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A. Ko ................................................................................................................................................................ 155

113

HELLENIC NEUROSURGERY
SEPTEMBER - DECEMBER 2007, Volume 14, Number 3

CONTENTS
Reviews
Snow sports head injuries: contemporary data and review of the literature........................................................ 115
P. Selviaridis
Spinal infections............................................................................................................................................................ 121
A. Christodoulou, P. Antonarakos

Clinical Study
Evaluation of surgical results of cervical discectomy and osteophytectomy with NDI index........................... 132
V. Christodoulou, D. Peios, A. Filippidis, N. Skoulios, I. Achoulias, I. Baltas

Case Reports
Anaplastic astrocytoma - representation with the latest techniques of magnetic resonance............................ 138
B. Lallas, T. Geroukis, A. Petridis, C. Tzikas, K. Anastasiadou, C. Grigoriadis, . Baltas,
S. Baroutas, P. Palladas
Sacral insufficiency fracture........................................................................................................................................ 145
C. Tzikas, V. Lallas, K. Anastasiadou, T. Geroukis, C. Grigoriadis, D. Peios, P. Paladas
Long-term survival of a glioblastoma multiforme patient: Case Report.............................................................. 150
G. Tsermoulas, P. Sioutos, K. Mataliotakis, A. Seretis

TO THE EDITOR
A. Kougialis .................................................................................................................................................................. 155

114


REVIEW

2007, 14(3):115-120
HELLENIC NEUROSURGERY 2007, 14(3):115-120

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SU M M A RY
Snow sports head injuries: contemporary data and review of the literature
Selviaridis P.
1st Neurosurgical Department, AHEPA University hospital, Thessaloniki

The popularity of skiing and snowboarding has been growing rapidly throughout the world. The purpose
of this study is to review the contemporary literature and to present the recent epidemiological data regarding the incidence, pattern and severity of head injuries. We reviewed the literature in Pubmed using the
key-words: ski and/or snowboard and head injury. An additional search was performed of Internets largest
search engine using the same terms. Head injuries constitute 3 to 29% of all injuries in winter sports. Injury
rates are relatively low, ranging from 2 to 3 and 4 to 6 head injuries per 1000 skier days for ski and snowboard
respectively. Collision, usually on a stationary object is the most common mechanism (4888%) and fall is
the second. Head injury after major fall, usually after jumping, presents itself as an important mechanism of
injury among snowboarders. Although head injury represents only a small fraction of skiers and snowboarders
injuries overall, it is the leading cause of death and serious injury on the slopes. The difference in technique
and age distribution between skiers and snowboarders may account for the differences in the incidence and
mechanisms of head injury.
Key-words: head injury, ski, snowboard

1. Bladin C, McCrory P. Snowboarding injuries. An overview.

Sports Med 19:358-364, 1995.

4. Davidson TM, Laliotis AT. Alpine skiing injuries: a nineyear study. West J Med 164:310-314, 1996.

2. Burtschner M, Philadelphy M. Skiing collision accidents:

frequency and types of injuries. In: Mote CD Jr, Johnson
RJ, Hauser W, et al., eds. Skiing Trauma and Safety, 10th
Vol. ASTM STP 1266. Philadelphia, PA: American Society
for Testing and Materials. 73-76, 1996.

5. Deibert MC, Aronsson DD, Johnson RJ, et al. Skiing

injuries in children, adolescents and adults. J Bone Joint
Surg Am 80: 25-32, 1998.

3. Chissell HR, Feagin Jr JA, Winston J, et al. Trends in ski

and snowboard injuries. Sports Med 22:141-145, 1996.

6. Diamond TP, Gale DS, Denkhaus KH. Head injuries in

skiers: an analysis of injury severity and outcome. Brain
Injury 15:429-434, 2001.
7. Earle AS, Moritz JR, Saviers GB. Ski injuries. JAMA

