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Di Rienzo A, Colasanti R, Dobran M, Carrassi E, Liverotti V, Capece M, Iacoangeli A, Iacoangeli M. Managing Ventriculoperitoneal Shunt Exposure in Adult Patients: Surgical Options and Implant Removal Prevention. World Neurosurg 2023; 175:e141-e150. [PMID: 36931343 DOI: 10.1016/j.wneu.2023.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunt exposure is rare. Small series reporting on managing this complication mainly focus on the pediatric population, where wound breaks over cerebrospinal fluid (CSF) chambers are observed most frequently. However, case series on adult patients are missing. METHODS Between June 2004 and December 2019, 18 patients underwent VP shunt revision due to implant exposure. Pertinent data were retrospectively collected from the hospital database. Their full clinical history, laboratory values, neuroradiological imaging, pretreatment CSF characteristics, photographic and video material, and surgery types were reviewed. RESULTS The ventricular catheter was exposed in 8 patients (the frontal region in 6 and the occipital region in 2), the valve chamber at the retroauricular region in 6, the shunt tube in 7 (at the neck in 4, the supraclavicular region in 2, and the abdominal incision in 1). Multiple exposure sites were found in 2 cases. Two patients with CSF infections benefitted from system removal and temporary external ventricular drainage until infection control was achieved. The remaining 16 patients underwent on-ward revision (wound curettage, skin mobilisation, and resuture over the exposed part of the shunt), which was effective in 14 patients, but further revision was required in 2 patients. CONCLUSIONS While rare, VP shunt exposure is a serious complication. In our experience, a prompt and accurate on-ward revision could save the implant in most patients without CSF infections.
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Affiliation(s)
- Alessandro Di Rienzo
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Roberto Colasanti
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy; Department of Neurosurgery, Padua University Hospital, Padua, Italy.
| | - Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Erika Carrassi
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Valentina Liverotti
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Mara Capece
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Alessio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
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2
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Yoshida B, Nguyen A, Formanek B, Alam M, Wang JC, Buser Z. Hypoalbuminemia and Elevated CRP are Risk Factors for Deep Infections and Urinary Tract Infections After Lumbar Spine Surgery in a Large Retrospective Patient Population. Global Spine J 2023; 13:33-44. [PMID: 33517797 PMCID: PMC9837497 DOI: 10.1177/2192568221990647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVES To determine if pre-operative albumin and CRP can predict post-operative infections after lumbar surgery. METHODS Patients who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lumbar discectomy were identified using a patient record database (PearlDiver) and were included in this retrospective study. Patients were stratified by Charlson Comorbidity Index (CCI) scores and pre-operative albumin and CRP status. Post-operative complications included deep infections and urinary tract infections within 3 months of the surgery and revisions within 1 year of the surgery. RESULTS 74,280 patients were included in this study. 21,903 had pre-operative albumin or CRP lab values. 7,191 (33%), 12,183 (56%), and 2,529 (12%) patients underwent an ALIF, PLIF, and a lumbar discectomy, respectively. 16,191 did not have any complication (74%). The most common complication was UTI (16%). Among all patients, hypoalbuminemia was a significant risk factor for deep infection and UTI after ALIF, deep infection, UTI, and surgical revision after PLIF, and deep infection after lumbar discectomy. Elevated CRP was a significant risk factor for deep infection after ALIF, UTI after PLIF, and deep infection after lumbar discectomy in patients with a CCI ≤ 3. CONCLUSIONS Pre-operative hypoalbuminemia and elevated CRP were significant risk factors for deep infection, UTI, and/or revision, after ALIF, PLIT, and/or lumbar discectomy. Future studies with a larger population of patients with low albumin and high CRP values are needed to further elaborate on the current findings.
