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S Sgouros

Publications and source records attributed to S Sgouros.

At least 19 recordsLinked to original sources
PubMed2006

Outcome of children with posterior fossa medulloblastoma: a single institution experience over the decade 1994-2003.

AIM: While the impact of radiotherapy in the management of medulloblastoma was recognised, the introduction of chemotherapy was investigated in clinical trials and shown to confer an additional advantage. We reviewed the outcome of a series of consecutive patients to assess the impact in a population-based clinical establishment. MATERIALS AND METHODS: A series of 38 children treated for medulloblastoma at Birmingham Children's Hospital between 1994 and 2003 was analysed. The effect of surgery, radiotherapy, chemotherapy and metastasis on survival was analysed. RESULTS: The overall 5-year survival rate was 61.4% for the 36 patients who had resective surgery, while 2 patients had biopsy only and died within a few months. There was no operative mortality. The incidence of hydrocephalus needing permanent shunting was higher in the first 3 years of life (p = 0.007, chi-square). The 5-year survival rate of patients with total and sub-total excision of medulloblastoma was 61.1% and 61.8%, respectively. The 5-year survival rate of patients older than 3 years was 73.4% and for patients under 3 years was 36.3% (p = 0.007, log rank). Metastases at presentation did not influence survival. All deaths occurred in the first 32 months. CONCLUSION: The contribution of chemotherapy in the improvement of the overall survival appears more evident in children younger than 3 years or presenting with metastases. The absence of significant difference in survival between patients with total or sub-total excision of medulloblastoma supports the view that total excision of medulloblastoma can be avoided when the risk for potential intra-operative damage and consequent neurological deficits is high.

Cerebellar Neoplasms↗
PubMed2006

Short echo time 1 H magnetic resonance spectroscopy of childhood brain tumours.

AIMS: To explore short echo time (30 ms) 1 H magnetic resonance spectroscopy (MRS) in children with brain tumours and determine the contributions to the characterization of these tumours of the metabolites inositol/myoinositol and glutamate/glutamine, which are not visible at long echo times (135 or 270 ms). METHODS: Over a 12-month period 86 single-voxel MRS investigations were performed on 59 children with various brain tumours on a Siemens Symphony 1.5-T Magnetom using point-resolved spectroscopy and echo time of 30 ms. RESULTS: The procedure was well tolerated, and good-quality data were obtained. N-Acetyl aspartate (NAA)/Choline (Cho) and creatine (Cr)/Cho concentration ratios were significantly (p<0.001) lower in tumour (0.95 and 1.63, respectively) compared with non-involved brain (3.68 and 3.98, respectively) in all histological types. Inositol/Myoinositol (Inos)/Cho ratios were significantly (p<0.05) lower in untreated tumours (1.91) than in treated tumours (3.93) and in non-involved brain (3.32). Inos/Cho ratios were high in diffuse pontine gliomas and low in medulloblastomas and supratentorial primitive neuroectodermal tumours (p<0.01). Glutamate/Glutamine (Glut)/Cho ratios were high in grade 1 astrocytomas (6.4) and unbiopsied optic gliomas (9.84) but low in diffuse pontine gliomas (2.44). Lipids and macromolecules were present in most tumours but in low quantities in non-involved brain. CONCLUSION: Good-quality short echo time MRS data can be collected routinely on children with brain tumours. Inos and Glut levels show greater variability between tumour types than NAA, Cho and Cr present at long echo times, providing improved tumour characterization. Inos/Cho levels differ between untreated and treated tumours and may be useful for treatment monitoring.

Aspartic Acid↗
PubMed2006

Diastematomyelia in children: treatment outcome and natural history of associated syringomyelia.

