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Panagopoulos D, Stranjalis G, Gavra M, Boviatsis E, Korfias S, Karydakis P, Themistocleous M. The Entity of Cerebellar Mutism Syndrome: A Narrative Review Centered on the Etiology, Diagnostics, Prevention, and Therapeutic Options. Children (Basel) 2022; 10:children10010083. [PMID: 36670634 PMCID: PMC9856273 DOI: 10.3390/children10010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
Cerebellar mutism syndrome (CMS), also known as posterior fossa syndrome, is an entity that entails a constellation of signs and symptoms which are recorded in a limited number of pediatric patients who have been operated on mainly for tumors involving the posterior cranial fossa, and more precisely, the region of the vermis. Medulloblastoma seems to constitute the most commonly recognized pathological substrate, associated with this entity. The most prevalent constituents of this syndrome are noted to be a, often transient, although protracted, language impairment, emotional lability, along with cerebellar and brainstem dysfunction. Apart from that, a definite proportion of involved individuals are affected by irreversible neurological defects and long-lasting neurocognitive impairment. A bulk of literature and evidence based on clinical trials exist, which reflect the continuous effort of the scientific community to highlight all perspectives of this complex phenomenon. There are several circumstances that intervene in our effort to delineate the divergent parameters that constitute the spectrum of this syndrome. In summary, this is implicated by the fact that inconsistent nomenclature, poorly defined diagnostic criteria, and uncertainty regarding risk factors and etiology are all constituents of a non-well-investigated syndrome. Currently, a preliminary consensus exists about the identification of a group of diagnostic prerequisites that are managed as sine qua non, in our aim to document the diagnosis of CMS. These include language impairment and emotional lability, as proposed by the international Board of the Posterior Fossa Society in their consensus statement. It is common concept that midline tumor location, diagnosis of medulloblastoma, younger age at diagnosis, and preoperatively established language impairment should be accepted as the most determinant predisposing conditions for the establishment of this syndrome. A well-recognized pathophysiological explanation of CMS includes disruption of the cerebellar outflow tracts, the cerebellar nuclei, and their efferent projections through the superior cerebellar peduncle. Despite the relative advancement that is recorded regarding the diagnostic section of this disease, no corresponding encouraging results are reported, regarding the available treatment options. On the contrary, it is mainly targeted toward the symptomatic relief of the affected individuals. The basic tenet of our review is centered on the presentation of a report that is dedicated to the definition of CMS etiology, diagnosis, risk factors, clinical presentation, and clinical management. Apart from that, an effort is made that attempts to elucidate the paramount priorities of the scientific forum, which are directed toward the expansion our knowledge in the era of diagnostics, prevention, and therapeutic options for patients suffering from CM, or who are at risk for development of this syndrome.
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Affiliation(s)
- Dimitrios Panagopoulos
- Neurosurgical Department, Pediatric Hospital of Athens, ‘Agia Sophia’, 45701 Athens, Greece
- Correspondence: ; Tel.: +30-698-132-8628
| | - Georgios Stranjalis
- 1st University Neurosurgical Department, ‘Evangelismos’ Hospital, University of Athens, Neurosurgery, Medical School, 10676 Athens, Greece
| | - Maria Gavra
- Radiology Department, Pediatric Hospital of Athens, ‘Agia Sophia’, 45701 Athens, Greece
| | - Efstathios Boviatsis
- 2nd University Neurosurgical Department, ‘Attikon’ Hospital, University of Athens, Neurosurgery, Medical School, 12462 Athens, Greece
| | - Stefanos Korfias
- 1st University Neurosurgical Department, ‘Evangelismos’ Hospital, University of Athens, Neurosurgery, Medical School, 10676 Athens, Greece
| | - Ploutarchos Karydakis
- Neurosurgical Department, General Hospital of Athens ‘Gennimatas’, 11527 Athens, Greece
| | - Marios Themistocleous
- Neurosurgical Department, Pediatric Hospital of Athens, ‘Agia Sophia’, 45701 Athens, Greece
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Lambrou GI, Poulou M, Giannikou K, Themistocleous M, Zaravinos A, Braoudaki M. Differential and Common Signatures of miRNA Expression and Methylation in Childhood Central Nervous System Malignancies: An Experimental and Computational Approach. Cancers (Basel) 2021; 13:cancers13215491. [PMID: 34771655 PMCID: PMC8583574 DOI: 10.3390/cancers13215491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Epigenetic modifications are considered of utmost significance for tumor ontogenesis and progression. Especially, it has been found that miRNA expression, as well as DNA methylation plays a significant role in central nervous system tumors during childhood. A total of 49 resected brain tumors from children were used for further analysis. DNA methylation was identified with methylation-specific MLPA and, in particular, for the tumor suppressor genes CASP8, RASSF1, MGMT, MSH6, GATA5, ATM1, TP53, and CADM1. miRNAs were identified with microarray screening, as well as selected samples, were tested for their mRNA expression levels. CASP8, RASSF1 were the most frequently methylated genes in all tumor samples. Simultaneous methylation of genes manifested significant results with respect to tumor staging, tumor type, and the differentiation of tumor and control samples. There was no significant dependence observed with the methylation of one gene promoter, rather with the simultaneous presence of all detected methylated genes' promoters. miRNA expression was found to be correlated to gene methylation. Epigenetic regulation appears to be of major importance in tumor progression and pathophysiology, making it an imperative field of study.
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Affiliation(s)
- George I. Lambrou
- Choremeio Research Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Myrto Poulou
- Department of Medical Genetics, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Krinio Giannikou
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine and of Genetics, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
| | - Marios Themistocleous
- Department of Neurosurgery, “Aghia Sofia” Children’s Hospital, 11527 Athens, Greece;
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Basic and Translational Cancer Research Center (BTCRC), Cancer Genetics, Genomics and Systems Biology Group, European University Cyprus, Nicosia 1516, Cyprus
- Correspondence: (A.Z.); (M.B.)
| | - Maria Braoudaki
- Department of Life and Environmental Sciences, School of Life and Health Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
- Correspondence: (A.Z.); (M.B.)
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Bautista W, Adelson PD, Bicher N, Themistocleous M, Tsivgoulis G, Chang JJ. Secondary mechanisms of injury and viable pathophysiological targets in intracerebral hemorrhage. Ther Adv Neurol Disord 2021; 14:17562864211049208. [PMID: 34671423 PMCID: PMC8521409 DOI: 10.1177/17562864211049208] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/09/2021] [Indexed: 01/18/2023] Open
Abstract
Intracerebral hemorrhage (ICH) can be divided into a primary and secondary phase. In the primary phase, hematoma volume is evaluated and therapies are focused on reducing hematoma expansion. In the secondary, neuroprotective phase, complex systemic inflammatory cascades, direct cellular toxicity, and blood-brain barrier disruption can result in worsening perihematomal edema that can adversely affect functional outcome. To date, all major randomized phase 3 trials for ICH have targeted primary phase hematoma volume and incorporated clot evacuation, intensive blood pressure control, and hemostasis. Reasons for this lack of clinical efficacy in the major ICH trials may be due to the lack of therapeutics involving mitigation of secondary injury and inflexible trial design that favors unilateral mechanisms in a complex pathophysiology. Potential pathophysiological targets for attenuating secondary injury are highlighted in this review and include therapies increasing calcium, antagonizing microglial activation, maintaining macrophage M1 versus M2 balance by decreasing M1 signaling, aquaporin inhibition, NKCCl inhibition, endothelin receptor inhibition, Sur1-TRPM4 inhibition, matrix metalloproteinase inhibition, and sphingosine-1-phosphate receptor modulation. Future clinical trials in ICH focusing on secondary phase injury and, potentially implementing adaptive trial design approaches with multifocal targets, may improve insight into these mechanisms and provide potential therapies that may improve survival and functional outcome.
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Affiliation(s)
- Wendy Bautista
- Center for Advanced Preclinical Research (CAPR), National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - P David Adelson
- Division of Pediatric Neurosurgery, Department of Child Health, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Nathan Bicher
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Rm 4B42, Washington, DC 20010, USA
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Panagopoulos D, Karydakis P, Themistocleous M. Slit ventricle syndrome: Historical considerations, diagnosis, pathophysiology, and treatment review. Brain Circ 2021; 7:167-177. [PMID: 34667900 PMCID: PMC8459697 DOI: 10.4103/bc.bc_29_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/08/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022] Open
Abstract
After the introduction of shunt treatment for the management of childhood hydrocephalus, a wide variety of complications related to this treatment modality have been recognized. The entity of slit ventricle syndrome (alternatively, symptomatic ventricular coaptation) is one of them, is frequently encountered in the pediatric population and its symptom complex resembles that of shunt failure. We conducted research on PubMed®, MEDLINE®, and Web of Science®, using the keywords: “slit ventricles,” “slit ventricle syndrome,” “SVS” and “ventricular coaptation.” The aim of our review was to trace the advances made through the past decades, concerning our knowledge about the clinical characteristics, pathophysiology, and treatment options of this entity. The discrepancy among researchers about the offending etiology and the optimum treatment algorithm of this entity, as well as the necessity of an updated concept regarding shunt over drainage is analyzed. The multiple treatment modalities proposed and pathophysiologic mechanisms implicated for the treatment of slit ventricle syndrome illustrate the complexity of this entity. Consequently, the issue requires more detailed evaluation. In this review, we comment on all the main facets related to shunt over drainage and the resultant slit ventricle syndrome.
