Aim Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor... more Aim Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus muscle on magnetic-resonance imaging (MRI) are associated with worse LBP and disability, but the association between multifidus morphology and post-operative outcomes is not known. The purpose of this systematic review is to examine the relationship between pre-operative multifidus morphology and post-operative changes in pain and disability. Methods We performed a systematic search using the Cochrane Library, EMBASE, MEDLINE, CINAHL and Scopus databases covering the period from January 1946 to January 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. All relevant papers were assessed for risk of bias according to the Quality in Prognosis Studies tool. Results The initial search yielded 436 ...
Objectives: To assess the reporting of study design and characteristics in multi-level degenerati... more Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. Methods: A literature search was performed in Embase and MEDLINE between 1995–2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016–2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studi...
Objective: The gold standard for the treatment of classic trigeminal neuralgia (TN) is carbamazep... more Objective: The gold standard for the treatment of classic trigeminal neuralgia (TN) is carbamazepine. However, the efficacy of carbamazepine is compromised by its adverse effects. Furthermore, after long-term follow-up only 22% of participants still find carbamazepine effective. Aim[for full text, please go to the a.m. URL]
We thank Dr. Amelot et al. for the response to our article.1 We are aware that in other centers o... more We thank Dr. Amelot et al. for the response to our article.1 We are aware that in other centers only patients with positive scans are referred to neurosurgeons. In our center, and in most of the UK National Health Service system, “suspected cauda equina syndrome (CES)” cases are seen by out-of-hours neurosurgery services for urgent transfer and MRI scanning. The proportion of patients with a scan-positive CES (47/198 or 24%) was consistent with a systematic review (19%)2 and our retrospective study (28%).3
Skull base : official journal of North American Skull Base Society ... [et al.], 2010
Only a handful of cases of de-novo malignancies of the vestibulocochlear nerve have been reported... more Only a handful of cases of de-novo malignancies of the vestibulocochlear nerve have been reported. Even rarer is the malignant transformation of a previously histologically diagnosed benign vestibular schwannoma. We present the case of a young adult who had combined operative/Gamma knife treatment for a benign vestibular schwannoma, followed by further surgery 2 years later. He represented 10 years after original diagnosis with facial numbness and ataxia, MRI showing gross tumor recurrence. After radical resection, histology showed malignant transformation to a malignant peripheral nerve sheath tumor. Within 3 months there was rapid, aggressive recurrence with brainstem compression, requiring further surgery for brainstem decompression. Histology confirmed further de-differentiation to an anaplastic sarcoma. While awaiting radiotherapy the tumor recurred again, the patient succumbing. The patient had no features of neurofibromatosis type 2. In the literature there are 13 other cases...
Introduction: Resident training is essential to be able and offer high-quality medical care. Neur... more Introduction: Resident training is essential to be able and offer high-quality medical care. Neurosurgical training in its traditional form is currently challenged by law-enforced working hour restrictions and general re-structuring within Europe. We aimed to evaluate the current situation of resident training in the Czech Republic. Methods: An electronic survey was sent to European neurosurgical trainees between 06/2014 and 03/2015. The responses of Czech trainees were compared to those of trainees from other European countries. Logistic regression analysis was used to assess the effect size of the relationship between a trainee being from Czech Republic and the outcomes (e.g. satisfaction, working time). Results: Of n=532 responses, 22 were from Czech trainees (4.14%). In multivariate analysis, Czech trainees were as likely as non-Czech European trainees to be satisfied with clinical lectures given at their teaching facility (OR 1.84, 95% CI 0.77-4.43, p=0.170). The satisfaction r...
Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely... more Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h...
Aim Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor... more Aim Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus muscle on magnetic-resonance imaging (MRI) are associated with worse LBP and disability, but the association between multifidus morphology and post-operative outcomes is not known. The purpose of this systematic review is to examine the relationship between pre-operative multifidus morphology and post-operative changes in pain and disability. Methods We performed a systematic search using the Cochrane Library, EMBASE, MEDLINE, CINAHL and Scopus databases covering the period from January 1946 to January 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. All relevant papers were assessed for risk of bias according to the Quality in Prognosis Studies tool. Results The initial search yielded 436 ...
Objectives: To assess the reporting of study design and characteristics in multi-level degenerati... more Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. Methods: A literature search was performed in Embase and MEDLINE between 1995–2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016–2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studi...
Objective: The gold standard for the treatment of classic trigeminal neuralgia (TN) is carbamazep... more Objective: The gold standard for the treatment of classic trigeminal neuralgia (TN) is carbamazepine. However, the efficacy of carbamazepine is compromised by its adverse effects. Furthermore, after long-term follow-up only 22% of participants still find carbamazepine effective. Aim[for full text, please go to the a.m. URL]
We thank Dr. Amelot et al. for the response to our article.1 We are aware that in other centers o... more We thank Dr. Amelot et al. for the response to our article.1 We are aware that in other centers only patients with positive scans are referred to neurosurgeons. In our center, and in most of the UK National Health Service system, “suspected cauda equina syndrome (CES)” cases are seen by out-of-hours neurosurgery services for urgent transfer and MRI scanning. The proportion of patients with a scan-positive CES (47/198 or 24%) was consistent with a systematic review (19%)2 and our retrospective study (28%).3
Skull base : official journal of North American Skull Base Society ... [et al.], 2010
Only a handful of cases of de-novo malignancies of the vestibulocochlear nerve have been reported... more Only a handful of cases of de-novo malignancies of the vestibulocochlear nerve have been reported. Even rarer is the malignant transformation of a previously histologically diagnosed benign vestibular schwannoma. We present the case of a young adult who had combined operative/Gamma knife treatment for a benign vestibular schwannoma, followed by further surgery 2 years later. He represented 10 years after original diagnosis with facial numbness and ataxia, MRI showing gross tumor recurrence. After radical resection, histology showed malignant transformation to a malignant peripheral nerve sheath tumor. Within 3 months there was rapid, aggressive recurrence with brainstem compression, requiring further surgery for brainstem decompression. Histology confirmed further de-differentiation to an anaplastic sarcoma. While awaiting radiotherapy the tumor recurred again, the patient succumbing. The patient had no features of neurofibromatosis type 2. In the literature there are 13 other cases...
Introduction: Resident training is essential to be able and offer high-quality medical care. Neur... more Introduction: Resident training is essential to be able and offer high-quality medical care. Neurosurgical training in its traditional form is currently challenged by law-enforced working hour restrictions and general re-structuring within Europe. We aimed to evaluate the current situation of resident training in the Czech Republic. Methods: An electronic survey was sent to European neurosurgical trainees between 06/2014 and 03/2015. The responses of Czech trainees were compared to those of trainees from other European countries. Logistic regression analysis was used to assess the effect size of the relationship between a trainee being from Czech Republic and the outcomes (e.g. satisfaction, working time). Results: Of n=532 responses, 22 were from Czech trainees (4.14%). In multivariate analysis, Czech trainees were as likely as non-Czech European trainees to be satisfied with clinical lectures given at their teaching facility (OR 1.84, 95% CI 0.77-4.43, p=0.170). The satisfaction r...
Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely... more Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h...
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Papers by Andreas Demetriades