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Article: Do Not Give Up on Ossified Tuberculum Sellae Meningioma - Vision Restored.

Candanedo, Carlos / Attia, Moshe

2020 Volume 12, Issue 10, Page(s) e11258

Abstract: This case report accompanies a video of the treatment of a Tuberculum sellae meningioma (TSM) in a woman that presented with left eye near-blindness. The senior author conducted the operation via a pterional retractorless approach, and the patient had a ... ...

Abstract	This case report accompanies a video of the treatment of a Tuberculum sellae meningioma (TSM) in a woman that presented with left eye near-blindness. The senior author conducted the operation via a pterional retractorless approach, and the patient had a full recovery. This case report discusses the unique anatomy of conchal sphenoid sinus, ossified TSM with very calcified consistency, and retractorless brain microsurgery. The resection of ossified TSM is still safe and viable with adequate microsurgical techniques and skull base instruments without compromising the neurovascular structure and with good neurological and visual outcomes for the patient.
Language	English
Publishing date	2020-10-30
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.11258
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Article: Janus Kinase-2 V617F Mutation and Antiphospholipid Syndrome in Cerebral Sinus Venous Thrombosis: Natural History and Retrospective Bicenter Analysis.

Orion, David / Itsekson-Hayosh, Ze'ev / Peretz, Shlomi / Mendel, Rom / Yaniv, Gal / Attia, Moshe / Grizim-Merkel, Drorit

Frontiers in neurology

2022 Volume 13, Page(s) 783795

Abstract: Background: Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular entity, usually associated with acquired or genetic hypercoagulable states. In up to 30% of the cases it remains idiopathic. Bone marrow proliferation disorders that are ... ...

Abstract	Background: Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular entity, usually associated with acquired or genetic hypercoagulable states. In up to 30% of the cases it remains idiopathic. Bone marrow proliferation disorders that are associated with Janus Kinase 2 V617F mutation (JAK-2) are known causes of the systemic and cerebral thrombosis-at times despite normal blood counts-for which hematologic treatment exists. However, JAK-2 prevalence in the CSVT cases is not clear. Methods: In this retrospective analysis, data of 236 patients with CSVT admitted to two tertiary centers between 2010 and 2020 were analyzed, with emphasis on laboratory and imaging data and clinical and interventional outcomes. Results: A total of 236 patients were included in the analysis. The patients' median age was 42 years and the average age was 44 years (±19 years), with 59% female patients. JAK-2 positivity rate was 18% (among 77 patients tested for the mutation). Patients with normal blood counts on presentation comprised 36% of the JAK-2 positive cases. Other hypercoagulability states were also investigated, with the antiphospholipid syndrome (APLA) showing the highest prevalence (11%) followed by other etiologies including oral contraceptive use, Factor V Leiden, prothrombin mutation, and malignancy. Selected JAK-2, APLA, and prothrombin mutation cases showed a more severe clinical course. Conclusion: JAK-2 mutation is underdiagnosed and its screening may be warranted in the cases of idiopathic CSVT, even despite normal blood counts, to allow disease-modifying treatment and blood cell count monitoring. JAK-2, APLA, and prothrombin mutation may be associated with a more complicated clinical course.
Language	English
Publishing date	2022-04-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2022.783795
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Article ; Online: Endoscopic endonasal posterior clinoidectomy.

Silva, Danilo / Attia, Moshe / Schwartz, Theodore H

Journal of neurosurgery

2015 Volume 122, Issue 2, Page(s) 478–479

MeSH term(s)	Cavernous Sinus/surgery ; Humans ; Natural Orifice Endoscopic Surgery/methods ; Neurosurgical Procedures/methods ; Nose/surgery ; Pituitary Gland/surgery
Language	English
Publishing date	2015-02
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2014.8.JNS141783
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Article ; Online: Linear accelerator stereotactic radiosurgery can modulate the clinical course of Hemangioblastoma: Case series and review of the literature.

Zibly, Z / Cohen, Z R / Peled, A / Zach, L / Nissim, U / Attia, Moshe / Graves, Christian / Camphausen, K / Spiegelman, R

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2020 Volume 82, Issue Pt A, Page(s) 162–165

Abstract: Hemangioblastomas (HB) are benign low grade vascular tumors most frequently occurring in the cerebellum, brain stem, and spinal cord. Often associated with Von Hippel Lindau disease (VHL), the lesions are often multifocal requiring complex resection and ... ...

