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Visocchi M. Transnasal and transoral approach to the clivus and the craniovertebral junction. J Neurosurg Sci 2015; 63:498-500. [PMID: 25737364 DOI: 10.23736/s0390-5616.16.03114-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Visocchi M, Conforti G, Roselli R, La Rocca G, Spallone A. From less to maximally invasiveness in cervical spine surgery: A "nightmare" case who deserve consideration. Int J Surg Case Rep 2015; 9:85-8. [PMID: 25734320 PMCID: PMC4392186 DOI: 10.1016/j.ijscr.2015.01.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. PRESENTATION OF CASE We present the case of a 62 year-old lady, harboring rheumatoid artritis (RA) with gait disturbances, pain, and weakness in both arms. A C5 and C6 somatectomy, C4-C7 discectomy and, instrumentation and fusion with telescopic distractor "piston like", anterior plate and expandable screws were performed. Two days later the patient complained dysfagia, and a cervical X-ray showed hardware dislocation. So a C4 somatectomy, telescopic extension of the construct up to C3 with expandible screws was performed. After one week the patient complained again soft dysfagia. New cervical X-ray showed the pull out of the cranial screws (C3). So the third surgery "one stage combined" an anterior decompression with fusion along with posterior instrumentation, and fusion was performed. DISCUSSION There is a considerable controversy over which surgical approach will receive the best clinical outcome for the minimum cost in the compressive cervical myelopathy. However, the most important factors in patient selection for a particular procedure are the clinical symptoms and the radiographic alignment of the spine. the goals of surgery for cervical multilevel stenosis include the restoration of height, alignment, and stability. CONCLUSION We stress the importance of a careful patients selection, and invocated still the importance for 360° cervical fixation.
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Visocchi M, Trevisi G, Iacopino DG, Tamburrini G, Caldarelli M, Barbagallo GMV. Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of "accordion phenomenon". EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S564-8. [PMID: 25519842 DOI: 10.1007/s00586-014-3720-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 12/04/2014] [Accepted: 12/05/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Transoral odontoidectomy followed by occipito-cervical fixation is a widely used approach to relieve ventral compressions at the craniovertebral junction (CVJ). Despite the large amount of literature on this approach and its complications, no previous reports of odontoid process and clival regeneration following transoral odontoidectomy are present in the English literature. METHODS We report the case of odontoid process and clival regeneration following transoral odontoidectomy. RESULTS A 7-year-old boy presented with symptoms of brainstem and upper cervical spinal cord compression due to a complex malformation at the CVJ including a basilar invagination with Chiari malformation. A successful transoral microsurgical endoscopic-assisted odontoidectomy extended to the clivus was performed along with occipito cervical instrumentation and fusion. Clinical and radiological resolution of the CVJ compression was evident up to 2 years post-op, when the child had a relapse of some of the presenting symptoms and the follow-up CT and MRI scans showed a quite complete regrowth of the odontoid process, clival partial regeneration and recurrence of preoperative Chiari malformation. CONCLUSIONS Besides the need of an accurate complete resection of the periosteum, which apparently was incompletely performed in our case, our experience suggests the need of resection of the odontoid down to the dentocentral synchondrosis and an accurate lateral removal of the bone surrounding the anterior tubercle of the Clivus is advised when an anterior CVJ decompression is required in children presenting a still evident synchondrosis at neuroradiological investigation.
