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Article ; Online: Autologous Temporalis Subfascial Fat Graft for Skull Base Repair: A Novel Technique.

Lee, Paul / Krisht, Khaled M / Cai, Li / Krisht, Ali F

Operative neurosurgery (Hagerstown, Md.)

2021 Volume 20, Issue 4, Page(s) E274–E278

Abstract: Background: Autologous abdominal fat grafts are occasionally used in the repair of skull base exposures. This surgical procedure typically requires an additional surgical site and may have unexpected postoperative complications.: Objective: To ... ...

Abstract	Background: Autologous abdominal fat grafts are occasionally used in the repair of skull base exposures. This surgical procedure typically requires an additional surgical site and may have unexpected postoperative complications. Objective: To describe an operative technique for harvesting subfascial fat from the temporal extension of the buccal fat pad for the repair of skull base defects. Methods: We review the pertinent anatomy of the temporalis subfascial fat pad and discuss the technique used to harvest the subfascial fat component in a clinical presentation. Results: A pretemporal approach was performed for clip ligation of an anterior circulation aneurysm. A standard frontotemporal incision was made with an interfascial flap to preserve the frontalis branches of the facial nerve. The subfascial fat was inspected and determined to be adequate for harvesting. Monopolar cauterization was carefully utilized to remove the fat. During closure, the graft was used to repair a pneumatized clinoid sinus and for the dural repair of the pretemporal exposure. The patient did not have any postoperative complications. Conclusion: Autologous temporalis subfascial fat graft is a viable and safe technique for skull base dural and sinus repair during frontotemporal approaches in select patients. This technique avoids an additional surgical procedure and potential complications that may be associated with it.
MeSH term(s)	Facial Nerve ; Humans ; Skull Base/surgery ; Surgical Flaps ; Temporal Muscle/surgery ; Transplantation, Autologous
Language	English
Publishing date	2021-01-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opaa442
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Article ; Online: Resection of an Isolated Pituitary Stalk Epidermoid Cyst Through a Pretemporal Approach: Case Report and Review of the Literature.

Lee, Paul / Krisht, Khaled M / Mukunyadzi, Perkins / Krisht, Ali F

World neurosurgery

2020 Volume 146, Page(s) 26–30

Abstract: Background: Intracranial epidermoid cysts are congenital epidermal inclusion cysts derived from ectodermal origin with desquamated skin. The majority of these cysts occur in the cerebellopontine angle cistern. Epidermoid cyst of the pituitary stalk, ... ...

Abstract	Background: Intracranial epidermoid cysts are congenital epidermal inclusion cysts derived from ectodermal origin with desquamated skin. The majority of these cysts occur in the cerebellopontine angle cistern. Epidermoid cyst of the pituitary stalk, however, is a rare location. To date, only 4 previous cases have been reported. Case description: A 63-year-old male presented to our clinic with migraine headaches, dizziness, increased thirst, increased urinary frequency, and impotence. Magnetic resonance imaging of the brain demonstrated a rim-enhancing cystic mass with diffusion restriction on diffusion-weighted imaging located within the pituitary stalk. The patient underwent a pretemporal approach with gross total resection of the cyst. The patient's postoperative course was uneventful with no new deficits and/or endocrinopathies. Conclusion: Epidermoid cyst of the pituitary stalk is an unusual and rare presentation. Four other cases treated via endoscopic approaches have been previously reported in the neurosurgical literature. To our knowledge this is the first case description of an infundibular epidermoid cyst pressing with isolated diabetes insipidus surgically treated via a transcranial pretemporal approach with gross total resection. The patient had a smooth and uneventful postoperative course with persistent diabetes insipidus.
MeSH term(s)	Central Nervous System Cysts/complications ; Central Nervous System Cysts/surgery ; Diabetes Insipidus/etiology ; Epidermal Cyst/complications ; Epidermal Cyst/surgery ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Pituitary Gland/surgery
Language	English
Publishing date	2020-09-10
Publishing country	United States
Document type	Case Reports
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2020.09.030
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Article ; Online: Temporary Clipping of the Intracavernous Internal Carotid Artery: A Novel Technique for Proximal Control.

