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Levi V, Stanziano M, Pinto C, Zibordi F, Fedeli D, Caldiera V, Cilia R, Golfrè Andreasi N, Braccia A, Carozzi C, Ciceri E, Grisoli M, Gemma M, Nazzi V, DiMeco F, Eleopra R, Zorzi G. Bilateral Simultaneous Magnetic Resonance-Guided Focused Ultrasound Pallidotomy for Life-Threatening Status Dystonicus. Mov Disord 2024. [PMID: 38641910 DOI: 10.1002/mds.29811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Invasive treatments like radiofrequency stereotactic lesioning or deep brain stimulation of the globus pallidus internus can resolve drug-resistant status dystonicus (SD). However, these open procedures are not always feasible in patients with SD. OBJECTIVE The aim was to report the safety and efficacy of simultaneous asleep bilateral transcranial magnetic resonance-guided focused ultrasound (MRgFUS) pallidotomy for life-threatening SD. METHODS We performed bilateral simultaneous MRgFUS pallidotomy under general anesthesia in 2 young patients with pantothenate kinase-associated neurodegeneration and GNAO1 encephalopathy. Both patients had medically refractory SD and severe comorbidities contraindicating open surgery. RESULTS SD resolved at 4 and 12 days after MRgFUS, respectively. Adverse events (intraoperative hypothermia and postoperative facial paralysis) were mild and transient. CONCLUSION Bilateral simultaneous MRgFUS pallidotomy under general anesthesia is safe and may be a valid alternative therapeutic option for fragile patients. Further studies are needed to assess long-term efficacy of the procedure. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vincenzo Levi
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carmela Pinto
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Zibordi
- Child Neuropsychiatry Movement Disorders Unit, Pediatric Neuroscience Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Davide Fedeli
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Caldiera
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Cilia
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nico Golfrè Andreasi
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arianna Braccia
- Parkinson and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carla Carozzi
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Ciceri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Gemma
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Eleopra
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giovanna Zorzi
- Child Neuropsychiatry Movement Disorders Unit, Pediatric Neuroscience Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Riccietti C, Schiavolin S, Caldiera V, Ganci G, Sgoifo A, Camarda G, Leonardi M, Ciceri E. Considering Psychological and Cognitive Factors in Interventional Neuroradiology: A Systematic Literature Review. AJNR Am J Neuroradiol 2023; 44:1282-1290. [PMID: 37827718 PMCID: PMC10631534 DOI: 10.3174/ajnr.a8007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Interventional neuroradiology is a relatively recent discipline that diagnoses and treats cerebral vascular diseases. However, specific literature on cognitive and psychological domains of patients undergoing interventional neuroradiology procedures is limited. PURPOSE Our aim was to review the existent literature on cognitive and psychological domains in patients undergoing interventional neuroradiology procedures to raise clinicians' awareness of their mental status. DATA SOURCES Articles were searched in PubMed, EMBASE, and Scopus from 2000 to 2022 using terms such as "interventional neuroradiology," "psychology," and "cognition" according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION Of 1483 articles in English, 64 were included and analyzed. Twelve focused on psychological aspects; 52, on cognitive ones. DATA ANALYSIS Regarding psychological aspects, it appears that early psychological consultations and "nonpharmacologic" strategies can impact the anxiety and depression of patients undergoing endovascular procedures. Regarding cognitive aspects, it appears that endovascular treatment is safe and generates similar or even fewer cognitive deficits compared with analogous surgical procedures. DATA SYNTHESIS Among the 12 articles on psychological aspects, 6/12 were retrospective with one, while 6/12 were prospective. Among the 52 articles on cognitive aspects, 7/54 were retrospective, while 45/52 were prospective. LIMITATIONS The main limitation derives from the inhomogeneity of the cognitive and psychological assessment tools used in the articles included in our analysis. CONCLUSIONS Our review highlights the need to include cognitive and psychological assessments in clinical practice in case patients eligible for interventional neuroradiology procedures. In the future, much more research of and attention to cognitive and psychologic aspects of neurovascular disease is needed. Systematic incorporation of strategies and tools to access and address pre, peri-, and postprocedural psychological and cognitive components could have major benefits in patient satisfaction, recovery, and the success of endovascular practice.
