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Article ; Online: Intraoperative confocal laser endomicroscopy for interpretation of a sellar hemangioblastoma: illustrative case.

Abramov, Irakliy / Furey, Charuta G / Xu, Yuan / Eschbacher, Jennifer M / Smith, Kris A / Preul, Mark C

Journal of neurosurgery. Case lessons

2023 Volume 6, Issue 12

Abstract: Background: Intraoperative frozen sections play a critical role in surgical strategy because of their ability to provide rapid histopathological information. In cases in which intraoperative biopsy carries a significant risk of bleeding, intraoperative ... ...

Abstract	Background: Intraoperative frozen sections play a critical role in surgical strategy because of their ability to provide rapid histopathological information. In cases in which intraoperative biopsy carries a significant risk of bleeding, intraoperative confocal laser endomicroscopy (CLE) can assist in decision-making. Observations: The authors present a rare case of a large sellar hemangioblastoma. Preoperative radiographic imaging and normal pituitary function suggested a differential diagnosis that included hemangioblastoma. The patient underwent partial preoperative embolization and a right-sided pterional craniotomy for resection of the lesion. Gross intraoperative examination revealed a highly vascular sellar lesion requiring circumferential dissection to minimize blood loss. The serious vascularity precluded intraoperative frozen section analysis, and CLE imaging was performed. CLE imaging provided excellent visualization of the remarkable vascular structure and characteristic histoarchitecture with microvasculature, intracytoplasmic vacuoles, and atypical cells consistent with hemangioblastoma. Resection and decompression of the chiasm was accomplished, and the patient was discharged with improved vision. The final histopathological diagnosis was hemangioblastoma. Lessons: When the benefits of obtaining intraoperative frozen sections greatly outweigh the associated risks, CLE imaging can aid in decision-making. CLE imaging offers real-time, on-the-fly evaluation of intraoperative tissue without the need to biopsy a vascular lesion.
Language	English
Publishing date	2023-09-18
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE23417
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Article ; Online: Anatomical Subpial Resection of Tumors in the Amygdala and Hippocampus.

Przybylowski, Colin J / Whiting, Alexander C / Preul, Mark C / Smith, Kris A

World neurosurgery

2021 Volume 151, Page(s) e652–e662

Abstract: Objective: Surgical techniques to achieve complete resection of mesial-basal temporal tumors should be pursued by neurosurgical oncologists. We describe the anatomical subpial amygdalohippocampectomy (SpAH) technique for tumor resection.: Methods: ... ...

Abstract	Objective: Surgical techniques to achieve complete resection of mesial-basal temporal tumors should be pursued by neurosurgical oncologists. We describe the anatomical subpial amygdalohippocampectomy (SpAH) technique for tumor resection. Methods: The key anatomical landmarks and critical steps of the SpAH technique were outlined and emphasized with medical illustrations and intraoperative photographs. The senior author's 90-day surgical outcomes with this approach were reviewed. Results: Twenty-five patients (men, 17 [68%]; women, 8 [32%]; median [range] age, 59 [23-80] years) with temporal tumors involving the amygdalohippocampal region were included. SpAH was performed selectively in 8 [32%] patients, whereas 17 [68%] patients underwent SpAH in conjunction with an anterior temporal lobectomy due to tumor involvement of the anterolateral temporal cortex. The subpial resection of the amygdala protected the critical structures of the suprasellar cistern and sylvian fissure. Identifying the choroidal fissure as the superior-most aspect of hippocampal resection protected the optic tract and the thalamus. Subpial resection of the parahippocampal gyrus inferiorly protected the brainstem and critical structures of the ambient cistern. Tumors in the amygdalohippocampal region were anatomically and completely resected in all 25 patients. Of the 15 patients who presented with seizures, 13 (87%) were seizure-free at the 90-day postsurgical follow-up. Permanent neurologic deficits occurred in 3 patients (12%). Conclusions: The SpAH technique permits complete resection of mesial-basal temporal tumors with an acceptable morbidity profile. An in-depth understanding of temporal lobe anatomy combined with a refined microsurgical technique allows for reproducible resection of tumor in the amygdalohippocampal region while protecting critical neurovascular structures.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Amygdala/surgery ; Brain Neoplasms/surgery ; Female ; Hippocampus/surgery ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/methods
Language	English
Publishing date	2021-04-30
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.2021.04.100
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Zs.A 1159: Show issues

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Article ; Online: Stereotactic-Guided Transcerebellar Cisternoperitoneal Shunt Placement for Idiopathic Intracranial Hypertension.

