Allan Friedman

Overview:

At the present time, I am participating in collaborative research in the areas of primary malignant brain tumors, epilepsy and subarachnoid hemorrhage.

Primary malignant brain tumors are increasing in frequency. Patients harboring glioblastoma, the most malignant primary brain tumor, have a life expectancy of less than one year. In colloboration with the Division of Neurology and the Department of Pathology, clinical and laboratory trials have been initiated to identify better treatment for this condition. At present, trials of monoclonal antibodies and novel chemotherapeutic agents are being carried out.

Although physicians have been interested in seizures since the time of Hippocrates, the origin of seizures remains obscure. At Duke University we have treated approximately thirty seizure patients a year by removing abnormal portions of brain. Tissue from these resections is being analyzed for genetics and receptor abnormalities. Positron emission tomography and magnetic resonance imaging are being used to ferret out the origin of the patient's seizures.

Approximately 28,000 patients each year suffer a ruptured intracranial aneurysm. Approximately ten percent of these patients have a genetic predisposition to forming intracranial aneurysms. In conjunction with the Division of Neurology, we are screening candidate genes searching for the cause of intracranial aneurysms.

Positions:

Guy L. Odom Distinguished Professor of Neurosurgery, in the School of Medicine

Neurosurgery
School of Medicine

Professor of Neurosurgery

Neurosurgery
School of Medicine

Interim Chair of Neurosurgery

Neurosurgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1974

University of Illinois

Grants:

Novel Targeted Therapeutics for CNS Malignancies

Administered By
Surgery, Surgical Sciences
Awarded By
National Institutes of Health
Role
Collaborating Investigator
Start Date
End Date

IPA - Bharathi Hattiangady

Administered By
Neurosurgery
Awarded By
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
End Date

IPA - Bing Shuai

Administered By
Neurosurgery
Awarded By
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
End Date

Publications:

Perioperative Assessment of Cerebellar Masses and the Potential for Cerebellar Cognitive Affective Syndrome.

The cerebellum was long perceived to be a region of limited importance with primary functions in the regulation of motor control. A degree of its functional topography in motor modulation has been traditionally appreciated. However, an evolving body of evidence supports its role in a range of cognitive processes, including executive decision making, language, emotional processing, and working memory. To this end, numerous studies of cerebellar stroke syndromes as well as investigations with functional magnetic resonance imaging and diffusion tensor imaging have given clinicians a better model of the functional topography within the cerebellum and the essential lanes of communication with the cerebrum. With this deeper understanding, neurosurgeons should integrate these domains into the perioperative evaluation and postoperative rehabilitation of patients with cerebellar tumors. This review aims to discuss these understandings and identify valuable tools for implementation into clinical practice.
Authors
Sankey, EW; Srinivasan, ES; Mehta, VA; Bergin, SM; Wang, TY; Thompson, EM; Fecci, PE; Friedman, AH
MLA Citation
Sankey, Eric W., et al. “Perioperative Assessment of Cerebellar Masses and the Potential for Cerebellar Cognitive Affective Syndrome.World Neurosurg, vol. 144, Dec. 2020, pp. 222–30. Pubmed, doi:10.1016/j.wneu.2020.09.048.
URI
https://scholars.duke.edu/individual/pub1461315
PMID
32949806
Source
pubmed
Published In
World Neurosurg
Volume
144
Published Date
Start Page
222
End Page
230
DOI
10.1016/j.wneu.2020.09.048

Complications after glioma surgery

To achieve optimal patient outcomes in brain tumor surgery, it is critical to know how to identify, manage and prevent common complications. From specific to broad, complications can be categorized as local, regional, or systemic. Local complications depend on tumor location and are presented in relation to the relevant anatomy, with a review of the utility of contemporary surgical technologies to facilitate tumor resection and minimize complications. Regional or CNS specific in addition to general or systemic complications are also discussed with a focus on prevention and management, injecting the personal advice of the second author with more than 35 years of experience in brain tumor surgery.
Authors
Bramall, AN; Friedman, A; Sampson, JH
MLA Citation
Bramall, A. N., et al. “Complications after glioma surgery.” Complications in Neurosurgery, 2018, pp. 107–13. Scopus, doi:10.1016/B978-0-323-50961-9.00021-9.
URI
https://scholars.duke.edu/individual/pub1463095
Source
scopus
Published Date
Start Page
107
End Page
113
DOI
10.1016/B978-0-323-50961-9.00021-9

Eosinophilic globules in a classic ependymoma: evidence of a possible secretory role.

