Publications by authors named "Stylianos Pikis"

19 Publications

  • Page 1 of 1

An International Multicenter Matched Cohort Analysis of Incidental Meningioma Progression During Active Surveillance or After Stereotactic Radiosurgery: The IMPASSE Study.

Neuro Oncol 2021 Jun 9. Epub 2021 Jun 9.

Department of Neurosurgery, University of Liverpool & The Walton Centre NHS Trust, Lower Lane, Liverpool, UK.

Background: The optimal management of patients with an incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and SRS management of asymptomatic meningioma patients.

Methods: Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups.

Results: In unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (p<0.001; OR 56.860 (95%CI 26.253-123.150))). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (p=0.764; OR 0.890 (95% CI 0.416-1.904)). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (p<0.001; OR 94.461 (95% CI 23.082-386.568)). In matched cohorts, new neurological deficits were noted in 2.3% of SRS treated and 3.2% of conservatively managed patients (p=0.475; OR 0.700 (95% CI 0.263-1.863)).

Conclusions: SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.
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http://dx.doi.org/10.1093/neuonc/noab132DOI Listing
June 2021

Stereotactic Radiosurgery for Differentiated Thyroid Cancer Brain Metastases: An International, Multicenter Study.

Thyroid 2021 May 11. Epub 2021 May 11.

Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.

Brain metastases (BM) from differentiated thyroid cancer are rare. Stereotactic radiosurgery (SRS) is commonly used for the treatment of BMs; however, the experience with SRS for thyroid cancer BMs remains limited. The goal of this international, multi-centered study was to evaluate the efficacy and safety of SRS for thyroid cancer BMs. From 10 institutions participating in the International Radiosurgery Research Foundation, we pooled patients with established papillary or follicular thyroid cancer diagnosis who underwent SRS for histologically confirmed or radiologically suspected BMs. We investigated patient overall survival (OS), local tumor control, and adverse radiation events (AREs). We studied 42 (52% men) patients who underwent SRS for 122 papillary (83%) or follicular (17%) thyroid cancer BMs. The mean age at SRS was 59.86 ± 12.69 years. The mean latency from thyroid cancer diagnosis to SRS for BMs was 89.05 ± 105.49 months. The median number of BMs per patient was 2 (range: 1-10 BMs). The median SRS treatment volume was 0.79 cm (range: 0.003-38.18 cm), and the median SRS prescription dose was 20 Gy (range: 8-24 Gy). The median survival after SRS for BMs was 14 months (range: 3-58 months). The OS was significantly shorter in patients harboring ≥2 BMs, when compared with patients with one BM (Log-rank = 5.452,  = 0.02). Two or more BMs (odds ratio [OR] = 3.688; confidence interval [CI]: 1.143-11.904;  = 0.03) and lower Karnofsky performance score at the time of SRS (OR = 0.807; CI: 0.689-0.945;  = 0.008) were associated with shorter OS. During post-SRS imaging follow-up of 25.21 ± 30.49 months, local failure (progression and/or radiation necrosis) of BMs treated with SRS was documented in five (4%) BMs at 7.2 ± 7.3 months after the SRS. At the last imaging follow-up, the majority of patients with available imaging data had stable intracranial disease (33%) or achieved complete (26%) or partial (24%) response. There were no clinical AREs. Post-SRS peritumoral T2/fluid attenuated inversion recovery signal hyperintensity was noted in 7% BMs. The SRS allows durable local control of papillary and follicular thyroid cancer BMs in the vast majority of patients. Higher number of BMs and worse functional status at the time of SRS are associated with shorter OS in patients with thyroid cancer BMs. The SRS is safe and is associated with a low risk of AREs.
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http://dx.doi.org/10.1089/thy.2020.0947DOI Listing
May 2021

Internal carotid artery stenosis and risk of cerebrovascular ischemia following stereotactic radiosurgery for recurrent or residual pituitary adenomas.

Pituitary 2021 Feb 20. Epub 2021 Feb 20.

Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.

Purpose: To evaluate the incidence of internal carotid artery (ICA) stenosis and cerebrovascular accident in a series of patients treated with stereotactic radiosurgery (SRS) for recurrent or residual pituitary adenoma.