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Affiliation(s)
- Dimitrios Panagopoulos
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
| | | | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
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Panagopoulos D, Karydakis P, Themistocleous M. The entity of the trapped fourth ventricle: A review of its history, pathophysiology, and treatment options. Brain Circ 2021; 7:147-158. [PMID: 34667898 PMCID: PMC8459693 DOI: 10.4103/bc.bc_30_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 11/04/2022] Open
Abstract
An isolated or trapped fourth ventricle is a relatively rare, although serious, adverse effect of hemorrhagic, infectious, or inflammatory processes that involve the central nervous system. This entity usually occurs after successful shunting of the lateral ventricles and may become clinically evident with the development of delayed clinical deterioration. This decline of the neurological status of the patient is evident after an initial period of improvement of the relevant symptoms. Surgical treatment options include cerebrospinal fluid shunting procedures, along with open surgical and endoscopic approaches. Complications related to its management are common and are related with obstruction of the fourth ventricular catheter, along with cranial nerve or brainstem dysfunction. We used the keywords: "isolated fourth ventricle," and "trapped fourth ventricle," in PubMed® and Web of Science®. Treatment of the trapped fourth ventricle remains a surgical challenge, although the neurosurgical treatment armamentarium has broadened. However, prompt recognition of the clinical and neurological findings that accompany any individual patient, in conjunction with the relevant imaging findings, is mandatory to organize our treatment plan on an individual basis. The current experience suggests that any individual intervention plan should be mainly based on the underlying pathological substrate of hydrocephalus. This could help us to preserve the patient's life, on an emergent basis, as well as to ensure an uneventful neurological outcome, maintaining at least the preexisting level of neurological function.
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Affiliation(s)
| | | | - Marios Themistocleous
- Department of Neurosurgical, Pediatric Hospital, Agia Sophia, Athens, Attica, Greece
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Panagopoulos D, Karydakis P, Noutsos G, Themistocleous M. Venous Thromboembolism Risk and Thromboprophylaxis in Pediatric Neurosurgery and Spinal Injury: Current Trends and Literature Review. Semin Thromb Hemost 2021; 48:318-322. [PMID: 34624914 DOI: 10.1055/s-0041-1733959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although the entities of venous thromboembolism (VTE), deep venous thrombosis, pulmonary embolus, and thromboprophylaxis in adult patients undergoing brain tumor and spine surgery, traumatic brain injury and elective neurosurgical procedures are widely elucidated, the same is not valid when pediatric patients are under consideration. An attempt to review the peculiarities of these patients through a comprehensive bibliographic review is undertaken. We performed a narrative summary of the relevant literature dedicated to pediatric patients, centered on traumatic brain injury, the general incidence of thromboembolic disease in this patient population, the role of low molecular weight heparin (LMWH) in the treatment and prophylaxis of VTE, and its role in elective neurosurgical procedures, including spinal operations. Additionally, the risk of deep venous thrombosis in elective neurosurgical procedures is reviewed. Due to inherent limitations of the current studies, particularly a restricted number of patients, our data are underpowered to give a definitive protocol and guidelines for all the affected patients. Our current conclusions, based only on pediatric patients, argue that there is limited risk of VTE in pediatric patients suffering from brain tumors and that the possibility of VTE is very low in children undergoing elective neurosurgical procedures. There is no consensus regarding the exact incidence of VTE in traumatic brain injury patients. LMWH seems to be a safe and effective choice for the "at risk" pediatric patient population defined as being older than 15 years, venous catheterization, nonaccidental trauma, increased length of hospital stays, orthopaedic (including spinal) surgery, and cranial surgery.
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Affiliation(s)
| | | | - Georgios Noutsos
- Department of Anesthesiology, Pediatric Hospital of Athens, "Agia Sophia," Athens, Greece
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia," Athens, Greece
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Palaiodimou L, Lioutas VA, Lambadiari V, Theodorou A, Themistocleous M, Aponte L, Papagiannopoulou G, Foska A, Bakola E, Quispe R, Mendez L, Selim M, Novak V, Tzavellas E, Halvatsiotis P, Voumvourakis K, Tsivgoulis G. Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study. Ther Adv Neurol Disord 2021; 14:17562864211045876. [PMID: 34589140 PMCID: PMC8474316 DOI: 10.1177/17562864211045876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/24/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Glycemic variability (GV) has been associated with worse prognosis in
critically ill patients. We sought to evaluate the potential association
between GV indices and clinical outcomes in acute stroke patients. Methods: Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke
patients underwent regular, standard-of-care finger-prick measurements and
continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were
obtained from CGM data. Clinical outcomes during hospitalization and
follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by
CGM but missed by finger-prick measurements were also documented. Results: A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median
NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%,
nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute
glucose (MAG) values was associated with a lower likelihood of neurological
improvement during hospitalization before and after adjusting for potential
confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022).
There was no association of GV indices with 3-month clinical outcomes.
During CGM recording, 32 hypoglycemic episodes were detected in 17
nondiabetic patients. None of these episodes were identified by the periodic
blood glucose measurements and therefore they were not treated. Conclusions: Greater GV of acute stroke patients may be related to lower odds of
neurological improvement during hospitalization. No association was
disclosed between GV indices and 3-month clinical outcomes.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vaia Lambadiari
- Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
| | - Laura Aponte
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Georgia Papagiannopoulou
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Foska
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Rodrigo Quispe
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laura Mendez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elias Tzavellas
- First Department of Psychiatry, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Halvatsiotis
- Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Rimini 1, Chaidari, Athens 12462, Greece
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8
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Baka M, Michos A, Alexopoulou A, Bouka P, Bouka E, Dana E, Dimitriou G, Doganis, Grivea I, Ioannidou M, Kourti M, Magkou E, Makis A, Malama A, Mantadakis E, Markozannes G, Mitsios A, Moschovi M, Papadakis V, Panagopoulou P, Papakonstantinou E, Papadopoulos S, Polychronopoulou S, Themistocleous M, Tzotzola V, Ntzani E, Petridou ET. COVID-19 among children with cancer in Greece (2020): Results from the Nationwide Registry of Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST). Pediatr Blood Cancer 2021; 68:e29079. [PMID: 33991383 PMCID: PMC8209897 DOI: 10.1002/pbc.29079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Margarita Baka
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece,Department of Pediatric Hematology‐OncologyP&Α Kyriakou Children's HospitalΑthensGreece
| | - Athanasios Michos
- Division of Infectious Diseases, First Department of Pediatrics, “Aghia Sophia” Children's Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - A. Alexopoulou
- Children's & Adolescents’ Radiotherapy DepartmentP&A Kyriakou Children's Hospital AthensGreece
| | - P. Bouka
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece
| | - E. Bouka
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece
| | - E. Dana
- Children and Adolescents’ Hematology‐Oncology Department‘Mitera’ Children's HospitalAthensGreece
| | - G. Dimitriou
- Department of Pediatrics, Medical SchoolUniversity of PatrasRio AchaiaGreece
| | - Doganis
- Department of Pediatric Hematology‐OncologyP&Α Kyriakou Children's HospitalΑthensGreece
| | - I. Grivea
- Department of Pediatrics, University General HospitalMedical School University of ThessalyLarissaGreece
| | - M. Ioannidou
- Hematology‐Oncology Unit, 2nd Pediatric DepartmentAristotle University of Thessaloniki, AHEPA HospitalThessaloniki
| | - M. Kourti
- Department of Pediatric OncologyHippokration General HospitalThessalonikiGreece
| | - E. Magkou
- Department of Pediatric Hematology‐OncologyP&Α Kyriakou Children's HospitalΑthensGreece
| | - A. Makis
- Pediatric Hematology‐Thalassemia Unit, Department of Pediatrics, Faculty of Medicine, School of Health SciencesUniversity of IoanninaIoanninaGreece
| | - A. Malama
- Department of Imaging, A Sofia Children's HospitalNational and Kapodistrian University of AthensAthensGreece
| | - E. Mantadakis
- Hematology‐Oncology Unit, Department of PediatricsUniversity General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Thrace, Greece
| | - G. Markozannes
- Department of Hygiene and Epidemiology, School of MedicineUniversity of IoanninaIoanninaGreece
| | - A. Mitsios
- Department of NeurosurgeryA. Sofia Children's HospitalAthensGreece
| | - M. Moschovi
- Pediatric Hematology‐Oncology Unit, First Department of Pediatrics, A. Sofia Children's Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - V. Papadakis
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece
| | - P. Panagopoulou
- 4th Department of PediatricsAristotle University of ThessalonikiGreece
| | - E. Papakonstantinou
- Department of Pediatric OncologyHippokration General HospitalThessalonikiGreece
| | - S. Papadopoulos
- Department of Pathology“Hygeia” General Hospital of AthensAthensGreece
| | - S. Polychronopoulou
- Dept of Pediatric Hematology‐OncologyA. Sofia Children's HospitalAthensGreece
| | - M. Themistocleous
- Department of NeurosurgeryA. Sofia Children's HospitalAthensGreece,Secretary General, Primary Health CareMinistry of HealthAthensGreece
| | - V. Tzotzola
- Dept of Pediatric Hematology‐OncologyA. Sofia Children's HospitalAthensGreece
| | - Evangelia Ntzani
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece,Department of Hygiene and Epidemiology, School of MedicineUniversity of IoanninaIoanninaGreece,Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Eleni Th Petridou
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece,Department of Epidemiology, Hygiene and Medical StatisticsNational and Kapodistrian University of AthensAthensGreece
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9
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Chang JJ, Dowlati E, Triano M, Kalegha E, Krishnan R, Kasturiarachi BM, Gachechiladze L, Pandhi A, Themistocleous M, Katsanos AH, Felbaum DR, Mai JC, Armonda RA, Aulisi EF, Elijovich L, Arthur AS, Tsivgoulis G, Goyal N. Admission Neutrophil to Lymphocyte Ratio for Predicting Outcome in Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2021; 30:105936. [PMID: 34174515 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE We sought to evaluate the relationship between admission neutrophil-to-lymphocyte ratio (NLR) and functional outcome in aneurysmal subarachnoid hemorrhage (aSAH) patients. MATERIAL AND METHODS Consecutive patients with aSAH were treated at two tertiary stroke centers during a five-year period. Functional outcome was defined as discharge modified Rankin score dichotomized at scores 0-2 (good) vs. 3-6 (poor). RESULTS 474 aSAH patients were evaluated with a mean NLR 8.6 (SD 8.3). In multivariable logistic regression analysis, poor functional outcome was independently associated with higher NLR, older age, poorer clinical status on admission, prehospital statin use, and vasospasm. Increasing NLR analyzed as a continuous variable was independently associated with higher odds of poor functional outcome (OR 1.03, 95%CI 1.00-1.07, p=0.05) after adjustment for potential confounders. When dichotomized using ROC curve analysis, a threshold NLR value of greater than 6.48 was independently associated with higher odds of poor functional outcome (OR 1.71, 95%CI 1.07-2.74, p=0.03) after adjustment for potential confounders. CONCLUSIONS Higher admission NLR is an independent predictor for poor functional outcome at discharge in aSAH patients. The evaluation of anti-inflammatory targets in the future may allow for improved functional outcome after aSAH.
