Publications by authors named "Kostas Fountas"

Article Synopsis
  • Chronic subdural hematoma (chSDH) primarily affects older adults, and this study investigates factors that influence its recurrence, particularly focusing on the effectiveness of the single burr hole surgical technique.
  • A retrospective analysis involved 166 patients who were categorized into two groups based on hematoma recurrence, revealing a recurrence rate of 7.2% using the single burr hole method, which is lower than some other techniques documented in existing studies.
  • Key risk factors for recurrence included the use of anticoagulants, previous brain stroke events, and mixed densities of hematoma on CT scans, with the average recurrence happening about 16 days post-surgery.
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Article Synopsis
  • * A case study of an 85-year-old male shows that initial treatment improved his condition, but subsequent recurrences led to more complicated surgeries and ultimately his death from intraparenchymal bleeding.
  • * Key predictors for CSDH recurrence include failure of brain re-expansion and age-related atrophy; high-risk patients may benefit from a comprehensive treatment plan that includes medications and advanced surgical techniques.
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The present report describes a patient with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery aneurysm presenting with subarachnoid hemorrhage. Diagnostic spinal angiography revealed an intramedullary AVM, located at the T10-T11 level, and a prenidal saccular aneurysm at the junction of the radiculomedullary artery and the anterior spinal axis, fed by the right T8 segmental artery. The patient underwent successful selective coil embolization of the aneurysm.

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Introduction: Lobectomy has recently been employed in the management of glioblastoma (GB). Compared to subtotal, gross total and supramarginal resection, lobectomy provides maximum cytoreduction and improves overall survival (OS).

Research Question: The primary aim of this study is to compare lobectomy to other techniques for managing GB in terms of OS and progression-free survival (PFS).

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Objectives: The present article aimed to review the safety and the clinical and radiological outcomes of clipped ruptured and unruptured anterior circulation aneurysms.

Materials And Methods: The study investigated the relative articles involving the outcome after surgical management of ruptures versus unruptured anterior circulation aneurysms through electronic databases from January 1980 to January 2023. The primary outcomes were mortality and modified Rankin scale (mRS) >3.

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Decompressive craniectomy (DC) is considered a cornerstone in the management of refractory intracranial hypertension. For decades, DC was known as an occasionally lifesaving procedure; however, it was associated with numerous severe complications. The present study is a single-center retrospective case series study on with 321 patients who underwent DC between January, 2010 and December, 2020.

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Intracranial aneurysms (IAs) are present in ~2% of the general population, and genetic factors cannot be excluded for the risk of their development. The gene factors that result in the changes in the vascular extracellular matrix (ECM) may also be a key reason for IAs being hereditary. The gene [also known as chondroitin sulfate proteoglycan 2 ()] plays various roles in maintaining ECM functions.

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Article Synopsis
  • * A systematic review and meta-analysis were conducted using databases like Cochrane Library and PubMed, identifying 48 relevant articles to assess the incidence of these ACA variations.
  • * The analysis reveals that there were no statistically significant differences in the prevalence of ACA variations when comparing cadaveric (autopsy) studies to imaging studies.
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Brain abscess (BA) constitutes 1-8% of intra-cerebral tumors, and thus the present study aimed to compare the surgical outcomes of patients with primary and secondary BA. The present retrospective study examined 32 of cases BA who underwent surgery in a local institution between February, 2013 and December, 2023. All patients received intravenous antibiotic therapy according to the antibiogram for antimicrobial susceptibility.

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The aim of the present retrospective study was to confer the factors that are related to bone graft absorption and affect the outcomes of patients following cranioplasty (CPL). The present retrospective study includes cases of patients that underwent CPL between February, 2013 and December, 2022. All participants had a follow-up period of 1 to 10 years from the day of discharge from the hospital.

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Intracranial cavernous malformations (CMs) are vascular lesions with a high bleeding rate. At present, the debate regarding their treatment is still ongoing. The present systematic review and meta-analysis aimed to evaluate the safety of surgery or radiosurgery (SRS) for the management of CMs and to determine their potential outcomes compared with conservative treatment.