Abstract	Hemangioblastomas (HB) are benign low grade vascular tumors most frequently occurring in the cerebellum, brain stem, and spinal cord. Often associated with Von Hippel Lindau disease (VHL), the lesions are often multifocal requiring complex resection and are difficult to control. Linear Accelerator (LINAC) Stereotactic Radiosurgery (SRS) has been demonstrated to provide additional tumor control. In this case series, we present our multi-center experience utilizing LINAC SRS in fourteen patients with 23 lesions. We observed a tumor control rate of 87% and found interval changes in the peritumoral enhancement to correlate with treatment outcome. In our study, SRS treatment was also well-tolerated in both cystic and noncystic patients with multifocal disease. Disease control was achieved in all but three patients post-resection and no longitudinal radiation-induced secondary malignancy was observed. SRS response correlated highly with lesion size and radiation dose. We conclude that LINAC SRS is safe and effective for patients with HB and should be considered in addition to surgery in asymptomatic, VHL patients, deep seated lesions and isolated lesions.
MeSH term(s)	Adolescent ; Adult ; Brain Neoplasms/pathology ; Brain Neoplasms/radiotherapy ; Brain Neoplasms/therapy ; Cerebellum/pathology ; Child ; Female ; Hemangioblastoma/pathology ; Hemangioblastoma/radiotherapy ; Hemangioblastoma/surgery ; Humans ; Male ; Middle Aged ; Particle Accelerators ; Radiosurgery ; Spinal Cord/pathology ; Treatment Outcome ; Young Adult ; von Hippel-Lindau Disease/complications
Language	English
Publishing date	2020-11-11
Publishing country	Scotland
Document type	Case Reports ; Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2020.09.026
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Article ; Online: Ogilvie's syndrome following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus.

Katzir, Miki / Abeshaus, Sergey / Attia, Moshe / Zaaroor, Menashe

Acta neurochirurgica

2014 Volume 156, Issue 4, Page(s) 787–788

MeSH term(s)	Aged ; Colonic Pseudo-Obstruction/etiology ; Colonic Pseudo-Obstruction/therapy ; Fluid Therapy ; Humans ; Hydrocephalus, Normal Pressure/surgery ; Intubation, Gastrointestinal ; Male ; Treatment Outcome ; Ventriculoperitoneal Shunt/adverse effects
Language	English
Publishing date	2014-04
Publishing country	Austria
Document type	Case Reports ; Letter
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-014-2014-z
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Article ; Online: Uncal herniation in a fully conscious patient-The sliding uncus syndrome.

Katzir, Miki / Attia, Moshe / Sviri, Gill E / Zaaroor, Menashe

British journal of neurosurgery

2015 Volume 29, Issue 2, Page(s) 308–309

Abstract: Uncal herniation is accompanied by a decreased level of consciousness. We describe a patient who remained fully alert despite the uncal herniation. The computed tomography (CT) scans allowed us to visualize the uncus and its spatial relation to the ... ...

Abstract	Uncal herniation is accompanied by a decreased level of consciousness. We describe a patient who remained fully alert despite the uncal herniation. The computed tomography (CT) scans allowed us to visualize the uncus and its spatial relation to the cerebral peduncle. We describe the sliding uncus syndrome.
MeSH term(s)	Brain Diseases/diagnosis ; Brain Diseases/surgery ; Encephalocele/diagnosis ; Encephalocele/surgery ; Hematoma, Subdural/diagnosis ; Hematoma, Subdural/surgery ; Humans ; Male ; Syndrome ; Tomography, X-Ray Computed/methods ; Treatment Outcome
Language	English
Publishing date	2015-04
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688697.2014.977779
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Article: Utility of the Polestar N30 low-field MRI system for resecting non-enhancing intra-axial brain lesions.

Ungar, Lior / Zibly, Zion / Wohl, Anton / Harel, Ran / Hadani, Moshe / Attia, Moshe / Spiegelmann, Roberto / Feldman, Zeev / Zaubermann, Jacob / Knoller, Nachshon / Cohen, Zvi R

Neurologia i neurochirurgia polska

2021 Volume 55, Issue 2, Page(s) 202–211

Abstract: Background: To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions.: Materials and methods: Seventy-three patients (60 ... ...