Cho, Steve S / Wakim, Andre A / Teng, Clare W / Sarris, Christina E / Smith, Kris A

Operative neurosurgery (Hagerstown, Md.)

2022 Volume 23, Issue 3, Page(s) 268–275

Abstract: Background: Idiopathic intracranial hypertension (IIH) can cause debilitating symptoms and optic nerve ischemia if untreated. Cerebrospinal fluid diversion is often necessary to reduce intracranial pressure; however, current ventriculoperitoneal and ... ...

Abstract	Background: Idiopathic intracranial hypertension (IIH) can cause debilitating symptoms and optic nerve ischemia if untreated. Cerebrospinal fluid diversion is often necessary to reduce intracranial pressure; however, current ventriculoperitoneal and lumboperitoneal shunting techniques have high failure rates in patients with IIH. Objective: To describe our experience treating IIH with a novel stereotactic-guided transcerebellar cisternoperitoneal shunt (SGTC-CPS) technique that places the proximal shunt catheter in the posterior cisterna magnum. Methods: Retrospective perioperative and postoperative data from all patients who underwent SGTC-CPS placement for IIH from March 1, 2015, to December 31, 2020, were analyzed. Patients were positioned as for ventriculoperitoneal shunt placement but with the head turned farther laterally to adequately expose the retrosigmoid space. Using neuronavigation, an opening was made near the transverse-sigmoid junction, and the proximal catheter was inserted transcerebellarly into the posterior foramen magnum. Results: Thirty-two patients underwent SGTC-CPS placement (29 female; mean body mass index, 36.0 ± 7.5; 14 with prior shunt failures). The mean procedure time for shunt placement was 145 minutes. No intraoperative complications occurred, and all patients were discharged uneventfully. At the 6-month follow-up, 81% of patients (21 of 26) had relief of their presenting symptoms. Shunt survival without revision was 86% (25 of 29) at 1 year and 67% (10 of 15) at 3 years, with no infections. Conclusion: The SGTC-CPS offers an alternative solution for cerebrospinal fluid diversion in patients with IIH and demonstrates a lower failure rate and more durable symptom relief compared with ventriculoperitoneal or lumboperitoneal shunt placement. Using proper techniques and equipment promotes safe and facile placement of the proximal catheter.
MeSH term(s)	Female ; Humans ; Neuronavigation/methods ; Pseudotumor Cerebri/diagnostic imaging ; Pseudotumor Cerebri/etiology ; Pseudotumor Cerebri/surgery ; Retrospective Studies ; Treatment Outcome ; Ventriculoperitoneal Shunt/adverse effects
Language	English
Publishing date	2022-07-04
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/ons.0000000000000289
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Article ; Online: Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Recurrent Glioblastoma and Radiation Necrosis: A Single-Surgeon Case Series.

Jubran, Jubran H / Scherschinski, Lea / Dholaria, Nikhil / Shaftel, Kelly A / Farhadi, Dara S / Oladokun, Femi C / Hendricks, Benjamin K / Smith, Kris A

World neurosurgery

2023 Volume 182, Page(s) e453–e462

Abstract: Objective: To evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM).: Methods: Patients with rGBM treated by LITT by a single surgeon (2013-2020) were ... ...

