Edward Robert Smith, MD

Edward Robert Smith, MD

Director, Pediatric Cerebrovascular Neurosurgery; Co-Director, Cerebrovascular Surgery and Interventions Center;Associate in Neurosurgery

Associate Professor, Harvard Medical School

"Together with my colleagues at Boston Children's Hospital, we have developed world-class programs to treat cerebrovascular disease and brain tumors through ongoing clinical innovation."

Medical Services

Specialties

  • Aneurysms
  • Arteriovenous Malformation (AVM)
  • Brain Tumors
  • Cavernous Malformations
  • Chiari Malformations
  • Neurosurgery
  • Moyamoya
  • Neurotrauma
  • Stroke
  • Pituitary Tumors
  • Skull Base Lesions
  • Vascular Anomalies

Departments

  • Neurosurgery
  • Hematology / Oncology

Languages

  • English

Programs

  • Brain Tumor Center
  • Brain Injury Center
  • Cerebrovascular Surgery and Intervention Center
  • Cerebrovascular Disorders and Stroke Program
  • Moyamoya Disease Program
  • Neurosurgical Service
  • Vascular Anomalies Center
  • Vascular Biology Program
To schedule an appointment: Call 617-355-6008 or Request an Appointment
Edward Robert Smith, MD

I was drawn to neurosurgery—and to Boston Children's Hospital and training with Emeritus Neurosurgeon-in-Chief R. Michael Scott in particular—when my good friend in high school was treated here for a brain tumor. 

That experience started me on my path to becoming a pediatric neurosurgeon and after that, Dr. Scott's name echoed in the back of my head as I entered medical school to begin my studies.

I was reintroduced to Dr. Scott when I was a medical student at Columbia University. The neurosurgery department's chair there at the time, Ben Stein, was a former partner of Dr. Scott's and encouraged me to go and work with him. I completed a rotation here and then quickly followed that up with a fellowship under Dr. Scott's guidance. I have been at Boston Children's ever since, and am indebted to Dr. Scott for helping me to become a leader in the treatment of moyamoya syndrome, cerebrovascular disease and brain tumors.

I believe strongly in my role as a surgeon/scientist, and, in the laboratory, am lucky to have been mentored by Marsha A. Moses, a great scientist and the director of the Vascular Biology Program here at Boston Children's.

I'm a New Englander, having grown up in Dartmouth, MA, followed by my undergraduate years studying biology and rowing at Dartmouth College. My patients often give me joke books, which might be a reflection on my sense of (or lack of!) humor and desire to try to keep kids laughing if at all possible during difficult circumstances.

Experience and Education

Education

Undergraduate Degree

Dartmouth College, 1992

Hanover, New Hampshire

Medical Degree

Columbia University, 1996

New York, New York

Internship

Massachusetts General Hospital, 1996-1997

Boston, Massachusetts

Residency

Neurosurgery - Massachusetts General Hospital, 1997-2003

Boston, Massachusetts

Fellowship

Boston Children's Hospital, 2003-2004

Boston, Massachusetts

Certifications

  • ABNS - American Board of Neurological Surgery

  • ABPNS - American Board of Pediatric Neurological Surgery

  • Neurological Surgery, Pediatric Neurological Surgery

Research

My research efforts are focused on finding cures for children with brain tumors and cerebrovascular disease. I am committed to building bridges between clinical practice and scientific research in order to leverage the unique perspective of a surgeon-scientist. The disorders that I treat—brain tumors and cerebrovascular disease—are  linked by similar operative approaches that I use in the hospital and by common biological processes that I study in the lab.

My research is primarily centered on understanding the molecular mechanisms of tumorigenesis and angiogenesis in the central nervous system, in conjunction with efforts of the Vascular Biology Program, led by Dr. Marsha Moses. My work has included basic science and translational studies investigating adult and pediatric brain tumors, moyamoya disease and cerebral arteriovenous malformations. In particular, my laboratory—with colleagues—has discovered novel biomarkers for neurosurgical disease and has studied a class of molecules that markedly influence the malginant nature of tumors and the capacity of blood vessels to grow in the brain. This research has direct impact on brain tumors, moyamoya and arteriovenous malformations.

In particular, I am interested in the development of tests to better screen for the presence, recurrence and progression of brain tumors and cerebrovascular disease using non-invasive biomarkers. My laboratory published the first report describing the successful use of urinary biomarkers to identify brain tumors and has since expanded this work to include—for the first time—the ability of urinary biomarkers to predict therapeutic efficacy in cerebrovascular disease.

This research, supported by the NIH and national foundations, serves as the core of an ongoing five-year national multicenter trial to study brain tumor recurrence and directly complements our mechanistic studies of brain tumor invasion conducted in the Vascular Biology Program. Together, this work has led to the current development of novel therapeutic agents now being studied in our lab.

Our comprehensive patient database, representing the largest experience with pediatric cerebrovascular disease in the world, provides rich source material for ongoing studies. The database allows us to track long-term patient outcomes, compare the results of different surgical and neurointerventional procedures, evaluate newly adopted interventions and improve our quality of care.

