Scholars@Duke
Stephen Harward

Stephen Harward

Assistant Professor of Neurosurgery
Neurosurgery
stephen.harward@duke.edu
Box 90226, Durham, NC 27708-0226
DUMC 3807, Durham, NC 27710

Selected Publications

Four-tract tractography: multiparametric direct targeting of the dentatorubrothalamic tract.

Journal Article Neurosurg Focus Video · October 2024 This video article presents a case study of a 70-year-old male with medically refractory essential tremor treated with magnetic resonance-guided focused ultrasound (MRgFUS). Following an initial successful ablation of the right thalamus, the patient underw ... Full text Link to item Cite

Beyond medical knowledge: a didactic curriculum focused on knowledge, wisdom, and application.

Journal Article J Neurosurg · September 1, 2024 OBJECTIVE: The aim of this study was to determine whether a flipped classroom curriculum coupled with case-based learning would improve residents' perceptions of the learning environment, improve education outcomes, and increase faculty engagement. Researc ... Full text Link to item Cite

Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor in a patient with von Willebrand disease: perioperative optimization for patients with coagulopathies. Illustrative case.

Journal Article J Neurosurg Case Lessons · June 10, 2024 BACKGROUND: Essential tremor (ET) is one of the most common movement disorders worldwide. In medically refractory ET, deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus is the current standard of care. However, DBS carries an ... Full text Link to item Cite

Ratios of head circumference to ventricular size vary over time and predict eventual need for CSF diversion in intraventricular hemorrhage of prematurity.

Journal Article Childs Nerv Syst · March 2024 PURPOSE: Intraventricular hemorrhage (IVH) of prematurity can lead to hydrocephalus, sometimes necessitating permanent cerebrospinal fluid (CSF) diversion. We sought to characterize the relationship between head circumference (HC) and ventricular size in I ... Full text Open Access Link to item Cite

A simple, automated method of seizure detection in mouse models of temporal lobe epilepsy.

Journal Article Epilepsy Res · December 2023 The lack of preventive and disease modifying therapies for temporal lobe epilepsy (TLE) is a major unmet medical need. Search for such therapies utilize mouse models and require detection of seizures in electroencephalography (EEG) recordings. The labor-in ... Full text Link to item Cite

High-resolution neural recordings improve the accuracy of speech decoding.

Journal Article Nat Commun · November 6, 2023 Patients suffering from debilitating neurodegenerative diseases often lose the ability to communicate, detrimentally affecting their quality of life. One solution to restore communication is to decode signals directly from the brain to enable neural speech ... Full text Link to item Cite

Flexible, high-resolution cortical arrays with large coverage capture microscale high-frequency oscillations in patients with epilepsy.

Journal Article Epilepsia · July 2023 OBJECTIVE: Effective surgical treatment of drug-resistant epilepsy depends on accurate localization of the epileptogenic zone (EZ). High-frequency oscillations (HFOs) are potential biomarkers of the EZ. Previous research has shown that HFOs often occur wit ... Full text Link to item Cite

MRI Radiogenomics of Pediatric Medulloblastoma: A Multicenter Study.

Journal Article Radiology · August 2022 Background Radiogenomics of pediatric medulloblastoma (MB) offers an opportunity for MB risk stratification, which may aid therapeutic decision making, family counseling, and selection of patient groups suitable for targeted genetic analysis. Purpose To de ... Full text Link to item Cite

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

Journal Article J Neurosurg Pediatr · November 1, 2021 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 variable ... Full text Link to item Cite

Machine Assist for Pediatric Posterior Fossa Tumor Diagnosis: A Multinational Study.

Journal Article Neurosurgery · October 13, 2021 BACKGROUND: Clinicians and machine classifiers reliably diagnose pilocytic astrocytoma (PA) on magnetic resonance imaging (MRI) but less accurately distinguish medulloblastoma (MB) from ependymoma (EP). One strategy is to first rule out the most identifiab ... Full text Link to item Cite

Autograft-derived spinal cord mass in the cervical spine following transplantation with olfactory mucosa cells for traumatic spinal cord injury: case report.