Abstract	Objective: To evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM). Methods: Patients with rGBM treated by LITT by a single surgeon (2013-2020) were evaluated for progression-free survival (PFS), overall survival (OS), and OS after LITT. Results: Forty-nine patients (33 men, 16 women; mean [SD] age at diagnosis, 58.7 [12.5] years) were evaluated. Among patients with genetic data, 6 of 34 (18%) had IDH-1 R132 mutations, and 7 of 21 (33%) had MGMT methylation. Patients underwent LITT at a mean (SD) of 23.8 (23.8) months after original diagnosis. Twenty of 49 (40%) had previously undergone stereotactic radiosurgery, 37 (75%) had undergone intensity-modulated radiation therapy, and 49 (100%) had undergone chemotherapy. Patients had undergone a mean of 1.2 (0.7) previous resections before LITT. Mean preoperative enhancing and T2 FLAIR volumes were 13.1 (12.8) cm Conclusions: In a diverse rGBM cohort, LITT was associated with a short duration of posttreatment PFS.
MeSH term(s)	Male ; Humans ; Female ; Child ; Glioblastoma/diagnostic imaging ; Glioblastoma/therapy ; Laser Therapy/adverse effects ; Neoplasm Recurrence, Local/surgery ; Brain Neoplasms/surgery ; Magnetic Resonance Imaging/adverse effects ; Magnetic Resonance Spectroscopy ; Treatment Outcome ; Surgeons ; Radiation Injuries/surgery ; Necrosis/surgery ; Lasers ; Retrospective Studies
Language	English
Publishing date	2023-11-29
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.2023.11.120
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Article ; Online: Comparison of minimally invasive to standard temporal lobectomy approaches to epilepsy surgery: Seizure relief and visual confrontation naming outcomes.

Hageboutros, Karine / Hewitt, Kelsey C / Lee, Gregory P / Bansal, Aastha / Block, Cady / Pedersen, Nigel P / Willie, Jon T / Loring, David W / Schoenberg, Mike R / Smith, Kris A / Giller, Cole A / Gross, Robert E / Drane, Daniel L

Epilepsy & behavior : E&B

2024 Volume 155, Page(s) 109669

Abstract: The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [ ... ...

Abstract	The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [SLAH], and anterior temporal lobectomy [ATL]), to determine which procedures are most favorable in terms of visual confrontation naming and seizure relief outcome. This was a retrospective study of 33 adults with intractable mTLE who underwent left temporal lobe surgery at three different epilepsy surgery centers who also underwent pre-, and at least 6-month post-surgical neuropsychological testing. Measures included the Boston Naming Test (BNT) and the Engel Epilepsy Surgery Outcome Scale. Fisher's exact tests revealed a statistically significant decline in naming in ATLs compared to SLAHs, but no other significant group differences. 82% of ATL and 36% of subSAH patients showed a significant naming decline whereas no SLAH patient (0%) had a significant naming decline. Significant postoperative naming improvement was seen in 36% of SLAH patients in contrast to 9% improvement in subSAH patients and 0% improvement in ATLs. Finally, there were no statistically significant differences between surgical approaches with regard to seizure freedom outcome, although there was a trend towards better seizure relief outcome among the ATL patients. Results support a possible benefit of SLAH in preserving visual confrontation naming after left TLE surgery. While result interpretation is limited by the small sample size, findings suggest outcome is likely to differ by surgical approach, and that further research on cognitive and seizure freedom outcomes is needed to inform patients and providers of potential risks and benefits with each.
Language	English
Publishing date	2024-04-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2024.109669
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Zs.A 5289: Show issues

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Article ; Online: Selective Amygdalohippocampectomy.

Hoyt, Alastair T / Smith, Kris A

Neurosurgery clinics of North America

2016 Volume 27, Issue 1, Page(s) 1–17

Abstract: Mesial temporal lobe epilepsy is a common condition that is frequently drug resistant. Anterior temporal lobectomy has been shown to be effective in controlling seizures but entails resecting anterior and lateral temporal lobe regions that are not ... ...

Abstract	Mesial temporal lobe epilepsy is a common condition that is frequently drug resistant. Anterior temporal lobectomy has been shown to be effective in controlling seizures but entails resecting anterior and lateral temporal lobe regions that are not necessarily included in the epileptogenic zone. Selective amygdalohippocampectomy spares uninvolved structures while providing the same benefit as anterior temporal lobectomy. This article describes the 3 most common surgical approaches for performing selective amygdalohippocampectomy and discusses their relative merits and risks.
MeSH term(s)	Amygdala/surgery ; Epilepsy, Temporal Lobe/surgery ; Hippocampus/surgery ; Humans ; Neurosurgical Procedures/methods ; Treatment Outcome
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196855-2
ISSN	1558-1349 ; 1042-3680
ISSN (online)	1558-1349
ISSN	1042-3680
DOI	10.1016/j.nec.2015.08.009
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Article: Ketogenic Metabolic Therapy for Glioma.