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Affiliation(s)
- Jason J Chang
- Department of Critical Care Medicine. MedStar Washington Hospital Center. Washington, DC, USA; Department of Neurology. Georgetown University Medical Center. Washington, DC, USA.
| | - Ehsan Dowlati
- Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA
| | - Matthew Triano
- Department of Critical Care Medicine. MedStar Washington Hospital Center. Washington, DC, USA.
| | - Enite Kalegha
- Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA.
| | - Rashi Krishnan
- Department of Neurology, University of Tennessee Health Science Center. Memphis, TN, USA.
| | | | - Leila Gachechiladze
- Department of Neurology, University of Tennessee Health Science Center. Memphis, TN, USA.
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee Health Science Center. Memphis, TN, USA.
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia. Athens, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, National and Kapodistrian University of Athens. Athens, Greece; Division of Neurology, McMaster University and Population Health Research Institute. Hamilton, ON, Canada
| | - Daniel R Felbaum
- Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA
| | - Edward F Aulisi
- Department of Neurosurgery. Georgetown University and MedStar Washington Hospital Center. Washington, DC, USA.
| | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Neurologic and Spine Clinic. Memphis, TN, USA.
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Neurologic and Spine Clinic. Memphis, TN, USA.
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center. Memphis, TN, USA; Department of Neurology, National and Kapodistrian University of Athens. Athens, Greece
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center. Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Neurologic and Spine Clinic. Memphis, TN, USA.
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Katsanos AH, Turc G, Psychogios M, Kaesmacher J, Palaiodimou L, Stefanou MI, Magoufis G, Shoamanesh A, Themistocleous M, Sacco S, Fiehler J, Gralla J, Strbian D, Alexandrov AV, Fischer U, Tsivgoulis G. Utility of Intravenous Alteplase Prior to Endovascular Stroke Treatment: A Systematic Review and Meta-analysis of RCTs. Neurology 2021; 97:e777-e784. [PMID: 34144996 DOI: 10.1212/wnl.0000000000012390] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide a critical appraisal on the evidence from randomized controlled clinical trials (RCTs) on the utility of direct endovascular treatment (dEVT) compared to the combination of endovascular treatment preceded by IV thrombolysis (bridging therapy [BT]) for patients with acute large vessel occlusion (LVO). METHODS Eligible RCTs were identified by searching Medline and Scopus. We calculated the corresponding odds ratios (ORs) and 95% confidence intervals (CIs) and pooled estimates using random-effects models. The primary outcome was the probability of modified Rankin scale (mRS) score of 0 to 2 at 3 months. RESULTS We included 3 studies comprising 1,092 patients. No difference between the dEVT and BT groups was detected for the outcomes of mRS score of 0 to 2 (OR 1.08, 95% CI 0.85-1.38; adjusted OR 1.11, 95% CI 0.76-1.63), mRS score of 0 to 1 (OR 1.10, 95% CI 0.84-1.43; adjusted OR 1.16, 95% CI 0.84-1.61), and functional improvement at 3 months (common OR 1.08, 95% CI 0.88-1.34; adjusted common OR 1.09, 95% CI 0.86-1.37). Patients receiving dEVT had significantly lower likelihood of successful recanalization before the endovascular procedure compared to those receiving BT (OR 0.37, 95% CI 0.18-0.77). Patients receiving dEVT had lower intracranial bleeding rates compared to those receiving BT (OR 0.67, 95% CI 0.49-0.92) but without a significant difference in the probability of symptomatic intracranial hemorrhage. No differences in all-cause mortality, serious adverse events, or procedural complications between the 2 groups were uncovered. CONCLUSIONS We detected no differences in functional outcomes of IV thrombolysis-eligible patients with an acute LVO receiving dEVT compared to BT. Because uncertainty for most endpoints remains large and the available data are not able to exclude the possibility of overall benefit or harm, further RCTs are needed.
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Affiliation(s)
- Aristeidis H Katsanos
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
| | - Guillaume Turc
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Marios Psychogios
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Johannes Kaesmacher
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Lina Palaiodimou
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Maria Ioanna Stefanou
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - George Magoufis
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Ashkan Shoamanesh
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Marios Themistocleous
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Simona Sacco
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Jens Fiehler
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Jan Gralla
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Daniel Strbian
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Andrei V Alexandrov
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Georgios Tsivgoulis
- From the Division of Neurology (A.H.K., A.S.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne; Université de Paris (G. Turc); INSERM U1266 (G. Turc); FHU Neurovasc (G. Turc), Paris, France; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel; Department of Diagnostic and Interventional Neuroradiology and Department of Diagnostic, Interventional and Pediatric Radiology (J.K., J.G.), Inselspital University Hospital Bern, Switzerland; Second Department of Neurology (L.P., M.I.S., G. Tsivgoulis), Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens; Stroke Unit (G.M.), Metropolitan Hospital, Piraeus; Department of Neurosurgery (M.T.), Pediatric Hospital of Athens, Agia Sophia, Greece; Neuroscience Section (S.S.), Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy; Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neurological Research Unit (D.S.), Department of Neurology, Neurocenter, Helsinki University Hospital, Finland; Department of Neurology (A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; and Department of Neurology (U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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Panagopoulos D, Karydakis P, Giakoumettis D, Themistocleous M. The 100 most cited papers about medulloblastomas. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Panagopoulos D, Karydakis P, Markogiannakis G, Themistocleous M. Pediatric arterial ischemic stroke: Overview of the literature and of the most cited relevant articles. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Katsanos AH, Safouris A, Nikolakopoulos S, Mavridis D, Goyal N, Psychogios MN, Magoufis G, Krogias C, Catanese L, Van Adel B, Raphaeli G, Sarraj A, Themistocleous M, Kararizou E, Turc G, Arthur A, Alexandrov AV, Tsivgoulis G. Endovascular treatment for basilar artery occlusion: A systematic review and meta-analysis. Eur J Neurol 2021; 28:2106-2110. [PMID: 33482047 DOI: 10.1111/ene.14751] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Independent randomized controlled clinical trials (RCTs) have provided robust evidence for endovascular treatment (EVT) as the standard of care treatment for acute large vessel occlusions in the anterior circulation. We examined available studies specific to posterior cerebral circulation ischemic strokes to see if any conclusions can be drawn regarding EVT options. METHODS We performed a systematic literature search to identify studies evaluating the safety and efficacy of EVT versus standard medical treatment for patients with acute basilar artery occlusion (BAO). We extracted data for outcomes of interest and presented associations between the two groups with the use of risk ratios (RRs) or odds ratios (ORs), with corresponding 95% confidence intervals (CIs). We used a random-effects model to pool the effect estimates. RESULTS We identified five studies (two RCTs, three observational cohorts) including a total of 1098 patients. Patients receiving EVT had a higher risk of symptomatic intracranial hemorrhage (sICH) compared to those receiving non-interventional medical management (RR 5.42, 95% CI 2.74-10.71). Nonsignificant trends towards modified Rankin Scale (mRS) scores 0-2 (RR 1.02, 95% CI 0.74-1.41), mRS scores 0-3 (RR = 0.97, 95% CI 0.64-1.47), overall functional improvement (OR 0.93, 95% CI 0.57-1.51), and all-cause mortality (RR 1.03, 95% CI 0.78-1.35) at 3 months were seen. CONCLUSION Although EVT increases the probability of sICH, the available data do not exclude the possibility of improved functional outcomes over standard therapy. As larger studies are challenged by the perceived lack of equipoise in this vulnerable patient population, results of ongoing RCTs are expected to provide substantial input for future meta-analyses.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Apostolos Safouris
- Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Stroke Unit, Metropolitan Hospital, Piraeus, Greece.,Interventional Neuroradiology, Rabin Medical Center, Tel Aviv, Israel
| | - Stavros Nikolakopoulos
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis, TN, USA
| | - Marios N Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Brian Van Adel
- Division of Neurology, Neurosurgery, and Diagnostic Imaging, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Guy Raphaeli
- Interventional Neuroradiology, Rabin Medical Center, Tel Aviv, Israel.,Department of Neurology, Rabin Medical Center, Tel Aviv, Israel
| | - Amrou Sarraj
- Department of Neurology, University of Texas at Houston, Houston, TX, USA
| | | | - Evangelia Kararizou
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Guillaume Turc
- Department of Neurology, GHU Paris et Psychiatrie et Neurosciences, Paris, France.,Université de Paris, Paris, France.,INSERM U1266, Paris, France.,FHU Neurovasc, Paris, France
| | - Adam Arthur
- Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis, TN, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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Panagopoulos D, Karydakis P, Themistocleous M, Markogiannakis G. The 100 most cited papers centered on tethered cord syndrome. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Panagopoulos D, Markogiannakis G, Themistocleous M. Post-Traumatic Status Epilepticus Masquerading as Acute Ischemic Stroke: A Case Report and Literature Review. Am J Case Rep 2020; 21:e922679. [PMID: 32362653 PMCID: PMC7213816 DOI: 10.12659/ajcr.922679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 7-year-old Final Diagnosis: Status epilepticus Symptoms: Local sezure Medication: — Clinical Procedure: Computed tomography • magnetic resonance imaging Specialty: Neurosurgery
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Affiliation(s)
| | | | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
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16
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Panagopoulos D, Markogiannakis G, Themistocleous M. Ruptured Arteriovenous Malformation Anterior to the Brainstem to a Child with Subsequent Spontaneous Thrombosis: Case Report and Literature Review. Am J Case Rep 2020; 21:e923289. [PMID: 32355154 PMCID: PMC7213815 DOI: 10.12659/ajcr.923289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cerebral arteriovenous malformations (AVMs) are considered to be abnormalities of congenital origin, presumably arising due to a disorder in the process of embryogenesis, in the phase of differentiation of premature vascular domes into mature arteries, capillaries, and veins. The end result of that process is the formation of direct arteriovenous communications, without intervening capillary beds. CASE REPORT We report the case of a 6-year-old female who suffered an abrupt deterioration of her level of consciousness due to a subarachnoid hemorrhage located in the basal cisterns. Radiological investigation with magnetic resonance arteriography-magnetic resonance venography (MRA-MRV) was negative, but digital subtraction angiography (DSA) revealed a micro-AVM in the vicinity of the brainstem. The patient subsequently developed communicating hydrocephalus and the repeat DSA, performed 1 month later, failed to re-imagine the lesion. Further workup with DSA 1 year after the ictus was negative for pathological findings. CONCLUSIONS There are a lot of controversies regarding the optimal imaging modality for surveillance of pediatric AVMs, the time period needed to follow-up a given lesion, even if it is considered treated, and the underlying mechanism of spontaneous thrombosis of untreated, yet ruptured, AVMs. All these issues, along with the unusual mode of evolution of the clinical picture of this lesion are discussed in detail, along with a review of the available literature.
