S Korfias

Evangelismos Hospital, Athínai, Attica, Greece

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Publications (20)40.67 Total impact

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    ABSTRACT: The diagnosis and assessment of brain damage is currently based on the clinical examination and the modern neuro-imaging techniques. Electrophysiology, haemodynamic monitoring and invasive neuromonitoring constitute additional tools for monitoring of the brain function and clinical course of the patient. However, despite the substantial progress, clinical and neuro-monitoring methods are quite often not sufficient to evaluate and quantify the severity of the initial and secondary destructive processes and hence they cannot guide efficient therapeutic measures and prognosticate effectively the outcome. During the last decades, researchers and clinicians have focused on specific markers of brain cell damage to improve the diagnosis and monitoring of neurological insults. Lactate dehydrogenase, creatine kinase, neuron specific enolase, have been proposed as potential markers of brain injury. More recently, other glial markers such as the Myelin Basic Protein, the glial fibrillary acidic protein and the S-100B protein have been measured in blood and used as surrogate biochemical markers for brain injury. This review summarizes published findings on the above brain specific serum biochemical markers with emphasis on those with clinical utility.
    Mini Reviews in Medicinal Chemistry 03/2009; 9(2):227-34. · 2.87 Impact Factor
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    ABSTRACT: We present a 30-year-old man with progressive spastic paraparesis. Spinal imaging revealed extensive calcification of the thoracic cord and cauda equina arachnoid, an intradural extramedullary cyst and evidence of rapidly progressing syringomyelia. Radiological diagnosis was arachnoiditis ossificans and an attempt at surgical decompression was made because of progressive neurologic deterioration. Due to tenacious adhesion of the calcified plaques to the cord and roots, only cyst drainage was achieved; the patient had no clinical improvement. A literature review revealed only two other cases reported in the literature with co-existence of arachnoiditis ossificans and syringomyelia. In none of the previous cases was there an intradural extramedullary arachnoid cyst, nor did the syrinx progress in such a rapid fashion. An attempt is made to explain possible pathophysiological mechanisms leading to this unusual pathology.
    Journal of Clinical Neuroscience 07/2007; 14(6):572-6. · 1.25 Impact Factor
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    ABSTRACT: Despite the major progress in neurophysiological monitoring, there are still difficulties in the early identification and quantification of cerebral damage after a stroke. In this prospective study we examined the associations between serum S-100B protein, a serum marker of brain injury, and initial neurological-neuroimaging severity, secondary deterioration, external ventricular drainage (EVD: therapeutic intervention) and outcome in patients with subarachnoid haemorrhage (SAH). We recorded all pertinent clinical data of 52 patients with SAH and measured S-100B serum levels on admission and every 24 h for a maximum of 9 consecutive days. Mann-Whitney U-test and Kruskal Wallis analysis were employed to assess the association of S-100B levels with all variables of interest. Log-rank test was used to evaluate survival and Cox's proportional hazard regression analysis to define the significant predictors of survival rate. Admission S-100B was statistically significantly associated with initial neurological status, neuroimaging severity, and one-year outcome (p = 0.0002, 0.001, and 0.017, Kruskal Wallis analysis). Admission S-100B above 0.3 microg/L predicted unfavourable outcome (p < 0.0001, log rank test) and constituted an independent predictor of short-term survival (p = 0.035 Cox's proportional hazard regression analysis) with a hazard ratio of 2.2 (95% C.I.: 1.06-4.6) indicating a more than doubling of death probability. Secondary neurological deterioration associated with S-100B increase (p < 0.0001) and external ventricular drainage (EVD) with S-100B reduction (p = 0.003, Wilcoxon signed rank test). Serum S-100B protein seems to be a useful biochemical indicator of neurological - neuroimaging severity, secondary deterioration, EVD (therapeutic intervention), and outcome in patients with SAH.