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Affiliation(s)
- Brandon Yoshida
- Department of Orthopaedic Surgery, Keck
School of Medicine of the University of Southern California, Los Angels, CA,
USA
| | - Ailene Nguyen
- Department of Orthopaedic Surgery, Keck
School of Medicine of the University of Southern California, Los Angels, CA,
USA
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck
School of Medicine of the University of Southern California, Los Angels, CA,
USA
| | - Milad Alam
- Department of Orthopaedic Surgery, Keck
School of Medicine of the University of Southern California, Los Angels, CA,
USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck
School of Medicine of the University of Southern California, Los Angels, CA,
USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck
School of Medicine of the University of Southern California, Los Angels, CA,
USA,Zorica Buser, PhD, Department of Orthopaedic
Surgery, Keck School of Medicine, University of Southern California, 1450 San
Pablo St., HC4-5400A, Los Angels, CA 90033, USA.
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3
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Zare A, Sabahi M, Safari H, Kiani A, Schmidt MH, Arjipour M. Spinal Surgery and Subsequent ESR and WBC Changes Pattern: A Single Center Prospective Study. Korean J Neurotrauma 2021; 17:136-147. [PMID: 34760824 PMCID: PMC8558019 DOI: 10.13004/kjnt.2021.17.e33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Postoperative inflammation and infections are common complications of spinal surgery and have similar symptoms. However, postoperative infection may lead to a poor outcome and must be differentiated from postoperative inflammation. The objective of this study is determine the changing pattern of postoperative ESR and WBC counts, and investigate the effects of different variables. Methods A total of 61 patients who underwent spinal surgery were enrolled in this prospective study. The erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts were measured the day before surgery and on 1st, 3rd, 5th, 7th, and 14th postoperative days. Results WBC counts increased on the 1st postoperative day in comparison with the preoperative day (p<0.001), and they gradually decreased until the preoperative value was reached on the 14th postoperative day (p=0.14). The ESR also increased postoperatively, reaching a peak on the 5th postoperative day in comparison with the preoperative day (p<0.001) and gradually decreased thereafter. However, on the 14th postoperative day, the ESR was significantly greater than the preoperative value (p<0.001). In addition, a significant positive correlation was observed between ESR and age, duration of surgery, intraoperative blood loss, and duration of anesthesia. Conclusion WBC count continued to rise and was the highest on the 1st postoperative day, after which it gradually decreased and attained normal values on the 14th postoperative day, while the ESR increased on the 1st postoperative day, reached the highest level in patients with and without simultaneous instrumentation on 7th and 5th postoperative days, respectively, and gradually decreased.
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Affiliation(s)
- Akram Zare
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadmahdi Sabahi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Safari
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arash Kiani
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Mahdi Arjipour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
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4
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Karczewski D, Pumberger M, Müller M, Andronic O, Perka C, Winkler T. Implications for diagnosis and treatment of peri-spinal implant infections from experiences in periprosthetic joint infections-a literature comparison and review. JOURNAL OF SPINE SURGERY 2020; 6:800-813. [PMID: 33447686 DOI: 10.21037/jss-20-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Both, periprosthetic joint infection (PJI) and peri-spinal implant infection (PSII) are serious complications occurring in arthroplasty and spine instrumentation with absolute numbers expected to rise in the next years. The currently existing literature data describing the characteristics of PSII are limited when compared to PJI studies. However, both PJI and PSII exhibit similarities concerning pathogenesis, symptoms, diagnosis, treatment and prognosis. This literature review aims at comparing PJI and PSII and to develop implications for diagnosis and treatment of PSII from existing studies about PJI. The review was performed on the basis of a structured PubMed, Cochrane Library, and Medline analysis and existing guidelines, with 99 references being included. The results indicate that specific terms like re-infection should be defined in the context of PSII based on existing definitions of PJI, that in vitro biofilm studies and studies analyzing different prosthesis surfaces in arthroplasty could be used for PSII, and that histopathology as an additional standard tool in PSII diagnosis might be helpful. In addition, the development of a standardized algorithm-based treatment system with antibiotic protocols, including long term suppression, for PSII similar to the ones existing for PJI is necessary.
