Miltiadis Georgiopoulos | McGill University (original) (raw)

Papers by Miltiadis Georgiopoulos

Brain and spine, May 1, 2024

Childs Nervous System, Jun 24, 2023

ISRN Neurology (Print), Mar 9, 2014

Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medical... more Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient's forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.

The Spine Journal, Aug 1, 2022

Lancet Oncology, Jul 1, 2022

Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS)... more Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS) decision-making framework for the treatment of patients with spinal metastatic disease. Despite this importance, emerging evidence relating systemic considerations to clinical outcomes following surgery for spinal metastatic disease has not been comprehensively summarised. We aimed to conduct a scoping literature review of this broad topic. We searched MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL databases from Jan 1, 2000, to July 31, 2021. 61 articles were included, accounting for a total of 22 335 patients. Preoperative systemic variables negatively associated with postoperative clinical outcomes included demographics (eg, older age [>60 years], Black race, male sex, low or elevated body-mass index, and smoking status), medical comorbidities (eg, cardiac, pulmonary, hepatic, renal, endocrine, vascular, and rheumatological), biochemical abnormalities (eg, hypoalbuminaemia, atypical blood cell counts, and elevated C-reactive protein concentration), low muscle mass, generalised motor weakness (American Spinal Cord Injury Association Impairment Scale grade and Frankel grade) and poor ambulation, reduced performance status, and systemic disease burden. This is the first comprehensive scoping review to broadly summarise emerging evidence relevant to the systemic assessment component of the widely used NOMS framework for spinal metastatic disease decision making. Medical, surgical, and radiation oncologists can consider these findings when prognosticating spinal metastatic disease-related surgical outcomes on the basis of patients’ systemic condition. These factors might inform a shared decision-making approach with patients and their families.

Journal of neurosurgery, Mar 1, 2023

OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD).... more OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess frailty in SMD. METHODS The AO Spine Knowledge Forum Tumor conducted an international cross-sectional survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to capture preoperative surrogate markers of frailty and relevant postoperative clinical outcomes in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. RESULTS Results were analyzed for 359 respondents, with an 87% completion rate. Study participants represented 71 countries. In the clinical setting, most respondents informally assess frailty and cognition in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained among respondents regarding the association between 14 preoperative clinical variables and frailty. Severe comorbidities, extensive systemic disease burden, and poor performance status were most associated with frailty. Severe comorbidities associated with Survey Administration Voluntary survey responses were anonymously collected using SurveyMonkey. No financial incentive was provided. Participation in the survey was considered consent for enrollment in the study. The survey was distributed by frailty included high-risk cardiopulmonary disease, renal failure, liver failure, and malnutrition. The most clinically relevant outcomes were major complications, neurological recovery, and change in performance status. CONCLUSIONS The respondents recognized that frailty is important, but they most commonly evaluate it based on general clinical impressions rather than using existing frailty tools. The authors identified numerous preoperative surrogate markers of frailty and postoperative clinical outcomes that spine surgeons perceived as most relevant in this population.

Childs Nervous System, Jun 24, 2023

ISRN Neurology (Print), Mar 9, 2014

Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medical... more Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient's forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.

The Spine Journal, Aug 1, 2022

Lancet Oncology, Jul 1, 2022

Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS)... more Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS) decision-making framework for the treatment of patients with spinal metastatic disease. Despite this importance, emerging evidence relating systemic considerations to clinical outcomes following surgery for spinal metastatic disease has not been comprehensively summarised. We aimed to conduct a scoping literature review of this broad topic. We searched MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL databases from Jan 1, 2000, to July 31, 2021. 61 articles were included, accounting for a total of 22 335 patients. Preoperative systemic variables negatively associated with postoperative clinical outcomes included demographics (eg, older age [>60 years], Black race, male sex, low or elevated body-mass index, and smoking status), medical comorbidities (eg, cardiac, pulmonary, hepatic, renal, endocrine, vascular, and rheumatological), biochemical abnormalities (eg, hypoalbuminaemia, atypical blood cell counts, and elevated C-reactive protein concentration), low muscle mass, generalised motor weakness (American Spinal Cord Injury Association Impairment Scale grade and Frankel grade) and poor ambulation, reduced performance status, and systemic disease burden. This is the first comprehensive scoping review to broadly summarise emerging evidence relevant to the systemic assessment component of the widely used NOMS framework for spinal metastatic disease decision making. Medical, surgical, and radiation oncologists can consider these findings when prognosticating spinal metastatic disease-related surgical outcomes on the basis of patients’ systemic condition. These factors might inform a shared decision-making approach with patients and their families.

Journal of neurosurgery, Mar 1, 2023

OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD).... more OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess frailty in SMD. METHODS The AO Spine Knowledge Forum Tumor conducted an international cross-sectional survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to capture preoperative surrogate markers of frailty and relevant postoperative clinical outcomes in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. RESULTS Results were analyzed for 359 respondents, with an 87% completion rate. Study participants represented 71 countries. In the clinical setting, most respondents informally assess frailty and cognition in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained among respondents regarding the association between 14 preoperative clinical variables and frailty. Severe comorbidities, extensive systemic disease burden, and poor performance status were most associated with frailty. Severe comorbidities associated with Survey Administration Voluntary survey responses were anonymously collected using SurveyMonkey. No financial incentive was provided. Participation in the survey was considered consent for enrollment in the study. The survey was distributed by frailty included high-risk cardiopulmonary disease, renal failure, liver failure, and malnutrition. The most clinically relevant outcomes were major complications, neurological recovery, and change in performance status. CONCLUSIONS The respondents recognized that frailty is important, but they most commonly evaluate it based on general clinical impressions rather than using existing frailty tools. The authors identified numerous preoperative surrogate markers of frailty and postoperative clinical outcomes that spine surgeons perceived as most relevant in this population.