    Acta Neurochirurgica 04/2007; 149(3):231-7; discussion 237-8. · 1.55 Impact Factor
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    ABSTRACT: Vagus nerve stimulation (VNS) is the most widely used non-pharmacological treatment for medically intractable epilepsy and has been in clinical use for over a decade. It is indicated in patients who are refractory to medical treatment or who experience intolerable side effects, and who are not candidates for resective surgery. VNS used in the acute setting can both abort seizures and have an acute prophylactic effect. This effect increases over time in chronic treatment to a maximum at around 18 months. The evidence base supporting the efficacy of VNS is strong, but its exact mechanism of action remains unknown. A vagus nerve stimulator consists of two electrodes embedded in a silastic helix that is wrapped around the cervical vagus nerve. The stimulator is always implanted on the left vagus nerve in order to reduce the likelihood of adverse cardiac effects. The electrodes are connected to an implantable pulse generator (IPG) which is positioned subcutaneously either below the clavicle or in the axilla. The IPG is programmed by computer via a wand placed on the skin over it. In addition, extra pulses of stimulation triggered by a hand-held magnet may help to prevent or abort seizures. VNS is essentially a palliative treatment and the number of patients who become seizure free is very small. A significant reduction in the frequency and severity of seizures can be expected in about one third of patients and efficacy tends to improve with time. Vagus nerve stimulation is well tolerated and has few significant side effects. We describe our experience on the use of VNS on drug-resistant epilepsy in 90 patients treated in two departments (in Athens, Greece and Newcastle, England).
    Acta neurochirurgica. Supplement 02/2007; 97(Pt 2):287-91.
  • C L Nicholson, S Korfias, A Jenkins
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    ABSTRACT: Chronic pain is a complex condition that requires a multi-disciplinary approach to management. Spinal cord stimulation (SCS) has evolved into a relatively easily implemented, reversible technique with low morbidity for the management of chronic, intractable pain in selected patients. Percutaneous placement of electrode arrays, under local anaesthesia. supported by programmable, implanted electronics has been a major technical advance. Multicenter prospective studies were conducted and demonstrated that SCS. as a neuromodulation procedure, is indeed a superior method for treatment of chronic pain if the patients are selected with caution and a proper strategy. Future development of innovative electrodes and pulse generation systems will continue to improve this therapy.
    Acta neurochirurgica. Supplement 02/2007; 97(Pt 1):71-7.
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    ABSTRACT: S-100 protein, described initially by Moore, constitutes a large family of at least 20 proteins with calcium binding ability. It is found as homo- or hetero-dimers of two different subunits (A and B). Types S-100AB and S-100BB are described as S-100B protein and are shown to be highly specific for nervous tissue. It is present in the cytosol of glial and Schwann cells, and also in adipocytes and chondrocytes, although in very low concentrations in the latter two. The role of protein S-100B is not yet fully understood. It is suggested that it has intracellular and extracellular neurotropic as well as neurotoxic function. At nanomolar levels, S-100B stimulates neurite outgrowth and enhances survival of neurons. However, at micromolar levels it stimulates the expression of inflammatory cytokines and induces apoptosis. Recently, serum S-100B protein has been proved to be an attractive surrogate marker of primary severe brain injury and secondary insults. It can be measured in the arterial and venous serum; it is not affected by haemolysis and remains stable for several hours without the need for immediate analysis. Its short half-life makes measurements crucial in the emergency and intensive care settings. This review summarises published findings on S-100B regarding its role as a serum biochemical marker of brain injury, i.e., after severe, moderate or mild neuro-trauma, subarachnoid haemorrhage, thrombo-embolic stroke, cerebral ischaemia and brain tumours, as well as extracranial trauma, neurodegenerative and psychiatric disorders.