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Affiliation(s)
- Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Michael Müller
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Octavian Andronic
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Julius Wolff Institute, Charité - Universit tsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité - Universit tsmedizin Berlin, Berlin, Germany
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5
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Beydoun N, Tandon S, Krengel S, Johnson E, Palacio Bedoya F, Moore M, Refai D, Rouphael N. A Retrospective Chart Review on the Role of Suppressive Therapy in the Management of Spinal Infections Involving Hardware. Open Forum Infect Dis 2020; 7:ofaa253. [PMID: 32715019 PMCID: PMC7372706 DOI: 10.1093/ofid/ofaa253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
Background One percent to 8% of patients undergoing spinal instrumentation surgeries develop infections. There is no consensus on the medical and surgical management of these infections. Methods We conducted a retrospective chart review based on International Classification of Diseases, Ninth Revision, and Common Procedural Terminology codes relevant to spinal infections with hardware within Emory Healthcare over a 10-year period. Extracted data included patient demographics, clinical presentation, laboratory and microbiologic results, and surgical and medical management including choice and duration of suppressive therapy. Multivariable logistic regression was used to assess the association of length of use of suppressive antibiotics with treatment success and to identify predictors of use of suppressive antibiotics. Results Of 869 records, 124 met inclusion criteria. Fifty patients (40.3%) had an infection that occurred after hardware placement, mostly within 3 months postsurgery, while the remainder had vertebral osteomyelitis that required hardware placement. After initial intravenous antibiotic treatment for ≥4 weeks, 72 patients (64.5%) were given suppressive antibiotics. The overall treatment success rate was 78.2%. In spinal infections involving hardware with gram-negative rods, patients were less likely to receive suppressive antibiotics, less likely to have hardware removed, and less likely to have treatment success compared with patients with infections with Staphylococcus species. Conclusions Management of spinal infections involving hardware should be tailored to the timing of onset of infection and causative organism. Further studies are needed to determine best management practices, particularly for gram-negative rod infections where the role of further suppressive antibiotics and hardware removal may be warranted.
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Affiliation(s)
- Nour Beydoun
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sonia Tandon
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sonia Krengel
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eric Johnson
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Federico Palacio Bedoya
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Moore
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Refai
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine Rouphael
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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6
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Nasi D, Dobran M, Pavesi G. The efficacy of postoperative bracing after spine surgery for lumbar degenerative diseases: a systematic review. 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 2019; 29:321-331. [DOI: 10.1007/s00586-019-06202-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/28/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
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7
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Nasi D, Ruscelli P, Gladi M, Mancini F, Iacoangeli M, Dobran M. Ultra-early surgery in complete cervical spinal cord injury improves neurological recovery: A single-center retrospective study. Surg Neurol Int 2019; 10:207. [PMID: 31768287 PMCID: PMC6826315 DOI: 10.25259/sni_485_2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background This study evaluated how the neurological outcome in patients operated on cervical spinal cord injury (SCI) was positively influenced by ultra-early surgery (UES). Methods Between 2010 and 2017, 81 patients with traumatic cervical SCI were assigned to the UES group (<12 h after injury; UES) and ES group (surgery between 12 and 48 h after injury; ES). Additional variables evaluated for the two groups included; age, sex, comorbidities charlson comorbidity index (CCI), level of trauma, type of fracture, preoperative and ASIA scores, pre- and post-operative neuroradiological examinations, surgical approaches, and