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Siempis T, Voulgaris S, Alexiou GA. The emerging role of blood-based biomarkers in predicting the outcomes of deep brain stimulation in patients with movement disorders. Clin Neurol Neurosurg 2024; 241:108276. [PMID: 38631154 DOI: 10.1016/j.clineuro.2024.108276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University of Ioannina, School of Medicine, Ioannina, Greece.
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Spiliotopoulos T, Kalogeras A, Shlobin NA, Tasiou A, Paschalis T, Alexiou GA, Fratzoglou M, Paleologos TS, Vasilios P, Prassas A, Tsitsopoulos PP, Vlachos K, Voulgaris S, Rosseau G, Fountas KN. Neurosurgery Training in Greece. World Neurosurg 2024; 185:e304-e308. [PMID: 38244686 DOI: 10.1016/j.wneu.2024.01.064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The structure and specifics of neurosurgery residency training vary substantially across programs and countries, potentially leading to differences in clinical reasoning, surgical skills, and professionalism. The Greek neurosurgical training system is unique in numerous respects. This manuscript delineates the current state of neurosurgical residency training in Greece and outlines future directions. METHODS A narrative review was conducted to describe the Greek neurosurgical residency training structure. The perspectives of the authors regarding challenges in training and future directions were synthesized. RESULTS This manuscript describes the neurosurgery residency curriculum and board certification process, existing training programs, and key challenges in neurosurgery residency training in Greece. The authors propose future directions to reform neurosurgical training in Greece. CONCLUSIONS Neurosurgery residency training in Greece has been largely unchanged for many years. This review leads to suggested modification of the existing training process may improve the quality of training and equip neurosurgeons to respond to the rapidly changing landscape of the field.
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Affiliation(s)
- Theodosios Spiliotopoulos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
| | - Adamantios Kalogeras
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanasis Paschalis
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Moschos Fratzoglou
- Department of Neurosurgery, General Hospital of Nikaia-Piraeus, Athens, Greece
| | | | | | - Aristeidis Prassas
- Department of Neurosurgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA; Barrow Global, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Zoi V, Kyritsis AP, Galani V, Lazari D, Sioka C, Voulgaris S, Alexiou GA. The Role of Curcumin in Cancer: A Focus on the PI3K/Akt Pathway. Cancers (Basel) 2024; 16:1554. [PMID: 38672636 PMCID: PMC11048628 DOI: 10.3390/cancers16081554] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Cancer is a life-threatening disease and one of the leading causes of death worldwide. Despite significant advancements in therapeutic options, most available anti-cancer agents have limited efficacy. In this context, natural compounds with diverse chemical structures have been investigated for their multimodal anti-cancer properties. Curcumin is a polyphenol isolated from the rhizomes of Curcuma longa and has been widely studied for its anti-inflammatory, anti-oxidant, and anti-cancer effects. Curcumin acts on the regulation of different aspects of cancer development, including initiation, metastasis, angiogenesis, and progression. The phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT) pathway is a key target in cancer therapy, since it is implicated in initiation, proliferation, and cancer cell survival. Curcumin has been found to inhibit the PI3K/Akt pathway in tumor cells, primarily via the regulation of different key mediators, including growth factors, protein kinases, and cytokines. This review presents the therapeutic potential of curcumin in different malignancies, such as glioblastoma, prostate and breast cancer, and head and neck cancers, through the targeting of the PI3K/Akt signaling pathway.
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Affiliation(s)
- Vasiliki Zoi
- Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece
| | | | - Vasiliki Galani
- Department of Anatomy Histology-Embryology, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
| | - Diamanto Lazari
- Laboratory of Pharmacognosy, Faculty of Health Sciences, School of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Chrissa Sioka
- Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece
| | - Spyridon Voulgaris
- Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece
- Department of Neurosurgery, University of Ioannina, 45500 Ioannina, Greece
| | - Georgios A. Alexiou
- Neurosurgical Institute, University of Ioannina, 45500 Ioannina, Greece
- Department of Neurosurgery, University of Ioannina, 45500 Ioannina, Greece
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Lampros M, Voulgaris S, Alexiou GA. Commentary: Impact of Molecular Subgroups on Prognosis and Survival Outcomes in Posterior Fossa Ependymomas: A Retrospective Study of 412 Cases. Neurosurgery 2024:00006123-990000000-01120. [PMID: 38619273 DOI: 10.1227/neu.0000000000002952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University of Ioannina School of Medicine, Ioannina, Greece
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Styliara EI, Astrakas LG, Alexiou G, Xydis VG, Zikou A, Kafritsas G, Voulgaris S, Argyropoulou MI. Survival Outcome Prediction in Glioblastoma: Insights from MRI Radiomics. Curr Oncol 2024; 31:2233-2243. [PMID: 38668068 PMCID: PMC11048751 DOI: 10.3390/curroncol31040165] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Extracting multiregional radiomic features from multiparametric MRI for predicting pretreatment survival in isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) patients is a promising approach. Methods: MRI data from 49 IDH wild-type glioblastoma patients pre-treatment were utilized. Diffusion and perfusion maps were generated, and tumor subregions segmented. Radiomic features were extracted for each tissue type and map. Feature selection on 1862 radiomic features identified 25 significant features. The Cox proportional-hazards model with LASSO regularization was used to perform survival analysis. Internal and external validation used a 38-patient training cohort and an 11-patient validation cohort. Statistical significance was set at p < 0.05. Results: Age and six radiomic features (shape and first and second order) from T1W, diffusion, and perfusion maps contributed to the final model. Findings suggest that a small necrotic subregion, inhomogeneous vascularization in the solid non-enhancing subregion, and edema-related tissue damage in the enhancing and edema subregions are linked to poor survival. The model's C-Index was 0.66 (95% C.I. 0.54-0.80). External validation demonstrated good accuracy (AUC > 0.65) at all time points. Conclusions: Radiomics analysis, utilizing segmented perfusion and diffusion maps, provide predictive indicators of survival in IDH wild-type glioblastoma patients, revealing associations with microstructural and vascular heterogeneity in the tumor.
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Affiliation(s)
- Effrosyni I. Styliara
- Department of Radiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (E.I.S.); (V.G.X.); (A.Z.); (M.I.A.)
| | - Loukas G. Astrakas
- Medical Physics Lab, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece;
| | - George Alexiou
- Department of Neurosurgery, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (G.K.); (S.V.)
| | - Vasileios G. Xydis
- Department of Radiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (E.I.S.); (V.G.X.); (A.Z.); (M.I.A.)
| | - Anastasia Zikou
- Department of Radiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (E.I.S.); (V.G.X.); (A.Z.); (M.I.A.)
| | - Georgios Kafritsas
- Department of Neurosurgery, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (G.K.); (S.V.)
| | - Spyridon Voulgaris
- Department of Neurosurgery, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (G.K.); (S.V.)
| | - Maria I. Argyropoulou
- Department of Radiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece; (E.I.S.); (V.G.X.); (A.Z.); (M.I.A.)