Smith, Kris A / Hendricks, Benjamin K / DiDomenico, Joseph D / Conway, Beth N / Smith, Tracy L / Azadi, Amir / Fonkem, Ekokobe

Cureus

2022 Volume 14, Issue 6, Page(s) e26457

Abstract: Purpose: This study describes a retrospective case series of patients with glioma who received ketogenic metabolic therapy through dietary adherence and intermittent fasting.: Methods: A retrospective chart review of a single surgeon's clinic records ...

Abstract	Purpose: This study describes a retrospective case series of patients with glioma who received ketogenic metabolic therapy through dietary adherence and intermittent fasting. Methods: A retrospective chart review of a single surgeon's clinic records was performed to identify patients who maintained nutritional ketosis for at least four months between January 2015 and October 2020. Results: Sixteen patients who met the inclusion criteria constituted a heterogeneous population of patients with diagnoses including eight World Health Organization (WHO) grade IV gliomas (seven glioblastoma, one gliosarcoma), seven WHO grade III gliomas (three oligodendroglioma, four astrocytoma), and one WHO grade II oligodendroglioma. Conclusion: Ketogenic metabolic therapy appears to convey a survival advantage within this patient series, which highlights the possibility that this therapy, when strictly applied, can augment the standard of care. Further exploration of this modality in a prospective series is warranted to formally explore this therapy.
Language	English
Publishing date	2022-06-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.26457
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Article: Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Management of Low-Grade Gliomas and Radiation Necrosis: A Single-Institution Case Series.

Scherschinski, Lea / Jubran, Jubran H / Shaftel, Kelly A / Furey, Charuta G / Farhadi, Dara S / Benner, Dimitri / Hendricks, Benjamin K / Smith, Kris A

Brain sciences

2022 Volume 12, Issue 12

Abstract: Background: Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for ablation of low-grade glioma (LGG) and radiation necrosis (RN).: Objective: To evaluate the efficacy, safety, and survival outcomes of ... ...

Abstract	Background: Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for ablation of low-grade glioma (LGG) and radiation necrosis (RN). Objective: To evaluate the efficacy, safety, and survival outcomes of patients with radiographically presumed recurrent or newly diagnosed LGG and RN treated with LITT. Methods: The neuro-oncological database of a quaternary center was reviewed for all patients who underwent LITT for management of LGG between 1 January 2013 and 31 December 2020. Clinical data including demographics, lesion characteristics, and clinical and radiographic outcomes were collected. Kaplan-Meier analyses comprised overall survival (OS) and progression-free survival (PFS). Results: Nine patients (7 men, 2 women; mean [SD] age 50 [16] years) were included. Patients underwent LITT at a mean (SD) of 11.6 (8.5) years after diagnosis. Two (22%) patients had new lesions on radiographic imaging without prior treatment. In the other 7 patients, all (78%) had surgical resection, 6 (67%) had intensity-modulated radiation therapy and chemotherapy, respectively, and 4 (44%) had stereotactic radiosurgery. Two (22%) patients had lesions that were wild-type Conclusions: LITT is a safe and effective treatment option for management of LGG and RN, however, there may be increased risk of permanent complications with treatment of deep-seated subcortical lesions.
Language	English
Publishing date	2022-11-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci12121627
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Article ; Online: Epilepsy, Functional Neurosurgery, and Pain.

Swanson, Kyle I / Smith, Kris A / Mirzadeh, Zaman / Ponce, Francisco A

Operative neurosurgery (Hagerstown, Md.)

2019 Volume 17, Issue Suppl 2, Page(s) S209–S228

MeSH term(s)	Adult ; Aged ; Electric Stimulation Therapy/methods ; Epilepsy/surgery ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Pain/surgery
Language	English
Publishing date	2019-05-17
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't ; Video-Audio Media
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opz075
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Article ; Online: Gliadel wafer implantation combined with standard radiotherapy and concurrent followed by adjuvant temozolomide for treatment of newly diagnosed high-grade glioma: a systematic literature review.