complications. Results Forty-seven of 81 (58.02%) patients exhibited improved neurological function 12 months postoperatively; better outcomes were observed in the UES (29 of 40 [72.5%]) versus ES groups (18 of 41 [43.9%]) (P = 0,009). For the 26 patients with complete cervical SCI (ASIA A), ultra-early surgical decompression was associated with significantly greater neurological improvement versus ES (61.53% vs. 7.69%; P = 0.003). Further, more neurological improvement correlated with the younger age, better ASIA grade at admission, and ultra-early surgical timing (< 12 h) both in the univariate and multivariate analysis (P = 0.037, P = 0.017, and P = 0.005, respectively), while CCI was correlated with improvement only in the univariate analysis (P = 0.005). Conclusion Ultra-early surgical timing in SCI patients appeared to be the most important factor determining the extent of postoperative neurological improvement, particularly regarding motor function recovery.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Marche Polytechnic University, Ancona, Italy
| | - Paolo Ruscelli
- Department of Emergency Surgery, Umberto I General Hospital, Marche Polytechnic University, Ancona, Italy
| | - Maurizio Gladi
- Department of Neurosurgery, Umberto I General Hospital, Marche Polytechnic University, Ancona, Italy
| | - Fabrizio Mancini
- Department of Neurosurgery, Umberto I General Hospital, Marche Polytechnic University, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Marche Polytechnic University, Ancona, Italy
| | - Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Marche Polytechnic University, Ancona, Italy
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8
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Dobran M, Nasi D, Della Costanza M, Formica F. Intralesional and subarachnoid bleeding of a spinal schwannoma presenting with acute cauda equina syndrome. BMJ Case Rep 2019; 12:12/7/e229251. [PMID: 31302617 DOI: 10.1136/bcr-2019-229251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present an unusual case of spinal neurinoma with intralesional and subarachnoid bleeding with acute cauda equina syndrome. A 38-year-old man was admitted to our department after a minor thoracic spinal trauma with right lower limb plegia and urinary retention. MRI showed a T11 intradural tumour with intralesional and subarachnoid haemorrhage. The patient was operated of spinal cord decompression and complete tumour resection. The histological examination documented a schwannoma with large haemorrhagic intratumoural areas. A full neurological recovery was documented at 6-month follow-up.
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Affiliation(s)
- Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | | | - Francesco Formica
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
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9
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Dobran M, Nasi D, Della Costanza M, Gladi M, Iacoangeli M, Rotim K, Splavski B. Characteristics of treatment and outcome in elderly patients with brain glioblastoma: a retrospective analysis of case series. Acta Clin Croat 2019; 58:221-228. [PMID: 31819317 PMCID: PMC6884380 DOI: 10.20471/acc.2019.58.02.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Treatment modalities affecting quality of life and survival in elderly brain glioblastoma patients are not well defined. A single-institution data were analyzed during a 3-year period to disclose prognostic difference in management related to age. Karnofsky Performance Scale (KPS), overall survival (OS), and adjuvant therapy were evaluated. The case group comprised of elderly patients (>75 years), while the control group included those of younger age (<65 years). The investigated variables were correlated between the groups. Twenty elderly patients and a corresponding number of younger ones were analyzed. Preoperative KPS >70 indicated longer overall survival. Statistically significant correlation was recorded in both the control (p=0.036) and case (p=0.0053) groups. Lower postoperative KPS was significantly correlated with shorter OS in elderly patients (p=0.023). The correlation between the extent of tumor resection and OS was statistically significant in younger patients only (p=0.04). Overall survival was significantly shorter in elderly patients regardless of the extent of tumor resection (p=0.0057). Adjuvant therapy was significantly associated with longer OS in both the case (p=0.032) and control (p=0.013) groups. Elderly population is a more endangered group of surgical brain glioblastoma patients having lower quality of life and shorter overall survival. The management protocol should be personalized for each individual case in this age group of patients to reduce postoperative complications and grant a satisfactory quality of life.
