Johnathan A Engh

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (69)213.55 Total impact

  • Christopher P Deibert · Johnathan A Engh
    Neurosurgery 08/2015; 77(2):N17. DOI:10.1227/01.neu.0000467295.18386.90 · 3.62 Impact Factor
  • Benjamin M Zussman · Johnathan A Engh
    Neurosurgery 06/2015; 76(6):N17. DOI:10.1227/01.neu.0000465855.63458.0c · 3.62 Impact Factor
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    ABSTRACT: Despite advances in multimodality management of brain metastases, local progression following stereotactic radiosurgery (SRS) can occur. Often, surgical resection is favored, as it frequently provides immediate symptom relief as well as pathological characterization of any residual tumor. Should the pathological specimen contain viable tumor cells, further radiation therapy is an option to sterilize the tumor bed. We evaluated the use of repeat SRS (rSRS) in lieu of whole-brain radiation therapy (WBRT) as a means of improving local control (LC) while minimizing potential toxicity and dose to the normal brain. A retrospective review was performed to identify patients with brain metastases who underwent SRS and then surgical resection for locally recurrent or persistent disease. From 2004 to 2014, 13 consecutive patients or 15 lesions were treated with rSRS after resection, either post-operatively to the tumor bed (n = 10, 66.6%) or after a second local recurrence (n = 5, 33.3%). LC, distant brain failure (DBF), and radiation toxicity were determined using patient records, RECIST criteria v1.1, and CTCAE v4.03. At a median follow-up interval of 9.0 months (range 1.8-54.9 months) from time of rSRS, five patients remain alive. Following rSRS, 13 of the 15 (86.6%) lesions were locally controlled with an estimated 100% LC at 6 months and 75% LC at 1 year. However, 11 of the 15 (73.3%) treated lesions developed DBF after rSRS with 3 of 13 patients proceeding to WBRT. Two of 15 (13.3%) resulted in either grade 2 radionecrosis with grade 3 seizures or grade 3 radionecrosis. Repeat SRS represents a potential salvage therapy for patients with locally recurrent brain metastases, providing additional tumor control with acceptable toxicity, even in the setting of prior SRS and surgical resection. rSRS may be reasonable to use as an alternative to WBRT in this setting.
    Frontiers in Oncology 04/2015; 5. DOI:10.3389/fonc.2015.00084
  • Christopher P Deibert · Benjamin M Zussman · Johnathan A Engh
    Neurosurgery 04/2015; 76(4):N22-3. DOI:10.1227/01.neu.0000462700.20586.94 · 3.62 Impact Factor
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    ABSTRACT: Background: Accuracy in Ommaya reservoir catheter placement is critical to chemotherapy infusion. Most frameless image guidance is light emitting diode (LED) based, requiring a direct line of communication between instrument and tracker, limiting freedom of instrument movement within the surgical field. Electromagnetic neuronavigation may overcome this challenge. Objective: To compare Ommaya reservoir ventricular catheter placement using electromagnetic neuronavigation to LED-based optical navigation, with emphasis on placement accuracy, operative time and complication rate. Methods: Twenty-eight patients who underwent placement of Ommaya reservoirs at our institution between 2010 and 2014 with either electromagnetic (12 patients) or optical neuronavigation (16 patients) were retrospectively reviewed. Results: Half of the patients were male. Their mean age was 56 years (range 28-87 years). Accuracy and precision in catheter tip placement at the target site (foramen of Monro) were both higher (p = 0.038 and p = 0.043, respectively) with electromagnetic neuronavigation. Unintended placement of the distal catheter contralateral to the target site occurred more frequently with optical navigation, as did superior or inferior positioning by more than 5 mm. Mean operative times were shorter (p = 0.027) with electromagnetic neuronavigation (43.2 min) than with optical navigation (51.0 min). There were three complications (10.7%) - one case each of cytotoxic edema, post-operative wound infection, and urinary tract infection. The rate of complication did not differ between groups. Conclusion: In contrast with optical neuronavigation, frameless and pinless electromagnetic image guidance allows the ability to track instrument depth in real-time. It may increase ventricular catheter placement accuracy and precision, and decrease operative times.
    Clinical Neurology and Neurosurgery 03/2015; 130. DOI:10.1016/j.clineuro.2014.12.018 · 1.13 Impact Factor
  • Benjamin M Zussman · Christopher P Deibert · Johnathan A Engh
    Neurosurgery 02/2015; 76(2):N20-N21. DOI:10.1227/01.neu.0000460598.68254.1a · 3.62 Impact Factor
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    ABSTRACT: Ventriculo-peritoneal shunts (VPS) are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet's syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters.