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Affiliation(s)
- Chiara Riccietti
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
| | - Silvia Schiavolin
- Department of Neurology (S.S., G.C., M.L.), Public Health and Disability Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Caldiera
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Ganci
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
| | - Annalisa Sgoifo
- Department of Neurology and Stroke Unit (A.S.), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgia Camarda
- Department of Neurology (S.S., G.C., M.L.), Public Health and Disability Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Department of Neurology (S.S., G.C., M.L.), Public Health and Disability Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Ciceri
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
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Nukovic JJ, Opancina V, Ciceri E, Muto M, Zdravkovic N, Altin A, Altaysoy P, Kastelic R, Velazquez Mendivil DM, Nukovic JA, Markovic NV, Opancina M, Prodanovic T, Nukovic M, Kostic J, Prodanovic N. Neuroimaging Modalities Used for Ischemic Stroke Diagnosis and Monitoring. Medicina (Kaunas) 2023; 59:1908. [PMID: 38003957 PMCID: PMC10673396 DOI: 10.3390/medicina59111908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Strokes are one of the global leading causes of physical or mental impairment and fatality, classified into hemorrhagic and ischemic strokes. Ischemic strokes happen when a thrombus blocks or plugs an artery and interrupts or reduces blood supply to the brain tissue. Deciding on the imaging modality which will be used for stroke detection depends on the expertise and availability of staff and the infrastructure of hospitals. Magnetic resonance imaging provides valuable information, and its sensitivity for smaller infarcts is greater, while computed tomography is more extensively used, since it can promptly exclude acute cerebral hemorrhages and is more favorable speed-wise. The aim of this article was to give information about the neuroimaging modalities used for the diagnosis and monitoring of ischemic strokes. We reviewed the available literature and presented the use of computed tomography, CT angiography, CT perfusion, magnetic resonance imaging, MR angiography and MR perfusion for the detection of ischemic strokes and their monitoring in different phases of stroke development.
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Affiliation(s)
- Jasmin J. Nukovic
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Diagnostic Imaging and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, 80131 Naples, Italy
| | - Elisa Ciceri
- Diagnostic Imaging and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, 80131 Naples, Italy
| | - Nebojsa Zdravkovic
- Department of Biomedical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ahmet Altin
- Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey
| | - Pelin Altaysoy
- Faculty of Medicine, Bahcesehir University, Istanbul 34349, Turkey
| | - Rebeka Kastelic
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Jusuf A. Nukovic
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Nenad V. Markovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Miljan Opancina
- Department of Biomedical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Military Medical Academy, Faculty of Medicine, University of Defense, 11000 Belgrade, Serbia
| | - Tijana Prodanovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Merisa Nukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Jelena Kostic
- Department of Radiology, Medical Faculty, University of Belgrade, 11120 Beograd, Serbia
| | - Nikola Prodanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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De Grado A, Manfredi C, Brugnera A, Groppo E, Valvassori L, Cencini F, Erbetta A, Ciceri E, Lerario R, Priori A, Scelzo E. Watch brain circulation in unexplained progressive myelopathy: a review of Cognard type V arterio-venous fistulas. Neurol Sci 2023; 44:3457-3480. [PMID: 37380820 PMCID: PMC10495521 DOI: 10.1007/s10072-023-06870-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/18/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Intracranial dural arterio-venous fistulas are pathological anastomoses between arteries and veins located within dural sheets and whose clinical manifestations depend on location and hemodynamic features. They can sometimes display perimedullary venous drainage (Cognard type V fistulas-CVFs) and present as a progressive myelopathy. Our review aims at describing CVFs' variety of clinical presentation, investigating a possible association between diagnostic delay and outcome and assessing whether there is a correlation