Hussam Abou-Al-Shaar

University of Pittsburgh | Pitt · Department of Neurological Surgery

OBJECTIVE Preoperative stereotactic radiosurgery (SRS) is emerging as a viable alternative to standard postoperative SRS. Studies have suggested that preoperative SRS provides comparable tumor control and overall survival (OS) and may reduce the incidence of leptomeningeal disease (LMD) and adverse radiation effects (AREs). It is unknown, however,...

OBJECTIVE Numerous studies have investigated the impact of inflammatory factors in cancer, yet few attempts have been made to investigate these markers in skull base chordoma (SBC). Inflammatory values including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), systemic immune inflammation index (S...

Pediatric optic pathway/hypothalamic gliomas (OPHG) pose challenges in treatment due to their location and proximity to vital structures. Surgical resection plays a key role in the management of OPHG especially when the tumor exhibits mass effect and causes symptoms. However, data regarding outcomes and complications of surgical resection for OPHG...

Desmoid tumors are locally aggressive, benign neoplasms originating in connective tissues. Although the exact pathophysiology remains unknown, antecedent trauma or surgery are believed to be important contributing factors. The occurrence of paraspinal desmoid tumor in pediatric patients is extremely uncommon. Here, we present an exceedingly rare ca...

Purpose Clival metastatic cancer is rare and has limited literature to guide management. We describe management of clival metastasis with Gamma Knife radiosurgery (GKRS). We augment our findings with a systematic review of all forms of radiation therapy for clival metastasis. Methods Records of 14 patients with clival metastasis who underwent GKRS...

INTRODUCTION Temporal lobe epilepsy (TLE) has historically been divided into mesial and lateral (neocortical) TLE, but electrophysiological, semiological, and anatomical evidence indicate that the epileptogenic zone (EZ) and areas of propagation involve both temporal and extratemporal structures. Hypothesis-driven, structured interrogation is cruci...

INTRODUCTION Management of neurofibromatosis type 2 (NF2)-associated meningiomas remains a case-by-case basis, and treatment options vary. METHODS Forty-nine patients (22 male, 44.90%) with 213 NF2-associated meningiomas treated with SRS between 1987 and 2022 were retrospectively reviewed. The median age at SRS was 56 (range: 20-79) years. Twenty-...

BACKGROUND AND OBJECTIVES Intracranial electrophysiology of thalamic nuclei has demonstrated involvement of thalamic areas in the propagation of seizures in focal drug-resistant epilepsy. Recent studies have argued that thalamus stereoencephalography (sEEG) may aid in understanding the epileptogenic zone and treatment options. However, the study of...

Background The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and...

Objective The present study aimed to analyze the academic attributes of the presidents of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) over the past four decades to elucidate the trajectories of these societies' leaderships. Methods Forty-three AANS and 43 CNS presidents of the past four...

Objective To elucidate the current academic, demographic, and professional factors influencing the career trajectories of the American Association of Neurological Surgeons (AANS) William P. Van Wagenen (VW) fellows while also identifying trends that may influence future fellow selection. Methods Fifty-five VW fellows were identified from 1968 to 2...

Objective: The objective was to evaluate the efficacy, outcomes, and complications of surgical intervention performed within 24 hours (≤ 24 hours) versus after 24 hours (> 24 hours) in managing acute traumatic central cord syndrome (ATCCS). Methods: Articles pertinent to the study were retrieved from PubMed, Scopus, Web of Science, and Cochrane. T...

The supracerebellar infratentorial (SCIT) approach is a well-described corridor to lesions in the quadrigeminal cistern, pineal gland, and dorsal midbrain. It can be performed in the prone or sitting position. The sitting position offers the benefit of gravity retraction of the cerebellum but comes at the expense of nonergonomic hand positioning an...

Intradural spinal tumors present significant challenges due to involvement of critical motor and sensory tracts. Achieving maximal resection while preserving functional tissue is therefore crucial. Fluorescence-guided surgery aims to improve resection accuracy and is well studied for brain tumors, but its efficacy has not been fully assessed for sp...

BACKGROUND AND OBJECTIVE Stereoelectroencephalography (SEEG) is an invasive monitoring method designed to define and localize the epileptogenic zone (EZ) and explore the putative network responsible for the electroclinical seizures using anatomo-functional-electroclinical correlations. When indicated by semiology in selected patients, exploration o...

