Publications by authors named "Constantine L Karras"

Background: Gamma knife stereotactic radiosurgery (GKRS) is recognized as an effective and safe alternative treatment for skull base tumors and trigeminal neuralgia. This study aims to evaluate the efficacy of targeting both tumor and trigeminal nerve in a single procedure for patients with benign tumor-related trigeminal neuralgia.

Methods: A retrospective study was conducted on 44 patients with benign tumor-related trigeminal neuralgia who underwent GKRS targeting both tumor and trigeminal nerve in a single procedure between December 2016 and December 2022.

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Background And Objective: While safe and effective modalities exist to treat small arteriovenous malformations (AVMs), large (>10 cm) AVMs remain difficult to cure via surgical or endovascular means. Staged stereotactic radiosurgery (SRS), either volume-staged (VS) or dose-staged (DS), has been proposed for large AVMs. The relative efficacy of these two strategies, with or without endovascular embolization, is unclear.

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Objective: To preserve facial nerve function in vestibular schwannoma (VS) microsurgery, some have advocated subtotal resection (STR) if the tumor is densely adherent to a thinned facial nerve. The objective of this study was to determine if residual volume is associated with progression and whether there is a threshold residual volume that should be pursued during STR to prevent recurrence. A secondary objective of this study was to determine whether facial nerve function at last follow-up was associated with extent of resection (EOR).

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Objective: Cervical spinal cord injury (SCI) and lower trunk brachial plexus injury (BPI) commonly result in hand paralysis. Although restoring hand function is complex and challenging to achieve, regaining volitional hand control drastically enhances functionality for these patients. The authors aimed to systematically review the outcomes of hand-opening function after supinator to posterior interosseous nerve (PIN) transfer.

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Article Synopsis
  • The study investigates the clinical characteristics and outcomes of trigeminal schwannoma (TS) surgical resections across two institutions from 2004 to 2022, analyzing data from 30 patients.
  • Most patients were middle-aged, with common symptoms including sensory loss and headaches; tumors primarily consisted of mixed cystic-solid types with an average diameter of 3.3 cm.
  • Although 87% of patients reported symptom improvements after surgery, there were notable risks, with 17% experiencing temporary and 10% experiencing permanent cranial nerve deficits.
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Article Synopsis
  • Meningioma classification and treatment have advanced significantly since their early descriptions in the 1920s, focusing on improving prognostication through histopathology, radiography, and molecular profiling.
  • Accurate classification is vital for patient management, involving monitoring, surgery, radiotherapy, and potential clinical trials, primarily guided by WHO grade, extent of resection, and patient features.
  • Recent research has identified molecular markers related to the disease's aggressiveness and response to treatment, though challenges remain in applying these discoveries effectively in clinical settings.
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Objective: Parasagittal meningiomas (PM) are treated with primary microsurgery, radiosurgery (SRS), or surgery with adjuvant radiation. We investigated predictors of tumor progression requiring salvage surgery or radiation treatment. We sought to determine whether primary treatment modality, or radiologic, histologic, and clinical variables were associated with tumor progression requiring salvage treatment.

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 Vestibular schwannomas (VSs) are treated with microsurgery and/or radiosurgery. Repeat resection is rare, and few studies have reported postoperative outcomes. The objective of this study was to describe clinical characteristics and outcomes in patients undergoing repeat surgery for VS.

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Article Synopsis
  • Trigeminal schwannomas (TS) are usually non-cancerous tumors, but they can sometimes be large or cause problems, leading to the need for surgery.
  • A study collected data from 26 research papers about 974 patients who had surgery for TS, focusing on their experiences and outcomes.
  • The study found that patients who had a complete removal of the tumor (gross total resection) had a much lower chance of the tumor coming back compared to those who didn’t get it all removed.
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Article Synopsis
  • This systematic review and individual patient data analysis aimed to summarize existing research on pineoblastoma, a rare type of brain tumor, and evaluate factors affecting overall survival.
  • The study analyzed data from 44 studies and 298 patients, using methods like Kaplan-Meier analyses and Cox regression to identify significant predictors of mortality.
  • Findings indicated that poorer prognostic factors included incomplete tumor resection, metastatic disease, and young age at diagnosis, but overall survival rates have improved significantly from 2012, rising from 32.8% to 56.1%.
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Background: The VS-5 index was recently proposed to predict complications, nonroutine discharge, length of stay (LOS), and cost after vestibular schwannoma (VS) resection. The VS-5 ranges from 0-17.86, and a score ≥2 was proposed as being predictive of postoperative adverse events.

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Objective: Odontoid fractures can be managed surgically when indicated. The most common approaches are anterior dens screw (ADS) fixation and posterior C1-C2 arthrodesis (PA). Each approach has theoretical advantages, but the optimal surgical approach remains controversial.

