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Guzzi G, Della Torre A, Bruni A, Lavano A, Bosco V, Garofalo E, La Torre D, Longhini F. Anatomo-physiological basis and applied techniques of electrical neuromodulation in chronic pain. J Anesth Analg Crit Care 2024; 4:29. [PMID: 38698460 PMCID: PMC11064427 DOI: 10.1186/s44158-024-00167-1] [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] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
Chronic pain, a complex and debilitating condition, poses a significant challenge to both patients and healthcare providers worldwide. Conventional pharmacological interventions often prove inadequate in delivering satisfactory relief while carrying the risks of addiction and adverse reactions. In recent years, electric neuromodulation emerged as a promising alternative in chronic pain management. This method entails the precise administration of electrical stimulation to specific nerves or regions within the central nervous system to regulate pain signals. Through mechanisms that include the alteration of neural activity and the release of endogenous pain-relieving substances, electric neuromodulation can effectively alleviate pain and improve patients' quality of life. Several modalities of electric neuromodulation, with a different grade of invasiveness, provide tailored strategies to tackle various forms and origins of chronic pain. Through an exploration of the anatomical and physiological pathways of chronic pain, encompassing neurotransmitter involvement, this narrative review offers insights into electrical therapies' mechanisms of action, clinical utility, and future perspectives in chronic pain management.
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Affiliation(s)
- Giusy Guzzi
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Attilio Della Torre
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Angelo Lavano
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Vincenzo Bosco
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy
| | - Domenico La Torre
- Neurosurgery Department, "R. Dulbecco" Hospital, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, "R. Dulbecco" Univesity Hospital, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, Catanzaro, 88100, Italy.
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Gurgone S, De Salvo S, Bonanno L, Muscarà N, Acri G, Caridi F, Paladini G, Borzelli D, Brigandì A, La Torre D, Sorbera C, Anfuso C, Di Lorenzo G, Venuti V, d'Avella A, Marino S. Changes in cerebral cortex activity during a simple motor task after MRgFUS treatment in patients affected by essential tremor and Parkinson's disease: a pilot study using functional NIRS. Phys Med Biol 2024; 69:025014. [PMID: 38100845 DOI: 10.1088/1361-6560/ad164e] [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: 05/17/2023] [Accepted: 12/15/2023] [Indexed: 12/17/2023]
Abstract
Objective.Magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) is a non-invasive thermal ablation method that involves high-intensity focused ultrasound surgery (FUS) and Magnetic Resonance Imaging for anatomical imaging and real-time thermal mapping. This technique is widely employed for the treatment of patients affected by essential tremor (ET) and Parkinson's disease (PD). In the current study, functional near-infrared spectroscopy (fNIRS) was used to highlight hemodynamics changes in cerebral cortex activity, during a simple hand motor task, i.e. unimanual left and right finger-tapping, in ET and PD patients.Approach.All patients were evaluated before, one week and one month after MRgFUS treatment.Main results.fNIRS revealed cerebral hemodynamic changes one week and one month after MRgFUS treatment, especially in the ET group, that showed a significant clinical improvement in tremor clinical scores.Significance.To our knowledge, our study is the first that showed the use of fNIRS system to measure the cortical activity changes following unilateral ventral intermediate nucleus thalamotomy after MRgFUS treatment. Our findings showed that therapeutic MRgFUS promoted the remodeling of neuronal networks and changes in cortical activity in association with symptomatic improvements.
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Affiliation(s)
- Sergio Gurgone
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology, 1-4, Yamadaoka, Suita City, 565-0871 Osaka, Japan
| | - Simona De Salvo
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Nunzio Muscarà
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Giuseppe Acri
- Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico 'G. Martino' Via Consolare Valeria 1, I-98125 Messina, Italy
| | - Francesco Caridi
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, V.le F. Stagno D'Alcontres 31, I-98166 Messina, Italy
| | - Giuseppe Paladini
- Dipartimento di Fisica e Astronomia 'Ettore Majorana', Università degli Studi di Catania, Via S. Sofia 64, I-95123 Catania, Italy
| | - Daniele Borzelli
- Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico 'G. Martino' Via Consolare Valeria 1, I-98125 Messina, Italy
- Laboratorio di Fisiologia Neuromotoria, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, I-00179 Roma, Italy
| | - Amelia Brigandì
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Domenico La Torre
- Dipartimento di Scienze Mediche e Chirurgiche, Istituto di Neurochirurgia, Università degli Studi 'Magna Graecia' di Catanzaro, Viale Europa, I-88100 Catanzaro, Italy
| | - Chiara Sorbera
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Carmelo Anfuso
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Giuseppe Di Lorenzo
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
| | - Valentina Venuti
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, V.le F. Stagno D'Alcontres 31, I-98166 Messina, Italy
| | - Andrea d'Avella
- Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico 'G. Martino' Via Consolare Valeria 1, I-98125 Messina, Italy
- Laboratorio di Fisiologia Neuromotoria, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, I-00179 Roma, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi 'Bonino-Pulejo', Via Palermo, Ctr. Casazza, S.S. 113, I-98121 Messina, Italy
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La Torre D, Della Torre A, Lo Turco E, Longo P, Pugliese D, Lacroce P, Raudino G, Romano A, Lavano A, Tomasello F. Primary Intracranial Gliosarcoma: Is It Really a Variant of Glioblastoma? An Update of the Clinical, Radiological, and Biomolecular Characteristics. J Clin Med 2023; 13:83. [PMID: 38202090 PMCID: PMC10779593 DOI: 10.3390/jcm13010083] [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: 10/22/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Gliosarcomas (GS) are sporadic malignant tumors classified as a Glioblastoma (GBM) variant with IDH-wild type phenotype. It appears as a well-circumscribed lesion with a biphasic, glial, and metaplastic mesenchymal component. The current knowledge about GS comes from the limited literature. Furthermore, recent studies describe peculiar characteristics of GS, such as hypothesizing that it could be a clinical-pathological entity different from GBM. Here, we review radiological, biomolecular, and clinical data to describe the peculiar characteristics of PGS, treatment options, and outcomes in light of the most recent literature. A comprehensive literature review of PubMed and Web of Science databases was conducted for articles written in English focused on gliosarcoma until 2023. We include relevant data from a few case series and only a single meta-analysis. Recent evidence describes peculiar characteristics of PGS, suggesting that it might be a specific clinical-pathological entity different from GBM. This review facilitates our understanding of this rare malignant brain tumor. However, in the future we recommend multi-center studies and large-scale metanalyses to clarify the biomolecular pathways of PGS to develop new specific therapeutic protocols, different from conventional GBM therapy in light of the new therapeutic opportunities.
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Affiliation(s)
- Domenico La Torre
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Attilio Della Torre
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Erica Lo Turco
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Prospero Longo
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Dorotea Pugliese
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Paola Lacroce
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Giuseppe Raudino
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Alberto Romano
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Angelo Lavano
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Francesco Tomasello
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
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Dragone D, Donadio FF, Mirabelli C, Cosentino C, Amato F, Zaffino P, Spadea MF, La Torre D, Merola A. Design and Experimental Validation of a 3D-Printed Embedded-Sensing Continuum Robot for Neurosurgery. Micromachines (Basel) 2023; 14:1743. [PMID: 37763906 PMCID: PMC10535800 DOI: 10.3390/mi14091743] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
A minimally-invasive manipulator characterized by hyper-redundant kinematics and embedded sensing modules is presented in this work. The bending angles (tilt and pan) of the robot tip are controlled through tendon-driven actuation; the transmission of the actuation forces to the tip is based on a Bowden-cable solution integrating some channels for optical fibers. The viability of the real-time measurement of the feedback control variables, through optoelectronic acquisition, is evaluated for automated bending of the flexible endoscope and trajectory tracking of the tip angles. Indeed, unlike conventional catheters and cannulae adopted in neurosurgery, the proposed robot can extend the actuation and control of snake-like kinematic chains with embedded sensing solutions, enabling real-time measurement, robust and accurate control of curvature, and tip bending of continuum robots for the manipulation of cannulae and microsurgical instruments in neurosurgical procedures. A prototype of the manipulator with a length of 43 mm and a diameter of 5.5 mm has been realized via 3D printing. Moreover, a multiple regression model has been estimated through a novel experimental setup to predict the tip angles from measured outputs of the optoelectronic modules. The sensing and control performance has also been evaluated during tasks involving tip rotations.
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Affiliation(s)
- Donatella Dragone
- Dipartimento di Ingegneria Elettrica e delle Tecnologie dell’Informazione, Università degli Studi di Napoli Federico II, Via Claudio 21, 80125 Napoli, Italy; (D.D.)
| | - Francesca Federica Donadio
- Biomechatronics Laboratory, Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy
| | - Chiara Mirabelli
- Biomechatronics Laboratory, Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy
| | - Carlo Cosentino
- Biomechatronics Laboratory, Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy
| | - Francesco Amato
- Dipartimento di Ingegneria Elettrica e delle Tecnologie dell’Informazione, Università degli Studi di Napoli Federico II, Via Claudio 21, 80125 Napoli, Italy; (D.D.)
| | - Paolo Zaffino
- Biomechatronics Laboratory, Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy
| | - Maria Francesca Spadea
- Biomechatronics Laboratory, Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy
| | - Domenico La Torre
- Department of Medical and Surgical Sciences, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy;
| | - Alessio Merola
- Biomechatronics Laboratory, Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia di Catanzaro, Campus Universitario “S. Venuta”, 88100 Catanzaro, Italy
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Tomasello F, Germanò A, Lavano A, Romano A, Cafarella D, Gorgoglione N, La Torre D. A Novel Technical Refinement of Microvascular Decompression: Pain Relief and Complication Rate in a Consecutive Series of Patients With Trigeminal Neuralgia. Neurosurgery 2021. [DOI: 10.1093/neuros/opaa044_s142] [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: 11/12/2022] Open
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Volpentesta G, Donato G, Ferraro E, Mignogna C, Radaelli R, Sabatini U, La Torre D, Malara N. Pilocytic Astrocytoma-Derived Cells in Peripheral Blood: A Case Report. Front Oncol 2021; 11:737730. [PMID: 34778052 PMCID: PMC8579051 DOI: 10.3389/fonc.2021.737730] [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: 07/07/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022] Open
Abstract
Imaging limitations, invasive tissue biopsies and poor information over the course of treatment to evaluate ‘real-time’ tumor dynamics justify the emerging use of liquid biopsies in the field of brain tumors. Circulating tumor cells (CTCs) from high-grade astrocytomas might reach the circulation by crossing the blood–brain barrier. Here, for the first time, CTCs cytology in a case of pylocitic astrocytoma is described. An obstructive hydrocephalous due to a lateral mesencephalic tectum mass occluding the Silvio Aqueduct was diagnosed in a young, 18 years old, male. Considering the location of the tumor and the rapid deterioration of the neurological status, it has been decided to urgency treat the patient with ventriculoperitoneal shunting. Magnetic resonance imaging showed a nodular shaped lesion localized within the left lateral mesencephalic tectum. Stereotactic biopsy was not approachable due significant risk of neurological consequences. The diagnosis was performed by blood sampling, a non-invasive procedure for the patient, in order to provide tumor information. Cytopathological features on detected circulating atypical GFAP positive cells led to pilocytic diagnosis confirmed by the patient’s 68 months outcome.