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Giugno A, Maugeri R, D’Arpa S, Visocchi M, Iacopino DG. Complex reconstructive surgery following removal of extra-intracranial meningiomas, including the use of autologous fibrin glue and a pedicled muscle flap. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2014. [DOI: 10.1016/j.inat.2014.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barbagallo GMV, Certo F, Visocchi M, Sciacca G, Piccini M, Albanese V. Multilevel mini-open TLIFs and percutaneous pedicle screw fixation: description of a simple technical nuance used to increase intraoperative safety and improve workflow. Tips and tricks and review of the literature. Neurosurg Rev 2014; 38:343-54; discussion 354. [DOI: 10.1007/s10143-014-0589-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 08/18/2014] [Accepted: 08/31/2014] [Indexed: 10/24/2022]
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Spallone A, Marchione P, Li Voti P, Ferrante L, Visocchi M. Anterior cervical discectomy and fusion with "mini-invasive" harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: a retrospective outcome analysis. Int J Surg 2014; 12:1328-32. [PMID: 25448654 DOI: 10.1016/j.ijsu.2014.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited outcome data suggested a minimal evidence for better clinical and radiographic outcome of polyetheretherketone cages compared with bone grafts in the anterior cervical discectomy and fusion. We proposed a "mini-invasive" surgical technique for harvesting iliac crest grafts that provides bicortical autografts of sufficient size to be used in multilevel cervical procedures and is not associated with long-term significant donor site pain. METHODS All patients undergoing discectomy and fusion during a three years period were consecutively extracted from computer database and retrospectively evaluated by means of telephonic interview, independently from surgical procedure (iliac crest autograph or prosthesis). Two procedure-blinded neurologists retrieved baseline clinical-demographic data and pre-surgical scores of routinely performed scales for pain and functional abilities. Afterwards, a third blinded neurologist performed clinical follow up by a semi-structured interview including Verbal Analog Scale for pain and Neck Disability Scale for discomfort. RESULTS 80 patients out of 115 selected cases completed the follow up. 40 patients had been treated by mini-invasive bone graft harvesting and 40 with PEEK cages for cervical fusion. VAS for both neck and arm pain were significantly reduced within groups. Patients did not complaint any significant pain and/or paraesthesias at donor site from the first week after intervention. Neck Disability Scale was significantly lower at the end of follow up in both groups. CONCLUSIONS "Miniinvasive" bicortical autografts is a less invasive, inexpensive technique to harvest iliac graft that may produce a reduced amount of general and local donor-site complications without outcome differences with prosthetic cages.
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Certo F, Visocchi M, Borderi A, Pennisi C, Albanese V, Barbagallo GMV. Lumbar intervertebral discal cyst: a rare cause of low back pain and radiculopathy. Case report and review of the current evidences on diagnosis and management. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:141-8. [PMID: 25364328 PMCID: PMC4212701 DOI: 10.1055/s-0034-1387806] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/02/2014] [Indexed: 12/21/2022]
Abstract
Study Design Case Report and review of the literature. Objective The objective of the article is to report an illustrative case successfully treated by microsurgery and to review the literature on the current evidence on diagnosis and management of lumbar discal cysts. Methods A 43-year-old male patient presented with severe back pain, radiating down to the right leg, as well as with paraesthesias in the right L3 and L4 dermatomes. Magnetic resonance imaging of the lumbar spine revealed an intraspinal, extradural space-occupying lesion at the L3–L4 disc level, causing compression of the neural structures. The lesion was surgically removed and a diagnosis of lumbar discal cyst was made. Postoperatively, symptoms improved and the patient was discharged with no complications. A systematic review of pertinent articles published up to February 2014 was performed. Key articles were searched to identify studies describing the diagnosis and management modalities of lumbar discal cysts and the comparative effectiveness and safety of microsurgery versus endoscopic treatment. Conclusions Discal cysts are rare causes of low back pain and radiculopathy. Few cases have been reported; however, conclusive information about their natural history is not available and the best mode of treatment remains controversial. We submit that lumbar intervertebral disc cysts, with their peculiar radiological and anatomic features, should be considered in the differential diagnosis among rare causes of low back pain and radiculopathy.
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Barbagallo G, Certo F, Albanese V, Visocchi M. The impact of complications following cervical spine surgery: a systematic review. J Neurosurg Sci 2014; 58:55-64. [PMID: 25371950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fontanella MM, Fazio M, Francione A, Bacigaluppi S, Griva F, Visocchi M, Panciani PP, Bergomi R, Spena G. Pre-symptomatic cervical myelopathy: should we operate or should we observe? What is the chance of spinal cord injury from an accident? J Neurosurg Sci 2014; 58:15-22. [PMID: 25371943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Barbagallo G, Certo F, Princiotto S, Piccini M, Albanese V, Visocchi M. Early postoperative extramedullary MRI signal changes after ACDF: misinterpretations can be dangerous and misleading. Case report and review of the literature. J Neurosurg Sci 2014; 58:123-128. [PMID: 25371962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Wang YN, Zhong J, Zhu J, Dou NN, Xia L, Visocchi M, Li ST. Microvascular decompression in patients with coexistent trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia. Acta Neurochir (Wien) 2014; 156:1167-71. [PMID: 24604137 DOI: 10.1007/s00701-014-2034-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trigeminal neuralgia(TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN) were referred to hyperactive dysfunction syndromes (HDSs) of the cranial nerves. These symptoms may occur synchronously or metachronously, but the combination of three diseases is extremely rare. METHODS From 2007 through 2013, six patients with coexistent GPN-HFS-TN were treated in our department. The combined symptoms occurred on the same side in three and on both sides in three. These patients underwent nine microvascular decompression (MVD) procedures in total. The clinical data including operative findings were respectively analyzed, and the etiological factors as well as treatment strategies were discussed. RESULTS Intraoperatively, in all the cases a small posterior fossa was found, which was crowded with cranial nerve roots and cerbellar vesels. Postoperatively, spasm was stopped immediately in four and within 3 months in two; the symptom of TN disappeared immediately in four and within 2 weeks in two; the symptom of GPN was relieved immediately in four and improved with medication in two. During the up to 77 months' follow-up, no changes, recurrence or any dysfunctions of cranial nerves were observed in any of the patients. CONCLUSIONS The combination of HFS-TN-GPN is extremely rare and is often associated with a looped VBA and a smaller posterior fossa. However, MVD is still a good choice for treatment. To achieve a safe and effective outcome, dissection of the caudal cranial nerves and proximal transposition of the vertebral artery before decompression of the affected nerve roots are strongly recommended.