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Affiliation(s)
| | | | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
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17
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Panagopoulos D, Antoniades E, Karydakis P, Giakoumettis D, Themistocleous M. Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review. Am J Case Rep 2020; 21:e920213. [PMID: 32161253 PMCID: PMC7081953 DOI: 10.12659/ajcr.920213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Various factors have been implicated in the pathogenesis of infarction after posterior fossa surgery such as venous air embolism, patient's position (seated or prone), hyperflexion of the neck, excessive spinal cord traction, cervical canal stenosis, and systemic arterial hypotension. The main aim of this case report was to elucidate a case in which hydrogen peroxide was implicated in a major and systemic complication after a neurosurgical procedure. CASE REPORT We describe the case of a 5-year-old female patient who was admitted to our hospital because of a cerebellar hemispheric astrocytoma associated with obstructive hydrocephalus and accompanied by 2 syringomyelic cavities in the cervicothoracic portion of the spinal cord. Immediately after gross total resection of the lesion, impaired mobility of the upper and lower extremities was observed, a finding that was not consistent with intraoperative neurophysiologic monitoring data. Hydrogen peroxide had been judiciously used to irrigate the resection tumor cavity. In the next few postoperative days, the patient suffered from transient diabetes insipidus and hyperpyrexia, indicative of hypothalamic injury. CONCLUSIONS Neurological evaluation of the patient, after stabilization of her medical condition, revealed residual spasticity of upper and lower extremities, rendering her able to mobilize via the aid of wheelchair only. The most possible pathophysiologic explanation of her neurological deterioration, including hypothalamic dysfunction, was analyzed. The role of hydrogen peroxide as a source of free radical formation, and its co-responsibility for vascular platelet aggregation and vasoconstriction was considered, upon case review, the main responsible etiologic factor.
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Affiliation(s)
| | - Elias Antoniades
- Department of Neurosurgery, Agia Sophia, Pediatric Hospital, Athens, Greece
| | | | - Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens, Medical School, Evangelismos Hospital, Athens, Greece
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18
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Panagopoulos D, Karydakis P, Giakoumettis D, Themistocleous M. The 100 Most Cited Papers About Brain Metastases. World Neurosurg 2020; 138:98-114. [PMID: 32147557 DOI: 10.1016/j.wneu.2020.02.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND A vast amount of articles centered on brain metastases have been published. OBJECTIVE To present the 100 most-cited articles dedicated to brain metastasis and to accomplish a broad literature review. METHODS In December 2019, we performed a title-focused search using the Thomson Reuters Web of Science database to identify the most cited articles centered on brain metastatic disease. Our search query term was based on using the following algorithm: "brain metastases" OR "brain metastasis" OR "brain metastatic disease" OR "cerebral metastases" OR "cerebral metastasis" OR "cerebral metastatic disease." Afterward, we reviewed the results to certify that they were relevant to the purposes of our research protocol. The 100 most cited papers were chosen and further analyzed. RESULTS Our search resulted in 11,579 articles, published from 1975 until the completion of our survey. The most cited article, by Patchell et al., was published in 1990, with 1862 citations, and an average of 62.07 citations per year, whereas the last in our list, by Gaspar et al., was published in 2010, with 195 total citations, and an average of 19.50 citations per year. Countries with the highest-cited articles included the United States (75 records), followed by Canada (16 records). CONCLUSIONS We discovered the top 100 most-cited articles centered on brain metastasis, all of which show a potentially increased level of interest, because they are meaningful scientific reports. In addition, we reviewed the historical development and advances in brain metastasis research and relevant points of interest, alongside the relevant contributions of different authors, fields of special interest, and countries. Many of the most cited articles were written by authors whose specialty was not neurosurgery or by neurosurgeons who were supported by colleagues from other medical fields. As a consequence, many of these articles were not published in neurosurgery-dedicated journals.
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Affiliation(s)
- Dimitrios Panagopoulos
- Department of Neurosurgery, Pediatric Hospital of Athens, Goudi, Athens, Attica, Greece.
| | - Ploutarchos Karydakis
- Department of Neurosurgery, 251 Greek Air Force Hospital, Goudi, Athens, Attica, Greece
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, Centre Hospitalier de Wallonie, Picarde-CHwapi A.S.B.L, Tournai, Belgium
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Goudi, Athens, Attica, Greece
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19
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Karagianni A, Karydakis P, Giakoumettis D, Nikas I, Sfakianos G, Themistocleous M. Fetal subependymal giant cell astrocytoma: A case report and review of the literature. Surg Neurol Int 2020; 11:26. [PMID: 32123614 PMCID: PMC7049878 DOI: 10.25259/sni_10_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background Subependymal giant cell astrocytomas (SEGAs) appear approximately in 10% of patients with tuberous sclerosis. These tumors are most commonly diagnosed in childhood and adolescence, with in utero diagnosed SEGAs being an extremely rare entity. Case Description We present the case of a congenital SEGA detected in an antenatal ultrasound and further investigated with fetal magnetic resonance imaging (MRI) scans at 22 and 32 weeks of gestational age. At 9 days of age, the child underwent craniotomy and partial excision of the tumor, followed by a second more extensive operation 13 days later. The patient was subsequently administered mammalian target of rapamycin inhibitor (everolimus). Conclusion In the latest follow-up MRI, at the age of two, the SEGA remained unchanged. Management of these tumors in neonates is challenging, mainly due to high morbidity and mortality of surgical treatment in these ages.
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Affiliation(s)
| | | | | | - Ioannis Nikas
- Departments of Imaging, Children's Hospital "Aghia Sofia", Athens, Greece
| | - George Sfakianos
- Departments of Neurosurgery, Children's Hospital "Aghia Sofia", Athens, Greece
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20
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Panagopoulos D, Themistocleous M, Apostolopoulou K. Edema of the Floor of the Fourth Ventricle Accompanying Shunt Malfunction and Disappearance of It After Shunt Repair: Case Report and Literature Review. Am J Case Rep 2019; 20:1936-1941. [PMID: 31874952 DOI: 10.12659/ajcr.919893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The ventriculoperitoneal shunt remains, despite recent advances, the mainstay of treatment for hydrocephalus. Although it is used as a routine practice, and besides its recorded and documented safety, it often malfunctions due to a variety of reasons, most commonly referred to as obstruction, breakage, migration and infection. A usual finding of those children suspected to magnetic resonance imaging is the detection of a rim of hyperintensity in the periventricular white matter (halo). CASE REPORT We describe the case of a 7-year-old male patient, treated 4 years ago for an infratentorial ependymoma, who developed hydrocephalus at the time of clinical presentation. During his previous follow-up, he was disease-free but developed clinically evident acute shunt malfunction, accompanied by imaging findings on magnetic resonance imaging (MRI) consisting of interstitial edema surrounding the supratentorial ventricular system, with additional involvement of the floor of the fourth ventricle. This peculiar and novel imaging finding subsided after successful management of hydrocephalus. CONCLUSIONS At present, contemporary computed tomography and MRI modalities constitute the gold standard in order to assess and follow-up patients with established hydrocephalus. Periventricular interstitial edema is a well-established imaging feature of acute hydrocephalus and, in cases of ventriculoperitoneal shunt, of shunt malfunction. Besides that, a newly described, to the best of our knowledge, imaging feature could be the distinction of that signal alteration at the floor of the fourth ventricle. It seems to have prognostic significance regarding the adequacy of management of hydrocephalus, as it disappeared after its successful treatment.