Methods: All patients treated with single fraction SRS in our institution for recurrent or residual non-functioning-, growth hormone- and ACTH-secreting pituitary adenomas were retrospectively identified and reviewed. A comprehensive literature review to identify studies reporting on ICA steno-occlusive disease following SRS for pituitary adenomas and compare the risks of carotid stenosis and ischemic stroke in the SRS treated group to the general population figures.

Results: 528 patients [312 women and 216 men; median age at SRS 46 years old (range 12-80 years)] treated with SRS at our institution met study inclusion criteria. Mean clinical and radiologic follow-ups were 68.87 (SD ± 43.29) and 55.99 months (SD ± 38.03), respectively, and there were no clinically evident cerebral ischemic events noted. Asymptomatic, post-SRS, ICA stenosis occurred in two patients. A total of eight patients with ICA steno-occlusive disease following pituitary adenoma radiosurgery have been reported. Two of them suffered from ischemic stroke with however excellent recovery.

Conclusion: As compared to the general population, SRS for pituitary adenomas does not seem to confer appreciable increased risk for ICA steno-occlusive disease and ischemic stroke. However, post-SRS radiation vessel injuries do occur and physicians should be aware about this rare event. Prompt identification and management according to current guidelines are essential to prevent ischemic strokes.
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http://dx.doi.org/10.1007/s11102-021-01134-7DOI Listing
February 2021

Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery.

Acta Neurochir (Wien) 2021 01 19;163(1):83-88. Epub 2020 Nov 19.

Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.

Background: Optimal management of asymptomatic skull base meningiomas is controversial. We evaluated the safety and efficiency of Gamma Knife radiosurgery (GKRS) for the management of asymptomatic skull base meningiomas.

Methods: This retrospective study involved patients managed with GKRS for asymptomatic, skull base meningiomas from 1997 to 2019. Patient clinico-radiologic data, tumor characteristics, and procedural details were analyzed. Favorable outcome was defined as lack of procedure-related mortality or permanent neurologic morbidity and radiologic evidence of tumor control. Tumor progression and regression were defined as an increase or decrease of > 20% in volume from baseline to the last neuroimaging study respectively. Tumor volumes within ± 20% of baseline volume were considered stable.

Results: Thirty-seven patients (30 women), median age 68 years old (range 42-83 months) were managed with a single-session GKRS for 40 asymptomatic, skull base meningiomas. At a median clinical follow-up of 58.5 months (range 14-150 months), no mortality associated with the procedure or the treated tumor was noted. Permanent neurologic morbidity was 2.75%. There was a statistically significant decrease in mean tumor volume (p < 0.001) from 4.04 cc (SD 3.09 cc) prior to radiosurgery to 2.73 cc (SD 2.24 cc) at last follow-up. Higher margin dose was associated with tumor regression at last follow-up (HR = 1.351; 95%CI [1.094-1.669]; p = 0.05).

Conclusion: As compared to natural history studies, GKRS affords long-standing tumor control and neurologic preservation in the vast majority of patients treated for asymptomatic, skull base meningiomas. Further study is necessary to identify the optimal management of asymptomatic skull base meningiomas.
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http://dx.doi.org/10.1007/s00701-020-04648-4DOI Listing
January 2021

Diffusion weighted image documented cerebral ischemia in the postprocedural period following pipeline embolization device with shield technology treatment of unruptured intracranial aneurysms: a prospective, single center study.

J Neurointerv Surg 2020 Apr 26;12(4):407-411. Epub 2019 Sep 26.

Interventional Neuroradiology, 'Korgialenio Benakio' The Red Cross Hospital of Athens, Athens, Greece.

Objective: Acute ischemic stroke and silent cerebral infarctions following pipeline embolization device (PED) treatment of intracranial aneurysms have been estimated to occur in 3-6% and in 50.9-90% of patients respectively. The PED with Shield technology (PED-Shield) incorporates a surface phosphorylcholine polymer to reduce the thrombogenicity of the implant. We sought to determine the incidence of diffusion weighted image (DWI) documented cerebral ischemia after PED-Shield treatment of unruptured intracranial aneurysms.

Methods: This prospective study involved a single center series of consecutive patients treated for an unruptured intracranial aneurysm with the PED-Shield. All participants underwent clinical evaluation on admission, after the procedure, at discharge, and 30 days following treatment. Brain MRI was obtained within 72 hours of the procedure. Ischemic lesions identified on DWI sequences where examined as to their number, size, and location in relation to the procedure.