Purpose Pituitary transposition is a novel surgical approach to access the retroinfundibular space and interpeduncular cistern. Few studies have evaluated post-surgical outcomes, including incidence of hyponatremia, following pituitary transposition. Methods This is a retrospective study including 72 patients who underwent endoscopic endonasal sur...

Objectives Our objective was to elucidate the demographic, academic, and career attributes of North American Skull Base Society (NASBS) presidents and determine how leadership of this society has changed over time. Design Thirty-one NASBS presidents have served between 1990 and 2021. Demographic and scholarly variables were recorded from publicly a...

OBJECTIVE The goal of this study was to characterize local tumor control (LC), overall survival (OS), and safety of stereotactic radiosurgery for colorectal brain metastasis (CRBM). METHODS Ten international institutions participating in the International Radiosurgery Research Foundation provided data for this retrospective case series. This study...

Simple Summary Brain tumors are difficult to treat, and surgeons need the best tools to safely remove them. This review looks at the various technologies that help surgeons see tumors more clearly during surgery. These technologies range from special microscopes and exoscopes to advanced imaging like handheld molecular diagnostic tools. While these...

Brainstem cavernous malformations (CMs) encompass up to 20% of all intracranial CMs and are considered more aggressive than cerebral CMs because of their high annual bleeding rates. Microsurgical resection remains the primary treatment modality for CMs, but long-term functional outcomes and complications are heterogenous in the literature. The auth...

BACKGROUND AND OBJECTIVE Conventional protocols for inferior petrosal sinus sampling (IPSS) during the workup of hypercortisolemia require adrenocorticotrophic hormone (ACTH) measurement at multiple time points with corticotropic-releasing hormone (CRH) used as a stimulator. Modernized evidence-based protocols must also reflect the increased utiliz...

Background: The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). Methods: Relevant articles were retrieved from Medline, Scopus, and Cochrane according to...

Spontaneous cerebellar hemorrhage (scICH) is a subset of intracerebral hemorrhage accounting for 5–10% of all cases. Despite potential advantages, minimally invasive surgical evacuation of scICH may be an underutilized strategy when compared to unilateral or bilateral large suboccipital craniectomy or craniotomy, with or without duraplasty. We perf...

Background and objectives: Intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) after stereotactic radiosurgery (SRS) is exceedingly rare. The aim of this study was to define its incidence and describe its management and outcomes in this subset of patients. Methods: A retrospective multi-institutional study was conducted, screening 9565 p...

Background Brainstem cavernous malformations (CMs) encompass up to 20% of all intracranial CMs and are considered more aggressive than cerebral CMs because of their high annual bleeding rates. Microsurgical resection remains the primary treatment modality for CMs, but long-term functional outcomes and complications are heterogenous in the literatur...

The techniques used for treatment of intracranial aneurysms have progressed dramatically over the decades. The introduction of modern endovascular techniques and the continued refinement of progressively less invasive neurosurgical approaches have contributed to steadily improving clinical outcomes. Moreover, innovations such as flow-diverting sten...

OBJECTIVE Petroclival meningiomas (PCMs) are challenging lesions to treat because of their deep location and proximity to critical neurovascular structures. Patients with these lesions commonly present because of local mass effect. A symptom that proves challenging to definitively manage is trigeminal neuralgia (TN), which occurs in approximately 5...

Background: Patients with idiopathic trigeminal neuralgia (iTN) absent arterial contact or venous contact only and classical trigeminal neuralgia (cTN) with morphologic changes of the trigeminal nerve secondary to venous compression are not routinely recommended microvascular decompression at our institution. In patients with these anatomical subt...

The de novo development of cerebral arteriovenous malformations (AVMs) in adults is an exceedingly rare event that has prompted the theory that a “second hit” is required to induce AVM formation. The authors document development of an occipital AVM in an adult a decade and a half after a brain magnetic resonance imaging (MRI) disclosed no abnormali...

Background and objectives: The management of octogenarians with vestibular schwannomas (VS) has received little attention. However, with the increase in octogenarian population, more effort is needed to clarify the value of stereotactic radiosurgery (SRS) in this population. The aim of this study was to evaluate the safety and efficacy of SRS in t...