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21
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Panagopoulos D, Apostolopoulou K, Themistocleous M. Severe Neuromuscular Scoliosis Implicated by Dysfunction of Intrathecal Baclofen Pump: Case Report and Review of the Literature. World Neurosurg 2019; 134:390-395. [PMID: 31733394 DOI: 10.1016/j.wneu.2019.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Complex spinal deformities are a common issue in pediatric patients with an underlying neurologic diagnosis or syndrome. Management of neuromuscular scoliosis is an awesome responsibility, because these patients present with the most challenging pathologies of the deformed spine. Along with surgical correction of the underlying deformity, an intrathecal baclofen (ITB) pump is considered effective in managing the associated spasticity. CASE DESCRIPTION We present the case of an 11-year-old female who sustained an episode of severe ischemic encephalopathy accompanied by hydrocephalus and severe spastic quadriplegia. An ITB pump was inserted to manage spasticity. Two years later, a very severe decompensated spinal curvature developed. In addition, malfunction of the pump was noted, and the decision was made to perform revision along with open hemilaminectomy at the L3-4 level. The inability of cerebrospinal fluid (CSF) to access the pump was verified intraoperatively, with the absence of CSF glow through the intrathecal space demonstrating blockage of CSF flow. CONCLUSIONS The association of cerebral palsy and relevant disorders with the relentless progression of scoliosis is analyzed, along with the possible offending mechanisms. The efficacy of an ITB pump in controlling intractable spasticity associated with neuromuscular scoliosis is reviewed, as well as its potential to accentuate the clinical progression of neuromuscular scoliosis. Although this is an extremely infrequent situation, we must always bear in mind the possibility that malfunction of an ITB pump could be related to obstruction of CSF flow, owing to the extreme severity of the curves established during the course of, most likely untreated, neuromuscular scoliosis.
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22
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Klonou A, Korkolopoulou P, Gargalionis AN, Themistocleous M, Sgouros S, Papavassiliou AG, Piperi C. P04.15 Impact of histone lysine methyltransferases SETDB1, SETD2, SUV39H1, MLL2, EZH2and their corresponding histone marks in pediatric astrocytomas. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Pediatric brain tumors are characterized by altered epigenetic profiles and deregulated chromatin remodelling that affects gene expression. Histone lysine methylation has emerged as important chromatin function regulator, with potential role in glioma formation. Τhis study investigates the expression of histone lysine methyltransferases (SETDB1, SUV39H1, EZH2, MLL2, SETD2) and their corresponding methylation marks (H3K9me3, H3K27me3, H3K4me2/3, H3K36me3) in pediatric astrocytomas.
MATERIAL AND METHODS
Thirty-four (34) archival pediatric astrocytomas [27 low grade (I/II) and 7 high grade (III/IV) tumors; 21 males, 13 females; 1–15 years old] and 5 postmortem normal brain samples were studied. Methyltransferases expression and histone marks were detected by immunohistochemistry as H-score (intensity multiplied with cell percentage, 0–300) and validated by western blot.
RESULTS
Elevated nuclear SETD2 and SETDB1 staining was observed in all astrocytomas (median H-score:165 and 110, respectively). SETDB1 and SETD2 expression levels were positively associated (p=0.004), being higher in high grade compared to lower grade tumors (p=0.001, p=0.027, respectively). Furthermore, SETDB1 staining was significantly increased in male children (p=0.051) and negatively associated with patients age (p=0.028). A moderate nuclear and cytoplasmic staining was obtained for MLL2 at low grade (median H-score:84) compared to high grade tumors (median H-score:144). In accordance, lower SUV39H1 nuclear and cytoplasmic expression was detected in low grade tissues (median H score:85) compared to high grade (median H-score:160). EZH2 presented no significant nuclear expression. Increased nuclear staining of H3K9me3 and H4K20me3 repressive marks was observed in astrocytomas (median H-score:297 and 270, respectively), being positively associated (p=0.02). Elevated nuclear staining of H3K4me3 active mark (median H-score:210) was detected in astrocytomas, being significantly higher in high grade tumors (p=0.025) and in male children (p=0.036).
CONCLUSION
SETDB1, SETD2, SUV39H1 and MLL2 may play a significant role in modulating gene expression in pediatric astrocytomas. Increased presence of H3K9me3, H4K20me3 and H3K4me3 histone marks signifies their possible participation in gliomagenesis.
Larger cohort studies need to elucidate the functional significance and underlying molecular mechanisms of these chromatin-modifying enzymes and respective histone changes in pediatric astrocytomas.
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Affiliation(s)
- A Klonou
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Korkolopoulou
- Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - A N Gargalionis
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Themistocleous
- Department of Neurosurgery, “Agia Sophia” Children’s Hospital, Athens, Greece
| | - S Sgouros
- Department of Neurosurgery, “Mitera” Children’s Hospital, Athens, Greece
| | - A G Papavassiliou
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Piperi
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Panagopoulos D, Themistocleous M, Apostolopoulou K, Sfakianos G. Herpes Simplex Encephalitis Initially Erroneously Diagnosed as Glioma of the Cerebellum: Case Report and Literature Review. World Neurosurg 2019; 129:421-427. [DOI: 10.1016/j.wneu.2019.06.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
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24
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Panagopoulos D, Themistocleous M, Apostolopoulou K, Sfakianos G. Primary, Dural-Based, Ewing Sarcoma Manifesting with Seizure Activity: Presentation of a Rare Tumor Entity with Literature Review. World Neurosurg 2019; 129:216-220. [DOI: 10.1016/j.wneu.2019.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/29/2022]
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25
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Karydakis P, Giakoumettis D, Themistocleous M. The 100 most cited papers about pediatric traumatic brain injury: a bibliometric analysis. Ir J Med Sci 2019; 189:315-325. [PMID: 31418153 DOI: 10.1007/s11845-019-02085-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The high incidence of traumatic brain injury (TBI) in children, combined with the challenges in diagnosis and treatment options, the difficulty of predicting the outcome of each case, and also the wide variety of possibly lifelong complications, has led to an extraordinary number of published papers regarding this topic. This bibliometric analysis is aimed at identifying and reviewing the 100 most cited papers in the most challenging and trending aspects of pediatric traumatic brain injury. METHODS A search was performed using the Web of Science database in October 2018. Results were organized by citation number, and the 100 most cited papers were further reviewed and analyzed. RESULTS Our search resulted in 2754 published papers from 1975 until October 2018, of which 1783 (64.74%) had been published in the last decade (2010-2018). The 100 most cited papers about traumatic brain injury in children have an average citation of 140.59 and have been published in 44 different journals. Four hundred thirty-five authors have contributed to these prominent articles, most of them from the USA. CONCLUSIONS By reviewing those highly cited papers, we sought to offer significant help not only for studying this challenging field but also for designing new studies.
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Affiliation(s)
- Ploutarchos Karydakis
- Department of Neurosurgery, 251 Hellenic Air Force General Hospital, Athanasiou Diakou 9 str., Cholargos, 15562, Athens, Greece.
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, 'Evangelismos Hospital', University of Athens, Athens, Greece
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26
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Rasul FT, Bal J, Pereira EA, Tisdall M, Themistocleous M, Haliasos N. Current Surgical Options for Patients with Epilepsy. Curr Pharm Des 2019; 23:6508-6523. [PMID: 29086680 DOI: 10.2174/1381612823666171031101839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/22/2022]
Abstract
Surgery for epilepsy dates back to 1886 and has undergone significant developments. Today it is considered a key treatment modality in patients who are resistant to pharmacological intervention. It improves seizure control, cognition and quality of life. New technologies, advances in surgical technique and progress in scientific research underlie the expansion of surgery in epilepsy treatment. Effectiveness of surgical treatment depends on several factors including the type of epilepsy, the underlying pathology and the localisation of the epileptogenic zone. Timely referral to an experienced epilepsy surgery centre is important to allow the greatest chance of seizure control and to minimise associated morbidity and mortality. Following referral, patients undergo thorough presurgical investigation to evaluate their suitability for surgery. The commonest form of epilepsy treated by surgery is mesial temporal lobe sclerosis and there is Class I evidence for the medium-term efficacy of temporal lobe resection from two randomised control trials. Various other forms of epilepsy are now considered for resective and neuromodulatory surgical intervention due to favourable results. In this article, the authors review the current status of surgical treatment for epilepsy including the presurgical evaluation of patients, surgical techniques and the future directions in epilepsy surgery.
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Affiliation(s)
- Fahid T Rasul
- Essex Neurosciences Centre, Barking, Havering and Redbridge University NHS Trust, United Kingdom
| | - Jarnail Bal
- Essex Neurosciences Centre, Barking, Havering and Redbridge University NHS Trust, United Kingdom
| | - Erlick A Pereira
- Academic Neurosurgery Unit, St. George's, University of London, United Kingdom
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children, United Kingdom
| | | | - Nikolaos Haliasos
- Essex Neurosciences Centre, Barking, Havering and Redbridge University NHS Trust, United Kingdom
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27
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Panagopoulos D, Themistocleous M. Central nervous system manifestation of lupus erythematosus resembling brain abscess. Int J Pediatr Adolesc Med 2019; 6:29-37. [PMID: 31304226 PMCID: PMC6603070 DOI: 10.1016/j.ijpam.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/08/2018] [Accepted: 11/25/2018] [Indexed: 11/30/2022]
Abstract
Manifestations of central nervous system involvement are one of the leading causes of morbidity and mortality in patients suffering from systemic lupus erythematosus. It frequently involves the central nervous system and sometimes need to be differentiated from lesions of infectious etiology, thus representing a major diagnostic dilemma. We present the case of a male adolescent with a known history of idiopathic thrombocytopenic purpura who presented with a seizure ictus and a space-occupying lesion, which posed significant diagnostic challenges to specify its characteristics.
