Seventeen patients (89.5 %) were symptom-free or clearly improved, one (5.3 %) was unchanged and one patient (5.3 %) was worse in the visual analogue scale (VAS) score for radicular pain. One patient had developed contralateral foraminal stenosis at the level of the surgery and had undergone anterior discectomy and fusion. ACF provided good or excellent outcomes, with minimal morbidities, for patients with CSR. The advantages of ACF include direct decompression of the nerve root, and the preservation of the intervertebral disc and the motion segment. Thus, fusion-related sequelae, including graft-related complications, graft site complications and the adjacent level disease are avoided. The ACF procedure appears to be a good alternative for carefully selected patients with unilateral CSR.
Journal of Neurosurgery Spine, 2005
HE independent point prevalence of sciatica in the adult population is greater than 5% 32 and its... more HE independent point prevalence of sciatica in the adult population is greater than 5% 32 and its lifetime prevalence is as high as 40%. 28 The percentage of these cases of sciatica caused by lumbar disc herniations, however, remains unclear. Lumbar spine surgery is performed annually in only approximately 0.2% 6,60 of this population. Prior to 1934, sciatica was viewed primarily as the result of sciatic nerve entrapment in the pelvis, 27,43,63 but Mixter and Barr's widely respected publication 47 revealed the clinical importance of lumbar disc herniation. New diagnostic technology is now able to demonstrate that many cases of sciatica are in fact due to causes unrelated to disc lesions 49 such as piriformis syndrome and distal foraminal impingements. Because of methodological flaws, many of these diagnoses have not been adequately considered despite two decades of high-quality epidemiological and clinical work in this field. In one report written by a leading group of
Syringomyelia, 2001
The history of syringomyelia is considered from the original observation of the entity, the theor... more The history of syringomyelia is considered from the original observation of the entity, the theories of pathogenesis, and the history of the development of treatment modalities.
Neurosurgical Focus, 2000
In this paper the author summarizes currently available surgical approaches to spinal syringomyel... more In this paper the author summarizes currently available surgical approaches to spinal syringomyelia that is unrelated to Chiari I malformation or hindbrain descent. Primary spinal syringomyelia is most comonly associated with spinal trauma but is also encountered as a sequela to intradural inflammatory processes (infections or chemical), as a delayed response to surgical procedures, and in association with intra- and extradural neoplasms as well as disc protrusions. The advantages of placing a shunt are its technical simplicity and immediate reduction of syrinx size; its major disadvantages are the high rate of failure observed in long-term follow up and the difficulty in applying this technique in septated cysts. Expansion of the subarachnoid space with resection of scars has better long-term results. Patients in whom a syrinx cavity has caused a kyphotic spinal deformity may need to undergo a procedure in which the kyphotic deformity is corrected to expand the subarachnoid space. ...
Journal of Neurosurgery: Spine, 2008
Object The most commonly reported treatment of primary syringomyelia has been laminectomy with du... more Object The most commonly reported treatment of primary syringomyelia has been laminectomy with duraplasty or direct shunting from the syrinx cavity. Diversion of cerebrospinal fluid (CSF) from the spinal subarachnoid space to peritoneal, atrial, or pleural cavities has been described previously in only a few case reports. Shunting of the CSF from the subarachnoid space rostral to the level of myelographic blockage may reduce the filling force of the syrinx cavity and avoids myelotomy and manipulation of the spinal cord parenchyma. The authors report on 7 patients who underwent thecal shunt placement for primary spinal syringomyelia. Methods This study is a retrospective review of a consecutive series. The authors reviewed the medical records and neuroimaging studies of 7 adult patients with posttraumatic, postsurgical, or postinflammatory syringomyelia treated with thecoperitoneal, thecopleural, or thecoatrial shunt placement at the University of California Los Angeles Medical Cente...
Journal of Neurosurgery: Spine, 2002
Object. Syringomyelia is often linked to pathological lesions of the foramen magnum. The most com... more Object. Syringomyelia is often linked to pathological lesions of the foramen magnum. The most common cause is hindbrain herniation, usually referred to as Chiari I or II malformation. Foramen magnum arachnoiditis without either Chiari I or II malformation is a rare cause of syringomyelia. The authors undertook a retrospective analysis of 21 patients with foramen magnum arachnoiditis (FMA) and syringomyelia treated between 1978 and 2000 to determine clinical course and optimum management. Methods. In the review of records, 21 patients with FMA and syringomyelia were documented. A stable clinical course was demonstrated in three patients in whom surgery was not performed, and one patient refused surgical intervention. Seventeen patients underwent 23 operations to treat progressive neurological disease. Of these 23 operations, 18 involved opening of the foramen magnum, arachnoid dissection, and placement of a large dural graft. One patient underwent insertion of a ventriculoperitoneal ...
Journal of Neurosurgery: Spine, 2006
Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) fo... more Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resectio...
Journal of Neurosurgery: Spine, 2006
Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) fo... more Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resectio...
Spine, 1991
Twenty-two patients who underwent a surgical decompressive procedure for cervical spondylotic mye... more Twenty-two patients who underwent a surgical decompressive procedure for cervical spondylotic myelopathy were studied with magnetic resonance imaging to evaluate the effectiveness of their decompressive procedures. Twelve patients were judged as adequately decompressed by magnetic resonance imaging criteria. Ten patients exhibited evidence of residual cord indentation. This along with cord atrophy, gliosis, and abnormal spine curvature presumably contributed to residual deficit in several patients. One patient underwent a second decompressive procedure for residual cord indentation, which subsequently improved, as seen on his second postoperative magnetic resonance image. Magnetic resonance imaging was useful in distinguishing mechanical problems from intrinsic cord damage or atrophy. Magnetic resonance imaging should be used after operation in patients with residual deficit to detect patients who may be considered for a second decompressive procedure.
Recent work-hour restrictions and the constantly evolving body of knowledge are challenging the c... more Recent work-hour restrictions and the constantly evolving body of knowledge are challenging the current ways of teaching neurosurgery residents. To develop a curriculum-based digital library of multimedia content to face the challenges in neurosurgery education. We used the residency program curriculum developed by the Congress of Neurological Surgeons to structure the library and Microsoft Sharepoint as the user interface. This project led to the creation of a user-friendly and searchable digital library that could be accessed remotely and throughout the hospital, including the operating rooms. The electronic format allows standardization of the content and transformation of the operating room into a classroom. This in turn facilitates the implementation of a curriculum within the training program and improves teaching efficiency. Future work will focus on evaluating the efficacy of the library as a teaching tool for residents.