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Theofilos G. Machinis and Kostas N. Fountas

✓ Herbert Olivecrona was one of the pioneers of modern neurosurgery. In one of his articles, published more than half a century ago, Olivecrona shared his thoughts on the development of neurosurgery in the first half of the twentieth century and his vision regarding the future of neurosurgery and neurosurgical training. In the present paper, the authors communicate their reflections and thoughts on Herbert Olivecrona's visionary article.

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Aristotelis Filippidis, Eftychia Kapsalaki, Gianna Patramani and Kostas N. Fountas

Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity. The incidence of CVST in children and neonates has been reported to be as high as 7 cases per million people, whereas in adults the incidence is 3–4 cases per million. The predisposing factors to this condition are mainly genetic and acquired prothrombotic states and infection. The clinical picture of CVST is nonspecific, highly variable, and can mimic several other clinical conditions. Diagnosis of CVST is established with the implementation of neuroimaging studies, especially MR imaging and venography. Identification and elimination of the underlying cause, anticoagulation, proper management of intracranial hypertension, and anticonvulsant prophylaxis constitute cornerstones of CVST treatment. Newer treatment strategies such as endovascular thrombolysis and decompressive craniectomy have been recently used in the treatment of patients with CVST with variable success rates. Further clinical research must be performed to delineate the exact role of these newer treatments in the management of severe cases of CVST. The recent advances in the diagnosis and treatment of patients with CVST have significantly lowered the associated mortality and morbidity and have improved the outcome of these patients.

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Eftychia Z. Kapsalaki, Efstathios D. Gotsis and Kostas N. Fountas

✓ Despite recent advances in neuroimaging, differentiation between cerebral abscesses and necrotic tumors with ring-type contrast enhancement can be puzzling at times. The introduction of advanced imaging techniques, such as diffusion-weighted imaging, has contributed to the identification of cerebral abscesses. However, differentiation may be impossible with imaging only. In this review the authors evaluate the role of proton magnetic resonance (MR) spectroscopy in differentiating between cerebral abscesses and necrotic tumors and address the spectral characteristics of intracranial abscesses. A large number of metabolites not detected in the normal brain spectra may be detected and give valuable information regarding the nature of the abscesses. Proton MR spectroscopy is a safe, noninvasive diagnostic modality, which could significantly increase the accuracy and specificity of conventional MR imaging in differentiating between malignant tumors and cerebral abscesses and provide valuable information regarding the cause of an abscess, as well as, its response to the chosen treatment.

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Familial intracranial ependymomas

Report of three cases in a family and review of the literature

Vassilios G. Dimopoulos, Kostas N. Fountas and Joe Sam Robinson

Familial cases of intracranial ependymomas have been well documented in the literature. The authors present two cases from a family in which three members harbored intracranial ependymomas. A 54-year-old man with fourth ventricular ependymoma underwent resection of the tumor followed by radiation therapy. His son presented at age 36 years with a fourth ventricular tanycytic ependymoma and underwent total resection of the ependymoma with postoperative radiation therapy. The father's sister had been treated at another institution for a posterior fossa ependymoma. The association of ependymomas with molecular genetic alterations in chromosome 22 has been previously described. Further investigation of the genetic influences may lead to better therapeutic approaches for this relatively rare clinicopathological entity.

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Cervical epidural hematoma in children: a rare clinical entity

Case report and review of the literature

Kostas N. Fountas, Eftychia Z. Kapsalaki and Joe Sam Robinson

✓ Pediatric spinal epidural hematoma is a very rare clinicopathological entity. In the vast majority of cases, spinal epidural hematomas have a nonspecific clinical presentation; this, along with their rapid progression, makes their early diagnosis and prompt surgical evacuation critical. Magnetic resonance imaging is the neuroimaging modality of choice, whereas hemilaminectomy or laminectomy is the indicated surgical intervention. The outcome is good when hematoma evacuation is performed before the onset of complete sensorimotor paralysis.

In this communication, the authors describe a 12-year-old girl with a traumatic acute cervical epidural hematoma. This lesion was successfully evacuated through a hemilaminectomy, and the patient had an excellent outcome. The pertinent literature is reviewed in terms of the incidence, origin, management, and prognosis of this rare and potentially disastrous clinical entity.