Clinical Neurology and Neurosurgery, May 1, 2010

Meige's syndrome is a rare form of segmental dyst... more Meige's syndrome is a rare form of segmental dystonia characterized by blepharospasm and oromandibular dystonia. Medical treatment including botulinum toxin injections usually present disappointing results. The experience on Deep Brain Stimulation (DBS) in the treatment of Meige's syndrome and other segmental dystonias is still limited. At the moment, only a few cases of pallidal DBS have been reported to improve this rare form of dystonia. We report on a case of a woman with a 7-year history of Meige's syndrome, which rendered her functionally blind. The treatment with botulinum toxin injections failed to improve her symptoms, whereas stereotactic bilateral DBS of the pallidum led to a dramatic clinical improvement. Clinical assessment using the Burke-Fahn-Mardsen Dystonia Rating Scale (BFMDRS) in a double-blind manner, showed an improvement of 70% in the Movement score and 93.33% in the Disability score (84% reduction of the total score) on the 3 and 6 month follow-up. Stereotactic pallidal DBS might be considered as a potential treatment in the management of Meige's syndrome.

Journal of Trauma-injury Infection and Critical Care, Oct 1, 2010

Background: The prevalence of postconcussion syndrome (PCS) in the first weeks after mild traumat... more Background: The prevalence of postconcussion syndrome (PCS) in the first weeks after mild traumatic brain injury varies from 40% to 80%. However, as many as 50% of patients report symptoms for up to 3 months and 10% to 15% for more than a year. The objective of this study is to analyze the characteristics and estimate the prevalence of PCS in an adult Greek population. Methods: This prospective study was performed in the University Hospital of Patras in Western Greece. Patients with mild traumatic brain injury (n ϭ 539) were randomly recruited on admission between May 2006 and May 2008. Overall, 223 patients (223 of 539, 41.5%) met the Colorado Medical Society guidelines for concussion; 141 men (63%) and 82 women (37%) with a median age of 30 years (range, 18.5-57.5 years) were included in the study. Patient follow-up consisted of telephone interviews at 1 month, 3 months, and 6 months postinjury, when they were asked about experiencing common postconcussion symptoms (International Classification of Diseases-10th revision criteria). Results: The rate of PCS at 1 month, 3 months, and 6 months postinjury was estimated to be 10.3%, 6%, and 0.9%, respectively. The syndrome was more frequent among women (17%) and individuals with bleeding diathesis (26%) compared with men (6.4%) and patients without clotting disorders (8.5%), respectively. In addition, higher rates of PCS affected patients who sustained assaults compared with other types of accidents. Conclusions: The prevalence of PCS was remarkably higher in previous studies. Cultural differences regarding symptom expectation and the lack of compensation might explain the low rate of chronic symptoms in Greeks.

Global Spine Journal, Mar 26, 2021

Study Design: Systematic review. Objectives: Adult spinal deformity (ASD) can be a debilitating c... more Study Design: Systematic review. Objectives: Adult spinal deformity (ASD) can be a debilitating condition with a profound impact on patients’ health-related quality of life (HRQoL). Many reports have suggested that the frailty status of a patient can have a significant impact on the outcome of the surgery. The present review aims to identify all pre-operative patient-specific frailty markers that are associated with postoperative outcomes following corrective surgery for ASD of the lumbar and thoracic spine. Methods: A systematic review of the literature was performed to identify findings regarding pre-operative markers of frailty and their association with postoperative outcomes in patients undergoing ASD surgery of the lumbar and thoracic spine. The search was performed in the following databases: PubMed, Embase, Cochrane and CINAHL. Results: An association between poorer performance on frailty scales and worse postoperative outcomes. Comorbidity indices were even more frequently employed with similar patterns of association between increased comorbidity burden and postoperative outcomes. Regarding the assessment of HRQoL, worse pre-operative ODI, SF-36, SRS-22 and NRS were shown to be predictors of post-operative complications, while ODI, SF-36 and SRS-22 were found to improve post-operatively. Conclusions: The findings of this review highlight the true breadth of the concept of “frailty” in ASD surgical correction. These parameters, which include frailty scales and various comorbidity and HRQoL indices, highlight the importance of identifying these factors preoperatively to ensure appropriate patient selection while helping to limit poor postoperative outcomes.