    Current Medicinal Chemistry 02/2006; 13(30):3719-31. · 3.72 Impact Factor
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    ABSTRACT: A CSF flow study in patients with Chiari malformation (ChM) who undergo craniocervical junction decompression (CCJD). Using spatial modulation of magnetization (SPAMM), cerebrospinal fluid (CSF) flow velocities were measured at the prepontine (PP), anterior cervical (AC), and posterior cervical (PC) subarachnoid spaces (SAS) in healthy subjects (n = 11) and patients with Chiari malformation (ChM) before and/or after CCJD (n = 15). In the syringes, the intrasyrigeal pulsatile CSF motion was estimated qualitatively as present or absent. In normal subjects, the mean CSF velocities were 2.4 +/- 0.2 cm/s (PP), 2.8 +/- 0.3 cm/s (AC), and 2.4 +/- 0.2 cm/s (PC). Velocities were significantly lower than normal in patients with ChM prior to CCJD, reduced by 38%, 25%, and 79% in the 3 regions, respectively (P<0.001). Post-CCJD, velocities were 20% (PP), 100% (AC), and 40% (PC) greater than preoperatively (P<0.001). In ChM, the posterior cervical CSF flow velocity was low, increased minimally after CCJD and, by itself, had limited predictive value. Post-CCJD, an increase of the sum of anterior and posterior cervical CSF flow velocities by more than 20% consistently preceded or coincided with marked headache improvement. After CCJD, the finding that the intrasyringeal CSF pulsatile motion had become absent was an earlier and more sensitive predictor of motor or sensory improvement than a reduction in syrinx's size. SPAMM can be used to assess whether CCJD has restored CSF flow, predict outcome and provide pathophysiological insights in ChM and syringomyelia.
    Acta Neurochirurgica 01/2006; 147(12):1223-33. · 1.55 Impact Factor
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    ABSTRACT: The aim of the investigation was to evaluate the outcome of spontaneous subarachnoid haemorrhage, in the era of new techniques, patient centralization and subspecialization, by taking into account the local conditions in Greece. A prospective observational study was conducted during a 4-year period. All patients with a first-ever spontaneous subarachnoid haemorrhage were enrolled. Clinical, management and outcome data were recorded. Two-hundred-and-eighteen consecutive patients with an 81% good, medium clinical grade (Hunt & Hess I-III) were identified. Rebleed and rebleed leading to death rates were 22 and 11%, respectively. Permanent deficit or death from vasospasm was 15%. Twenty-eight per cent of the study population died early, were unsuitable for further management (poor clinical status, advanced age) or declined angiography or treatment, and another 22% had a negative angiogram. The remaining 50% underwent intervention (neurosurgical/endovascular), for obliteration of an aneurysm. The overall favourable 6-month outcome was 59%, whereas the favourable outcome of the intervention group was 70%. Our results confirm the findings of previous series. The relatively worse results are due to delayed referral, and lack of availability of surgical or endovascular management in the early post-haemorrhage period (28% of the patients), particularly in potentially salvageable cases. On the basis of these observations, we recommend early intervention (surgery or embolization) and centralization/subspecialization, in order to improve the outcome.
    British Journal of Neurosurgery 10/2005; 19(5):389-94. · 0.86 Impact Factor
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    ABSTRACT: The optimum cranial site for ventricular catheter insertion in CSF shunts is still under debate and there has been no general consensus as far as surgical technicalities are concerned. Furthermore, there have been no reports dealing with appropriate cranial site selection in debilitated patients. The aim of this report is to stress the need to utilize a frontal approach when dealing with patients who are likely to remain bed-bound for long periods and to emphasize the well-known prerequisites such as meticulous surgical technique and peri-operative general and local care. A retrospective analysis of all shunt operations and revisions performed in our department during the last 6 years. This analysis revealed 8 long-term recumbent patients with late valve extrusion (N1 = 5) or primary wound breakdown (N2 = 3), all through the occipital area. Extended periods of bed rest due to neurological disease combined with poor nursing and dietary intake had led to either chronic valve extrusion or wound breakdown. Shunt revision was performed successfully by a frontal approach in 5 whereas 2 tolerated shunt removal and one died of meningitis. In debilitated patients or those who are likely to remain bed-bound for long periods, a frontal approach for proximal catheter insertion may help prevent immediate postoperative wound breakdown or late valve extrusion.