Results: Over 12 months, 33 patients harboring 38 intracranial aneurysms were treated with the PED-Shield in 36 procedures. Neither mortality nor clinically evident ischemic events were noted in the 30 day postprocedural period. DWI documented, silent cerebral ischemia occurred in six patients (18.18%) after six procedures (16.66%). No statistically significant risk factors for postprocedural silent cerebral ischemia were identified.

Conclusion: We demonstrated a reduced rate of silent cerebral infarcts following PED-Shield treatment of intracranial aneurysms than previously reported with other endovascular treatment modalities and with the previous device generations. Further research is necessary to evaluate our results and to identify methods to reduce the incidence of postprocedural cerebral ischemic events.
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http://dx.doi.org/10.1136/neurintsurg-2019-015363DOI Listing
April 2020

Endovascular Treatment of Type Ib Endoleak after Evar Using the IBD Device: A Case Report.

Ann Vasc Dis 2016 28;9(3):209-212. Epub 2016 Jun 28.

Department of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece.

In the modern endovascular era, abdominal aortic aneurysm repair is still not free of complications with re-interventions following endovascular aneurysm repair (EVAR) being more common than with open surgical repair. A variety of endovascular, open surgical and combined techniques were described according to the anatomical considerations and general health of the patient to achieve the best possible result after these complications. In cases of type Ib endoleak following aorto-uni-lateral EVAR for an abdominal aortic aneurysm, the use of the internal branched device (IBD) constitutes a safe and effective technique.
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http://dx.doi.org/10.3400/avd.cr.15-00095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027259PMC
June 2016

Malignant transformation of a residual cerebellopontine angle epidermoid cyst.

J Clin Neurosci 2016 Nov 9;33:59-62. Epub 2016 Aug 9.

Department of Neurosurgery, Hadassah University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address:

Malignant transformation is a rare but devastating complication following partial resection of an intracranial epidermoid cyst (EC). Time to malignant transformation is highly variable and optimal management is unclear. A literature search from 1965 to January 2016 identified manuscripts discussing clinical presentation, management, and outcome of malignant transformation of a remnant intracranial EC. One male patient diagnosed with malignant transformation of a remnant intracranial EC in our institution was also included in the study. There were 21 patients with malignant transformation of a remnant intracranial EC, including the current patient. Mean age was 51.4years (range 36 to 77) and there was a female predominance (12 women, 9 men, ratio 1.33:1). The mean time interval from partial resection of a benign intracranial EC to malignant transformation was 7.74years (range from 3months to 33years). Surgical resection of the tumor alone was the treatment of choice in 10 patients with one of them requiring a second operation and radiotherapy 2months following the first operation. Adjuvant treatment modalities were employed in 11 patients and included radiotherapy (n=4), stereotactic radiosurgery (SRS) (n=3), chemotherapy (n=1), chemotherapy combined with SRS (n=1) and with radiotherapy (n=1) and radiotherapy combined with SRS and followed by a second tumor resection (n=1). Follow-up period ranged from 1 day to 5years and 11/19 patients (57.8%) were reported dead on follow-up. Prospective studies are required to define the optimal management of malignant transformation of remnant intracranial EC.
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http://dx.doi.org/10.1016/j.jocn.2016.04.008DOI Listing
November 2016

Cerebellar liponeurocytoma in two siblings suggests a possible familial predisposition.

J Clin Neurosci 2016 Oct 24;32:154-6. Epub 2016 Jun 24.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address:

There is limited data on the genetic origin and natural history of cerebellar liponeurocytoma. To the best of our knowledge there has been only one report of a familial presentation of this rare entity. We report a 72-year-old female with a posterior fossa tumor presenting with progressive cerebellar signs and symptoms. The patient underwent total tumor resection via an uncomplicated sub-occipital craniotomy. Histopathologic examination was diagnostic for cerebellar liponeurocytoma. Her sister was previously treated for a similar tumor. Our report provides further evidence for the possible existence of a hereditary abnormality predisposing afflicted families to cerebellar liponeurocytoma development.
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http://dx.doi.org/10.1016/j.jocn.2016.04.004DOI Listing
October 2016

Basilar artery dissection: A rare complication of posterior fossa epidermoid cyst resection, and evaluation of the possible effects of cerebrospinal fluid drainage on disease progression.