European Spine Journal, Apr 19, 2023

Η τεχνική της στερεοταξίας ήταν η πρώτη καλά τεκμηριωμένη και παραδοσιακά η “gold standard” μέθοδ... more Η τεχνική της στερεοταξίας ήταν η πρώτη καλά τεκμηριωμένη και παραδοσιακά η “gold standard” μέθοδος στόχευσης ενδοκράνιων δομών. Η εκτενής βελτίωση των στερεοτακτικών συσκευών μαζί με την ανάπτυξη της Μαγνητικής Τομογραφίας (MRI) τη δεκαετία του 90 και ένας μεγάλος αριθμός σχετικών μελετών με σταθερά αποτελέσματα καθιέρωσαν τη στερεοτακτική βιοψία εγκεφάλου βασισμένη σε πλαίσιο ως τη “gold standard” τεχνική και για τις βιοψίες εγκεφάλου. (Hall 1998, Yu, Liu et al. 2000, Heper, Erden et al. 2005) Παρόλα αυτά, η στερεοτακτική μέθοδος χαρακτηρίζεται από διάφορα σημαντικά μειονεκτήματα: 1) τη δυσανεξία εκ μέρους του ασθενή, 2) την αναγκαιότητα νέας λήψης Αξονικής τομογραφίας (CT)/MRI άμεσα προεγχειρητικά, 3) την απαίτηση υπολογισμού και επαλήθευσης των συντεταγμένων, 4) τα πλαίσια κεφαλής αυτά καθεαυτά, που μπορεί να εμποδίζουν τόσο τον αναισθησιολόγο όσο και τον χειρουργό, και 5) το γεγονός ότι τα δείγματα βιοψίας δύναται να ληφθούν διεγχειρητικά μόνο από τους στόχους που ορίστηκαν προεγχειρητικά. (Goldstein, Gumerlock et al. 1987, Matsumoto, Tomita et al. 1995, Lozano, Gildenberg et al. 2009, Shooman, Belli et al. 2010)Τα σύγχρονα συστήματα πλοήγησης προσφέρουν διάφορα σημαντικά πλεονεκτήματα, π.χ. ανακατασκευές εικόνων διαφόρων όψεων (π.χ. εγκάρσια, στεφανιαία, οβελιαία και «κορυφής καθετήρα») και τρισδιάστατο προ- και δι-εγχειρητικό προγραμματισμό, πραγματικού χρόνου διεγχειρητική καθοδήγηση των χειρουργικών εργαλείων και ακριβή εντόπιση ενδοκράνιων στόχων. (Bale, Laimer et al. 2006, Georgiopoulos, Ellul et al. 2014) Επιπλέον, στην περίπτωση των βιοψιών εγκεφάλου συνδυάζονται με συσκευές τύπου mini πλαισίου. Ως αποτέλεσμα, τα διάφορα μειονεκτήματα των στερεοτακτικών μεθόδων και συσκευών (π.χ. Cosman-Roberts-Wells (CRW) ή Leksell σύστημα) μπορούν να αποφευχθούν.Για να διενεργηθεί μια βιοψία εγκεφάλου, μια βελόνα βιοψίας πρέπει να εισαχθεί με ακρίβεια και ασφάλεια στον επιλεγμένο στόχο. Κατά συνέπεια, μια αξιόπιστη συσκευή στόχευσης (στερεοτακτική συσκευή ή σύστημα πλοήγησης) είναι απαραίτητη, όπως επίσης και μια συσκευή που να κρατάει σταθερά τη βελόνα στην προκαθορισμένη πορεία καθώς εισάγεται, π.χ. ένας οδηγός βελόνας προσαρτημένος στη στερεοτακτική συσκευή ή μια συσκευή τύπου mini πλαισίου.Σχετικά με τη Νευραλγία Τριδύμου (TGN), η διαδερμική συμπίεση με μπαλόνι (PBC) είναι μια πολύ αξιόπιστη τεχνική, που μαζί με τη θερμοπηξία με ραδιοσυχνότητες (RFT), είναι οι πιο αποτελεσματικές διαδερμικές μέθοδοι μακροπρόθεσμα. Επιπροσθέτως, χαρακτηρίζεται από σχετικά χαμηλότερη και ηπιότερη θνητότητα από ότι η μικροαγγειακή αποσυμπίεση και η RFT (16.1% εναντίον 29.2%), που επίσης περιλαμβάνει αποφυγή της «επώδυνης αναισθησίας» και της κερατίτιδας, ενώ είναι κατάλληλη και σε προσβολή του οφθαλμικού κλάδου. (Lopez, Hamlyn et al. 2004, Tatli, Satici et al. 2008, Toda 2008) Επιπλέον, οι ασθενείς δε χρειάζεται να συνεργαστούν, ενώ είναι υπό γενική αναισθησία αποφεύγοντας το άλγος και το stress. Παρόλα αυτά, αποτυχία εισαγωγής στο ωοειδές τρήμα (FO) (με οποιαδήποτε από τις διαδερμικές μεθόδους) χρησιμοποιώντας μόνο ακτινόσκοπηση είναι ένα σημαντικό πρόβλημα σε κάποιες περιπτώσεις, εξαιτίας διαφόρων αιτιών, π.χ. ανεπαρκής ακτινοσκοπική ανάδειξη του FO, παρουσία ανατομικών παραλλαγών (μικρότερο μέγεθος, ενδοτρηματικές οστικές ακρολοφίες ή οστεοποιημένος πτερυγοσπονδυλικός ή pterygoalar σύνδεσμος) ή στην περίπτωση της PBC, η ευρεία βελόνα τύπου Tuohy. Επιπρόσθετα, η έκθεση στην ακτινοβολία θα μπορούσε να είναι σημαντική για το χειρουργό, ενώ πολλαπλές προσπάθειες εισόδου στο FO θα μπορούσε να αυξήσει το κίνδυνο επιπλοκών. (Georgiopoulos, Ellul et al. 2014)Ο πρώτος σκοπός αυτής της διατριβής ήταν να συγκρίνει τα χαρακτηριστικά, δηλαδή αποτελεσματικότα, διάρκεια κάθε διαδικασίας, ασφάλεια και διάρκεια νοσηλείας, μιας μεθόδου βιοψίας εγκεφάλου χωρίς πλαίσιο ούτε fiducials (καθοδηγούμενη από πλοήγηση) με αυτά της τυπικής βασισμένης σε πλαίσιο στερεοτακτικής τεχνικής. Δεύτερο, σε αυτή τη διατριβή, προτείναμε επίσης μια εναλλακτική μέθοδο αντιμετώπισης: τη χρήση ενός οπτικού συστήματος πλοήγησης (StealthStation® S7™, Medtronic Inc., Minneapolis, MN, USA) για την καθοδήγηση της τεχνικής PBC για TGN, σε περιπτώσεις επανεπέμβασης, μετά από προηγούμενη αποτυχία εισόδου στο FO υπό ακτινοσκόπηση μόνο. Συνολικά, ο σκοπός της παρούσας διατριβής ήταν να εκτιμήσουμε την ανατομική ακρίβεια του συστήματος νευροπλοήγησης StealthStation σε νευροχειρουργικές επεμβάσεις, συγκεκριμένα σε επεμβάσεις βιοψίας εγκεφάλου και PBC, ελέγχοντας την αποτελεσματικότητα, την ακρίβεια στόχευσης και την ασφάλεια των επεμβάσεων καθοδηγούμενων από το σύστημα StealthStation, σε σύγκριση με τις αντίστοιχες κλασικές τεχνικές.Βιοψίες εγκεφάλου, Ασθενείς/Υλικό και Μέθοδος: Στην παρούσα προοπτική μελέτη κοόρτης συμμετείχαν 56 ενήλικες ασθενείς: 1) για του οποίους δεν υπήρξε οριστική διάγνωση με μη επεμβατικό τρόπο και οι οποίοι 2α) είχαν βλάβες σε εν τω βάθει ή κρίσιμες περιοχές ή πολυεστιακές βλάβες ή βλάβες για τις οποίες η πιθανή διάγνωση είναι αντένδειξη για…