Background: Hyperbaric oxygen therapy (HBOT) has shown to be an effective modality in the management of variety of conditions. However, its role in traumatic brain injury (TBI) remains an area of controversy. This study aims to evaluate the safety and outcomes of HBOT in managing the long-term sequelae of TBI. Methods: The records of TBI patient...

Background Management of hydrocephalus symptoms in the setting of leptomeningeal disease (LMD) includes cerebrospinal fluid (CSF) diversion, which can in the form of ventriculoperitoneal shunting (VPS) and lumboperitoneal shunting (LPS). However, the quantifiable postoperative course following this intervention is poorly defined. Correspondingly th...

Isocitrate dehydrogenase (IDH) is a key enzyme in normal metabolism and homeostasis. However, mutant forms of IDH are also defining features of a subset of diffuse gliomas. In this review, we highlight current techniques targeting IDH-mutated gliomas and summarize current and completed clinical trials exploring these strategies. We discuss clinical...

OBJECTIVE The aim of this study was to describe the efficacy, clinical outcomes, and complications of open cerebrovascular surgery, endovascular surgery, and conservative management of dolichoectatic vertebrobasilar aneurysms (DVBAs). METHODS Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane databases according to...

Background: Clival chordomas are challenging because of their proximity to critical neurovascular structures. Stereotactic radiosurgery (SRS) has been proven effective with minimal adverse effects. Objective: To compare the outcomes of histologically confirmed primary clival chordomas in adults who underwent SRS alone (SRS group) vs SRS after fr...

Intracranial aneurysms are reported to affect 2–5% of the population. Despite advances in the surgical management of this disease, diagnostic technologies have marginally improved and still rely on expensive or invasive imaging procedures. Currently, there is no blood-based test to detect cerebral aneurysm formation or quantify the risk of rupture....

OBJECTIVE Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific notable sequelae are otogenic (otitic) hydrocephalus and CVST management. Correspondingly, the aim of this study was to integrate the currently published metadata to summari...

Background Stereotactic radiosurgical rhizolysis of the trigeminal nerve is an established modality increasingly employed to alleviate the symptoms of refractory trigeminal neuralgia. This study analyzes the academic impact of the top 100 cited articles on the radiosurgical management of trigeminal neuralgia. Methods The Scopus database was searche...

Background and importance: Medial orbital access through a transcaruncular corridor has yet to be fully characterized as a potential approach to intradural lesions within the skull base. Transorbital approaches present unique potential in the management of complex neurological pathologies and require subspecialty collaboration across multiple disc...

Background: Vestibular schwannomas (VSs) related to neurofibromatosis type 2 (NF2) are challenging tumors. The increasing use of stereotactic radiosurgery (SRS) necessitates further investigations of its role and safety. Objective: To evaluate tumor control, freedom from additional treatment (FFAT), serviceable hearing preservation, and radiatio...

Aneurysmal subarachnoid hemorrhage (aSAH) refers to spontaneous rupture of an intracranial aneurysm resulting in extravasation of blood into the subarachnoid space Immediate death occurs in 12.4% of aSAH patients Patients who survive initial hemorrhage have a 30-day mortality rate of 45%; with 46% of survivors remaining at risk of long-term impair...

OBJECTIVE The eustachian tube (ET) limits endoscopic endonasal access to the infrapetrous region. Transecting or mobilizing the ET may result in morbidities. This study presents a novel approach in which a subtarsal contralateral transmaxillary (ST-CTM) corridor is coupled with the standard endonasal approach to facilitate access behind the intact...

Background: Stereoelectroencephalography (SEEG) is an established and safe methodology for extra-operative invasive monitoring in patients with medical refractory epilepsy. SEEG has several advantages such as the ability to record deep cortical structures, mapping the epileptogenic zone in a three-dimensional manner, and analyze bihemispheric regi...

Purpose Eccrine gland carcinoma (EC) is a rare skin neoplasm that uncommonly spreads to the brain or pituitary gland. We describe the role of multiple stereotactic radiosurgery (SRS) procedures to manage recurrent brain metastases of this rare disease. Materials and methods Retrospective chart review was completed to obtain details for this report...

Background: Temporal bone skull base pathologies represent a complex differential because they can be radiographically obscure and difficult to diagnose without biopsy. Radiomics involves the use of mathematical quantification of imaging data beyond simple intensity, size, and location to inform diagnosis and prognosis. We examined the feasibility...