120

180:285-288, 1962.
8. Fukuda , Tabaka M, Saito T, et al. Head injuries in
snowboarders compared with head injuries in skiers. A
prospective analysis of 1076 patients from 1994 to 1999
in Niigata, Japan. Am J Sports Med 29(4):437-440, 2001
9. Furrer M, Erhart S, Frutinger A, et al. Severe skiing injuries: a retrospective analysis of 361 patients including
mechanism of trauma, severity of injury and mortality.
J Trauma 39:737-741, 1995.
10. Hagel B, Goulet C, Platt WR, et al. Injuries among skiers
and snowboarders in Quebec. Epidemiology 15:279-286,
2004.
11. Hagel B, Pless IB, Goulet C, et al. Effectiveness of helmets
in skiers and snowboarders: case-control and crossover
study. BMJ 330(5):281, 2005.
12. Harris J. Snowboarding and head injury. J Neurosurg
98:932. Author reply 932-933, 2003.
13. Health Statistics Section, Colorado Department of Public
Health and Enviroment. Recreational fatalities in Colorado, 1996-1998. Denver, CO: Colorado Department of
Public Health and Enviroment. Health Statistics Brief,
2000.
14. Heller MF. World Ski Atlas. London, Cavendish, 1978.
15. Hunter ER: Skiing Injuries. Am J Sports Med 27:381-389,
1999.
16. Johnson RJ, Ettlinger CF, Shealy JE. A method to help
reduce the risk of serious knee sprains incurred in alpine
skiing. Am J Sports Med 23:531-537, 1995.
17. Levy AS, Hawkes AP, Hemminger LM, et al. An analysis
of head injuries among skiers and snowboarders. J Trauma
nj 53:695-704, 2002.
18. Levy AS, Smith RH. Neurologic injuries in skiers and
snowboarders. Semin Neurol 20:233-245, 2000.
19. Macnab AJ, Smith T, Gagnon FA, et al. Effect of helmet
wear on the incidence of head/face and cervical spine

, . 14, 3, 2007

injuries in young skiers and snowboarders. Inj Prev 8:324327, 2002.

20. Moritz JR. Ski injuries. Am J Surg 98:493-505, 1959.
21. Morrow PL, McQuillen EN, Eaton LA Jr, et al. Downhill
ski fatalities: the Vermont experience. J Trauma 28:95-100,
1988.
22. Nakaguchi H, Fujimaki T, Ueki K, et al. Snowboard head
injury: prospective study in Chino, Nagano, for two seasons from 1995 to 1997. J Trauma 46:1066-1069, 1999.
23. Nakaguchi H, Tsutsumi K. Mechanisms of snowboarding-related severe head injury: shear strain induced by
the opposite-edge phenomenon. J Neurosurg 97:542-548,
2002.
24. Shealy JE, Ettlinger CF. Gender-related injury patterns
in skiing. In: Mote CD Jr, Johnson RJ, Hauser W, et al.,
eds. Skiing Trauma and Safety, 10th Vol. ASTM STP 1266.
Philadelphia, PA: American Society for Testing and Materials. 45-57, 1996.
25. Sherry E, Clout L. Deaths associated with skiing in Australia: a 32-year study fo cases from the Snowy Mountains.
Med J Aust 149:615-616, 1988.
26. Sulheim S, Holme I, Ekeland A, et al. Helmet use and
risk of head injuries in alpine skiers and snowboarders.
JAMA 295(22):919-924, 2006.
27. U.S. Consumer Product Safety Commission. Skiing
helmets: an evaluation of the potential to reduce head
injury. Washington DC: U.S. Government Printing Office; 1999.
28. Wakabayashi T, Fujiwara N, Mori K, et al. Snowboarding
injury: Comparison with skiing injuries. Clin Sports Med
13:1187-1192, 1996.
29. Wilderness Medical Society Summer Conference and
Annual Meeting, Park City, Utah, Aug 2000.
30. Zacharopoulos A. 16th International Symposium of the
ISSS, Mount Arai, Japan, April 2005.

 2007, 14(3):121-131
HELLENIC NEUROSURGERY 2007, 14(3):121-131

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 129

SU M M A RY
Spinal infections
Christodoulou A., Antonarakos P.
1 Orthopaedic Department, University of Thessaloniki, General Hospital G. Papanikolaou
Thessaloniki, Greece
st

Spinal infections still remain a serious medical problem associated with high rates of morbidity and mortality. All the advances occurred within this century have certainly improved the clinical outcomes but many
factors have also contributed to the increase of the number of new cases with spinal infection such as the
increase of the mean life expectancy, the number of patients suffering from immunocompression and lung
tuberculosis as well as the wide popularization of spine surgery itself. Patients symptoms can last for weeks
or months before the diagnosis is made. Early diagnosis is of outmost importance for a good clinical outcome.
From the time the diagnosis is made the mainstay of treatment remains antimicrobial therapy based on the
cultures obtained and immobilization of the spine with rest and orthotics. In most of the cases conservative treatment will be adequate to eradicate the infection and prevent the development of spinal deformity,
abscess formation or neural compromise. However still many cases will need further surgical intervention,
especially cases which present with severe neural compression and neurological compromise, mechanical
instability of the spine or severe abscess formation. The type of surgical procedure depends on the specific
indications and advantages of each procedure as well as the preferences of the surgeon. Anterior procedures
give the advantage of the radical eradication of the infection and a more stable reconstruction of the anterior
column against the increased rate of morbidity. On the other hand posterior procedures have the disadvantage
of the limited approach and a less stable fixation of the spine with the apparent advantage of decreased rate
of morbidity. Recently minimal access procedures have emerged and are expected to play an important role
to the treatment of spinal infections
Key words: diagnosis, infection, incidence, spinal, treatment