between clinical and/or radiological signs and clinical outcomes. METHODS We conducted a systematic search on Pubmed, looking for articles describing patients with CVFs complicated with myelopathy. RESULTS A total of 72 articles for an overall of 100 patients were selected. The mean age was 56.20 ± 14.07, 72% of patients were man, and 58% received an initial misdiagnosis. CVFs showed a progressive onset in 65% of cases, beginning with motor symptoms in 79% of cases. As for the MRI, 81% presented spinal flow voids. The median time from symptoms' onset to diagnosis was 5 months with longer delays for patients experiencing worse outcomes. Finally, 67.1% of patients showed poor outcomes while the remaining 32.9% obtained a partial-to-full recovery. CONCLUSIONS We confirmed CVFs' broad clinical spectrum of presentation and found that the outcome is not associated with the severity of the clinical picture at onset, but it has a negative correlation with the length of diagnostic delay. We furthermore underlined the importance of cervico-dorsal perimedullary T1/T2 flow voids as a reliable MRI parameter to orient the diagnosis and distinguish CVFs from most of their mimics.
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Affiliation(s)
- Amedeo De Grado
- Clinica Neurologica, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio Di Rudinì, 8, Milan, Italy
| | - Chiara Manfredi
- Clinica Neurologica, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio Di Rudinì, 8, Milan, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Elisabetta Groppo
- Clinica Neurologica, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio Di Rudinì, 8, Milan, Italy
| | - Luca Valvassori
- Department of Neuroradiology, ASST Santi Paolo E Carlo, Milan, Italy
| | - Federica Cencini
- Clinica Neurologica, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio Di Rudinì, 8, Milan, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Ciceri
- Department of Imaging Radiology and Interventional Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rosanna Lerario
- Institute of Bari, Spinal Unit, ICS MAUGERI SPA SB, IRCCS, Bari, Italy
| | - Alberto Priori
- Clinica Neurologica, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio Di Rudinì, 8, Milan, Italy.
- Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.
| | - Emma Scelzo
- Clinica Neurologica, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Antonio Di Rudinì, 8, Milan, Italy
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Chiapparini L, Opancina V, Erbetta A, Pollo B, Broggi M, Ciceri E. Case 310: Posterior Epidural Migration of a Lumbar Disk Herniation. Radiology 2023; 306:e212607. [PMID: 36689345 DOI: 10.1148/radiol.212607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
HISTORY A 49-year-old man presented with right foot drop, bilateral cruralgia mainly on the left side, and genital and perianal hypoesthesia, which started suddenly 12 days before. After onset of symptoms, the patient also experienced an accidental fall at home, resulting in a left fibular fracture, which was treated with reduction and with seven-hole plate Synthes Locking Compression Plate at the orthopedic clinic. The neurologic examination showed paresthesias on the posterior aspect of both thighs and crural regions that was worse on the left side, hypoesthesia in the L5 root region on the right side, and right foot drop. There was no urinary retention or fecal incontinence. The patient denied past surgery, back trauma, heavy manual labor, hypermobility, or any other remarkable medical history. The patient was afebrile. Laboratory results on the 1st day of hospitalization showed increased C-reactive protein level (0.62 mg/dL; reference range, 0.0-0.5 mg/dL), elevated erythrocyte sedimentation rate (60 mm/h; reference range, 0-20 mm/h), and increased aspartate transaminase (38 U/L [0.63 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), alanine transaminase (70 U/L [1.17 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), and high lymphocyte (4.55 × 103/mL; reference range, [1.0-3.0] ×103/mL), and neutrophil (8.79 × 103/mL; reference range, [2.0-7.0] × 103/mL) levels. Absence of coagulopathy was demonstrated by normal coagulation values (international normalized ratio, 1.19; reference value, 0.80-1.25; activated partial thromboplastin time ratio, 0.88 second; reference range, 0.79-1.27 seconds). Electroneurography showed marked hypoevocable F response in the right tibia. Electromyography indicated severe reduction of muscle recruitment pertaining to right L4, L5, and S1 nerve territory and, to a lesser extent, of muscles pertaining to L3 territory bilaterally in the absence of spontaneous denervation. Unenhanced CT and contrast-enhanced MRI of the lumbosacral spine were performed.
