Philippos Tsitsopoulos

Lumbar spinal epidural angiolipoma

Spinal angiolipomas are rare benign tumours most commonly found in the thoracic spine. A case of an extradural lumbar angiolipoma in a 47-year-old female is described. She had a recent history of lower back pain accompanied by sciatica. Lumbar MRI revealed a dorsal epidural mass at the L2-L3 level. The patient underwent a bilateral laminectomy, in which the tumour was totally excised. The pathological examination indicated haemangiolipoma. Post-operatively, the patients neurological signs and symptoms improved remarkably quickly. MRI at 6 and 18 months after surgery revealed no evidence of tumour recurrence.

A 5-year epidemiological study of nosocomial bloodstream infections in a neurosurgery department.

The characteristics of nosocomial bloodstream infections (BSIs) in a neurosurgical department were studied over a 5-year period. The rate of nosocomial BSI was 3.0%. Gram-negative bacteria were the most commonly isolated pathogens (65.9% of isolates). For all the pathogens isolated, the rate of resistance to commonly used antimicrobial agents was high. Of the 101 patients with nosocomial BSI, 50 (49.5%) died during their stay at the Department of Neurosurgery. At the same time, overall mortality rate among neurosurgical inpatients without nosocomial BSI was 5.4% (ie, 175 of 3,216 patients died).

Long-term follow-up of a non-infantile desmoplastic ganglioglioma.

Desmoplastic gangliogliomas are mixed cerebral tumors traditionally reported in infants. However, a few non-infantile cases have been documented. A case of a desmoplastic ganglioglioma in a 16-year male is presented. The patient reported severe headaches. Radiological examination revealed a large mass occupying the right frontal lobe. The lesion was totally excised. Histopathological examination confirmed the diagnosis of a desmoplastic ganglioglioma. The postoperative course was excellent. At the 10(1/2) year follow-up there was no evidence of tumor recurrence. Although desmoplastic gangliogliomas have aggressive features, complete surgical removal is the treatment of choice obviating the need for adjuvant therapy.

Intracranial meningioma in a patient with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a heritable disorder characterized mainly by connective tissue manifestations. In dinstinct cases, several neurological features have also been described. A 46-year-old male with a known family history of OI type I presented with progressive gait disturbances and diminished muscle strength. Brain MRI scans revealed an infiltrative intracranial mass occupying both frontoparietal lobes. The patient underwent surgical intervention. The histological diagnosis was an atypical (Grade II) meningioma. The bony parts demonstrated a mixture of osseous defects due to OI and infiltration by the tumor. At one-year follow up the patient′s muscle power partially returned while repeat MRI scans were negative for tumor recurrence.

Intraoperative facet joint injury during anterior cervical discectomy and fusion: an experimental study.

OBJECT Disorders of the cervical spine can be successfully addressed by surgical intervention when the choice of such intervention takes into account the possible complications in the treated and adjacent structures. The aim of this study was to investigate the potential for intraoperative trauma in cervical zygapophysial joints and to describe possible pathological changes that may occur during cervical spine surgery. METHODS Fifteen sheep underwent surgical intervention via an anterior cervical approach; discectomy at the C5-6 level was performed. In 10 animals, the discectomy was accompanied by titanium cage fusion. The sheep were killed immediately after completion of the operation. Radiological examination of the isolated cervical spines followed. Furthermore, the cervical spines were submitted to decalcification and incised using a microtome, and tissue sections were then studied using light microscopy. RESULTS Radiological examination was used to assess vertebral alignment, vertebral body (VB) morphology, implant position, and endplate and facet joint gross morphology. Histological examination of the endplate and VB demonstrated degenerative lesions as well as cellular necrosis. The study of the facet joints at the treated as well as at adjacent segments (both above and below) revealed in some cases edema between the collagen fibers of the joint capsules, congestion, and microhemorrhages. Injuries were evident in animals in which the Caspar device was used. CONCLUSIONS Histopathologically confirmed lesions occurred in facet joints while anterior cervical spine surgery was being performed in sheep. The findings were indicative of trauma and, in the case of human spine surgery, could possibly account for several postoperative complications and patient complaints.