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BACKGROUND/OBJECTIVES: Aggressive clinical and biological behavior, high morbidity and mortality are the main characteristics of pediatric high-grade-gliomas (HGG). Our aim was to study patients (pts) with ΗGG or diffuse-intrinsic-pontine-glioma (DIPG), diagnosed in the largest pediatric neurooncology Center in Greece. DESIGN-METHODS: We performed a retrospective-review of newly-diagnosed pts with HGG or DIPG during 2014-2021. Gender, age, location, resectability, type of surgery, histological and molecular characteristics, management and outcome were analyzed. RESULTS: During the study-period, 38pts (18females), median age:9.35y(range:3days-16.9y), were diagnosed in our center. The most common tumor-location were pons (17/38 pts) and parietal lobe (11/38 pts). DIPG based on imaging-studies was diagnosed in 16pts. Surgical approach was performed in 32pts (VP-shunt insertion:8, biopsy:12, partial resection:6, subtotal: 6). In 23pts(5 brainstem-tumors) a histological-diagnosis was feasible. Astrocytoma grIV was found in 60.8% and grΙΙΙ in 26.1%(14 and 6 respectively). Of notice, 3 additional pts with histological findings of low-grade(2grII and 1gr1), were upgraded in grIV after molecular-studies and DNA-methylation analysis. Furthermore, 17.3% of the pts (4/23, 3 located in the midline) carried a Η3Κ27Μ-mutation (diffuse midline glioma, DMG), 17.3% a Η3F3A-mutation and 8.6% showed ΕGFR-overexpression. All patients>3years of age were treated upfront according to HIT-HGG2013 with radiotherapy-temozolomide (29/32pts). In 5DIPG pts, reirradiation after disease-progression resulted in temporary symptomatic improvement. HGG-pts upon progression were treated with bevacizumab-irinotecan. Of the 38pts, 6pts elected to receive treatment in other countries. Overall-survival was 75.1%,15.1% and 3.7% at 1,2 and 3 years post-diagnosis respectively. Patients with DIPG/ DMG and non-midline HGG had a median overall-survival of 1.10 years and1.34 years, respectively. CONCLUSIONS: The experience of our unit concurs with worldwide published series and shows that pediatric HGG and DIPG have a dismal prognosis. Re-irradiation may offer short survival prolongation. ASKNOWLEDGEMENTS: Authors asknowledge the contribution of KiTZ-Heidelberg in molecular diagnostics through collaboration with ACCC.

Background The entity of pediatric stroke has been recognized for centuries and is defined as a focal neurological deficit, lasting more than 24 h, being attributed only to causes of vascular origin, and it refers to patients from 0 to 18 years old. It is a condition implicated with personal, familial, economic, andsocial consequences and related with a diverse spectrum of risk factors. Methods A bibliometric analysis centered on pediatric stroke was performed along with a broad literature review. Risk factors and modern treatment options, including endovascular techniques and decompressive craniectomy, as a treatment option for life threatening circumstances, are reviewed. Results The search resulted in 410 articles, published from 1975 until now (May 2020). All of them combined have been cited 4.038 times, in 2.351 different articles, with an average citation per item of 80.76. The most cited article was published by Ganesan, V in 2003. It has received 303 citations, with an average 16.83 citations per year, while the last was published by Tsivgoulis, G in 2008, with 26 total citations, and an average of 2 citations per year. Conclusion Asignificant proportion of the published articles relevant to ischemic stroke appeared in the literature during the last decade, with a great amount of them focused on the relevant risk factors. Relatively less studies were concentrated on therapeutic options related to massive cerebral infarction, indicating that there is a relative lack of evidence related to acute therapeutic intervention.

Background There is a vast amount of published articles, centered on tethered cord syndrome, which is related to a constellation of diverse pathological entities, included under the term occult spinal dysraphism. Objective To present the 100 most-cited articles dedicated to the entity of tethered cord syndrome and to present a comprehensive review of the relevant literature. Methods In April 2020, we executed a title- focused search using Thomson Reuters Web of Science database in order to identify the most cited articles relevant to tethered cord syndrome. Consequently, we reviewed the results to certify that they were relevant to the criteria of our research protocol. The 100 most cited papers were chosen and further analyzed. Results Our search resulted in 769 articles, published from 1976 until now. All of them combined, have been cited 5.340 times, in a total of 2.097 different articles, with an average citation per item of 53.4.The most cited article was published by Yamada S., in 1981, while the last in our list was published by Walton, M et al in 1995. Conclusions We distinguished the top 100 most-cited articles dedicated to tethered cord syndrome, all of which are demonstrating important aspects and conclusions, being well-supported and methodologically fully adequate. We also reviewed the relevant evolution of the concept of management and the knowledge of the natural history, as well as new data in tethered cord syndrome research, alongside with the relevant contributions of different authors, fields of special interest, and countries.