J Clin Neurosci 2016 Oct 22;32:141-3. Epub 2016 Jun 22.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel. Electronic address:

We report a rare case of a 45-year-old female with an unruptured basilar artery dissecting aneurysm presenting with locked-in syndrome due to brainstem ischemia eleven months following resection of a giant cerebellopontine angle epidermoid cyst and three months after insertion of ventriculo peritoneal shunt due to hydrocephalus. The etiology of basilar artery dissection and the effect of hydrocephalus and ventricular cerebrospinal fluid drainage on disease progression in this patient are unclear. Our report suggests a possible effect of hydrocephalus and ventricular cerebrospinal fluid drainage on intracranial arterial dissection progression.
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http://dx.doi.org/10.1016/j.jocn.2016.03.017DOI Listing
October 2016

Spinal cord compression due to brown tumor.

J Clin Neurosci 2015 Jun 11;22(6):1063-6. Epub 2015 Mar 11.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address:

We report a rare case of a vertebral brown tumor causing spinal cord compression and resulting in progressive paraparesis in a 27-year-old female with end-stage renal failure, managed with hemodialysis. Urgent neurosurgical intervention and gross total resection resulted in complete resolution of the symptoms.
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http://dx.doi.org/10.1016/j.jocn.2014.12.008DOI Listing
June 2015

Ischemic complications after tailored carotid artery stenting in different subpopulations with high-grade stenosis: feared but rare.

J Clin Neurosci 2015 Jan 28;22(1):189-94. Epub 2014 Nov 28.

Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Although the procedural and postoperative safety profile of carotid artery stenting (CAS) has been steadily improving, many centers still recommend carotid endarectomy (CEA) over CAS. We assessed outcomes (procedural and postoperative stroke) following tailored CAS in a cohort of patients managed at a single academic medical center. Outcomes for patients with carotid artery stenosis treated from 2005-2013 with CAS were retrospectively reviewed. Stenosis was assessed with Doppler ultrasonography and/or CT angiogram, and angiography. Symptomatic and asymptomatic patients were dichotomized (based on the North American Symptomatic Carotid Endarterectomy Trial [NASCET] and the Asymptomatic Carotid Atherosclerosis Study [ACAS]). CAS technique was chosen based on angiographic and clinical characteristics; procedures were performed with/without pre-angioplasty, cerebral protection, and post-dilation. Endpoints were cumulative incidence of ipsilateral stroke, myocardial infarction, and death within 30 days (primary) or 12 months (secondary). Overall 249 patients (151 men/98 women; mean age 69.9 years) with 254 carotid stenoses were included; 148 lesions (58%) were asymptomatic, and 106 (42%) were symptomatic. CAS was successfully performed in all lesions. At 30 days, ipsilateral transient ischemic attack (TIA)/minor stroke was seen in 6/104 (5.8%) symptomatic patients and no asymptomatic patients; there was no myocardial infarction or ipsilateral major stroke. At 12 months, there was ipsilateral TIA/minor stroke in an additional 3/98 (3.1%) symptomatic and 1/127 (0.8%) asymptomatic patients, and major stroke in 1/98 (1%). The incidence of stroke after CAS compares favorably with rates reported after CEA. The majority of peri-procedural ischemic events following CAS are TIA/minor strokes causing only transient or minor functional impact; major disabling stroke is rare with current techniques.
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http://dx.doi.org/10.1016/j.jocn.2014.09.005DOI Listing
January 2015

Ventriculo-peritoneal shunt malfunction due to complete migration and subgaleal coiling of the proximal and distal catheters.

J Clin Neurosci 2015 Jan 28;22(1):224-6. Epub 2014 Oct 28.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel; Department of Pediatric Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address:

Ventriculo-peritoneal (VP) shunt malfunction due to proximal and distal catheter migration has been rarely reported in the literature. Shunt migration has been proposed to occur as a result of a combination of various mechanisms, including the windlass effect, retained memory of the shunt tubing, inadequate shunt fixation, and increased intra-abdominal pressures. We describe a rare case of a 6-week-old child who presented in our department with VP shunt malfunction due to complete proximal migration and coiling of the peritoneal and ventricular VP shunt catheters within a subgaleal pocket at the left occipital area.
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http://dx.doi.org/10.1016/j.jocn.2014.08.005DOI Listing
January 2015

Potential neurotoxic effects of polymethylmethacrylate during cranioplasty.