OBJECTIVE: To quantify the long-term outcome of children with diastematomyelia and the implication of syringomyelia in the natural history. MATERIALS: Retrospective study of 17 children (nine girls and eight boys) with diastematomyelia operated during 1989-2004. Mean age at diagnosis was 3.4 years (range 5 days-12 years), mean follow-up was 5 years; 14 had excision of spur and cord untethering, 3 had excision of spur alone. RESULTS: The bony spur was in the lumbar region in 12 and thoracic in 5 patients. Syringomyelia was present in eight (47%), associated with bony spur between L1 and 4 (p=0.088), spina bifida occulta in ten (58.8%), and spinal lipoma in one (6%). Preoperative Necker Enfants Malades (NEM) scores were 17 in eight patients, 16 in four, 15 in three, 13 in one, and 12 in one patient. Presenting neurological deficits were motor in eight, sensory deficits in three, and anal incontinence in one patient. There was improvement of NEM scores postoperatively in five patients only, but still with residual deficit. Repeat spur excision and cord untethering was performed in three patients for neurological deterioration 1-4 years after first operation. On postoperative MRI scans syringomyelia remained unchanged in all eight patients. There were one skin infection, one transient motor deterioration, and one patient with sensory deficit after surgery. CONCLUSION: Prophylactic operations were associated with the best clinical outcome. Despite improvement, all patients with established preoperative deficit still had residual neurological deficits at their last follow-up. The associated syringomyelia remained unchanged after surgery, indicating that it does not contribute to the neurological syndrome.

Child↗
PubMed2006

Prophylactic antibiotics in pediatric shunt surgery.

INTRODUCTION: The optimal antibiotic prophylaxis for pediatric shunt-related procedures is not clear. There is much inconsistency among different medical centers. This paper summarizes and analyzes the various prophylactic antibiotic regiments used for shunt-related surgeries at different pediatric neurosurgery centers in the world. MATERIALS AND METHODS: A survey questionnaire was distributed through the Pediatric Neurosurgery list-server (an e-mail-based special interest group in pediatric neurosurgery). Forty-five completed questionnaires were received, one per medical center, primarily from pediatric neurosurgeons with the following geographic breakdown: 25 from North America, 13 from Europe, and 7 from Asia and other countries. All centers routinely administered prophylactic antibiotics for shunt-related procedures. The drugs of choice were first-generation cephalosporins (23), second-generation cephalosporins (10), naficillin/oxacillin (4), vancomycin (3), clindamycin (1), amoxicillin (1), and mixed protocols in three centers. The initial drug administration ("first dose") was: in the department before transfer to operating room (5), upon arrival to operating room (11), at induction of anesthesia (13), and at initial skin incision (16). The duration of antibiotic dosage also varied: single dose (13), 24-h administration (26), 48-h administration (2), and longer than 48 h in four centers. RESULTS AND DISCUSSION: Two general tendencies were noted, common to the majority of participating centers. There was a general trend to modify antibiotic treatment protocol in "high-risk" populations. The second common theme noted in more than half of responding centers was the use of long-term antibiotic treatment for externalized devices (such as externalized shunts, external ventricular drains or lumbar drains), usually till the device was in place.

Anti-Bacterial Agents↗
PubMed2006

Assessment of the influence of operative factors in the success of endoscopic third ventriculostomy in children.

OBJECTIVE: To determine if operative factors correlate with success of endoscopic third ventriculostomy (ETV) in the treatment of hydrocephalus. MATERIALS AND METHODS: The ETV procedure video of 33 hydrocephalic children was reviewed. Mean age at operation was 76 months (range: 1-196). Success was defined as no need for shunt in the long term. We calculated the relative size of stoma as the percentage of stoma diameter to the distance between posterior clinoid-basilar artery. Factors analysed were: intra-operative haemorrhage, stoma size, thick/double third ventricular floor, pre-pontine adhesions presence, brisk cerebro-spinal fluid (CSF) flow through the stoma as well as hydrocephalus cause, previous shunt presence, CSF infection or haemorrhage and previous ETV. Analysis was performed using chi-square, linear regression, and one-way ANOVA. RESULTS: Overall ETV success rate was 42%. Mean stoma size was 37%. For the entire group, none of the operative factors correlated statistically with success. Previous shunt presence adversely correlated with success (p=0.008). The highest success rate was in the aqueduct stenosis group. In patients without previous shunt (n=17), stoma size over 30% tended towards significance (p=0.094), CSF leak was adversely associated with ETV success (p=0.041) and mean stoma size was 41.3% in successful ETV and 27.8% in unsuccessful ETV (p=0.072). In patients with previous shunt (n=16), thin third ventricular floor was a negative predisposing factor (p=0.057). CONCLUSION: This study did not demonstrate a correlation between the presence of pre-pontine adhesions, double or thickened floor of third ventricle and ETV success. In patients without previous shunt, stoma size may correlate with success. CSF leak was strongly associated with failure.

Adolescent↗
PubMed2006

Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury.