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Affiliation(s)
- Luisa Chiapparini
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Valentina Opancina
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Alessandra Erbetta
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Bianca Pollo
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Morgan Broggi
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Elisa Ciceri
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
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Acerbi F, Mazzapicchi E, Falco J, Vetrano IG, Restelli F, Faragò G, La Corte E, Bonomo G, Bersano A, Canavero I, Gemma M, Broggi M, Schiariti M, Ziliani V, Raccuia G, Mangiafico S, Ganci G, Ciceri E, Ferroli P. The Role of Bypass Surgery for the Management of Complex Intracranial Aneurysms in the Anterior Circulation in the Flow-Diverter Era: A Single-Center Series. Brain Sci 2022; 12:brainsci12101339. [PMID: 36291273 PMCID: PMC9599372 DOI: 10.3390/brainsci12101339] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the increasing popularity of flow diverters (FDs) as an endovascular option for intracranial aneurysms, the treatment of complex aneurysms still represents a challenge. Combined strategies using a flow-preservation bypass could be considered in selected cases. In this study, we retrospectively reviewed our series of patients with complex intracranial aneurysms submitted to bypass. From January 2015 to May 2022, 23 patients were selected. We identified 11 cases (47.8%) of MCA, 6 cases (26.1%) of ACA and 6 cases (26.1%) of ICA aneurysms. The mean maximal diameter was 22.73 ± 12.16 mm, 8 were considered as giant, 9 were fusiform, 8 presented intraluminal thrombosis, 10 presented wall calcification, and 18 involved major branches or perforating arteries. Twenty-five bypass procedures were performed in 23 patients (two EC–IC bypasses with radial artery graft, seventeen single- or double-barrel STA–MCA bypasses and six IC–IC bypasses in anterior cerebral arteries). The long-term bypass patency rate was 94.5%, and the total aneurysm exclusion was 95.6%, with a mean follow-up of 28 months. Median KPS values at last follow-up was 90, and a favorable outcome (KPS ≥ 70 and mRS ≤ 2) was obtained in 87% of the cases. The use of bypass techniques represents, in selected cases, a valid therapeutic option in the management of complex anterior circulation aneurysms when a simpler direct approach, including the use of FD, is considered not feasible.
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Affiliation(s)
- Francesco Acerbi
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-022-394-2309
| | - Elio Mazzapicchi
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ignazio Gaspare Vetrano
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giuseppe Faragò
- Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Bonomo
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Anna Bersano
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Isabella Canavero
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Gemma
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Schiariti
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Vanessa Ziliani
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Gabriella Raccuia
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | | | - Giuseppe Ganci
- Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elisa Ciceri
- Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Chiapparini L, Opancina V, Erbetta A, Pollo B, Broggi M, Ciceri E. Case 310. Radiology 2022; 305:239-241. [PMID: 36154283 DOI: 10.1148/radiol.212606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HISTORY A 49-year-old man presented with right foot drop, bilateral cruralgia mainly on the left side, and genital and perianal hypoesthesia, which started suddenly 12 days before. After onset of symptoms, the patient also experienced an accidental fall at home, resulting in a left fibular fracture, which was treated with reduction and with seven-hole plate Synthes Locking Compression Plate at the orthopedic clinic. The neurologic examination showed paresthesias on the posterior aspect of both thighs and crural regions that was worse on the left side, hypoesthesia in the L5 root region on the right side, and right foot drop. There was no urinary retention or fecal incontinence. The patient denied past surgery, back trauma, heavy manual labor, hypermobility, or any other remarkable medical history. The