J Clin Neurosci 2015 Jan 29;22(1):139-43. Epub 2014 Jul 29.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address:

Cranioplasty for the surgical correction of cranial defects is often performed using polymethyl methacrylate (PMMA), or bone cement. Immediately prior to PMMA application, a liquid monomer form (methylacrylate) and a benzoyl peroxide accelerator are mixed resulting in polymerization, an exothermic reaction during which monomer linking and subsequent formation of solid polymer occur. The potential side effects of residual methylacrylate monomer toxicity and thermal damage of neural tissue during PMMA hardening have been described in various in vitro, animal, and cadaveric studies; however, clinically documented in vivo neurotoxicity in humans attributed to either of the above two mechanisms during PMMA cranioplasty is lacking. We present a series of four patients operated for removal of cerebellopontine angle lesions and two operated for the excision of parieto-occipital tumors who sustained cranial neuropathies and encephalopathies with transient or permanent neurological deficits that could not be attributed to surgical manipulation. We hypothesize that these complications most likely occurred due to thermal damage and/or chemical toxicity from exposure to PMMA during cranioplasty. Our case series indicates that even small volumes of PMMA used for cranioplasty may cause severe side effects related to thermal damage or to exposure of neural tissue to methylacrylate monomer.
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http://dx.doi.org/10.1016/j.jocn.2014.06.006DOI Listing
January 2015

Superficial siderosis of the central nervous system secondary to spinal ependymoma.

J Clin Neurosci 2014 Nov 17;21(11):2017-9. Epub 2014 Jul 17.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address:

Superficial siderosis of the central nervous system is a syndrome caused by deposition of hemosiderin in the subpial layers of the central nervous system, occurring as a result of recurrent asymptomatic or symptomatic bleeding into the subarachnoid space. We report a rare case of superficial siderosis in a 33-year-old man who presented with sensorineural hearing loss. The diagnosis of superficial siderosis on MRI brain studies led to further investigations with detection of a spinal ependymoma at L1-L2, compressing the cauda equina. Gross total resection of the tumor arrested the progression of the neurological deterioration. Our report underlies the importance of early diagnosis and surgical management, with imaging examination of the full neuroaxis to identify the source of bleeding, to halt disease progression and improve prognosis.
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http://dx.doi.org/10.1016/j.jocn.2014.05.020DOI Listing
November 2014

Preoperative embolization of hypervascular spinal tumors: current practice and center experience.

Neurol Res 2014 Jun 13;36(6):502-9. Epub 2014 Apr 13.

Preoperative transarterial embolization of hypervascular spinal tumors has been extensively used, and is considered to be a highly effective adjuvant technique in reducing intraoperative blood loss during surgery. Moreover, it has been reported to increase the feasibility and safety of the surgical procedure, leading to better surgical outcomes. We review the English literature in an attempt to identify indications, appropriate timing of embolization in relation to surgery, technical aspects of the procedure, complications, and the contribution of embolization to the surgical management of spinal tumors. In addition, we report our experience with embolization of hypervascular metastases.
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http://dx.doi.org/10.1179/1743132814Y.0000000361DOI Listing
June 2014

Spinal meningioma becoming symptomatic in the third trimester of pregnancy.

J Clin Neurosci 2013 Dec 14;20(12):1797-9. Epub 2013 Aug 14.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.

We report a rare case of a spinal meningioma leading to symptoms of spinal cord compression starting in the third trimester of gestation in a 32-year-old woman. Neurological symptoms, which continued to progress after the patient had given birth, were assumed to be sequelae of pregnancy and delivery, leading to a 6 month delay in diagnosis and treatment. Fortunately a gross total resection was achieved at surgery and the patient recovered fully, without permanent consequences. Associated symptoms of spinal cord compression may be falsely attributed to pregnancy, both by the pregnant women and her treating physician. A high index of suspicion and thorough history and physical examination to identify red flags should be performed in patients with neurological symptoms.
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http://dx.doi.org/10.1016/j.jocn.2013.08.001DOI Listing
December 2013

Cauda equina syndrome after spinal epidural steroid injection into an unrecognized paraganglioma.