Abstract	Background: To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions. Materials and methods: Seventy-three patients (60 males [83.3%], mean age 37 years) with intra-axial brain lesions underwent resection at Sheba Medical Centre using the Polestar between February 2012 and the end of August 2018. Demographic and imaging data were retrospectively analysed. Thirty-five patients had a non-enhancing lesion (48%). Results: Complete resection was planned for 60/73 cases after preoperative imaging. Complete resection was achieved in 59/60 (98.3%) cases. After iMRI, additional resection was performed in 24/73 (32.8%) cases, and complete resection was performed in 17/60 (28.8%) cases in which a complete resection was intended. In 6/13 (46%) patients for whom incomplete resection was intended, further resection was performed. The extent of resection was extended mainly for non-enhancing lesions: 16/35 (46%) as opposed to only 8/38 (21%) for enhancing lesions. Further resection was not significantly associated with sex, age, intended resection, recurrence, or affected side. Univariate analysis revealed non-eloquent area, intended complete resection, and enhancing lesions to be predictive factors for complete resection, and non-enhancing lesions and scan time to be predictive factors for an extended resection. Non-enhancement was the only independent factor for extended resection. Conclusions: The Polestar N30 is useful for evaluating residual non-enhancing intra-axial brain lesions and achieving maximal resection.
MeSH term(s)	Adult ; Brain/diagnostic imaging ; Brain/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Glioma ; Humans ; Magnetic Resonance Imaging ; Male ; Monitoring, Intraoperative ; Neoplasm Recurrence, Local ; Retrospective Studies
Language	English
Publishing date	2021-02-09
Publishing country	Poland
Document type	Journal Article
ZDB-ID	415519-1
ISSN	1897-4260 ; 0028-3843
ISSN (online)	1897-4260
ISSN	0028-3843
DOI	10.5603/PJNNS.a2021.0017
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Article ; Online: Neuro-ophthalmologic outcomes of standard versus hypo-fractionated stereotactic radiotherapy of AVPM.

Zach, Leor / Agami, Amir / Furman, Orit / Attia, Moshe / Cohen, Zvi / Mizrachi, Iris Ben-Bassat / Tam, Guy / Zibly, Zion / Nissim, Ouzi / Spiegelmann, Roberto / Huna-Baron, Ruth

Radiation oncology (London, England)

2021 Volume 16, Issue 1, Page(s) 166

Abstract: Background: Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated ... ...

Abstract	Background: Most anterior visual pathway meningiomas (AVPM) are benign and slow-growing, but these tumors may affect visual functions, including visual acuity (VA) and visual field (VF). Due to location, most are treated non-surgically by fractionated stereotactic radiotherapy (FSRT), aiming to prevent tumor progression and visual functions deterioration. Unfortunately, FSRT in itself may affect visual functions. The current preferred treatment regimen (in terms of safety and effectiveness) is undetermined. While most cases are treated with conventional fractionation (cFSRT)-50.4-54 Gy in 28-30 fractions of 1.8-2 Gy, advances in technology have allowed shortening of total treatment length to hypofractionation (hSRT)-25-27 Gy in 3-5 fractions of 5-9 Gy. Our aim was to evaluate the association of radiotherapy regimen for treating AVPM (cFSRT vs. hSRT) with visual function outcomes (VA, VF) at the last neuro-ophthalmologic evaluation. Methods: We conducted a retrospective cohort study of AVPM cases treated at Sheba Medical Center during 2004-2015. We compared cFSRT and hSRT regimens regarding visual function (VA, VF) outcomes at the last neuro-ophthalmologic evaluation. VA was determined by the logarithm of the minimum angle of resolution (LogMAR). VF was determined by the mean deviation (MD). A clinically relevant change in VA was defined as 0.2 LogMAR. Results: 48 patients (13 receiving hSRT, 35 receiving cFSRT) were included, with a median follow-up of 55 months. No significant difference was evident regarding LogMAR or MD of involved eyes at the last evaluation. Six (17%) patients in the cFSRT group experienced clinically relevant VA deterioration in the involved eye, compared with six (46%) in hSRT (p = 0.06). Conclusion: Our findings, using comprehensive and meticulous investigation of visual outcomes, suggest that hSRT may be associated with higher risk for VA and VF deterioration in AVPM especially in ONSM. We recommend the use of cFSRT for ONSM.
MeSH term(s)	Humans ; Meningeal Neoplasms/diagnostic imaging ; Meningeal Neoplasms/radiotherapy ; Meningioma/diagnostic imaging ; Meningioma/radiotherapy ; Radiation Dose Hypofractionation ; Radiosurgery/adverse effects ; Radiotherapy Dosage ; Retrospective Studies ; Visual Acuity ; Visual Fields ; Visual Pathways
Language	English
Publishing date	2021-08-28
Publishing country	England
Document type	Comparative Study ; Journal Article
ISSN	1748-717X
ISSN (online)	1748-717X
DOI	10.1186/s13014-021-01879-2
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Article ; Online: Comparison of Frame-Based Versus Frameless Image-Guided Intracranial Stereotactic Brain Biopsy: A Retrospective Analysis of Safety and Efficacy.