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Affiliation(s)
| | - Davide Nasi
- 1Department of Neurosurgery Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Martina Della Costanza
- 1Department of Neurosurgery Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Maurizio Gladi
- 1Department of Neurosurgery Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Maurizio Iacoangeli
- 1Department of Neurosurgery Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Krešimir Rotim
- 1Department of Neurosurgery Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Bruno Splavski
- 1Department of Neurosurgery Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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10
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Dobran M, Nasi D, Paracino R, Gladi M, Costanza MD, Marini A, Lattanzi S, Iacoangeli M. Analysis of risk factors and postoperative predictors for recurrent lumbar disc herniation. Surg Neurol Int 2019; 10:36. [PMID: 31528374 PMCID: PMC6743684 DOI: 10.25259/sni-22-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background: This study identified risk factors and postoperative indicators for recurrent lumbar disc herniations (rLDH) following microdiscectomy. Methods: We retrospectively reviewed the 1-year recurrence rate for LDH in 209 consecutive patients undergoing microdiscectomy (2013–2018). Results: Utilizing a multivariate analysis, higher body mass index (BMI) and postsurgery Oswestry disability index (ODI) were significantly associated with an increased risk of rLDH. Conclusion: Elevated postsurgery ODI and higher BMI were significantly associated with increased risk of rLDH.
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Affiliation(s)
- M Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - R Paracino
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M Gladi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M Della Costanza
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - A Marini
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - S Lattanzi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
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11
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Nasi D, Dobran M, di Somma L, Di Rienzo A, De Nicola M, Iacoangeli M. Coil Extrusion into the Naso- and Oropharynx Ten Years after Internal Carotid Artery Pseudoaneurysm Embolization: A Case Report. Case Rep Neurol 2019; 11:4-9. [PMID: 30792650 PMCID: PMC6381882 DOI: 10.1159/000496283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Coil migration and extrusion outside the cranial compartment after embolization of cerebral aneurysms represents a very rare complication of the endovascular procedures and few cases are reported in the literature. Instability of the vascular malformation wall and the resolution of the intramural hematoma, especially in pseudoaneurysm, might generate extravascular migration of the coils in the first months after embolization. However, to the best of our knowledge, an extrusion of coil 10 years after embolization has never been reported. We reported the unique case of a patient with coil extrusion into the naso- and oropharynx 10 years after internal carotid artery pseudoaneurysm embolization. The pseudoaneurysm occurred after an internal carotid artery injury during an endoscopic endonasal surgery for a clival giant cell tumor.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Lucia di Somma
- Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Alessandro Di Rienzo
- Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Maurizio De Nicola
- Department of Neuro-Radiology, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
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12
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Nasi D, Iaccarino C, Romano A, De Bonis P, Farneti M, Servadei F, Ghadirpour R. Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review. Neurosurg Rev 2019; 43:893-901. [PMID: 30715641 DOI: 10.1007/s10143-019-01083-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/13/2019] [Accepted: 01/23/2019] [Indexed: 01/22/2023]
Abstract
Post-traumatic supra and infratentorial acute extradural hematomas (SIEDHs) are an uncommon type of extradural hematoma with only few small series published. In this scenario, the purposes of the present study are to present our experience in the management of 8 patients with acute SIEDH and to perform a systematic literature review. The clinical and radiological data of 8 patients operated for SIEDH at our department were analyzed retrospectively. Using the PRISMA guidelines, we reviewed the articles published from January 1990 to January 2018 reporting data about SIEDH. A total of 3 articles fulfilled the inclusion criteria and were analyzed. The incidence of SIEDHs is very rare constituting < 2% of all traumatic extradural hematomas (EDH). SIEDHs are associated with non-specific symptoms. Only 20% of patients were in coma (GCS < 8) at admission. A "lucid interval" was not reported. The source of bleeding of SIEDH was venous in all cases due to the following: bone fracture with diploe bleeding (50%), transverse/sigmoid sinus injury (22%), oozing meningeal venous vessel (8%), detachment of transverse sinus without wall injury (6%), and unknown in the other cases. Due to the venous nature of the source of hemorrhage, the clinical manifestation of a SIEDH may develop in a slow way, but once a critical volume of hematoma is reached, the deterioration can become rapid and fatal for acute brain stem compression. Surgery is the mainstay of SIEDHs treatment: among 42 cases with SIEDH included in this review, 40 (95.23%) patients were treated with surgery while only two were managed conservatively. Also in our series, all patients underwent surgery. A combined supratentorial craniotomy and suboccipital craniotomy leaving in a bone bridge over the transverse sinus for dural tenting sutures resulted the most used and safe surgical approach. SIEDH is a rare type of EDH. Early diagnosis of SIEDH and prompt surgical evacuation with a combined supratentorial and suboccipital approach provide excellent recovery.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy.