1. Boachie-Adjei O, Squillante RG. Tuberculosis of the spine.

OrthopClin North Am 27:95103, 1996.
2. Brugieres P, Revel MP, Dumas JL. CT-guided vertebral
biopsy: a report of 89 cases. J Neuroradiol 18:351359,
1991.
3. Bruschwein DA, Brown ML, McLeod RA. Gallium scintigraphy in the evaluation of disk-space infections: concise
communication. J Nucl Med 21:925927, 1980.
4. Buranapanitkit B, Lim A, Geater A. Misdiagnosis in
vertebral osteomyelitis: problems and factors. J Med Assoc
Thai 84:17431750, 2001.
5. Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint
Surg 79:874880, 1997.
6. Chelsom J, Solberg CO. Vertebral osteomyelitis at a
Norwegian university hospital 1987-97: clinical features,
laboratory findings and outcome. Scand J Infect Dis
30:147151, 1998.
7. Christodoulou A, Zidrou C, Savvidou OD, et al. Percutaneous Harlow Wood needle biopsy of the spine: a
retrospective analysis of 238 spine lesions. Orthopedics
28:784-9, 2005.

8. Christodoulou AG, Givissis P, Karataglis D, et al. Treatment

of tuberculous spondylitis with anterior stabilization and
titanium cage. Clin Orthop Relat Res 444:60-5, 2006
9. Colmenero JD, Jimenez-Mejias ME, Reguera JM, et al.
Tuberculous vertebral osteomyelitis in the new millennium: still a diagnostic and therapeutic challenge. Eur J
Clin Microbiol Infect Dis 23:477483, 2004.
10. Cunha BA. Osteomyelitis in elderly patients. Clin Infect
Dis 35:287293, 2002.
11. Currier BL, Eismont FJ. Infections of the Spine. In:
Herkowitz HN, Garfin SR, Balderston RA, Eismont FJ,
Bell GR, Wiesel SW, eds. The Spine. Vol 2. Fourth ed.
Philadelphia, PA: W.B. Saunders Company: 12071258,
1999.
12. Cushing AH. Diskitis in children. Clin Infect Dis 17:16,
1993.
13. Early SD, Kay RM, Tolo VT. Childhood diskitis. J Am
Acad Orthop Surg 11:413420, 2003.
14. Eismont FJ, Bohlman HH, Soni PL, et al. Pyogenic and
fungal vertebral osteomyelitis with paralysis. J Bone Joint
Surg 65:1929, 1983.