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Affiliation(s)
- Giorgio Volpentesta
- Department of Medical and Surgical Sciences, University "Magna Græcia", Catanzaro, Italy
| | - Giuseppe Donato
- Department of Health Sciences, University Magna Græcia, Catanzaro, Italy
| | | | - Chiara Mignogna
- Department of Health Sciences, University Magna Græcia, Catanzaro, Italy
| | - Riccardo Radaelli
- Department of Medical and Surgical Sciences, University "Magna Græcia", Catanzaro, Italy
| | - Umberto Sabatini
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Domenico La Torre
- Department of Medical and Surgical Sciences, University "Magna Græcia", Catanzaro, Italy
| | - Natalia Malara
- Department of Experimental and Clinical Medicine, University Magna Græcia, Catanzaro, Italy
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Mechelli A, Quattrone A, Nisticò R, Crasà M, La Torre D, Vescio B, Quattrone A. Blink reflex recovery cycle distinguishes patients with idiopathic normal pressure hydrocephalus from elderly subjects. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118511] [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: 11/16/2022]
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Quattrone A, Sarica A, La Torre D, Morelli M, Mechelli A, Arcuri PP, Quattrone A. Progressive supranuclear palsy with marked ventricular dilatation mimicking normal pressure hydrocephalus. Neurol Sci 2021; 43:1783-1790. [PMID: 34499242 DOI: 10.1007/s10072-021-05594-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) patients can show ventricular enlargement mimicking normal pressure hydrocephalus (NPH). The aim of this study was to distinguish PSP patients with marked ventricular dilatation (PSP-vd) from those with normal ventricular system and to evaluate the coexistence of NPH in PSP-vd patients. METHODS One hundred three probable PSP patients, 18 definite NPH patients, and 41 control subjects were enrolled in the study. Evans index (EI) > 0.32 associated with callosal angle (CA) < 100° was used to identify PSP-vd patients. Automated ventricular volumetry (AVV) and Magnetic Resonance Hydrocephalic Index (MRHI) were performed on T1-weighted MR images to evaluate the presence of NPH in PSP-vd patients. RESULTS Twelve (11.6%) out of 103 PSP patients had both abnormal EI and CA values (PSP-vd). In two of these 12 patients, AVV and MRHI values suggested PSP + NPH. In the remaining 10 PSP-vd patients, AVV and MRHI values were higher than PSP patients with normal ventricular system and controls, but lower than PSP + NPH and NPH patients, suggesting a non-hydrocephalic ventricular enlargement. DISCUSSION Our study provides evidence that the combination of EI and CA biomarkers allowed to identify PSP patients with marked ventricular dilatation mimicking NPH. Only a few of these patients had PSP + NPH. Recognition of these PSP patients with enlarged ventricles can positively impact the care of this disease, helping clinicians to identify patients with PSP + NPH who could benefit from shunt procedure and avoid surgery in those with enlarged ventricles without NPH.
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Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Alessia Sarica
- Department of Medical and Surgical Sciences, Neuroscience Centre, University "Magna Graecia", Catanzaro, Italy
| | - Domenico La Torre
- Institute of Neurosurgery, University "Magna Graecia", Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | | | - Pier Paolo Arcuri
- Department of Radiology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy. .,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy. .,Neuroscience Centre and Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Magna Graecia University, 88100, Catanzaro, Italy.
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Caligiuri ME, Quattrone A, Mechelli A, La Torre D, Quattrone A. Semi-automated assessment of the principal diffusion direction in the corpus callosum: differentiation of idiopathic normal pressure hydrocephalus from neurodegenerative diseases. J Neurol 2021; 269:1978-1988. [PMID: 34426880 DOI: 10.1007/s00415-021-10762-9] [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: 05/17/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) shares clinical and radiological features with progressive supranuclear palsy (PSP) and Alzheimer's disease (AD). Corpus callosum (CC) involvement in these disorders is well established on structural MRI and diffusion tensor imaging (DTI), but alterations overlap and lack specificity to underlying tissue changes. OBJECTIVE We propose a semi-automated approach to assess CC integrity in iNPH based on the spatial distribution of DTI-derived principal diffusion direction orientation (V1). METHODS We processed DTI data from 121 subjects (Site1: iNPH = 23, PSP = 27, controls = 14; ADNI: AD = 35, controls = 22) to obtain V1, fractional anisotropy (FA) and mean diffusivity (MD) maps. To increase the estimation accuracy of DTI metrics, analyses were restricted to the midsagittal CC portion (± 6 slices from midsagittal plane). Group-wise comparison of normalized altered voxel count in midsagittal CC was performed using Kruskal-Wallis tests, followed by post hoc comparisons (Bonferroni-corrected p < 0.05). ROC analysis was used to evaluate the diagnostic power of DTI alterations compared to callosal volume. RESULTS We found specific changes of V1 distribution in CC splenium of iNPH compared to AD and PSP, while MD and FA showed patterns of alterations common to all disorders. ROC curves showed that, compared to splenial volume, V1 represented the most accurate marker of iNPH diagnosis versus AD and PSP. CONCLUSIONS Our results provide evidence that V1 is a powerful biomarker for distinguishing patients with iNPH from patients with AD or PSP. Indeed, our findings also provide more specific insight into the pathophysiological mechanisms that underlie tissue damage across iNPH and its mimics.
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Affiliation(s)
- Maria Eugenia Caligiuri
- Neuroscience Research Center, University "Magna Graecia", Viale Europa, 88100, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | | | - Domenico La Torre
- Institute of Neurosurgery, University "Magna Graecia", Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, University "Magna Graecia", Viale Europa, 88100, Catanzaro, Italy.
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Mechelli A, Quattrone A, Nisticò R, Crasà M, La Torre D, Vescio B, Quattrone A. Blink reflex recovery cycle distinguishes patients with idiopathic normal pressure hydrocephalus from elderly subjects. J Neurol 2021; 269:1007-1012. [PMID: 34213613 DOI: 10.1007/s00415-021-10687-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The R2 component of blink reflex recovery cycle (R2BRrc) is a simple neurophysiological tool to detect the brainstem hyperexcitability commonly occurring in several neurological diseases such as Parkinson's disease and atypical parkinsonisms. In our study, we investigated for the first time the usefulness of R2BRrc to assess brainstem excitability in patients with idiopathic Normal Pressure Hydrocephalus (iNPH) in comparison with healthy subjects. METHODS Eighteen iNPH patients and 25 age-matched control subjects were enrolled. R2BRrc was bilaterally evaluated at interstimulus intervals (ISIs) of 100, 150, 200, 300, 400, 500 and 750 ms in all participants. We investigated the diagnostic performance of R2BRrc in differentiating iNPH patients from control subjects using ROC analysis. Midbrain area and Magnetic Resonance Hydrocephalic Index (MRHI), an MRI biomarker for the diagnosis of iNPH, were measured on T1-weighted MR images, and correlations between R2BRrc values and MRI measurements were investigated. RESULTS Fourteen (78%) of 18 iNPH patients showed an enhanced R2BRrc at ISIs 100-150-200 ms, while no control subjects had abnormal R2BRrc. The mean amplitude of bilateral R2BRrc at the shortest ISIs (100-150-200 ms) showed high accuracy in differentiating iNPH patients from controls (AUC = 0.89). R2BRrc values significantly correlated with midbrain area and MRHI values. CONCLUSIONS This study represents the first evidence of brainstem hyperexcitability in iNPH patients. Given its low cost and wide availability, R2BRrc could be a useful tool for selecting elderly subjects with mild gait and urinary dysfunction who should undergo an extensive diagnostic workup for the diagnosis of NPH.
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Affiliation(s)
- Alessandro Mechelli
- Department of Medical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Andrea Quattrone
- Department of Medical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - Rita Nisticò
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Marianna Crasà
- Neuroscience Research Centre, University Magna Graecia, Catanzaro, Italy
| | - Domenico La Torre
- Department of Medical Sciences, Institute of Neurosurgery, University Magna Graecia, Catanzaro, Italy
| | | | - Aldo Quattrone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. .,Neuroscience Research Centre, University Magna Graecia, Catanzaro, Italy. .,Neuroscience Centre and Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Magna Graecia University, 88100, Catanzaro, Italy.
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11
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Tomasello F, Germanò A, Lavano A, Romano A, Cafarella D, Gorgoglione N, La Torre D. A Novel Technical Refinement of Microvascular Decompression: Pain Relief and Complication Rate in a Consecutive Series of Patients With Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2021; 19:226-233. [PMID: 32167148 DOI: 10.1093/ons/opaa044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/27/2019] [Accepted: 01/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. We recently proposed some technical nuances for complication avoidance related to MVD. OBJECTIVE To verify the efficacy of the proposed refinement of the standard MVD technique in terms of resolution of the pain and reduction of complication rates. METHODS We analyzed surgical and outcome data of patients with TN using a novel surgical refinement to MVD, over the last 4 yr. Outcome variables included pain relief, facial numbness, muscular atrophy, local cutaneous occipital and temporal pain or numbness, cerebellar injury, hearing loss, cranial nerve deficits, wound infection, and cerebrospinal fluid (CSF) leak. Overall complication rate was defined as the occurrence of any of the aforementioned items. RESULTS A total of 72 consecutive patients were enrolled in the study. Pain relief was achieved in 91.6% and 88.8% of patients at 1- and 4-yr follow-up, respectively. No patient reported postoperative facial numbness during the entire follow-up period. The incidence of CSF leak was 1.4%. One patient developed a complete hearing loss and another a minor cerebellar ischemia. There was no mortality. The overall complication rate was 5.6%, but only 1.4% of patients experienced permanent sequelae. CONCLUSION The proposed refinement of the standard MVD technique has proved effective in maintaining excellent results in terms of pain relief while minimizing the overall complication rate associated with this surgical approach.