INTRODUCTION: We compared the effect of early decompressive craniectomy (<24 h) vs non-operative treatment on the outcome of children with refractory intracranial hypertension after severe traumatic brain injury. MATERIAL AND METHODS: We retrospectively reviewed 12 consecutive patients treated between 1999 and 2001 for refractory intracranial hypertension after isolated severe head injury without any intracranial haematomas. In all patients, treatment included sedation, paralysis and i.v. mannitol under intracranial pressure monitoring. Early decompressive craniectomy was carried out in six patients (mean age: 13 years) at mean time from injury of 7 h (range: 2-18 h), whereas six patients (mean age: 11.5 years) were managed with non-operative treatment. The Marshall Grading system was used to score the severity of radiological abnormalities in CT scans. The Glasgow Outcome Scale (GOS) at 1-year follow-up was used as outcome measure. RESULTS: The mean Marshall grade was 3 in the craniectomy group and 2 in the non-operative group. All patients in the craniectomy group survived: four patients scored 5 and two patients scored 4 on the GOS. In the non-operative group, two patients (33%) died, one of whom received late decompressive craniectomy at 9 days, while three patients scored 5 and one patient scored 3 on the GOS. CONCLUSION: In children who suffered severe head injury with refractory intracranial hypertension without intracranial haematoma, early decompressive craniectomy employed in the first few hours after injury before the onset of irreversible ischaemic changes may be an effective method to treat the secondary deterioration that commonly leads to death or severe neurological deficit.

Adolescent↗
PubMed2006

Extradural spinal arachnoid cysts associated with spina bifida occulta.

INTRODUCTION: Spinal extradural arachnoid cysts are an uncommon cause of neural compression in children. Even more uncommon is the association of such cysts with spina bifida occulta. MATERIAL: Two girls, 12 and 8-years-old, presented with left leg pain, deteriorating gait, clinical signs of left L5 and S1 root compression, without bladder or bowel symptoms. The first patient had left foot drop. The second patient had muscle wasting and smaller left foot with pes cavus. Radiographs showed spina bifida occulta of S1 in both. MRI revealed an extradural cyst at the S1 level, indenting the thecal sac and the L5 and S1 roots. At operation in both patients a large arachnoid cyst arising from a small dural defect in the axilla of the left S1 root was compressing and displacing it and the dural sac. It was removed and the defect was repaired. The first patient improved with complete recovery of the foot drop. An MRI at 12 months showed no cyst recurrence. The second patient made good recovery initially, but at 10 months developed recurrent symptoms. An MRI scan showed recurrence of the cyst with root compression. On repeat exploration a different dural defect was identified in a more anterior position and was repaired. DISCUSSION: The coexistence of extradural arachnoid cyst and corresponding bifid spinal segment has not been described previously. It raises the suspicion that the dural defect giving rise to the arachnoid cyst may be due to segmental dural dysgenesis in the context of the dysrhaphic neuroectodermal malformation.

Arachnoid↗
PubMed2005

The International Infant Hydrocephalus Study: concept and rational.

INTRODUCTION: During the recent meetings of the International Study Group on Neuroendoscopy and the International Society for Pediatric Neurosurgery, the consensus view emerged that there is a need to assess the value and efficacy of neuroendoscopic procedures against shunting in a scientific manner, to resolve long-lasting debates on the subject. MATERIAL AND METHODS: A prospective randomized, controlled trial of endoscopic third ventriculostomy vs shunting in children presenting under the age of 2 years with pure aqueduct stenosis is been proposed and organized (the International Infant Hydrocephalus Study, IIHS). The participating surgeons must adhere to the philosophy of randomization and be suitably experienced in endoscopic techniques in infants. The primary outcome of the trial will be the overall health-related quality of life of these children at 5 years of age. Hence, the study is focusing on the effect of surgery on neurodevelopment, rather than the less important issue of shunt or stoma survival, that has been debated extensively with no conclusion so far. Intention-to-treat analysis will be performed according to the first surgery. Secondary outcomes such as complication and reoperation rate, total hospitalization time and cost, need for repeat imaging, and others will be analyzed as well. RESULTS: Pure aqueduct stenosis is relatively rare, making recruitment problematic, but has been chosen to avoid other confounding factors that could influence outcome. More than 25 centers worldwide have committed already to patient recruitment to the study. It is anticipated that recruitment will last for 2 years, aiming for 91 patients per arm. The study has started recruiting patients already in some countries. CONCLUSION: It is hoped that the trial will not only provide answers to unsettled debates on the value of neuroendoscopy but also create a network of collaborating pediatric neurosurgeons for future initiatives.