130

15. Fernandez M, Carrol CL, Baker CJ. Discitis and vertebral

osteomyelitis in children: an 18-year review. Pediatrics
105:12991304, 2000.
16. Griffiths DL, Seddon H, Ball J, et al. A 10-year assessment
of a controlled trial comparing debridement and anterior
spinal fusion in the management of tuberculosis of the
spine in patients on standard chemotherapy in Hong
Kong. Eighth Report of the Medical Research Council
Working Party on Tuberculosis of the Spine. J Bone Joint
Surg 64:393398, 1982.
17. Jung NY, Jee WH, Ha KY, et al. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI.
AJR Am J Roentgenol 182:14051410, 2004.
18. Kallio MJ, Unkila-Kallio L, Aalto K, et al. Serum C-reactive protein, erythrocyte sedimentation rate and white
blood cell count in septic arthritis in children. Pediatr
Infect Dis 16:411413, 1997.
19. Kapeller P, Fazekas F, Krametter D, et al. Pyogenic infectious spondylitis: clinical, laboratory and MRI features.
Eur Neurol 38:9498, 1997.
20. Khoo LT, Mikawa K, Fessler RG. A surgical revisitation
of Pott distemper of the spine. Spine J 3:130145, 2003.
21. Krogsgaard MR, Wagn P, Bengtsson J. Epidemiology of
acute vertebral osteomyelitis in Denmark: 137 cases in
Denmark 19781982, compared to cases reported to the
National Patient Register 1991-1993. Acta Orthop Scand
69:513517, 1998.
22. Lifeso RM, Weaver P, Harder EH. Tuberculous spondylitis
in adults. J Bone Joint Surg 67:14051413, 1985.
23. Liljenqvist U, Lerner T, Bullmann V, et al. Titanium cages
in the surgical treatment of severe vertebral osteomyelitis.
Eur Spine J 12:606612, 2003.
24. Lindholm TS, Pylkkanen P. Discitis following removal
of intervertebral disc. Spine 7:618622, 1982.
25. Mallya RK, de Beer FC, Berry H. Correlation of clinical
parameters of disease activity in rheumatoid arthritis with
serum concentration of C-reactive protein and erythrocyte
sedimentation rate. J Rheumatol 9:224228, 1982.
26. McAfee PC, Regan JR, Zdeblick T, et al. The incidence
of complications in endoscopic anterior thoracolumbar
spinal reconstructive surgery. A prospective multicenter
study comprising the first 100 consecutive cases. Spine
20:16241632, 1995.
27. Mirovsky Y, Copeliovich L, Halperin N. Gowers sign
in children with discitis of the lumbar spine. J Pediatr
Orthop B 14:6870, 2005
28. Modic MT, Feiglin DH, Piraino DW, et al. Vertebral osteomyelitis: assessment using MR. Radiology 157:157166,
1985.
29. Moon MS. Tuberculosis of the spine. Controversies and
a new challenge. Spine 22:17911797, 1997.
30. Quinones-Hinojosa A, Jun P, Jacobs R, et al. General
principles in the medical and surgical management of

, . 14, 3, 2007

spinal infections: a multidisciplinary approach. Neurosurg

Focus 17, 2004
31. Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior
arthrodesis. J Bone Joint Surg 71:13141323, 1989.
32. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural
abscess: a meta-analysis of 915 patients. Neurosurg Rev
23:175205, 2000.
33. Rezai AR, Lee M, Cooper PR, et al. Modern management
of spinal tuberculosis. Neurosurgery 36:8797, 1995
34. Rezai AR, Woo HH, Errico TJ, et al. Contemporary
management of spinal osteomyelitis. Neurosurgery 44:
10181025, 1999
35. Rodiek SO. Diagnostic methods in spinal infections.
Radiology 41:976986, 2001.
36. Ross PM, Fleming JL. Vertebral body osteomyelitis:
spectrum and natural history. A retrospective analysis
of 37 cases. Clin Orthop Relat Res 118:190198, 1976.
37. Rothman SL. The diagnosis of infections of the spine
by modern imaging techniques. Orthop Clin North Am
27:111123, 1996.
38. Salvalaggio PR, Bassetti M, Lorber MI, et al. Aspergillus
vertebral osteomyelitis after simultaneous kidney-pancreas
transplantation. Transpl Infect Dis 5:187190, 2003.
39. Sapico FL, Montgomerie JZ. Vertebral osteomyelitis. Infect
Dis Clin North Am 4:539550, 1990.
40. Sapico FL. Microbiology and antimicrobial therapy of
spinal infections. Orthop Clin North Am 27:913, 1996.
41. Schulitz KP, Assheuer J. Discitis after procedures on the
intervertebral disc. Spine 19:11721177, 1994.
42. Tali ET. Spinal infections. Eur J Radiol 50:120133,
2004.
43. Tay BK, Deckey J, Hu SS. Spinal infections. J Am Acad
Orthop Surg 10:188197, 2002.
44. Thelander U, Larsson S. Quantitation of C-reactive protein
levels and erythrocyte sedimentation rate after spinal
surgery. Spine 17:400404, 1992.
45. Tsiodra S, Falagas ME. Clinical Assessment and Medical
Treatment of Spine Infections. Clin Ortho Rel Res 444:3850, 2006
46. Varma R, Lander R, Assaf A. Imaging of pyogenic infectious spondylodiscitis. Radiol Clin North Am 39:203213,
2001.
47. Weber M, Gubler J, Fahrer H, et al. Spondylodiscitis caused
by viridans streptococci: three cases and a review of the
literature. Clin Rheumatol 18:417421, 1999.
48. Weinstein MA, Eismont FJ. Infections of the spine in
patients with human immunodeficiency virus. J Bone
Joint Surg 87:604609, 2005.
49. Weiss H, Katz S. Salmonella paravertebral abscess and
cervical osteomyelitis in sickle-thalassemia disease. South
Med J 63:339341, 1970.