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Affiliation(s)
- Francesco Tomasello
- AOU Policlinico "G. Martino," Università degli Studi di Messina, Messina, Italy
| | - Antonino Germanò
- AOU Policlinico "G. Martino," Università degli Studi di Messina, Messina, Italy
| | - Angelo Lavano
- AOU "Mater Domini," Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
| | | | | | - Nicola Gorgoglione
- AOU Policlinico "G. Martino," Università degli Studi di Messina, Messina, Italy
| | - Domenico La Torre
- AOU "Mater Domini," Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
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12
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Quattrone A, Sarica A, La Torre D, Morelli M, Bianco MG, Quattrone A. Reply to: "MRI Linear Measurements in Normal Pressure Hydrocephalus Versus Progressive Supranuclear Palsy". Mov Disord 2021; 35:2122. [PMID: 33463753 DOI: 10.1002/mds.28337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Andrea Quattrone
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Alessia Sarica
- Department of Medical and Surgical Sciences Neuroscience Centre, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Domenico La Torre
- Department of Medical and Surgical Sciences, Institute of Neurosurgery, "University Magna Graecia", Catanzaro, Italy
| | - Maurizio Morelli
- Department of Medical and Surgical Sciences, Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Maria G Bianco
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy
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13
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Sarica A, Quattrone A, Quarantelli M, Arcuri PP, Mechelli A, La Torre D, Vaccaro MG, Cascini GL, Quattrone A. Reduced Striatal DAT Uptake Normalizes After Shunt in Normal-Pressure Hydrocephalus. Mov Disord 2020; 36:261-262. [PMID: 33044015 DOI: 10.1002/mds.28336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alessia Sarica
- Department of Medical and Surgical Sciences, Neuroscience Centre, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, University "Magna Graecia,", Catanzaro, Italy
| | - Mario Quarantelli
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Pier P Arcuri
- Department of Radiology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | | | - Domenico La Torre
- Institute of Neurosurgery, "University Magna Graecia,", Catanzaro, Italy
| | - Maria G Vaccaro
- Institute of Neurology, University "Magna Graecia,", Catanzaro, Italy
| | - Giuseppe L Cascini
- Department of Nuclear Medicine, University "Magna Graecia,", Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, University "Magna Graecia,", Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy
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14
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Conti A, La Torre D, Calisto A. Commentary: A Simple Technique for Endoscopic Hypothalamic Hamartoma Disconnection in Refractory Epilepsy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E161-E162. [PMID: 32324881 DOI: 10.1093/ons/opaa087] [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: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alfredo Conti
- Neurosurgery, Dipartimento di Scienze Biomediche e Neuromotorie (DIBIDEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.,Department of Neurosurgery, Charité Faculty of Medicine, Berlin, Germany
| | - Domenico La Torre
- Neurosurgery, Department of Medical and Surgical Sciences, University "Magna GRAECIA", Catanzaro, Italy
| | - Amedeo Calisto
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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15
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Coluccio ML, Presta I, Greco M, Gervasi R, La Torre D, Renne M, Voci CP, Lunelli L, Donato G, Malara N. Microenvironment Molecular Profile Combining Glycation Adducts and Cytokines Patterns on Secretome of Short-term Blood-derived Cultures during Tumour Progression. Int J Mol Sci 2020; 21:E4711. [PMID: 32630302 PMCID: PMC7369824 DOI: 10.3390/ijms21134711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/20/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022] Open
Abstract
Cancer cells are known to secrete many bioactive factors acting both with paracrine and autocrine mechanisms by which they condition the surrounding microenvironment. At the same time, the intracytoplasmic metabolic activities microenvironment influences the profile of this secretion. It is well known that cancer cells exhibit prevalent glycolytic metabolism and a more oxidative atmosphere compared to their healthy counterparts; this metabolic phenotype promotes glycate adducts formation and secretion. Considering the exacerbation of metabolic changes during the cancer progression, it is suggestive to explore the potential correlation between the increasing rate of glycan adducts and the specific pattern of secreted cytokines in different phases of cancer disease. We analyzed the secretomes of blood-derived cancer cell cultures from cancer patients and healthy subjects. The relative glycate adducts content in cancer secretomes was higher in comparison to that of healthy samples. Moreover, the stratification based on different phases of cancer disease correlated with a specific cytokines panel. The results obtained open a new perspective of observation of the intricate relationship between metabolome and inflammation in cancer. By using the analysis of secretome combined with a standardized protocol of liquid biopsy, it would be possible to identify specific profiles of molecular markers useful to arrange alternative and personalized medicine strategies.
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Affiliation(s)
- Maria Laura Coluccio
- University of Magna Graecia, 88100 Catanzaro, Italy; (M.L.C.); (I.P.); (M.G.); (D.L.T.); (G.D.)
| | - Ivan Presta
- University of Magna Graecia, 88100 Catanzaro, Italy; (M.L.C.); (I.P.); (M.G.); (D.L.T.); (G.D.)
| | - Marta Greco
- University of Magna Graecia, 88100 Catanzaro, Italy; (M.L.C.); (I.P.); (M.G.); (D.L.T.); (G.D.)
| | - Rita Gervasi
- Mater Domini Hospital, 88100 Catanzaro, Italy; (R.G.); (M.R.); (C.P.V.)
| | - Domenico La Torre
- University of Magna Graecia, 88100 Catanzaro, Italy; (M.L.C.); (I.P.); (M.G.); (D.L.T.); (G.D.)
| | - Maria Renne
- Mater Domini Hospital, 88100 Catanzaro, Italy; (R.G.); (M.R.); (C.P.V.)
| | - Carlo Pietro Voci
- Mater Domini Hospital, 88100 Catanzaro, Italy; (R.G.); (M.R.); (C.P.V.)
| | - Lorenzo Lunelli
- Fondazione Bruno Kessler, 38123 Trento, Italy;
- CNR Institute of Biophysics, 38123 Trento, Italy
| | - Giuseppe Donato
- University of Magna Graecia, 88100 Catanzaro, Italy; (M.L.C.); (I.P.); (M.G.); (D.L.T.); (G.D.)
| | - Natalia Malara
- University of Magna Graecia, 88100 Catanzaro, Italy; (M.L.C.); (I.P.); (M.G.); (D.L.T.); (G.D.)
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16
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Quattrone A, Sarica A, La Torre D, Morelli M, Vescio B, Nigro S, Barbagallo G, Nisticò R, Salsone M, Arcuri PP, Novellino F, Bianco MG, Arabia G, Cascini G, Quattrone A. Magnetic Resonance Imaging Biomarkers Distinguish Normal Pressure Hydrocephalus From Progressive Supranuclear Palsy. Mov Disord 2020; 35:1406-1415. [PMID: 32396693 DOI: 10.1002/mds.28087] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/16/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus and PSP share several clinical and radiological features, making differential diagnosis, at times, challenging. OBJECTIVES To differentiate idiopathic normal pressure hydrocephalus from PSP using MR volumetric and linear measurements. METHODS Twenty-seven idiopathic normal pressure hydrocephalus patients, 103 probable PSP patients, and 43 control subjects were consecutively enrolled. Automated ventricular volumetry was performed using Freesurfer 6 on MR T1 -weighted images. Linear measurements, such as callosal angle and a new measure, termed MR Hydrocephalic Index, were calculated on MR T1 -weighted images. Receiver operating characteristic analyses were used for differentiating between patient groups. Generalizability and reproducibility of the results were validated, dividing each participant group in two cohorts used as training and testing subsets. RESULTS Ventricular volumes and linear measurements (callosal angle and Magnetic Resonance Hydrocephalic Index) revealed greater ventricular enlargement in patients with idiopathic normal pressure hydrocephalus than in PSP patients and controls. PSP patients had ventricular volume larger than controls. Automated ventricular volumetry and Magnetic Resonance Hydrocephalic Index were the most accurate measures (98.5%) in differentiating patients with idiopathic normal pressure hydrocephalus from PSP patients, whereas callosal angle misclassified several PSP patients and showed low positive predictive value (70.0%) in differentiating between these two diseases. All measurements accurately differentiated idiopathic normal pressure hydrocephalus patients from controls. Accuracy values obtained in the training set (automated ventricular volumetry, 98.4%; Magnetic Resonance Hydrocephalic Index, 98.4%; callosal angle, 87.5%) were confirmed in the testing set. CONCLUSIONS Our study demonstrates that AVV and Magnetic Resonance Hydrocephalic Index were the most accurate measures for differentiation between idiopathic normal pressure hydrocephalus and PSP patients. Magnetic Resonance Hydrocephalic Index is easy to measure and can be used in clinical practice to prevent misdiagnosis and ineffective shunt procedures in idiopathic normal pressure hydrocephalus mimics. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Alessia Sarica
- Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | - Domenico La Torre
- Institute of Neurosurgery, "University Magna Graecia", Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | | | - Salvatore Nigro
- Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy
| | | | - Rita Nisticò
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Maria Salsone
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Pier Paolo Arcuri
- Department of Radiology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy
| | | | - Gennarina Arabia
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Giuseppe Cascini
- Department of Nuclear Medicine, University "Magna Graecia", Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy
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17
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La Torre D, Volpentesta G, Stroscio C, Bombardieri C, Chirchiglia D, Guzzi G, Pugliese D, De Bartolo E, Lavano A. Percutaneous intradiscal injection of radiopaque gelified ethanol: short- and long-term functional outcome and complication rate in a consecutive series of patients with lumbar disc herniation. Br J Pain 2020; 15:234-241. [PMID: 34055344 DOI: 10.1177/2049463720917182] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lumbar disc herniation (LDH) is a common cause of low back pain (LBP) and/or radicular pain (RP). Over the years, different therapies have been proposed to treat symptomatic LDH, including different minimally invasive techniques and open surgical methods. Recently, percutaneous intradiscal injection of radiopaque gelified ethanol (RGE) DiscoGel® has emerged as an effective therapeutic option in patients with LDH. Nevertheless, only few studies addressed the reliability of this technique. The purpose of this study was to evaluate the efficacy and safety of this procedure. We analysed surgical and outcome data of patients with small or medium LDH treated by DiscoGel between 2012 to 2015. Outcome variables included pain relief, the limitation on physical activity and severity of depression status. Overall, complication rate was defined as the occurrence of any perioperative adverse events. A total of 94 consecutive patients were enrolled in the study. Pain relief was achieved in 90.6% and 88.8% of patients at 1- and 4-year follow-up, respectively. At the last follow-up, at least a satisfactory result was achieved in 92.5% of patients. Similar results were obtained in the limitation on physical activity. Depression status did not significantly change after treatment. There was no mortality, and no patients experienced permanent sequelae. In well-selected patients, DiscoGel has proved effective in maintaining excellent functional results in terms of pain relief and limitation on physical activity while minimizing the overall rate of complications related to these kinds of surgical procedures.
