Emil Margolin

Hebrew University of Jerusalem, Yerushalayim, Jerusalem, Israel

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Publications (11)27.14 Total impact

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    ABSTRACT: Background: Endoscopic techniques are an integral part of the neurosurgical armamentarium with a growing list of indications. We describe the purely endoscopic removal of an atypical parasagittal meningioma in a patient who could not undergo standard craniotomy due to severe scalp atrophy following childhood irradiation for tinea capitis. Methods: A 68-year-old man in good general health presented with a parasagittal meningioma that recurred following subtotal removal and adjuvant fractionated stereotactic radiosurgery (FSR). The scalp above the tumor location was very diseased and precluded a regular craniotomy for tumor removal. A 4-cm craniotomy was made in the midline forehead, where the skin was normal. A rigid endoscope was advanced under neuronavigation through the interhemispheric fissure, which provided good access with limited retraction, until the tumor was encountered at a depth of 7-8 cm. Two surgeons performed the surgery using a "four-hands technique". The tumor was removed and the insertion area was resected and coagulated. Results: The surgery was uneventful, with no coagulation or transection of major veins. A subtotal resection was achieved, and the patient recovered with no neurological deficit. Conclusions: Safe resection of parasagittal meningiomas with a purely endoscopic technique is feasible. This option needs further exploration as an alternative strategy in patients with severely atrophic scalp skin that greatly increases the risk of significant healing complications with calvarian craniotomy.
    No preview · Article · Jan 2016 · Acta Neurochirurgica
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    ABSTRACT: Pterional craniotomy is one of the most widely used approaches in neurosurgery. The MacCarty keyhole has remained the preferred means of beginning the craniotomy to achieve a low access point; however, the bone opening may result in a residual defect and an aesthetically unpleasant depression in the periorbital area. We present our modification of the traditional technique. Instead of drilling the keyhole in the frontoperiorbital area, the classical location, we perform a 5×15mm strip craniectomy at the lowest accessible point in the infratemporal fossa, corresponding to the projection of the most lateral point of the sphenoid ridge. The anterior half of this opening exposes the basal frontal dura, while the posterior half brings the temporal dura into view. This modified technique was applied in 48 pterional craniotomies performed for removal of a variety of neoplasms during 2014-2015. There were no approach-related complications. Aesthetic outcomes and patient acceptance have been good; no patient developed skin depression in the periorbital area. In our experience, craniotomy for a pterional approach with the lowest possible access to the frontotemporal skull base may be performed by drilling a narrow oblong opening, without the use of any keyhole or burr hole, to create a smaller skull defect and achieve optimal aesthetic outcomes.
    Full-text · Article · Oct 2015 · Journal of Clinical Neuroscience
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    ABSTRACT: The sitting position during surgery is thought to provide important advantages, yet it remains controversial. We compared surgical and neurological outcomes for patients operated on in the sitting versus lateral position. Technically difficult procedures performed from the years 2001-2008 for complex lesions in the posterior fossa (vestibular schwannomas, other cerebellopontine angle tumors, foramen magnum meningiomas, brainstem cavernomas, pineal region tumors) were included. Outcomes in the two surgical positions were compared for all 243 patients (93 sitting, 38.3%; 150 lateral, 61.7%) and for 130/243 patients with vestibular schwannomas (50 sitting, 38.5%; 80 lateral, 61.5%). Sitting and lateral patient subgroups were clinically comparable. There were no surgical mortalities. The extent of removal and surgical and neurological outcomes were comparable. We found no advantage in surgical or neurological outcomes for use of the sitting or lateral surgical positions in technically difficult posterior fossa procedures. In vestibular schwannoma surgeries facial nerve preservation (House-Brackmann score 1-2) was related to extent of resection but not to surgical position. The choice of operative position should be based on lesion characteristics and the patient's preoperative medical status as well as the experience and preferences of the surgeons performing the procedure. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Mar 2015 · Journal of Clinical Neuroscience

  • No preview · Article · Jun 2012 · Journal of Neurological Surgery, Part B: Skull Base
  • S. Spektor · F. Umansky · E. Margolin · Y. Shoshan

    No preview · Article · Jun 2012 · Journal of Neurological Surgery, Part B: Skull Base

  • No preview · Article · Aug 2010 · The Israel Medical Association journal: IMAJ

  • No preview · Article · Sep 2009 · Acta Neuropathologica
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    ABSTRACT: To present results of early angiographic diagnosis and endovascular treatment of traumatic intracranial aneurysms (TICA). From June 2002 to December 2006, diagnostic angiography was performed on patients with moderate to severe traumatic brain injury that involved a cranial base fracture or a penetrating brain injury with a tract from the penetrating agent that entered at the pterional area, went through the middle cerebral artery candelabra, and crossed the midline. TICAs were treated by various endovascular techniques during the same angiographic procedure. Thirty-four patients with traumatic brain injury underwent angiography (25 penetrating brain injuries, nine blunt injuries); 13 TICAs were diagnosed (10 penetrating brain injuries, three blunt injuries). The Glasgow Coma Scale score at diagnosis ranged from 5 to 15. Angiography was performed for screening in eight patients and for clinical indications in five patients; 11 TICAs were diagnosed before rupture. Seven aneurysms were located on branches of the middle cerebral artery, two on pericallosal branches of the anterior cerebral artery, and four on the internal carotid artery. No recanalization was detected in 12 patients. One patient treated with a bare stent and coiling had a growing intracavernous pseudoaneurysm; therefore, internal carotid artery occlusion with extracranial-intracranial microvascular bypass was performed. Six patients refused angiographic follow-up, but computed tomographic angiography has failed to show recanalization. No patient presented with delayed bleeding (mean follow-up, 2.6 yr). There were no procedure-related complications or mortality. Early angiographic diagnosis with immediate endovascular treatment provided an effective approach for TICA detection and management. Endovascular therapy is versatile and offers a valuable alternative to surgery, allowing early aneurysm exclusion with excellent results.
    No preview · Article · Oct 2008 · Neurosurgery

  • No preview · Article · Oct 2008 · Neurosurgery
  • Sergei Spektor · Emil Margolin · Felix Umansky

    No preview · Article · Jan 2007 · Skull Base Surgery
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    ABSTRACT: We evaluate a new technique for plateless fixation of a bone flap after fronto-orbital craniotomy. From September 1999 to October 2004, we performed fronto-orbital craniotomy reconstruction using the Craniofix titanium clamp in 108 consecutive patients with a variety of lesions in the anterior skull base. Postoperative computed tomographic imaging studies and clinical evaluations were performed to prospectively assess cosmetic conformity and bone flap stability and to evaluate the surgical benefit of Craniofix in these patients. Excellent bone flap fixation and cosmetic results were obtained in all patients 6 to 68 months (average, 36 months) after surgery. The Craniofix titanium clamp is a reliable, safe, and simple fixation device for reconstruction of fronto-orbital craniotomy.
    Full-text · Article · Feb 2006 · Surgical Neurology