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Affiliation(s)
- Dimitrios Panagopoulos
- Neurosurgical Department of Pediatric Hospital of Athens, 'Agia Sophia', Thivon & Papadiamantopoulou St, Goudi, Athens, Attica, 11527, Greece
| | - Marios Themistocleous
- Neurosurgical Department of Pediatric Hospital of Athens, 'Agia Sophia', Thivon & Papadiamantopoulou St, Goudi, Athens, Attica, 11527, Greece
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28
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Karydakis P, Nikas I, Panagopoulos D, Filippidou M, Sfakianos G, Themistocleous M. Intraparenchymal Pericatheter Cyst after Cerebrospinal Fluid Shunt: A Rare Complication with Challenging Diagnosis - Case Presentation and Review of the Literature. Asian J Neurosurg 2019; 14:581-584. [PMID: 31143289 PMCID: PMC6515991 DOI: 10.4103/ajns.ajns_288_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An intraparenchymal pericatheter cyst is a rare complication of ventriculoperitoneal shunt, which is not well described yet. Due to its rarity, lack of characteristic symptoms and radiological features that often mimic brain tumors or abscesses, especially in head computed tomography without contrast can be easily misdiagnosed. We report the case of a 9-year-old girl who was admitted to a peripheral hospital due to severe headaches and vomiting. The child had a history of craniotomy and ventriculoperitoneal shunt for posterior fossa tumor, performed in our department, 4 years earlier. The patient underwent a brain magnetic resonance imaging (MRI) scan and transmitted to our hospital with the diagnosis of brain tumor. However, a closer look at the MRI established the diagnosis of intraparenchymal pericatheter cerebrospinal fluid cyst; hence, the patient underwent shunt revision and cyst drainage. We researched the literature and described 20 reported cases, discussing the pathophysiological mechanisms, the radiological features, and the optimal treatment of this interesting, yet a challenging complication.
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Affiliation(s)
| | - Ioannis Nikas
- Department of Medical Imaging and Interventional Radiology, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Maria Filippidou
- First Department of Pediatrics, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - George Sfakianos
- Department of Neurosurgery, Children Hospital "Aghia Sophia", Athens, Greece
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Panagopoulos D, Themistocleous M, Sfakianos G. Repair of a Transclival Meningocele Through a Transoral Approach: Case Report and Literature Review. World Neurosurg 2018; 123:259-264. [PMID: 30579031 DOI: 10.1016/j.wneu.2018.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Transclival meningoceles and related primary spontaneous cerebrospinal fluid leaks at the clivus are extremely rare lesions, with only a few cases reported in the literature. CASE DESCRIPTION An infant presented with nasal airway obstruction and meningitis secondary to cerebrospinal fluid leak from a transclival meningocele. The radiologic investigation and surgical repair of the lesion are reported, along with intraoperative findings. Basic anatomy, embryology, and development of the clivus are reviewed to clarify the relationship of anatomic variants with the formation of transclival meningoceles. CONCLUSIONS Transclival meningocele should be considered in patients with spontaneous cerebrospinal fluid rhinorrhea. The existing classification of meningoencephaloceles based on the location of the defect in the cranium should probably be reconsidered, taking into consideration the described entity.
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Affiliation(s)
| | | | - Georgios Sfakianos
- Neurosurgical Department, "Agia Sophia" Children's Hospital, Athens, Greece
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Panagopoulos D, Themistocleous M, Mitsios A, Sfakianos G. Torkildsen shunt as a salvage procedure for an infant with post-hemorrhagic hydrocephalus. Int J Surg Case Rep 2018; 54:1-6. [PMID: 30503956 PMCID: PMC6277217 DOI: 10.1016/j.ijscr.2018.11.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/07/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Torkildsen operation is a ventriculo-cisternal shunt that diverts the cerebrospinal fluid flow from one of the lateral ventricles, via a ventricular catheter, to the cisterna magna of the posterior fossa. It is the first described operation of CSF diversion for the treatment of hydrocephalus [1] (Scarff, 1963). PRESENTATION OF CASE We present the case of a premature infant who presented with post hemorrhagic hydrocephalus who underwent several failed CSF diversion surgeries before Torkildsen shunt procedure. The patient overcame the irregularities of CSF circulation that were observed before the operation and his post-operative course was uneventful, in terms of CSF -related complications. DISCUSSION We summarize the historical data and the technical aspects of the procedure, and we present a brief literature review of the indications and limitations associated with it. CONCLUSION Torkildsen shunt can be effective in selected patients with hydrocephalus even in the modern era of computed tomography and magnetic resonance imaging. the procedure enables one to avoid a standard ventriculoperitoneal shunt, especially in cases it is not technically feasible.
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Affiliation(s)
| | | | - Andreas Mitsios
- Thivon & Papadiamantopoulou St, Goudi, 11527, Athens, Attica, Greece.
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31
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Karydakis P, Mitsios A, Giakoumettis D, Antoniades E, Karagianni A, Sfakianos G, Themistocleous M. Primitive synovial sarcoma of suboccipital region in child. J Surg Case Rep 2018; 2018:rjy286. [PMID: 30386549 PMCID: PMC6202503 DOI: 10.1093/jscr/rjy286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
Synovial sarcoma (SS) most commonly affects the lower limbs of males in the third to fifth decades of life, with masses of the head and neck accounting for 3–10% of all cases, mainly as a metastatic lesion. The lack of specific symptoms and radiological features in addition to the diversity of their microscopic aspects may cause confusion in the diagnosis; hence, knowledge of the unusual locations of SSs is very important. The immunohistochemistry, and more recently the cytogenetic studies, contribute to the differential diagnosis. We report the case of a 12-year-old girl with a rare primary SS in the suboccipital region, which underwent complete surgical resection.
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Affiliation(s)
| | - Andreas Mitsios
- Department of Neurosurgery, Children's Hospital 'Aghia Sophia', Athens, Greece
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens, 'Evangelismos Hospital', Athens, Greece
| | - Elias Antoniades
- Department of Neurosurgery, Children's Hospital 'Aghia Sophia', Athens, Greece
| | - Aikaterini Karagianni
- Department of Neurosurgery, 'K.A.T.-N.R.C.' General Hospital of Attica, Nikis Street 2, Kifissia, Athens, Greece
| | - George Sfakianos
- Department of Neurosurgery, Children's Hospital 'Aghia Sophia', Athens, Greece
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32
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Kalyvas AV, Drosos E, Korfias S, Gatzonis S, Themistocleous M, Sakas DE. Intrathecal Baclofen Therapy for Painful Muscle Spasms in a Patient with Friedreich's Ataxia. Stereotact Funct Neurosurg 2018; 96:127-130. [PMID: 29886479 DOI: 10.1159/000489220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/10/2018] [Indexed: 01/30/2023]
Abstract
Friedreich's ataxia (FA) is the most frequent hereditary ataxia syndrome, while painful muscle spasms and spasticity have been reported in 11-15% of FA patients. This report describes the successful management of painful spasms in a 65-year-old woman with FA via intrathecal baclofen (ITB) therapy following unsuccessful medical treatments. To our knowledge, this is the third reported case in the literature. Unfortunately, the pathophysiological characteristics of muscle spasms in FA are not well explored and understood while the therapeutic mechanisms of the different treatments are rather vague. Taking into consideration the suggested spinal atrophy in FA, the clinical resemblance of FA and chronic spinal injury muscle spasms, together with the rapid ITB therapy effectiveness in alleviating FA muscle spasms, we attempted to suggest a putative pathophysiological mechanism acting at the spinal level and possibly explained by the presence of independent spinal locomotor systems producing muscle spasms. Specifically, overexcitement of these centers, due to loss of normal regulation from upper CNS levels, may result in the uncontrolled firing of secondary motor neurons and may be the key to producing muscle spasms. However, further research under experimental and clinical settings seems to be necessary.
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Affiliation(s)
- Aristotelis V Kalyvas
- 1st Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Drosos
- 1st Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Korfias
- 1st Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Gatzonis
- 1st Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Damianos E Sakas
- 1st Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
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33
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Drosos E, Giakoumettis D, Blionas A, Mitsios A, Sfakianos G, Themistocleous M. Pediatric Nonmissile Penetrating Head Injury: Case Series and Literature Review. World Neurosurg 2018; 110:193-205. [DOI: 10.1016/j.wneu.2017.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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34
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Karydakis P, Giakoumettis D, Nikas I, Panagopoulos D, Sfakianos G, Themistocleous M. Post-traumatic tremor in child after mild head trauma. Pan Afr Med J 2018; 31:53. [PMID: 30923598 PMCID: PMC6431418 DOI: 10.11604/pamj.2018.31.53.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 09/15/2018] [Indexed: 11/26/2022] Open
Abstract
Despite the fact that movement disorders can be noted after severe traumatic brain injury (TBI), there are very few cases in the literature regarding children with a mild head injury. In addition, their pathophysiological mechanism, radiological features, and treatment options have not been well described yet. Hereby, we report a case of a 3-year-old girl who suffered a head injury after a two-meter fall, resulting in generalized body tremor and dystonia.