Basma, Jaafar / Krisht, Khaled M / Lee, Paul / Cai, Li / Krisht, Ali F

Operative neurosurgery (Hagerstown, Md.)

2020 Volume 20, Issue 2, Page(s) E91–E97

Abstract: Background: Securing proximal control in complex paraclinoid aneurysm surgery through traditional techniques may be challenging and risky in certain situations. Advancements of anatomical knowledge of the cavernous sinus (CS) and hemostasis have made it ...

Abstract	Background: Securing proximal control in complex paraclinoid aneurysm surgery through traditional techniques may be challenging and risky in certain situations. Advancements of anatomical knowledge of the cavernous sinus (CS) and hemostasis have made it more accessible as a surgical option. Objective: To describe the technique of temporary clipping of the horizontal segment of the intracavernous internal carotid artery (IC-ICA) in preparation for permanent clipping of complex paraclinoid aneurysms. Methods: Through an extradural pretemporal approach, the lateral wall of the CS is exposed. The dura between the trochlear nerve and V1 is opened, and access is made to the horizontal segment of the IC-ICA. After circumferential dissection, the temporary clip can be introduced to the artery, and the extradural clinoidectomy can be continued under secured proximal control. Results: Seven patients with complex paraclinoid aneurysms were treated between May 2013 and May 2016 by the senior author. Temporary clipping of the IC-ICA was performed in all cases. Average time to achieve proximal control was 22.6 min (22.6 ± 13.8). One patient developed transient oculomotor palsy postoperatively. There were no other complications. Conclusion: When the exposed clinoidal segment of the internal carotid artery does not offer sufficient proximal space for temporary clipping, the extradural approach can be extended to the horizontal portion of the IC-ICA. In our experience, this technique is a quick, reliable, and safe alternative to the classical modalities of temporary occlusion.
MeSH term(s)	Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery ; Cavernous Sinus/surgery ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery ; Neurosurgical Procedures ; Surgical Instruments
Language	English
Publishing date	2020-12-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opaa302
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Article ; Online: Interhemispheric Approach for Excision of Callosal Marginal Dissecting Aneurysm With End-to-End Anastomosis: 3-Dimensional Operative Video.

Neil, Jayson A / Krisht, Khaled M / Couldwell, William T

Operative neurosurgery (Hagerstown, Md.)

2018 Volume 12, Issue 4, Page(s) 394

Language	English
Publishing date	2018-03-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1227/NEU.0000000000001411
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Article ; Online: Rapid M1 Hemoclips Arteriotomy Repair After Emergency Coil Embolectomy.

Saad, Hassan / Krisht, Khaled M / Yang, Wei-Hsun / Aboud, Emad / Krisht, Ali F

Operative neurosurgery (Hagerstown, Md.)

2018 Volume 15, Issue 1, Page(s) 25–31

Abstract: Background: The vascular closure staple clips have been studied in animal models and shown to have comparable results with sutured repair when it comes to the healing process, degree of vessel narrowing, and risk of thrombosis. However, they are clearly ...

Abstract	Background: The vascular closure staple clips have been studied in animal models and shown to have comparable results with sutured repair when it comes to the healing process, degree of vessel narrowing, and risk of thrombosis. However, they are clearly superior when the speed of application is taken into account, and they were clinically used in many vascular repair processes. Nevertheless, their usefulness in intracranial vascular surgery has not been described. Objective: To describe the usefulness of hemoclips in fast and efficient repair of medium-sized and large intracranial vessels. Methods: Two female patients diagnosed with giant symptomatic cavernous sinus aneurysms were undergoing elective endovascular procedures that were complicated by the dislodgement of coils into the M1 segment of the middle cerebral artery. Both patients were treated performing M1 arteriotomies and coil embolectomy. To avoid prolonged temporary occlusion in the M1 perforator's territory, the arteriotomies were repaired using microhemoclips in less than 10 min with re-establishment of flow. Results: In both patients, flow was re-established in the M1 segments. In 1 patient, the coils extended to the temporal M2 causing intimal injury and leading to diminished flow. M1 segments in both patients were patent on later angiographic studies. Conclusion: We describe the advantage of emergent cerebrovascular arteriotomy and embolectomy in a rapid repair process that helped avoid massive ischemic injury. We believe this technique should be added to the armamentarium of neurosurgical cerebrovascular options.
MeSH term(s)	Aged ; Embolectomy/methods ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Female ; Humans ; Intracranial Aneurysm/surgery ; Middle Aged ; Middle Cerebral Artery/surgery ; Treatment Outcome
Language	English
Publishing date	2018-04-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opx187
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Article: Tanycytic ependymoma: a challenging histological diagnosis.