Neurobiology of Pain, 2023

Asia pacific journal of clinical trials, 2017

During neurosurgical operations, the soft material of the brain, the cerebrospinal fluid (CSF), t... more During neurosurgical operations, the soft material of the brain, the cerebrospinal fluid (CSF), the opening of the skull's cavity, the opening of the dura mater, the CSF loss along with gravity and other factors make the brain susceptible to the brain-shift phenomenon (displacement of the brain in relation with its natural position captured during imaging acquisition). As a result, after some point of the operation the neurosurgeon cannot really rely on the navigation system's guidance. The navigational inaccuracies caused by the brain-shift phenomenon and the demand for updated intraoperative imaging acquisition aiming to increase accuracy and reliability led to the development of intraoperative imaging systems. Such systems are the intraoperative ultrasound device, and the intraoperative computed tomography (ioCT) or magnetic resonance imaging (ioMRI) scanners. Each system is characterized by its own advantages and disadvantages, which are described in the present review. As a conclusion, intraoperative imaging systems provide very important advantages in various types of operations by updating the imaging scan. However, their benefit is unclear in some instances, while ioCT and especially ioMRI are associated with huge costs affordable only by specific hospitals worldwide.

Journal of Neurolinguistics, May 1, 2017

Objectives: Investigation of potential differences in both perception and expression of emotional... more Objectives: Investigation of potential differences in both perception and expression of emotional prosody between the stimulation and non-stimulation state of Parkinson's disease (PD) patients treated with subthalamic nucleus Deep Brain Stimulation (STN-DBS). Materials and methods: A group of 16 PD patients were studied for two distinct research tasks. In the first one (estimation of prosody perception), a battery of words/sentences recorded by a professional announcer was administered to them in STN-DBS-on state and they were asked to select the correct prosody each time. The procedure was repeated in the STN-DBS-off state. In the second task (estimation of prosody expression), the patients were given a second battery of recordings using the same words and sentences but in different prosody and were asked to reproduce the prosody they heard, again in STN-DBSon/off states. Their recorded voice was later given to 50 healthy control listeners, aware of the target prosody, who evaluated the patients' ability to correctly reproduce the prosody using a 6-point scale. Results: The overall performance of the PD participants in the perception of prosody task was 45.3% and 49.8% for the DBS-on and DBS-off state respectively (p ¼ 0.173). The specific percentages of correct perception of different types of prosody ranged from 31.3% to 62.5% and did not differ significantly between the DBS states. The rates of misclassifications were not consistently in favor of DBS-on or DBS-off state. Prosody expression in DBS-off state was rated by normal listeners as better compared to the DBS-οn state. Conclusions: Regarding prosody perception, no significant differences were found either in the overall performance of PD patients or in the prosody-specific correct classification rates. However, particular stimulation states favor different misclassification directions. DBS-on state negatively influences the expression of emotional prosody in the speech of patients with Parkinson's disease.