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Affiliation(s)
| | | | - Ioannis Nikas
- Department of Medical Imaging and Interventional Radiology, Agia Sofia Children's Hospital, Athens, Greece
| | | | - George Sfakianos
- Department of Neurosurgery, Agia Sofia Children's Hospital, Athens, Greece
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35
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Karamanou M, Tsoucalas G, Themistocleous M, Giakoumettis D, Stranjalis G, Androutsos G. Epilepsy and Neurosurgery: Historical Highlights. Curr Pharm Des 2017; 23:6373-6375. [PMID: 29076417 DOI: 10.2174/1381612823666171024150121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022]
Abstract
Epilepsy has been known since antiquity and trepanation has been documented as a therapeutic option. The Greek born physician Aretaeus of Cappadocia (2nd century BC) was the first to recommend trepanation for the treatment of refractory epilepsy to drugs, pointing out the efficacy of the method (Fig. 1). Trepanation was practiced throughout the Middle Ages, as it is proved by the book of "Quattuor Magistri" and during Renaissance as well. In 19th century, Sir Victor Alexander Horsley (1857-1916), combining analysis of clinical presentation with cortical stimulation, performed a series of craniotomies for the treatment of epilepsy Fig. 2. In the following years the advent of electrophysiology and neurosurgery provided a fertile ground for further progress in epilepsy surgery such as the preoperative use of electroencephalography (EEG) to determine the epileptogenic zone by Otfrid Foerster (1873-1941); the research of Wilder Graves Penfield (1891-1976) in Montreal Neurological Institute and the use of stereoelectroencephalography (SEEG) by the neurosurgeon Jean Talairach (1911-2007) and the neurologist Jean Bancaud (1921-1994)) Fig. 3. Nowadays, epilepsy surgery remains a valuable therapeutic option in cases of drug resistant epilepsy.
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Affiliation(s)
- Marianna Karamanou
- Institute of History of Medicine and Public Health, Medical School, University of Lausanne, Switzerland
| | - Gregory Tsoucalas
- History of Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Dimitrios Giakoumettis
- Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
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36
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Antoniades E, Themistocleous M, Drosos E, Giakoumettis D, Paraskeva K, Georgis PA, Sfakianos G. Brainstem dermoid cyst rupture with hydrocephalus in a child. Oxf Med Case Reports 2017; 2017:omx048. [PMID: 28878954 PMCID: PMC5581501 DOI: 10.1093/omcr/omx048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/01/2017] [Indexed: 11/12/2022] Open
Abstract
Intracranial dermoid cysts are ectodermal lesions of embryological origin. They are of slow progression and symptoms associated with unruptured cysts are most commonly due to mass effect. However, a potential rupture in the ventricular system is rare and can cause meningitis, seizures and hydrocephalus. Hereby, we report a case of a 12-year-old boy presenting with obstructive hydrocephalus due to brainstem dermoid cyst rupture.
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Affiliation(s)
- Elias Antoniades
- Department of Neurosurgery, University of Thessaloniki Medical School, ‘AHEPA’ University Hospital, Thessaloniki, Greece
| | - Marios Themistocleous
- Department of Neurosurgery, Children's Hospital ‘Agia Sofia’, Athens, Greece
- Correspondence address. Children's Hospital ‘Agia Sofia’ Department of Neurosurgery, Thivon Street and Papadiamantopoulou Street, 11527 Athens, Greece. E-mail:
| | - Evangelos Drosos
- Department of Neurosurgery, University of Athens Medical School, ‘Evangelismos’ General Hospital, Athens, Greece
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens Medical School, ‘Evangelismos’ General Hospital, Athens, Greece
| | | | | | - George Sfakianos
- Department of Neurosurgery, Children's Hospital ‘Agia Sofia’, Athens, Greece
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37
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Georgakis MK, Papathoma P, Ryzhov A, Zivkovic-Perisic S, Eser S, Taraszkiewicz Ł, Sekerija M, Žagar T, Antunes L, Zborovskaya A, Bastos J, Florea M, Coza D, Demetriou A, Agius D, Strahinja RM, Themistocleous M, Tolia M, Tzanis S, Alexiou GA, Papanikolaou PG, Nomikos P, Kantzanou M, Dessypris N, Pourtsidis A, Petridou ET. Malignant central nervous system tumors among adolescents and young adults (15-39 years old) in 14 Southern-Eastern European registries and the US Surveillance, Epidemiology, and End Results program: Mortality and survival patterns. Cancer 2017; 123:4458-4471. [DOI: 10.1002/cncr.30884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Marios K. Georgakis
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Paraskevi Papathoma
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
- Department of Neurology; University Hospital; Linköping Sweden
| | - Anton Ryzhov
- National Cancer Registry of Ukraine; National Institute of Cancer; Kiev Ukraine
| | | | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub; Izmir and Hacettepe University Institute of Public Health; Ankara Turkey
| | - Łukasz Taraszkiewicz
- Greater Poland Cancer Registry, Department of Cancer Prevention and Epidemiology; Greater Poland Cancer Center; Poznan Poland
| | - Mario Sekerija
- Croatian National Cancer Registry; Croatian Institute of Public Health; Zagreb Croatia
| | - Tina Žagar
- Cancer Registry of the Republic of Slovenia; Institute of Oncology; Ljubljana Slovenia
| | - Luis Antunes
- North Region Cancer Registry of Portugal; Portuguese Oncology Institute of Porto; Porto Portugal
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology; Childhood Cancer Subregistry of Belarus; Minsk Belarus
| | - Joana Bastos
- Central Region Cancer Registry of Portugal; Portuguese Oncology Institute of Coimbra; Coimbra Portugal
| | - Margareta Florea
- Regional Cancer Registry of Iasi; National Institute of Public Health; Iasi Romania
| | - Daniela Coza
- Regional Cancer Registry of Cluj; Ion Chiricuta Oncological Institute; Cluj-Napoca Romania
| | - Anna Demetriou
- Cyprus Cancer Registry, Health Monitoring Unit; Ministry of Health; Nicosia Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research; Valletta Malta
| | - Rajko M. Strahinja
- Cancer Registry, Department for Epidemiology of Noncommunicable Diseases, Center for Disease Prevention and Control; Institute of Public Health; Podgorica Montenegro
| | | | - Maria Tolia
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, School of Medicine; National and Kapodistrian University of Athens; Greece Athens
| | - Spyridon Tzanis
- Neurosurgery Department; Errikos Dunant Hospital Center; Athens Greece
| | - George A. Alexiou
- Neurosurgical Institute; Ioannina University School of Medicine; Ioannina Greece
| | | | - Panagiotis Nomikos
- Department of Neurosurgery and Gamma Knife Radiosurgery; Hygeia Hospital; Athens Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology and Oncology; Panagiotis and Aglaia Kyriakou Children's Hospital; Athens Greece
| | - Eleni T. Petridou
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine; National and Kapodistrian University of Athens; Athens Greece
- Clinical Epidemiology Unit, Department of Medicine; Karolinska Institute; Stockholm Sweden
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38
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Themistocleous M, Giakoumettis D, Mitsios A, Anagnostopoulos C, Kalyvas A, Koutsarnakis C. Hereditary hemorrhagic telangiectasia patient presenting with brain abscess due to silent pulmonary arteriovenous malformation. Pan Afr Med J 2017; 25:145. [PMID: 28292107 PMCID: PMC5326030 DOI: 10.11604/pamj.2016.25.145.11010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia is a rare autosomal dominant inherited disease that is usually complicated by visceral vascular malformations. Patients harboring such malformations are at increased risk of brain abscess formation, which despite advances in diagnostic and surgical methods remains a life threatening medical emergency with high mortality and morbidity rates. In the present report we describe a case of cerebral abscess due to silent pulmonary arteriovenous malformation (AVM) in a young patient previously undiagnosed for hereditary hemorrhagic telangiectasia syndrome (HHT).
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Affiliation(s)
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Andreas Mitsios
- Department of Neurosurgery, Children's Hospital "Agia Sofia", Athens, Greece
| | - Christos Anagnostopoulos
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Aristoteles Kalyvas
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
| | - Christos Koutsarnakis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece
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39
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Affiliation(s)
| | - Irene Vraka
- Radiology Department, Mitera Children's Hospital, Athens, Greece
| | | | - Ioannis Nikas
- Imaging Department, Agia Sophia Children's Hospital, Athens, Greece
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40
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Margetis K, Korfias S, Boutos N, Gatzonis S, Themistocleous M, Siatouni A, Dalivigka Z, Flaskas T, Stranjalis G, Boviatsis E, Sakas D. Intrathecal baclofen therapy for the symptomatic treatment of hereditary spastic paraplegia. Clin Neurol Neurosurg 2014; 123:142-5. [DOI: 10.1016/j.clineuro.2014.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 05/11/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
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41
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Stathis P, Boviatsis E, Smpiliris M, Darras, N, Themistocleous M, Magafosis D, Tziomaki M, Panourias, I, Sakas D. 2.328 PRE-POST GAIT KINEMATIC AND STATIC BALANCE ANALYSIS FOR PARKINSON DISEASE PATIENTS UNDERWENT DBS-STN OPERATION. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Boviatsis EJ, Stavrinou LC, Themistocleous M, Kouyialis AT, Sakas DE. Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature. Acta Neurochir (Wien) 2010; 152:2053-62. [PMID: 20658301 DOI: 10.1007/s00701-010-0749-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/12/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Deep brain stimulation (DBS) has been established as a safe and efficient method for the treatment of various movement disorders. As the emerging applications continue to expand and more centers become eligible for the procedure, complication rates and complication avoidance become increasingly important. Our aim was to report the DBS-related complication in our department over the last 7 years, compare our rates with those reported in the literature, and highlight those practices that will aid complications avoidance. PATIENTS AND METHODS Since 2003, 106 patients underwent DBS for various pathologies in our department. There were 38 (36%) females and 68 (64%) males with a mean age of 57 years. Preoperative diagnoses included Parkinson's disease (n = 88), dystonia (n = 12), tremor (n = 3), epilepsy (n = 1), obsessive-compulsive disorder (n = 1), and central pain syndrome (n = 1). Surgical and hardware-related complications, their treatment, and outcome were recorded and compared with those reported in the literature. RESULTS There were 12 procedure-related complications (11.3% of patients, 5.7% of the procedures). These included death (n = 1), aborted procedure (n = 1), postoperative respiratory distress (n = 3), intracranial hemorrhage (n = 2), epilepsy (n = 1), postoperative confusion or agitation (n = 3), and malignant neuroleptic syndrome (n = 1). Hardware-related complications presented in 4.3% of the procedures and included infection (five patients, 4.7%), electrode breakage (0.94%), lead migration or misplacement (0.94%), and stricture formation (two patients, 1.9%). CONCLUSIONS Complication rates after DBS surgery remain low, proving that DBS is not only effective but also safe. Certain strategies do exist in order to minimize complications.