| | - Corrado Iaccarino
- Department of Neurosurgery of Institute for Scientific and Care Research "ASMN", Neurosurgery-Neurotraumatology Unit of University Hospital of Parma, Reggio Emilia, Italy
| | - Antonio Romano
- Department of Neurosurgery of Institute for Scientific and Care Research "ASMN", Neurosurgery-Neurotraumatology Unit of University Hospital of Parma, Reggio Emilia, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Marco Farneti
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Institute, Milan, Italy
| | - Reza Ghadirpour
- Department of Neurosurgery of Institute for Scientific and Care Research "ASMN", Neurosurgery-Neurotraumatology Unit of University Hospital of Parma, Reggio Emilia, Italy
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Nasi D, di Somma L, Gladi M, Moriconi E, Scerrati M, Iacoangeli M, Dobran M. New or Blossoming Hemorrhagic Contusions After Decompressive Craniectomy in Traumatic Brain Injury: Analysis of Risk Factors. Front Neurol 2019; 9:1186. [PMID: 30697186 PMCID: PMC6340989 DOI: 10.3389/fneur.2018.01186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/24/2018] [Indexed: 01/02/2023] Open
Abstract
Background: The development or expansion of a cerebral hemorrhagic contusion after decompressive craniectomy (DC) for traumatic brain injury (TBI) occurs commonly and it can result in an unfavorable outcome. However, risk factors predicting contusion expansion after DC are still uncertain. The aim of this study was to identify the factors associated with the growth or expansion of hemorrhagic contusion after DC in TBI. Then we evaluated the impact of contusion progression on outcome. Methods: We collected the data of patients treated with DC for TBI in our Center. Then we analyzed the risk factors associated with the growth or expansion of a hemorrhagic contusion after DC. Results: 182 patients (149 males and 41 females) were included in this study. Hemorrhagic contusions were detected on the initial CT scan or in the last CT scan before surgery in 103 out of 182 patients. New or blossoming hemorrhagic contusions were registered after DC in 47 patients out of 182 (25.82%). At multivariate analysis, only the presence of an acute subdural hematoma (p = 0.0076) and a total volume of contusions >20 cc before DC (p = < 0.0001) were significantly associated with blossoming contusions. The total volume of contusions before DC resulted to have higher accuracy and ability to predict postoperative blossoming of contusion with strong statistical significance rather than the presence of acute subdural hematoma (these risk factors presented respectively an area under the curve [AUC] of 0.896 vs. 0.595; P < 0.001). Patients with blossoming contusions presented an unfavorable outcome compared to patients without contusion progression (p < 0.0185). Conclusions: The presence of an acute subdural hematoma was associated with an increasing rate of new or expanded hemorrhagic contusions after DC. The total volume of hemorrhagic contusions > 20 cc before surgery was an independent and extremely accurate predictive radiological sign of contusion blossoming in decompressed patients for severe TBI. After DC, the patients who develop new or expanding contusions presented an increased risk for unfavorable outcome.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia di Somma
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Gladi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Elisa Moriconi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Scerrati
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
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Gómez Cáceres A, Lucena Jiménez J, Reyes Martín Á, Moriel Durán J, Sobrino Diaz B, García de Quevedo Puerta D. Prognosis of deep infection in spinal surgery using implants, treated by retention, removal of bone graft and lengthy antibiotherapy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Dobran M, Gladi M, Mancini F, Nasi D. Rare case of anterior cervical discectomy and fusion complication in a patient with Zenker's diverticulum. BMJ Case Rep 2018; 11:11/1/e226022. [PMID: 30567215 DOI: 10.1136/bcr-2018-226022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of Zenker's diverticulum in a 45-year-old woman, occurred as complication after anterior cervical discectomy and fusion for a cervical spine injury. The oesophageal complication occurred 12 months after vertebral cervical surgery and presenting symptoms were fever, dysphagia and neck pain with evidence of retropharyngeal infection. We performed a posterior cervical stabilisation C3-D1 by screws and rods and a second anterior left cervical approach with anterior plate removing and oesophageal wall break repairing with a sternohyoid muscle patch. Despite pharyngo-oesophageal diverticulum may be a complication of anterior cervical surgery (traction diverticulum), in case of an already present true Zenker's diverticulum, delayed complication may occur without cervical hardware pull-out.