Cerebral Aqueduct↗
PubMed2005

Spontaneous resolution of isolated Chiari I malformation.

INTRODUCTION: Spontaneous resolution of Chiari I abnormality is very rare. In most patients, the radiological abnormality either stays unchanged with time or deriorates. CASE REPORT: We present a male patient who was diagnosed at the age of 18 months as having radiological evidence of Chiari I malformation without syringomyelia, which had resolved 5 years later on a subsequent MR scan. At the time of initial diagnosis, he had been experiencing recurrent jerking movements of his body and was a sufferer of chronic renal failure. DISCUSSION: The symptoms were thought to be unrelated to the hindbrain hernia. Such spontaneous resolution of an isolated Chiari I malformation has only been described once more before, although resolution of hindbrain hernia associated with syringomyelia has been described before in several cases, albeit at single figures. The mechanism for such a natural evolution is not clear. CONCLUSION: This patient demonstrates that surgical treatment should not be considered hastily in patients with radiological evidence of Chiari I in the absence of convincing associated clinical symptoms.

Adolescent↗
PubMed2005

The use of an adjustable valve to treat over-drainage of a cyst-peritoneal shunt in a child with a large sylvian fissure arachnoid cyst.

INTRODUCTION: The cyst-peritoneal shunt is a recognised surgical alternative in the management of sylvian fissure arachnoid cysts. Shunt overdrainage is well described in literature on ventriculo-peritoneal shunts, but not often appreciated as a complication of cysto-peritoneal shunts. CASE REPORT: A 5-year-old boy presented with a symptomatic left sylvian fissure arachnoid cyst. This was initially treated by craniotomy and membrane fenestration in the carotid cistern. Recurrence led to insertion of a valveless cyst-peritoneal shunt 5 months later. Initial progress was followed by persistent headaches 18 months after shunt insertion. CT scan revealed a significant reduction in the cyst size, enlargement of the ipsilateral lateral ventricle, collapse of the contra-lateral ventricle and midline shift towards the side of the shunt. These findings were interpreted as over-drainage of the cyst-peritoneal shunt. RESULT: A Codman Medos adjustable valve was inserted, with the intention of gradually increasing the pressure until the midline shift was restored and the contra-lateral ventricle was reconstituted. This was achieved with the valve set at 90 mm H(2)O, verified by CT scan. Radiological improvement was associated with dramatic symptomatic improvement. CONCLUSION: Over-drainage of cyst-peritoneal shunts is often not appreciated, especially when the main manifestation is headaches. As it is difficult to predict the required valve pressure setting, it may be advisable to consider the use of an adjustable valve.

Arachnoid Cysts↗
PubMed2004

Cranioplasty in children.

OBJECTIVE: The objective was to assess the outcome and complications associated with different cranioplasty implant materials in children. MATERIALS AND METHODS: A retrospective review was conducted of 28 consecutive cranioplasties carried out on 24 children between 1994 and 2001 (age range, 9 months to 15 years; minimum follow-up 18 months). The indications were: defect from previous craniectomy for trauma, tumour, infection or evacuation of haematoma (n=21), intradiploic dermoid cysts (n=2), growing fractures (n=4) and residual bony defect following craniofacial reconstruction (n=1). The materials used were: patient's craniectomised bone flap (n=16), split calvarial graft (n=8), acrylic (n=3) and titanium (n=1). All patients were assessed for bony fixation, cosmesis, wound healing and flap infection. RESULTS: There was no mortality and 18% morbidity (n=5: 3 infected flaps, 1 sterile wound dehiscence and 1 sterile wound discharge; overall infection rate 10%). Out of the 14 patients who had their own craniectomised bone flaps implanted initially, 3 became infected (2 in patients with bilateral defects) necessitating flap removal. Two of these were successfully re-implanted. No donor or recipient bone flap complications were seen in the 8 split calvarial grafts, wound discharge was seen in 1, requiring wound toilet. No complications were seen with acrylic or titanium cranioplasties. CONCLUSION: In this series, the use of the patients' own craniectomised flap had a low infection rate, and was mainly seen in patients who had bilateral flaps re-implanted soon after removal. There were no complications arising from the use of split calvarial and allograft material. Use of autologous implant material should be preferred whenever possible due to obvious resource and biological advantages, and can even be re-implanted if infected.

Adolescent↗
PubMed2004

Adaptation of skull clamp for use in image-guided surgery of children in the first 2 years of life.