 131

50. Whalen JL, Brown ML, McLeod R, et al. Limitations

of indium leukocyte imaging for the diagnosis of spine
infections. Spine 16:193197, 1991.
51. Wiley AM, Trueta J. The vascular anatomy of the spine
and its relationship to pyogenic vertebral osteomyelitis.

J Bone Joint Surg 41-B:796809, 1959.

52. Yue WM, Tan SB. Distant skip level discitis and vertebral
osteomyelitis after caudal epidural injection: a case report
of a rare complication of epidural injections. Spine 28:
E209E211, 2003.

KINIKH
cLINICAL STUDY

2007, 14(3):132-137
HELLENIC NEUROSURGERY 2007, 14(3):132-137

NDI

116
.
Neck Disability Index
. 5-14 ( ), 15-24 ( ),
25-31 ( )
>34 ( ). 116 .
14 (57%).
41 38 (92%).
33 ,
28 . 116 , 104 96
(92,4%). 12 .
(50%), (33%),
(17%).

, .
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,
,
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: , NDI, , ,

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50% , 50 ,
, 20%
,

:
,
. 27,
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),
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,
.

127 , 56 71 ,
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2006.

2007.
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134

, . 14, 3, 2007

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136

, . 14, 3, 2007

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 NDI 137

Summary
Evaluation of surgical results of cervical discectomy and osteophytectomy with NDI index
Christodoulou V., Peios D., Filippidis A., Skoulios N., Achoulias I., Baltas I.
Neurosurgical Department G. Papanikolaou Hospital, Thessaloniki

To evaluate the surgical results of cervical discectomy and osteophytectomy we studied 116 patients with the
Neck Disability Index. Group A (score 5-14) included 14 patients and improved 8 (57%). Group B (score 1524) included 41 patients and improved 38 (92%). Group C (score 25-31) included 33 patients and improved
all. Group D (score >34) included 28 patients and improved all. From the 116 patients, 104 presented with
radiculopathy and improved 96 (92,4%). 12 presented with myelopathy and improved six (50%), four (33%)
remained stable and two deteriorated. The outcome was related to the clinical symptoms. We conclude that
outcome from radiculopathy with high disability is better than the outcome of radiculopathy with slight
disability, if proper surgical technique is applied. Outcome from myelopathy is less good despite the proper
surgical technique.
Key words: cervical discectomy, neck disability index, outcome.

1. Bertalanffy , Eggert R. Complications of anterior

cervical discectomy without fusion in 450 consecutive
patients. Acta Neurochir (Wien) 99:41-50, 1989.

cervical myelopathy: indications and techniques for multilevel cervical discectomy. Spine J 6(6 Suppl):242S-251S,
2006.

2. Boni M, Cherubino P, Benazzo F, et al. Multiple subtotal

somatectomy. Technique and evaluation of a series of 39
cases. Spine 9:358-362, 1984.

10. Lunsford LD, Bissonette DJ, Zorub DS. Anterior surgery

for cervical disc disease. Part 2: Treatment of cervical
spondylotic myelopathy in 32 cases. J Neurosurg 5:12-19,
1980.

3. DuBois CM, Bolt PM, Gupta P, et al. Static versus dynamic

plating for multilevel anterior cervical discectomy and
fusion. Spine J 7:188-193, 2007.
4. Eck JC, Humphreys SC, Hodges SD, et al. A comparison
of outcomes of anterior cervical discectomy and fusion
in patients with and without radicular symptoms. J Surg
Orthop Adv 15:24-26, 2006.
5. Frymoyer GW. The adult spine Second Edition Volume
3, p 1357-1371. Lippincott-Raven Pub. 1997.
6. Garvey TA, Transfeldt EE, Malcolm JR, et al. Outcome of
anterior cervical discectomy and fusion as perceived by
patients treated for dominant axial-mechanical cervical
spine pain. Spine 27:1887-1895, 2002.
7. Greenberg MS. Handbook of Neurosurgery, 5th edition,
p 322-327, Thieme 2001.
8. Hacker RJ. A randomized prospective study of an anterior
cervical interbody fusion device with a minimum of 2
years of follow-up results. J Neurosurg 93(2 Suppl):222226, 2000.
9. Hillard VH, Apfelbaum RJ. Surgical management of