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Visocchi M, Della Pepa GM, Roselli R, La Rocca G, Conforti G, Spallone A, Barbagallo G. Laminoplasty and laminectomy in cervical stenotic myelopathy: allies not enemies. J Neurosurg Sci 2014; 58:101-105. [PMID: 25371958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Visocchi M, Conforti G, La Rocca G, Roselli R, Spallone A, Barbagallo G. Invasive and mini-invasive lumbar fusions. Does exist a state of art? An enigma in search of solutions. J Neurosurg Sci 2014; 58:113-117. [PMID: 25371960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Neroni M, Gazzeri R, Conforti G, Visocchi M. State of art of recurrent lumbar disk herniation, interspinous and interlumbar fusions. J Neurosurg Sci 2014; 58:45-48. [PMID: 25371948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Barbagallo GMV, Certo F, Visocchi M, Sciacca G, Albanese V. Double-level cervical total disc replacement for adjacent segment disease: is it a useful treatment? Description of late onset heterotopic ossification and review of the literature. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2014; 18:15-23. [PMID: 24825036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a rare case of double-level adjacent segment disease (ASD), occurring ten years later an anterior cervical discectomy (ACD) without fusion, treated by cervical arthroplasty, highlighting the outcome at long-term follow-up and focusing on heterotopic ossification. In 1995 a 25-year-old man satisfactorily underwent ACD at C4/C5. At that time MRI also showed signs of degenerative disc disease (DDD) at C3/C4 and C5/C6. Ten years later, a new MRI scan showed a large C3/C4 and a smaller C5/C6 soft disc hernia together with spondylotic changes at the level above and below the site of the first surgery. At C4/C5 imaging revealed a kyphotic stable "pseudoarthrosis" with anterior bridging osteophyte. The patient underwent double-level arthroplasty with ProDisc-C. Clinical and radiological outcome was satisfactory. 3 and 5 years after surgery, X-rays and CT scan documented the progressive development of heterotopic ossification, with gradual reduction of range of motion. A late onset heterotopic ossification can neutralize the theoretical advantages of cervical arthroplasty, which should be considered an effective surgical option only in selected cases. ACDF and restoration of normal lordosis can be a viable alternative in cervical revision surgery, as motion preservation can not be always mantained for a long time.
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Della Pepa GM, Roselli R, La Rocca G, Spallone A, Barbagallo G, Visocchi M. Laminoplasty is better of laminectomy in cervical stenotic myelopathy: myth or truth? EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2014; 18:50-54. [PMID: 24825042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Laminoplasty has been proposed as a treatment for cervical stenotic myelopathy (CSM) as an alternative to standard laminectomy as this has been considered directly associated with an increased risk of postoperative deformity. METHODS We retrospective reviewed postoperative results of open door laminoplasty (unilateral approach technique) compared with laminectomy in terms of clinical/electophysiological results (somatosensory evoked potentials - SSEP, and motor evoked potentials - MEP); in addition the rate of subsequent spinal deformities was analyzed in both techniques. RESULTS Postoperative results in terms of late follow up neurological assessment and neurophysiological improvement was substantially comparable in both groups. Postoperative dynamic cervical X-rays showed a kyphotic deformity in (12.5%) in patients undergoing laminectomy; none was unstable. No case of kypothic deformity occurred in patients undergoing open door laminoplasty. Complication rate was similar in both groups. DISCUSSION AND CONCLUSIONS Standard laminectomy seems to be associated to late cervical spine deformities in a more relevant percentage of patients, possibly leading to severe forms of kyphosis and segmental instability over time compared with open-door expansive laminoplasty. The unilateral approach represents an evolution to standard open door technique that further spares posterior elements, may decrease the incidence of progressive spinal deformity and prevent the need for subsequent spinal stabilization.