    Acta Neurochirurgica 08/2005; 147(7):763-5; discussion 765. · 1.55 Impact Factor
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    ABSTRACT: We report the case of a 32-year-old female with a diagnosis of supratentorial tumour. Total removal of the tumour was achieved in a two-stage procedure. Histopathology revealed a primitive neuroectodermal tumour (PNET), an unusual and highly malignant, mainly infratentorial tumour of childhood that is uncommonly described in the supratentorial compartment of adults. We review the literature and describe the existing knowledge of these tumours.
    Journal of Clinical Neuroscience 06/2005; 12(4):492-5. · 1.25 Impact Factor
  • A T Kouyialis, S Korfias
    Acta Neurochirurgica 06/2005; 147(5):575-6; discussion 576-7. · 1.55 Impact Factor
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    ABSTRACT: Spontaneous peritumoural haemorrhage in meningiomas is a rare but serious complication with a grave prognosis. It occurs at the interface between the tumour and the parenchyma, either from the tumour surface or the cortical vessels in association with it. Although several pathophysiologic mechanisms for this complication have been proposed, they all remain speculative. We report a 72-year-old female who presented with sudden onset of headache and a left homonymous hemianopia. Neuroimaging revealed a parasagittal meningioma at the posterior third of the superior sagittal sinus with peritumoural intracerebral haematoma, 1 cm away from the tumour. An uncomplicated gross total excision of the meningioma and aspiration of the haematoma was achieved through a craniotomy. The postoperative course was uneventful with an excellent clinical outcome. Possible mechanisms for this unusual complication are discussed. We emphasise the importance of prompt diagnosis and simultaneous excision of the tumour and aspiration of the haematoma as prerequisites for a favourable outcome.
    Journal of Clinical Neuroscience 12/2004; 11(8):906-9. · 1.25 Impact Factor
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    ABSTRACT: We present a 65-year-old female with bilateral thalamic astrocytoma. The unusual long survival of this patient allowed the manifestation of a complex neurobehavioural syndrome due to gradual involvement of several thalamic nuclei. An attempt is made to approach the complexity of symptoms according to the anatomical areas, nuclei and thalamic connections infiltrated.
    British Journal of Neurosurgery 11/2004; 18(5):534-7. · 0.86 Impact Factor
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    ABSTRACT: We present the case of a young male with severe head injury, cervico-thoracic fractures, and an initially unrecognized brainstem infarct due to unilateral dissection of vertebral artery, who made an unusually excellent recovery. This report stresses the importance of prompt clinico-imaging diagnosis and prophylactic anticoagulant treatment in such cases.
    British Journal of Neurosurgery 09/2004; 18(4):389-91. · 0.86 Impact Factor
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    ABSTRACT: Intrathecal baclofen administration by means of an implantable pump is nowadays a safe and effective method in the treatment of spasticity. One of the rare but devastating complications of this technique is pump infection, with a variety of Gram (-) and Gram (+) organisms being involved. Treatment of these infections, according to international literature, requires removal of the device and appropriate antibiotic therapy. This article reports the authors experience in treating 3 patients with severe, medically intractable spasticity, suffering from infection of the intrathecally-delivering pump. A decision was made not to replace the device, but to treat this complication with pump disinfection and with a new treatment modality that has never been used before, the intra-pocket administration of antibiotics. In all cases the infection was eradicated and the integrity of the pump maintained. None of the patients required a procedure under general anesthesia. Removal should no longer be considered the first treatment option in infections of intrathecally delivering pumps, especially those due to non-adherent bacteria, with mild clinical symptomatology. An initial attempt should always be made for conservative treatment. Intra-pocket administration of antibiotics helps in achieving high drugs levels locally, and may prove an important element in our armamentarium against such infections.