Brain and spine, May 1, 2024

Childs Nervous System, Jun 24, 2023

ISRN Neurology (Print), Mar 9, 2014

Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medical... more Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient's forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.

The Spine Journal, Aug 1, 2022

Lancet Oncology, Jul 1, 2022

Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS)... more Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS) decision-making framework for the treatment of patients with spinal metastatic disease. Despite this importance, emerging evidence relating systemic considerations to clinical outcomes following surgery for spinal metastatic disease has not been comprehensively summarised. We aimed to conduct a scoping literature review of this broad topic. We searched MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL databases from Jan 1, 2000, to July 31, 2021. 61 articles were included, accounting for a total of 22 335 patients. Preoperative systemic variables negatively associated with postoperative clinical outcomes included demographics (eg, older age [>60 years], Black race, male sex, low or elevated body-mass index, and smoking status), medical comorbidities (eg, cardiac, pulmonary, hepatic, renal, endocrine, vascular, and rheumatological), biochemical abnormalities (eg, hypoalbuminaemia, atypical blood cell counts, and elevated C-reactive protein concentration), low muscle mass, generalised motor weakness (American Spinal Cord Injury Association Impairment Scale grade and Frankel grade) and poor ambulation, reduced performance status, and systemic disease burden. This is the first comprehensive scoping review to broadly summarise emerging evidence relevant to the systemic assessment component of the widely used NOMS framework for spinal metastatic disease decision making. Medical, surgical, and radiation oncologists can consider these findings when prognosticating spinal metastatic disease-related surgical outcomes on the basis of patients’ systemic condition. These factors might inform a shared decision-making approach with patients and their families.

Journal of neurosurgery, Mar 1, 2023

OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD).... more OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess frailty in SMD. METHODS The AO Spine Knowledge Forum Tumor conducted an international cross-sectional survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to capture preoperative surrogate markers of frailty and relevant postoperative clinical outcomes in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. RESULTS Results were analyzed for 359 respondents, with an 87% completion rate. Study participants represented 71 countries. In the clinical setting, most respondents informally assess frailty and cognition in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained among respondents regarding the association between 14 preoperative clinical variables and frailty. Severe comorbidities, extensive systemic disease burden, and poor performance status were most associated with frailty. Severe comorbidities associated with Survey Administration Voluntary survey responses were anonymously collected using SurveyMonkey. No financial incentive was provided. Participation in the survey was considered consent for enrollment in the study. The survey was distributed by frailty included high-risk cardiopulmonary disease, renal failure, liver failure, and malnutrition. The most clinically relevant outcomes were major complications, neurological recovery, and change in performance status. CONCLUSIONS The respondents recognized that frailty is important, but they most commonly evaluate it based on general clinical impressions rather than using existing frailty tools. The authors identified numerous preoperative surrogate markers of frailty and postoperative clinical outcomes that spine surgeons perceived as most relevant in this population.

Childs Nervous System, Jun 24, 2023

ISRN Neurology (Print), Mar 9, 2014

Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medical... more Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient's forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.

The Spine Journal, Aug 1, 2022

Lancet Oncology, Jul 1, 2022

Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS)... more Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS) decision-making framework for the treatment of patients with spinal metastatic disease. Despite this importance, emerging evidence relating systemic considerations to clinical outcomes following surgery for spinal metastatic disease has not been comprehensively summarised. We aimed to conduct a scoping literature review of this broad topic. We searched MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL databases from Jan 1, 2000, to July 31, 2021. 61 articles were included, accounting for a total of 22 335 patients. Preoperative systemic variables negatively associated with postoperative clinical outcomes included demographics (eg, older age [>60 years], Black race, male sex, low or elevated body-mass index, and smoking status), medical comorbidities (eg, cardiac, pulmonary, hepatic, renal, endocrine, vascular, and rheumatological), biochemical abnormalities (eg, hypoalbuminaemia, atypical blood cell counts, and elevated C-reactive protein concentration), low muscle mass, generalised motor weakness (American Spinal Cord Injury Association Impairment Scale grade and Frankel grade) and poor ambulation, reduced performance status, and systemic disease burden. This is the first comprehensive scoping review to broadly summarise emerging evidence relevant to the systemic assessment component of the widely used NOMS framework for spinal metastatic disease decision making. Medical, surgical, and radiation oncologists can consider these findings when prognosticating spinal metastatic disease-related surgical outcomes on the basis of patients’ systemic condition. These factors might inform a shared decision-making approach with patients and their families.

Journal of neurosurgery, Mar 1, 2023

OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD).... more OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess frailty in SMD. METHODS The AO Spine Knowledge Forum Tumor conducted an international cross-sectional survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to capture preoperative surrogate markers of frailty and relevant postoperative clinical outcomes in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. RESULTS Results were analyzed for 359 respondents, with an 87% completion rate. Study participants represented 71 countries. In the clinical setting, most respondents informally assess frailty and cognition in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained among respondents regarding the association between 14 preoperative clinical variables and frailty. Severe comorbidities, extensive systemic disease burden, and poor performance status were most associated with frailty. Severe comorbidities associated with Survey Administration Voluntary survey responses were anonymously collected using SurveyMonkey. No financial incentive was provided. Participation in the survey was considered consent for enrollment in the study. The survey was distributed by frailty included high-risk cardiopulmonary disease, renal failure, liver failure, and malnutrition. The most clinically relevant outcomes were major complications, neurological recovery, and change in performance status. CONCLUSIONS The respondents recognized that frailty is important, but they most commonly evaluate it based on general clinical impressions rather than using existing frailty tools. The authors identified numerous preoperative surrogate markers of frailty and postoperative clinical outcomes that spine surgeons perceived as most relevant in this population.

