Eleftherios Archavlis | Johannes Gutenberg-Universität Mainz (original) (raw)

Papers by Eleftherios Archavlis

Die supratentorielle dekompressive Kraniektomie mit Eröffnung und Erweiterungsplastik der Dura ma... more Die supratentorielle dekompressive Kraniektomie mit Eröffnung und Erweiterungsplastik der Dura mater ist heutzutage eine wichtige Therapiemaßnahme in der Behandlung des konservativ nicht kontrollierbaren Hirndrucks. Unter Kranioplastik versteht man den chirurgischen Verschluss des entstandenen Knochendefekts zum Schutz des direkt unter der Kopfhaut liegenden Gehirns, zur ästhetischen Wiederherstellung der Konturen sowie zur Verbesserung einer neurologischen Symptomatik („syndrome of the trephined“). In der vorliegenden Arbeit werden die Daten von insgesamt 242 Patienten, die einer Kranioplastik unterzogen worden waren, retrospektiv analysiert. Die Patienten wurden im Zeitraum 2001-2008 in der neurochirurgischen Abteilung der Städtischen Kliniken Frankfurt am Main-Höchst operiert. Um Aufschluss über das postoperative, funktionelle und kosmetische Ergebnis zu erhalten, wurde im Anschluss an die Aktenauswertung bei diesen Patienten eine telefonische Befragung durchgeführt. Ziel der Arb...

Neurosurgical Review, 2022

Resection of complex falcotentorial meningiomas, growing along the pineal region (PR), and poster... more Resection of complex falcotentorial meningiomas, growing along the pineal region (PR), and posterior incisural space (PIS) represents a neurosurgical challenge. Here, we present our strategy for effective resection of large falcotentorial meningiomas applying a paramedian supracerebellar infratentorial and interhemispheric occipital transtentorial approach in staged surgeries. We further systematically compared the effectiveness of midline (MSIA) and paramedian (PSIA) supracerebellar infratentorial, as well as interhemispheric occipital transtentorial approaches (IOTA) to operate along the PR and PIS in 8 cadaveric specimens. The staged PSIA and IOTA enabled successful resection of both falcotentorial meningiomas with an uneventful postoperative course. In our anatomo-morphometrical study, superficial vermian veins at an average depth of 11.38 ± 1.5 mm and the superior vermian vein (SVV) at 54.13 ± 4.12 mm limited the access to the PIS during MSIA. MSIA required sacrifice of these v...

Objective: Minimally invasive spine (MIS) procedures are increasingly being recognized as equival... more Objective: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however,[for full text, please go to the a.m. URL]

Objective: The occipitocervical region poses an anatomical dilemma, given the presence of the V3 ... more Objective: The occipitocervical region poses an anatomical dilemma, given the presence of the V3 segment of the vertebral artery (VA) when performing posterolateral approaches to the odontoid process in cases of pseudarthrosis, tumor or rheumatoid pannus. In such cases, a novel minimally invasive dorsolateral,[for full text, please go to the a.m. URL]

Neurosurgery, 2017

INTRODUCTION Surgical education has hitherto relied heavily on the age-old acute;see one, do onea... more INTRODUCTION Surgical education has hitherto relied heavily on the age-old acute;see one, do oneacute; paradigm. Factors such as traineesacute; decreased OR exposure due to worktime directives have put this paradigm to the test. The improvement of surgical skills in simulation laboratories has been touted as a possible solution and adopted in disciplines such as general surgery. We investigated the efficacy of a simulation curriculum on skill acquisition of a neurosurgical procedure (EVD-placement) by means of a single-blinded RCT. METHODS The Simulation Efficacy in Neurosurgical Education (SENSE) trial is a single-blinded RCT with two arms. Recruits to Arm A underwent simulation training (software and cadaver-based), after which they attempted to place an EVD on a plastic skull model. Recruits to the control Arm B witnessed the placement of an EVD by an experienced surgeon, after which attempted the EVD placement. The time needed to undertake the procedure and the accuracy of cathe...

