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LA Pira B, Picotti V, Zappalà M, Maiola V, Pesce A, Frati A, Santoro A, D'Andrea G. Microsurgical clipping of unruptured intracranial aneurysms by a single surgeon's experience: why should we preserve the neurosurgical skills in our health areas? J Neurosurg Sci 2024; 68:157-163. [PMID: 34342193 DOI: 10.23736/s0390-5616.21.05366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The long-standing comparison between the endovascular and microsurgical treatment is still ongoing. While not any center avails of a neuroendovascular service, and not every aneurysm is suitable for endovascular treatment, the neurovascular technique is slowly disappearing from our territories, whereas in the current literature, the role of the neurosurgical treatment is being re-appreciated. The aim of this paper was to discuss a single surgeon's clinical and radiological results with the microsurgical management of unruptured intracranial aneurysms (UIA). METHODS We retrospectively reviewed the clinical and radiological records of patients treated for UIA, by a single surgeon, in the period ranging between 2015 and 2019. We recorded all the relevant anatomic features of the aneurysm, saliencies of the surgical treatment, such as the need for temporary clipping, intraoperative rupture, or postoperative complications. The results of the clinical and radiological follow-up examinations were recorded either. RESULTS Fifty-eight patient undergoing microsurgical clipping were included, harboring a total of 65 UIAs. CTA with 3D reconstructions was sufficient to reach a reliable preoperative planning in 46 patients (76%). A total of 94% of the cases were unchanged or neurologically unremarkable at follow-up. The presence of postoperative complications was associated to the neck size and predictor of a longer hospitalizations, as well as longer hospitalizations are associated to the patients' age, size of the aneurysms and surgical times. CONCLUSIONS According to our experience, we believe that microsurgical clipping plays a critical role in the management of UIA, also on the ground of the encouraging results of the relevant literature.
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Affiliation(s)
| | | | | | | | | | | | - Antonio Santoro
- Department of Human Neurosciences, Sapienza University, Rome, Italy
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Frati A, Cimatti M, Ileyassoff H, Capobianco M, Santoro A, Armocida D. Combined Anterior Odontoid Screw Fixation and C1-C2 Jefferson Fracture Anterior Fixation: A Step-by-Step Technical Note. World Neurosurg 2024; 184:112-118. [PMID: 38266989 DOI: 10.1016/j.wneu.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience. METHODS We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. RESULTS We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. CONCLUSIONS Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
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Affiliation(s)
- Alessandro Frati
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Cimatti
- Neurosurgery Service, Azienda Ospedaliera-Universitaria Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Hernán Ileyassoff
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mattia Capobianco
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Armocida
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
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Ferrucci M, Lenzi P, Lazzeri G, Busceti CL, Frati A, Puglisi-Allegra S, Fornai F. Combined light and electron microscopy (CLEM) to quantify methamphetamine-induced alpha-synuclein-related pathology. J Neural Transm (Vienna) 2024; 131:335-358. [PMID: 38367081 PMCID: PMC11016004 DOI: 10.1007/s00702-024-02741-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/09/2024] [Indexed: 02/19/2024]
Abstract
Methamphetamine (METH) produces a cytopathology, which is rather specific within catecholamine neurons both in vitro and ex vivo, in animal models and chronic METH abusers. This led some authors to postulate a sort of parallelism between METH cytopathology and cell damage in Parkinson's disease (PD). In fact, METH increases and aggregates alpha-syn proto-fibrils along with producing spreading of alpha-syn. Although alpha-syn is considered to be the major component of aggregates and inclusions developing within diseased catecholamine neurons including classic Lewy body (LB), at present, no study provided a quantitative assessment of this protein in situ, neither following METH nor in LB occurring in PD. Similarly, no study addressed the quantitative comparison between occurrence of alpha-syn and other key proteins and no investigation measured the protein compared with non-protein structure within catecholamine cytopathology. Therefore, the present study addresses these issues using an oversimplified model consisting of a catecholamine cell line where the novel approach of combined light and electron microscopy (CLEM) was used measuring the amount of alpha-syn, which is lower compared with p62 or poly-ubiquitin within pathological cell domains. The scenario provided by electron microscopy reveals unexpected findings, which are similar to those recently described in the pathology of PD featuring packing of autophagosome-like vesicles and key proteins shuttling autophagy substrates. Remarkably, small seed-like areas, densely packed with p62 molecules attached to poly-ubiquitin within wide vesicular domains occurred. The present data shed new light about quantitative morphometry of catecholamine cell damage in PD and within the addicted brain.
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Affiliation(s)
- Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Paola Lenzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Gloria Lazzeri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Carla L Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135, Rome, Italy
| | - Stefano Puglisi-Allegra
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126, Pisa, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077, Pozzilli, Italy.
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Lenzi P, Lazzeri G, Ferrucci M, Scotto M, Frati A, Puglisi-Allegra S, Busceti CL, Fornai F. Is There a Place for Lewy Bodies before and beyond Alpha-Synuclein Accumulation? Provocative Issues in Need of Solid Explanations. Int J Mol Sci 2024; 25:3929. [PMID: 38612739 PMCID: PMC11011529 DOI: 10.3390/ijms25073929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
In the last two decades, alpha-synuclein (alpha-syn) assumed a prominent role as a major component and seeding structure of Lewy bodies (LBs). This concept is driving ongoing research on the pathophysiology of Parkinson's disease (PD). In line with this, alpha-syn is considered to be the guilty protein in the disease process, and it may be targeted through precision medicine to modify disease progression. Therefore, designing specific tools to block the aggregation and spreading of alpha-syn represents a major effort in the development of disease-modifying therapies in PD. The present article analyzes concrete evidence about the significance of alpha-syn within LBs. In this effort, some dogmas are challenged. This concerns the question of whether alpha-syn is more abundant compared with other proteins within LBs. Again, the occurrence of alpha-syn compared with non-protein constituents is scrutinized. Finally, the prominent role of alpha-syn in seeding LBs as the guilty structure causing PD is questioned. These revisited concepts may be helpful in the process of validating which proteins, organelles, and pathways are likely to be involved in the damage to meso-striatal dopamine neurons and other brain regions involved in PD.
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Affiliation(s)
- Paola Lenzi
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.); (M.S.)
| | - Gloria Lazzeri
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.); (M.S.)
| | - Michela Ferrucci
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.); (M.S.)
| | - Marco Scotto
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.); (M.S.)
| | - Alessandro Frati
- IRCCS—Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy or (A.F.); (S.P.-A.); (C.L.B.)
- Neurosurgery Division, Department of Human Neurosciences, Sapienza University, 00135 Roma, Italy
| | - Stefano Puglisi-Allegra
- IRCCS—Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy or (A.F.); (S.P.-A.); (C.L.B.)
| | - Carla Letizia Busceti
- IRCCS—Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy or (A.F.); (S.P.-A.); (C.L.B.)
| | - Francesco Fornai
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.); (M.S.)
- IRCCS—Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy or (A.F.); (S.P.-A.); (C.L.B.)
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Piazza A, Petrella G, Corvino S, Campione A, Campeggi A, Serioli S, Frati A, Santoro A. 3-Dimensionally Printed Affordable Nose Model: A Reliable Start in Endoscopic Training for Young Neurosurgeons. World Neurosurg 2023; 180:17-21. [PMID: 37625637 DOI: 10.1016/j.wneu.2023.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Training neurosurgical skills is one of the most important tasks of a residency program. Techniques' complexity and pathology rarity define a long learning curve for mastering different surgical skills for which simulation on anatomic samples is extremely important. For this purpose, cadaver laboratory training is the most reliable tool. However, since access to cadaveric specimens is limited, due to costs and availability, surgical skills could be developed using inanimate models. This work aimed to develop a printable 3-dimensional model of the nasal cavity and sellar floor using an open-source downloadable file, to give residents the opportunity to improve their endoscopic surgical skills in a low-risk atmosphere with little cost. METHODS The 3D model was realized taking as a sample a real-case CT scan imaging from which the sellar floor was removed. A quail egg was placed underneath the printed model covering the sellar floor opening. Under endoscopic visualization, the "sellar floor" was drilled by each participant with the goal of sparing the egg's inner membrane. Once the task was achieved, surgeons were asked to participate in a satisfaction survey. RESULTS The total cost for printing was 6.31€ (6,72$). A satisfaction survey showed technical improvement (90%), increased confidence (80%), and bringing learned skills into the operating room (70%), leading to a 100% agreement in introducing this project into residency programs. CONCLUSIONS Training on affordable anatomic models represents a useful tool in technical skills improvement. We believe this model could help residents bring their technical capabilities to more sophisticated levels.
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Affiliation(s)
- Amedeo Piazza
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy.
| | | | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università Federico II, Naples, Italy
| | - Alberto Campione
- University of Insubria, Neurosurgery Residency Program, Varese, Italy
| | - Alice Campeggi
- Department of Emergency, Sapienza University of Rome, Rome, Italy
| | - Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Frati
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
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Familiari P, Relucenti M, Lapolla P, Palmieri M, Antonelli M, Cristiano L, Barbaranelli C, Catalano M, D'Angelo L, Familiari G, Santoro A, Frati A, Bruzzaniti P. Adult IDH Wild-Type Glioblastoma Ultrastructural Investigation Suggests a Possible Correlation between Morphological Biomarkers and Ki-67 Index. Biomedicines 2023; 11:1968. [PMID: 37509607 PMCID: PMC10377045 DOI: 10.3390/biomedicines11071968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Glioblastoma is an aggressive brain tumor with an average life expectancy between 14 and 16 months after diagnosis. The Ki-67 labeling index (LI), a measure of cellular proliferation, is emerging as a prognostic marker in GBM. In this study, we investigated the ultrastructure of glioblastoma tissue from 9 patients with the same molecular profile (adult IDH wild-type glioblastoma, wild-type ATRX, and positive for TP53 expression, GFAP expression, and EGFR overexpression) to find possible ultrastructural features to be used as biomarkers and correlated with the only parameter that differs among our samples, the Ki-67 LI. Our main results were the visualization of the anatomical basis of astrocyte-endothelial cells crosstalk; the ultrastructural in situ imaging of clusters of hyperactivated microglia cells (MsEVs); the ultrastructural in situ imaging of microglia cells storing lipid vesicles (MsLVs); the ultrastructural in situ imaging of neoplastic cells mitophagy (NCsM). The statistical analysis of our data indicated that MsEVs and MsLVs correlate with the Ki-67 LI value. We can thus assume they are good candidates to be considered morphological biomarkers correlating to Ki-67 LI. The role of NCsM instead must be further evaluated. Our study findings demonstrate that by combining ultrastructural characteristics with molecular information, we can discover biomarkers that have the potential to enhance diagnostic precision, aid in treatment decision-making, identify targets for therapy, and enable personalized treatment plans tailored to each patient. However, further research with larger sample sizes is needed to validate these findings and fully utilize the potential of ultrastructural analysis in managing glioblastoma.