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Affiliation(s)
- Domenico La Torre
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Giorgio Volpentesta
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Carmelino Stroscio
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Caterina Bombardieri
- Neuroradiology Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Domenico Chirchiglia
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Giusy Guzzi
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Dorotea Pugliese
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Emilio De Bartolo
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Angelo Lavano
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
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18
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La Torre D, Della Torre A, Chirchiglia D, Volpentesta G, Guzzi G, Lavano A. Deep brain stimulation for treatment-resistant depression: a safe and effective option. Expert Rev Neurother 2020; 20:449-457. [PMID: 32223454 DOI: 10.1080/14737175.2020.1749049] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Major depressive disorder (MDD) is the leading cause of years lost to disability worldwide. Pharmacotherapy and psychotherapy are effective treatments in most depressive episodes; but, about 30% of MDD patients remain symptomatic, and relapse is a common event. Recently, deep brain stimulation (DBS) has emerged as a valid therapeutic option in treatment-resistant depression (TRD) patients.Areas covered: In this paper, the authors summarize the findings of studies focused on these pathophysiologic phenomena and specifically on the role of DBS as a therapeutic option in TRD patients. The authors simply reviewed RCTs, open-label studies, neurophysiological mechanisms of DBS in MDD, and the possible role of different targets. Finally, we suggest possible future options.Expert opinion: Depression is a systems-level disorder, involving several brain structures. Neuroimaging studies demonstrate multiple interconnected regions that modulate different neural networks. DBS can modulate different targets, and others are under investigation. Among these subcallosal cingulate gyrus (SCG), ventral capsule and ventral striatum (VC/VS) seems to be the most relevant targets. We believe that, in the next future, DBS for TRD might become a first-line of treatment, especially using directional leads, that may help us to improve therapeutic effects.
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Affiliation(s)
- Domenico La Torre
- AOU "Mater Domini", Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
| | - Attilio Della Torre
- AOU "Mater Domini", Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
| | - Domenico Chirchiglia
- AOU "Mater Domini", Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
| | - Giorgio Volpentesta
- AOU "Mater Domini", Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
| | - Giusy Guzzi
- AOU "Mater Domini", Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
| | - Angelo Lavano
- AOU "Mater Domini", Università degli Studi "Magna Greacia" di Catanzaro, Catanzaro, Italy
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19
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Chirchiglia D, Chirchiglia P, La Torre D. Nummular headache – three years later: What happened. Ro J Neurol 2020. [DOI: 10.37897/rjn.2020.1.4] [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: 11/22/2022] Open
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20
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Presta I, Novellino F, Donato A, La Torre D, Palleria C, Russo E, Malara N, Donato G. UbcH10 a Major Actor in Cancerogenesis and a Potential Tool for Diagnosis and Therapy. Int J Mol Sci 2020; 21:E2041. [PMID: 32192022 PMCID: PMC7139792 DOI: 10.3390/ijms21062041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/27/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 01/22/2023] Open
Abstract
Malignant transformation is a multistep process in which several molecular entities become dysregulated and result in dysfunction in the regulation of cell proliferation. In past years, scientists have gradually dissected the pathways involved in the regulation of the cell cycle. The mitotic ubiquitin-conjugating enzymes UbcH10, has been extensively studied since its cloning and characterization and it has been identified as a constantly overexpressed factor in many types of cancer. In this paper, we have reviewed the literature about UbcH10 in human cancer, pointing out the association between its overexpression and exacerbation of cancer phenotype. Moreover, many recalled studied demonstrated how immunohistochemistry or RT-PCR analysis can distinguish normal tissues and benign lesions from malignant neoplasms. In other experimental studies, many of the consequences of UbcH10 overexpression, such as increased proliferation, metastasizing, cancer progression and resistance to anticancer drugs are reversed through gene silencing techniques. In recent years, many authors have defined UbcH10 evaluation in cancer patients as a useful tool for diagnosis and therapy. This opinion is shared by the authors who advertise how it would be useful to start using in clinical practice the notions acquired about this important moleculein the carcinogenesis of many human malignancies.
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Affiliation(s)
- Ivan Presta
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (E.R.); (G.D.)
| | - Fabiana Novellino
- Neuroimaging Unit, Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR) Viale Europa, 88100 Catanzaro, Italy;
| | - Annalidia Donato
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (A.D.); (D.L.T.)
| | - Domenico La Torre
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (A.D.); (D.L.T.)
| | - Caterina Palleria
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (E.R.); (G.D.)
| | - Emilio Russo
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (E.R.); (G.D.)
| | - Natalia Malara
- Department of Clinical and Experimental Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Giuseppe Donato
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy; (C.P.); (E.R.); (G.D.)
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21
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Torregrossa F, Aguennouz M, La Torre D, Sfacteria A, Grasso G. Role of Erythropoietin in Cerebral Glioma: An Innovative Target in Neuro-Oncology. World Neurosurg 2020; 131:346-355. [PMID: 31658577 DOI: 10.1016/j.wneu.2019.06.221] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/27/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Erythropoietin (EPO) is a cytokine primarily involved in the regulation of erythropoiesis. In response to hypoxia-ischemia, hypoxia-inducible factor 1 induces EPO production, which, in turn, inhibits apoptosis of erythroid progenitor cells. By the same mechanism and acting through other signaling pathways, EPO exerts neuroprotective effects. Increased resistance to hypoxia and decreased apoptosis are thought to be important mechanisms for tumor progression, including malignant glioma. Because recent studies have demonstrated that EPO and its receptor (EPOR) are expressed in several tumors and can promote tumor growth, in the present study, we investigated EPO and EPOR expression in human glioma and the effect of EPO administration in a rat model of glioma implantation. METHODS Using Western blotting and immunohistochemical analysis, we examined the expression of EPO, EPOR, platelet endothelial cell adhesion molecule, and Ki-67 in human glioma specimens and experimentally induced glioma in rats. In the experimental setting, a daily dose of recombinant human EPO (rHuEPO) or saline solution were administered for 21 days in Fischer rats subjected to 9L cell line implantation. RESULTS In both human and animal specimens, we found an increase in EPOR expression as long as the lesion presented with an increasing malignant pattern. A significant direct correlation was found between the expression of EPOR and Ki-67 and EPOR and platelet endothelial cell adhesion molecule in low- and high-grade gliomas. The rats treated with rHuEPO presented with significantly larger tumor spread compared with the saline-treated rats. CONCLUSIONS The results of our study have shown that the EPO/EPOR complex might play a significant role in the aggressive behavior of high-grade gliomas. The larger tumor spread in rHuEPO-treated rats suggests a feasible role for EPO in the aggressiveness and progression of malignant glioma.
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Affiliation(s)
- Fabio Torregrossa
- Neurosurgical Unit, Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy.
| | - M'hammed Aguennouz
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico La Torre
- Neurosurgical Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | | | - Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
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22
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Polito F, Cucinotta M, Abbritti RV, Brogna A, Pergolizzi S, Tomasello C, Barresi V, Angileri FF, Di Giorgio R, Conti A, La Torre D, Germanò A, Aguennouz M. Silencing of telomere-binding protein adrenocortical dysplasia (ACD) homolog enhances radiosensitivity in glioblastoma cells. Transl Res 2018; 202:99-108. [PMID: 30080989 DOI: 10.1016/j.trsl.2018.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/23/2018] [Accepted: 07/10/2018] [Indexed: 11/30/2022]
Abstract
Adrenocortical dysplasia (ACD) is a shelterin protein involved in the maintenance of telomere length and in cancer radioresistance. This study investigated the expression profile of ACD in human gliomas and its role in radioresistance of glioma cells. The expression of ACD was analyzed in 62 different grades of glioma tissues and correlated with prognosis. A radioresistant cell line was generated from U87MG cells. For mechanistic studies, ACD was inhibited by small interfering RNA-targeting ACD and the effect on cell radioresistance, telomerase activity, cyclinD1, caspase-3, hTERT, and BIRC1 was evaluated. Clonogenic assay was performed after irradiation, to investigate the effect of ACD silencing on radiation sensitivity. ACD expression appeared strongly upregulated in higher grade gliomas, and its expression was significantly correlated to grading and poor prognosis. In glioma cell lines, ACD expression pattern was similar to those observed in glioma tissues. In irradiated cells, ACD expression was increased in an ionizing radiation dose-dependent manner. A higher expression of ACD was observed in the radioresistant clones than parental cells. Silencing of ACD led to the enhanced radiation sensitivity, decreased telomerase activity and cyclin D1 expression, reduced expression of BIRC1, and finally to the upregulation of caspase-3. This study represents the first report, which demonstrated the expression pattern of ACD in gliomas and its prognostic value. Our results suggested that ACD is involved in glioblastoma radioresistance, likely through the modulation of telomerase activity, proliferation, and apoptosis. ACD might represent a potential molecular biomarker and a novel therapeutic target in glioblastoma.
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Affiliation(s)
- Francesca Polito
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Maria Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Rosaria V Abbritti
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Anna Brogna
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Stefano Pergolizzi
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Chiara Tomasello
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | | | - Flavio F Angileri
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | | | - Alfredo Conti
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Domenico La Torre
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - Antonino Germanò
- Department of Biomedical, Dental Sciences and of Morphological and Functional Images, University of Messina, Italy
| | - M'hammed Aguennouz
- Department of Clinical and Experimental Medicine, University of Messina, Italy.
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Visalli C, Cavallaro M, Concerto A, La Torre D, Di Salvo R, Mazziotti S, Salamone I. Ultrasonography of traumatic injuries to limb peripheral nerves: technical aspects and spectrum of features. Jpn J Radiol 2018; 36:592-602. [DOI: 10.1007/s11604-018-0765-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
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La Torre D, Raffa G, Pino MA, Fodale V, Rizzo V, Visalli C, Guzzi G, Della Torre A, Lavano A, Germanò A. A Novel Diagnostic and Prognostic Tool for Simple Decompression of Ulnar Nerve in Cubital Tunnel Syndrome. World Neurosurg 2018; 118:e964-e973. [PMID: 30048793 DOI: 10.1016/j.wneu.2018.07.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/02/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Surgical decompression of the ulnar nerve (UN) is effective for treating cubital tunnel syndrome (CubTS). Nevertheless, the outcome is not always satisfying. Different surgical, clinical, and imaging findings have been claimed as outcome predictors, but there is no consensus in the literature. We analyzed the outcome-predicting role of ultrasonography (US) of the UN in patients with CubTS and its possible role for diagnosis and follow-up. METHODS Patients with CubTS treated by simple UN decompression underwent US and electrodiagnotic (ED) studies of the UN at the elbow before and after surgery. Outcome was evaluated through the Bishop scale. A correlation analysis between pre- and postoperative clinical, US, and ED findings was performed. RESULTS Thirty-six patients were enrolled. Preoperatively, we observed a negative correlation between the motor conduction velocity (MCV) and the transverse (TD) and anteroposterior diameters and cross-sectional area (CSA) of the UN at the precubital (P = 0.001, P = 0.001, P = 0.005) and cubital level (P = 0.02, P = 0.002, P = 0.001). Preoperative precubital TD and CSA were associated with outcome (P = 0.01, P = 0.006) and postoperative MCV (P = 0.004, P = 0.008). The cut-off values TD >6 mm and CSA >23.91 mm2 were predictors of poor outcome. Finally, postoperative cubital TD and CSA values were inversely correlated with outcome (P = 0.0002, P = 0.0007) and postoperative MCV (P = 0.0002, P = 0.0004). CONCLUSIONS The US examination of the UN is useful for the management of patients with CubTS as an adjunct to clinical and ED evaluations. US measurements are correlated with pre- and postoperative ED findings and thus are useful for diagnosis and follow-up. Interestingly, specific precubital US measurements are good predictors of outcome.