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Siempis T, Rehder R, Voulgaris S, Alexiou GA. Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: A systematic review. World Neurosurg X 2024; 22:100325. [PMID: 38455249 PMCID: PMC10918277 DOI: 10.1016/j.wnsx.2024.100325] [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: 04/10/2023] [Revised: 10/08/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Background Stereotactic radiosurgery (SRS) has recently gained space as an accepted non-invasive alternative treatment option for drug resistant Glossopharyngeal neuralgia (GPN). The purpose of this systematic review was to provide an overview of the outcomes of SRS treatment in patients with GPN. Methods A literature review until March 2023 was performed. Data about patient's demographics, complications and recurrence rates, additional treatment post procedure as well as pain outcomes in the short and long term were collected. Studies without reported pain outcomes were excluded. Results Sixteen studies with a total of 97 patients diagnosed with GPN who had undergone SRS were identified. The mean reported maximal radiation dose ranged from 70 to 88.7 Gy with the glossopharyngeal meatus (GPM) being the most common target in 12/16 studies. The median time from SRS till pain response was between 2 and 120 days. The mean proportion of patients requiring further treatment after SRS ranged from 11.1 to 57.14% in a time frame between 2 and 36 months post procedure. Favourable pain response rates after SRS (BNI-IIIb) ranged from 60% to 100% and 57.1%-100% in short and long term respectively. Conclusion SRS for GPN remains a safe alternative to surgery with low complication rates and favourable pain outcomes in both short and long term.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, University of Ioannina, Ioannina, Greece
| | - Roberta Rehder
- Division of Neurosurgery, HCor - Hospital do Coração, São Paulo, Brazil
- Division of Pediatric Neurosurgery, Hospital Santa Marcelina, São Paulo, Brazil
- Division of Neurosurgery, Hospital do Coracao, 130 Des. Eliseu Guilherme St, 3rd floor, 05280-110, São Paulo, SP, Brazil
| | | | - George A. Alexiou
- Department of Neurosurgery, University of Ioannina, Ioannina, Greece
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Alexiou GA, Voulgaris S. The multiple roles of admission glucose levels in trauma patients. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02496-w. [PMID: 38499852 DOI: 10.1007/s00068-024-02496-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University of Ioannina, School of Medicine, 45500, Ioannina, Greece.
| | - Spyridon Voulgaris
- Department of Neurosurgery, University of Ioannina, School of Medicine, 45500, Ioannina, Greece
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Tsakiris C, Siempis T, Lianos GD, Vlachodimitropoulou L, Voulgaris S, Alexiou GA. Blood biomarkers: a new solution to the silent pandemic of traumatic brain injury. Biomark Med 2023; 17:783-785. [PMID: 38223950 DOI: 10.2217/bmm-2023-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Affiliation(s)
- Charalampos Tsakiris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | - Timoleon Siempis
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
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Lampros MG, Alexiou ES, Zika J, Alexiou GA, Voulgaris S, Alexiou G. Letter to the editor for "Detecting traumatic brain injury-induced coagulopathy: What we are testing and what we are not". J Trauma Acute Care Surg 2023; 95:e17. [PMID: 37125967 DOI: 10.1097/ta.0000000000003931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Lampros M, Vlachos N, Tsitsopoulos PP, Zikou AK, Argyropoulou MI, Voulgaris S, Alexiou GA. The Role of Novel Imaging and Biofluid Biomarkers in Traumatic Axonal Injury: An Updated Review. Biomedicines 2023; 11:2312. [PMID: 37626808 PMCID: PMC10452517 DOI: 10.3390/biomedicines11082312] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of disability worldwide. Traumatic axonal injury (TAI) is a subtype of TBI resulting from high-impact forces that cause shearing and/or stretching of the axonal fibers in white matter tracts. It is present in almost half of cases of severe TBI and frequently associated with poor functional outcomes. Axonal injury results from axonotomy due to mechanical forces and the activation of a biochemical cascade that induces the activation of proteases. It occurs at a cellular level; hence, conventional imaging modalities often fail to display TAI lesions. However, the advent of novel imaging modalities, such as functional magnetic resonance imaging and fiber tractography, has significantly improved the detection and characteristics of TAI. Furthermore, the significance of several fluid and structural biomarkers has also been researched, while the contribution of omics in the detection of novel biomarkers is currently under investigation. In the present review, we discuss the role of imaging modalities and potential biomarkers in diagnosing, classifying, and predicting the outcome in patients with TAI.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
| | - Nikolaos Vlachos
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
| | - Parmenion P. Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, 54942 Thessaloniki, Greece;
| | - Anastasia K. Zikou
- Department of Radiology, University of Ioannina, 45110 Ioannina, Greece; (A.K.Z.); (M.I.A.)
| | - Maria I. Argyropoulou
- Department of Radiology, University of Ioannina, 45110 Ioannina, Greece; (A.K.Z.); (M.I.A.)
| | - Spyridon Voulgaris
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
| | - George A. Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
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Siempis T, Georgalis PA, Lianos G, Kafritsas G, Metaxas D, Alexiou ES, Zika J, Sotiropoulos A, Alexiou GA, Voulgaris S. Blood Biomarkers for Prediction of Positive CT Findings in Mild Traumatic Brain Injury in Paediatric Population. J Integr Neurosci 2023; 22:91. [PMID: 37519178 DOI: 10.31083/j.jin2204091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/27/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Paediatric Traumatic Brain Injury (TBI) has received less research attention compared to TBI in adults, despite its potential morbidity in all ages. Our aim was to determine whether neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and glucose levels at admission can reliably predict the need for imaging in children presenting with mild TBI. METHODS We retrospectively reviewed the clinical records of paediatric patients who presented in the emergency department with mild TBI within a 5 year period and had undergone computed tomography (CT) scan of the head. RESULTS Overall, 43 eligible patients were included in the study, with falls being the most commonly reported cause of injury. Twenty-three children had positive CT findings. Patients with abnormal CT findings were found to have higher NLR ratios compated with patients with normal CT, with the mean NLR on admission being 5.2 ± 3.8. Children with abnormal CT findings had lower PLR levels and higher glucose levels at presentation compared to children with normal CT, however the differences were not statistically significant. Using the receiver operating characteristic (ROC) curve, we found that a NLR cut off value of 6.1 yielded a sensitivity of 54.2% and a specificity of 89.5% for the prediction of abnormal CT findings. CONCLUSIONS The findings of this study suggest that NLR may have a role in CT decision-making in the emergency department for mild TBI in paediatric patients.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Pavlos A Georgalis
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Georgios Lianos
- Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Georgios Kafritsas
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Dimitrios Metaxas
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | - Jiolanda Zika
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
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Tse E, Plakitsi K, Voulgaris S, Alexiou GA. Schoolteachers Teach First Aid and Trauma Management to Young Primary School Children: An Experimental Study with Educational Intervention. Children (Basel) 2023; 10:1076. [PMID: 37371307 DOI: 10.3390/children10061076] [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: 04/25/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES The primary objective of this pilot study was to examine the effectiveness of teaching first aid to 6-8-year-old children within their primary school setting. The study aimed to address two key research questions: (1) Can children of this age group acquire first aid and trauma management skills from their schoolteachers? (2) How long do children retain the acquired first aid knowledge? METHODS A pilot experimental study with an educational intervention was conducted in a single primary school in Greece. A total of 60 schoolchildren aged 6-8 years were randomly selected for participation, with 30 children assigned to the training group and 30 children assigned to the control group, which did not receive any intervention. To assess the children's understanding of first aid, a specialized questionnaire was administered to all children one day before the training, as well as to the training group one day after the training, and at two and six months following the training. RESULTS Prior to the training, there were no significant differences in first aid knowledge between the children in the training group and those in the control group. However, one day after the training, the trained children demonstrated significantly higher scores (p < 0.05) compared to the control group. Over time, the first aid knowledge of the trained children gradually declined at the two- and six-month follow-up assessments, although it remained higher than their pre-training level. CONCLUSIONS First aid training provided by their teachers improved the knowledge of 6-8-year-old primary school children in first aid and trauma management.