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A rare, delayed complication of a ventriculogallbladder shunt

Case report and review of the literature

Kostas N. Fountas, Mozaffar A. Kassam and Arthur A. Grigorian

✓The use of the gallbladder as an alternative cerebrospinal fluid diversion site has been previously described in cases in which all other body cavities, such as the peritoneal cavity, right atrium, or pleural cavity, have been exhausted. Various ventriculogallbladder (VG) shunt complications have been described as well. In the present paper, the authors report on a rare, delayed VG shunt complication. A distal obstruction developed in a previously inserted VG shunt because of a large, radiolucent bile calculus. The presence of the VG shunt could be implicated in the pathogenetic mechanism of the bile calculus formation. The authors also review the pertinent literature.

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Ioannis Karampelas, Angel N. Boev III, Kostas N. Fountas and Joe Sam Robinson Jr.

The authors offer a brief overview of early theories and treatments of sciatica. Tracing medical traditions through early Greek, Roman, and Eastern epochs, the authors demonstrate the slow sequential steps that were required to delineate this disease as a uniquely human affliction.

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Kostas N. Fountas, Joseph R. Smith, Patrick D. Jenkins and Anthony M. Murro

Several cases of congenital or acquired temporal encephaloceles have been reported in the literature as the causative mechanism of simple and/or complex partial seizures. In this report the authors describe a rare case of spontaneous parietal encephalocele presenting with simple partial seizures and progressively increasing contralateral upper-extremity motor deficit. The unusual anatomical location of an encephalocele associated with seizures and the delayed seizure onset represent distinctive characteristics in this case. Preoperative imaging included surface electroencephalography, computerized tomography, and brain magnetic resonance imaging. Frameless neuronavigation and intraoperative cortical mapping were used to aid resection of the encephalocele, and the dural and bone defects were reconstructed. The surgical outcome in this case was excellent, and the patient has remained seizure free. The pertinent literature is reviewed in this report.

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Theofilos G. Machinis, Kostas N. Fountas, Vassilios Dimopoulos and Joe Sam Robinson

The purpose of this article is to provide insight into the development of surgery for acoustic neurinomas throughout the years. The significant contribution of surgical authorities such as Cushing, Dandy, and House are discussed. The advances in surgical techniques from the very first operations for acoustic tumors at the end of the 19th century until today are described, with special emphasis on the technological and diagnostic milestones that preceded each step of this development.

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Maria Mpakopoulou, Haralambos Gatos, Alexandros Brotis, Konstantinos N. Paterakis and Kostas N. Fountas


Stereotactic amygdalotomy has been utilized as a surgical treatment for severe aggressive behavioral disorders. Several clinical studies have been reported since the first description of the procedure. In the current study, the authors reviewed the literature and evaluated the surgical results, neuropsychological outcome, and complication rate in patients who had undergone stereotactic amygdalotomy for severe aggressive behavioral disorders.


The PubMed database was searched using the following terms: “amygdalotomy,” “amygdalectomy,” “amygdaloidectomy,” “psychosurgery,” “aggressive disorder,” and “behavioral disorder.” Clinical series with more than 5 patients undergoing stereotactic amygdalotomy for aggressive or other behavioral disorders were included in this review. The surgical technique, anatomical target, improvement in psychiatric symptomatology, postoperative employment and social rehabilitation, postoperative neurocognitive function, procedure-related complications, and long-term follow-up were evaluated.


Thirteen clinical studies met our inclusion criteria. Reported postoperative improvement in aggressive behavior varied between 33 and 100%. Procedure-related complication rates ranged from 0 to 42%, whereas the mortality rate was as high as 3.8%. In the majority of the reviewed clinical series, the performance of stereotactic amygdalotomy did not compromise a patient’s learning, language, and intellectual capabilities. The long-term follow-up, although very limited, revealed that initially observed improvement was maintained in most cases.


Stereotactic amygdalotomy can be considered a valid surgical treatment option for carefully selected patients with medically refractory aggressive behavioral disorders. Recent advances in imaging and stereotactic navigation can further improve outcome and minimize the complication rate associated with this psychosurgical procedure.