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Affiliation(s)
- Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Michela Relucenti
- Department of Anatomy, Histology, Forensic Medicine, and Orthopedics, Sapienza University of Rome, 00185 Rome, Italy
| | - Pierfrancesco Lapolla
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Mauro Palmieri
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Loredana Cristiano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | | | - Myriam Catalano
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, 00185 Rome, Italy
| | - Luca D'Angelo
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Familiari
- Department of Anatomy, Histology, Forensic Medicine, and Orthopedics, Sapienza University of Rome, 00185 Rome, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandro Frati
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico Neuromed, 86077 Pozzilli, Italy
| | - Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00185 Rome, Italy
- Fabrizio Spaziani Hospital, 03100 Frosinone, Italy
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Familiari P, Lapolla P, Picotti V, Palmieri M, Pesce A, Carosi G, Relucenti M, Nottola S, Gianno F, Minasi S, Antonelli M, Frati A, Santoro A, D'Andrea G, Bruzzaniti P, LA Pira B. Role of 1p/19q Codeletion in Diffuse Low-grade Glioma Tumour Prognosis. Anticancer Res 2023; 43:2659-2670. [PMID: 37247932 DOI: 10.21873/anticanres.16432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/18/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM In the latest 2021 WHO classification of central nervous system tumours (CNS), gliomas that present isocitrate dehydrogenase (IDH) mutations are defined as diffuse low-grade gliomas (DLGGs). IDH mutations are commonly observed in this tumour type. The Extent of Resection (EOR) positively influence survival; however, it is still debated whether the predictive value of EOR is independent of the 1p/19q co-deletion. We carried out a retrospective analysis on patients operated on for DLGG at the Sant'Andrea University Hospital Sapienza University of Rome, correlating the outcome with the presence of 1p/19q co-deletion and EOR. PATIENTS AND METHODS The study examined 66 patients with DLGG who had undergone surgery for tumour resection between 2008 and 2018. Patients with DLGG were divided into two groups; diffuse astrocytoma (DA) in which 1p/19q codeletion is absent and oligodendroglioma (OG) in which 1p/19q codeletion is present. According to EOR, both groups were divided into two subgroups: subtotal resection (STR) and gross total resection (GTR). Three end-point variables were considered: overall survival (OS), progression-free survival (PFS) and time to malignant transformation (TMT). RESULTS In the DA group, the GTR subgroup had an average OS of 81.6 months, an average PFS of 45.9 months and an average TMT of 63.6 months. After surgery, these patients had an average Karnofsky Performance Score (KPS) of 83.4. The STR subgroup had an average OS of 60.4 months, PFS was 38.7 months, and TMT was 46.4 months, post-operative KPS was 83.4. In contrast, in the OG group, the GTR averagely had 101.7 months of OS, 64.9 months of PFS, 80.3 months of TMT and an average post-operative KPS of 84.2, and the STR subgroup had an average of OS of 73.3 months, PFS of 48.2 months, TMT of 57.3 and an average postoperative KPS of 96.2. CONCLUSION In patients affected by DLGGs, 1p/19q codeletion is significantly associated with prolonged survival and longer time-to-malignant transformation (TMT) compared to the absence of 1p/19q codeletion. Also, the extent of surgical resection (EOR) in DLGG patients has been confirmed as one of the main prognostic factors. However, its predictive value is substantially influenced by the presence of the 1p/19q codeletion.
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Affiliation(s)
- Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, U.K.;
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Veronica Picotti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Division of Neurosurgery, Policlinico Tor Vergata, University Tor Vergata of Rome, Rome, Italy
| | - Mauro Palmieri
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, Latina, Italy
- Department of Radiological, Oncological and Anatomo-Patological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Carosi
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Michela Relucenti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Stefania Nottola
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Patological Sciences, Sapienza University of Rome, Rome, Italy
| | - Simone Minasi
- Department of Radiological, Oncological and Anatomo-Patological Sciences, Sapienza University of Rome, Rome, Italy
| | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo-Patological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Frati
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Fabrizio Spaziani Hospital, Frosinone, Italy
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Pinelli R, Ferrucci M, Biagioni F, Berti C, Bumah VV, Busceti CL, Puglisi-Allegra S, Lazzeri G, Frati A, Fornai F. Autophagy Activation Promoted by Pulses of Light and Phytochemicals Counteracting Oxidative Stress during Age-Related Macular Degeneration. Antioxidants (Basel) 2023; 12:1183. [PMID: 37371913 DOI: 10.3390/antiox12061183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
The seminal role of autophagy during age-related macular degeneration (AMD) lies in the clearance of a number of reactive oxidative species that generate dysfunctional mitochondria. In fact, reactive oxygen species (ROS) in the retina generate misfolded proteins, alter lipids and sugars composition, disrupt DNA integrity, damage cell organelles and produce retinal inclusions while causing AMD. This explains why autophagy in the retinal pigment epithelium (RPE), mostly at the macular level, is essential in AMD and even in baseline conditions to provide a powerful and fast replacement of oxidized molecules and ROS-damaged mitochondria. When autophagy is impaired within RPE, the deleterious effects of ROS, which are produced in excess also during baseline conditions, are no longer counteracted, and retinal degeneration may occur. Within RPE, autophagy can be induced by various stimuli, such as light and naturally occurring phytochemicals. Light and phytochemicals, in turn, may synergize to enhance autophagy. This may explain the beneficial effects of light pulses combined with phytochemicals both in improving retinal structure and visual acuity. The ability of light to activate some phytochemicals may further extend such a synergism during retinal degeneration. In this way, photosensitive natural compounds may produce light-dependent beneficial antioxidant effects in AMD.
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Affiliation(s)
- Roberto Pinelli
- SERI, Switzerland Eye Research Institute, 6900 Lugano, Switzerland
| | - Michela Ferrucci
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Francesca Biagioni
- IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy
| | - Caterina Berti
- SERI, Switzerland Eye Research Institute, 6900 Lugano, Switzerland
| | - Violet Vakunseth Bumah
- Department of Chemistry and Biochemistry, College of Sciences, San Diego State University, San Diego, CA 92182, USA
- Department of Chemistry and Physics, University of Tennessee, Martin, TN 38237, USA
| | - Carla Letizia Busceti
- IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy
| | | | - Gloria Lazzeri
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Frati
- IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy
| | - Francesco Fornai
- Human Anatomy, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
- IRCCS, Istituto di Ricovero e Cura a Carattere Scientifico, Neuromed, 86077 Pozzili, Italy
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LA Pira B, Picotti V, Frati A, Pesce A, D'Andrea G. An understimated maneuver for oculomotor nerve palsy due to posterior communicating artery aneurysm: the opening of the anterior petroclinoid ligament. A technical note. J Neurosurg Sci 2023:S0390-5616.23.06020-4. [PMID: 37184632 DOI: 10.23736/s0390-5616.23.06020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Posterior communicating artery aneurysms (PcomAs) present with oculomotor nerve (OMN) palsy in 20-30% of cases, and the sudden onset of OMN palsy has to raise the suspicion of rupture, until proven otherwise. The surgical technique is described in a stepwise fashion. An illustrative case is reported: a 57-year-old female was admitted to our department with the diagnosis of a right sided-PcomA. Three months before the admission, when she harbored with the acute onset of complete ptosis, diplopia, orbital pain, impairment of the medial, upward, and downward gaze, with no pupil dysfunction. The origin of the Pcom and the neck of the aneurysm were easily identified and the aneurysm was clipped. Then, we followed the OMN and cut for less than 4 mm the above-lying anterior petroclinoid ligament (APL) to obtain nerve release. Although few cases are described in the literature, and ours represents a single case, we support that this maneuver should be introduced in the clinical practice of expert neurosurgeons dealing with vascular pathologies, such as the opening of the falciform ligament occurs for the decompression of the optical nerve.
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Affiliation(s)
- Biagia LA Pira
- Department of Neurosurgery, F. Spaziani Hospital, Frosinone, Italy
| | | | - Alessandro Frati
- Department of Neurosurgery, Neuromed IRCCS, Pozzilli, Isernia, Italy
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Armocida D, Pesce A, Palmieri M, Cofano F, Palmieri G, Cassoni P, Busceti CL, Biagioni F, Garbossa D, Fornai F, Santoro A, Frati A. EGFR-Driven Mutation in Non-Small-Cell Lung Cancer (NSCLC) Influences the Features and Outcome of Brain Metastases. J Clin Med 2023; 12:jcm12103372. [PMID: 37240478 DOI: 10.3390/jcm12103372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Brain metastases (BMs) is one of the most frequent metastatic sites for non-small-cell lung cancer (NSCLC). It is a matter of debate whether EGFR mutation in the primary tumor may be a marker for the disease course, prognosis, and diagnostic imaging of BMs, comparable to that described for primary brain tumors, such as glioblastoma (GB). This issue was investigated in the present research manuscript. Methods: We performed a retrospective study to identify the relevance of EGFR mutations and prognostic factors for diagnostic imaging, survival, and disease course within a cohort of patients affected by NSCLC-BMs. Imaging was carried out using MRI at various time intervals. The disease course was assessed using a neurological exam carried out at three-month intervals. The survival was expressed from surgical intervention. Results: The patient cohort consisted of 81 patients. The overall survival of the cohort was 15 ± 1.7 months. EGFR mutation and ALK expression did not differ significantly for age, gender, and gross morphology of the BM. Contrariwise, the EGFR mutation was significantly associated with MRI concerning the occurrence of greater tumor (22.38 ± 21.35 cm3 versus 7.68 ± 6.44 cm3, p = 0.046) and edema volume (72.44 ± 60.71 cm3 versus 31.92 cm3, p = 0.028). In turn, the occurrence of MRI abnormalities was related to neurological symptoms assessed using the Karnofsky performance status and mostly depended on tumor-related edema (p = 0.048). However, the highest significant correlation was observed between EGFR mutation and the occurrence of seizures as the clinical onset of the neoplasm (p = 0.004). Conclusions: The presence of EGFR mutations significantly correlates with greater edema and mostly a higher seizure incidence of BMs from NSCLC. In contrast, EGFR mutations do not affect the patient's survival, the disease course, and focal neurological symptoms but seizures. This contrasts with the significance of EGFR in the course and prognosis of the primary tumor (NSCLC).