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Background: Spetzler-Martin (SM) grade III arteriovenous malformations (AVMs) show angioarchitecture heterogeneity and lack a clearly defined treatment strategy. This study aims to evaluate outcomes after treatment of SM grade III AVMs with Gamma Knife radiosurgery (GKRS).

Methods: A single-institution retrospective analysis was conducted of 307 patients with SM grade III AVMs undergoing GKRS between October 2006 and December 2020 with follow-up times of at least 24 months.

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Objective: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of telehealth visits (THVs). The effects on neurosurgical practice have not been well characterized, especially concerning new-patient THVs. Therefore, the authors of this study reviewed their institution's experience with outpatient clinic visits and THVs from before the COVID-19 pandemic to the present to focus on clinical metrics, rates of surgery, and the effects of implementing THVs in order to better understand their implications for clinical practice as more data emerge over time.

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Background: Stereotactic body radiotherapy (SBRT) has been established as a safe and effective treatment modality for control of long-term pain and tumor growth. However, few studies have investigated the efficacy of postoperative SBRT versus conventional external beam radiation therapy (EBRT) in extending survival within the context of systemic therapy.

Methods: A retrospective chart review of patients who underwent surgery for spinal metastasis at our institution was conducted.

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Objective: Sociodemographic factors may play a role in incidence and treatment of metastatic spinal tumors, as there is a delay in diagnosis and increased incidence of relevant primaries. There has yet to be a detailed analysis of the impact of sociodemographic factors on surgical outcomes for spinal metastases. We sought to examine the influence of socioeconomic factors on outcomes for patients with metastatic spinal tumors.

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Supratentorial non-skull base meningiomas are the most common primary central nervous system tumor subtype. An understanding of their pathophysiology, imaging characteristics, and clinical management options will prove of substantial value to the multi-disciplinary team which may be involved in their care. Extensive review of the broad literature on the topic is conducted.

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Objective: Foramen magnum meningiomas (FMMs) pose a unique challenge given their intimate anatomical relationship with the craniovertebral junction. While resection has been studied extensively, much less has been reported about the use of stereotactic radiosurgery (SRS) for FMMs. This study includes what is to the authors' knowledge the first systematic review in the literature that summarizes patient and treatment characteristics and synthesizes outcomes following SRS for FMMs.

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Objective: The coronavirus disease 2019 (COVID-19) pandemic has sparked interest in telemedicine, resulting in an increase in neurosurgical publications focused on it. We summarize this new literature to evaluate telemedicine applications to neurosurgery.

Methods: A systematic literature review was performed in accordance with the PRISMA guidelines by searching PubMed, Embase, and Scopus for journal articles published after January 1, 2020.

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Purpose: Thoracic outlet syndrome (TOS) is a rare disorder involving compression of the brachial plexus, subclavian artery, and subclavian vein. There is a paucity of data for this pathology's surgical treatment within pediatrics. The objective of this study is to explore the presentation, management, and outcome of pediatric TOS.

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Objective: While neurosurgeons are experienced in treating penetrating brain injuries (PBIs) in civilian settings, much less is known about management and outcomes of PBIs in military settings.

Methods: A systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Data extracted included surgical management, age, gender, location/type of injury, initial Glasgow Coma Scale (GCS) score, and outcomes.

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Objective: Intraoperative stimulation is used as a crucial adjunct in neurosurgical oncology, allowing for greater extent of resection while minimizing morbidity. However, limited data exist regarding the impact of cortical stimulation on the frequency of perioperative seizures in these patients.

Methods: A retrospective chart review of patients undergoing awake craniotomy with electrocorticography data by a single surgeon at the authors' institution between 2013 and 2020 was conducted.

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Objective: Tuberous sclerosis complex (TSC) is an autosomal dominant, multisystem neurocutaneous disorder associated with cortical tubers, brain lesions seen in nearly all patients with TSC, which are frequently epileptogenic. Seizures are often the earliest clinical manifestation of TSC, leading to epilepsy in over 70% of patients. Medical management with antiepileptic drugs constitutes early therapy, but over 50% develop medically refractory epilepsy, necessitating surgical evaluation and treatment.

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Background: In the present study, we aimed to identify the obliteration outcomes, complications, and predictors in gamma knife radiosurgery (GKRS) treatment of brain arteriovenous malformations (AVMs) at a tertiary center in a developing country in a 15-year experience.

Methods: We retrospectively reviewed the clinical data and GKRS procedures of patients who had undergone GKRS from 2006 to 2011 (cohort 1) and from 2011 to 2020 (cohort 2) at Cho Ray Hospital, Vietnam. The exclusion criteria included patients with <24 months of follow-up without obliteration or AVM-related hemorrhage during the study period.

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