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Affiliation(s)
- Domenico La Torre
- Division of Neurosurgery, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy.
| | - Maria Angela Pino
- Division of Neurosurgery, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Vincenzo Fodale
- Anesthesiology and Intensive Care Unit, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Vincenzo Rizzo
- Division of Neurology, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Carmela Visalli
- Division of Radiological Sciences, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Giusy Guzzi
- Division of Neurosurgery, Department of Medical and Surgical Sciences, University of Catanzaro, Messina, Italy
| | - Attilio Della Torre
- Division of Neurosurgery, Department of Medical and Surgical Sciences, University of Catanzaro, Messina, Italy
| | - Angelo Lavano
- Division of Neurosurgery, Department of Medical and Surgical Sciences, University of Catanzaro, Messina, Italy
| | - Antonino Germanò
- Division of Neurosurgery, University of Messina, A.O.U. Policlinico "G. Martino", Messina, Italy
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Tomasello F, Angileri FF, Conti A, Scibilia A, Cardali S, La Torre D, Germanò A. Petrosal Meningiomas: Factors Affecting Outcome and the Role of Intraoperative Multimodal Assistance to Microsurgery. Neurosurgery 2018; 84:1313-1324. [DOI: 10.1093/neuros/nyy188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
- Depart-ment of Neurosurgery, Charité Univer-sitätsmedizin, Berlin, Germany
| | | | | | | | - Antonino Germanò
- Department of Neurosurgery, University of Messina, Messina, Italy
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Raffa G, Conti A, Scibilia A, Cardali SM, Esposito F, Angileri FF, La Torre D, Sindorio C, Abbritti RV, Germanò A, Tomasello F. The Impact of Diffusion Tensor Imaging Fiber Tracking of the Corticospinal Tract Based on Navigated Transcranial Magnetic Stimulation on Surgery of Motor-Eloquent Brain Lesions. Neurosurgery 2017; 83:768-782. [DOI: 10.1093/neuros/nyx554] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/05/2017] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND
Navigated transcranial magnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMS with diffusion tensor imaging fiber tracking (DTI-FT) of the corticospinal tract (CST) has been described; however, its impact on surgery of motor-eloquent lesions has not been addressed.
OBJECTIVE
To analyze the impact of nTMS-based mapping on surgery of motor-eloquent lesions.
METHODS
In this retrospective case-control study, we reviewed the data of patients operated for suspected motor-eloquent lesions between 2012 and 2015. The patients underwent nTMS mapping of M1 and, from 2014, nTMS-based DTI-FT of the CST. The impact on the preoperative risk/benefit analysis, surgical strategy, craniotomy size, extent of resection (EOR), and outcome were compared with a control group.
RESULTS
We included 35 patients who underwent nTMS mapping of M1 (group A), 35 patients who also underwent nTMS-based DTI-FT of the CST (group B), and a control group composed of 35 patients treated without nTMS (group C). The patients in groups A and B received smaller craniotomies (P = .01; P = .001), had less postoperative seizures (P = .02), and a better postoperative motor performance (P = .04) and Karnofsky Performance Status (P = .009) than the controls. Group B exhibited an improved risk/benefit analysis (P = .006), an increased EOR of nTMS-negative lesions in absence of preoperative motor deficits (P = .01), and less motor and Karnofsky Performance Status worsening in case of preoperative motor deficits (P = .02, P = .03) than group A.
CONCLUSION
nTMS-based mapping enables a tailored surgical approach for motor-eloquent lesions. It may improve the risk/benefit analysis, EOR and outcome, particularly when nTMS-based DTI-FT is performed.
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Affiliation(s)
- Giovanni Raffa
- Department of Neurosurgery, University of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
| | | | | | - Felice Esposito
- Department of Neurosurgery, University of Messina, Messina, Italy
| | | | | | - Carmela Sindorio
- Department of Neurosurgery, University of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Antonino Germanò
- Department of Neurosurgery, University of Messina, Messina, Italy
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Tomasello F, Esposito F, Abbritti RV, Angileri FF, Conti A, Cardali SM, La Torre D. Microvascular Decompression for Trigeminal Neuralgia: Technical Refinement for Complication Avoidance. World Neurosurg 2016; 94:26-31. [DOI: 10.1016/j.wneu.2016.06.097] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/15/2022]
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Conti A, Romeo SG, Cama A, La Torre D, Barresi V, Pezzino G, Tomasello C, Cardali S, Angileri FF, Polito F, Ferlazzo G, Di Giorgio R, Germanò A, Aguennouz M. MiRNA expression profiling in human gliomas: upregulated miR-363 increases cell survival and proliferation. Tumour Biol 2016; 37:14035-14048. [PMID: 27495233 DOI: 10.1007/s13277-016-5273-x] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/15/2016] [Indexed: 12/21/2022] Open
Abstract
The role of microRNAs (miRNAs) in glioma biology is increasingly recognized. To investigate the regulatory mechanisms governing the malignant signature of gliomas with different grades of malignancy, we analyzed miRNA expression profiles in human grade I-IV tumor samples and primary glioma cell cultures. Multiplex real-time PCR was used to profile miRNA expression in a set of World Health Organization (WHO) grade I (pilocytic astrocytoma), II (diffuse fibrillary astrocytoma), and IV (glioblastoma multiforme) astrocytic tumors and primary glioma cell cultures. Primary glioma cell cultures were used to evaluate the effect of transfection of specific miRNAs and miRNA inhibitors. miRNA microarray showed that a set of miRNAs was consistently upregulated in all glioma samples. miR-363 was upregulated in all tumor specimens and cell lines, and its expression correlated with tumor grading. The transfection of glioma cells with the specific inhibitor of miR-363 increased the expression level of tumor suppressor growth-associated protein 43 (GAP-43). Transfection of miR-363 induced cell survival, while inhibition of miR-363 significantly reduced glioma cell viability. Furthermore, miRNA-363 inhibition induced the downregulation of AKT, cyclin-D1, matrix metalloproteinase (MMP)-2, MMP-9, and Bcl-2 and upregulation of caspase 3. Together, these data suggest that the upregulation of miR-363 may play a role in malignant glioma signature.
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Affiliation(s)
- Alfredo Conti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Sara G Romeo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Annamaria Cama
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Domenico La Torre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Valeria Barresi
- Department of Adulthood and Childhood Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Gaetana Pezzino
- Department of Adulthood and Childhood Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Chiara Tomasello
- Department of Adulthood and Childhood Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Salvatore Cardali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Filippo F Angileri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Francesca Polito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Guido Ferlazzo
- Department of Adulthood and Childhood Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Rosamaria Di Giorgio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonino Germanò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - M'hammed Aguennouz
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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30
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Conti A, Pontoriero A, Iatì G, Marino D, La Torre D, Vinci S, Germanò A, Pergolizzi S, Tomasello F. 3D-Printing of Arteriovenous Malformations for Radiosurgical Treatment: Pushing Anatomy Understanding to Real Boundaries. Cureus 2016; 8:e594. [PMID: 27335707 PMCID: PMC4914061 DOI: 10.7759/cureus.594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 11/05/2022] Open
Abstract
Radiosurgery of arteriovenous malformations (AVMs) is a challenging procedure. Accuracy of target volume contouring is one major issue to achieve AVM obliteration while avoiding disastrous complications due to suboptimal treatment. We describe a technique to improve the understanding of the complex AVM angioarchitecture by 3D prototyping of individual lesions. Arteriovenous malformations of ten patients were prototyped by 3D printing using 3D rotational angiography (3DRA) as a template. A target volume was obtained using the 3DRA; a second volume was obtained, without awareness of the first volume, using 3DRA and the 3D-printed model. The two volumes were superimposed and the conjoint and disjoint volumes were measured. We also calculated the time needed to perform contouring and assessed the confidence of the surgeons in the definition of the target volumes using a six-point scale. The time required for the contouring of the target lesion was shorter when the surgeons used the 3D-printed model of the AVM (p=0.001). The average volume contoured without the 3D model was 5.6 ± 3 mL whereas it was 5.2 ± 2.9 mL with the 3D-printed model (p=0.003). The 3D prototypes proved to be spatially reliable. Surgeons were absolutely confident or very confident in all cases that the volume contoured using the 3D-printed model was plausible and corresponded to the real boundaries of the lesion. The total cost for each case was 50 euros whereas the cost of the 3D printer was 1600 euros. 3D prototyping of AVMs is a simple, affordable, and spatially reliable procedure that can be beneficial for radiosurgery treatment planning. According to our preliminary data, individual prototyping of the brain circulation provides an intuitive comprehension of the 3D anatomy of the lesion that can be rapidly and reliably translated into the target volume.
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Affiliation(s)
- Alfredo Conti
- Department of Neurological Surgery, University of Messina
| | | | | | - Daniele Marino
- Department of Neurological Surgery, University of Messina
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Tomasello F, Conti A, Cardali S, La Torre D, Angileri FF. Telovelar Approach to Fourth Ventricle Tumors: Highlights and Limitations. World Neurosurg 2015; 83:1141-7. [DOI: 10.1016/j.wneu.2015.01.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 11/25/2022]
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32
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Merlo L, Cimino F, Angileri FF, La Torre D, Conti A, Cardali SM, Saija A, Germanò A. Alteration in synaptic junction proteins following traumatic brain injury. J Neurotrauma 2015; 31:1375-85. [PMID: 24661152 DOI: 10.1089/neu.2014.3385] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Extensive research and scientific efforts have been focused on the elucidation of the pathobiology of cellular and axonal damage following traumatic brain injury (TBI). Conversely, few studies have specifically addressed the issue of synaptic dysfunction. Synaptic junction proteins may be involved in post-TBI alterations, leading to synaptic loss or disrupted plasticity. A Synapse Protein Database on synapse ontology identified 109 domains implicated in synaptic activities and over 5000 proteins, but few of these demonstrated to play a role in the synaptic dysfunction after TBI. These proteins are involved in neuroplasticity and neuromodulation and, most importantly, may be used as novel neuronal markers of TBI for specific intervention.