Journal of Contemporary Brachytherapy, 2019

Purpose: To report our results of image-guided interstitial (IRT) high-dose-rate (HDR) brachyther... more Purpose: To report our results of image-guided interstitial (IRT) high-dose-rate (HDR) brachytherapy (BRT) in the primary treatment of patients with inoperable glioblastoma multiforme (GBM) in the pre-temozolomide period. Material and methods: Between 1994 and 2004, 17 patients were treated with HDR BRT for inoperable GBM. Of those, only 11 patients were treated with IRT BRT, and the remaining six patients received combined IRT BRT and external beam radiotherapy (EBRT). Patient's median age was 59.3 years (range, 29-83 years) and median tumor volume was 39.3 cm 3 (range, 2-162 cm 3). The prescribed HDR dose was median 40 Gy (range, 30-40 Gy), delivered twice daily in 5.0 Gy fractions over four consecutive days. Survival from BRT, toxicity as well as the impact of several prognostic factors was evaluated. Results: At a median follow-up of 9.3 months, the median overall survival for the whole population, after BRT alone, and combined BRT with EBRT was 9.3, 7.3, and 10.1 months, respectively. Of the prognostic variables evaluated in univariate analysis, i.e., age, Karnofsky performance score, BRT dose, and tumor volume, only the latter one reached statistical significance. Two patients (11.7%) developed treatment-associated adverse events, with one (5.8%) symptomatic radionecrosis and one (5.8%) severe convulsion episode, respectively. Conclusions: For patients with inoperable GBM, IRT HDR BRT alone or in combination with EBRT is a safe and effective irradiation method providing palliation without excessive toxicity.

Surgical Neurology International, 2018

How to cite this article: Sponton LE, Ayyad A, Archavlis E, Ringel FA. Unique case of trigeminal ... more How to cite this article: Sponton LE, Ayyad A, Archavlis E, Ringel FA. Unique case of trigeminal neuralgia due to Epstein-Barr-virus-associated B-cell lymphomatoid granulomatosis of the Meckel's cave and cavernous sinus: Important clinical and therapeutic implications. Surg Neurol Int 2018;9:148. http://surgicalneurologyint.com/Unique-case-of-trigeminal-neuralgia-due-to-Epstein-Barr-virus-associated-B-cell-lymphomatoid-granulomatosis-of-the-Meckel's-cave-andcavernous-sinus:-Important-clinical-and-therapeutic-implications/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Neurosurgical Review, 2018

Ipsilateral approaches remain the standard technique for clipping paraclinoid aneurysms. Surgeons... more Ipsilateral approaches remain the standard technique for clipping paraclinoid aneurysms. Surgeons must however be prepared to deal with bony and neural structures restricting accessibility. The application of a contralateral approach has been proposed claiming that some structures in the region can be better exposed from this side. Yet, only few case series have been published evaluating this approach, and there is a lack of systematic reviews assessing its specific advantages and disadvantages. We performed a structured literature search and identified 19 relevant publications summarizing 138 paraclinoid aneurysms operated via a contralateral approach. Patient's age ranged from 19 to 79 years. Aneurysm size mainly varied between 2 and 10 mm and only three articles reported larger aneurysms. Most aneurysms were located at the origin of the ophthalmic artery, followed by the superior hypophyseal artery and carotid cave. All aneurysm protruded from the medial aspect of the carotid artery. Interestingly, minimal or even no optic nerve mobilization was required during exposure from the contralateral side. Strategies to achieve proximal control of the carotid artery were balloon occlusion and clinoid segment or cervical carotid exposure. Successful aneurysm occlusion was achieved in 135 cases, while 3 ophthalmic aneurysms had to be wrapped only. Complications including visual deterioration, CSF fistula, wound infection, vasospasm, artery dissection, infarction, and anosmia occurred in a low percentage of cases. We conclude that a contralateral approach can be effective and should be considered for clipping carefully selected cases of unruptured aneurysms arising from medial aspects of the above listed vessels.

Journal of Neurological Surgery Part B: Skull Base, 2018

Objective The aim of this study was to compare tentorial incision (group A) versus retraction and... more Objective The aim of this study was to compare tentorial incision (group A) versus retraction and tack up suture (group B) of the tentorial edge during the subtemporal approach for surgery in the high basilar region. Design 24 cadaveric dissections and 4 clinical cases of aneurysms of the high basilar region are presented. Assessment included visibility and operability afforded by either tentorial incision creating a dural flap (group A) or retraction of the tentorial edge and tethering with a suture (group B). Four patients, two with superior cerebellar artery aneurysms and two with proximal posterior cerebral artery aneurysms were treated with each approach. Results In the quantitative evaluations, we found no significant difference in the exposure of the posterior cerebral, superior cerebellar, and perforant arteries as well as surgical working area provided by either approach. However, tentorial incision allowed a significantly greater exposure of the basilar artery and the four...