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Affiliation(s)
- Eleana Tse
- Department of Neurosurgery, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
| | - Katerina Plakitsi
- Department of Early Childhood Education, School of Education, University of Ioannina, 45110 Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
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Vartholomatos G, Markopoulos GS, Vartholomatos E, Goussia AC, Dova L, Dimitriadis S, Mantziou S, Zoi V, Nasios A, Sioka C, Kyritsis AP, Voulgaris S, Alexiou GA. Assessment of Gliomas' Grade of Malignancy and Extent of Resection Using Intraoperative Flow Cytometry. Cancers (Basel) 2023; 15:cancers15092509. [PMID: 37173975 PMCID: PMC10177593 DOI: 10.3390/cancers15092509] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Intraoperative Flow Cytometry (iFC) is a novel technique for the assessment of the grade of malignancy and the diagnosis of tumor type and resection margins during solid tumor surgery. Herein, we set out to analyze the role of iFC in the grading of gliomas and the evaluation of resection margins. MATERIAL AND METHODS iFC uses a fast cell cycle analysis protocol (Ioannina Protocol) that permits the analysis of tissue samples within 5-6 min. Cell cycle analysis evaluated the G0/G1 phase, S-phase, mitosis, and tumor index (S + mitosis phase fraction) and ploidy status. In the current study, we evaluated tumor samples and samples from the peripheral borders from patients with gliomas who underwent surgery over an 8-year period. RESULTS Eighty-one patients were included in the study. There were sixty-eight glioblastoma cases, five anaplastic astrocytomas, two anaplastic oligodendrogliomas, one pilocytic astrocytoma, three oligodendrogliomas and two diffuse astrocytomas. High-grade gliomas had a significantly higher tumor index than low grade gliomas (median value 22 vs. 7.5, respectively, p = 0.002). Using ROC curve analysis, a cut-off value of 17% in the tumor index could differentiate low- from high-grade gliomas with a 61.4% sensitivity and 100% specificity. All low-grade gliomas were diploid. From the high-grade gliomas, 22 tumors were aneuploid. In glioblastomas, aneuploid tumors had a significantly higher tumor index (p = 0.0018). Twenty-three samples from glioma margins were evaluated. iFC verified the presence of malignant tissue in every case, using histology as the gold standard. CONCLUSION iFC constitutes a promising intraoperative technique for glioma grading and resection margin assessment. Comparative studies with additional intraoperative adjuncts are necessary.
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Affiliation(s)
- George Vartholomatos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Georgios S Markopoulos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | | | - Anna C Goussia
- Department of Pathology, Ioannina University Hospital, 45500 Ioannina, Greece
- Department of Pathology, German Oncology Center, 4108 Limassol, Cyprus
| | - Lefkothea Dova
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Savvas Dimitriadis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Stefania Mantziou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
| | - Vaso Zoi
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Anastasios Nasios
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory, Unit of Molecular Biology and Translational Flow Cytometry, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Chrissa Sioka
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Nuclear Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Athanasios P Kyritsis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Spyridon Voulgaris
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - George A Alexiou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
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14
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Filis P, Alexiou GA, Zigouris A, Sioka C, Filis N, Voulgaris S. Meningioma grading based on positron emission tomography: A systematic review and meta-analysis. World Neurosurg X 2023; 18:100167. [PMID: 36825220 PMCID: PMC9941365 DOI: 10.1016/j.wnsx.2023.100167] [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: 09/13/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade. Materials and methods The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented. Results Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used 18F-FDG, one study used 18F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%-91%) and the pooled specificity was 89% (95% CI: 83%-93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22-80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54-11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11-0.61). Conclusion PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well.
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Key Words
- 1/LR-, inverse of the negative likelihood ratio
- 11C-MET, 11C-methionine
- 18F-FDG, fluorine-18 fluorodeoxyglucose
- 18F-FET, O-(2-[18F]Fluoroethyl)-l-tyrosine
- CIs, 95% confidence intervals
- CT, computerized tomography
- DOR, diagnostic odds ratio
- HSROC, hierarchical summary receiver operating characteristic
- LR+, positive likelihood ratios
- LR−, negative likelihood ratios
- MRI, magnetic resonance imaging
- Mendingioma
- Meta-analysis
- PET
- PET, positron emission tomography
- SPECT, single-photon emission computerized tomography
- SUV, standardized uptake value
- SUVmax, maximum standardized uptake value
- TBR, tumour-to-brain ratios
- TGR, tumor-to-contralateral gray matter ratios
- WHO, World Health Organization
- [18F]FLT, 3′-deoxy-3′-[18F]fluorothymidine
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Affiliation(s)
- Panagiotis Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Corresponding author.
| | - Andreas Zigouris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, University of Ioannina, Greece
| | - Nikolaos Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
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15
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Siempis T, Tsakiris C, Anastasia Z, Alexiou GA, Voulgaris S, Argyropoulou MI. Radiological assessment and surgical management of cervical spine involvement in patients with rheumatoid arthritis. Rheumatol Int 2023; 43:195-208. [PMID: 36378323 PMCID: PMC9898347 DOI: 10.1007/s00296-022-05239-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
The purpose of the present systematic review was to describe the diagnostic evaluation of rheumatoid arthritis in the cervical spine to provide a better understanding of the indications and options of surgical intervention. We performed a literature review of Pub-med, Embase, and Scopus database. Upon implementing specific inclusion and exclusion criteria, all eligible articles were identified. A total of 1878 patients with Rheumatoid Arthritis (RA) were evaluated for cervical spine involvement with plain radiographs. Atlantoaxial subluxation (AAS) ranged from 16.4 to 95.7% in plain radiographs while sub-axial subluxation ranged from 10 to 43.6% of cases. Anterior atlantodental interval (AADI) was found to between 2.5 mm and 4.61 mm in neutral and flexion position respectively, while Posterior Atlantodental Interval (PADI) was between 20.4 and 24.92 mm. 660 patients with RA had undergone an MRI. A pannus diagnosis ranged from 13.33 to 85.36% while spinal cord compression was reported in 0-13% of cases. When it comes to surgical outcomes, Atlanto-axial joint (AAJ) fusion success rates ranged from 45.16 to 100% of cases. Furthermore, the incidence of postoperative subluxation ranged from 0 to 77.7%. With regards to AADI it is evident that its value decreased in all studies. Furthermore, an improvement in Ranawat classification was variable between studies with a report improvement frequency by at least one class ranging from 0 to 54.5%. In conclusion, through careful radiographic and clinical evaluation, cervical spine involvement in patients with RA can be detected. Surgery is a valuable option for these patients and can lead to improvement in their symptoms.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Charalampos Tsakiris
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Zikou Anastasia
- Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece.
| | - Spyridon Voulgaris
- Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece
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16
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Vlachos N, Lampros MG, Filis P, Voulgaris S, Alexiou GA. Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis. World Neurosurg X 2023; 18:100170. [PMID: 36825221 PMCID: PMC9942116 DOI: 10.1016/j.wnsx.2023.100170] [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: 09/19/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Objective The standard of care in patients with solitary brain metastasis involves surgical resection and postoperative whole-brain radiotherapy (WBRT). However, WBRT is associated with adverse effects, mainly neurocognitive deterioration. Stereotactic radiosurgery (SRS) is a more targeted form of radiation therapy that could be as effective as WBRT without the detrimental neurocognitive decline. Methods We performed the first systematic review and meta-analysis comparing postoperative SRS versus postoperative WBRT in patients with one resected brain metastasis. PubMed, Scopus, and Cochrane library were systematically searched for studies comparing the efficacy of the two radiation modalities in terms of local and distant brain control, leptomeningeal disease control, and overall survival. Additionally, we extracted patients' neurocognitive function and quality of life after each postoperative radiation form. Results Four studies with 248 patients (128: WBRT, 120: SRS) were included in our analysis. There was no difference between SRS and WBRT in the risk of local recurrence (RR = 0.92, CI = 0.51-1.66, p = 0.78, I2 = 0%) and leptomeningeal disease (RR = 1.21, CI = 0.49-2.98, p = 0.67, I2 = 18%), neither in the patients' overall survival (HR = 1.06, CI = 0.61-1.85, p = 0.83, I2 = 63%). Nevertheless, SRS appeared to increase the risk of distant brain failure (RR = 2.03, CI = 0.94-4.40, p = 0.07, I2 = 61%). Neurocognitive function and quality of life in the SRS group were equal or superior to the WBRT group. Conclusions Although SRS may increase the risk of distant brain failure, it appears to be as effective as WBRT in terms of local control, risk of leptomeningeal disease, and overall survival while sparing the patients of the detrimental, WBRT-associated cognitive deterioration.