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Affiliation(s)
- Lucia Merlo
- 1 Department of Neurosciences, University of Messina , Messina, Italy
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33
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Conti A, Pontoriero A, Midili F, Iatì G, Siragusa C, Tomasello C, La Torre D, Cardali SM, Pergolizzi S, De Renzis C. CyberKnife multisession stereotactic radiosurgery and hypofractionated stereotactic radiotherapy for perioptic meningiomas: intermediate-term results and radiobiological considerations. Springerplus 2015; 4:37. [PMID: 25674497 PMCID: PMC4320239 DOI: 10.1186/s40064-015-0804-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/08/2015] [Indexed: 12/25/2022]
Abstract
Single fraction radiosurgery is conventionally precluded for lesions lying <2-3 mm of the anterior visual pathway because of the radiosensitivity of the optic nerve. We analyzed a series of 64 patients with “perioptic” meningiomas treated by CyberKnife multisession radiosurgery and hypofractionated stereotactic radiotherapy (hSRT). Between July 2007-May 2010, patients were treated using conventional multisession Cyberknife schemes (2–5 fractions) and results were retrospectively analyzed. A radiobiological model was then developed to estimate the best tumor control probability (TCP)/ normal tissue complication probability (NTCP) for these lesions. Resulting dose/fraction schemes were applied to patients treated between May 2010 and July 2014. Data were prospectively collected Twenty-five patients were included in the retrospective part of the study. Median tumor volume was 4.95 cc; median dose was 23.0 Gy and median number of fraction was 5 (range 2–5). No patient had visual deterioration at mean follow-up of 60 ± 12 months. Tumor control was achieved in all cases. Thirty-nine patients were treated according the radiobiology model and results prospectively analyzed. Median tumor volume was 7.5 cc, median dose 25.0 Gy and mean number of fraction 5 (range 3–15). No patient had visual deterioration or tumor progression at mean follow-up of 17 ± 10 months. Conventional multisession CyberKnife treatments (2–5 fractions) provided satisfactory results. Nonetheless, our estimation of TCP suggests the use of higher doses to grant long-term disease control. To achieve higher equivalent doses without significantly increasing the NTCP, we suggest the use of a greater number of fractions, moving to hSRT, in tumors in which the encasement of optic nerves is presumed.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Antonio Pontoriero
- Department of Radiation Oncology, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Federica Midili
- Department of Medical Physics, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Carmelo Siragusa
- Department of Medical Physics, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Chiara Tomasello
- Department of Oncology, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Domenico La Torre
- Department of Neurosurgery, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Salvatore M Cardali
- Department of Neurosurgery, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Stefano Pergolizzi
- Department of Radiation Oncology, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Costantino De Renzis
- Department of Radiation Oncology, University of Messina, AOU "Policlinico G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
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Priola SM, Raffa G, Abbritti RV, Merlo L, Angileri FF, La Torre D, Conti A, Germanò A, Tomasello F. The pioneering contribution of italian surgeons to skull base surgery. World Neurosurg 2013; 82:523-8. [PMID: 23895928 DOI: 10.1016/j.wneu.2013.07.076] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/01/2013] [Accepted: 07/20/2013] [Indexed: 11/16/2022]
Abstract
The origin of neurosurgery as a modern, successful, and separate branch of surgery could be dated back to the end of the 19th century. The most important development of surgery occurred in Europe, particularly in Italy, where there was a unique environment, allowing brilliant open-minded surgeons to perform, with success, neurosurgical operations. Neurosurgery began at the skull base. In everyday practice, we still pay tribute to early Italian neuroanatomists and pioneer neurosurgeons who represented a starting point in a new, obscure, and still challenging field of medicine and surgery during their times. In this paper, we report at a glance the contributions of Tito Vanzetti from Padua (1809-1888), for his operation on a destructive skull base cyst that had, indeed, an intracranial expansion; of Davide Giordano (1864-1954) from Venice, who described the first transnasal approach to the pituitary gland; and, most importantly, of Francesco Durante from Messina (1844-1934), who was the first surgeon in the history of neurosurgery to successfully remove a cranial base meningioma. They carried out the first detailed reported surgical excision of intracranial lesions at the skull base, diagnosed only through clinical signs; used many of the advances of the 19th century; and conceived and performed new operative strategies and approaches. Their operations were radical enough to allow the patient to survive the surgery and, in the case of Durante, for the first time, to obtain more than 12 years of good survival at a time when a tumor of this type would have been fatal.
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Affiliation(s)
- Stefano M Priola
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Giovanni Raffa
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Rosaria V Abbritti
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Lucia Merlo
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Filippo F Angileri
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy.
| | - Domenico La Torre
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Alfredo Conti
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Antonino Germanò
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Francesco Tomasello
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
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La Torre D, Conti A, Aguennouz MH, De Pasquale MG, Romeo S, Angileri FF, Cardali S, Tomasello C, Alafaci C, Germanò A. Telomere length modulation in human astroglial brain tumors. PLoS One 2013; 8:e64296. [PMID: 23691191 PMCID: PMC3653865 DOI: 10.1371/journal.pone.0064296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 12/12/2012] [Accepted: 04/11/2013] [Indexed: 11/23/2022] Open
Abstract
Background Telomeres alteration during carcinogenesis and tumor progression has been described in several cancer types. Telomeres length is stabilized by telomerase (h-TERT) and controlled by several proteins that protect telomere integrity, such as the Telomere Repeat-binding Factor (TRF) 1 and 2 and the tankyrase-poli-ADP-ribose polymerase (TANKs-PARP) complex. Objective To investigate telomere dysfunction in astroglial brain tumors we analyzed telomeres length, telomerase activity and the expression of a panel of genes controlling the length and structure of telomeres in tissue samples obtained in vivo from astroglial brain tumors with different grade of malignancy. Materials and Methods Eight Low Grade Astrocytomas (LGA), 11 Anaplastic Astrocytomas (AA) and 11 Glioblastoma Multiforme (GBM) samples were analyzed. Three samples of normal brain tissue (NBT) were used as controls. Telomeres length was assessed through Southern Blotting. Telomerase activity was evaluated by a telomere repeat amplification protocol (TRAP) assay. The expression levels of TRF1, TRF2, h-TERT and TANKs-PARP complex were determined through Immunoblotting and RT-PCR. Results LGA were featured by an up-regulation of TRF1 and 2 and by shorter telomeres. Conversely, AA and GBM were featured by a down-regulation of TRF1 and 2 and an up-regulation of both telomerase and TANKs-PARP complex. Conclusions In human astroglial brain tumours, up-regulation of TRF1 and TRF2 occurs in the early stages of carcinogenesis determining telomeres shortening and genomic instability. In a later stage, up-regulation of PARP-TANKs and telomerase activation may occur together with an ADP-ribosylation of TRF1, causing a reduced ability to bind telomeric DNA, telomeres elongation and tumor malignant progression.
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Affiliation(s)
- Domenico La Torre
- Department of Neurosciences, University of Messina School of Medicine, Messina, Italy.
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Germanò A, Priola S, Angileri FF, Conti A, La Torre D, Cardali S, Raffa G, Merlo L, Granata F, Longo M, Tomasello F. Long-term follow-up of ruptured intracranial aneurysms treated by microsurgical wrapping with autologous muscle. Neurosurg Rev 2012; 36:123-31; discussion 132. [PMID: 22777660 DOI: 10.1007/s10143-012-0408-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 04/11/2012] [Accepted: 05/17/2012] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to describe our series of nine unclippable and uncoilable ruptured aneurysms in eight patients treated by microsurgical wrapping with autologous muscle. Records were retrospectively reviewed for rebleeding rate, morbidity and mortality, changes in size or the aneurysm's configurations, and inflammatory reaction. We conducted a Medline search in the post-microsurgical era, excluding patients in whom wrapping was part of the aneurysm treatment in combination with clipping or coiling. The surgically related morbidity was 12.5%. Global mortality rate was 25% due to vasospasm (one case) and rebleeding (one case). Six patients are still alive. Rebleeding rate was 14.3% within 6 months; then, it was zero. Glasgow outcome scale (GOS) score at discharge was 1 and 4 in one patient, respectively, and 5 in the remaining six. Mean clinical follow-up was 126 months. GOS at last follow-up was 4 and 5 in 50% of patients, respectively. Mean mRS score was 0.8 at 2 months, and 2.4 at 12 months. Follow-up MR demonstrated persistence of the aneurysm's sac, without changes in size and configuration. Patients did not describe or exhibit symptoms attributable to complications inherent to the use of muscle. Microsurgical muscle-wrapping of ruptured intracranial aneurysm is safe, is associated with a low rate of acute and delayed postoperative complications and rebleeding, and could be a valid alternative for unclippable and non-amenable to endovascular procedure ruptured aneurysms.
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Affiliation(s)
- Antonino Germanò
- Neurosurgical Clinic, Department of Neurosciences, Psychiatry and Anaesthesiology, University of Messina Medical School, A.O.U. Policlinico G. Martino, Via Consolare Valeria, 1, 98125, Messina, Italy
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Conti A, Pontoriero A, Salamone I, Siragusa C, Midili F, La Torre D, Calisto A, Granata F, Romanelli P, De Renzis C, Tomasello F. Protecting venous structures during radiosurgery for parasagittal meningiomas. Neurosurg Focus 2009; 27:E11. [PMID: 19877789 DOI: 10.3171/2009.8.focus09-157] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic edema is a potential complication of meningioma radiosurgery. Parasagittal meningiomas are at a particular risk for symptomatic edema, suggesting a role for a venous occlusive complication. The authors sought to develop a strategy to optimize CyberKnife stereotactic radiosurgical treatment parameters to reduce the irradiation of the peritumoral venous system. Multislice CT venography with 3D reconstructions was performed and coregistered with thin-section, contrast-enhanced, volumetric MR images. The tumor and critical volumes were contoured on the MR images. Venous anatomical details obtained from the CT venographic study were then exported onto the MR imaging and fused MR imaging-CT study. Target and critical structure volumes and dosimetric parameters obtained with this method were analyzed. The authors found that reducing the irradiation of veins that course along the surface of the meningioma, which may be at risk for radiation-induced occlusion, is feasible in parasagittal meningioma radiosurgery without compromising other treatment parameters including conformality, homogeneity, and target coverage. Long-term follow-up is needed to assess the clinical validity of this treatment strategy.