Acta neurochirurgica, 2016

Blister-like aneurysms of the internal carotid artery (ICA) present a severe therapeutical challe... more Blister-like aneurysms of the internal carotid artery (ICA) present a severe therapeutical challenge. While several reconstructive techniques are in use in case of acute rupture sacrifice of the parent vessel may be required. We present a combined technique of micro-sutures and clip application to repair the parent vessel in an intraoperatively ruptured blister-like aneurysm. Following temporary trapping of an intraoperatively ruptured 7-mm blister-like aneurysm four 8-0 nylon sutures were applied to adapt the vessel walls and support the branches of subsequently applied mini-clips. The combination of micro-sutures and mini-clips might be a valuable alternative to direct clipping or suturing in some cases with intraoperative rupture of blister-like aneurysms.

Journal of Neurological Surgery Part A: Central European Neurosurgery, 2017

Background Minimally invasive pedicle screw placement may have a higher incidence of violation of... more Background Minimally invasive pedicle screw placement may have a higher incidence of violation of the superior cephalad unfused facet joint. Study Aims We investigated the incidence and risk factors of upper facet joint violation in percutaneous robot-assisted instrumentation versus percutaneous fluoroscopy-guided and open transpedicular instrumentation. Methods A retrospective study including all consecutive patients who underwent lumbar instrumentation, fusion, and decompression for spondylolisthetic stenosis and degenerative disk disease was conducted between January 2012 and January 2016. All operations were performed by the same surgeon; the patients were divided into three groups according to the method of instrumentation. Group 1 involved the robot-assisted instrumentation in 58 patients, group 2 consisted of 64 patients treated with a percutaneous transpedicular instrumentation using fluoroscopic guidance, and 72 patients in group 3 received an open midline approach for pedi...

Case reports in oncology

Intracranial glioblastoma multiforme (GBM) constitutes the most frequent and unfortunately aggres... more Intracranial glioblastoma multiforme (GBM) constitutes the most frequent and unfortunately aggressive primary central nervous system malignancy. Despite the high tendency of these tumors to show local relapse within the brain after primary therapy, dissemination into the spinal axis is an infrequent event. If spinal metastases occur they are leptomeningeal in the vast majority of cases and always in the context of intracranial progressive disease. Spinal intramedullary metastases of intracranial GBM have rarely been described to date. We report the unique case of a young woman with subacute progressive paraparesis due to spinal intramedullary metastases of a temporal lobe GBM despite the remarkable absence of intracranial tumor relapse. The patient had undergone gross total resection of a left temporal GBM in contact with the ventricles and cisternal space followed by radio- and chemotherapy 13 months before. At the moment of diagnosis of spinal intramedullary metastases, there were...

Journal of Neurosurgery: Spine, 2017

OBJECTIVE The goal of this study was to demonstrate the clinical and technical nuances of a minim... more OBJECTIVE The goal of this study was to demonstrate the clinical and technical nuances of a minimally invasive, dorsolateral, tubular approach for partial odontoidectomy, autologous bone augmentation, and temporary C1–2 fixation to treat dens pseudarthrosis. METHODS A cadaveric feasibility study, a 3D virtual reality reconstruction study, and the subsequent application of this approach in 2 clinical cases are reported. Eight procedures were completed in 4 human cadavers. A minimally invasive, dorsolateral, tubular approach for odontoidectomy was performed with the aid of a tubular retraction system, using a posterolateral incision and an oblique approach angle. Fluoroscopy and postprocedural CT, using 3D volumetric averaging software, were used to evaluate the degree of bone removal of C1–2 lateral masses and the C-2 pars interarticularis. Two clinical cases were treated using the approach: a 23-year-old patient with an odontoid fracture and pseudarthrosis, and a 35-year-old patient...