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Visocchi M, Di Rocco C. Os odontoideum syndrome: pathogenesis, clinical patterns and indication for surgical strategies in childhood. Adv Tech Stand Neurosurg 2014; 40:273-93. [PMID: 24265050 DOI: 10.1007/978-3-319-01065-6_9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Os odontoideum is a rare condition with a controversial pathogenesis and poorly understood natural history. Hypoplasia of the odontoid associated with an independent oval ossicle, with smooth margins widely separated from C2 and well above the superior facets of the axis, is termed "os odontoideum". The neurological manifestations arise from bulbospinal compression both at rest and during motion, due to the craniovertebral junction (CVJ) instability itself. Consequently, the surgical management of os odontoideum should aim at achieving both neural decompression and stabilization of the CVJ. The aims of this paper are to introduce the embryological steps involved in the CVJ development, to underline the updated theories propounded to interpret developmental and congenital disorders of the os odontoideum, to introduce the most updated surgical techniques and to discuss some exemplary cases selected from our personal experience.
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Della Pepa GM, La Rocca G, Barbagallo G, Spallone A, Visocchi M. Transient breathing disorders after posterior cervical surgery for degenerative diseases: pathophysiological interpretation. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2014; 18:89-92. [PMID: 24825050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Central sleep apnea is a breathing disorder that manifests as repetitive cessation of the breath during the sleep. The occurrence of breathing disorders after cervical laminectomy has been exceptionally described as a complication after cervical decompressive laminectomy for cervical stenotic myelopathy. In 1994, Naim-ur-Rahman reported the first case of postoperative central sleep apnea following C3-C6 laminectomy, occurring right after surgery and associated with spyncterial incontinence, that spontaneously recovered three weeks after onset. Recently we described a rare complication of cervical laminectomy for cervical stenotic myelopathy: the onset was delayed from surgery (nearly two weeks later) and cervical stenotic myelopathy was not associated to any other neurological sign of spinal cord damage as demonstrated by the neurophysiological assessment. Possible familiar predisposition can be matter of discussion. No definite interpretation of pathophysiological mechanisms can ultimately explain the occurrence of delayed and isolated central sleep apnea after laminectomy for the treatment of cervical stenotic myelopathy. Such a reversible and benign complication remain unpredictable in the best surgical hands.
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Spallone A, Izzo C, Galassi S, Visocchi M. Is "mini-invasive" technique for iliac crest harvesting an alternative to cervical cage implant? An overview of a large personal experience. Surg Neurol Int 2013; 4:157. [PMID: 24381800 PMCID: PMC3872648 DOI: 10.4103/2152-7806.123202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/10/2013] [Indexed: 11/21/2022] Open
Abstract
Background: Autograft bone provides an excellent substrate for multilevel arthrodesis after anterior discectomy and is inexpensive. However, the use of tricortical bone could increase the discomfort for the patient. Methods: We reviewed cases of cervical disc diseases operated on by a single neurosurgeon (AS), within the period June 2000-December 2011. A total of 221 patients were considered for the present study; 109 female, 112 male, averaging 49 years of age. Only patients who could be followed up for at least one year were included in the present study. The grafts obtained with the technique described are bi- (and not tri-) cortical, and always of sufficient size in order to fit two spaces if necessary. Results: The technique is not associated with long-term significant donor site pain except for a striking minority of patients, it shortens the hospital stay, it offers comparable results to the published surgical series in which cage and/or modern implants are used. Conclusions: Autograft bone can be reasonably considered as one of the possible alternatives to be used in the surgical management of cervical disk disease.