    Acta Neurochirurgica 06/2004; 146(5):463-7. · 1.55 Impact Factor
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    ABSTRACT: Sequentially evolving intracranial bilateral haematomas, where the second haematoma develops after the surgical removal of the first one is rarely reported. To report a patient who developed an epidural haematoma after evacuation of a contralateral subdural haematoma. A 49-year-old male was admitted to our department after head injury. A brain computerized tomography (CT) scan revealed an acute subdural haematoma in the right temporal area which was evacuated. During his stay in the intensive care unit, he was submitted to intracranial pressure monitoring, which soon rose. A new CT scan showed an acute epidural haematoma in the contralateral parietal area that was also evacuated. While rising intracranial pressure after the evacuation of a traumatic haematoma is usually attributed to brain oedema or recurrent haematoma at the craniotomy site, the development of a contralateral epidural haematoma requiring surgical treatment should not be overlooked.
    Irish Journal of Medical Science 01/2004; 173(4):217-8. · 0.51 Impact Factor
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    ABSTRACT: Appropriate therapy of brain stem lesions should be guided by an accurate diagnosis. Clinical evaluation combined with modern neuroimaging techniques may nowadays approach the diagnosis but not always with accuracy, thus leading to erroneous treatment. We report a series of 11 patients who underwent stereotactic biopsy for brain stem lesions. In 8 patients, the lesion was approached transfrontally. In the remaining 3 patients, the lesion was approached via the suboccipital transcerebellar route. There was no surgical mortality. Precise histological diagnosis was achieved in all patients. Three patients (27.2%) suffered complications attributed to the procedure and were successfully treated conservatively. Histological results were in accordance with preoperative diagnosis in 9 patients (81.8%). Despite the limited number of patients, our data suggest that stereotactic biopsy of brain stem lesions is a safe technique that can obtain adequate tissue for histological diagnosis, thus providing each patient with the best available treatment.
    Neurological Sciences 11/2003; 24(3):97-102. · 1.41 Impact Factor
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    ABSTRACT: To analyze the time course of serum protein S-100b in patients with traumatic brain injury deteriorating to brain death and to investigate the predictive value of initial S-100b levels in relation to clinical and radiologic measures of injury severity with regard to brain death. Forty-seven patients who sustained severe head injury were studied. Blood samples for measurement of S-100b were drawn on admission in the intensive care unit and every 24 hours thereafter for a maximum of 6 consecutive days or until brain death occurred. Variables related to outcome were recorded, including age, sex, Glasgow Coma Scale (GCS), and brain CT findings on admission. Outcome was defined as deterioration to brain death or not. Of the 47 patients studied, 17 deteriorated to brain death and 30 did not. On admission, patients who became brain dead had higher median serum S-100b levels compared with those who did not (2.32 microg/L vs 1.04 micro g/L, p = 0.0028). Logistic regression analysis showed that initial S-100b was an independent predictor of brain death (p = 0.041), in the presence of advanced age (p = 0.043) and low GCS score (p = 0.013). The odds ratio of 2.09 (95% CI, 1.03 to 4.25) indicates a more than doubling of the probability of deteriorating to brain death per 1- micro g/L increase in S-100b on admission. At clinical brain death, median S-100b was higher in patients with brain death compared with the peak S-100b value obtained over a 6-day period in those who did not become brain dead (6.58 microg/L vs 1.49 microg/L, p < 0.0001). Prediction of brain death after severe head injury can be improved by combining clinical and S-100b data; thus, serum S-100b determination deserves to be included in the neuromonitoring of patients with severe traumatic brain injury.
    Neurology 03/2003; 60(6):947-51. · 8.25 Impact Factor
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    Critical Care 01/2003; 7:1-1. · 4.93 Impact Factor
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    Critical Care 01/2002; 6:1-1. · 4.93 Impact Factor