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Affiliation(s)
- Mauro Dobran
- Neurosurgery, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Gladi
- Neurosurgery, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Fabrizio Mancini
- Neurosurgery, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Neurosurgery, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
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16
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Gómez Cáceres A, Lucena Jiménez JS, Reyes Martín ÁL, Moriel Durán J, Sobrino Diaz B, García de Quevedo Puerta D. Prognosis of deep infection in spinal surgery using implants, treated by retention, removal of bone graft and lengthy antibiotherapy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:7-11. [PMID: 30528059 DOI: 10.1016/j.recot.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/17/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Surgical site infections (SSIs) are complications that predispose to a high risk of unfavourable surgical outcomes. The aim of this study was to assess the SSI rate in this type of patients and their prognosis with similar treatment. MATERIALS AND METHODS A retrospective case series of 799 patients above 18 years old with spinal instrumentation surgery, between January 2010 and December 2014 in the traumatology and orthopaedic surgery department of our institution. All patients with SSIs were treated by debridement, graft replacement, retention of the instrumentation and lengthy courses of antimicrobial therapy. The patients were followed up for a period of 12 months. RESULTS Of all the patients with arthrodesis, 32 (4%) had spinal SSIs. Three patients were lost to follow-up. The final sample analyzed comprised 29 cases, with a median age of 54.9 years (IQR, 45.7-67 years) and a Charlson comorbidity index of 2.0 (IQR; 0-3). A microbiological diagnosis was obtained in 75.8% of the cases. Of these, the ISSs were monomicrobial in 68.2% and polymicrobial in 31.8%. Once treatment had been completed, 96% were cured without sequelae, and the rate of recurrence and reoperation was 4%. CONCLUSIONS Treatment based on debridement, retention of the instrumentation, graft replacement and lengthy courses of antimicrobial therapy seems a very effective strategy in the treatment of patients with deep surgical site infection in spine surgery.
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Affiliation(s)
- A Gómez Cáceres
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
| | - J S Lucena Jiménez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España
| | - Á L Reyes Martín
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España
| | - J Moriel Durán
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España
| | - B Sobrino Diaz
- Departamento de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga, España
| | - D García de Quevedo Puerta
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España
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Relationship between the location of the ventricular catheter tip and the ventriculoperitoneal shunt malfunction. Clin Neurol Neurosurg 2018; 175:50-53. [PMID: 30366188 DOI: 10.1016/j.clineuro.2018.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Ventriculoperitoneal (VP) shunt is the most common neurosurgical procedure to treat obstructive and communicating hydrocephalus, but failures are frequent. The most common causes of shunt failure are malpositioning and obstruction of the ventricular catheter by debris or blood clothes. The knowledge of the relationship between ventricular catheter tip position, etiology of hydrocephalus and patient's age with shunt malfunction may be useful to avoid shunt failure. PATIENTS AND METHODS We retrospectively analyze 89 adult patients affected by obstructive and communicating hydrocephalus operated with Ventriculoperitoneal shunt at our Institute. Patients with evident abdominal shunt malfunction were excluded from this study. Statistical analysis was performed in the group of patients with intracranial catheter malfunction in order to correlate shunt malfunction with the position of the catheter tip in brain ventricles, etiology of hydrocephalus and patient's age. RESULTS Shunt revision was performed in 26 patients out of 89 and cranial catheter malfunction was documented in 11 patients out of 26. Tip position in Monro foramen, lateral ventricles and third ventricle ("good position") had a lower rate of surgical shunt revision compared to septum pellucidum and wall of lateral ventricle ("bad position") p value = 0,049. No statistical significant association was observed between shunt malfunction and etiology of the hydrocephalus or patient's age. CONCLUSIONS Ventricular catheter tip position is one the most important factor for shunt function.