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Key Words
- Brain metastasis
- CI, Confidence Interval
- HR, Hazard Ratio
- KPS, Karnofsky Performance Status
- M-H, Mantel – Haenszel
- MMME, Mini-Mental State Examination
- MRC, Medical Research Council
- Neurocognitive function
- Overall survival
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses
- QLQ, Quality of Life Questionnaire
- RCTs, Randomized Controlled Trials
- RR, Risk Ratio
- SRS, Stereotactic radiosurgery
- Stereotactic radiosurgery
- WBRT, whole-brain radiotherapy
- Whole-brain radiotherapy
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Affiliation(s)
- Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Marios G. Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Panagiotis Filis
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece,Corresponding author.
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17
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Alexiou GA, Markopoulos GS, Vartholomatos E, Goussia AC, Dova L, Dimitriadis S, Mantziou S, Zoi V, Nasios A, Sioka C, Kyritsis AP, Voulgaris S, Vartholomatos G. Intraoperative Flow Cytometry for the Evaluation of Meningioma Grade. Curr Oncol 2023; 30:832-838. [PMID: 36661712 PMCID: PMC9858265 DOI: 10.3390/curroncol30010063] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Meningiomas are the most frequent central nervous system tumors in adults. The majority of these tumors are benign. Nevertheless, the intraoperative identification of meningioma grade is important for modifying surgical strategy in order to reduce postoperative complications. Here, we set out to investigate the role of intraoperative flow cytometry for the differentiation of low-grade (grade 1) from high-grade (grade 2-3) meningiomas. The study included 59 patients. Intraoperative flow cytometry analysis was performed using the 'Ioannina Protocol' which evaluates the G0/G1 phase, S-phase, mitosis and tumor index (S + mitosis phase fraction) of a tumor sample. The results are available within 5 min of sample receipt. There were 41 grade 1, 15 grade 2 and 3 grade 3 meningiomas. High-grade meningiomas had significantly higher S-phase fraction, mitosis fraction and tumor index compared to low-grade meningiomas. High-grade meningiomas had significantly lower G0/G1 phase fraction compared to low-grade meningiomas. Thirty-eight tumors were diploids and twenty-one were aneuploids. No significant difference was found between ploidy status and meningioma grade. ROC analysis indicated 11.4% of tumor index as the optimal cutoff value thresholding the discrimination between low- and high-grade meningiomas with 90.2% sensitivity and 72.2% specificity. In conclusion, intraoperative flow cytometry permits the detection of high-grade meningiomas within 5 min. Thus, surgeons may modify tumor removal strategy.
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Affiliation(s)
- George A. Alexiou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Georgios S. Markopoulos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | - Anna C. Goussia
- Department of Pathology, University Hospital of Ioannina, 45500 Ioannina, Greece
- Department of Pathology, German Oncology Center, 4108 Limassol, Cyprus
| | - Lefkothea Dova
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Savvas Dimitriadis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Stefania Mantziou
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Vasiliki Zoi
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Anastasios Nasios
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Chrissa Sioka
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Nuclear Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Athanasios P. Kyritsis
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
| | - Spyridon Voulgaris
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Department of Neurosurgery, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - George Vartholomatos
- Neurosurgical Institute, University of Ioannina School of Medicine, 45110 Ioannina, Greece
- Haematology Laboratory—Unit of Molecular Biology and Translational Flow Cytometry, University Hospital of Ioannina, 45500 Ioannina, Greece
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18
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Alexiou GA, Markopoulos G, Voulgaris S, Vartholomatos G. Usefulness of intraoperative rapid flow cytometry in the surgical treatment of brain tumors. Neuropathology 2022. [PMID: 36415116 DOI: 10.1111/neup.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022]
Affiliation(s)
- George A. Alexiou
- Neurosurgical Institute, University of Ioannina School of Medicine Ioannina Greece
- Department of Neurosurgery University Hospital of Ioannina Ioannina Greece
| | - Georgios Markopoulos
- Neurosurgical Institute, University of Ioannina School of Medicine Ioannina Greece
| | - Spyridon Voulgaris
- Neurosurgical Institute, University of Ioannina School of Medicine Ioannina Greece
- Department of Neurosurgery University Hospital of Ioannina Ioannina Greece
| | - George Vartholomatos
- Neurosurgical Institute, University of Ioannina School of Medicine Ioannina Greece
- Haematology Laboratory‐Unit of Molecular Biology and Translational Flow Cytometry University Hospital of Ioannina Ioannina Greece
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19
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Tse E, Plakitsi K, Voulgaris S, Alexiou GA. First Aid Training for Children in Kindergarten: A Pilot Randomized Control Study. Children (Basel) 2022; 9:children9111626. [PMID: 36360354 PMCID: PMC9688767 DOI: 10.3390/children9111626] [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: 09/14/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
First aid is a fundamental skill for every human of every age, so training in first aid is necessary at a variety of levels. First aid training in schools is essential, but to date, only short reports have been published on the effectiveness of first aid training in kindergarten. We conducted a pilot randomized controlled study on the impact of first aid training on children in kindergarten. We randomly selected 24 children aged 4-5 years from one kindergarten, who were allocated to either a training group (14 children) or a control group (10 children). The training program consisted of three lessons. An eleven-question questionnaire was administered to the children in the training group one day before, one day after, and two and six months after the training, and once to the those in the control group. Before the training, no significant difference was detected in the score on the questionnaire between the two groups. After the lessons, the children in the training group scored significantly higher on the questionnaire than before the lessons, and than the children in the control group. At two and six months after the training, the scores of the children in the training group had decreased but remained higher than before the training and higher that those of the control group. These preliminary results indicate that kindergarten children may benefit from first aid training, but further studies are needed to verify these observations and to explore ways of maintaining the knowledge acquired in training.
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Affiliation(s)
- Eleana Tse
- Department of Neurosurgery, School of Medicine, University of Ioannina, 451-10 Ioannina, Greece
| | - Katerina Plakitsi
- Department of Early Childhood Education, School of Education, University of Ioannina, 451-10 Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, School of Medicine, University of Ioannina, 451-10 Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, 451-10 Ioannina, Greece
- Correspondence: ; Tel.: +30-6948-525134; Fax: +30-26510-99700
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21
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Siempis T, Prassas A, Alexiou GA, Voulgaris S, Tsitsopoulos PP. A systematic review on the prevalence of preoperative and postoperative depression in lumbar fusion. J Clin Neurosci 2022; 104:91-95. [PMID: 35987119 DOI: 10.1016/j.jocn.2022.08.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and Degenerative Spine Disease (DSD) frequently co-exist. Pooled prevalence estimates of depression before and after lumbar fusion surgery has not been analyzed before. The purpose of this systematic review was to estimate the pre- and post-operative prevalence of depression in patients with DSD undergoing lumbar fusion. METHODS A literature review until April 30th 2022 was performed. All studies on DSD patients undergoing lumbar spine fusion surgery with either a history of formal diagnosis of depression or a recording of depression using a validated tool were included. Patients with other psychiatric conditions or undergoing a different form of spinal surgery were excluded. Risk of bias of the included studies was evaluated using the Newcastle-Ottawa Scale. RESULTS Fifteen (15) studies with a total of 98.375 patients met the inclusion and exclusion criteria and were included in the analysis. The prevalence estimate of depression in patients before surgery was 15,35 % (95% CI: 10,56-20,86%). In the 7 studies including patients who had undergone lumbar fusion, the pooled prevalence was estimated 11,46% (95% CI: 8,11-15,30%). CONCLUSION An increased prevalence of depression in patients undergoing lumbar spine fusion was noted. Given the correlation between depression and poor surgical outcomes, strategies should be identified to prevent and treat depression in these patients.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Aristeidis Prassas
- Department of Neurosurgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - George A Alexiou
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece.