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Article Synopsis
  • Severe drug-resistant unilateral hemispheric epilepsy presents surgical challenges, leading to a shift from anatomical hemispherectomy to functional hemispherotomy, which has lower complications and improved outcomes.
  • A consensus statement was created by European epilepsy surgeons to outline history, indications, surgical techniques, and complications for hemispheric disconnection procedures.
  • This paper represents the first European consensus on the topic, providing an overview of current practices and emphasizing the need for further long-term outcome data, especially regarding minimal invasive techniques.
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Introduction: Open resective surgery remains the main treatment modality for refractory epilepsy, but is often considered a last resort option due to its invasiveness.

Research Question: This manuscript aims to provide an overview on traditional as well as minimally invasive surgical approaches in modern state of the art epilepsy surgery.

Materials And Methods: This narrative review addresses both historical and contemporary as well as minimal invasive surgical approaches in epilepsy surgery.

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The treatment option for unruptured intracranial aneurysms (UIAs) depends on their natural history-related risk of rupture vs. the risk of surgical management. The present meta-analysis sought to assess the association between the surgical outcomes of anterior and posterior circulation UIAs.

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The application of decompressive craniectomy (DC) is thoroughly documented in the management of brain edema, particularly following traumatic brain injury. However, an increasing amount of concern is developing among the universal medical community as regards the application of DC in the treatment of other causes of brain edema, such as subarachnoid hemorrhage, cerebral hemorrhage, sinus thrombosis and encephalitis. Managing stroke continues to remain challenging, and demands the aggressive and intensive consulting of a number of medical specialties.

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The vestibular system plays a fundamental role in body orientation, posture control, and spatial and body motion perception, as well as in gaze and eye movements. We aimed to review the current knowledge regarding the location of the cortical and subcortical areas, implicated in the processing of vestibular stimuli. The search was performed in PubMed and Scopus.

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Objective: The structure and specifics of neurosurgery residency training vary substantially across programs and countries, potentially leading to differences in clinical reasoning, surgical skills, and professionalism. The Greek neurosurgical training system is unique in numerous respects. This manuscript delineates the current state of neurosurgical residency training in Greece and outlines future directions.

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Introduction: Cavernous malformations (CM) of the central nervous system constitute rare vascular lesions. They are usually asymptomatic, which has allowed their management to become quite debatable. Even when they become symptomatic their optimal mode and timing of treatment remains controversial.

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Background: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has been associated with severe morbidity and high mortality. It has been demonstrated that early intervention is of paramount importance. The aim of our study is to evaluate the functional outcome and the overall survival of early microsurgically treated patients.

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Meningitis/ventriculitis (MV) is an illness which can occur as a complication following neurosurgical procedures. Devices such as an external ventricular drain (EVD) are also related to considerable complications, such as infections. The present study examined the risk factors associated with central nervous system (CNS) infections associated with the external ventricle drainage system.

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Introduction: Large populations in middle- and low-income countries in Africa, Asia, and Central and South Americas face a dramatic neurosurgical crisis. However, large social groups in high-income countries face similar limited access to neurosurgical services. Proper identification of such a problem, analysis of the underlying causes, and proposal of potential solutions may not only address the problem at a national level, but may also provide valuable reflections on the efficient management of global neurosurgical crisis.

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Cerebellar metastases represent the most common lesion requiring surgical treatment in the daily neurosurgical praxis. We report a rare case with Lhermitte-Duclos disease presenting to the neurosurgical outpatient department and describe our diagnostic and treatment challenges. A 57-year-old man presented with transient cerebellar manifestations, including walking difficulties, dizziness, and a persistent occipital headache.

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Pseudomeningocele (PMC) is a rare complication of anterior cervical procedures resulting in pain, headaches, nerve root entrapment, and in rare cases, spinal cord compression. Here we present a 57-year-old male with increasing myelopathy due to late-onset PMC that developed two years following a 360-degree cervical surgery for ossification of the posterior longitudinal ligament (OPLL). In this case, the PMC was successfully treated with a lumboperitoneal shunt.

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Background: Aggressive resection without compromising the patient's neurological status remains a significant challenge in treating intracranial gliomas. Our current study aims to evaluate the efficacy and safety of extra-operative stimulation and mapping via implanted subdural electrodes with or without depth (EOCSM), offering an alternative approach when awake mapping is contraindicated.

Methods: Fifty-one patients undergoing EOCSM for glioma resection in our institution formed the sample study of our current retrospective study.

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