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Nasi D, Gladi M, Di Rienzo A, di Somma L, Moriconi E, Iacoangeli M, Dobran M. Risk factors for post-traumatic hydrocephalus following decompressive craniectomy. Acta Neurochir (Wien) 2018; 160:1691-1698. [PMID: 30054725 DOI: 10.1007/s00701-018-3639-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-traumatic hydrocephalus (PTH) is one of the main complications of decompressive craniectomy (DC) after traumatic brain injury (TBI). Then, the recognition of risk factors and subsequent prompt diagnosis and treatment of PTH can improve the outcome of these patients. The purpose of this study was to identify factors associated with the development of PTH requiring surgical treatment in patients undergoing DC for TBI. METHODS In this study, we collected the data of 190 patients (149 males and 41 females), who underwent DC for TBI in our Center. Then we analyzed the type of surgical treatment for all patients affected by PTH and the risk factors associated with the development of PTH. RESULTS Post-traumatic hydrocephalus (PTH) developed in 37 patients out of 130 alive 30 days after DC (28.4%). The development of PTH required ventriculoperitoneal shunt (VPS) in 34 patients out of 37 (91.9%), while, in the remaining 3 patients, cerebrospinal fluid hydrodynamic (CSF) disturbances resolved after urgent cranioplasty and temporary external lumbar drain. Multivariate analysis showed that the presence of interhemispheric hygroma (p < 0.001) and delayed cranioplasty (3 months after DC) (p < 0.001) was significantly associated with the need for a VPS or other surgical procedure for PTH. Finally, among the 130 patients alive after 30 days from DC, PTH was associated with unfavorable outcome as measured by the 6-month Glasgow Outcome Scale score (p < 0.0001). CONCLUSIONS Our results showed that delayed cranial reconstruction was associated with an increasing rate of PTH after DC. The presence of an interhemispheric hygroma was an independent predictive radiological sign of PTH in decompressed patients for severe TBI.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy.
| | - Maurizio Gladi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy
| | - Alessandro Di Rienzo
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy
| | - Lucia di Somma
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy
| | - Elisa Moriconi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy
| | - Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy
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Surgical treatment of aggressive vertebral hemangioma causing progressive paraparesis. Ann Med Surg (Lond) 2018; 25:17-20. [PMID: 29326813 PMCID: PMC5758835 DOI: 10.1016/j.amsu.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/22/2017] [Accepted: 12/04/2017] [Indexed: 11/22/2022] Open
Abstract
Vertebral hemangioma is a benign vascular lesion that may onset with neurologic symptoms due to spinal cord compression by epidural extension. Surgical procedure, embolization and radiotherapy are the gold standard for the treatment of this disease. We present a case of a 84 years old woman admitted at our department with worsening paraparesis and urinary retention. Her magnetic resonance images (MRI) showed a lesion involving both anterior and posterior vertebral element of D5, with extension into epidural space and spinal cord compression. The patient was operated for laminectomy and epidural lesion removal. Histological examination confirmed the diagnosis of cavernous hemangioma. Rare cases of aggressive vertebral hemangioma. Clinical presentation with rapid worsening of neurological functions. Surgery without stabilization. Typical histological finding.
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