Ungar, Lior / Nachum, Ortal / Zibly, Zion / Wohl, Anton / Harel, Ran / Attia, Moshe / Spiegelmann, Roberto / Zaubermann, Jacob / Feldman, Zeev / Knoller, Nachshon / Cohen, Zvi R

World neurosurgery

2021 Volume 164, Page(s) e1–e7

Abstract: Background: A definitive diagnosis of brain lesions not amenable to surgery is mainly made by stereotactic needle biopsy. The diagnostic yield and safety of the frameless versus frame-based image-guided stereotactic techniques is unclear. Our objective ... ...

Abstract	Background: A definitive diagnosis of brain lesions not amenable to surgery is mainly made by stereotactic needle biopsy. The diagnostic yield and safety of the frameless versus frame-based image-guided stereotactic techniques is unclear. Our objective was to evaluate the safety and accuracy of frameless versus frame-based stereotactic brain biopsy techniques. Methods: A total of 278 patients (153 men; mean age: 65.5 years) with intra-axial brain lesions underwent frame-based (n = 148) or frameless image-guided stereotactic brain biopsy (n = 130) using a minimally invasive twist drill technique during 2010-2016 at Sheba Medical Center. Demographic, imaging, and clinical data were retrospectively analyzed. Results: The diagnostic yield (>90%) did not differ significantly between groups. Overall morbidity (6.8% vs. 8.5%), incidence of permanent neurologic deficits (2.1% vs. 1.6%), mortality rate (0.7% vs. 0.8%), and postoperative computed tomography-detected asymptomatic (14.2% vs. 16.1%) and symptomatic (2.0% vs. 1.6%) bleeding also did not differ significantly between the frame-based and frameless cohorts, respectively. The diagnostic yield and complication rates related to the biopsy technique were not significantly associated with sex, age, entry angle to the skull and skull thickness, lesion location or depth, or radiologic characteristics. Diagnostic yield was significantly associated with the mean lesion volume. Smaller lesions were less diagnostic than larger lesions in both techniques (P = 0.043 frame-based and P = 0.048 frameless). Conclusions: The frameless biopsy technique is as efficient as the frame-based brain biopsy technique with a low complication rate. Lesion volume was the only predictive factor of diagnostic yield. The minimally invasive twist drill technique is safe and efficient.
MeSH term(s)	Aged ; Biopsy/adverse effects ; Biopsy/methods ; Brain/diagnostic imaging ; Brain/pathology ; Brain/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery ; Humans ; Image-Guided Biopsy ; Male ; Neuronavigation/methods ; Retrospective Studies ; Stereotaxic Techniques
Language	English
Publishing date	2021-07-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.07.063
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Article ; Online: Spinal intradural extramedullary tumors: the value of intraoperative neurophysiologic monitoring on surgical outcome.

Harel, Ran / Schleifer, David / Appel, Shmuel / Attia, Moshe / Cohen, Zvi R / Knoller, Nachshon

Neurosurgical review

2017 Volume 40, Issue 4, Page(s) 613–619

Abstract: Nerve sheath tumors and meningiomas account for most intradural extramedullary (IDEM) tumors. These tumors are benign and amenable to complete surgical resection. In recent years, these surgeries are performed with intraoperative neurophysiologic ... ...

Abstract	Nerve sheath tumors and meningiomas account for most intradural extramedullary (IDEM) tumors. These tumors are benign and amenable to complete surgical resection. In recent years, these surgeries are performed with intraoperative neurophysiologic monitoring (IONM) in order to minimize neurological injury, but the evidence for the statistical efficacy of this utility is lacking. This paper evaluates IONM benefits in IDEM tumor resection. Data of patients treated surgically for spinal intradural tumors from 1998 to 2003 was previously collected and analyzed. We retrospectively evaluated patients' charts operated in the years 2011 to 2013. Patients' medical files were reviewed including radiological examinations and electrophysiological reports. The data was collected and evaluated. Forty-one cases of meningioma or nerve sheath tumor resection surgery were performed in the study period. The surgical results were compared to 70 cases of historical controls. Demographic data was similar in these two groups. Sensitivity, specificity, and positive and negative predicted values of IONM were 75, 100, 100, and 97%, respectively. New neurological deficit rate was evident in 10 and 14% for the study and control groups, respectively (not significant). While IONM predicts neurological deficits with high accuracy level, this study does not suggest that there is a significant global benefit of IONM in these cases. As reported by others, in this series, the rate of new neurological deficits in non-monitored cases is similar to the monitored cases series; hence, IONM role in preventing new neurological deficits has yet to be proven.
MeSH term(s)	Adult ; Aged ; Female ; Humans ; Intraoperative Neurophysiological Monitoring ; Male ; Meningeal Neoplasms/surgery ; Meningioma/surgery ; Middle Aged ; Nerve Sheath Neoplasms/surgery ; Neurosurgical Procedures ; Retrospective Studies ; Spinal Cord Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2017-01-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-017-0815-2
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