Management of central nervous system (CNS) lymphoma requires multidisciplinary care. The disease can manifest in the context of immunocompromised states or in the context of chronic infections. Nervous system damage from this lymphoma has highly variable presentation that is dependent on the location of the tumor lesions. Damage from disease progre...

Smooth symmetric facial muscle function is important for social interactions. When lesions of the facial nerve occur, achieving complete restoration of balanced and spontaneous facial function can be challenging. In this video, the authors demonstrate the surgical details and long-term follow-up of a masseter-to-facial nerve transfer in a 3-year-ol...

INTRODUCTION Intratumoral hemorrhage (ITH) is a rare occurrence in vestibular schwannomas (VS) resulting in worsening vestibular and cranial nerve deficits. Scarce data described the occurrence, management, and outcomes of ITH after stereotactic radiosurgery (SRS). OBJECTIVE The aim of this study is to delineate the incidence, presentation, manage...

INTRODUCTION Preoperative stereotactic radiosurgery (SRS) is an emerging therapeutic strategy for treatment of brain metastasis requiring surgical resection. Prior reports have been highly-controlled, excluding very large brain metastases. Here, we report a prospectively-collected preoperative series reflective of a real-world neurosurgical patient...

OBJECTIVE The objective of this retrospective study was to compare the survival of patients with biopsy-proven skull base chordoma who had undergone stereotactic radiosurgery (SRS) with versus without prior fractionated radiation therapy (RT). METHODS Relevant articles from database inception to September 2021 were retrieved from the PubMed, Scopu...

Purpose While United States (US) neurosurgery residency programs have been subject to many studies, none have focused solely on the program directors (PDs). We aim to analyze the demographics, educational, and academic attributes of this cohort to understand current and future trends of PDs. Methods One hundred sixteen neurosurgeons listed as PDs...

Vitamin D deficiency is a common condition that affects people of different age groups and genders. Vitamin D can be obtained either from dietary sources or from its cutaneous synthesis in the skin. Various etiological factors contribute to the development of vitamin D deficiency. Vitamin D functions are beyond calcium and phosphate homeostasis and...

The frontotemporal-orbitozygomatic (FTOz) approach is an extension of the traditional pterional approach. It provides the neurosurgeon with a wide access to the skull base with minimal or no brain retraction needed; it also offers a panoramic view that enables various trajectories toward the anterior, middle, and central cranial fossae as well as t...

Background: Stereotactic radiosurgery (SRS) offers a minimally invasive treatment modality for appropriately selected intracranial arteriovenous malformations (AVMs). Recent reports have described the development of rare, delayed chronic encapsulated expanding hematomas (CEEHs) at the site of an angiographically confirmed obliterated AVM. Objecti...

Purpose This study evaluates the role and outcomes of Gamma Knife radiosurgery (GKRS) in the management of pituitary metastases. Methods The records of brain metastases patients who underwent GKRS at the University of Pittsburgh Medical Center during the 10-year interval of 2010–2020 were systematically reviewed. Outcome measures included patient...

Robotics is a fascinating and rapidly evolving field that—in parallel with advances in artificial intelligence and machine learning—is transforming the practice of medicine in general, and in particular neurosurgery. Robotic-assisted surgery has been performed for decades in different areas such as cardiac and general surgery. More recently, advanc...

The first industrial applications of robotics in industry can be traced back to the partnership forged between George Devol and Joseph Engelberger. In 1959, General Motors installed the fruits of their labor, the Unimate #001 (which Devol termed a “Programmed Article Transfer Device”) at its die casting production line in New Jersey, ushering in a...

Background Parkinson’s disease (PD) has been recognized as responsible for concurrent spinal disorders. Surgical correction may be necessary, but the complexity of such fragile patients may require specific considerations. We systematically reviewed the literature on degenerative spine surgery in PD patients. Methods PubMed, Scopus, Web-of-Science...

Background Pediatric brainstem lesions are diagnoses that require tissue sampling to advance our understanding of them and their management. Frameless, robot-assisted biopsy of these lesions has emerged as novel, viable biopsy approach. Correspondingly, the aim of this study was to quantitively and qualitatively summarize the contemporary literatur...

Purpose Meningiomas arising from the confluence of the falx and tentorium (CFT) are a rare and challenging subset of meningiomas. Gamma Knife radiosurgery (GKRS) is well-established as a safe and effective management strategy for intracranial meningiomas, but its role in treating CFT meningiomas is not well-described. This paper reports the largest...