patient was afebrile. Laboratory results on the 1st day of hospitalization showed increased C-reactive protein level (0.62 mg/dL; reference range, 0.0-0.5 mg/dL), elevated erythrocyte sedimentation rate (60 mm/h; reference range, 0-20 mm/h), and increased aspartate transaminase (38 U/L [0.63 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), alanine transaminase (70 U/L [1.17 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), and high lymphocyte (4.55 × 103/μL; reference range, [1.0-3.0] × 103/μL), and neutrophil (8.79 × 103/μL; reference range, [2.0-7.0] × 103/μL) levels. Absence of coagulopathy was demonstrated by normal coagulation values (international normalized ratio, 1.19; reference value, 0.80-1.25; activated partial thromboplastin time ratio, 0.88 second; reference range, 0.79-1.27 seconds). Electroneurography showed marked hypoevocable F response in the right tibia. Electromyography indicated severe reduction of muscle recruitment pertaining to right L4, L5, and S1 nerve territory and, to a lesser extent, of muscles pertaining to L3 territory bilaterally in the absence of spontaneous denervation. Unenhanced CT (Fig 1) and contrast-enhanced MRI of the lumbosacral spine were performed (Figs 2, 3).
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Affiliation(s)
- Luisa Chiapparini
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Valentina Opancina
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Alessandra Erbetta
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Bianca Pollo
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Morgan Broggi
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Elisa Ciceri
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
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Pierot L, Lamin S, Barreau X, Berlis A, Ciceri E, Cohen JE, Costalat V, Eker OF, Henkes H, Holtmannspötter M, Januel AC, Keston P, Klisch J, Psychogios MN, Valvassori L, Cognard C, Spelle L. Coating (Coating to Optimize Aneurysm Treatment in the New Flow Diverter Generation) study. The first randomized controlled trial evaluating a coated flow diverter (p64 MW HPC): study design. J Neurointerv Surg 2022:neurintsurg-2022-018969. [PMID: 35609974 DOI: 10.1136/neurintsurg-2022-018969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Due to its high efficacy, flow diversion is increasingly used in the management of unruptured and recanalized aneurysms. Because of the need for perioperative dual antiplatelet treatment (DAPT), flow diversion is not indicated for the treatment of ruptured aneurysms. To overcome this major limitation, surface modification-'coating'-of flow diverters has been developed to reduce platelet aggregation on the implanted device, reduce thromboembolic complications, and facilitate the use of coated flow diverter treatment in patients with single antiplatelet treatment (SAPT). COATING (Coating to Optimize Aneurysm Treatment in the New Flow Diverter Generation) is a prospective, randomized, multicenter trial that aims to determine whether the use of the coated flow diverter p64 MW HPC under SAPT is non-inferior (or even superior) to the use of the bare flow diverter p64 MW under DAPT in relation to thromboembolic and hemorrhagic complications. METHODS Patients with unruptured or recanalized aneurysms for which endovascular treatment with a flow diverter is indicated will be enrolled and randomly assigned on a 1:1 ratio to one of two treatment groups: p64 MW HPC with SAPT or p64 MW with DAPT. RESULTS The primary endpoint is the number of diffusion-weighted imaging lesions visualized via MRI assessed within 48 hours (±24 hours) of the index procedure. Secondary primary endpoints are comparing safety and efficacy in both arms. CONCLUSIONS This randomized controlled trial is the first to directly compare safety and efficacy of coated flow diverters under SAPT with bare flow diverters under DAPT. TRIAL REGISTRATION NUMBER http://clinicaltrials.gov/ - NCT04870047.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Université Reims Champagne Ardenne, Reims, France
| | - Saleh Lamin
- Department of Interventional Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Xavier Barreau
- Department of Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Bayern, Germany
| | - Elisa Ciceri
- Department of Neuroradiology, Fondazione IRCSS Instituto Neurologico Carlo Besta, Milano, Lombardia, Italy
| | - José E Cohen
- Department of Neurosurgery and Radiology, Hadassah Hebrew University, University Medcal Centers, Jerusalem, Jerusalem, Israel
