Herbert Fuchs

Overview:

Clinical neuro-oncology research including collaborations studying molecular genetics of childhood brain tumors.
Potential role of the free electron laser in surgery of pediatric brain tumors. Current work includes animal models with human brain tumor xenografts in preclinical studies.
Collaboration with the neurooncology laboratory of Dr. Darell Bigner in preclinical studies of new therapeutic agents.

Positions:

Professor of Neurosurgery

Neurosurgery
School of Medicine

Professor of Pediatrics

Pediatrics
School of Medicine

Assistant Professor of Pathology

Pathology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1984

Duke University

Ph.D. 1984

Duke University

Grants:

Publications:

Ventriculomegaly and postoperative lateral/third ventricular blood as predictors of cerebrospinal fluid diversion following posterior fossa tumor resection.

OBJECTIVE: Postoperative hydrocephalus occurs in one-third of children after posterior fossa tumor resection. Although models to predict the need for CSF diversion after resection exist for preoperative variables, it is unknown which postoperative variables predict the need for CSF diversion. In this study, the authors sought to determine the clinical and radiographic predictors for CSF diversion in children following posterior fossa tumor resection. METHODS: This was a retrospective cohort study involving patients ≤ 18 years of age who underwent resection of a primary posterior fossa tumor between 2000 and 2018. The primary outcome was the need for CSF diversion 6 months after surgery. Candidate predictors for CSF diversion including age, race, sex, frontal occipital horn ratio (FOHR), tumor type, tumor volume and location, transependymal edema, papilledema, presence of postoperative intraventricular blood, and residual tumor were evaluated using a best subset selection method with logistic regression. RESULTS: Of the 63 included patients, 26 (41.3%) had CSF diversion at 6 months. Patients who required CSF diversion had a higher median FOHR (0.5 vs 0.4) and a higher percentage of postoperative intraventricular blood (30.8% vs 2.7%) compared with those who did not. A 0.1-unit increase in FOHR or intraventricular blood was associated with increased odds of CSF diversion (OR 2.9 [95% CI 1.3-7.8], p = 0.02 and OR 20.2 [95% CI 2.9-423.1], p = 0.01, respectively) with an overfitting-corrected concordance index of 0.68 (95% CI 0.56-0.80). CONCLUSIONS: The preoperative FOHR and postoperative intraventricular blood were significant predictors of the need for permanent CSF diversion within 6 months after posterior fossa tumor resection in children.
Authors
Park, C; Liu, B; Harward, SC; Zhang, AR; Gloria, J; Lee, H-J; Fuchs, HE; Muh, CR; Hodges, SE; Thompson, EM
MLA Citation
Park, Christine, et al. “Ventriculomegaly and postoperative lateral/third ventricular blood as predictors of cerebrospinal fluid diversion following posterior fossa tumor resection.J Neurosurg Pediatr, vol. 28, no. 5, Aug. 2021, pp. 533–43. Pubmed, doi:10.3171/2021.4.PEDS2188.
URI
https://scholars.duke.edu/individual/pub1494549
PMID
34388710
Source
pubmed
Published In
J Neurosurg Pediatr
Volume
28
Published Date
Start Page
533
End Page
543
DOI
10.3171/2021.4.PEDS2188

Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium.