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Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, 00161 Rome, RM, Italy
- IRCCS "Neuromed", 86077 Pozzilli, IS, Italy
| | - Alessandro Pesce
- Neurosurgery Unit, "Santa Maria Goretti" University Hospital, 04100 Latina, LT, Italy
| | - Mauro Palmieri
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, 00161 Rome, RM, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126 Turin, TO, Italy
| | - Giuseppe Palmieri
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126 Turin, TO, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, TO, Italy
| | | | | | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126 Turin, TO, Italy
| | | | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, 00161 Rome, RM, Italy
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Armocida D, Proietti L, Frati A. Letter to editor regarding: "Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion.". Spine J 2023:S1529-9430(23)00189-4. [PMID: 37149151 DOI: 10.1016/j.spinee.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy; IRCCS "Neuromed" Pozzilli (IS), Italy.
| | - Luca Proietti
- Division of Spinal Surgery IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Armocida D, Santoro A, Frati A. Letter to the Editor Regarding "Case Series and Systematic Review of Electronic Scooter Crashes and Severe Traumatic Brain Injury". World Neurosurg 2023; 173:301-302. [PMID: 37189321 DOI: 10.1016/j.wneu.2023.02.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division "Sapienza" University, AOU Policlinico Umberto I, Rome, Italy; IRCCS "Neuromed" Pozzilli (IS), Molise, Italy.
| | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division "Sapienza" University, AOU Policlinico Umberto I, Rome, Italy
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Frati A, Armocida D, Tartara F, Cofano F, Corvino S, Paolini S, Santoro A, Garbossa D. Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication? Brain Sci 2023; 13:brainsci13050706. [PMID: 37239179 DOI: 10.3390/brainsci13050706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms' onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4-82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases.
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Affiliation(s)
- Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Daniele Armocida
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Human Neurosciences Department, Neurosurgery Division "Sapienza" University, AOU Policlinico Umberto I, 00161 Rome, Italy
| | - Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Fabio Cofano
- Neurosurgery, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Division of Neurosurgery Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Sergio Paolini
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Antonio Santoro
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S), Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Diego Garbossa
- Neurosurgery, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
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Palmieri M, Armocida D, De Pietro R, Chiarello G, Rizzo F, Garbossa D, Marampon F, Santoro A, Frati A. Clinical efficacy of adjuvant radiotherapy for WHO grade II intracranial meningioma. World Neurosurg 2023:S1878-8750(23)00560-0. [PMID: 37088414 DOI: 10.1016/j.wneu.2023.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Maximal surgical resection remains the treatment of choice for grade II meningiomas, and for some authors to be sufficient to guarantee a long indolent course even without post-surgical radiotherapy (RT), but there is no consensus on the use of RT in this patient population. METHODS We retrospectively compared clinical and radiological outcome between WHO grade I (group A) and grade II (group B) surgically-treated meningiomas, focusing on the role of adjuvant RT. We registered clinical, surgical and radiological data to detect differences in survival and functional outcome between the two groups. RESULTS The final cohort consisted of 284 patients for group A and 94 patients for group B. Group B showed a higher risk of developing recurrence independently of the EOR (7,75% for Group A versus 27,7% for Group B, p=0.01). Patients who did not undergo adjuvant RT documented recurrence in 50% of cases, compared with 19% of patients who underwent RT (p=0.024). There is a weak difference in the risk of developing postoperative seizures in the group submitted to radiotherapy (p=0.08). Performance status remained stable for both groups, but for group B tended to decrease significantly after 1 year with regard to EOR and RT. CONCLUSIONS Recurrence is more frequent for Grade II meningiomas, even though there are not significant differences in terms of complications and functional outcome. Radiotherapy in grade II meningiomas does indeed lead to better control of recurrence, however, leading to an increased risk of seizures and reduced performance status.
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Affiliation(s)
- Mauro Palmieri
- Human Neurosciences Department Neurosurgery Division "Sapienza" University
| | - Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University; IRCCS "Neuromed", Pozzilli, IS, Italy
| | - Raffaella De Pietro
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Giuseppina Chiarello
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Francesca Rizzo
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Francesco Marampon
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University
| | - Alessandro Frati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University; IRCCS "Neuromed", Pozzilli, IS, Italy
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Petrone S, Ajello M, Marengo N, Bozzaro M, Pesaresi A, Allevi M, Fiumefreddo A, Denegri F, Cogoni M, Garnero A, Tartara F, Di Perna G, Armocida D, Pesce A, Frati A, Zenga F, Garbossa D, Cofano F. Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience. Front Surg 2023; 10:1158836. [PMID: 37077862 PMCID: PMC10106706 DOI: 10.3389/fsurg.2023.1158836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionEvaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome.Materials and methodsFrom 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire).Results72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p < 0.001), height of the foramina (p < 0.001), thickness of the yellow ligament (p = 0.001) and anterior height of the interbody space (p = 0.02) were observed. Older age (p = 0.042), presence of spondylolisthesis (p = 0.042), presence of intra-articular facet effusion (p = 0.003) and posterior height of the implanted cage (p = 0.020) positively affected the increase of the canal area. Change in root canal area (p < 0.001), height of the implanted cage (p = 0.020) and younger age (p = 0.035) were predictive factors of root pain relief, while increased vertebral canal area (p = 0.020) and height of the interbody fusion cage (p = 0.023) positively affected the severity of clinical stenosis.ConclusionsLLIF indirect decompression showed both clinical and radiological improvements. Presence and degree of spondylolisthesis, presence of intra-articular facet effusion, age of the patient and height of the cage were predictive factors of major clinical improvements.
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Affiliation(s)
- Salvatore Petrone
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
- Correspondence: Salvatore Petrone
| | - Marco Ajello
- Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Nicola Marengo
- Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
| | - Alessandro Pesaresi
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
| | - Mario Allevi
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
| | | | - Federica Denegri
- Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Cogoni
- Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Andrea Garnero
- Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fulvio Tartara
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
| | - Giuseppe Di Perna
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
- Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy
| | - Daniele Armocida
- Neurosurgery Unit, Department of Human Neuroscience, University Sapienza of Rome, Rome, Italy
| | | | - Alessandro Frati
- Neurosurgery Unit, Department of Human Neuroscience, University Sapienza of Rome, Rome, Italy
| | - Francesco Zenga
- Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
- Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fabio Cofano
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
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Familiari P, Lapolla P, Relucenti M, Battaglione E, Cristiano L, Sorrentino V, Aversa S, D'Amico A, Puntorieri P, Bruzzaniti L, Mingoli A, Brachini G, Barbaro G, Scafa AK, D'Andrea G, Frati A, Picotti V, Berra LV, Petrozza V, Nottola S, Santoro A, Bruzzaniti P. Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties. Sci Rep 2023; 13:3400. [PMID: 36854960 PMCID: PMC9975247 DOI: 10.1038/s41598-023-30135-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.
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Affiliation(s)
- Pietro Familiari
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Oxford University Hospital, Headington, Oxford, OX3 9DU, UK.
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy.
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy.
| | - Michela Relucenti
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy
| | - Ezio Battaglione
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Loredana Cristiano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Veronica Sorrentino
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Sara Aversa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessia D'Amico
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
- Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Rome, Italy
| | | | - Lucia Bruzzaniti
- DICEAM Department, University Mediterranea of Reggio Calabria, Reggio Calabria, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Gioia Brachini
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Giuseppe Barbaro
- DICEAM Department, University Mediterranea of Reggio Calabria, Reggio Calabria, Italy
| | | | | | - Alessandro Frati
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy
| | - Veronica Picotti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
- Division of Neurosurgery, Policlinico Tor Vergata, University Tor Vergata of Rome, Rome, Italy
| | | | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Stefania Nottola
- Department of Anatomical, Histological, Medical Legal Sciences and Locomotor Apparatus, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Placido Bruzzaniti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
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Armocida D, Busceti CL, Biagioni F, Fornai F, Frati A. The Role of Cellular Prion Protein in Glioma Tumorigenesis Could Be through the Autophagic Mechanisms: A Narrative Review. Int J Mol Sci 2023; 24:ijms24021405. [PMID: 36674920 PMCID: PMC9865539 DOI: 10.3390/ijms24021405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
The carcinogenesis of glial tumors appears complex because of the many genetic and epigenetic phenomena involved. Among these, cellular prion protein (PrPC) is considered a key factor in cell-death resistance and important aspect implicated in tumorigenesis. Autophagy also plays an important role in cell death in various pathological conditions. These two cellular phenomena are related and share the same activation by specific alterations in the cellular microenvironment. Furthermore, there is an interdependence between autophagy and prion activity in glioma tumorigenesis. Glioma is one of the most aggressive known cancers, and the fact that such poorly studied processes as autophagy and PrPC activity are so strongly involved in its carcinogenesis suggests that by better understanding their interaction, more can be understood about its origin and treatment. Few studies in the literature relate these two cellular phenomena, much less try to explain their combined activity and role in glioma carcinogenesis. In this study, we explored the recent findings on the molecular mechanism and regulation pathways of autophagy, examining the role of PrPC in autophagy processes and how they may play a central role in glioma tumorigenesis. Among the many molecular interactions that PrP physiologically performs, it appears that processes shared with autophagy activity are those most implicated in glial tumor carcinogeneses such as activity on MAP kinases, PI3K, and mTOR. This work can be supportive and valuable as a basis for further future studies on this topic.
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Affiliation(s)
- Daniele Armocida
- Department of Human Neuroscience, Sapienza University of Rome, Via Caserta 6, 00161 Roma, Italy
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Roma, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-39-3287-4496
| | - Carla Letizia Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Francesca Biagioni
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Francesco Fornai
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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Lenzi P, Busceti CL, Lazzeri G, Ferese R, Biagioni F, Salvetti A, Pompili E, De Franchis V, Puglisi-Allegra S, Frati A, Ferrucci M, Fornai F. Autophagy Activation Associates with Suppression of Prion Protein and Improved Mitochondrial Status in Glioblastoma Cells. Cells 2023; 12:cells12020221. [PMID: 36672156 PMCID: PMC9857229 DOI: 10.3390/cells12020221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023] Open
Abstract
Cells from glioblastoma multiforme (GBM) feature up-regulation of the mechanistic Target of Rapamycin (mTOR), which brings deleterious effects on malignancy and disease course. At the cellular level, up-regulation of mTOR affects a number of downstream pathways and suppresses autophagy, which is relevant for the neurobiology of GBM. In fact, autophagy acts on several targets, such as protein clearance and mitochondrial status, which are key in promoting the malignancy GBM. A defective protein clearance extends to cellular prion protein (PrPc). Recent evidence indicates that PrPc promotes stemness and alters mitochondrial turnover. Therefore, the present study measures whether in GBM cells abnormal amount of PrPc and mitochondrial alterations are concomitant in baseline conditions and whether they are reverted by mTOR inhibition. Proteins related to mitochondrial turnover were concomitantly assessed. High amounts of PrPc and altered mitochondria were both mitigated dose-dependently by the mTOR inhibitor rapamycin, which produced a persistent activation of the autophagy flux and shifted proliferating cells from S to G1 cell cycle phase. Similarly, mTOR suppression produces a long-lasting increase of proteins promoting mitochondrial turnover, including Pink1/Parkin. These findings provide novel evidence about the role of autophagy in the neurobiology of GBM.