Patient: Male, 7-year-old Final Diagnosis: Status epilepticus Symptoms: Local sezure Medication: — Clinical Procedure: Computed tomography • magnetic resonance imaging Specialty: Neurosurgery Objective: Rare co-existance of disease or pathology Background: Advanced imaging is one of the main modalities utilized in the diagnostic investigation of a first-time epileptic ictus, as well as in the evaluation of a patient suspected of having an ischemic stroke. Case Report: We report the case of a 7-year-old boy who was admitted to our hospital because of a depressed skull fracture. Soon after its initial evaluation, he had an episode of generalized tonic-clonic seizures; therefore, a detailed diagnostic work up was scheduled, which raised the diagnostic dilemma of ischemic stroke versus imaging alterations related to status epilepticus. He underwent surgical exploration, and a few days later the repeat MRI verified that the initial signal changes should be attributed to the ictus. Conclusions: Brain edema, most commonly affecting a cerebral hemisphere in its entirety, is a rare post-ictal imaging finding that is causally related to focal-onset status epilepticus. The aforementioned perfusion changes can aid in the differentiation of ictal-related brain abnormalities from acute ischemic stroke, if regional or more diffuse areas of increased perfusion are shown on MRI. Consequently, MRI should be considered the preferred imaging modality when we are confronted with cases of postictal signal changes that could masquerade as acute ischemic stroke.

Patient: Female, 6-year-old Final Diagnosis: Arteriovenous malformation Symptoms: Nausea • vomitting Medication:— Clinical Procedure: Computed tomography • digital subtraction angiography Specialty: Neurosurgery Objective: Unusual clinical course Background: Cerebral arteriovenous malformations (AVMs) are considered to be abnormalities of congenital origin, presumably arising due to a disorder in the process of embryogenesis, in the phase of differentiation of premature vascular domes into mature arteries, capillaries, and veins. The end result of that process is the formation of direct arteriovenous communications, without intervening capillary beds. Case Report: We report the case of a 6-year-old female who suffered an abrupt deterioration of her level of consciousness due to a subarachnoid hemorrhage located in the basal cisterns. Radiological investigation with magnetic resonance arteriography-magnetic resonance venography (MRA-MRV) was negative, but digital subtraction angiography (DSA) revealed a micro-AVM in the vicinity of the brainstem. The patient subsequently developed communicating hydrocephalus and the repeat DSA, performed 1 month later, failed to re-imagine the lesion. Further workup with DSA 1 year after the ictus was negative for pathological findings. Conclusions: There are a lot of controversies regarding the optimal imaging modality for surveillance of pediatric AVMs, the time period needed to follow-up a given lesion, even if it is considered treated, and the underlying mechanism of spontaneous thrombosis of untreated, yet ruptured, AVMs. All these issues, along with the unusual mode of evolution of the clinical picture of this lesion are discussed in detail, along with a review of the available literature.

Significant research has been conducted on skills’ enhancement school programs, since their importance has been well established. The pre-sented study evaluates “Steps for life”, a Greek, universal, annual, teacher-taught programme, designed to improve personal and social skills in young elementary students by the use of questions, diffusion in formal and hidden curriculum, and parental involvement. The experimental study was conducted in Greece during 2013-2014. The sample consisted of 2439 students, with 1516 forming the experimental group and 923 the control group. The study questionnaire included demographics, Personal and Social Skills Scale-Elementary, and the BASE scale. It investigated students’ self-esteem, concentration of attention, participation/cooperation, emotions’ identification and expression, emotions’ management, ability to control verbal and physical aggressiveness, ability to control victimization, empathy, friendship skills, problem-solving, ability to take responsibility, and use of spoken and written language. The experimental group exhibited significant improvement in all inves-tigated skills post-intervention, while the control group did not improve concentration of attention, emotions’ management, and their ability to control verbal and physical aggressiveness and victimization. The analysis also revealed that intervention students had significantly higher improvement than the controls in all dimensions. Appropriately designed mental health promotion programs can improve several children’s social-emotional skills and abilities