11. Nandoe Tewarie RD, Bartels RH, Peul WC, et al. Longterm outcome after anterior cervical discectomy without
fusion. Eur Spine J, pub ahead of print, 2007.
12. Peolsson A, Vavruch L, Oberg B. Predictive factors for
arm pain, neck pain, neck specific disability and health
after anterior cervical decompression and fusion. Acta
Neurochir (Wien) 14:167-173, 2006.
13. , , . : ;
12:97-100, 2005.
14. Vernon H, Mior S. The Neck Disability Index: a study of
reliability and validity. J Manipulative Physiol Ther 14:
409-415, 1991.
15. Yue WM, Brodner W, Highland TR. Long-term results
after anterior cervical discectomy and fusion with allograft and plating: a. 5- to 11-year radiologic and clinical
follow-up study. Spine 30:2138-2144, 2005.
16. Zoega B, Karrholm J, Lind B. Outcome scores in degenerative cervical disc surgery. Eur Spine J 9:137-143, 2000.

 2007, 14(3):138-144
HELLENIC NEUROSURGERY 2007, 14(3):138-144

CASE REPORT

35 ,
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-DTI -Spectroscopy).

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o 139

1,5.
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140

, . 14, 3, 2007

3-7. FLAIR, :
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o 141

9. , ()
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(Perfusion-CBV).

( de novo). 25%
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(:=1.8:1),
40-50 5,8,9,11.

,

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.

(WHO grade II)

(grade IV) (. 1).


(grade
II)1,4,6,8.

142

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().

1. WHO
Grade 1, (1-2 )
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ADC)

o 143

(
)

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SU M M A RY
Anaplastic astrocytoma - representation with the latest techniques of magnetic resonance
Lallas B.1, Geroukis T.1, Petridis A.1, Tzikas C.1, Anastasiadou K.1, Grigoriadis C.2,
Baltas I.2, Baroutas S.2, Palladas P.1
1

Department f CT and MRI and 2Department of Neurosurgery, G. Papanikolaou Hospital Thessaloniki

MRI is specific and sensitive and is considered the investigation of choice in the diagnosis of brain tumors.
The latest MRI applications aim in differentiating low grade astrocytomas from anaplastic astrocytomas
or cerebral ischemia. We describe the case of a 35-year old male patient, presented with headache, seizures
and instability of gait. The MRI examination, including T1WI, T2WI, Flair sequences, as well as T1WI after
intravenous contrast injection raised the suspicious of astrocytoma. Further examination with DWI, PWI,
DTI images and spectroscopy revealed as the most likely diagnosis the Anaplastic Astrocytoma. A stereotactic
brain biopsy confirmed this diagnosis. Advanced techniques, like DWI, PWI, DTI and spectroscopy expand
the role of the MRI in the diagnosis of brain tumors.
Key words: anaplastic astrocitoma, MRI applications

144

, . 14, 3, 2007

1. Brain Tumor Pathology. Current Diagnostic Hotspots

and Pitfalls. AJNR 28:1832-1833, 2007.
2. Bulakbasi N, Kocaoglu M, rs F, et al. Combination of
Single-Voxel-Voxel Proton MR Spectroscopy and Apparent Diffusion Coefficient Calculation in the Evaluation
of Common Brain Tumors. AJNR 24:225-233, 2003.
3. Esposito Felice J, Mithalal R, Papa M, et al. Astrocytoma,
Brain. WebMD. 2006.
4. Kono K, Inoue Y, Nakayama K, et al. The Role of Diffusion-weighted Imaging in Patients with Brain Tumors.
AJNR 22:1081-1088, 2001.
5. Ana L, Castillo M, Armao D, et al. Unusual MR Spectroscopic Imaging Pattern of an Astrocytoma: Lack of
Elevated Choline and High myo-Inositol and Glycine
Levels. Radiology 241:839-846, 2006.
6. Stanley L, Ahn D, Johnson G, et al. Peritumoral Diffusion
Tensor Imaging of High-Grade Gliomas and Metastatic
Brain Tumors. AJNR 24:937-941. 2003.
7. Stephan ME, Bogner P, Bajzik G, et al. Normal Brain and
Brain Tumor: Multicomponent Apparent Diffusion Coefficient Line Scan Imaging. Radiology 219: 842. 2001.