Krisht, Khaled M / Schmidt, Meic H

Case reports in neurological medicine

2013 Volume 2013, Page(s) 170791

Abstract: Tanycytic ependymoma is a rare form of ependymoma that usually arises in the intramedullary spine. It has a unique histology emphasized by the inconspicuous ependymal pattern of cells and close resemblance to schwannoma and astrocytoma. The authors ... ...

Abstract	Tanycytic ependymoma is a rare form of ependymoma that usually arises in the intramedullary spine. It has a unique histology emphasized by the inconspicuous ependymal pattern of cells and close resemblance to schwannoma and astrocytoma. The authors report a 50-year-old man with a cervical tanycytic ependymoma that was initially thought to be a schwannoma. The frozen histology section showed spindle cells with oval and elongated nuclei with occasional hemosiderin deposits present suggesting a preliminary diagnosis of schwannoma. Immunohistochemical staining of the permanent section revealed strong immunoreactivity for glial fibrillary acidic protein with intermittent S-100 positivity, confirming that the tumor was a tanycytic ependymoma. This underlines the challenges involved in making an accurate diagnosis and demonstrates that careful and detailed histological inspection with immunohistochemical stains and ultrastructural microscopy may be necessary to distinguish tanycytic ependymoma from other neoplasms.
Language	English
Publishing date	2013-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2629909-4
ISSN	2090-6676 ; 2090-6668
ISSN (online)	2090-6676
ISSN	2090-6668
DOI	10.1155/2013/170791
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Article ; Online: Multiple osteomas of the falx cerebri and anterior skull base: case report.

Krisht, Khaled M / Palmer, Cheryl A / Couldwell, William T

Journal of neurosurgery

2016 Volume 124, Issue 5, Page(s) 1339–1342

Abstract: The authors describe a rare case of intracranial extraaxial parafalcine and anterior skull base osteomas in a 22-year-old woman presenting with bifrontal headaches. This case highlights the possible occurrence of such lesions along the anterior skull ... ...

Abstract	The authors describe a rare case of intracranial extraaxial parafalcine and anterior skull base osteomas in a 22-year-old woman presenting with bifrontal headaches. This case highlights the possible occurrence of such lesions along the anterior skull base and parafalcine region that, as such, should be considered as part of the differential diagnosis for extraaxial calcific lesions involving the anterior skull base. To the authors' knowledge, this is the first reported case of a patient who underwent complete successful resection of multiple extraaxial osteomas of the anterior skull base and parafalcine region.
MeSH term(s)	Craniotomy/methods ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasms, Multiple Primary/diagnostic imaging ; Neoplasms, Multiple Primary/pathology ; Neoplasms, Multiple Primary/surgery ; Osteoma/diagnosis ; Osteoma/pathology ; Osteoma/surgery ; Reoperation ; Skull Base Neoplasms/diagnostic imaging ; Skull Base Neoplasms/pathology ; Skull Base Neoplasms/surgery ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/pathology ; Spinal Cord Neoplasms/surgery ; Tomography, X-Ray Computed ; Young Adult
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2015.6.JNS15865
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Article: Early Conquest of the Rock: Julius Lempert's Life and the Complete Apicectomy Technique for the Treatment of Suppurative Petrous Apicitis.

Krisht, Khaled M / Shelton, Clough / Couldwell, William T

Journal of neurological surgery. Part B, Skull base

2014 Volume 76, Issue 2, Page(s) 101–107

Abstract: Julius Lempert (1891-1968) was one of the most revolutionary and innovative neuro-otologists of the 20th century. He had a remarkable role in advancing the field of otolaryngology to its modern shape and form, especially through his groundbreaking ... ...