| | - Spyridon Voulgaris
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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22
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Vlachos N, Lampros MG, Lianos GD, Voulgaris S, Alexiou GA. Blood biomarkers for predicting coagulopathy occurrence in patients with traumatic brain injury: a systematic review. Biomark Med 2022; 16:935-945. [PMID: 35833883 DOI: 10.2217/bmm-2022-0294] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The occurrence of coagulopathy in patients with traumatic brain injury (TBI) is related to severe complications. The authors performed the first systematic review to investigate whether biomarkers can predict the occurrence of hypocoagulopathy or progressive hemorrhagic injury in patients with TBI. Methods: The authors included studies that performed a receiver operating characteristics analysis for the biomarker and provided a clear value along with the respective sensitivity and specificity. Additionally, they attempted to classify each biomarker, taking into account its physiological role. Results: Twelve studies were included. All biomarkers were protein molecules, except in one study that examined the prognostic role of glucose. Copeptin had the highest sensitivity, and S100A12 had the highest specificity in predicting coagulopathy, while IL-33 had the highest sensitivity and GALECTIN-3 had the highest specificity in predicting progressive hemorrhagic injury. Conclusion: The study of the role of biomarkers in predicting the occurrence of coagulopathy in patients with TBI remains in its infancy.
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Affiliation(s)
- Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Marios G Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Georgios D Lianos
- Department of Surgery, University of Ioannina, Ioannina, 45500, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45500, Greece
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Lampros M, Voulgaris S, Alexiou GΑ. Commentary: Intrathecal Fentanyl With a Myofascial Plane Block in Open Lumbar Surgeries: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:e243-e244. [DOI: 10.1227/ons.0000000000000196] [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] [Received: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/19/2022] Open
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Alexiou GA, Tzima A, Lianos GD, Lampros M, Sotiropoulos A, Rizos D, Ygropoulou O, Zika J, Alexiou ES, Voulgaris S. Neutrophil to lymphocyte ratio in the prediction of coagulopathy in traumatic brain injury. Biomark Med 2022; 16:163-168. [PMID: 35081739 DOI: 10.2217/bmm-2021-0582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: Traumatic brain injury (TBI) is a public health issue of increasing incidence. Coagulopathy after TBI is a frequent event, associated with a poor prognosis, and biomarkers that could predict coagulopathy occurrence are needed. The neutrophil-to-lymphocyte ratio (NLR) is useful as a cost-effective biomarker to assess prognosis and the need for cranial computed tomography in patients with mild TBI. As no study has yet evaluated the association of NLR with coagulopathy, we investigated whether the NLR at presentation could predict coagulopathy occurrence after TBI. Materials & methods: A retrospective study was conducted of patients aged >18 years who attended the emergency department (ED) with TBI, over a 3-year period. We included all patients for whom the NLR at presentation was available, and who underwent a brain CT scan. Results: The study included 173 patients (mean age 57.4 ± 21.1 years) with TBI, the most frequent cause of which was a fall. According to the Glasgow Coma Scale, 37 patients had severe TBI, 19 moderate and 117 mild TBI and 40 patients (23.1%) developed coagulopathy. Their mean NLR was 7.5 ± 6.7. Using receiver operating characteristic curve analysis, a cut-off value of 4.2 for NLR had 87.5% sensitivity and 52.9% specificity for predicting coagulopathy occurrence. Conclusion: Coagulopathy occurs frequently after TBI. This study investigated the value of NLR as a biomarker to predict coagulopathy occurrence, and concluded that NLR might be a novel and inexpensive biomarker for decision making in the management of TBI. Combination of NLR with other low-cost biomarkers and the clinical findings might further increase accuracy in the prediction of coagulopathy.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Aggeliki Tzima
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Dimitrios Rizos
- Department of Intensive Care Unit, 'Hatzikosta General Hospital', Ioannina, Greece
| | - Olga Ygropoulou
- Department of Intensive Care Unit, 'Hatzikosta General Hospital', Ioannina, Greece
| | - Jiolanda Zika
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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Lampros M, Alexiou GA, Voulgaris S. Commentary: Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases. Oper Neurosurg (Hagerstown) 2021; 21:E393-E394. [PMID: 34245155 DOI: 10.1093/ons/opab256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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Kousi C, Lampri E, Voulgaris S, Vougiouklakis T, Galani V, Mitselou A. Expression of orexin-A (hypocretin-A) in the hypothalamus after traumatic brain injury: A postmortem evaluation. Forensic Sci Int 2021; 327:110961. [PMID: 34454377 DOI: 10.1016/j.forsciint.2021.110961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/17/2021] [Revised: 04/16/2021] [Accepted: 08/17/2021] [Indexed: 01/01/2023]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. The key component of TBI pathophysiology is traumatic axonal injury (TAI), commonly referred to as diffuse axonal injury (DAI). Coma is a serious complication which can occur following traumatic brain injury (TBI). Recently, studies have shown that the central orexinergic/ hypocretinergic system exhibit prominent arousal promoting actions. Therefore, the purpose of this study is to investigate by immunohistochemistry the expression of beta-amyloid precursor protein (β-APP) in white matter of parasagittal region, corpus callosum and brainstem and the expression of orexin-A (ORXA) in the hypothalamus after traumatic brain injury. RESULTS: DAI was found in 26 (53.06%) cases, assessed with β-APP immunohistochemical staining in parasagittal white matter, corpus callosum and brainstem. Orexin-A immunoreactivity in hypothalamus was completely absent in 5 (10.2%) of the cases; moderate reduction of ORXA was observed in 9 (18.4%) of the cases; and severe reduction was observed in 7 (14.3%) of the cases. A statistically significant correlation was found between β-APP immunostaining in white matter, corpus callosum and brainstem in relation to survival time (p < 0.002, p < 0.003 and p < 0.005 respectively). A statistically positive correlation was noted between ORX-A immunoreactivity in hypothalamus to survival time (p < 0.003). An inverse correlation was noted between the expression of β-APP in the regions of brain studied to the expression of ORX-A in the hypothalamus of the cases studied (p < 0.005). CONCLUSIONS: The present study demonstrated by immunohistochemistry that reduction of orexin-A neurons in the hypothalamus, involved in coma status and arousal, enhanced the immunoexpression of β-APP in parasagital white matter, corpus callosum and brainstem.