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Hôpital Gui de Chauliac, Montpellier, France
| | - Omer F Eker
- Department of Neuroradiology, CHU Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Markus Holtmannspötter
- Department of Neuroradiology, Nuremberg Hospital, South Campus, Paracelsus Medical University, Nuremberg, Bayern, Germany
| | | | - Peter Keston
- Department of Neuroradiology, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
| | - Joachim Klisch
- Department of Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Thüringen, Germany
| | | | - Luca Valvassori
- Department of Neuroradiology, San Carlo Borromeo Hospital, Milano, Lombardia, Italy
| | | | - Laurent Spelle
- NEURI Interventional Neuroradiology, APHP, Paris, Île-de-France, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
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9
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Raggi A, Bianchi Marzoli S, Ciasca P, Cammarata G, Melzi L, Chiapparini L, Erbetta A, Ciceri E, Faragò G, Gioppo A, Usai S, D'Amico D. The Pre-Lumbar puncture Intracranial Hypertension Scale (PLIHS): A practical scale to identify subjects with normal cerebrospinal fluid pressure in the management of idiopathic intracranial hypertension. J Neurol Sci 2021; 429:118058. [PMID: 34461550 DOI: 10.1016/j.jns.2021.118058] [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: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Idiopathic Intracranial Hypertension (IIH) diagnosis requires lumbar puncture to measure cerebrospinal fluid (CSF) pressure. The Pre-Lumbar puncture Intracranial Hypertension Scale (PLIHS) is aimed to detect cases that will show raised or normal CSF opening pressure. METHODS Retrospective analysis of records of patients who underwent lumbar puncture for suspect IIH. The target was CSF opening pressure ≥ 250 mmH2O, whereas a set of known neurological, neuro-ophthalmological and neuro-radiological parameters, plus obesity, were used as predictors in a logistic regression model. The PLIHS was based on significant predictors and a cut-off was validated using chi-squared test around CSF opening pressure ≥ 250 and < 200 mmH2O. RESULTS Records of 162 patients were included: CSF opening pressure was <200 mmH2O in 40 and ≥ 250 mmH2O in 95 patients; 85 fulfilled IIH diagnosis. PLIHS is based on Frisén grade 2 or higher papilledema, tinnitus, empty sella, perioptic subarachnoid space distension, and obesity. Score range is 0-7: correlation with CSF opening pressure is 0.508 (p < .001), and PLIHS score is different between subjects not diagnosed with IIH, and those diagnosed with IIH both with and without papilledema (p < .001). PLIHS score ≤ 2 identifies cerebrospinal fluid pressure < 200 mmH2O; PLIHS score ≥ 3 identifies CSF opening pressure ≥ 250 mmH2O, IIH diagnosis, visual acuity ≤0.7, and optic nerve atrophy. CONCLUSIONS The PLIHS, can be used to identify patients who will particularly need LP, thus helping with the organization of the diagnostic work-up by optimising healthcare resources and potentially limit the likelihood to incur in LP-related adverse events.
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Affiliation(s)
- Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurology, Public Health and Disability Unit, Milano, Italy.
| | - Stefania Bianchi Marzoli
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Paola Ciasca
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Gabriella Cammarata
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Lisa Melzi
- Istituto Auxologico Italiano IRCCS, Neuro-ophthalmology Center - Scientific Institute Capitanio Hospital, Milano, Italy.
| | - Luisa Chiapparini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milano, Italy.
| | - Alessandra Erbetta
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milano, Italy.
| | - Elisa Ciceri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Radiodiagnostic and Interventional Neuroradiology, Milano, Italy.
| | - Giuseppe Faragò
- Papa Giovanni XXII Hospital, Neuroradiology Department, Bergamo, Italy.
| | - Andrea Gioppo
- ASST Santi Paolo e Carlo, P.O San Carlo, Radiologia II - Neurodiagnostica-Neurointerventistica, Milano, Italy.
| | - Susanna Usai
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroalgology Unit, Milano, Italy.
| | - Domenico D'Amico
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroalgology Unit, Milano, Italy.