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Affiliation(s)
- Paola Lenzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Carla L. Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gloria Lazzeri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Rosangela Ferese
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Francesca Biagioni
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Alessandra Salvetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Elena Pompili
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Via A. Borelli 50, 00161 Rome, Italy
| | - Valerio De Franchis
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Via A. Borelli 50, 00161 Rome, Italy
| | - Stefano Puglisi-Allegra
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Neurosurgery Division, Department of Human Neurosciences, Sapienza University, 00135 Roma, Italy
| | - Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: or ; Tel.: +39-050-2218667
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Armocida D, Perna A, Cofano F, Cimatti M, Arcidiacono UA, Marengo N, Ajello M, Garbossa D, Proietti L, Tamburrelli FC, Maiotti M, Santoro A, Frati A. Extreme Lateral Interbody Fusion (XLIF) with Lateral Modular Plate Fixation: Preliminary Report on Clinical and Radiological Outcomes. Acta Neurochir Suppl 2023; 135:431-437. [PMID: 38153505 DOI: 10.1007/978-3-031-36084-8_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The lateral transpsoas approach (extreme lateral interbody fusion, or XLIF) allows surgeons to use various lordotic cage sizes to help restore intervertebral disk height, correct sagittal alignment, and improve fusion rates. The use of standalone devices has consistently raised doubts due to the high risk of complications and inadequate functional recovery that a circumferential arthrodesis can support. The recent introduction of a novel XLIF cage with adapted lateral plate fixation (XLPF) may further enhance the structural rigidity, consolidating the cage and plate into a singular modular entity. Nine patients from our surgical centers underwent a procedure of 1-level XLIF with XLPF in selected cases. We observed that XLPF does not extend the intraoperative footprint and provides immediate rigidity to the anterior column without any additional risk of complications and with minimal increased time compared to the traditional cage implant procedure. Although it has been shown that the use of interbody fusion cages with supplemental posterior fixation improves stabilization in all directions, the technique of standalone lateral cages may also have a place in spine surgery in that the stability may be sufficient in selected cases, such as junctional syndrome and in some forms of degenerative scoliosis.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Rome (RM), Italy
| | - Andrea Perna
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Fabio Cofano
- Spine Surgery Unit-Humanitas Gradenigo, Torino, Italy
- Department of Neuroscience, "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Marco Cimatti
- Unit of Neurosurgery, Sant'Andrea Hospital, Rome, Italy
| | | | - Nicola Marengo
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Marco Ajello
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Diego Garbossa
- Department of Neuroscience, "Rita Levi Montalcini," University of Torino, Torino, Italy
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Maiotti
- Shoulder Unit Villa Stuart Clinic (Rome), Shoulder-Knee Unit PIO XI Clinic (Rome), Rome, Italy
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Rome (RM), Italy
| | - Alessandro Frati
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Rome (RM), Italy
- IRCCS "Neuromed", Pozzilli (IS), Italy
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20
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Palmieri M, Frati A, D'Andrea G, Santoro A, Salvati M, Pesce A. Editorial: Novel techniques and technologies in spine surgery: New approaches for the traumatic, oncologic, and aging spine. Front Surg 2023; 10:1155636. [PMID: 36891550 PMCID: PMC9986538 DOI: 10.3389/fsurg.2023.1155636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Mauro Palmieri
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy
| | - Alessandro Frati
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy.,Neurosurgery, IRCCS-"Neuromed", Pozzilli, Italy
| | | | - Antonio Santoro
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Pesce
- Neurosurgery Division, A.O. "Santa Maria Goretti", Latina, Italy
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21
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Arcidiacono UA, Armocida D, Pesce A, Maiotti M, Proietti L, D’Andrea G, Santoro A, Frati A. Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review. J Clin Med 2022; 11:jcm11247409. [PMID: 36556025 PMCID: PMC9781971 DOI: 10.3390/jcm11247409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon's inappropriate decision to resort to a second surgical treatment. METHODS We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. RESULTS We retrieve 20 articles. Most of the papers are clinical cases showing the disorder's rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. CONCLUSION CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately.
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Affiliation(s)
| | - Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00185 Rome, Italy
- IRCCS “Neuromed”, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-393-287-4496
| | - Alessandro Pesce
- Neurosurgery Unit, Santa Maria Goretti Hospital, Via Guido Reni 1, 04100 Latina, Italy
| | - Marco Maiotti
- Villa Stuart Hospital, Orthopedic Clinic, 00135 Roma, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Institute of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00185 Rome, Italy
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Arcidiacono UA, Berra L, Serraino A, Cedrone G, Venditti E, Armocida D, Quinzi A, Brunetto F, D'Angelo L, Di Norcia V, Frati A, Familiari P, Santoro A. P17.18.B Augmentative craniotomy in recurrent glioblastoma. Preliminary clinical and radiological outcomes. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The compression of peritumoral healthy tissue in brain tumor patients is considered a major cause of life-threatening neurologic symptoms. This condition is associated with an increase in intracranial pressure. The literature reports that GBM has a mass effect in 72% of autoptic brains of patients who died of brain tumor, with herniation in 50% of all cases.
Material and methods
We present a preliminary clinical series on 5 cases. The patients are chosen based on criteria of recurrent glioblastoma without the possibility of a gross total resection with a recurrence after STUPP protocol. The surgeries include cytoreduction and augmentative craniotomy. The aim is to increase the intracranial volume and reduce the intracranial pressure in evolving glioblastoma. Clinical and radiological follow-up considers different objective scales and contrast enhancement MRI performed every 3 months. We evaluate KPS, survival rate, complication rate, quality of life using QOL-BN20 and neuropsychological assessment.
Results
The 12 months of follow-up shows a mean survival rate of 9 months after the surgery. This procedure has no negative impact on the survival rate, complication rate, and quality of life reduction. The neuropsychological evaluation does not show an impact on self-perception of aesthetic appearance. The surgery does not show surgical wound complications. The mean operative time was 225 minutes and was comparable with standard recurrence glioblastoma procedure.
Conclusion
This work has the main limitation of being preliminary results on small population. However, these results show encouraging outcomes and could be an innovative and salvage therapy for recurrent and incurable glioblastoma. Further follow-up and study must be performed.
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Affiliation(s)
| | - L Berra
- University of Rome "La Sapienza" , Roma , Italy
| | - A Serraino
- University of Rome "La Sapienza" , Roma , Italy
| | - G Cedrone
- University of Rome "La Sapienza" , Roma , Italy
| | - E Venditti
- University of Rome "La Sapienza" , Roma , Italy
| | - D Armocida
- University of Rome "La Sapienza" , Roma , Italy
| | - A Quinzi
- University of Rome "La Sapienza" , Roma , Italy
| | - F Brunetto
- University of Rome "La Sapienza" , Roma , Italy
| | - L D'Angelo
- University of Rome "La Sapienza" , Roma , Italy
| | - V Di Norcia
- University of Rome "La Sapienza" , Roma , Italy
| | - A Frati
- University of Rome "La Sapienza" , Roma , Italy
| | - P Familiari
- University of Rome "La Sapienza" , Roma , Italy
| | - A Santoro
- University of Rome "La Sapienza" , Roma , Italy
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Pesce A, Armocida D, Fiorentino F, Ciarlo S, La Pira B, Salvati M, Frati A, Pompucci A, Palmieri M. Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark. Tomography 2022; 8:2164-2170. [PMID: 36136877 PMCID: PMC9498924 DOI: 10.3390/tomography8050181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Calvarial metastases are a relatively rare entity, with an overall incidence of 3-4%. Among these cases, metastases arising from salivary gland cancers are even rarer; in fact, large studies regarding salivary gland tumors showed that brain metastases are observed in 0.8% of the cases. Generally, bone metastases have been described in proximity to primary tumors, while bloodstream-disseminated lesions are often located inside the brain parenchyma. During every surgical step, traction on lower-lying infiltrated tissues must be avoided in order to successfully remove the lesion. This case report presents the first ever case of a 67-year-old woman affected by submandibular gland undifferentiated adenocarcinoma metastasis with a full-thickness involvement of the calvarium, pachy- and leptomeninges.
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Affiliation(s)
- Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Daniele Armocida
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
| | | | - Silvia Ciarlo
- Neurosurgery Department, A.O.U. ‘Mater Domini’, Università degli Studi ‘Magna Greacia’ di Catanzaro, 88100 Catanzaro, Italy
| | - Biagia La Pira
- Neurosurgery Department, Azienda Ospedaliera Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome ‘‘Tor Vergata”, 00133 Rome, Italy
| | - Alessandro Frati
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
- IRCCS—“Neuromed”, Via Atinense 18, 86077 Pozzilli, Italy
| | - Angelo Pompucci
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Mauro Palmieri
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
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Ferrucci M, Busceti CL, Lazzeri G, Biagioni F, Puglisi-Allegra S, Frati A, Lenzi P, Fornai F. Bacopa Protects against Neurotoxicity Induced by MPP+ and Methamphetamine. Molecules 2022; 27:molecules27165204. [PMID: 36014442 PMCID: PMC9414486 DOI: 10.3390/molecules27165204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
The neurotoxins methamphetamine (METH) and 1-methyl-4-phenylpyridinium (MPP+) damage catecholamine neurons. Although sharing the same mechanism to enter within these neurons, METH neurotoxicity mostly depends on oxidative species, while MPP+ toxicity depends on the inhibition of mitochondrial activity. This explains why only a few compounds protect against both neurotoxins. Identifying a final common pathway that is shared by these neurotoxins is key to prompting novel remedies for spontaneous neurodegeneration. In the present study we assessed whether natural extracts from Bacopa monnieri (BM) may provide a dual protection against METH- and MPP+-induced cell damage as measured by light and electron microscopy. The protection induced by BM against catecholamine cell death and degeneration was dose-dependently related to the suppression of reactive oxygen species (ROS) formation and mitochondrial alterations. These were measured by light and electron microscopy with MitoTracker Red and Green as well as by the ultrastructural morphometry of specific mitochondrial structures. In fact, BM suppresses the damage of mitochondrial crests and matrix dilution and increases the amount of healthy and total mitochondria. The present data provide evidence for a natural compound, which protects catecholamine cells independently by the type of experimental toxicity. This may be useful to counteract spontaneous degenerations of catecholamine cells.