Clinical Neurology and Neurosurgery, May 1, 2010

Meige's syndrome is a rare form of segmental dyst... more Meige's syndrome is a rare form of segmental dystonia characterized by blepharospasm and oromandibular dystonia. Medical treatment including botulinum toxin injections usually present disappointing results. The experience on Deep Brain Stimulation (DBS) in the treatment of Meige's syndrome and other segmental dystonias is still limited. At the moment, only a few cases of pallidal DBS have been reported to improve this rare form of dystonia. We report on a case of a woman with a 7-year history of Meige's syndrome, which rendered her functionally blind. The treatment with botulinum toxin injections failed to improve her symptoms, whereas stereotactic bilateral DBS of the pallidum led to a dramatic clinical improvement. Clinical assessment using the Burke-Fahn-Mardsen Dystonia Rating Scale (BFMDRS) in a double-blind manner, showed an improvement of 70% in the Movement score and 93.33% in the Disability score (84% reduction of the total score) on the 3 and 6 month follow-up. Stereotactic pallidal DBS might be considered as a potential treatment in the management of Meige's syndrome.

Journal of Trauma-injury Infection and Critical Care, Oct 1, 2010

Background: The prevalence of postconcussion syndrome (PCS) in the first weeks after mild traumat... more Background: The prevalence of postconcussion syndrome (PCS) in the first weeks after mild traumatic brain injury varies from 40% to 80%. However, as many as 50% of patients report symptoms for up to 3 months and 10% to 15% for more than a year. The objective of this study is to analyze the characteristics and estimate the prevalence of PCS in an adult Greek population. Methods: This prospective study was performed in the University Hospital of Patras in Western Greece. Patients with mild traumatic brain injury (n ϭ 539) were randomly recruited on admission between May 2006 and May 2008. Overall, 223 patients (223 of 539, 41.5%) met the Colorado Medical Society guidelines for concussion; 141 men (63%) and 82 women (37%) with a median age of 30 years (range, 18.5-57.5 years) were included in the study. Patient follow-up consisted of telephone interviews at 1 month, 3 months, and 6 months postinjury, when they were asked about experiencing common postconcussion symptoms (International Classification of Diseases-10th revision criteria). Results: The rate of PCS at 1 month, 3 months, and 6 months postinjury was estimated to be 10.3%, 6%, and 0.9%, respectively. The syndrome was more frequent among women (17%) and individuals with bleeding diathesis (26%) compared with men (6.4%) and patients without clotting disorders (8.5%), respectively. In addition, higher rates of PCS affected patients who sustained assaults compared with other types of accidents. Conclusions: The prevalence of PCS was remarkably higher in previous studies. Cultural differences regarding symptom expectation and the lack of compensation might explain the low rate of chronic symptoms in Greeks.

Global Spine Journal, Mar 26, 2021

Study Design: Systematic review. Objectives: Adult spinal deformity (ASD) can be a debilitating c... more Study Design: Systematic review. Objectives: Adult spinal deformity (ASD) can be a debilitating condition with a profound impact on patients’ health-related quality of life (HRQoL). Many reports have suggested that the frailty status of a patient can have a significant impact on the outcome of the surgery. The present review aims to identify all pre-operative patient-specific frailty markers that are associated with postoperative outcomes following corrective surgery for ASD of the lumbar and thoracic spine. Methods: A systematic review of the literature was performed to identify findings regarding pre-operative markers of frailty and their association with postoperative outcomes in patients undergoing ASD surgery of the lumbar and thoracic spine. The search was performed in the following databases: PubMed, Embase, Cochrane and CINAHL. Results: An association between poorer performance on frailty scales and worse postoperative outcomes. Comorbidity indices were even more frequently employed with similar patterns of association between increased comorbidity burden and postoperative outcomes. Regarding the assessment of HRQoL, worse pre-operative ODI, SF-36, SRS-22 and NRS were shown to be predictors of post-operative complications, while ODI, SF-36 and SRS-22 were found to improve post-operatively. Conclusions: The findings of this review highlight the true breadth of the concept of “frailty” in ASD surgical correction. These parameters, which include frailty scales and various comorbidity and HRQoL indices, highlight the importance of identifying these factors preoperatively to ensure appropriate patient selection while helping to limit poor postoperative outcomes.