Background Spinal lipomas are generally thought to occur as a result of failed primary neurulation. Failed primary neurulation allows invasion of mesenchymal tissue of mesodermic origin into the neural structure, leading to the formation of a spinal lipoma. Despite most spinal lipomas being regarded as the result of failed primary neurulation, some confusion in terms of the embryogenesis of spinal lipomas remains. Recently, a novel classification of spinal lipomas based on embryonic changes seen during primary and secondary neurulation was has been proposed. Case Description We present a case of an intradural–extramedullary spinal cord lipoma, associated with a subjacent subcutaneous lipoma at the cervicothoracic region. The patient presented with worsening neurologic symptoms, indicating ongoing cervical myelopathy. A subtotal resection along with posterior cervical stabilization was achieved, with mild improvement of neurologic symptoms. Clinical, pathologic, and radiologic records are reviewed. Conclusions To the best of our knowledge, this is the first described case of a spinal cord lipoma with at such a location, one that cannot be fully categorized within the newly proposed classification system.

The aim of the present research is to explore preschool teachers' perceptions about the effective strategies for bullying prevention in preschool context. The sample of this research study was 164 preschool teachers from Greece. Data were collected by a questionnaire that was based on previous research. The findings show that teachers regard that classroom activities for diversity acceptance, the development of empathy, the cooperation between school and family, the implementation of socio-emotional learning programs in school context and teacher training, are among the most effective strategies. They also value the cooperation between school, family, and community services for bullying prevention as well as peer support and the creation of prevention activities and material such as videos. Research findings may be utilized for designing teacher training and professional development programs aiming at preventing school bullying at an early age.

The Personal and Social Skills Scale for Preschool K-Students Aged 4 - 6 (Kourmousi & Koutras, in Kourmousi, 2012) is a measure comprising eight subscales, designed to measure kindergarten students’ personal and social skills in the school environment. The presented study aimed to adapt it for use in elementary students—also adding two more dimensions, namely “Responsibility Taking” and “Use of Spoken and Written language”—and assess its reliability and validity in a sample of 2.691 first and second graders of Greek elementary schools. The adapted scale’s construct validity was examined initially by an exploratory factor analysis (EFA). The adapted scale’s correlation with the Behavioral Academic Self-Esteem (B.A.S.E.) scale and with demographic information was also investigated. Internal consistency reliability was satisfactory with Cronbach’s alphas ranging from 0.82 to 0.92 for all subscales. EFA identified an 11 factor model. The extracted factors explained 70.9% of the total variance. All subscales were found to be significantly and positively correlated with each other. Correlations of self-esteem with all subscales were also significant with the highest ones found with Problem Solving, Concentration of Attention, Participation/Cooperation in class, Friendship skills and Use of Spoken and Written Language. In most questionnaire subscales lower scores were exhibited by boys, by younger students, by those who did not comprehend the spoken language well, by students who received special education support (attended an integration class or received parallel support), by those re-attending the same grade, and by those whose mothers had lower educational level. In conclusion, the Personal and Social Skills Scale for Elementary Students Aged 7 - 9(PSSS-E), namely the adaptation of the PSSS-K for use in older children, was found to have satisfactory psychometric properties. Therefore, it can be used to evaluate elementary students’ personal and social skills.

Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

The aim of the present research is to explore teachers' perceptions about the effective strategies for addressing children's depression in school context, as well as the appropriate preventive counseling interventions within school context. The sample of this research study was 116 teachers of primary education. Data were collected by a questionnaire that was based on previous research. The findings show that teachers regard that supporting children, a positive interpersonal relationship with these children, a positive climate in the classroom, cooperation with parents and mental health professionals are among the effective strategies. In relation to the appropriate preventive counseling interventions, they argue that the implementation of socio-emotional programs by teachers in cooperation with mental health professionals, as well as the delivery of mental health prevention programs to all children by mental health specialists are effective strategies. Research findings may be utilized for designing teacher training and professional development programs aiming at supporting children with depression and mental health promotion.