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Sakas DE, Stavrinou LC, Boviatsis EJ, Stathis P, Themistocleous M, Gatzonis S. Restoration of erect posture by deep brain stimulation of the globus pallidus in disabling dystonic spinal hyperextension. J Neurosurg 2010; 112:1279-82. [DOI: 10.3171/10.3171/2009.10.jns09588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dystonia is a movement disorder notoriously difficult to treat. While primary dystonia is classically considered to respond well to deep brain stimulation (DBS), treatment of secondary dystonia yields variable results. Patient selection should be done on a case-by-case basis. Clearly, there is a need to accumulate additional information with regard to prognostic factors that may aid neurosurgeons in selecting those patients in whom the disorder is most likely to respond favorably to pallidal DBS.
The authors report the case of a 29-year-old man with secondary dystonia due to perinatal hypoxia. The most prominent symptom was what we have termed ectatocormia—that is, severe, fixed truncal hyperextension and retrocollis, exacerbated by phasic, twisting movements of the trunk and head. This made it impossible for the patient to maintain a normal upright posture or to walk. The patient underwent bilateral DBS of the globus pallidus internus (GPi), and the authors observed impressive improvement in motor abilities and function. The patient's body adopted the normal upright posture and he became able to walk again, 4 months after the commencement of GPi stimulation.
This report, along with others, emphasizes that the GPi as an ideal target for alleviating axial tonic symptoms. The presence of normal MR imaging findings, a phenotypical purity of predominantly dystonic symptoms, and a younger age seem to favor a positive outcome.
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Affiliation(s)
- Damianos E. Sakas
- 1Unit of Functional Neurosurgery, Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Lampis C. Stavrinou
- 1Unit of Functional Neurosurgery, Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Efstathios J. Boviatsis
- 1Unit of Functional Neurosurgery, Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Pantelis Stathis
- 1Unit of Functional Neurosurgery, Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Marios Themistocleous
- 1Unit of Functional Neurosurgery, Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Stylianos Gatzonis
- 1Unit of Functional Neurosurgery, Department of Neurosurgery, University of Athens, Evangelismos Hospital; and
- 2P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
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Sakas DE, Panourias IG, Stavrinou LC, Boviatsis EJ, Themistocleous M, Stathis P, Tagaris G, Angelopoulos E, Gatzonis S. Restoration of erect posture in idiopathic camptocormia by electrical stimulation of the globus pallidus internus. J Neurosurg 2010; 113:1246-50. [PMID: 20380528 DOI: 10.3171/2010.3.jns09981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on 2 young patients who developed drug-resistant idiopathic dystonic camptocormia (bent spine) and were treated successfully by deep brain stimulation (DBS) of the globus pallidus internus (GPi). The first patient, a 26-year-old woman, suffered for 3 years from such severe camptocormia that she became unable to walk and was confined to bed or a wheelchair. The second patient, a 21-year-old man, suffered for 6 months from less severe camptocormia; he was able to walk but only for short distances with a very bent spine, the arms in a parallel position to the legs, and the hands almost approaching the floor to potentially support him in case of a forward fall. Within a few days following DBS, both patients experienced marked clinical improvement. At most recent follow-up (44 months in one case and 42 in the other), the patients' ability to walk upright remained normal. Similar findings have only been reported recently in a few cases of camptocormia secondary to Parkinson disease or tardive dyskinesia. On the basis of the experience of these 2 idiopathic cases and the previously reported cases of secondary camptocormia with a favorable response to GPi DBS, the authors postulate that specific patterns of oscillatory activity in the GPi are vital for the maintenance of erect posture and the adoption of bipedal walking by humans.
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Affiliation(s)
- Damianos E Sakas
- Unit of Functional and Stereotactic Neurosurgery, Department of Neurosurgery, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
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Panourias IG, Themistocleous M, Sakas DE. Intrathecal baclofen in current neuromodulatory practice: established indications and emerging applications. Acta Neurochir Suppl 2007; 97:145-54. [PMID: 17691370 DOI: 10.1007/978-3-211-33079-1_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Intrathecal baclofen (ITB) has evolved into a standard treatment for severe spasticity of both spinal and cerebral origin. The accumulated promising data from reported series of patients receiving ITB therapy together with the fact that spastic hypertonia commonly coexists with other neurological disorders have constituted a solid basis for offering this kind of treatment to patients suffering from other movement disorders. These include motor disorders such as dystonia, amyotrophic lateral sclerosis, status dystonicus, Hallervorden-Spatz disease, Freidreich's ataxia, "stiff-man" syndrome, but also vegetative states after revere brain trauma, anoxic encephalopathy or other pathology and more recently, various chronic pain syndromes. In this article, on the basis of the established applications of ITB therapy, we review the important emerging indications of this rewarding neuromodulation method and attempt to identify its future potential beneficial role in other chronic and otherwise refractory neurological disorders.
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Affiliation(s)
- I G Panourias
- P S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
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Themistocleous M, Khoumbati K, Irani Z. Toward the Development of a Model for the Adoption of Integration Technologies. Journal of Intelligent Systems 2006. [DOI: 10.1515/jisys.2006.15.1-4.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fries DM, Paxinou E, Themistocleous M, Swanberg E, Griendling KK, Salvemini D, Slot JW, Heijnen HFG, Hazen SL, Ischiropoulos H. Expression of inducible nitric-oxide synthase and intracellular protein tyrosine nitration in vascular smooth muscle cells: role of reactive oxygen species. J Biol Chem 2003; 278:22901-7. [PMID: 12690103 DOI: 10.1074/jbc.m210806200] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A significant increase in the induction of inducible nitric-oxide synthase (iNOS) protein expression and in the levels of nitrite plus nitrate was observed in rat aortic smooth muscle cells (RASMCs) stably transfected with catalase (RASMC-2C2) as compared with empty vector-transfected RASMC-V4 cells after exposure to cytokines and lipopolysaccharide. The increased expression of iNOS protein in the RASMC-2C2 cells was associated with a significant activation of nuclear transcription factor kappaB, one of the transcriptional regulators of iNOS expression. The induction of iNOS was also accompanied by increased protein tyrosine nitration in both cell types as revealed by immunocytochemical staining and high pressure liquid chromatography with on-line electrospray ionization tandem mass spectrometry. Nitrotyrosine formation was inhibited by 1400W, an iNOS inhibitor, by 4-(2-aminoethyl) benzenesulfonyl fluoride, an inhibitor of NADPH oxidase, and by the superoxide dismutase mimetic M40403, but not by the peroxidase inhibitor 4-aminobenzoic hydrazide. Electron microscopy using affinity-purified anti-nitrotyrosine antibodies revealed labeling at the cytosolic side of the rough endoplasmic reticulum membranes, in the nucleus, occasionally in mitochondria, and consistently within the fibrillar layer underneath the plasma membrane. Collectively, the data in this model system indicate that hydrogen peroxide, by inhibiting the activation of nuclear transcription factor kappaB, prevents iNOS expression, whereas superoxide contributes in a precise pattern of intracellular protein tyrosine nitration.
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Affiliation(s)
- Diana M Fries
- Stokes Research Institute, Children's Hospital of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania 19140, USA
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Souza JM, Chen Q, Blanchard-Fillion B, Lorch SA, Hertkorn C, Lightfoot R, Weisse M, Friel T, Paxinou E, Themistocleous M, Chov S, Ischiropoulos H. Reactive nitrogen species and proteins: biological significance and clinical relevance. Adv Exp Med Biol 2002; 500:169-74. [PMID: 11764931 DOI: 10.1007/978-1-4615-0667-6_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- J M Souza
- Stokes Research Institute and Department of Biochemistry and Biophysics, Children's Hospital of Philadelphia and The University of Pennsylvania, 19104, USA
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Gow AJ, Chen Q, Gole M, Themistocleous M, Lee VM, Ischiropoulos H. Two distinct mechanisms of nitric oxide-mediated neuronal cell death show thiol dependency. Am J Physiol Cell Physiol 2000; 278:C1099-107. [PMID: 10837337 DOI: 10.1152/ajpcell.2000.278.6.c1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To better understand the mechanism(s) underlying nitric oxide (. NO)-mediated toxicity, in the presence and absence of concomitant oxidant exposure, postmitotic terminally differentiated NT2N cells, which are incapable of producing. NO, were exposed to PAPA-NONOate (PAPA/NO) and 3-morpholinosydnonimine (SIN-1). Exposure to SIN-1, which generated peroxynitrite in the range of 25-750 nM/min, produced a concentration- and time-dependent delayed cell death. In contrast, a critical threshold concentration (>440 nM/min) was required for. NO to produce significant cell injury. Examination of cells by electron microscopy shows a largely necrotic injury after peroxynitrite exposure but mainly apoptotic-like morphology after. NO exposure. Cellular levels of reduced thiols correlated with cell death, and pretreatment with N-acetylcysteine (NAC) fully protected from cell death in either PAPA/NO or SIN-1 exposure. NAC given within the first 3 h posttreatment further delayed cell death and increased the intracellular thiol level in SIN-1 but not. NO-exposed cells. Cell injury from. NO was independent of cGMP, caspases, and superoxide or peroxynitrite formation. Overall, exposure of non-. NO-producing cells to. NO or peroxynitrite results in delayed cell death, which, although occurring by different mechanisms, appears to be mediated by the loss of intracellular redox balance.
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Affiliation(s)
- A J Gow
- Stokes Research Institute, Children's Hospital of Philadelphia, University of Pennsylvania 19104, USA
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