    01/2015; 6(1):97-9. DOI:10.4103/0976-3147.143212
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    ABSTRACT: BACKGROUND: Postoperative stereotactic radiosurgery for brain metastases potentially offers similar local control rates and fewer long-term neurocognitive sequelae compared to whole brain radiation therapy, although patients remain at risk for distant brain failure (DBF). OBJECTIVE: To describe clinical outcomes of adjuvant stereotactic radiosurgery for large brain metastases and identify predictors of intracranial failure and their implications on optimal patient selection criteria. METHODS: We performed a retrospective review on 100 large (>3 cm) brain metastases in 99 patients managed by resection followed by postoperative stereotactic radiosurgery to a median dose of 22 Gy (range, 10-28) in 1 to 5 fractions (median, 3). Primary histology was nonsmall cell lung in 40%, breast cancer in 18%, and melanoma in 17%. Forty (40%) patients had uncontrolled systemic disease. RESULTS: With a median follow-up of 12.2 months (range, 0.6-87.4), the 1-year Kaplan-Meier local control was 72%, DBF 64%, and overall survival 55%. Nine patients (9%) developed evidence of radiation injury, and 6 (6%) developed leptomeningeal disease. Uncontrolled systemic disease (P = .03), melanoma histology (P = .04), and increasing number of brain metastases (P < .001) were significant predictors of DBF on Cox multivariate analysis. Patients with,4 metastases, controlled systemic disease, and nonmelanoma primary (n = 47) had a 1-year DBF of 48.6% vs 80.1% for all others (P = .01). CONCLUSION: Postoperative stereotactic radiosurgery to the resection cavity safely and effectively augments local control of large brain metastases. Patients with <4 metastases and controlled systemic disease have significantly lower rates of DBF and are ideal treatment candidates.
    Neurosurgery 12/2014; 76(2). DOI:10.1227/NEU.0000000000000584 · 3.62 Impact Factor
  • Christopher P Deibert · Benjamin M Zussman · Johnathan A Engh
    Neurosurgery 12/2014; 75(6):N16-7. DOI:10.1227/01.neu.0000457196.94533.21 · 3.62 Impact Factor
  • Benjamin M Zussman · Christopher P Deibert · Johnathan A Engh
    Neurosurgery 10/2014; 75(4):N22-N23. DOI:10.1227/01.neu.0000454763.29872.6b · 3.62 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S192-S193. DOI:10.1016/j.ijrobp.2014.05.729 · 4.26 Impact Factor
  • Benjamin M Zussman · Phillip V Parry · Johnathan A Engh
    Neurosurgery 08/2014; 75(2):N23. DOI:10.1227/01.neu.0000452320.29979.a8 · 3.62 Impact Factor
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    ABSTRACT: Purpose: WHO grade 2 low-grade gliomas (LGG) with high risk factors for recurrence are mostly lethal despite current treatments. We conducted a phase I study to evaluate the safety and immunogenicity of subcutaneous vaccinations with synthetic peptides for glioma-associated antigen (GAA) epitopes in HLA-A2(+) adults with high-risk LGGs in the following three cohorts: (i) patients without prior progression, chemotherapy, or radiotherapy (RT); (ii) patients without prior progression or chemotherapy but with prior RT; and (iii) recurrent patients. Experimental design: GAAs were IL13Rα2, EphA2, WT1, and Survivin. Synthetic peptides were emulsified in Montanide-ISA-51 and given every 3 weeks for eight courses with intramuscular injections of poly-ICLC, followed by q12 week booster vaccines. Results: Cohorts 1, 2, and 3 enrolled 12, 1, and 10 patients, respectively. No regimen-limiting toxicity was encountered except for one case with grade 3 fever, fatigue, and mood disturbance (cohort 1). ELISPOT assays demonstrated robust IFNγ responses against at least three of the four GAA epitopes in 10 and 4 cases of cohorts 1 and 3, respectively. Cohort 1 patients demonstrated significantly higher IFNγ responses than cohort 3 patients. Median progression-free survival (PFS) periods since the first vaccine are 17 months in cohort 1 (range, 10-47+) and 12 months in cohort 3 (range, 3-41+). The only patient with large astrocytoma in cohort 2 has been progression-free for more than 67 months since diagnosis. Conclusion: The current regimen is well tolerated and induces robust GAA-specific responses in WHO grade 2 glioma patients. These results warrant further evaluations of this approach. Clin Cancer Res; 21(2); 286-94. ©2014 AACR.
    Neuro-Oncology 07/2014; 16 Suppl 3(2):iii39. DOI:10.1093/neuonc/nou208.62 · 5.56 Impact Factor