Ashby, Lynn S / Smith, Kris A / Stea, Baldassarre

World journal of surgical oncology

2016 Volume 14, Issue 1, Page(s) 225

Abstract: Since 2003, only two chemotherapeutic agents, evaluated in phase III trials, have been approved by the US Food and Drug Administration for treatment of newly diagnosed high-grade glioma (HGG): Gliadel wafers (intracranially implanted local chemotherapy) ... ...

Abstract	Since 2003, only two chemotherapeutic agents, evaluated in phase III trials, have been approved by the US Food and Drug Administration for treatment of newly diagnosed high-grade glioma (HGG): Gliadel wafers (intracranially implanted local chemotherapy) and temozolomide (TMZ) (systemic chemotherapy). Neither agent is curative, but each has been shown to improve median overall survival (OS) compared to radiotherapy (RT) alone. To date, no phase III trial has tested these agents when used in sequential combination; however, a number of smaller trials have reported favorable results. We performed a systematic literature review to evaluate the combination of Gliadel wafers with standard RT (60 Gy) plus concurrent and adjuvant TMZ (RT/TMZ) for newly diagnosed HGG. A literature search was conducted for the period of January 1995 to September 2015. Data were extracted and categorized, and means and ranges were determined. A total of 11 publications met criteria, three prospective trials and eight retrospective studies, representing 411 patients who received Gliadel plus standard RT/TMZ. Patients were similar in age, gender, and performance status. The weighted mean of median OS was 18.2 months (ten trials, n = 379, range 12.7 to 21.3 months), and the weighted mean of median progression-free survival was 9.7 months (seven trials, n = 287, range 7 to 12.9 months). The most commonly reported grade 3 and 4 adverse events were myelosuppression (10.22 %), neurologic deficit (7.8 %), and healing abnormalities (4.3 %). Adverse events reflected the distinct independent safety profiles of Gliadel wafers and RT/TMZ, with little evidence of enhanced toxicity from their use in sequential combination. In the 11 identified trials, an increased benefit from sequentially combining Gliadel wafers with RT/TMZ was strongly suggested. Median OS tended to be improved by 3 to 4 months beyond that observed for Gliadel wafers or TMZ when used alone in the respective phase III trials. Larger prospective trials of Gliadel plus RT/TMZ are warranted.
MeSH term(s)	Antineoplastic Agents, Alkylating/administration & dosage ; Antineoplastic Agents, Alkylating/adverse effects ; Antineoplastic Agents, Alkylating/therapeutic use ; Brain Neoplasms/mortality ; Brain Neoplasms/pathology ; Brain Neoplasms/therapy ; Carmustine/administration & dosage ; Carmustine/adverse effects ; Carmustine/therapeutic use ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Clinical Trials, Phase III as Topic ; Combined Modality Therapy/methods ; Dacarbazine/administration & dosage ; Dacarbazine/adverse effects ; Dacarbazine/analogs & derivatives ; Dacarbazine/therapeutic use ; Decanoic Acids/administration & dosage ; Decanoic Acids/adverse effects ; Decanoic Acids/therapeutic use ; Disease-Free Survival ; Drug Implants ; Glioblastoma/mortality ; Glioblastoma/pathology ; Glioblastoma/therapy ; Humans ; Middle Aged ; Neoplasm Grading ; Polyesters/administration & dosage ; Polyesters/adverse effects ; Polyesters/therapeutic use ; United States ; United States Food and Drug Administration
Chemical Substances	Antineoplastic Agents, Alkylating ; Decanoic Acids ; Drug Implants ; Polyesters ; carmustine, poliferprosan 20 drug combination ; Dacarbazine (7GR28W0FJI) ; Carmustine (U68WG3173Y) ; temozolomide (YF1K15M17Y)
Language	English
Publishing date	2016-08-24
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2118383-1
ISSN	1477-7819 ; 1477-7819
ISSN (online)	1477-7819
ISSN	1477-7819
DOI	10.1186/s12957-016-0975-5
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