INTRODUCTION: We describe a simple but effective modification of the skull clamp, aimed at stabilising the head of very young children, while avoiding the risk of creating a depressed skull fracture, in order to enable the utilisation of image-guidance in such young patients. METHODS: We machined three small perspex discs 3 cm in diameter. On the outer surface of these pads we drilled reception holes for the pins to prevent slippage. To avoid direct contact with the skin, we interfaced a thick pad of soft felt. During intraoperative positioning, the weight of the head was supported by a suction bean-bag placed on the operating table. Hence, the clamp apparatus was employed only to secure the head position, and not to support the weight of the head, thus requiring less clamp force. We employed this modification in three children (aged 9, 13 and 15 months) who required image-guided surgery for brain tumours. OUTCOME: In all cases the head remained immobile throughout the operation, making possible the accurate use of image guidance. At the end of the operation, some transient skin redness was noticed in the contact areas, which settled in a few days.

Brain Neoplasms↗
PubMed2004

Stereotactic biopsy of brain tumours in the paediatric population.

OBJECTIVE: Our objective was to establish the role of stereotactic neurosurgical techniques in the management of brain tumours in children. MATERIALS AND METHODS: A retrospective analysis was conducted of all stereotactic procedures performed in a single centre between 1996 and 2001. The success rates of achieving histologic diagnosis and a correlation between radiologic and histologic diagnosis were examined. RESULTS: There were 7 boys and 7 girls with a mean age of 9.1 years (range: 4-15). Under general anaesthetic 15 procedures were performed in 14 patients: 12 diagnostic and 3 therapeutic; 10 with CT and 5 with MRI guidance; 10 lesions were supratentorial and 4 were in the pons. A definitive histologic diagnosis was established in 10 of the 12 cases (diagnostic yield 83%). The pre-operative radiological diagnosis was accurate for tumour type in only 75% of the cases. In 3 patients cyst aspiration was attempted: post-operatively the cyst size was decreased in 2 and unchanged in 1. Seizures and acute confusion following biopsy of a thalamic tumour occurred in 1 patient. Post-operative scans were performed in 7 patients and in 2 we noted small, clinically insignificant, haemorrhages at the biopsy site. There was no mortality and morbidity was 6.6%. CONCLUSIONS: This small series confirms that stereotactic procedures in children are safe, well tolerated, with a high diagnostic yield, which could be improved with the use of intraoperative histopathological examination.

Basal Ganglia↗
PubMed2002

Spinal lipoma misinterpreted as a meningomyelocele on antenatal MRI scan in a baby girl.

INTRODUCTION: Antenatal screening for spina bifida with ultrasound and MR imaging is increasingly used. CASE REPORT: A baby girl's antenatal MRI examination showed features originally interpreted as a lumbar meningomyelocele. Repeat MRI examination soon after birth showed features of a spinal lipoma (lipomeningomyelocele). This was excised surgically and complete spinal cord untethering was achieved. CONCLUSION: As antenatal MR scanning is increasingly used, and fetal surgery is becoming more prominent, the correct interpretation of such images is crucial. We present a rare case of a misleading antenatal radiological diagnosis of spina bifida, which would have had severe implications if termination of the pregnancy or intra-uterine surgical repair had been considered.

Diagnosis, Differential↗
PubMed2002

Investigation of extracellular amino acid release in children with severe head injury using microdialysis. A pilot study.

Microdialysis has been used to investigate the pathophysiology of severe head injury in adults. No similar data exist, however, for children. As part of routine neuromonitoring, five children with severe, closed head injury (GCS < 8) were fitted with a microdialysis probe (CMA 70) at the time of intracranial pressure bolt insertion. Samples were collected at hourly intervals prior to analysis of amino acids by High Performance Liquid Chromatography. In contrast to adult patients, glutamate and aspartate did not correlate with structural amino acid levels and were inversely related to glutamine levels, suggesting that excitatory aminoacid release in children with severe head injury is likely to be an active process rather than an effect of indiscriminate cell destruction and that glutamate levels extracellularly may also depend on glutamate uptake and metabolism. The nitric oxide metabolite citrulline remained at similar levels in different patients throughout the monitoring period, indicating that nitric oxide metabolism may not follow the pattern of glutamate release. Our study is suggesting that amino acid release in severe head injury in children may not correspond to the recognised patterns from cell culture and animal studies and may also differ from that in adults.

Adult↗