Journal of Minimally Invasive Orthopedics, 2016

Study design: Retrospective review of prospectively collected data. Background: There is no conse... more Study design: Retrospective review of prospectively collected data. Background: There is no consensus regarding the ideal approach for corpectomy in destructive metastatic thoracolumbar spine disease. Many surgical techniques have been described but none has proved its definite superiority. The main drawback of these procedures is directly related to the morbidity of the approach. As one-stage minimally invasive pedicle screw fixation combined with mini-open posterolateral transpedicular corpectomy for treatment of thoracolumbar metastatic lesions is gaining popularity, its efficacy has yet to be established. Purpose: The purpose of this study is to report operative data, clinical and radiological outcomes of patients undergoing minimally invasive stabilization, decompression, transpedicular corpectomy and anterior column reconstruction of thoracolumbar metastatic disease at our institutions. Methods: Forty patients underwent minimally invasive pedicle screws stabilization, mini open decompression and transpedicular corpectomy for treatment of single-level metastatic destruction of the thoracic or lumbar spine. All patients were neurologically intact. There were 19 males and 21 females with an average age of 58 years. Results: The mean follow-up was 17 months (7—2 1 months). The mean operative time was 256 min (230-390 min) and the mean blood loss was 1350 mL. VAS was significantly improved from 6.7 to 0.7 at last follow-up. Vertebral kyphosis decreased by 16◦ to 7.8◦ postoperatively (P < 0.001). Local kyphosis and percentage of collapse were also significantly improved from 8◦ to 5.6◦ and from 35% to 16% at last follow-up. No patient worsened his or her neurological condition postoperatively. Conclusion: Minimally invasive transpedicular corpectomy seems to be a safe and effective technique to manage thoracolumbar fractures without neurological impairment.

World neurosurgery, Jan 20, 2016

The main difficulties of transpedicular corpectomies is lack of space for vertebral body replacem... more The main difficulties of transpedicular corpectomies is lack of space for vertebral body replacement in the neighborhood of critical structures, the necessity for sacrifice of nerve roots in the thoracic spine and the extent of hemorrhage due to venous epidural bleeding. We present a modified technique of transpedicular corpectomy by using an endoscopic assisted microsurgical technique performed through a single posterior approach. A 3D preoperative reconstruction could be helpful in preoperative planning for this complex anatomical region. Surface and volume 3D reconstruction were performed by Amira or the Dextroscope. The clinical experience of this study includes 7 cases, two with an unstable burst fracture and five with metastatic destructive vertebral body disease, all with significant retropulsion and obstruction of the spinal canal. We performed a comparison with a conventional cohort of transpedicular thoracic corpectomies. Qualitative parameters of the 3D virtual reality pl...

Journal of Spine, 2013

Object: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent... more Object: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures in combination with minimally invasive transforaminal interbody fusion (MI-TLIF) and percutaneous pedicle screw insertion are effective in complex cases of stenotic degenerative spondylolisthesis with severe facet joint osteoarthritis (FJO). Methods: This study retrospectively reviewed all patients who underwent lumbar instrumentation, fusion and decompression for degenerative spondylolisthesis with severe stenosis and facet joint osteoarthritis (FJO) between June 2010 and June 2011. Blood loss, operative time and intraoperative complications were assessed in all surgically treated patients who were treated with MIS decompression, MI-TLIF and percutaneous transpedicular instrumentation. Clinical outcome was measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back pain, leg pain, and activity level. Satisfaction was assessed with VAS for satisfaction. Radiological follow-up includes x-ray films, computed tomography and in some cases magnetic tomography scan. Results: Twenty four cases with severe stenotic changes accompanied by severe FJO were treated with minimally invasive procedure. The minimum follow-up was 6 months with a mean of 8 months. The mean preoperative ODI score was 46.8, decreasing to a mean of 23 postoperatively. The mean VAS leg and back pain scores were 67.5 improving to means of 25.8. Twenty one out of 24 cases experienced a clinical benefit according to VAS for satisfaction and ODI. Complications included wound healing disturbance (4%), CSF fistula (4%) and contralateral radiculopathy due to articular bone spurs (8%). The accuracy of pedicle screws was high and only one revision surgery was performed. Conclusion: MIS for severe stenotic spondylolisthesis leads to adequate and safe decompression of lumbar stenosis and results in a highly significant reduction of symptoms and disability. MIS-TLIF and percutaneous pedicle screw insertion constitute a promising treatment alternative for patients with severe stenosis and facet joint osteoarthritis.