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Affiliation(s)
- Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | | | - Gloria Lazzeri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | | | | | - Alessandro Frati
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Neurosurgery Division, Department of Human Neurosciences, Sapienza University, 00135 Rome, Italy
| | - Paola Lenzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: or ; Tel.: +39-050-221-8667
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25
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Lenzi P, Biagioni F, Busceti CL, Lazzeri G, Polzella M, Frati A, Ferrucci M, Fornai F. Alterations of Mitochondrial Structure in Methamphetamine Toxicity. Int J Mol Sci 2022; 23:ijms23168926. [PMID: 36012188 PMCID: PMC9408775 DOI: 10.3390/ijms23168926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 12/30/2022] Open
Abstract
Recent evidence shows that methamphetamine (METH) produces mitochondrial alterations that contribute to neurotoxicity. Nonetheless, most of these studies focus on mitochondrial activity, whereas mitochondrial morphology remains poorly investigated. In fact, morphological evidence about the fine structure of mitochondria during METH toxicity is not available. Thus, in the present study we analyzed dose-dependent mitochondrial structural alterations during METH exposure. Light and transmission electron microscopy were used, along with ultrastructural stoichiometry of catecholamine cells following various doses of METH. In the first part of the study cell death and cell degeneration were assessed and they were correlated with mitochondrial alterations observed using light microscopy. In the second part of the study, ultrastructural evidence of specific mitochondrial alterations of crests, inner and outer membranes and matrix were quantified, along with in situ alterations of mitochondrial proteins. Neurodegeneration induced by METH correlates significantly with specific mitochondrial damage, which allows definition of a scoring system for mitochondrial integrity. In turn, mitochondrial alterations are concomitant with a decrease in fission/mitophagy protein Fis1 and DRP1 and an increase in Pink1 and Parkin in situ, at the mitochondrial level. These findings provide structural evidence that mitochondria represent both direct and indirect targets of METH-induced toxicity
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Affiliation(s)
- Paola Lenzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Francesca Biagioni
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Carla L. Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gloria Lazzeri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Maico Polzella
- Aliveda Laboratories, Viale Karol Wojtyla, 19, 56042 Crespina Lorenzana, Italy
| | - Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Neurosurgery Division, Department of Human Neurosciences, Sapienza University, 00135 Roma, Italy
| | - Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: or ; Tel.: +39-050-2218667
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Frati A, Armocida D, Arcidiacono UA, Pesce A, D’Andrea G, Cofano F, Garbossa D, Santoro A. Peritumoral Brain Edema in Relation to Tumor Size Is a Variable That Influences the Risk of Recurrence in Intracranial Meningiomas. Tomography 2022; 8:1987-1996. [PMID: 36006064 PMCID: PMC9413236 DOI: 10.3390/tomography8040166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and can increase their morbidity. It is not uncommon for a neurosurgeon to confront meningiomas with a large proportion of PBE independently from the site and size of the contrast-enhancing lesion with increased surgical risks. We performed a retrospective review of 216 surgically-treated patients suffering from IM. We recorded clinical, biological, and radiological data based on the rate of tumor and edema volume and divided the patients into a group with high Edema/Tumor ratio and a group with a low ratio. We investigated how the ratio of edema/lesion may affect the outcome. Multivariate analysis was performed for the two groups. Smokers were found to be more likely to belong to the high-rate group. The edema/tumor ratio did not affect the surgical radicality; however, independently of the biological sub-type, WHO grading, and EOR, a higher frequency of recurrence is shown in patients with a high edema/tumor ratio (70.5% vs. 8.4%. p < 0.01). There is evidence to suggest that the blood-brain barrier (BBB) damage from smoke could play a role in an increased volume of PBE. The present study demonstrates that IMs showing a high PBE ratio to tumor volume at diagnosis are associated with a smoking habit and a higher incidence of recurrence independently of their biological type and grading.
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Affiliation(s)
| | - Daniele Armocida
- IRCCS “Neuromed” Pozzilli, 86170 Isernia, Italy
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00135 Rome, Italy
| | | | - Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, Via Guido Reni, 04100 Latina, Italy
- Correspondence:
| | - Giancarlo D’Andrea
- Neurosurgery Department of Fabrizio Spaziani Hospital, 03100 Frosinone, Italy
| | - Fabio Cofano
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, 10126 Torino, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, 10126 Torino, Italy
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy
| | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00135 Rome, Italy
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27
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Maiese A, Frati P, Manetti AC, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Frati A, Fineschi V. Traumatic Internal Carotid Artery Injuries: Do We Need a Screening Strategy? Literature Review, Case Report, and Forensic Evaluation. Curr Neuropharmacol 2022; 20:1752-1773. [PMID: 34254918 PMCID: PMC9881067 DOI: 10.2174/1570159x19666210712125929] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
Internal carotid artery dissection (ICAD) represents the cause of ictus cerebri in about 20% of all cases of cerebral infarction among the young adult population. ICAD could involve the extracranial and intracranial internal carotid artery (ICA). It could be spontaneous (SICAD) or traumatic (TICAD). It has been estimated that carotid injuries could complicate the 0,32% of cases of general blunt trauma and the percentage seems to be higher in cases of severe multiple traumas. TICAD is diagnosed when neurological symptoms have already occurred, and it could have devastating consequences, from permanent neurological impairment to death. Thus, even if it is a rare condition, a prompt diagnosis is essential. There are no specific guidelines regarding TICAD screening. Nevertheless, TICAD should be taken into consideration when a young adult or middle-aged patient presents after severe blunt trauma. Understanding which kind of traumatic event is most associated with TICAD could help clinicians to direct their diagnostic process. Herein, a review of the literature concerning TICAD has been carried out to highlight its correlation with specific traumatic events. TICAD is mostly correlated to motor vehicle accidents (94/227), specifically to car accidents (39/94), and to direct or indirect head and cervical trauma (76/227). As well, a case report is presented to discuss TICAD forensic implications.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy; ,IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy;
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Raffaele La Russa
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandro Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; ,Address correspondence to this author at the Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; E-mail:
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Armocida D, Catapano A, Palmieri M, Arcidiacono UA, Pesce A, Cofano F, Picotti V, Salvati M, Garbossa D, D’Andrea G, Santoro A, Frati A. The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie. Brain Sci 2022; 12:brainsci12070817. [PMID: 35884624 PMCID: PMC9313316 DOI: 10.3390/brainsci12070817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
- Correspondence: ; Tel.: +39-393-287-4496
| | - Antonia Catapano
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Umberto Aldo Arcidiacono
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Pesce
- Neurosurgery Unit, Ospedale Santa Maria Goretti, Via Guido Reni 1, 04100 Latina, LT, Italy;
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Veronica Picotti
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Maurizio Salvati
- Policlinico Tor Vergata, University Tor Vergata of Rome, Viale Oxford, 81, 00133 Roma, RM, Italy;
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Giancarlo D’Andrea
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Frati
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
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Mastroiacovo F, Biagioni F, Lenzi P, Lazzeri G, Ferrucci M, Puglisi-Allegra S, Frati A, Nicoletti F, Fornai F. Within the Ischemic Penumbra, Sub-Cellular Compartmentalization of Heat Shock Protein 70 Overlaps with Autophagy Proteins and Fails to Merge with Lysosomes. Molecules 2022; 27:molecules27103122. [PMID: 35630599 PMCID: PMC9144499 DOI: 10.3390/molecules27103122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
The brain area which surrounds the frankly ischemic region is named the area penumbra. In this area, most cells are spared although their oxidative metabolism is impaired. area penumbra is routinely detected by immunostaining of a molecule named Heat Shock Protein 70 (HSP70). Within the area penumbra, autophagy-related proteins also increase. Therefore, in the present study, the autophagy-related microtubule-associated protein I/II-Light Chain 3 (LC3) was investigated within the area penumbra along with HSP70. In C57 black mice, ischemia was induced by permanent occlusion of the distal part of the middle cerebral artery. Immunofluorescence and electron microscopy show that LC3 and HSP70 are overexpressed and co-localize within the area penumbra in the same cells and within similar subcellular compartments. In the area penumbra, marked loss of co-localization of HSP70 and LC3-positive autophagy vacuoles, with lysosomal-associated membrane protein 1 (LAMP1) or cathepsin-D-positive lysosome vacuoles occurs. This study indicates that, within the area penumbra, a failure of autophagolysosomes depends on defective compartmentalization of LC3, LAMP1 and cathepsin-D and a defect in merging between autophagosomes and lysosomes. Such a deleterious effect is likely to induce a depletion of autophagolysosomes and cell clearing systems, which needs to be rescued in the process of improving neuronal survival.
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Affiliation(s)
- Federica Mastroiacovo
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.M.); (F.B.); (S.P.-A.); (A.F.); (F.N.)
| | - Francesca Biagioni
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.M.); (F.B.); (S.P.-A.); (A.F.); (F.N.)
| | - Paola Lenzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.)
| | - Gloria Lazzeri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.)
| | - Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.)
| | - Stefano Puglisi-Allegra
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.M.); (F.B.); (S.P.-A.); (A.F.); (F.N.)
| | - Alessandro Frati
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.M.); (F.B.); (S.P.-A.); (A.F.); (F.N.)
- Neurosurgery Division, Department of Human Neurosciences, Sapienza University, 00135 Rome, Italy
| | - Ferdinando Nicoletti
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.M.); (F.B.); (S.P.-A.); (A.F.); (F.N.)
- Department of Physiology and Pharmacology, University Sapienza of Rome, 00135 Rome, Italy
| | - Francesco Fornai
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.M.); (F.B.); (S.P.-A.); (A.F.); (F.N.)
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (P.L.); (G.L.); (M.F.)
- Correspondence: or ; Tel.: +39-050-2218601
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Bruzzaniti P, Lapolla P, D'Amico A, Zancana G, Katsev M, Relucenti M, Familiari G, Mingoli A, D'Andrea G, Frati A, Salvati M, Santoro A, Familiari P. En Bloc Resection of Solitary Brain Metastasis: The Role of Perilesional Edema. In Vivo 2022; 36:1274-1284. [PMID: 35478118 PMCID: PMC9087063 DOI: 10.21873/invivo.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The treatment of solitary brain metastasis is a challenging intervention since the incidence increases and prognosis is poor. This study investigated the role of perilesional edema in the overall mass effect of solitary brain metastasis. PATIENTS AND METHODS We conducted a retrospective analysis on 88 patients with single supratentorial brain metastasis and concomitant perilesional edema undergoing en bloc resection. Each patient was evaluated for perilesional brain edema grading. We stratified patients into three groups based on the size of the metastatic lesion and the extent of perilesional edema. RESULTS The grade of perilesional edema at 30 days after surgical removal did not correlate with the maximum diameter of the metastasis (Pearson's correlation 0.098, p=0.494). In patients with a maximal metastatic diameter ≤2 cm, the grade of perilesional edema before surgical treatment was 1.63 (STD 0.43), while 30 days after removal it was significantly reduced; 0.47 (STD 0.26), p<0.001. CONCLUSION The overall mass effect of solitary supratentorial brain metastases is not correlated to the size of the lesion and the grade of the associated perilesional edema should be considered. Surgical en bloc resection can be considered the first choice of treatment in the presence of solitary metastasis ≤2 cm in maximal diameter but with high-grade edema, since this treatment reduces the overall mass effect.