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Affiliation(s)
- Chrysavgi Kousi
- Department of Forensic Medicine and Toxicology Health Sciences, School of Medicine, University of Ioannina, Greece
| | - Evangeli Lampri
- Department of Pathology Health Sciences, School of Medicine, University of Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, Health Sciences, School of Medicine, University of Ioannina, Greece
| | - Theodoros Vougiouklakis
- Department of Forensic Medicine and Toxicology Health Sciences, School of Medicine, University of Ioannina, Greece
| | - Vassiliki Galani
- Department of Anatomy-Histology-Embryology, University of Ioannina, Greece.
| | - Antigony Mitselou
- Department of Forensic Medicine and Toxicology Health Sciences, School of Medicine, University of Ioannina, Greece
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Zoi V, Galani V, Lianos GD, Voulgaris S, Kyritsis AP, Alexiou GA. The Role of Curcumin in Cancer Treatment. Biomedicines 2021; 9:biomedicines9091086. [PMID: 34572272 PMCID: PMC8464730 DOI: 10.3390/biomedicines9091086] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 07/27/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Curcumin is a polyphenol extracted from the rhizomes of the turmeric plant, Curcuma longa which has anti-inflammatory, and anticancer properties. Chronic inflammation is associated with the development of cancer. Curcumin acts on the regulation of various immune modulators, including cytokines, cyclooxygenase-2 (COX-2), and reactive oxygen species (ROS), which partly explains its anticancer effects. It also takes part in the downregulation of growth factors, protein kinases, oncogenic molecules and various signaling pathways, such as nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), c-Jun N-terminal kinase (JNK) and signal transducer and activator of transcription 3 (STAT3) signaling. Clinical trials of curcumin have been completed or are ongoing for various types of cancer. This review presents the molecular mechanisms of curcumin in different types of cancer and the evidence from the most recent clinical trials.
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Affiliation(s)
- Vasiliki Zoi
- Neurosurgical Institute, School of Medicine, University of Ioannina, 45500 Ioannina, Greece; (V.Z.); (S.V.); (A.P.K.)
- Department of Anatomy Histology-Embryology, School of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Vasiliki Galani
- Department of Anatomy Histology-Embryology, School of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Georgios D. Lianos
- Department of Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Spyridon Voulgaris
- Neurosurgical Institute, School of Medicine, University of Ioannina, 45500 Ioannina, Greece; (V.Z.); (S.V.); (A.P.K.)
- Department of Neurosurgery, School of Medicine Ioannina, University of Ioannina, 45500 Ioannina, Greece
| | - Athanasios P. Kyritsis
- Neurosurgical Institute, School of Medicine, University of Ioannina, 45500 Ioannina, Greece; (V.Z.); (S.V.); (A.P.K.)
| | - George A. Alexiou
- Neurosurgical Institute, School of Medicine, University of Ioannina, 45500 Ioannina, Greece; (V.Z.); (S.V.); (A.P.K.)
- Department of Neurosurgery, School of Medicine Ioannina, University of Ioannina, 45500 Ioannina, Greece
- Correspondence:
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Vlachos N, Lampros MG, Zigouris A, Voulgaris S, Alexiou GA. Anaplastic gangliogliomas of the spinal cord: a scoping review of the literature. Neurosurg Rev 2021; 45:295-304. [PMID: 34312775 DOI: 10.1007/s10143-021-01612-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/24/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
Gangliogliomas (GGs) are rare, usually low-grade tumors that account for 1-2% of all central nervous system (CNS) neoplasms. Spinal GGs are exceedingly rare (1% of all spinal tumors) and the presentation of anaplastic features in them is even rarer. According to the last World Health Organization (WHO) classification of CNS neoplasms, anaplastic GG (AGG) is classified as a malignant neoplasm (grade III). We performed a scoping review of the literature to elucidate the epidemiology, clinical features, histopathology, treatment, and outcome of primary spinal AGGs, which, to the best of our knowledge, is the first such review. Relevant studies were identified by a search of the MEDLINE and SCOPUS databases, using the following combination of search strings: (anaplastic ganglioglioma or malignant ganglioglioma or high grade ganglioglioma) AND (spine or spinal or spinal cord). We included studies related to primary or recurrent AGGs and malignant transformation of low-grade GGs. The search produced 15 eligible studies, plus two studies from the references, all of which were case reports of patients with spinal AGGs (17 studies with 22 patients). The mean age of the patients was 21.4 years and the sex ratio was 1:1, with male predominance. Motor impairment was the most common presentation, followed by sensory impairment, gait problems, urinary disturbances, and back pain. The thoracic spine was the most frequently involved area (14/22) followed by the cervical (6/22) and lumbar (5/22) spine. In terms of histology, the anaplastic features were usually predominant in the glial element, resembling high-grade astrocytomas, while the neuronal element was composed of the so-called dysplastic ganglion (neuronal) synaptophysin-positive cells, without mitotic figures. Complete surgical resection of the tumor without neurological compromise, plus adjuvant chemotherapy and radiotherapy, was the treatment protocol implemented in the two patients with the best outcome. Primary spinal AGG is an exceedingly rare entity, with only 22 cases being retrieved after an extensive literature search. They appear to affect children and young adults and tend to manifest aggressive behavior. Most studies report that only the glial component of AGGs presents high-grade malignant features, with low mitotic activity in the neuronal component. We therefore suggest that, pending novel targeted therapy, AGGs should be treated as high-grade gliomas, with an aggressive treatment protocol consisting of maximal safe resection and adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Marios G Lampros
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, 45500, Neohoropoulo, Ioannina, Greece.
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Alexiou GA, Lianos GD, Voulgaris S. Letter to the Editor Regarding "Neutrophil-to-Lymphocyte Ratio and Traumatic Brain Injury: A Review Study". World Neurosurg 2021; 145:544. [PMID: 33348513 DOI: 10.1016/j.wneu.2020.09.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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Nasios A, Alexiou G, Zygouris A, Voulgaris S. Spontaneous epidural hematoma of the cervical spine in two patients with sarcoidosis. Surg Neurol Int 2021; 12:168. [PMID: 34084596 PMCID: PMC8168800 DOI: 10.25259/sni_173_2021] [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: 02/17/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Sarcoidosis is correlated with hematological abnormalities that can result in spontaneous spinal epidural hematomas (EDH). As there is significant risk for permanent neurologic sequelae due to acute cord compression, these lesions often warrant emergent surgical intervention. Case Description: Two females, 56 and 62 years of age, respectively, both with sarcoidosis on corticosteroids, presented with the spontaneous acute onset of cervical pain, and progressive myeloradiculopathy. Emergent MR scans revealed cervical EDHs with cord compression, respectively, from C5-T1, and C6-C7. Following emergent laminectomies in both cases, patients’ neurological deficits resolved. Conclusion: Two patients with sarcoidosis at increased risk for spontaneous hemorrhages, presented with cervical EDHs warranting emergent decompressive laminectomies.