A number of neoplasms of the central nervous system can demonstrate diffuse eosinophilic globules, known to be secretory products of the corresponding cell type, but they have not been a salient feature in descriptions of classic ependymoma. Here, we present a case of a posterior fossa ependymoma demonstrating glassy PAS-positive, diastase-resistant, eosinophilic globules with light microscopic and ultrastructural features resembling Reissner fiber, the secretory product of the subcommissural organ. While there has been a single published description of an ependymoma with intra- and extracellular granulofibrillary material suggested to be evidence of secretory differentiation, ours is the first case to demonstrate diffuse eosinophilic globules in an ependymoma. The extent of globules allowed full study by electron microscopy to provide new insight into the secretory material and the surrounding structures. Our findings suggest that neoplastic ependymal cells can recapitulate the secretory capacity of the subcommissural organ.
Authors
MLA Citation
Ahn, Janice S., et al. “Eosinophilic globules in a classic ependymoma: evidence of a possible secretory role.Ultrastruct Pathol, vol. 44, no. 4–6, Nov. 2020, pp. 511–18. Pubmed, doi:10.1080/01913123.2020.1843578.
URI
https://scholars.duke.edu/individual/pub1464178
PMID
33148106
Source
pubmed
Published In
Ultrastruct Pathol
Volume
44
Published Date
Start Page
511
End Page
518
DOI
10.1080/01913123.2020.1843578

Restarting Therapeutic Anticoagulation After Elective Craniotomy for Patients with Chronic Atrial Fibrillation: A Review of the Literature.

The decision to restart systemic anticoagulation after surgery requires a nuanced risk-benefit analysis. The potential for surgical site bleeding must be balanced against the risk of thromboembolic events. In the context of postoperative neurosurgical patients, the consequences of either hemorrhage or thromboembolism can be devastating. However, few studies to date have attempted to determine the optimal time to resume anticoagulation after craniotomy. As a result, the decision of when to restart anticoagulation remains largely subjective and highly variable between surgeons and institutions. In this study, we aim to develop an algorithm that incorporates existing metrics and expert opinion toward the goal of developing guidelines for restarting anticoagulation after elective craniotomy.
Authors
Mehta, VA; Wang, TY; Sankey, EW; Howell, EP; Goodwin, CR; Levy, JH; Friedman, AH
MLA Citation
Mehta, Vikram A., et al. “Restarting Therapeutic Anticoagulation After Elective Craniotomy for Patients with Chronic Atrial Fibrillation: A Review of the Literature.World Neurosurg, vol. 137, May 2020, pp. 130–36. Pubmed, doi:10.1016/j.wneu.2020.01.235.
URI
https://scholars.duke.edu/individual/pub1431178
PMID
32036067
Source
pubmed
Published In
World Neurosurg
Volume
137
Published Date
Start Page
130
End Page
136
DOI
10.1016/j.wneu.2020.01.235

In Memoriam: Robert H. Wilkins, MD, 1934 to 2017.

Authors
MLA Citation
Ewend, Matthew G., et al. “In Memoriam: Robert H. Wilkins, MD, 1934 to 2017.Neurosurgery, vol. 81, no. 1, July 2017, pp. 6–8. Pubmed, doi:10.1093/neuros/nyx283.
URI
https://scholars.duke.edu/individual/pub1427065
PMID
31895452
Source
pubmed
Published In
Neurosurgery
Volume
81
Published Date
Start Page
6
End Page
8
DOI
10.1093/neuros/nyx283