8. Carles M, Juli-Sap M, Alonso J, et al. Brain Tumor

Classification by Proton MR Spectroscopy: Comparison
of Diagnostic Accuracy at Short and Long TE. AJNR
25:1696-1704. 2004.
9. Mitsuhashi T, Shimizu Y, Ban S. Anaplastic oligodendroglioma: a case report with characteristic cytologic
features, including minigemistocytes. Acta Cytol 51:657660, 2007.
10. Provenzale M. James, Srinivasan Mukundan, Barboriak
DP. Diffusion-weighted and Perfusion MR Imaging for
Brain Tumor Characterization and Assessment of Treatment Response. Radiology 239:632-649, 2006.
11. Higano S, Yun X, Kumabe T, et al. Malignant Astrocytic
Tumors: Clinical Importance of Apparent Diffusion
Coefficient in Prediction of Grade and Prognosis. Radiology 241:839-846; published online before print as
10.1148/radiol.2413051276. 2006.
12. Melissa Y, Fisch C, Lamarche JB. AFIP Archives: Gliomatosis Cerebri Affecting the Entire Neuraxis. Radiographics
23:247, 2003.

 2007, 14(3):145-149
HELLENIC NEUROSURGERY 2007, 14(3):145-149

CASE REPORT

.

. 55 ,
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.
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146

, . 14, 3, 2007

.
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CT
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(RI).

RI Siemens, Symphony 1,5 Tesla.
1, 2 STIR
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CT.

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 147

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148

, . 14, 3, 2007

7.
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SU M M A RY
Sacral insufficiency fracture
Tzikas C.1, Lallas V.1, Anastasiadou K.1, Geroukis T.1, Grigoriadis C.2, Peios D.2, Paladas P.1
1

Department of CT and MRI G. Papanikolaou Hospital Thessaloniki, 2Department of Neurosurgery

G. Papanikolaou Hospital Thessaloniki

Sacral insufficiency fractures are very rare and they might be confusing in their diagnosis. The aim of this
assignment is to present a similar case and to outline its difficulty in approaching imaging findings. A female
patient aged 55, after lumbar injury presented with ache in the lumbar area. The X-ray was normal and she
received anti-inflammatory treatment. One year later, there was no improvement, so she had a CT of pelvis
and hips which did not revealed any specific findings except of degeneration of L5-S1 and facets. Due to
inconsistency of CT-findings and the clinical presentation, an MRI scan was performed. Axial sagital semi
coronal T1-T2-STIR were taken. T2 and STIR sequences revealed hyper tense signal of marrow with characteristic bilateral distribution sparing sacral-iliac joints giving an H pattern. There was no linear fracture
as this usually appears up to three months after the injury. In T1 sequence the signal was hypotense. Sacral
insufficiency fractures are stress fractures resulting from normal physiological stress on demineralized bone
with decreased elastic resistance. They are difficult to be diagnosed as they do not usually need high stress
pressure. The patients are usually treated for different medical conditions as degeneration of intravertebral
disc, spinal stenosis and hip arthritis. These fractures usually present to postmenopausal women aged 60 to
80 years old, who may have osteoporosis, rheumatoid arthritis, renal osteodystrophy, corticosteroid excess,
radiation therapy, Paget disease and other osteopenic reasons. The most common reason is osteoporosis and
almost always the history of the injury is detected after the diagnosis. Differential diagnosis includes sacral

 149

metastases, primary sacral neoplasm, sacral osteomyelitis, sacroiliitis and osteoarthritis. MRI is specific and
sensitive and the investigation of choice in diagnosing sacral insufficiency fractures, as there is no other way
to reveal the marrow bone edema with the characteristic H shaped pattern.
Key words: marrow bone edema, sacral fracture

1. Anderson MW and A Greenspan Stress fractures. Radiology 199: 1-12, 1996.

unsuspected bone and soft-tissue injury. Radiology 197:

263-267, 1995.

2. Berger PE, Ofstein RA, Jackson DW, et al. MRI demonstration of radiographically occult fractures: what have
we been missing? Radiographics 9: 407-436, 1989.

5. Diel J, Orlando O, Richard A, et al. The Sacrum: Pathologic Spectrum, Multimodality Imaging, and Subspecialty
Approach. Radiographics 21: 83-104, 2001.

3. Blomlie V, Lien HH, Iversen T, et al. Radiation-induced

insufficiency fractures of the sacrum: evaluation with
MR imaging. Radiology 188: 241, 1993.

6. Manaster BJ. Adult Chronic Hip Pain: Radiographic

Evaluation. Radiographics 20: S3-S25, 2000.