European Spine Journal, Apr 19, 2023

Η τεχνική της στερεοταξίας ήταν η πρώτη καλά τεκμηριωμένη και παραδοσιακά η “gold standard” μέθοδ... more Η τεχνική της στερεοταξίας ήταν η πρώτη καλά τεκμηριωμένη και παραδοσιακά η “gold standard” μέθοδος στόχευσης ενδοκράνιων δομών. Η εκτενής βελτίωση των στερεοτακτικών συσκευών μαζί με την ανάπτυξη της Μαγνητικής Τομογραφίας (MRI) τη δεκαετία του 90 και ένας μεγάλος αριθμός σχετικών μελετών με σταθερά αποτελέσματα καθιέρωσαν τη στερεοτακτική βιοψία εγκεφάλου βασισμένη σε πλαίσιο ως τη “gold standard” τεχνική και για τις βιοψίες εγκεφάλου. (Hall 1998, Yu, Liu et al. 2000, Heper, Erden et al. 2005) Παρόλα αυτά, η στερεοτακτική μέθοδος χαρακτηρίζεται από διάφορα σημαντικά μειονεκτήματα: 1) τη δυσανεξία εκ μέρους του ασθενή, 2) την αναγκαιότητα νέας λήψης Αξονικής τομογραφίας (CT)/MRI άμεσα προεγχειρητικά, 3) την απαίτηση υπολογισμού και επαλήθευσης των συντεταγμένων, 4) τα πλαίσια κεφαλής αυτά καθεαυτά, που μπορεί να εμποδίζουν τόσο τον αναισθησιολόγο όσο και τον χειρουργό, και 5) το γεγονός ότι τα δείγματα βιοψίας δύναται να ληφθούν διεγχειρητικά μόνο από τους στόχους που ορίστηκαν προεγχειρητικά. (Goldstein, Gumerlock et al. 1987, Matsumoto, Tomita et al. 1995, Lozano, Gildenberg et al. 2009, Shooman, Belli et al. 2010)Τα σύγχρονα συστήματα πλοήγησης προσφέρουν διάφορα σημαντικά πλεονεκτήματα, π.χ. ανακατασκευές εικόνων διαφόρων όψεων (π.χ. εγκάρσια, στεφανιαία, οβελιαία και «κορυφής καθετήρα») και τρισδιάστατο προ- και δι-εγχειρητικό προγραμματισμό, πραγματικού χρόνου διεγχειρητική καθοδήγηση των χειρουργικών εργαλείων και ακριβή εντόπιση ενδοκράνιων στόχων. (Bale, Laimer et al. 2006, Georgiopoulos, Ellul et al. 2014) Επιπλέον, στην περίπτωση των βιοψιών εγκεφάλου συνδυάζονται με συσκευές τύπου mini πλαισίου. Ως αποτέλεσμα, τα διάφορα μειονεκτήματα των στερεοτακτικών μεθόδων και συσκευών (π.χ. Cosman-Roberts-Wells (CRW) ή Leksell σύστημα) μπορούν να αποφευχθούν.Για να διενεργηθεί μια βιοψία εγκεφάλου, μια βελόνα βιοψίας πρέπει να εισαχθεί με ακρίβεια και ασφάλεια στον επιλεγμένο στόχο. Κατά συνέπεια, μια αξιόπιστη συσκευή στόχευσης (στερεοτακτική συσκευή ή σύστημα πλοήγησης) είναι απαραίτητη, όπως επίσης και μια συσκευή που να κρατάει σταθερά τη βελόνα στην προκαθορισμένη πορεία καθώς εισάγεται, π.χ. ένας οδηγός βελόνας προσαρτημένος στη στερεοτακτική συσκευή ή μια συσκευή τύπου mini πλαισίου.Σχετικά με τη Νευραλγία Τριδύμου (TGN), η διαδερμική συμπίεση με μπαλόνι (PBC) είναι μια πολύ αξιόπιστη τεχνική, που μαζί με τη θερμοπηξία με ραδιοσυχνότητες (RFT), είναι οι πιο αποτελεσματικές διαδερμικές μέθοδοι μακροπρόθεσμα. Επιπροσθέτως, χαρακτηρίζεται από σχετικά χαμηλότερη και ηπιότερη θνητότητα από ότι η μικροαγγειακή αποσυμπίεση και η RFT (16.1% εναντίον 29.2%), που επίσης περιλαμβάνει αποφυγή της «επώδυνης αναισθησίας» και της κερατίτιδας, ενώ είναι κατάλληλη και σε προσβολή του οφθαλμικού κλάδου. (Lopez, Hamlyn et al. 2004, Tatli, Satici et al. 2008, Toda 2008) Επιπλέον, οι ασθενείς δε χρειάζεται να συνεργαστούν, ενώ είναι υπό γενική αναισθησία αποφεύγοντας το άλγος και το stress. Παρόλα αυτά, αποτυχία εισαγωγής στο ωοειδές τρήμα (FO) (με οποιαδήποτε από τις διαδερμικές μεθόδους) χρησιμοποιώντας μόνο ακτινόσκοπηση είναι ένα σημαντικό πρόβλημα σε κάποιες περιπτώσεις, εξαιτίας διαφόρων αιτιών, π.χ. ανεπαρκής ακτινοσκοπική ανάδειξη του FO, παρουσία ανατομικών παραλλαγών (μικρότερο μέγεθος, ενδοτρηματικές οστικές ακρολοφίες ή οστεοποιημένος πτερυγοσπονδυλικός ή pterygoalar σύνδεσμος) ή στην περίπτωση της PBC, η ευρεία βελόνα τύπου Tuohy. Επιπρόσθετα, η έκθεση στην ακτινοβολία θα μπορούσε να είναι σημαντική για το χειρουργό, ενώ πολλαπλές προσπάθειες εισόδου στο FO θα μπορούσε να αυξήσει το κίνδυνο επιπλοκών. (Georgiopoulos, Ellul et al. 2014)Ο πρώτος σκοπός αυτής της διατριβής ήταν να συγκρίνει τα χαρακτηριστικά, δηλαδή αποτελεσματικότα, διάρκεια κάθε διαδικασίας, ασφάλεια και διάρκεια νοσηλείας, μιας μεθόδου βιοψίας εγκεφάλου χωρίς πλαίσιο ούτε fiducials (καθοδηγούμενη από πλοήγηση) με αυτά της τυπικής βασισμένης σε πλαίσιο στερεοτακτικής τεχνικής. Δεύτερο, σε αυτή τη διατριβή, προτείναμε επίσης μια εναλλακτική μέθοδο αντιμετώπισης: τη χρήση ενός οπτικού συστήματος πλοήγησης (StealthStation® S7™, Medtronic Inc., Minneapolis, MN, USA) για την καθοδήγηση της τεχνικής PBC για TGN, σε περιπτώσεις επανεπέμβασης, μετά από προηγούμενη αποτυχία εισόδου στο FO υπό ακτινοσκόπηση μόνο. Συνολικά, ο σκοπός της παρούσας διατριβής ήταν να εκτιμήσουμε την ανατομική ακρίβεια του συστήματος νευροπλοήγησης StealthStation σε νευροχειρουργικές επεμβάσεις, συγκεκριμένα σε επεμβάσεις βιοψίας εγκεφάλου και PBC, ελέγχοντας την αποτελεσματικότητα, την ακρίβεια στόχευσης και την ασφάλεια των επεμβάσεων καθοδηγούμενων από το σύστημα StealthStation, σε σύγκριση με τις αντίστοιχες κλασικές τεχνικές.Βιοψίες εγκεφάλου, Ασθενείς/Υλικό και Μέθοδος: Στην παρούσα προοπτική μελέτη κοόρτης συμμετείχαν 56 ενήλικες ασθενείς: 1) για του οποίους δεν υπήρξε οριστική διάγνωση με μη επεμβατικό τρόπο και οι οποίοι 2α) είχαν βλάβες σε εν τω βάθει ή κρίσιμες περιοχές ή πολυεστιακές βλάβες ή βλάβες για τις οποίες η πιθανή διάγνωση είναι αντένδειξη για…