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Affiliation(s)
- Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, U.K
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Alessia D'Amico
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
- Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Division of Grottaferrata, Rome, Italy
| | - Giuseppa Zancana
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Michael Katsev
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Michela Relucenti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Familiari
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | | | - Alessandro Frati
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata", Rome, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
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Armocida D, D’Angelo L, Berra LV, Pesce A, di Palma V, Galati G, Frati A, Santoro A. Awake surgery for arteriovenous malformations (AVMs) in eloquent areas does not increase intraoperative risks and allows for shorter-term recovery and improved status. World Neurosurg 2022; 164:e1015-e1023. [PMID: 35643402 DOI: 10.1016/j.wneu.2022.05.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
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Rustia A, Pesce A, Palmieri M, D'Andrea G, Frati A. Ultrasound Lancet-aided Translaminar Posterior Lumbar Approach to the Recesso-Foraminal Area: Technical Note. Clin Spine Surg 2022; 35:107-110. [PMID: 34670985 DOI: 10.1097/bsd.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
Extrusion and sequestration of the nucleus pulposus involving the spinal canal or the foramina/recesses complicates up to 28% of the lumbar disc herniations. The transpars/translaminar anatomical approach is well described and its advantages when handling with a lateral, foraminal extruded disc herniation are appreciated and recognized. Nevertheless, this approach presents several pitfalls such as the risk of disconnecting the pars interarticularis, which may cause segmental instability. This particular eventuality is because of the particular anatomical conformation of the pars interarticularis. Although already part of the modern surgical armamentarium for general, orthopedic, cranial and spinal surgeons, the use of the ultrasonic scalpel technique for such approach has never been discussed to date, to the best of our knowledge. The purpose of the present paper is therefore to introduce and describe the stepwise technique along with an extensive discussion of the facilitating role of the ultrasonic scalpel in the translaminar/transpars approach in the management of extruded disc herniation of the lumbar spine.
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Affiliation(s)
| | | | - Mauro Palmieri
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Department of Human Neurosciences, Sapienza University, Rome
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Ryskalin L, Biagioni F, Morucci G, Busceti CL, Frati A, Puglisi-Allegra S, Ferrucci M, Fornai F. Spreading of Alpha Synuclein from Glioblastoma Cells towards Astrocytes Correlates with Stem-like Properties. Cancers (Basel) 2022; 14:cancers14061417. [PMID: 35326570 PMCID: PMC8946011 DOI: 10.3390/cancers14061417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The present study questions whether cells from glioblastoma multiforme (GBM), which overexpress α-synuclein (α-syn), may alter neighboring non-tumoral astrocyte cell lines. The occurrence of α-syn in GBM correlates with the expression of the stem cell marker nestin. When astrocytes are co-cultured with GBM cells in a trans-well apparatus the occurrence of α-syn and nestin rises remarkably. The increase in α-syn in co-cultured astrocytes is more pronounced at the plasma membrane, which mimics the placement of α-syn in GBM cells. When the mTOR inhibitor rapamycin is administered, GBM-induced expression of α-syn and nestin within co-cultured astrocytes is occluded, and morphological alterations are reverted. In the presence of rapamycin the sub-cellular placement of α-syn is modified being allocated within whorls and vacuoles instead of the plasma membrane. The effects induced by rapamycin occur both in baseline GBM cells and within astrocytes primed by co-cultured GBM cells. Abstract Evidence has been recently provided showing that, in baseline conditions, GBM cells feature high levels of α-syn which are way in excess compared with α-syn levels measured within control astrocytes. These findings are consistent along various techniques. In fact, they are replicated by using antibody-based protein detection, such as immuno-fluorescence, immuno-peroxidase, immunoblotting and ultrastructural stoichiometry as well as by measuring α-syn transcript levels at RT-PCR. The present manuscript further questions whether such a high amount of α-syn may be induced within astrocytes, which are co-cultured with GBM cells in a trans-well system. In astrocytes co-cultured with GBM cells, α-syn overexpression is documented. Such an increase is concomitant with increased expression of the stem cell marker nestin, along with GBM-like shifting in cell morphology. This concerns general cell morphology, subcellular compartments and profuse convolutions at the plasma membrane. Transmission electron microscopy (TEM) allows us to assess the authentic amount and sub-cellular compartmentalization of α-syn and nestin within baseline GBM cells and the amount, which is induced within co-cultured astrocytes, as well as the shifting of ultrastructure, which is reminiscent of GBM cells. These phenomena are mitigated by rapamycin administration, which reverts nestin- and α-syn-related overexpression and phenotypic shifting within co-cultured astrocytes towards baseline conditions of naïve astrocytes. The present study indicates that: (i) α-syn increases in astrocyte co-cultured with GBM cells; (ii) α-syn increases in astrocytes along with the stem cell marker nestin; (iii) α-syn increases along with a GBM-like shift of cell morphology; (iv) all these changes are replicated in different GBM cell lines and are reverted by the mTOR inhibitor rapamycin. The present findings indicate that α-syn does occur in high amount within GBM cells and may transmit to neighboring astrocytes as much as a stem cell phenotype. This suggests a mode of tumor progression for GBM cells, which may transform, rather than merely substitute, surrounding tissue; such a phenomenon is sensitive to mTOR inhibition.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (G.M.); (M.F.)
| | - Francesca Biagioni
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (G.M.); (M.F.)
| | - Carla L. Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
| | - Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135 Roma, Italy
| | - Stefano Puglisi-Allegra
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
| | - Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (G.M.); (M.F.)
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (G.M.); (M.F.)
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
- Correspondence: ; Tel.: +39-050-2218601
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Armocida D, Arcidiacono UA, Palmieri M, Pesce A, Cofano F, Picotti V, Salvati M, D’Andrea G, Garbossa D, Santoro A, Frati A. Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality. Diagnostics (Basel) 2022; 12:diagnostics12020351. [PMID: 35204442 PMCID: PMC8871449 DOI: 10.3390/diagnostics12020351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group (<65) and 152 in the elderly. The two subgroups did not present significant differences concerning biological characteristics of tumor, localization, diameters, lesion and edema volumes and surgical radicality. Despite these comparable data, elderly presented with a significantly lower Karnofsky Performance status value on admission and remained consistently lower during the follow-up. We establish instead that there is no intrinsic correlation to the presence of IM and no significant increased risk of complications or recurrence in elderly patients, but rather only an increased risk of reduced performance status with mortality related to the comorbidity of the patient, primarily cardiovascular disease, and an intrinsic frailty of the aged population.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
- Correspondence: ; Tel.: +39-393-287-4496
| | - Umberto Aldo Arcidiacono
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
| | | | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy; (F.C.); (D.G.)
| | - Veronica Picotti
- Neurosurgery Department, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy; (V.P.); (G.D.)
| | - Maurizio Salvati
- Policlinico Tor Vergata, University Tor Vergata of Rome, 00133 Rome, Italy;
| | - Giancarlo D’Andrea
- Neurosurgery Department, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy; (V.P.); (G.D.)
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy; (F.C.); (D.G.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
| | - Alessandro Frati
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
- IRCCS “Neuromed”, 86077 Pozzilli, Italy
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Berra LV, Di Rita A, Longhitano F, Mailland E, Reganati P, Frati A, Santoro A. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop 2021; 12:961-969. [PMID: 35036338 PMCID: PMC8696601 DOI: 10.5312/wjo.v12.i12.961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 11/03/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Far lateral lumbar disc herniations (FLLDH) represent a separate category of disc pathology which includes both intraforaminal and extraforaminal lumbar disc herniations, that are characterized by a peculiar clinical presentation, diagnostic and treatment modalities as compared to the more frequent median and paramedian disc hernias. Surgical treatment often represents the only effective weapon for the cure of this disease and over the years different approaches have been developed that can reach the region of the foramen or external to it, with different degrees of invasiveness. The diagnosis is more demanding and still underestimated as it requires a more detailed knowledge in the spine anatomy and dedicated radiological studies. Computerized tomography and in particular magnetic resonance imaging are the appropriate tools for the diagnosis of FLLDH. Despite the widespread use of these diagnostic tests, many cases of FLLDH are overlooked due to insufficiently detailed radiological examinations or due to the execution of exams not focused to the foraminal or the extraforaminal region. Neurophysiological studies represent a valid aid in the diagnostic classification of this pathology and in some cases they can facilitate the differential diagnosis with other types of radiculopathies. In the present study, a comprehensive review of the clinical presentation, epidemiology, radiological study and the neurophysiological aspects is presented.
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Affiliation(s)
- Luigi Valentino Berra
- Department of Neurosurgery, Policlinico Umberto I - Sapienza Università di Roma, Roma 00161, Italy
| | - Andrea Di Rita
- Department of Neurosurgery, San Carlo Borromeo Hospital, Milano 20153, Italy
| | - Federico Longhitano
- Department of Neurosurgery, San Carlo Borromeo Hospital, Milano 20153, Italy
| | - Enrico Mailland
- Department of Neurology, San Carlo Borromeo Hospital, Milano 20153, Italy
| | - Paolo Reganati
- Department of Neuroradiology, Manzoni Hospital, Lecco 23900, Italy
| | - Alessandro Frati
- Neurosurgery Division Human Neurosciences Department, Sapienza University, Roma 00135, Italy andDepartment of Neurosurgery, IRCCS Neuromed, Pozzilli IS 86077, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Sapienza Università di Roma, Roma 00161, Italy
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Palmieri M, Pesce A, Zancana G, Armocida D, Maiese A, Cirelli C, Santoro A, Frati P, Fineschi V, Frati A. Correction to: Post‑traumatic intracranial pseudo‑aneurysms of posterior circulation: a comprehensive review of an under‑diagnosed and rare entity. Neurosurg Rev 2021; 45:1823. [PMID: 34853927 DOI: 10.1007/s10143-021-01700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division, "Sapienza" University, Roma, Italy.
| | - Alessandro Pesce
- Santa Maria Goretti Hospital, Neurosurgery Division, Latina, Italy
| | - Giuseppa Zancana
- Human Neuroscience Department - Neurosurgery Division, "Sapienza" University, Roma, Italy
| | - Daniele Armocida
- Human Neuroscience Department - Neurosurgery Division, "Sapienza" University, Roma, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL, "Sapienza" University, Rome, Italy
| | - Carlo Cirelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Unit of Interventional Neuroradiology, Sapienza" University of Rome, Umberto I University Hospital, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division, "Sapienza" University, Roma, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL, "Sapienza" University, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL, "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Human Neuroscience Department - Neurosurgery Division, "Sapienza" University, Roma, Italy.,IRCCS "Neuromed", Pozzilli, IS, Italy
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Becelli R, Palmieri M, Facchini V, Armocida D, Pesce A, Kapitonov A, Zappalà M, Colangeli W, Bozza F, Salvati M, Santoro A, Frati A. Management of frontal sinus fractures: A comprehensive review and treatment algorithm from Sapienza university of Rome. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pesce A, Armocida D, Paglia F, Palmieri M, Frati A, D'Andrea G, Salvati M, Santoro A. IDH Wild-type Glioblastoma Presenting with Seizure: Clinical Specificity, and Oncologic and Surgical Outcomes. J Neurol Surg A Cent Eur Neurosurg 2021; 83:351-360. [PMID: 34794192 DOI: 10.1055/s-0041-1735515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients. METHODS We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs. RESULTS A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival. CONCLUSIONS The typical patient with IDH-WT GBM with SaO is a young (<55 year) male without a history of headache. The lesion is typically small to medium in size and located in the temporoparietal dominant lobe, with a high tendency to involve the SVZ.