Abstract	Julius Lempert (1891-1968) was one of the most revolutionary and innovative neuro-otologists of the 20th century. He had a remarkable role in advancing the field of otolaryngology to its modern shape and form, especially through his groundbreaking introduction of the fenestration procedure for the treatment of otosclerosis. Although he is highly celebrated by many neuro-otologists for his contributions to our surgical and anatomical understanding of the petrous bone, he is not well known to the neurosurgical community. In this article, we give a detailed account of Dr. Lempert's life and discuss his invaluable contribution to skull base petrous bone anatomy and surgery through his pioneering work on the complete apicectomy for the treatment of suppurative petrous apicitis.
Language	English
Publishing date	2014-10-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2654269-9
ISSN	2193-634X ; 2193-6331
ISSN (online)	2193-634X
ISSN	2193-6331
DOI	10.1055/s-0034-1389372
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Article: Intraventricular hemorrhage after epidural blood patching: an unusual complication.

Sorour, Mohammad / Krisht, Khaled M / Couldwell, William T

Case reports in neurological medicine

2014 Volume 2014, Page(s) 406289

Abstract: The authors present two cases of intraventricular hemorrhage (IVH) believed to be a result of epidural blood patching. The first was a 71-year-old woman who had new onset of nontraumatic IVH on computed tomography (CT) scan after undergoing an epidural ... ...

Abstract	The authors present two cases of intraventricular hemorrhage (IVH) believed to be a result of epidural blood patching. The first was a 71-year-old woman who had new onset of nontraumatic IVH on computed tomography (CT) scan after undergoing an epidural blood patch (EBP). This amount of intraventricular blood was deemed an incidental finding since it was of very small volume to account for her overall symptoms. The second patient, a 29-year-old woman, was found to have nontraumatic IVH three days after undergoing an EBP. This was seen on CT scan of the head for workup of pressure-like headaches, nausea, vomiting, and absence seizures. Conservative management was followed in both instances. Serial CT scan of the head in our first patient displayed complete resolution of her IVH. The second patient did not have follow-up CT scans because her overall clinical picture had improved significantly. This highlights a potential sequel of EBP that may be observed on CT scan of the head. In the event that IVH is detected, signs and symptoms of hydrocephalus should be closely monitored with the consideration for a future workup if warranted by the clinical picture.
Language	English
Publishing date	2014-12-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2629909-4
ISSN	2090-6676 ; 2090-6668
ISSN (online)	2090-6676
ISSN	2090-6668
DOI	10.1155/2014/406289
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Article ; Online: Biocompatible Amniotic Sac Implant Maintains a Scar-Free Brain Surface During Recurrent Glioma Surgery.

Saad, Hassan / Krisht, Khaled M / Yang, Wei-Hsun / Lopez-Gonzalez, Miguel Angel / Aboud, Emad / Krisht, Ali F

World neurosurgery

2017 Volume 107, Page(s) 308–313

Abstract: Background: Dissection of brain surface adhesions during recurrent glioma surgery carries a risk of injury to cortical vessels and important surface vessels. We present our experience with the use of BioD film, a biocompatible amniotic membrane implant, ...

Abstract	Background: Dissection of brain surface adhesions during recurrent glioma surgery carries a risk of injury to cortical vessels and important surface vessels. We present our experience with the use of BioD film, a biocompatible amniotic membrane implant, to help prevent postoperative adhesions. We describe a novel method for preventing postoperative adhesions after high-grade glioma surgery using BioD film. Methods: Amniotic sac implants were laid on the brain surface after resection of gliomas located near major surface arteries (sylvian fissure) and major veins (parasagittal convexity). Seven cases involved reoperation for tumor recurrence. Results: In all 7 of the cases requiring reoperation, a new arachnoid-like surface layer was formed without any dural adhesions. The newly formed layer allowed for easy and simple dissection and mobilization of surface vessels while avoiding any trauma to the cortex. Conclusions: Amniotic sac implants have a promising role in preventing most surgical brain adhesions associated with recurrent glioma surgery, reducing the risks of cortical vessel and tissue injury.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2017.07.143
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