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Affiliation(s)
- Alfredo Conti
- Departments of Neurosurgery, University of Messina, Italy.
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La Torre D, Maugeri R, Angileri FF, Pezzino G, Conti A, Cardali SM, Calisto A, Sciarrone G, Misefari A, Germanò A, Tomasello F. Human leukocyte antigen frequency in human high-grade gliomas: a case-control study in Sicily. Neurosurgery 2009; 64:1082-8; discussion 1088-9. [PMID: 19487887 DOI: 10.1227/01.neu.0000345946.35786.92] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Human leukocyte antigens (HLAs) are widely expressed cell surface molecules that present antigenic peptides to T lymphocytes and modulate immune response against inflammatory and malignant diseases. The aim of this study was to compare HLA distribution in patients with newly diagnosed high-grade gliomas (HGGs) and 2 control groups from a restricted geographic area (eastern Sicily). METHODS HLA allele frequency, as determined from peripheral blood of 56 adult patients with HGGs, was compared with that of 2 different control groups: 140 healthy bone marrow donors (group A) and 69 virtually brain tumor-free patients (group B). HLA expression was evaluated using a reverse transcriptase polymerase chain reaction-sequence-specific oligonucleotide probe. RESULTS There was significant expression of HLA-A*11 in patients with HGGs compared with control groups A and B (P < 0.003 and P < 0.018, respectively). Significant expression of HLA genotypes in patients with HGGs was also identified for HLA-DQB1*06 (P = 0.005), HLA-DRB1*14 (P = 0.001), and HLA-DRB3*01 (P = 0.007) compared with control group B. In HGG patients, there was statistically significantly decreased expression, compared with control groups A and B, of HLA-B*07 (P = 0.002 and P = 0.03, respectively) and HLA-C*04 (P = 0.007 and P = 0.016, respectively). There was statistically significant lower expression of HLA-C*05 in the HGG group compared with group B (P < 0.03). CONCLUSION This is the first study to describe the frequency of distribution of HLAs in a population from a restricted geographic area. The findings suggest a possible correlation between HLA allele distribution and the occurrence of newly diagnosed malignant astroglial brain tumors.
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Santamaria LB, Schifilliti D, La Torre D, Fodale V. Drugs of anaesthesia and cancer. Surg Oncol 2009; 19:63-81. [PMID: 19394815 DOI: 10.1016/j.suronc.2009.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 03/15/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
Abstract
Anaesthesia represents one of the most important medical advances in history, and, nowadays, can widely be considered safe, thanks to the discovery of new drugs and the adoption of modern technologies. Nevertheless, anaesthetic practices still represent cause for concern regarding the consequences they produce. Various anaesthetics are frequently used without knowing their effects on specific diseases: despite having been reported that invasion or metastasis of cancer cells easily occurs during surgical procedures, numerous anaesthetics are used for cancer resection even if their effect on the behaviour of cancer cells is unclear. Guidelines for a proper use of anaesthetics in cancer surgery are not available, therefore, the aim of the present review is to survey available up-to-date information on the effects of the most used drugs in anaesthesia (volatile and intravenous anaesthetics, nitrous oxide, opioids, local anaesthetics and neuromuscular blocking drugs) in correlation to cancer. This kind of knowledge could be a basic valuable support to improve anaesthesia performance and patient safety.
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Affiliation(s)
- Letterio B Santamaria
- Department of Neurosciences, Psychiatric and Anesthesiological Sciences, University of Messina, Via C.Valeria, Messina, Italy
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Conti A, Iacopino DG, Spada A, Cardali SM, Giusa M, La Torre D, Campennì A, Penna O, Baldari S, Tomasello F. Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations. Neurocrit Care 2009; 10:326-35. [PMID: 19238589 DOI: 10.1007/s12028-009-9199-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 01/29/2009] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10%. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations. METHODS Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar system, transorbital insonation of the ICA and ophthalmic artery, and transcervical insonation of the extracranial ICA. Repeated exams were performed in cases of persistent diastolic flow. RESULTS The specificity of the testing was 100%, no false-positive cases were recorded. The sensitivity of conventional TCD examination was 82.1%. The insonation of the extracranial ICA increased sensitivity to 88% allowing the detection of CCA in those patients lacking temporal windows; serial examinations further increased sensitivity to 95.6%. CONCLUSIONS The addition of insonation of the cervical ICA and of the siphon increased sensitivity of TCD. Nevertheless, a CCA flow patterns may appear later on those segments. Serial examinations, may be needed in those cases.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, University of Messina, Policlinico Universitario, Via Consolare Valeria 1, 98125, Messina, Italy.
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Angileri FF, Aguennouz M, Conti A, La Torre D, Cardali S, Crupi R, Tomasello C, Germanò A, Vita G, Tomasello F. Nuclear factor-kappaB activation and differential expression of survivin and Bcl-2 in human grade 2-4 astrocytomas. Cancer 2008; 112:2258-66. [PMID: 18327814 DOI: 10.1002/cncr.23407] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Antiapoptotis resulting from hyperactivation of the transcription factor NF-kappaB has been described in several cancer types. It is triggered by the interaction of the tumor necrosis factor (TNF) with its receptors and recruitment of the intermediate factor TNF-receptor associated factor (TRAF) 2. The NF-kappaB transcriptional activity could amplify the expression of antiapoptotic genes. The authors investigated the activity of NF-kappaB, and the mRNA expression of TNFalpha, TNFalpha receptor, TRAF1, TRAF2, and TRAF-associated NF-kappaB activator (TANK), and the antiapoptotic genes Bcl-2, c-IAP 1 and 2, and Survivin in human astrocytic tumors. METHODS Eight low-grade astrocytomas (LGA), 10 anaplastic astrocytomas (AAs), 10 glioblastoma multiforme (GBM) samples were used; 4 samples of normal brain tissue were used as controls. The NF-kappaB activation was analyzed by electrophoretic mobility shift assay; TRAF1, TRAF2, TANK/I-TRAF, Bcl-2, c-IAP 1 and 2, and Survivin mRNA expressions were studied using real-time quantitative reverse-transcriptase polymerase chain reaction. RESULTS NF-kappaB hyperactivity was detected in tumor samples. mRNA of antiapoptotic genes, particularly BCL-2 and Survivin, was hyperexpressed in gliomas. Interestingly, BCL-2 was hyperexpressed in LGAs, whereas a very high level of Survivin featured high-grade gliomas. The differential expression of antiapoptotic genes yielded a tight clustering of all LGA and nearly all GBM samples in cluster analysis. CONCLUSIONS NF-kappaB and factors involved in its intracellular activation were up-regulated in gliomas. NF-kappaB-activated antiapoptotic genes were hyperexpressed in tumor samples, but showed a differential expression with higher levels of Bcl-2 in LGAs and higher levels of Survivin in GBMs.
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Affiliation(s)
- Filippo F Angileri
- Department of Neuroscience, University of Messina School of Medicine, Messina, Italy
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Grasso G, Sfacteria A, Erbayraktar S, Passalacqua M, Meli F, Gokmen N, Yilmaz O, La Torre D, Buemi M, Iacopino DG, Coleman T, Cerami A, Brines M, Tomasello F. Amelioration of spinal cord compressive injury by pharmacological preconditioning with erythropoietin and a nonerythropoietic erythropoietin derivative. J Neurosurg Spine 2006; 4:310-8. [PMID: 16619678 DOI: 10.3171/spi.2006.4.4.310] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [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: 11/06/2022]
Abstract
OBJECT Spinal cord injury (SCI) is a devastating clinical syndrome for which no truly efficacious therapy has yet been identified. In preclinical studies, erythropoietin (EPO) and its nonerythropoietic derivatives asialoEPO and carbamylated EPO have markedly improved functional outcome when administered after compressive SCI. However, an optimum treatment paradigm is currently unknown. Because the uninjured spinal cord expresses a high density of EPO receptor (EPOR) in the basal state, signaling through these existing receptors in advance of injury (pharmacological preconditioning) might confer neuroprotection and therefore be potentially useful in situations of anticipated damage. METHODS The authors compared asialoEPO, a molecule that binds to the EPOR with high affinity but with a brief serum half-life (t1/2 < 2 minutes), to EPO to determine whether a single dose (10 microg/kg of body weight) administered by intravenous injection 24 hours before 1 minute of spinal cord compression provides benefit as determined by a 6-week assessment of neurological outcome and by histopathological analysis. Rats pretreated with asialoEPO or EPO and then subjected to a compressive injury exhibited improved motor function over 42 days, compared with animals treated with saline solution. However, pretreatment efficacy was substantially poorer than efficacy of treatment initiated at the time of injury. Serum samples drawn immediately before compression confirmed that no detectable asialoEPO remained within the systemic circulation. Western blot and immunohistochemical analyses performed using uninjured spinal cord 24 hours after a dose of asialoEPO exhibited a marked increase in glial fibrillary acidic protein, suggesting a glial response to EPO administration. CONCLUSIONS These results demonstrate that EPO and its analog do not need to be present at the time of injury to provide tissue protection and that tissue protection is markedly effective when either agent is administered immediately after injury. Furthermore, the findings suggest that asialoEPO is a useful reagent with which to study the dynamics of EPO-mediated neuroprotection. In addition, the findings support the concept of using a nonerythropoietic EPO derivative to provide tissue protection without activating the undesirable effects of EPO.
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Cardali S, Romano A, Angileri FF, Conti A, La Torre D, de Divitiis O, d'Avella D, Tschabitscher M, Tomasello F. Microsurgical anatomic features of the olfactory nerve: relevance to olfaction preservation in the pterional approach. Neurosurgery 2006; 57:17-21; discussion 17-21. [PMID: 15987566 DOI: 10.1227/01.neu.0000144844.72403.7b] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2004] [Accepted: 08/13/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The pterional approach represents the standard approach for most lesions of the anterior and middle cranial fossa. It requires some degree of frontal lobe retraction, which may result in temporary or permanent damage of olfaction because of nerve avulsion or mechanical compression. The purpose of this study, based on microanatomic dissection of human cadaveric specimens, was to review the microsurgical anatomic features of the nerve and suggest operative nuances that may contribute to reducing the rate of postoperative olfactory dysfunction. METHODS Twenty olfactory nerves and tracts were examined in 10 human cadaveric heads obtained from three fresh and seven formalin-fixed adult cadavers. A standard pterional craniotomy was performed. The olfactory nerve was dissected from its arachnoidal envelopes and then mobilized for an average length of 30 mm (range, 25-35 mm). RESULTS The possible retraction of the frontal lobe was 10 to 15 mm. More retraction invariably resulted in nerve disruption. CONCLUSION The standard sylvian and basal cistern opening may be insufficient to guarantee preservation of olfactory function. Early identification and arachnoidal dissection of the nerve may reduce the rate of olfaction compromise. The opening of the subarachnoidal space should be performed in a proximal-to-distal manner to allow early visualization of the olfactory bulb and its dissection. The arachnoidal dissection should be performed with sharp instruments, avoiding any traction on the posterior portion of the olfactory tract. Any direct retractor compression should also be avoided to spare the microvasculature lying on the dorsal surface of the nerve.