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Affiliation(s)
| | - Daniele Armocida
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Francesco Paglia
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Mauro Palmieri
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy.,IRCCS "Neuromed" Pozzilli (IS), Italy
| | | | - Maurizio Salvati
- IRCCS "Neuromed" Pozzilli (IS), Italy.,Department of Mental and Neurological, Dental and Sensory Organs Health, Tor Vergata University, Rome Italy
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Armocida D, Pesce A, Santoro A, Salvati M, Frati A. Letter to the Editor: "The Neurosurgical Perspective for the 2021 WHO Classification of Tumors of the Central Nervous System: A Missed Opportunity?". World Neurosurg 2021; 155:203-204. [PMID: 34724739 DOI: 10.1016/j.wneu.2021.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniele Armocida
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy.
| | | | - Antonio Santoro
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Maurizio Salvati
- Division of Neurosurgery, Policlinico Tor Vergata, University Tor Vergata of Rome, Rome, Italy
| | - Alessandro Frati
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy; Division of Neurosurgery, IRCCS "Neuromed", Pozzilli, Italy
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Palmieri M, Frati A, Santoro A, Frati P, Fineschi V, Pesce A. Diffuse Axonal Injury: Clinical Prognostic Factors, Molecular Experimental Models and the Impact of the Trauma Related Oxidative Stress. An Extensive Review Concerning Milestones and Advances. Int J Mol Sci 2021; 22:ijms221910865. [PMID: 34639206 PMCID: PMC8509530 DOI: 10.3390/ijms221910865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a condition burdened by an extremely high rate of morbidity and mortality and can result in an overall disability rate as high as 50% in affected individuals. Therefore, the importance of identifying clinical prognostic factors for diffuse axonal injury (DAI) in (TBI) is commonly recognized as critical. The aim of the present review paper is to evaluate the most recent contributions from the relevant literature in order to understand how each single prognostic factor determinates the severity of the clinical syndrome associated with DAI. The main clinical factors with an important impact on prognosis in case of DAI are glycemia, early GCS, the peripheral oxygen saturation, blood pressure, and time to recover consciousness. In addition, the severity of the lesion, classified on the ground of the cerebral anatomical structures involved after the trauma, has a strong correlation with survival after DAI. In conclusion, modern findings concerning the role of reactive oxygen species (ROS) and oxidative stress in DAI suggest that biomarkers such as GFAP, pNF-H, NF-L, microtubule associated protein tau, Aβ42, S-100β, NSE, AQP4, Drp-1, and NCX represent a possible critical target for future pharmaceutical treatments to prevent the damages caused by DAI.
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Affiliation(s)
- Mauro Palmieri
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale Del Policlinico 155, 00161 Rome, Italy; (A.F.); (A.S.)
- Correspondence: ; Tel.: +39-063-377-5298
| | - Alessandro Frati
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale Del Policlinico 155, 00161 Rome, Italy; (A.F.); (A.S.)
- IRCCS “Neuromed”, Via Atinense 18, 86077 Pozzilli, Italy
| | - Antonio Santoro
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale Del Policlinico 155, 00161 Rome, Italy; (A.F.); (A.S.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL, “Sapienza” University, Viale Regina Elena 336, 00185 Rome, Italy; (P.F.); (V.F.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL, “Sapienza” University, Viale Regina Elena 336, 00185 Rome, Italy; (P.F.); (V.F.)
| | - Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, Via Lucia Scaravelli, 04100 Latina, Italy;
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Palmieri M, Pesce A, Zancana G, Armocida D, Maiese A, Cirelli C, Santoro A, Frati P, Fineschi V, Frati A. Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity. Neurosurg Rev 2021; 45:1019-1029. [PMID: 34608549 PMCID: PMC8976800 DOI: 10.1007/s10143-021-01657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.
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Affiliation(s)
- Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.
| | - Alessandro Pesce
- Santa Maria Goretti Hospital, Neurosurgery Division, Latina, Italy
| | - Giuseppa Zancana
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Daniele Armocida
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Carlo Cirelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Unit of Interventional Neuroradiology, "Sapienza" University of Rome, Umberto I University Hospital, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.,IRCCS "Neuromed", Pozzilli, IS, Italy
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Ferrucci M, Biagioni F, Busceti CL, Vidoni C, Castino R, Isidoro C, Ryskalin L, Frati A, Puglisi-Allegra S, Fornai F. Inhibition of Autophagy In Vivo Extends Methamphetamine Toxicity to Mesencephalic Cell Bodies. Pharmaceuticals (Basel) 2021; 14:ph14101003. [PMID: 34681227 PMCID: PMC8538796 DOI: 10.3390/ph14101003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/21/2023] Open
Abstract
Methamphetamine (METH) is a widely abused psychostimulant and a stress-inducing compound, which leads to neurotoxicity for nigrostriatal dopamine (DA) terminals in rodents and primates including humans. In vitro studies indicate that autophagy is a strong modulator of METH toxicity. In detail, suppressing autophagy increases METH toxicity, while stimulating autophagy prevents METH-induced toxicity in cell cultures. In the present study, the role of autophagy was investigated in vivo. In the whole brain, METH alone destroys meso-striatal DA axon terminals, while fairly sparing DA cell bodies within substantia nigra pars compacta (SNpc). No damage to either cell bodies or axons from ventral tegmental area (VTA) is currently documented. According to the hypothesis that ongoing autophagy prevents METH-induced DA toxicity, we tested whether systemic injection of autophagy inhibitors such as asparagine (ASN, 1000 mg/Kg) or glutamine (GLN, 1000 mg/Kg), may extend METH toxicity to DA cell bodies, both within SNpc and VTA, where autophagy was found to be inhibited. When METH (5 mg/Kg × 4, 2 h apart) was administered to C57Bl/6 mice following ASN or GLN, a frank loss of cell bodies takes place within SNpc and a loss of both axons and cell bodies of VTA neurons is documented. These data indicate that, ongoing autophagy protects DA neurons and determines the refractoriness of cell bodies to METH-induced toxicity.
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Affiliation(s)
- Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (M.F.); (L.R.)
| | - Francesca Biagioni
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Isernia, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
| | - Carla L. Busceti
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Isernia, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
| | - Chiara Vidoni
- Department of Health Sciences, Università del Piemonte Orientale, Via P. Solaroli 17, 28100 Novara, Italy; (C.V.); (R.C.); (C.I.)
| | - Roberta Castino
- Department of Health Sciences, Università del Piemonte Orientale, Via P. Solaroli 17, 28100 Novara, Italy; (C.V.); (R.C.); (C.I.)
| | - Ciro Isidoro
- Department of Health Sciences, Università del Piemonte Orientale, Via P. Solaroli 17, 28100 Novara, Italy; (C.V.); (R.C.); (C.I.)
| | - Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (M.F.); (L.R.)
| | - Alessandro Frati
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Isernia, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135 Rome, Italy
| | - Stefano Puglisi-Allegra
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Isernia, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (M.F.); (L.R.)
- I.R.C.C.S. Neuromed, Via Atinense 18, 86077 Isernia, Italy; (F.B.); (C.L.B.); (A.F.); (S.P.-A.)
- Correspondence: or ; Tel.: +39-050-2218601
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Ryskalin L, Biagioni F, Busceti CL, Polzella M, Lenzi P, Frati A, Ferrucci M, Fornai F. Lactoferrin Protects against Methamphetamine Toxicity by Modulating Autophagy and Mitochondrial Status. Nutrients 2021; 13:nu13103356. [PMID: 34684361 PMCID: PMC8537867 DOI: 10.3390/nu13103356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 01/18/2023] Open
Abstract
Lactoferrin (LF) was used at first as a vehicle to deliver non-soluble active compounds to the body, including the central nervous system (CNS). Nonetheless, it soon became evident that, apart from acting as a vehicle, LF itself owns active effects in the CNS. In the present study, the effects of LF are assessed both in baseline conditions, as well as to counteract methamphetamine (METH)-induced neurodegeneration by assessing cell viability, cell phenotype, mitochondrial status, and specific autophagy steps. In detail, cell integrity in baseline conditions and following METH administration was carried out by using H&E staining, Trypan blue, Fluoro Jade B, and WST-1. Western blot and immuno-fluorescence were used to assess the expression of the neurofilament marker βIII-tubulin. Mitochondria were stained using Mito Tracker Red and Green and were further detailed and quantified by using transmission electron microscopy. Autophagy markers were analyzed through immuno-fluorescence and electron microscopy. LF counteracts METH-induced degeneration. In detail, LF significantly attenuates the amount of cell loss and mitochondrial alterations produced by METH; and mitigates the dissipation of autophagy-related proteins from the autophagy compartment, which is massively induced by METH. These findings indicate a protective role of LF in the molecular mechanisms of neurodegeneration.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (P.L.); (M.F.)
| | - Francesca Biagioni
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.)
| | - Carla L. Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.)
| | - Maico Polzella
- Aliveda Laboratories, Viale Karol Wojtyla, 19, 56042 Crespina Lorenzana, Italy;
| | - Paola Lenzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (P.L.); (M.F.)
| | - Alessandro Frati
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.)
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135 Rome, Italy
| | - Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (P.L.); (M.F.)
| | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy; (L.R.); (P.L.); (M.F.)
- Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; (F.B.); (C.L.B.); (A.F.)