Clin J Pain 2013 Dec;29(12):e39-41

Departments of *Neurosurgery †Radiology ‡Pathology §Anesthesiology ∥Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Objective: Clinically significant spinal hemorrhage is an extremely rare but potentially devastating complication of spinal epidural steroid injection. We report a rare case of cauda equina syndrome after spinal epidural injection that inadvertently penetrated an unrecognized spinal paraganglioma.

Methods: The clinical records for a patient presenting with cauda equina syndrome were retrospectively reviewed. A literature search was performed to identify reports of cauda equina syndrome in patients undergoing spinal epidural steroid injection, as well as recent large series describing complications associated with these injections.

Case Report: A 37-year-old man presented to our emergency department with severe low back pain radiating bilaterally to the lower extremities and urinary incontinence. His pain had greatly intensified 1 day after spinal epidural steroid injection. He had a 1-year history of low back pain diagnosed as disk herniation and managed conservatively but had experienced recent onset of a similar pain and new onset of nocturnal back pain causing sleep disturbance. Epidural injection had been administered based on the earlier diagnosis of disk herniation. Examination using magnetic resonance imaging revealed a previously unrecognized oval hemorrhagic mass lesion at L2-3, which had been inadvertently penetrated during epidural injection. Emergent en bloc resection resolved the patient's neurological symptoms. At histopathologic analysis, the tumor was diagnosed as a spinal paraganglioma.

Discussion: The presented case indicates the importance of a thorough history, physical examination, and imaging assessment before spinal epidural steroid injection.
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http://dx.doi.org/10.1097/AJP.0b013e31829a4cc6DOI Listing
December 2013

Symptomatic facet cysts of the subaxial cervical spine.

J Clin Neurosci 2013 Jul 16;20(7):928-32. Epub 2013 May 16.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.

Subaxial cervical facet cysts are uncommon. We report two patients with intraspinal, extradural, subaxial cervical spinal facet cysts, and review the literature to describe the epidemiology, clinical presentation, imaging findings, and treatment options for these lesions. Intraspinal, extradural, cervical spinal cysts should be considered as part of the differential diagnosis in patients presenting with clinical signs of cervical radiculopathy or myelopathy.
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http://dx.doi.org/10.1016/j.jocn.2012.10.018DOI Listing
July 2013

Cerebral sinodural thrombosis following minor head injury in children.

J Clin Neurosci 2013 Apr 7;20(4):481-4. Epub 2013 Feb 7.

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.

Cerebral sinodural thrombosis (CSDT) is a rare complication of minor head trauma in children. Despite recommendations, anticoagulation is frequently withheld. We aimed to evaluate the etiology, clinical presentation, risk factors, diagnosis, treatment, and outcome of pediatric CSDT following minor head trauma, and specifically to evaluate factors associated with anticoagulation use following minor head trauma in pediatric patients with CSDT. A literature search from 1990 to 2012 identified manuscripts discussing epidemiology, risk factors, clinical presentation, management, and outcome in pediatric patients with CSDT subsequent to minor head trauma. One pediatric patient diagnosed with CSDT following minor head trauma in our institution was also included in the study. There were 18 pediatric patients with CSDT following minor trauma, including the current patient. Mean patient age was 7.8years (range 23months-15years). There was a strong female predominance (2.4:1). Vomiting and headache were the most common symptoms. Five patients had pre-existing risk factors (gastroenteritis, protein S deficiency, estroprogestenic medication, elevated antiphospholipid antibodies, malnutrition). Anticoagulation was administered to six patients with additional risk factors, severe symptoms, or deterioration. There was no mortality, 12 patients recovered fully, and four patients improved with residual symptoms. One patient required lumboperitoneal shunt placement. Pediatric CSDT is a rare complication of minor head trauma, with variable presentation. Anticoagulation has generally been reserved for patients suffering from severe symptoms, for those who deteriorate neurologically during observation, and for those who suffer from a concomitant prothrombotic disorder.
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http://dx.doi.org/10.1016/j.jocn.2012.09.009DOI Listing
April 2013