4. Bogost GA, Lizerbram EK, Crues JV, 3rd MR imaging

in evaluation of suspected hip fracture: frequency of

7. Peh WC, Khong PL, Yin Y, et al. Imaging of pelvic insufficiency fractures. Radiographics 16: 335-348, 1996.

 2007, 14(3):150-154
HELLENIC NEUROSURGERY 2007, 14(3):150-154

CASE REPORT

, ( 9 )
.

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,
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.

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,
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: 6947773315
e-mail: gtsermoulas@gmail.com

 151

.
.
grade
IV WHO
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).

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152

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,
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,
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13.

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.: : . 20
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, . 14, 3, 2007

(<5%
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acidic protein)12. ,
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 153

.


.

MGMT (O6methylguanine (O6-mG) -DNA-methyltransferase)
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(O6-alkylguanine-DNA-alkyltransferase)
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SU M M A RY
Long-term survival of a glioblastoma multiforme patient: Case Report
Tsermoulas G., Sioutos P., Mataliotakis K., Seretis A.
Neurosurgical Department, Athens General Hospital G. Genimatas

A case of a female patient with glioblastoma multiforme surviving for more than nine years is presented.
Factors associated with long term survival in patients with glioblastoma multiforme are: young age at diagnosis, female sex, gross total resection of the tumor and a high preoperative Karnofsky Performance Score.
Pathology findings associated with long-term survival in glioblastoma multiforme include the presence of
oligodendroglial cell isles, the presence of giant cells, the absence of small anaplastic cells, and a low proliferative cell rate. Genetic changes associated with long-term survival in patients with glioblastoma multiforme
are discussed as well.
Key words: glioblastoma multiforme, long-term survival, malignant glioma.

1. Athanassiou , Synodinou M, Maragoudakis E, et al.

Randomized Phase II Study of Temozolomide and Radiotherapy Compared With Radiotherapy Alone in Newly
Diagnosed Glioblastoma Multiforme. Journal of Clinical
Oncology 23: 2372-2377, 2005.

3. Binder DK, Keles GE, Aldape K, et al. Aggressive Glial

Neoplasms. In Neurological Surgery. Principles and
Practice, Batjer HH, Loftus CM (eds.). Volume 1: Lippincott Williams and Wilkins: Philadelphia, 1st ed., pp
1270-1280, 2003.

2. Back MF, Ang EL, Ng WH, et al. Improved median survival for glioblastoma multiforme following introduction
of adjuvant temozolomide chemotherapy. Ann Acad Med
Singapore 36:338-342, 2007.

4. Burger PC, Vogel FS, Green SB, et al. Glioblastoma Multiforme and Anaplastic Astrocytoma: Pathologic Criteria and Prognostic Implications. Cancer 56:1106-1111,
1985.

154

5. Chandler KL, Prados MD, Malec M, et al. Long-term

survival in patients with glioblastoma multiforme. Neurosurgery 32:716-720, discussion 720, 1993.
6. Kelly PJ, Hunt CH. The limited value of cytoreductive
surgery in elderly patients with malignant gliomas. Neurosurgery 33:62-67, 1994.
7. Krex D, Klink B, Hartmann C, et al. Long-term survival
with glioblastoma multiforme. Brain 130:2596-2606,
2007.
8. Phuphanich S, Ferrall S, Greenberg H. Long-term survival
in malignant glioma. Prognostic factors. J Fla Med Assoc
80:181-184, 1993.
9. Prabal D, Chand SM, Kumar MA, et al. Glioblastoma
multiforme with long term survival. Neurology India
53:329-332, 2005.
10. , , , .

, . 14, 3, 2007

E : . 20
, , 8-11 , 2006.
11. Santiago P, Silbergerd DL. Malignant gliomas: Anaplastic
Astrocytoma, Glioblastoma Multiforme, Gliosarcoma,
Malignant Oligodendroglioma. In Youmans Neurological Surgery, Winn RH (ed.). Volume 1: W.B. Saunders:
Philadelphia, 5th ed., pp 969-980, 2004.
12. Shinojima N, Kochi M, Hamada J, et al. The influence
of sex and the presence of giant cells on postoperative
long-term survival in adult patients with supratentorial glioblastoma multiforme. J Neurosurg 101:219-226,
2004.
13. Westphal M, Hilt DC, Bortey E, et al. A phase 3 trial
of local chemotherapy with biodegradable carmustine
(BCNU) wafers (Gliadel wafers) in patients with primary
malignant glioma. Neuro-Oncology 5:79-88, 2003.

 2007, 14(3):155-156
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