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Affiliation(s)
- Anastasios Nasios
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Epirus, Greece
| | - George Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Epirus, Greece
| | - Andreas Zygouris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Epirus, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Epirus, Greece
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Lampros M, Vlachos N, Zigouris A, Voulgaris S, Alexiou GA. Transcutaneous Vagus Nerve Stimulation (t-VNS) and epilepsy: A systematic review of the literature. Seizure 2021; 91:40-48. [PMID: 34090145 DOI: 10.1016/j.seizure.2021.05.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Transcutaneous auricular vagus nerve stimulation (t-VNS) has been proposed as an alternative method for the treatment of various neurological and psychiatric disorders. Contrary to the classic invasive vagus nerve stimulation (i-VNS), t-VNS does not require surgical intervention. The application of t-VNS for the treatment of epilepsy has been poorly studied. Hence, we performed a systematic review of the literature to elucidate efficacy, adverse effects and technical features of t-VNS in patients with epilepsy. MATERIAL AND METHODS We systematically searched MEDLINE and SCOPUS databases using the following keywords: [TRANSCUTANEOUS VAGUS NERVE STIMULATION OR TRANSCUTANEOUS VAGAL NERVE STIMULATION] AND [EPILEPSY OR SEIZURES]. We searched for observational studies in English concerning the application of t-VNS for the treatment of epilepsy in humans. The full-text version of relevant studies was obtained and reviewed. Technical parameters of the stimulation, percentage of seizure frequency reduction, QOLIE-31(Quality of Life In Epilepsy-31) and LSSS (Liverpool Seizure Severity Scale) questionnaires and adverse effects were recorded and analyzed. RESULTS A total of 10 studies with 350 patients were included. Both bilateral and unilateral placement of the electrode were applied. Stimulation frequency varied from 10-30Hz, while treatment intensity was usually adjusted according to patients' preferences and tolerance (around 1mA) and below the pain threshold. In the clinical trials included in our review, the mean seizure frequency reduction varied from 30 to 65%. Eight and four studies provided information about QOLIE-31 and LSSS questionnaires respectively. Three studies reported a statistically significant (p<0,05) improvement in patients' quality of life and two studies reported statistically significant (p<0,05) seizure severity reduction. The most common side effect was headache (8,9%), followed by skin irritation at the placement site (7,1%) and nasopharyngitis (5,1%). No serious or life-threatening side effects were reported. CONCLUSION Due to the heterogeneity of the included studies, no safe conclusions could be extracted concerning the efficacy of t-VNS. However, the results of this review suggest that patients with epilepsy could possibly benefit from the use of t-VNS. The present study also emphasizes the limitations of previous clinical trials concerning the applications of t-VNS in people with epilepsy and thus could be a guidance for the conduction of future trials.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
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Alexiou GA, Voulgaris S. Letter to the Editor. Leukocytosis in pediatric TBI. J Neurosurg Pediatr 2021; 27:732. [PMID: 33770753 DOI: 10.3171/2021.1.peds2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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34
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Tsakiris C, Siempis T, Alexiou GA, Zikou A, Sioka C, Voulgaris S, Argyropoulou MI. Differentiation Between True Tumor Progression of Glioblastoma and Pseudoprogression Using Diffusion-Weighted Imaging and Perfusion-Weighted Imaging: Systematic Review and Meta-analysis. World Neurosurg 2020; 144:e100-e109. [DOI: 10.1016/j.wneu.2020.07.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
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35
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Alexiou GA, Vartholomatos G, Goussia A, Voulgaris S, Kyritsis AP. Letter: Is Intraoperative Pathology Needed if 5-Aminolevulinic-Acid-Induced Tissue Fluorescence Is Found in Stereotactic Brain Tumor Biopsy? Neurosurgery 2020; 87:E425-E426. [PMID: 32503034 DOI: 10.1093/neuros/nyaa231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- George A Alexiou
- Neurosurgical Institute University of Ioannina School of Medicine Ioannina, Greece.,Department of Neurosurgery University Hospital of Ioannina Ioannina, Greece
| | - George Vartholomatos
- Neurosurgical Institute University of Ioannina School of Medicine Ioannina, Greece.,Haematology Laboratory-Unit of Molecular Biology University Hospital of Ioannina Ioannina, Greece
| | - Ann Goussia
- Department of Pathology University Hospital of Ioannina Ioannina, Greece
| | - Spyridon Voulgaris
- Neurosurgical Institute University of Ioannina School of Medicine Ioannina, Greece.,Department of Neurosurgery University Hospital of Ioannina Ioannina, Greece
| | - Athanasios P Kyritsis
- Neurosurgical Institute University of Ioannina School of Medicine Ioannina, Greece.,Department of Neurology University Hospital of Ioannina Ioannina, Greece
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Lampros M, Voulgaris S, Alexiou GA. Hydrocephalus in primary intradural spinal cord tumors: a systematic review of the literature in the pediatric population. Neurosurg Rev 2020; 44:2079-2084. [PMID: 32918116 DOI: 10.1007/s10143-020-01386-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
Abstract
Hydrocephalus in children with primary intradural spinal cord tumors is exceedingly rare. Herewith, we performed a systematic literature review to address epidemiology, suggested pathophysiological mechanisms, prognostic factors, and treatment of such cases. We performed a systematic review with the best available evidence on cases of pediatric primary intradural tumors of the spinal cord presented with hydrocephalus. The patients were subjected to quantitative analysis on a basis of epidemiological features (age, sex, tumor type and location, clinical presentation, survival, dissemination). The possible pathophysiological theories are discussed in detail. Forty-four studies with a total of 121 patients were included in the study. Astrocytomas were the most frequent tumor (64.5%) type, while most tumors were located in cervical (31.4%) or cervicothoracic region (25.6%). About half of the cases concerned children under 6 years of age. The block of subarachnoid CSF (cerebrospinal fluid) pathways from disseminated tumor cells and the neoplastic inflammation caused by tumor elements advocated to be the major pathogenetic mechanisms. Surgical excision of the tumor and hydrocephalus treatment is usually performed. Primary intradural spinal cord tumors should be considered in children with communicative hydrocephalus of unknown etiology. Onset of hydrocephalus after tumor removal is related to higher mortality.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, Ioannina, Greece. .,Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, Neohoropoulo, 45500, Ioannina, Greece.
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Alexiou GA, Lianos GD, Tzima A, Sotiropoulos A, Nasios A, Metaxas D, Zigouris A, RN JZ, Mitsis M, Voulgaris S. Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury. Biomark Med 2020; 14:1085-1090. [DOI: 10.2217/bmm-2020-0150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Traumatic brain injury (TBI) is a serious health concern. We set out to investigate the role of neutrophil-to-lymphocytes ratio (NLR) at admission for predicting the need for computed tomography (CT) in mild-TBI. Materials & methods: A retrospective study of adult patients who presented with mild-TBI Results: One hundred and thirty patients met the inclusion criteria. Seventy-four patients had positive CT-findings. The mean NLR-levels at presentations were 5.6 ± 4.8. Patients with positive CT-findings had significant higher NLR-levels. Receiver operating characteristic curve analysis was conducted and the threshold of NLR-levels for detecting the cases with positive CT-findings was 2.5, with 78.1% sensitivity and 63% specificity Conclusion: To the best of our knowledge no previous study has assessed the value of NLR-levels for predicting the need for CT in mild-TBI.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Aggeliki Tzima
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Anastasios Nasios
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitris Metaxas
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Jolanda Zika RN
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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Alexiou GA, Voulgaris S. Commentary: Retrieval of an Intracranially Migrated Dental Injection Needle Through the Foramen Ovale: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E169. [DOI: 10.1093/ons/opaa005] [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] [Received: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 11/12/2022] Open
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Alexiou GA, Voulgaris S. The role of biomarkers for the management of mild traumatic brain injury. Clin Neurol Neurosurg 2020; 193:105845. [DOI: 10.1016/j.clineuro.2020.105845] [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] [Received: 07/29/2019] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
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40
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Alexiou GA, Vartholomatos G, Kobayashi T, Voulgaris S, Kyritsis AP. The emerging role of intraoperative flow cytometry in intracranial tumor surgery. Clin Neurol Neurosurg 2020; 192:105742. [PMID: 32087499 DOI: 10.1016/j.clineuro.2020.105742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/16/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022]
Abstract
Intraoperative flow cytometry has been recently emerged as a novel and promising tool for intracranial tumor surgery. Herewith, we discuss the role of intraoperative flow cytometry for the identification of gliomas boundaries, which may permit maximal resection and better prognosis. We also discuss its role in assessing tumor's grade of malignancy, both in adults and children and the prognostic information that may provide. Finally, intraoperative immunophenotypic analysis opens new horizons for flow cytometry. By evaluating tumor's specific cluster differentiation markers a diagnosis, within minutes, of certain tumor type can be achieved and additional information for therapeutic guidance can be provided.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Greece; Neurosurgical Research Institute, University of Ioannina, Greece.