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    ABSTRACT: Background: Sinus histiocytosis with massive lymphadenopathy (also known as Rosai-Dorfman disease [RDD]) is a benign but chronic cervical lymphadenopathy associated with systemic inflammation. Although extranodal manifestations of RDD have been described, isolated central nervous system (CNS) involvement is exceedingly rare. Case description: We present the case of a 66-year-old woman who presented with 3 weeks of intermittent headaches, diplopia, and increasing confusion who was found on work-up to have isolated hypothalamic RDD, evidenced by a dense admixture of large histiocytic cells admixed with numerous small mature lymphocytes and some scattered plasma cells and neutrophils on stereotactic brain biopsy. Over 19 months of follow-up, neurologic examination continues to reveal stable bilateral partial abducens nerve palsies without diplopia, and a new gradual onset short-term memory loss. Interim treatment for the histiocytic lesion consisted of 10 cycles of external-beam radiation therapy along with high-dose steroids. The patient currently experiences minimal functional loss from treatment of her intracranial sinus histiocytosis, with a Karnofsky performance status of 80, and she remains without any disease involvement outside of the CNS. Conclusion: Because misdiagnosis of a hypothalamic contrast-enhancing lesion could potentially lead to therapeutic mismanagement and poor outcomes, it is important to consider RDD in the differential diagnosis.
    Journal of Neurological Surgery. Part A: Central European Neurosurgery 06/2014; 76(03). DOI:10.1055/s-0034-1382780 · 0.61 Impact Factor
  • Phillip V Parry · Johnathan A Engh
    Neurosurgery 06/2014; 74(6):N18-9. DOI:10.1227/01.neu.0000450235.91492.8f · 3.62 Impact Factor
  • Phillip V Parry · Johnathan A Engh
    Neurosurgery 04/2014; 74(4):N8-N9. DOI:10.1227/NEU.0000000000000310 · 3.62 Impact Factor
  • Srinivas Chivukula · Gregory M Weiner · Johnathan A Engh
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    ABSTRACT: Two key discoveries in the 19th century-infection control and the development of general anesthesia-provided an impetus for the rapid advancement of surgery, especially within the field of neurosurgery. Yet the field of neurosurgery would not have existed in the modern sense without the development and advancement of techniques in hemostasis. Improvement in intraoperative hemostasis came more gradually but was no less important to enhancing neurosurgical outcomes. The history of hemostasis in neurosurgery is often overlooked. Herein, the authors briefly review the historical progression of hemostatic techniques since the beginning of the early modern era of neurosurgery.
    Neurosurgical FOCUS 04/2014; 36(4):E5. DOI:10.3171/2014.1.FOCUS13565 · 2.11 Impact Factor
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    ABSTRACT: High Definition Fiber Tractography (HDFT), an advanced white matter (WM) imaging technique, was evaluated in the management of supratentorial cavernous malformations (CMs). To investigate the relationship of CMs to the relevant perilesional WM tracts using HDFT and to characterize associated changes first qualitatively and then quantitatively, using our novel imaging measure, quantitative anisotropy (QA). Imaging analysis was carried out, blinded to the clinical details. Contralateral WM tracts were used for comparison. Mean QA values were obtained for whole WM tracts. Qualitatively affected superior longitudinal fasciculus/arcuate fibers and corticospinal tracts were further analyzed, using mean QA values for the perilesional segments. Of 10 patients, HDFT assisted with the decision-making process and offering of surgical resection in two, lesion approach and removal in seven, and conservative management in one. Of 17 analyzed WM tracts, HDFT demonstrated partial disruption in two, complete disruption in two, combination of displacement and partial disruption in one, displacement only in seven, and no change in five. Qualitative changes correlated with clinical symptoms. Mean QA for the whole WM tracts were similar, with the exception of one case demonstrating complete disruption of two WM tracts. QA-based perilesional segment analysis was consistent with qualitative data in five assessed WM tracts. HDFT illustrated the precise spatial relationship of CMs to multiple WM tracts in a three-dimensional fashion, optimizing surgical planning, and demonstrated associated disruption and/or displacement, with both occurring perilesionally. These changes were supported by our quantitative marker, which will need further validation.
    Neurosurgery 02/2014; 74(6). DOI:10.1227/NEU.0000000000000336 · 3.62 Impact Factor
  • Phillip V Parry · Johnathan A Engh
    Neurosurgery 02/2014; 74(2):N14-5. DOI:10.1227/01.neu.0000442976.61335.f6 · 3.62 Impact Factor
  • Phillip V Parry · Johnathan A Engh
    Neurosurgery 12/2013; 73(6):N11-N13. DOI:10.1227/01.neu.0000438331.72566.2e · 3.62 Impact Factor

Publication Stats

808 Citations
213.55 Total Impact Points


  • 2005–2015
    • University of Pittsburgh
      • Department of Neurological Surgery
      Pittsburgh, Pennsylvania, United States
  • 2006–2009
    • Carnegie Mellon University
      • • Department of Biomedical Engineering
      • • Robotics Institute
      Pittsburgh, PA, United States