Complex Neurosurgery Yesterday, Discharge Tomorrow

Mar 30, 2020 at 04:18 pm by admin

©Wesley Hitt 2015

Neurosurgeon Ali Krisht, MD, cites remarkable progress improving outcomes

Ali Krisht, MD, director and lead neurosurgeon at CHI St. Vincent's Arkansas Neuroscience Institute, is internationally known for his work including delivering more than 170 presentations and lectures around the world. He is chief editor of the journal Contemporary Neurosurgery, and rated among the top one percent of all neurosurgeons in the U.S. by the ratings firm Castle Connolly.

In addition to all those achievements, Krisht is quick to give credit to others for the quantum leap seen regarding outcomes from neurosurgery in the past 40-50 years.

"At one time in neurosurgery, 50 percent of the patients used to die or not do well. One of my mentors, Professor M.G. Yasargil, MD, with whom I worked here in Arkansas for 15 years, had a different understanding of the anatomy and how to navigate brain space. He converted that to 85-90 percent positive outcomes. Today, we can conduct complex surgeries, and the patient will be out of the hospital in two days after an 18 to 19-hour surgery."

Krisht said Yasargil's work created a domino effect for more advances. Now, in the neurosciences, one of the biggest advantages is being able to see the brain and identify many of the pathologies without opening the skull.

"With CT scans and now MRI, we are really able to get a lot of information and pinpoint almost exactly what kind of tumor it is, how you navigate getting to it safely and follow it closely," Krisht said. "Still, the advances are minute compared to our ignorance about how the brain functions and how diseases occur. We still are in the dark on how the brain connects, how the brain functions, the environment of the brain and so forth.

"The difference between it and the rest of the body is like the difference between the oceans and the lands. With the liver, the kidneys and the stomach, there are different geographies where you can go from one place to another and you have more understanding of how they connect and how they function. The brain is more like an ocean. Wherever you dive, it's still going to be a deep dive before you get some information, and there's a lot of ocean to explore."

Neurosurgery used to be considered a last resort because of risks of death or poor outcomes. But today, neurosurgery is extremely safe.

"In the majority of my cases now, there is less than a one percent chance of major problems like stroke, paralysis, coma or anything like that from surgery," Krisht said. "This is even less risky than being in a car driving on the road. That is really important for people to know. People should not fear when they have the right surgeon with the right experience and the right knowledge."

Sometimes people are told their condition is non-operable or cannot be treated, but Krisht said there are centers like the Arkansas Neuroscience Institute at CHI St. Vincent where they tackle the non-operable and untreatable because they are not going to give up on patients.

"Difficulty doesn't exist and impossible doesn't exist," he said. "Ignorance exists. We can conquer a lot of things if we overcome our own ignorance about it. There are a lot of bright minds we have to invest in, and I'm sure we'll make more progress."

Strokes are the fifth most common cause of death in the U.S., and a leading cause of disability. Stroke treatments have revolutionized stroke survival and recovery with the impact most felt in those who get care quickly.

"If we can catch a patient within an hour or two or three, there is much that can be done today," Krisht said. "If they have a small clot in the brain, you can give them medications that will start to break it down so the extent of the stroke is not as significant. Recently we reached a serious advancement in cases where you encounter a big clot like those that usually come from the heart in patients who have cardiac arrhythmias and are prone to developing clots in their heart, and they throw the clots up stream. We can now take them to the angio suite where we use a catheter to go and fish the clot out and reestablish blood flow."

A brain cath is similar to a heart cath.

Krisht said you may not salvage every area that was affected, but you will end up going from somebody who is completely paralyzed and unable to talk, to somebody who may have residual weakness, but can still walk and talk.

"It is a remarkable improvement," Krisht said. "What needs to be married to it is the social and maybe governmental input to enhance the process of getting these patients to the proper care quickly. Most people don't want to believe they're having a stroke. They'll say, 'My arm is numb and it feels heavy, but maybe I'm just tired.' If they sit on it for another two-to-three hours, their condition will deteriorate to where it becomes an irreversible injury."

Krisht was born in Nigeria to Lebanese parents. His father had moved to Nigeria to get into the peanut business. Krisht returned to Lebanon for boarding school and later went on to medical school at the American University in Beirut. He completed his surgical residency training at Emory University in Atlanta and moved to Little Rock in 1994 for the opportunity to work with two men who would become his mentors, Yasargil and Ossama Al-Mefty, whom Krisht considered two of the most talented neurosurgeons in the world.

Initially he planned a career as a professional soccer player. A complex fracture in his leg sidelined him from the game he loved, and required him to go through five operations in a year. While he recovered, it wasn't enough to play soccer professionally. That is when he started thinking of medicine. He was interested in philosophy and psychology, which are related to the brain and the nervous system. He decided on surgery because it is more active than other options.

"As an athlete, I like to wake up in the morning and be active," he said. "I also like to paint and do a little sculpture, and I felt like you could apply the arts perspective along with the surgery, and it was a combination of all these things together."

For more information, go online to:

CHI St. Vincent Arkansas Neuroscience Institute

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