OBJECTIVE: The aim of this study was to determine differences in complications and outcomes between posterior fossa decompression with duraplasty (PFDD) and without duraplasty (PFD) for the treatment of pediatric Chiari malformation type I (CM1) and syringomyelia (SM). METHODS: The authors used retrospective and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM1-SM who received PFD or PFDD and had at least 1 year of follow-up data. Preoperative, treatment, and postoperative characteristics were recorded and compared between groups. RESULTS: A total of 692 patients met the inclusion criteria for this database study. PFD was performed in 117 (16.9%) and PFDD in 575 (83.1%) patients. The mean age at surgery was 9.86 years, and the mean follow-up time was 2.73 years. There were no significant differences in presenting signs or symptoms between groups, although the preoperative syrinx size was smaller in the PFD group. The PFD group had a shorter mean operating room time (p < 0.0001), fewer patients with > 50 mL of blood loss (p = 0.04), and shorter hospital stays (p = 0.0001). There were 4 intraoperative complications, all within the PFDD group (0.7%, p > 0.99). Patients undergoing PFDD had a 6-month complication rate of 24.3%, compared with 13.7% in the PFD group (p = 0.01). There were no differences between groups for postoperative complications beyond 6 months (p = 0.33). PFD patients were more likely to require revision surgery (17.9% vs 8.3%, p = 0.002). PFDD was associated with greater improvements in headaches (89.6% vs 80.8%, p = 0.04) and back pain (86.5% vs 59.1%, p = 0.01). There were no differences between groups for improvement in neurological examination findings. PFDD was associated with greater reduction in anteroposterior syrinx size (43.7% vs 26.9%, p = 0.0001) and syrinx length (18.9% vs 5.6%, p = 0.04) compared with PFD. CONCLUSIONS: PFD was associated with reduced operative time and blood loss, shorter hospital stays, and fewer postoperative complications within 6 months. However, PFDD was associated with better symptom improvement and reduction in syrinx size and lower rates of revision decompression. The two surgeries have low intraoperative complication rates and comparable complication rates beyond 6 months.
Authors
Akbari, SHA; Yahanda, AT; Ackerman, LL; Adelson, PD; Ahmed, R; Albert, GW; Aldana, PR; Alden, TD; Anderson, RCE; Bauer, DF; Bethel-Anderson, T; Bierbrauer, K; Brockmeyer, DL; Chern, JJ; Couture, DE; Daniels, DJ; Dlouhy, BJ; Durham, SR; Ellenbogen, RG; Eskandari, R; Fuchs, HE; Grant, GA; Graupman, PC; Greene, S; Greenfield, JP; Gross, NL; Guillaume, DJ; Hankinson, TC; Heuer, GG; Iantosca, M; Iskandar, BJ; Jackson, EM; Jallo, GI; Johnston, JM; Kaufman, BA; Keating, RF; Khan, NR; Krieger, MD; Leonard, JR; Maher, CO; Mangano, FT; McComb, JG; McEvoy, SD; Meehan, T; Menezes, AH; Muhlbauer, MS; O'Neill, BR; Olavarria, G; Ragheb, J; Selden, NR; Shah, MN; Shannon, CN; Shimony, JS; Smyth, MD; Stone, SSD; Strahle, JM; Tamber, MS; Torner, JC; Tuite, GF; Tyler-Kabara, EC; Wait, SD; Wellons, JC; Whitehead, WE; Park, TS; Limbrick, DD
URI
https://scholars.duke.edu/individual/pub1517752
PMID
35426814
Source
pubmed
Published In
J Neurosurg Pediatr
Published Date
Start Page
1
End Page
13
DOI
10.3171/2022.2.PEDS21446

Predictors of Blood Transfusion for Endoscopic Assisted Craniosynostosis Surgery.

ABSTRACT: Blood loss is a main cause of morbidity after craniofacial procedures. The purpose of this study is to identify the incidence and predictors for transfusion of blood products in the endoscopic assisted strip craniectomy population. Data was prospectively collected from a single-center multi-surgeon cohort of 78 consecutive patients who underwent endoscopic assisted strip craniectomy for craniosynostosis between July 2013 and December 2020. The authors reviewed patient and treatment characteristics and outcomes. Of the 78 patients, 26 patients were transfused yielding an overall rate of transfusion of 33%. The most common fused suture was sagittal (n = 42, 54%) followed by metopic (n = 15, 19%), multiple (n = 10, 13%), coronal (n = 7, 9%) and finally lambdoid (n = 4, 5%). On univariate analysis, patients' weight in the transfusion cohort were significantly lower than those who did not receive a transfusion (5.6 ± 1.1 versus 6.5 ± 1.1 kg, P = 0.0008). The transfusion group also had significantly lower preoperative hemoglobin compared to the non-transfusion group (10.6 versus 11.1, P = .049). Eleven percent patients admitted to step-down received a transfusion, whereas 39% of patients admitted to the pediatric intensive care unit received a transfusion (P = 0.042). On multivariate analysis, only higher patient weight (operating room [OR] 0.305 [0.134, 0.693], P = 0.005) was protective against a transfusion, whereas colloid volume (OR 1.018 [1.003, 1.033], P = 0.019) predicted the need for a transfusion. Our results demonstrate that endoscopic craniosynostosis cases carry a moderate risk of transfusion. Individuals with lower weight and those that receive colloid volume are also at elevated risk.
Authors
Suarez, AD; Taicher, B; Fuchs, H; Marcus, J; Vestal, M; Homi, M; Allori, A; Thompson, EM
MLA Citation
Suarez, Alexander D., et al. “Predictors of Blood Transfusion for Endoscopic Assisted Craniosynostosis Surgery.J Craniofac Surg, Dec. 2021. Pubmed, doi:10.1097/SCS.0000000000008441.
URI
https://scholars.duke.edu/individual/pub1504891
PMID
34930880
Source
pubmed
Published In
J Craniofac Surg
Published Date
DOI
10.1097/SCS.0000000000008441

Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia.