- Correspondence:
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Armocida D, Pesce A, Cimatti M, Proietti L, Santoro A, Frati A. Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Cages: Increased Risk of Late Postoperative Subsidence Without a Real Improvement of Perioperative Outcomes: A Clinical Monocentric Study. World Neurosurg 2021; 156:e57-e63. [PMID: 34492389 DOI: 10.1016/j.wneu.2021.08.127] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is one of several approaches to lumbar interbody fusion that has proven to be a safe and effective treatment for symptomatic lumbar degenerative disease The clinical outcomes of MIS-TLIF are generally favorable, but there is still controversy regarding its ability to restore sagittal alignment. For this reason, expandable transforaminal lumbar interbody fusion cages have been developed and designed to improve ability to restore disc height and segmental lordosis. The use of expandable cages in transforaminal lumbar interbody fusion has increased drastically; however, it is not clear how effective cage expansion is in regard to disc space lordosis, distraction, and long-term outcome. METHODS We reviewed a cohort of patients with symptomatic lumbar degenerative disc pathology who underwent MIS-TLIF at our institution. We compared clinical and radiographic outcomes of expandable versus nonexpandable cage use in MIS-TLIF focusing on mean changes in segmental lordosis, disc height, and postoperative complications. The results were compared with other studies reported in the international literature. RESULTS Mean change in segmental lordosis was not significantly different between the 2 groups. A significantly higher rate of postoperative subsidence was demonstrated in the expandable cage group. CONCLUSION This study established that expandable cage use in single-level transforaminal lumbar interbody fusion did not reduce the rate of postoperative complications, but rather significantly increased a patient's risk of postoperative subsidence. Expandable cages do not presently demonstrate improved clinical outcomes or improved sagittal alignment compared with static cages.
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Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department, Sapienza University, Rome, Italy.
| | | | - Marco Cimatti
- Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Institute of Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Santoro
- Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Alessandro Frati
- Human Neurosciences Department, Sapienza University, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
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Fumo C, Armocida D, Perna A, Pesce A, Ricci E, Tamburrelli FC, Frati A, Santoro A, Proietti L. Surgical Decision-Making in Spinal Instability in Facioscapulohumeral Muscular Dystrophy Related with a Spinal Muscle Atrophy. J Neurosci Rural Pract 2021; 12:445-446. [PMID: 33927541 PMCID: PMC8064827 DOI: 10.1055/s-0041-1722816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Caterina Fumo
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Italy
| | - Andrea Perna
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | - Enzo Ricci
- Division of Neurology, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
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Relucenti M, Familiari P, Iacopino G, Bruzzaniti P, Miglietta S, Salvati M, Li X, Chen R, D'Andrea G, Frati A, Di Gioia C, Pernazza A, Della Rocca C, Familiari G, Santoro A. RET/PTC3 translocation in a rare hemorrhagic brain metastasis of papillary thyroid cancer post Chernobyl radiation affects vessels ultrastructure. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tariciotti L, Brunetto GMF, Landi A, Gregori F, Santoro F, Frati A, Delfini R, Santoro A. Outcome Features Analysis in Intramedullary Tumors of the Cervicomedullary Junction: A Surgical Series. J Neurol Surg A Cent Eur Neurosurg 2021; 82:225-231. [PMID: 33540453 DOI: 10.1055/s-0040-1719080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECT The aim of this study is to investigate the impact of surgery for different cervicomedullary lesions on symptomatic pattern expression and postoperative outcome. We focused on specific outcome features of the early and late postoperative assessments. The former relies on surgery-related transient and permanent morbidity and feasibility of radicality in eloquent areas, whereas the latter on long-term course in lower grade tumors and benign tumorlike lesions (cavernomas, etc.). MATERIAL AND METHODS We retrospectively analyzed 28 cases of intramedullary tumors of the cervicomedullary junction surgically treated at our institution between 1990 and 2018. All cases were stratified for gender, histology, macroscopic appearance, location, surgical approach, and presence of a plane of dissection (POD). Mean follow-up was 5.6 years and it was performed via periodic magnetic resonance imaging (MRI) and functional assessments (Karnofsky Performance Scale [KPS] and modified McCormick [MC] grading system). RESULTS In all, 78.5% were low-grade tumors (or benign lesions) and 21.5% were high-grade tumors. Sixty-one percent underwent median suboccipital approach, 18% a posterolateral approach, and 21% a posterior cervical approach. Gross total resection was achieved in 54% of cases, near-total resection (>90%) in 14%, and subtotal resection (50-90%) in 32% of cases. Early postoperative morbidity was 25%, but late functional evaluation in 79% of the patients showed KPS > 70 and MC grade I; only 21% of cases showed KPS < 70 and MC grades II and III at late follow-up. Mean overall survival was 7 years in low-grade tumors or cavernomas and 11.7 months in high-grade tumors. Progression-free survival at the end of follow-up was 71% (evaluated mainly on low-grade tumors). CONCLUSIONS The surgical goal should be to achieve maximal cytoreduction and minimal postoperative neurologic damage. Functional outcome is influenced by the presence of a POD, radicality, histology, preoperative status, and employment of advanced neuroimaging planning and intraoperative monitoring.
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Affiliation(s)
- Leonardo Tariciotti
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy.,Division of Neurosurgery, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
| | | | - Alessandro Landi
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Gregori
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Francesca Santoro
- Department of Neuroradiology, Regional Hospital San Carlo, Potenza, Basilicata, Italy
| | - Alessandro Frati
- Division of Neurosurgery, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Molise, Italy
| | - Roberto Delfini
- Department of Neurology and Psychiatry, "Sapienza," University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Rome, Italy
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Salvati M, Armocida D, Pesce A, Palmieri M, Venditti E, D'Andrea G, Frati A, Santoro A. No prognostic differences between GBM-patients presenting with postoperative SMA-syndrome and GBM-patients involving cortico-spinal tract and primary motor cortex. J Neurol Sci 2020; 419:117188. [PMID: 33075591 DOI: 10.1016/j.jns.2020.117188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The supplementary motor area (SMA) is involved in several aspects of motor control and its can be associated to a contralateral motor deficit and speech disorders. After the resection of low-grade gliomas, this syndrome is diffusely reported but it is rarely investigated in high-grade gliomas. SMA deficits may resolve completely or with minor sequelae within weeks. Whether this condition of transient deficit affects survival, was not previously investigated, and is not currently understood. OBJECTIVE The study aimed to perform an accurate investigation concerning the real clinical and prognostic impact of the postoperative SMA syndrome in order to shed light over its relationship to survival parameters and postoperative functional status of the patients. METHODS We performed a retrospective review of a series of 176 surgically treated patients suffering from Glioblastomas. Tumors classified as Group A: Involving the SMA and Group B: Lesion located outside and distal to the SMA but in anatomical relationship to primary motor cortices (PM1) or corticospinal tract (CST), in order to investigate differences concerning immunohistochemical and molecular profiles in regard to the survival parameters. RESULTS Although lesions involving SMA demonstrated a significantly higher volume in respect to their general counterparts they did not significantly differ in concerns to the molecular patterns, pre and postoperative KPS scores and in PFS and OS findings. CONCLUSIONS In our cohort SMA-syndrome is reversible and therefore guarantees a satisfactory functional status at follow-up, apparently not compromising survival when compared to other lesions affecting the primary or cortical motor area -spinal tract.
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Affiliation(s)
- Maurizio Salvati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed", Pozzilli (IS), Italy
| | - Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.
| | - Alessandro Pesce
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed", Pozzilli (IS), Italy
| | - Mauro Palmieri
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | - Emiliano Venditti
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | | | | | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
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Cofano F, Pesce A, Vercelli G, Mammi M, Massara A, Minardi M, Palmieri M, D'Andrea G, Fronda C, Lanotte MM, Tartara F, Zenga F, Frati A, Garbossa D. Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study. Front Neurol 2020; 11:560269. [PMID: 33329304 PMCID: PMC7732444 DOI: 10.3389/fneur.2020.560269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/14/2020] [Indexed: 01/31/2023] Open
Abstract
Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear. Objective: To identify factors associated with increased risk of recurrence. Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes. Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013). Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.
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Affiliation(s)
- Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Giovanni Vercelli
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Marco Mammi
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Armando Massara
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Massimiliano Minardi
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Mauro Palmieri
- Neurosurgery Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | | | - Chiara Fronda
- Stereotactic and Functional Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Michele Maria Lanotte
- Stereotactic and Functional Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Francesco Zenga
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Lapolla P, Familiari P, Bruzzaniti P, Arcese R, Matassa R, Frati A, D'Andrea G, Santoro A. First-in-man craniectomy and asportation of solitary cerebellar metastasis in COVID-19 patient: A case report. Int J Surg Case Rep 2020; 77:753-758. [PMID: 33251091 PMCID: PMC7679517 DOI: 10.1016/j.ijscr.2020.11.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has an impact on the delivery of neurosurgical care, and it is changing the perioperative practice worldwide. We present the first case in the literature of craniectomy procedure and asportation of a solitary cerebellar metastasis of the oesophagus squamous carcinoma in a 77 years old woman COVID-19 positive. In these particular circumstances, we show that adequate healthcare resources and risk assessments are essential in the management of COVID-19 patients referred to emergency surgery. PRESENTATION OF CASE The case here presented was treated in 2019 for squamous carcinoma of the oesophagus. In April 2020, she presented a deterioration of her clinical picture consisting of dysphagia, abdominal pain, hyposthenia and ataxia. A Head CT scan was performed, which showed the presence of a solitary cerebellar metastasis. Her associated SARS-CoV-2 positivity status represented the principal clinical concern throughout her hospitalisation. DISCUSSION The patient underwent a suboccipital craniectomy procedure with metastasis asportation. She tested positive for SARS-CoV-2 in the pre- and post-operative phases, but she was not admitted to the intensive care unit because she did not present any respiratory complications. Her vital parameters and inflammation indexes fell within the reference ranges, and she was kept in isolation for 16 days in our neurosurgical unit following strict COVID-19 measures. She was asymptomatic and not treated for any of the specific and non-specific symptoms of COVID-19. CONCLUSION This is the first case reported of solitary cerebellar metastasis of oesophagus carcinoma operated on a COVID-19 positive patient. It shows that asymptomatic COVID-19 positive patients can undergo major emergency surgeries without the risk of infecting the operating team if adequate Personal Protection Equipment (PPE) is used. The patient remained asymptomatic and did not develop the disease's active phase despite undergoing a stressful event such as a major emergency neurosurgical procedure. In the current crisis, a prophylactic COVID-19 screening test can identify asymptomatic patients undergoing major emergency surgery and adequate resource planning and Personal Protective Equipment (PPE) for healthcare workers can minimise the effect of the COVID-19 pandemic.
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Affiliation(s)
- Pierfrancesco Lapolla
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.
| | - Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberto Arcese
- Department of Anatomical Pathology, F. Spaziani Hospital, Frosinone, Italy
| | - Roberto Matassa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Section of Human Anatomy, Sapienza University of Rome, Italy
| | - Alessandro Frati
- Department of Neurosurgery, IRCCS Neuromed Pozzilli, Isernia, Italy
| | - Giancarlo D'Andrea
- Department of Head and Neck Surgery, Neurosurgery Unit, F. Spaziani Hospital, Frosinone, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
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