Journal Article J Neurosurg Spine · February 1, 2021 This study describes a patient with an autograft-derived spinal cord mass following transplantation of olfactory mucosa for treatment of cervical spine injury. The authors report the case of a 35-year-old man who suffered a complete spinal cord injury (SCI ... Full text Link to item Cite

Split cord malformation in adults: Literature review and classification.

Journal Article Clin Neurol Neurosurg · June 2020 The objective of this study was to summarize the available literature describing the presentation, diagnostic evaluation, and management for adults with Type 1 and Type 2 split spinal cord malformations. A review of the literature was performed using the C ... Full text Link to item Cite

Targeting BDNF/TrkB pathways for preventing or suppressing epilepsy.

Journal Article Neuropharmacology · May 1, 2020 Traumatic brain injury (TBI) and status epilepticus (SE) have both been linked to development of human epilepsy. Although distinct etiologies, current research has suggested the convergence of molecular mechanisms underlying epileptogenesis following these ... Full text Link to item Cite

Interneuron transplantation: a prospective surgical therapy for medically refractory epilepsy.

Journal Article Neurosurg Focus · April 1, 2020 Excitatory-inhibitory imbalance is central to epilepsy pathophysiology. Current surgical therapies for epilepsy, such as brain resection, laser ablation, and neurostimulation, target epileptic networks on macroscopic scales, without directly correcting the ... Full text Link to item Cite

Seizures in meningioma.

Chapter · 2020 More than one-third of patients with meningiomas will experience seizures at some point in their disease. Despite this, meningioma-associated epilepsy remains significantly understudied, as most investigations focus on tumor progression, extent of resectio ... Full text Link to item Cite

Regression of Epileptogenesis by Inhibiting Tropomyosin Kinase B Signaling following a Seizure.

Journal Article Ann Neurol · December 2019 OBJECTIVE: Temporal lobe epilepsy (TLE) is a devastating disease in which seizures persist in 35% of patients despite optimal use of antiseizure drugs. Clinical and preclinical evidence implicates seizures themselves as one factor promoting epilepsy progre ... Full text Open Access Link to item Cite

Neurological Outcomes After Surgical or Conservative Management of Spontaneous Spinal Epidural Abscesses: A Systematic Review and Meta-Analysis of Data From 1980 Through 2016.

Journal Article Clin Spine Surg · February 2019 STUDY DESIGN: This is a meta-analysis. OBJECTIVE: Perform a systematic review and quantitative meta-analysis of neurological outcomes from all available spinal epidural abscess (SEA) literature published between 1980 and 2016. SUMMARY OF BACKGROUND DATA: C ... Full text Link to item Cite

Toward Functional Restoration of the Central Nervous System: A Review of Translational Neuroscience Principles.

Journal Article Neurosurgery · January 1, 2019 Injury to the central nervous system (CNS) can leave patients with devastating neurological deficits that may permanently impair independence and diminish quality of life. Recent insights into how the CNS responds to injury and reacts to critically timed i ... Full text Link to item Cite

Socioeconomic Factors, Perioperative Complications, and 30-Day Readmission Rates Associated With Delayed Cranial Vault Reconstruction for Craniosynostosis.

Journal Article J Craniofac Surg · October 2018 BACKGROUND: Premature fusion of the cranial sutures can lead to significant neurocognitive, developmental, and esthetic consequences, especially if not corrected within the first year of life. This study aimed to identify the drivers of delayed cranial vau ... Full text Link to item Cite

Evidence based diagnosis and management of chronic subdural hematoma: A review of the literature.

Journal Article J Clin Neurosci · April 2018 Chronic subdural hematomas are encapsulated blood collections within the dural border cells with characteristic outer "neomembranes". Affected patients are more often male and typically above the age of 70. Imaging shows crescentic layering of fluid in the ... Full text Link to item Cite

Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis.

Journal Article Neurosurgery · March 1, 2018 BACKGROUND: Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure ... Full text Link to item Cite

T2-weighted images are superior to other MR image types for the determination of diffuse intrinsic pontine glioma intratumoral heterogeneity.