OBJECTIVE: The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM). METHODS: The authors used retro- and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes. RESULTS: A total of 637 patients met inclusion criteria, and race or ethnicity data were available for 603 (94.7%) patients. A total of 463 (76.8%) were non-Hispanic White (NHW) and 140 (23.2%) were non-White. The non-White patients were older at diagnosis (p = 0.002) and were more likely to have an individualized education plan (p < 0.01). More non-White than NHW patients presented with cerebellar and cranial nerve deficits (i.e., gait ataxia [p = 0.028], nystagmus [p = 0.002], dysconjugate gaze [p = 0.03], hearing loss [p = 0.003], gait instability [p = 0.003], tremor [p = 0.021], or dysmetria [p < 0.001]). Non-White patients had higher rates of skull malformation (p = 0.004), platybasia (p = 0.002), and basilar invagination (p = 0.036). Non-White patients were more likely to be treated at low-volume centers than at high-volume centers (38.7% vs 15.2%; p < 0.01). Non-White patients were older at the time of surgery (p = 0.001) and had longer operative times (p < 0.001), higher estimated blood loss (p < 0.001), and a longer hospital stay (p = 0.04). There were no major group differences in terms of treatments performed or complications. The majority of subjects used private insurance (440, 71.5%), whereas 175 (28.5%) were using Medicaid or self-pay. Private insurance was used in 42.2% of non-White patients compared to 79.8% of NHW patients (p < 0.01). There were no major differences in presentation, treatment, or outcome between insurance groups. In multivariate modeling, non-White patients were more likely to present at an older age after controlling for sex and insurance status (p < 0.01). Non-White and male patients had a longer duration of symptoms before reaching diagnosis (p = 0.033 and 0.004, respectively). CONCLUSIONS: Socioeconomic and demographic factors appear to influence the presentation and management of patients with CM-I and SM. Race is associated with age and timing of diagnosis as well as operating room time, estimated blood loss, and length of hospital stay. This exploration of socioeconomic and demographic barriers to care will be useful in understanding how to improve access to pediatric neurosurgical care for patients with CM-I and SM.
Authors
Akbari, SHA; Rizvi, AA; CreveCoeur, TS; Han, RH; Greenberg, JK; Torner, J; Brockmeyer, DL; Wellons, JC; Leonard, JR; Mangano, FT; Johnston, JM; Shah, MN; Iskandar, BJ; Ahmed, R; Tuite, GF; Kaufman, BA; Daniels, DJ; Jackson, EM; Grant, GA; Powers, AK; Couture, DE; Adelson, PD; Alden, TD; Aldana, PR; Anderson, RCE; Selden, NR; Bierbrauer, K; Boydston, W; Chern, JJ; Whitehead, WE; Dauser, RC; Ellenbogen, RG; Ojemann, JG; Fuchs, HE; Guillaume, DJ; Hankinson, TC; O'Neill, BR; Iantosca, M; Oakes, WJ; Keating, RF; Klimo, P; Muhlbauer, MS; McComb, JG; Menezes, AH; Khan, NR; Niazi, TN; Ragheb, J; Shannon, CN; Smith, JL; Ackerman, LL; Jea, AH; Maher, CO; Narayan, P; Albert, GW; Stone, SSD; Baird, LC; Gross, NL; Durham, SR; Greene, S; McKinstry, RC; Shimony, JS; Strahle, JM; Smyth, MD; Dacey, RG; Park, TS; Limbrick, DD
MLA Citation
Akbari, Syed Hassan A., et al. “Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia.J Neurosurg Pediatr, Dec. 2021, pp. 1–10. Pubmed, doi:10.3171/2021.9.PEDS2185.
URI
https://scholars.duke.edu/individual/pub1503250
PMID
34861643
Source
pubmed
Published In
J Neurosurg Pediatr
Published Date
Start Page
1
End Page
10
DOI
10.3171/2021.9.PEDS2185

Pediatric Giant Prolactinoma Presenting With Acute Obstructive Hydrocephalus and Intracranial Hypertension.

Authors
Hendrix, G; Benjamin, R; MacIver, N; Barboriak, DP; Fuchs, H; Gumus Balikcioglu, P
MLA Citation
Hendrix, Grace, et al. “Pediatric Giant Prolactinoma Presenting With Acute Obstructive Hydrocephalus and Intracranial Hypertension.J Endocr Soc, vol. 5, no. 12, Dec. 2021, p. bvab160. Pubmed, doi:10.1210/jendso/bvab160.
URI
https://scholars.duke.edu/individual/pub1500425
PMID
34765855
Source
pubmed
Published In
Journal of the Endocrine Society
Volume
5
Published Date
Start Page
bvab160
DOI
10.1210/jendso/bvab160