| | - George Vartholomatos
- Neurosurgical Research Institute, University of Ioannina, Greece; Department of Hematology-Unit of Molecular Biology, University Hospital of Ioannina, Greece
| | - Tatsuya Kobayashi
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan; Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Greece; Neurosurgical Research Institute, University of Ioannina, Greece
| | - Athanasios P Kyritsis
- Neurosurgical Research Institute, University of Ioannina, Greece; Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
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Lianos GD, Alexiou GA, Exarchos C, Rausei S, Mitsis M, Voulgaris S. Prognostic significance of neutrophil-to-lymphocyte ratio in several malignancies: where do we stand? Biomark Med 2020; 14:169-172. [DOI: 10.2217/bmm-2019-0497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University of Ioannina School of Medicine, Ioannina, Greece
| | - George A Alexiou
- Deparment of Neurosurgery, University of Ioannina School of Medicine, Ioannina, Greece
| | - Christos Exarchos
- Deparment of Neurosurgery, University of Ioannina School of Medicine, Ioannina, Greece
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy
| | - Michail Mitsis
- Department of Surgery, University of Ioannina School of Medicine, Ioannina, Greece
| | - Spyridon Voulgaris
- Deparment of Neurosurgery, University of Ioannina School of Medicine, Ioannina, Greece
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Siempis T, Tsakiris C, Alexiou GA, Xydis VG, Voulgaris S, Argyropoulou MI. Diagnostic performance of diffusion and perfusion MRI in differentiating high from low-grade meningiomas: A systematic review and meta-analysis. Clin Neurol Neurosurg 2019; 190:105643. [PMID: 31865221 DOI: 10.1016/j.clineuro.2019.105643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/04/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of the present meta-analysis and systematic review was to evaluate the currently published data on the potential role of perfusion (PWI) and diffusion (DWI) weighted imaging for the assessment of meningioma grade. PATIENTS AND METHODS A search of MEDLINE and relative reference lists was conducted to identify all the eligible studies assessing the diagnostic performance of DWI and PWI in grading meningiomas. Meta-Disc and Rev-Man were used for the statistical analysis. Methodological quality and risk of bias were assessed with the use of the updated Quality assessment of the diagnostic accuracy (QUADAS-2) tool. Pooled sensitivity, specificity and area under the summary receiver operating characteristic curve were calculated individually for DWI and PWI to demonstrate the diagnostic performance of each modality. RESULTS Fourteen studies with 1063 patients were included. The 8 studies evaluating DWI showed a pooled sensitivity of 80% (95% CI, 74%-86%) and a pooled specificity of 76% (95% CI, 72%-79%). As for the 6 remaining studies concerning PWI, the pooled sensitivity and specificity were found 80% (95% CI, 71%-88%) and 91% (95% CI, 87%-94%), respectively. The area under the SROC curve was 0.94 (95% CI) for PWI and 0.91 (95% CI) for DWI. The comparison of the two AUCs showed that neither technique was superior with regards to the diagnostic performance. CONCLUSIONS The current evidence proves that both techniques are efficient at differentiating high from low-grade meningiomas.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, Medical School, University of Ioannina, Greece
| | | | - George A Alexiou
- Department of Neurosurgery, Medical School, University of Ioannina, Greece.
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, Medical School, University of Ioannina, Greece
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Alexiou GA, Vartholomatos G, Voulgaris S, Kyritsis AP. Letter to the Editor Regarding "Fluorescein Sodium in Surgical Treatment of Recurrent Glioblastoma Multiforme". World Neurosurg 2019; 128:616. [PMID: 31675764 DOI: 10.1016/j.wneu.2019.03.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/28/2022]
Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece; Neurosurgical Research Institute, University Hospital of Ioannina, Ioannina, Greece.
| | - George Vartholomatos
- Neurosurgical Research Institute, University Hospital of Ioannina, Ioannina, Greece; Department of Hematology-Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece; Neurosurgical Research Institute, University Hospital of Ioannina, Ioannina, Greece
| | - Athanasios P Kyritsis
- Neurosurgical Research Institute, University Hospital of Ioannina, Ioannina, Greece; Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
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Sotiropoulos A, Alexiou GA, Voulgaris S. Letter to the Editor Regarding “Glial Fibrillary Acidic Protein (GFAP) Outperforms S100 Calcium-Binding Protein B (S100B) and Ubiquitin C-Terminal Hydrolase L1 (UCH-L1) as Predictor for Positive Computed Tomography of the Head in Trauma Subjects”. World Neurosurg 2019; 131:294. [DOI: 10.1016/j.wneu.2019.06.237] [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] [Received: 06/25/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 10/25/2022]
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Alexiou GA, Lianos GD, Sotiropoulos A, Voulgaris S. Novel biomarkers may aid the decision for CT scan in emergency settings in mild head trauma. Biomark Med 2019; 13:1055-1057. [DOI: 10.2217/bmm-2019-0277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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Alexiou GA, Voulgaris S. Commentary: Surgical Resection of Cervical Meningioma: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 16:E165. [DOI: 10.1093/ons/opy322] [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] [Received: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 11/14/2022] Open
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Zigouris A, Konsolakis N, Alexiou G, Voulgaris S. A piece of wire into the brain. Asian J Neurosurg 2019; 14:333. [PMID: 30937070 PMCID: PMC6417316 DOI: 10.4103/ajns.ajns_46_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina
| | | | - George Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina
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Triantafyllidi E, Papoudou-Bai A, Alexiou GA, Zikou A, Charchanti A, Konsolakis N, Skiada D, Voulgaris S, Goussia AC. Adult intradural extramedullary teratoma of the spinal cord: A case presentation. Clin Neurol Neurosurg 2018; 175:54-56. [DOI: 10.1016/j.clineuro.2018.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
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Alexiou GA, Voulgaris S. Letter to the Editor. Second cancer risk in patients with spinal ependymomas. J Neurosurg Spine 2018; 29:612-613. [DOI: 10.3171/2018.6.spine18719] [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: 11/06/2022]
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Zika J, Alexiou GA, Giannopoulos S, Kastanioudakis I, Kyritsis AP, Voulgaris S. Outcome factors in surgically treated patients for cervical spondylotic myelopathy. J Spinal Cord Med 2018; 43:206-210. [PMID: 30040606 PMCID: PMC7054977 DOI: 10.1080/10790268.2018.1500225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context/Objective: To investigate prospectively preoperative parameters that might be related to the outcome of surgically treated patients for cervical spondylotic myelopathy (CSM).Design: Prospective study.Setting: Single Center in Ioannina, Greece.Participants: Thirty-six patients were included in the study. There were 21 males and 15 females, mean age 50.8 years, range 39-70 years. The mean BMI was 27.3.Outcome measures: From each patient, we recorded age, sex, BMI, symptoms, duration of symptoms, comorbidities, lifestyle, myelopathy grade based on MRI and levels of compression. All patients completed the modified JOA (mJOA) and NPE questionnaires preoperatively and at 1, 3, 12 months and 5-years postoperatively.Results: The mean mJOA score significant improved from 10.8 ± 1.9 points preoperatively to 16.6 ± 2.2 points at 12 months postoperatively. The mean mJOA score at 5-years postoperatively was 15.5 ± 3 points. The difference was still highly significant. The mean NPE score significant improved from 59.8 ± 12.2 points preoperatively to 28.2 ± 8.5 points at 1 month, to 35.8 ± 8.1 points at 3 month and to 28.2 ± 8.8 points at 12 months postoperatively. Younger patients had significant higher baseline mJOA scores and significant higher mJOA scores 5-year postoperatively. No correlation was found between sex, BMI, symptom duration, baseline mJOA or myelopathy grade and outcome at 12 months or 5-year postoperatively.Conclusion: Age was highly predictive factor of outcome for patients undergoing surgical treatment of CSM.
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Affiliation(s)
- Jiolanda Zika
- Department of Rehabilitation Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece,Correspondence to: George A. Alexiou, Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, Neohoropoulo, Ioannina 45500, Greece; Ph: +30 6948525134. ;
| | | | - Ioannis Kastanioudakis
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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