Journal Article Childs Nerv Syst · March 2018 PURPOSE: Diffuse intrinsic pontine glioma (DIPG) remains the main cause of death in children with brain tumors. Given the inefficacy of numerous peripherally delivered agents to treat DIPG, convection enhanced delivery (CED) of therapeutic agents is a prom ... Full text Link to item Cite

Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review.

Journal Article Epilepsia · December 2017 OBJECTIVE: Medically refractory epilepsy is a debilitating disorder that is particularly challenging to treat in patients who have already failed a surgical resection. Evidence regarding outcomes of further epilepsy surgery is limited to small case series ... Full text Link to item Cite

Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data.

Journal Article Epilepsy Behav · January 2017 OBJECTIVE: Drug-resistant epilepsy is a devastating disorder associated with diminished quality of life (QOL). Surgical resection leads to seizure freedom and improved QOL in many epilepsy patients, but not all individuals are candidates for resection. In ... Full text Link to item Cite

Autocrine BDNF-TrkB signalling within a single dendritic spine.

Journal Article Nature · October 6, 2016 Brain-derived neurotrophic factor (BDNF) and its receptor TrkB are crucial for many forms of neuronal plasticity, including structural long-term potentiation (sLTP), which is a correlate of an animal's learning. However, it is unknown whether BDNF release ... Full text Link to item Cite

Rho GTPase complementation underlies BDNF-dependent homo- and heterosynaptic plasticity.

Journal Article Nature · October 6, 2016 The Rho GTPase proteins Rac1, RhoA and Cdc42 have a central role in regulating the actin cytoskeleton in dendritic spines, thereby exerting control over the structural and functional plasticity of spines and, ultimately, learning and memory. Although previ ... Full text Link to item Cite

Aligning animal models with clinical epilepsy: where to begin?

Journal Article Adv Exp Med Biol · 2014 Treatment of the epilepsies have benefitted immensely from study of animal models, most notably in the development of diverse anti-seizure medications in current clinical use. However, available drugs provide only symptomatic relief from seizures and are o ... Full text Link to item Cite

Aligning animal models with clinical epilepsy: Where to begin?

Journal Article Advances in Experimental Medicine and Biology · January 1, 2014 Treatment of the epilepsies have benefitted immensely from study of animal models, most notably in the development of diverse anti-seizure medications in current clinical use. However, available drugs provide only symptomatic relief from seizures and are o ... Full text Cite

Aligning animal models with clinical epilepsy: Where to begin?

Journal Article Advances in Experimental Medicine and Biology · January 1, 2014 Treatment of the epilepsies have benefitted immensely from study of animal models, most notably in the development of diverse anti-seizure medications in current clinical use. However, available drugs provide only symptomatic relief from seizures and are o ... Full text Cite

Diminished FoxP2 levels affect dopaminergic modulation of corticostriatal signaling important to song variability.

Journal Article Neuron · December 18, 2013 Mutations of the FOXP2 gene impair speech and language development in humans and shRNA-mediated suppression of the avian ortholog FoxP2 disrupts song learning in juvenile zebra finches. How diminished FoxP2 levels affect vocal control and alter the functio ... Full text Link to item Cite

In search of the ever-elusive positive endozepine.

Journal Article Neuron · June 19, 2013 In this issue of Neuron, Christian et al. (2013) provide functional evidence for positive endozepines (positive allosteric modulators of GABAARs) within the thalamic reticular nucleus. These molecules are encoded by the Dbi gene and modulate thalamocortica ... Full text Link to item Cite

Arterial pole progenitors interpret opposing FGF/BMP signals to proliferate or differentiate.

Journal Article Development · September 2010 During heart development, a subpopulation of cells in the heart field maintains cardiac potential over several days of development and forms the myocardium and smooth muscle of the arterial pole. Using clonal and explant culture experiments, we show that t ... Full text Open Access Link to item Cite

Emerging therapeutic targets and agents for glioblastoma migrating cells.

Journal Article Anticancer Agents Med Chem · September 2010 Glioblastoma multiforme (GBM) is one of the most common and most aggressive types of primary brain tumors in humans. Even with aggressive surgical resections using state of the art preoperative and intraoperative neuroim-aging, along with the most recent t ... Full text Link to item Cite