Introduction Trigeminal schwannomas (TS) are rare skull base tumors that have been associated with significant neuropathic sequalae for patients. The authors aim to evaluate the clinical features, treatment outcomes, and neuropathic sequelae following endoscopic endonasal approach (EEA) for TS. Methods The study involves a retrospective review of p...

Cat scratch disease (CSD), caused by Bartonella henselae, may atypically present with vertebral osteomyelitis. Antibiotic regimens are tailored to presentation, which is markedly variable and not well defined for any atypical disease. In cases of spinal instability, the use of antibiotics alone may not be sufficient. Atlantoaxial instability caused...

Background The lateral supraorbital approach (LSO) provides an optimal access corridor for various skull bases lesions, including olfactory groove meningiomas (OGMs). The aim of this study is to describe the authors’ experience with the management of large and giant OGMs utilizing the LSO approach and describe the technical nuances of the procedure...

OBJECTIVE In mesial temporal lobe epilepsy (MTLE), the ideal surgical approach to achieve seizure freedom and minimize morbidity is an unsolved question. Selective approaches to mesial temporal structures often result in suboptimal seizure outcomes. The authors report the results of a pilot study intended to evaluate the clinical feasibility of usi...

This section reviews the selection criteria and best practices for endoscopic cerebrovascular surgery, focusing on purely endoscopic endonasal approaches. Although these approaches still play a limited role in open vascular neurosurgery, they offer a robust and potentially safer technique for establishing visualization and vascular control of parti...

Background The literature consists of many studies examining the genetic abnormalities that influence pituitary adenomas (PA). This report clearly states the collective knowledge on the genetic underpinnings of PAs by organizing, summarizing, and consolidating the literature. This study will serve as a comprehensive review for scientists and clinic...

PurposeTo compare the efficacy, outcomes, and complications of single session (SS-SRS) and multisession (MS-SRS) stereotactic radiosurgery in the treatment of intracranial meningiomas.Methods Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane. A systematic review and meta-analysis of treatment protocols and outcomes...

Objective Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure; as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infect...

Objective Technological advances have significantly fostered the use of robotics in neurosurgery. Due to their novelty, there is a need to develop training methods within neurosurgical residency programs that provide trainees the skills to utilize these systems in their future practices safely and effectively. Methods We describe a detailed curric...

The cerebral perfusion pressure (CPP) and its relationship between intracranial pressure and mean arterial pressure is a concept ubiquitous in caring for the critically ill patient. CPP is often used as a surrogate measure for cerebral blood flow (CBF); however, this view fails to account for changes in cerebral vascular resistance (CVR). Changes i...

Purpose To review our institutional experience with the surgical management of prolactinomas through the endoscopic endonasal approach with specific focus on cavernous sinus invasion. Methods Clinical and radiographic data were collected retrospectively from the electronic medical record of 78 consecutive patients with prolactinomas undergoing end...

OBJECTIVE Vestibular schwannomas (VSs) are benign tumors of the cerebellopontine angle that are typically managed with stereotactic radiosurgery (SRS). Intratumoral hemorrhage (ITH) of VSs is a rare occurrence that results in worsening vestibular and new cranial nerve deficits. Few reports have described the management and outcomes of this entity a...

Background Treatment of patients with a large number of brain metastases using radiosurgery remains controversial. In this study we sought to conduct a volume matched comparison to evaluate the clinical outcome of patients with > 20 brain metastases and compared it with patents with solitary brain tumor form non-small cell lung cancer (NSCLC). Met...

32 patients (27M, 84%), average age 68 underwent DBS placement for PD • Majority (n=30) had bilateral DBS implantation • Demographics, clinical data, preoperative UPDRS III scores (ON/OFF medication), STN span, and cerebral volumetric data (T1 MRI) were collected. • Mean MER STN span: • Left: 4.85 (0.82) mm • Right: 4.80 (0.81) mm • Left STN span h...

Background: Craniofacial fibrous dysplasia (CFD) typically occurs in the facial bones and anterior cranial vault and can produce both disfigurement and functional limitations for patients disfigurement. Treatment consists of reducing the abnormal bone. Bone contouring can become challenging when the exposure does not extend to the corresponding no...