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Affiliation(s)
- Salvatore Cardali
- Neurosurgical Clinic, Department of Neurosciences, University of Messina Medical School, Messina, Italy
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Conti A, Ageunnouz M, La Torre D, Cardali S, Angileri FF, Buemi C, Tomasello C, Iacopino DG, D'Avella D, Vita G, Tomasello F. Expression of the tumor necrosis factor receptor-associated factors 1 and 2 and regulation of the nuclear factor-kappaB antiapoptotic activity in human gliomas. J Neurosurg 2005; 103:873-81. [PMID: 16304992 DOI: 10.3171/jns.2005.103.5.0873] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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: 12/23/2022]
Abstract
OBJECT Tumor necrosis factor receptor (TNFR)-associated factors (TRAFs) are a recently established group of proteins involved in the intracellular signaling of the TNFR superfamily members. The TRAFs have been implicated in promoting cell survival through the activation of transcription factor nuclear factor (NF)-kappaB. The authors investigated the expression of NF-kappaB, caspase 3, TRAF1, TRAF2, and TRAF-associated NF-kappaB activator/TRAF-interacting protein (TANK/I-TRAF), a regulator of TRAF activity, in human gliomas. METHODS Tumor samples were obtained in 27 adult patients harboring seven low-grade gliomas, nine anaplastic astrocytomas, and 11 glioblastomas multiforme. The NF-kappaB activation was analyzed using the electrophoresis mobility shift assay; TRAF1, TRAF2, TANK/I-TRAF, and caspase 3 expression were studied using Western blot analysis. Upregulated NF-kappaB DNA-binding activity, compared with that in normal brain tissue, was detected in all tumor samples (p = 0.002). The level of NF-kappaB activity showed some correlation with World Health Organization tumor grades (p = 0.01), even though variable activity levels were demonstrated in relation to tissue heterogeneity, which resulted in a substantial number of outliers in the quantitative analysis. Increased levels of TRAF1, TRAF2, and TANK/ I-TRAF were expressed in astrocytomas compared with levels in normal brain tissue (p = 0.02, 0.006, and 0.01, respectively). CONCLUSIONS Data in this study confirm the upregulation of NF-kappaB in gliomas and reveal a correlation between levels of this transcription factor and tumor grade. A constitutive expression of TRAF1, TRAF2, and TANK/I-TRAF in human gliomas was documented. These proteins are involved in the intracellular signal transduction of the TNFR superfamily and in the control of NF-kappaB expression and its antiapoptotic activity.
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Affiliation(s)
- Alfredo Conti
- Department of Neuroscience, Neurosurgical and Neurological Clinics, University of Messina School of Medicine, Messina, Italy.
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La Torre D, de Divitiis O, Conti A, Angileri FF, Cardali S, Aguennouz M, Aragona M, Panetta S, d'Avella D, Vita G, La Torre F, Tomasello F. Expression of Telomeric Repeat Binding Factor-1 in Astroglial Brain Tumors. Neurosurgery 2005; 56:802-10. [PMID: 15792519 DOI: 10.1227/01.neu.0000156468.41461.6f] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 11/01/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In human somatic cells, telomeres shorten with successive cell divisions, resulting in progressive genomic instability, altered gene expression, and cell death. Recently, telomere-specific deoxyribonucleic acid-binding proteins, such as telomeric repeat binding factor-1 (TRF1), have been proposed as candidates for the role of molecules regulating telomerase activity, and they have been suggested to play key roles in the maintenance of telomere function. The present study was designed to assess TRF1 expression in human astroglial brain tumors and to speculate on the clinical implications of its expression. METHODS Twenty flash-frozen surgical specimens obtained from adult patients who underwent craniotomy for microsurgical tumor resection, histologically verified as World Health Organization Grade II to IV astrocytomas, were used. Expression of TRF1 in astrocytomas of different grades was studied by means of both immunohistochemical and Western blotting analysis. The correlation between the extent of TRF1 expression and histological grading, performance status, and length of survival of patients underwent statistical analyses. RESULTS TRF1 was expressed in all tumor samples. The level of its expression was variable, decreasing from low-grade through high-grade astrocytomas (P = 0.0032). TRF1 expression correlated with the patient's length of survival (P < 0.001) and performance status (P < 0.001) and proved to be an independent indicator of length of survival. CONCLUSION Our findings suggest that the loss of TRF1 expression capability, as a result of down-regulation of TRF1 expression in malignant gliomas cells, may play a role in the malignant progression of astroglial brain tumors.
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Affiliation(s)
- Domenico La Torre
- Neurosurgical Clinic, Department of Neurosciences, Psychiatric and Anesthesiological Sciences, University of Messina School of Medicine, Messina, Italy
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La Rosa G, Cardali S, Genovese T, Conti A, Di Paola R, La Torre D, Cacciola F, Cuzzocrea S. Inhibition of the nuclear factor-kappaB activation with pyrrolidine dithiocarbamate attenuating inflammation and oxidative stress after experimental spinal cord trauma in rats. J Neurosurg Spine 2004; 1:311-21. [PMID: 15478370 DOI: 10.3171/spi.2004.1.3.0311] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [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: 11/06/2022]
Abstract
OBJECT The nuclear factor-kappaB (NF-kappaB) is a transcription factor that plays a pivotal role in the induction of genes involved in physiological processes and in the response to inflammation. The authors of recent studies have demonstrated that NF-kappaB and oxidative stress contribute to secondary injury after impact-induced spinal cord injury (SCI) in the rat. Dithiocarbamates are antioxidants that are potent inhibitors of NF-kappaB. The authors postulated that pyrrolidine dithiocarbamate (PDTC) would attenuate NF-kappaB-related inflammatory and oxidative events that occur after SCI. METHODS Spinal cord injury was induced by the application of vascular clips (force of 50 g) to the dura mater after a four-level T5-8 laminectomy. The authors investigated the effects of PDTC (30 mg/kg administered 30 minutes before SCI and 6 hours after SCI) on the development of the inflammatory response associated with SCI in rats. Levels of myeloperoxidase activity were measured as an indicator of polymorphonuclear infiltration; malondialdehyde levels in the spinal cord tissue were determined as an indicator of lipid peroxidation. The following studies were performed: immunohistochemical analysis to assess levels of inducible nitric oxide synthase (iNOS), nitrotyrosine formation, poly([adenosine diphosphate]-ribose) polymerase (PARP) activity; Western blot analysis to determine cytoplasmic levels of inhibitory-kappaB-alpha (IkappaB-alpha); and electrophoretic mobility-shift assay to measure the level of DNA/NF-kappaB binding. The PDTC treatment exerted potent antiinflammatory effects with significant reduction of polymorphonuclear cell infiltration, lipid peroxidation, and iNOS activity. Furthermore, administration of PDTC reduced immunohistochemical evidence of formation of nitrotyrosine and PARP activation in the spinal cord section obtained in the SCI-treated rats. Additionally, PDTC treatment significantly prevented the activation of NF-kappaB (electrophoretic mobility-shift assay and immunoblot analysis). CONCLUSIONS Overall, the results clearly demonstrate that PDTC-related prevention of the activation of NF-kappaB reduces the development of some secondary injury events after SCI. Therefore, inhibition of NF-kappaB may represent a novel approach in the treatment of SCIs.
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Affiliation(s)
- Giovanni La Rosa
- Neurosurgical Clinic and Institute of Pharmacology, University of Messina School of Medicine, Messina, Italy
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de Divitiis O, Conti A, Angileri FF, Cardali S, La Torre D, Tschabitscher M. Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: anatomic study. Neurosurgery 2004; 54:125-30; discussion 130. [PMID: 14683549 DOI: 10.1227/01.neu.0000097271.55741.60] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2003] [Accepted: 08/27/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to review the endoscopic anatomic features of the anterior brainstem and surrounding cisternal spaces via a transoral-transclival approach. METHODS Fifteen adult human cadaveric heads, obtained from 10 fresh cadavers and 5 formalin-fixed cadavers, were used to demonstrate both the feasibility of an endoscopic transoral-transclival intradural approach and its exposure potential. To analyze the exact extension of a safe entry zone through the clivus, 20 skull bases were used to obtain anatomic measurements. RESULTS The transoral approach was performed without maxillotomy or mandibulotomy and with a clival opening of 20 by 15 mm. Such a limited clival and dural opening allowed the insertion of the endoscope and instruments, full visualization of the anterolateral brainstem and cisternal spaces around it, and reconstruction of all anatomic layers by means of a paraendoscopic technique. CONCLUSION The endoscopic transoral-transclival approach enables full access to the anterolateral brainstem and to the cisternal space around it. The use of the endoscope has the potential to reduce the need for a wider cranial base opening and the danger of postoperative complications.
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Affiliation(s)
- Oreste de Divitiis
- Neurosurgical Clinic, University of Messina School of Medicine, Messina, Italy.
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La Rosa G, Conti A, Cacciola F, Cardali S, La Torre D, Gambadauro NM, Tomasello F. Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg 2003; 99:143-50. [PMID: 12956455 DOI: 10.3171/spi.2003.99.2.0143] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [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: 11/06/2022]
Abstract
OBJECT Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. METHODS Thirty-five consecutive patients underwent pedicle screw fixation for isthmic spondylolisthesis. In 18 patients posterior lumbar fusion was performed, and in 17 patients PLIF was added. Clinical, economic, functional, and radiographic data were assessed to determine differences in clinical and functional results and biomechanical properties. At 2-year follow-up examination, the correction of subluxation, disc height, and foraminal area were maintained in the group in which a PLIF procedure was performed, but not in the posterolateral fusion-only group (p < 0.05). Nevertheless, no statistical intergroup differences were demonstrated in terms of neurological improvement (p = 1), economic (p = 0.43), or functional (p = 0.95) outcome, nor in terms of fusion rate (p = 0.49). CONCLUSIONS The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.
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Affiliation(s)
- Giovanni La Rosa
- Neurosurgical Clinic, University of Messina School of Medicine, Messina, Italy
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