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Della Pepa GM, Visocchi M. Intracranial metastasis from a "giant" nonoperated sacrococcygeal chordoma: an underestimated metastatic potential? Br J Neurosurg 2013; 28:564-5. [PMID: 24102667 DOI: 10.3109/02688697.2013.847175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Della Pepa GM, Fukaya C, La Rocca G, Zhong J, Visocchi M. Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going? Stereotact Funct Neurosurg 2013; 91:275-87. [DOI: 10.1159/000348271] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 10/16/2012] [Indexed: 11/19/2022]
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Visocchi M, Sturiale CL, Esposito G, Maira G. Occipito-cervical instrumentation failure after radio-chemotherapy for axis solitary plasmacytoma: a case-based update. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 22 Suppl 1:45-51. [PMID: 26662747 DOI: 10.1007/s00590-011-0930-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 12/08/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Axis solitary plasmacytoma is a rare cause of cranio-vertebral junction instability and atlanto-axial subluxation. Occipito-cervical instrumentation through lateral mass screws fixation is commonly used to obtain an internal stabilisation through a posterior approach in the management of axis tumours. Although radiotherapy and chemotherapy have been strongly advocated for treatment of spinal solitary plasmacytoma, their role in determining failure of instrumented fusion has not yet been emphasised. CASE REPORT A 52-year-old man affected by an axis solitary plasmacytoma underwent occipito-cervical instrumentation through lateral mass screws fixation and subsequent radio-chemotherapy. Bone resorption and failure of instrumented fusion were observed at 6-month follow-up. New instrumented surgery by using Songer titanium sublaminar wires was then performed. Post-operatively, a Halo-Vest system was applied for 3-months and administration of oral bisphosphonates was started. The patient quickly regained walking ability. Computed tomography scan demonstrated the correct position of the sublaminar wires, as the initial bone fusion too. A 30-month follow-up computed tomography scan documented the maintenance of spinal stability and alignment due to successful fusion. DISCUSSION Despite the effect of radio-chemotherapy on bony metabolism has been widely discussed, its role in influencing the failure of instrumented fusion has not yet been definitively analysed, especially when glucocorticoids are chosen as chemotherapic agent. Moreover, the most appropriate technique of instrumented fusion to be used after radio-chemotherapy is not established. Also the role of bisphosphonates in preventing the failure of instrumented surgery has not yet documented. All these aspects are discussed by the authors along with a literature review, taking a cue from the management of this case.
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Novello M, Lauriola L, Della Pepa GM, La Rocca G, Coli A, Visocchi M. ALK
‐positive anaplastic large cell lymphoma presenting as intradural spinal mass: First reported case and review of literature. Neuropathology 2012; 33:418-23. [DOI: 10.1111/j.1440-1789.2012.01359.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/15/2012] [Accepted: 09/18/2012] [Indexed: 11/29/2022]
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Visocchi M, Esposito G, Della Pepa GM, Doglietto F, Nucci CG, Maria Fontanella M, Montano N. Internal decompressive craniectomy with craniotomy: a novel surgical therapy of giant frontal mucocele complicated by subdural empyema. Acta Neurol Belg 2011; 111:365-370. [PMID: 22368985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Giant frontal mucocele (GFM) is an extremely rare cause of frontal lobe syndrome. Subdural empyema (SDE) is an uncommon complication of paranasal sinisutis, for which craniotomy and decompressive craniotomy are the most effective surgical procedures. CASE REPORT A 54-year-old man was brought unconscious to the Emergency Room where recurrent generalized seizures occurred. Heroine abuse, HCV related hepatitis, prolonged antibiotic therapy for treatment of purulent rhinorrhea, along with recent personality changes, was reported. High white blood cell count, pansinusitis, GFM, SDE and cerebritis were documented. The patient underwent bifrontal craniotomy in emergency, extensive drilling of the inner aspect of the frontal bone, surgical toilette of the enlarged frontal sinus and its "cranialization". Prevotella intermedia and Fusobacterium nucleatum were isolated and antibiotic therapy was started intravenously and then continued orally for three months. Two years later the patient has recovered, though minor signs of frontal lobe syndrome persist. DISCUSSION To the Authors knowledge this is the first case of GFM with SDE reported in the literature. Although decompressive craniectomy is advocated in extreme conditions, as in this case, "internal decompressive craniectomy", obtained with craniotomy and cranialization of the frontal sinuses, is strongly advocated in cases of SDE associated with megasinuses.
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Leone A, Costantini A, Visocchi M, Vestito A, Colelli P, Magarelli N, Colosimo C, Bonomo L. The role of imaging in the pre- and postoperative evaluation of posterior occipito-cervical fusion. Radiol Med 2011; 117:636-53. [DOI: 10.1007/s11547-011-0746-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
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