Neurobiology of Pain, 2023

Asia pacific journal of clinical trials, 2017

During neurosurgical operations, the soft material of the brain, the cerebrospinal fluid (CSF), t... more During neurosurgical operations, the soft material of the brain, the cerebrospinal fluid (CSF), the opening of the skull's cavity, the opening of the dura mater, the CSF loss along with gravity and other factors make the brain susceptible to the brain-shift phenomenon (displacement of the brain in relation with its natural position captured during imaging acquisition). As a result, after some point of the operation the neurosurgeon cannot really rely on the navigation system's guidance. The navigational inaccuracies caused by the brain-shift phenomenon and the demand for updated intraoperative imaging acquisition aiming to increase accuracy and reliability led to the development of intraoperative imaging systems. Such systems are the intraoperative ultrasound device, and the intraoperative computed tomography (ioCT) or magnetic resonance imaging (ioMRI) scanners. Each system is characterized by its own advantages and disadvantages, which are described in the present review. As a conclusion, intraoperative imaging systems provide very important advantages in various types of operations by updating the imaging scan. However, their benefit is unclear in some instances, while ioCT and especially ioMRI are associated with huge costs affordable only by specific hospitals worldwide.

Journal of Neurolinguistics, May 1, 2017

Objectives: Investigation of potential differences in both perception and expression of emotional... more Objectives: Investigation of potential differences in both perception and expression of emotional prosody between the stimulation and non-stimulation state of Parkinson's disease (PD) patients treated with subthalamic nucleus Deep Brain Stimulation (STN-DBS). Materials and methods: A group of 16 PD patients were studied for two distinct research tasks. In the first one (estimation of prosody perception), a battery of words/sentences recorded by a professional announcer was administered to them in STN-DBS-on state and they were asked to select the correct prosody each time. The procedure was repeated in the STN-DBS-off state. In the second task (estimation of prosody expression), the patients were given a second battery of recordings using the same words and sentences but in different prosody and were asked to reproduce the prosody they heard, again in STN-DBSon/off states. Their recorded voice was later given to 50 healthy control listeners, aware of the target prosody, who evaluated the patients' ability to correctly reproduce the prosody using a 6-point scale. Results: The overall performance of the PD participants in the perception of prosody task was 45.3% and 49.8% for the DBS-on and DBS-off state respectively (p ¼ 0.173). The specific percentages of correct perception of different types of prosody ranged from 31.3% to 62.5% and did not differ significantly between the DBS states. The rates of misclassifications were not consistently in favor of DBS-on or DBS-off state. Prosody expression in DBS-off state was rated by normal listeners as better compared to the DBS-οn state. Conclusions: Regarding prosody perception, no significant differences were found either in the overall performance of PD patients or in the prosody-specific correct classification rates. However, particular stimulation states favor different misclassification directions. DBS-on state negatively influences the expression of emotional prosody in the speech of patients with Parkinson's disease.