My clinical expertise has led to authoring a number of important guidelines and articles about these conditions, including the American Heart Association Guidelines for the Management of Cerebrovascular Disorders in Infants and Children, a New England Journal of Medicine paper on moyamoya disease, and some of the largest studies published on arteriovenous malformations, cavernous malformations and pediatric aneurysms.

The special environment of Boston Children’s Hospital—combining world-class clinical care with internationally renowned scientists—has enabled remarkable advances in the science and treatment of pediatric disease.  Our lab has been fortunate to contribute to these efforts and we continue to work as hard as we can to pave the way for new treatments.  Some of the foundation from our lab for exciting future work includes:

Smith ER, Manfredi M, Scott RM, Black PM, Moses MA. A recurrent craniopharyngioma illustrates the potential usefulness of urinary matrix metalloproteinases as noninvasive biomarkers: case report. Neurosurgery 2007 Jun; 60(6):E1148-9; discussion E1149.

Smith ER, Zurakowski D, Saad A, Scott RM, Moses MA. Urinary biomarkers predict brain tumor presence and response to therapy. Clin Cancer Res 2008 Apr 15; 14(8):2378-86.

Roach ES (Chair), Golomb M, Adams R, Biller, Daniels JS, deVeber G, Ferriero D, Ichord R, Jones B, Kirkham F, Scott RM, Smith ER. Guidelines for the management of cerebrovascular disorders in infants and children: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2008 Jul 17; 39(9): 2644-91.

Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med 2009 Mar 19; 360(12):1226-37.

Smith ER, McClain CD, Heeney M, Scott RM. Pial synangiosis in patients with moyamoya syndrome and sickle cell anemia: perioperative management and surgical outcome. Neurosurgery Focus 2009 Apr;26(4):E10.

Gross BA, Scott RM, Smith ER, Management of Brain Arteriovenous Malformations, Lancet, 2014, May 383(9929):1635

Akino T, Han X, Nakayama H, McNeish B, Zurakowski D, Mammoto A, Klagsbrun M, Smith ER, Netrin-1 promotes medulloblastoma cell invasiveness and angiogenesis, and   demonstrates elevated expression in tumor tissue and urine of pediatric medulloblastoma patients, Cancer Research 2014 Jul 15;74(14):3716-26

Orbach D, Storey A, Morash D, Estroff J, Smith E, Trenor C, Olson H, Pathogenesis of dural sinus malformations as demonstrated by fetal imaging: a decision-making crucible    for parents and clinicians. Journal of Neurointerventional Surgery, 2014 Jul;6 Suppl 1:A69-70.

Weinstock P, Prabhu S, Flynn K, Orbach DB, Smith ER, Optimizing Cerebrovascular Surgical and Endovascular Procedures in Children via Personalized 3-Dimensional Printing, Journal of Neurosurgery, Pediatrics (in press)

Professional History

I focus my practice on treating patients with cerebrovascular disease and brain tumors, with a particular focus on moyamoya syndrome, arteriovenous malformations and skull base tumors. Together with my colleagues at Boston Children's Hospital, we have developed world-class programs to treat these conditions through ongoing clinical innovation.

Under the tutelage of Dr. R. Michael Scott, we have continued to refine a novel, cutting-edge surgery for children with moyamoya based on the procedure of pial synangiosis, pioneered by Dr. Scott here at Boston Children's. Surgery has proven to be the only effective long-term treatment for this disease and we are a global leader in treating children with this disorder. Our department heads one of the world's largest pediatric moyamoya programs, with 40 to 50 operations annually and more than 1,000 revascularization procedures performed overall. This high-volume international practice is mirrored throughout our department, particularly in regard to cerebrovascular malformations and brain tumors. This has enabled me and my colleagues to develop a number of important innovations, including advances in minimally invasive skull base endoscopic techniques in young children and new perioperative and surgical approaches for moyamoya and arteriovenous malformation patients. 

This clinical expertise has led to authoring a number of important guidelines and articles about these conditions. I have tried to work on a national level to drive research on pediatric neurosurgical diseases, including in my roles as former president of the Young Neurosurgeons Committee of the American Association of Neurological Surgery, the current chair of the national research committee for the pediatric section of neurological surgery and the ethics committee of the American Society of Pediatric Neurosurgery, while also lecturing and teaching nationally and internationally.

This work is equally focused here at home. In 2014, together with my colleague and friend Darren Orbach, we founded the Cerebrovascular Surgery and Intervention Center—a first-of-its-kind program that integrates translational research into clinical efforts. This center includes a dedicated translational research fellowship to train clinician-scientists and a series of funded seed grants awarded to foster research in this area. Our center is a pilot program sponsored by the hospital designed to innovate paradigms of medical care partnered with research. My colleagues and I in the Center have created 3-D models of patients' brains and blood vessels to rehearse neurointerventional procedures in advance, an innovation that has been shown to save resources and—importantly—improve patient outcomes. Our goal is for our center to serve as a national leader to transform the way that care is delivered to children.

To schedule an appointment: Call 617-355-6008 or Request an Appointment

Locations

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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