Surgical Neurology International, 2015

Background: Primary intraosseous cavernous hemangiomas (PICH) of the skull represent an infrequen... more Background: Primary intraosseous cavernous hemangiomas (PICH) of the skull represent an infrequent bone tumor. Although some rare cases of PICHs located in the skull base have been published, to our concern only three cases have been reported in the English literature of PICHs arising within the clivus. Case Description: We present the case of a patient presenting an isolated abducens paresis due to a rare PICH of the clivus showing also an unusual destruction of the inner table as well as infiltration of the dura mater. Due to this uncommon infiltrative pattern of an otherwise expected intraosseous tumor, a cerebrospinal fluid (CSF)-fistula occurred while performing a transnasal biopsy. The patient recovered successfully without need of lumbar drainage or re-surgery. Additionally, intratumoral decompression was sufficient to relief the abducens paresis. Conclusions: Our case provides new and meaningful information about clinical features as well as growth pattern of these rare clival tumors. We also discuss the importance of knowing these peculiarities before surgery in order to plan the optimal operative management as well as to avoid complications while approaching PICHs localized in such a delicate cranial region.

Journal of neuro-oncology, 2014

Glioblastoma multiforme patients presenting with recurrence following multimodality therapy have ... more Glioblastoma multiforme patients presenting with recurrence following multimodality therapy have limited palliative treatment options when the major modalities of therapy including surgery, radiochemotherapy and adjuvant chemotherapy have been exhausted. The authors introduce a clinical and radiological indication-solving algorithm and provide outcome rates of a glioblastoma recurrence cohort. Sixty six consecutive adult patients with recurrent glioblastoma who underwent a combined scheme of salvage treatments consisting of reoperation, high dose rate (HDR) brachytherapy and chemotherapy were included in this prospective study and were compared to a historical control group of 24 recurrent glioblastoma patients who have been treated with intensive temozolomide chemotherapy as the only treatment modality. Median follow-up was 32 months (range 28-36 months). Median survival was 9 months for the entire cohort after salvage treatment and can be translated into a 3-month improvement in s...

Neurological research, 2014

Several studies have revealed that different salvage treatments in glioblastoma multiforme patien... more Several studies have revealed that different salvage treatments in glioblastoma multiforme patients presenting a recurrence have limited palliative treatment options. The aim of this study was to evaluate the utility and limitations of multimodal salvage treatments in recurrent glioblastoma multiforme patients combining 5-aminolevulinic acid (5-ALA) fluorescence-guided resurgery, interstitial irradiation, and dense dose temozolomide chemotherapy (ddTMZ). Seventeen consecutive patients with recurrent globlastoma multiforme underwent a combined scheme of salvage treatments including fluorescence-guided reoperation, high dose rate (HDR) brachytherapy, and ddTMZ chemotherapy and were included in this prospective study. This multimodal treatment group was compared with a 1∶1 matched historical control group of 17 patients who have been treated with intensive temozolomide chemotherapy as the only treatment modality. All patients were previously treated with surgery of the primary patholog...

BMJ open, Jan 15, 2013

Tumour recurrence of glioblastoma multiforme (GBM) after initial treatment with surgical resectio... more Tumour recurrence of glioblastoma multiforme (GBM) after initial treatment with surgical resection, radiotherapy and chemotherapy is an inevitable phenomenon. This retrospective cohort study compared the efficacy of interstitial high dose rate brachytherapy (HDR-BRT), re-resection and sole dose dense temozolomide chemotherapy (ddTMZ) in the treatment of recurrent glioblastoma after initial surgery and radiochemotherapy. Retropective cohort study. Primary level of care with two participating centres. The geographical location was central Germany. From January 2005 to December 2010, a total of 111 patients developed recurrent GBM after initial surgery and radiotherapy with concomitant temozolomide. The inclusion criteria were as follows: (1) histology-proven diagnosis of primary GBM (WHO grade 4), (2) primary treatment with resection and radiochemotherapy, and (3) tumour recurrence/progression. This study compared retrospectively the efficacy of interstitial HDR-BRT, re-resection and ...