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De Grado A, Manfredi C, Groppo E, Scarabello M, Valvassori L, Cencini F, Bartesaghi F, Erbetta A, Ciceri E, Bocci T, Priori A, Scelzo E. Progressive myelopathy due to treatable intracranial dural arterovenous fistulae. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Piano M, Lozupone E, Sgoifo A, Nuzzi NP, Asteggiano F, Pero G, Quilici L, Iannucci G, Cerini P, Comelli C, Peschillo S, Princiotta C, Pedicelli A, Limbucci N, Ganci G, Trasimeni G, Ciceri E, Faragò G, Giorgianni A, DE Nicola M, Remida P, Lafe E, Mardighian D, Ruggiero M, Lazzarotti GA, Cavasin N, Castellan L, Chiumarulo L, Burdi N, Paolucci A, Briganti F, Natrella M, Florio FP, Pavia M, Gallesio I, Lucente G, Gozzoli L, Caputo N, Vagnarelli S, Boccardi E, Valvassori L. Long-term follow-up of the Derivo® Embolization Device (DED®) for intracranial aneurysms: the Italian Multicentric Registry. J Neurosurg Sci 2021; 65:361-368. [PMID: 33879762 DOI: 10.23736/s0390-5616.21.05300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The flow-diverter devices (FDDs) safety and effectiveness have been demonstrated by large series and meta-analyses. Due to the high occlusion rates and the acceptable morbidity rates of FDDs, the indications for their use are continuously expanding. We presented our Italian multicentric experience using the second generation of DERIVO® Embolization Device (DED®; Acandis, Pforzheim, Germany) to cure cerebral aneurysms, evaluating both middle and long-term safety and efficacy of this device. METHODS Between July 2016 and September 2017 we collected 109 consecutive aneurysms in 108 patients treated using DED® during 109 endovascular procedures in 34 Italian centers (100/109 aneurysms were unruptured, 9/109 were ruptured). The collected data included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and post-treatment modified Rankin Scale scores. Midterm and long-term clinical, angiographic and cross-sectional CT/MR follow-up were recorded and collected until December 2018. RESULTS In 2/109 cases, DED® placement was classified as technical failures. The overall mortality and morbidity rates were respectively 6.5% and 5.5%. Overall DERIVO® related mortality and morbidity rates were respectively 0% and 4.6% (5 out of 108 patients). Midterm neuroimaging follow-up showed the complete or nearly complete occlusion of the aneurysm in 90% cases, which became 93% at long-term follow-up. Aneurysmal sac shrinking was observed in 65% of assessable aneurysms. CONCLUSIONS Our multicentric experience using DED® for endovascular treatment of unruptured and ruptured aneurysms showed a high safety and efficacy profile, substantially equivalent or better compared to the other FDDs.
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Affiliation(s)
| | | | | | | | | | - Guglielmo Pero
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Quilici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Paolo Cerini
- Maggiore della Carità University Hospital, Novara, Italy
| | | | | | | | | | | | | | | | - Elisa Ciceri
- Azienda Ospedaliera Universitaria Integrata di Verona (AOUI-Vr), Verona, Italy
| | - Giuseppe Faragò
- IRCCS Neurologic Institute C. Besta Foundation, Milan, Italy
| | | | | | - Paolo Remida
- ASST San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Elvis Lafe
- IRCCS Polyclinic San Matteo Foundation, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | - Francesco P Florio
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | | | - Ivan Gallesio
- AON SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Casetta I, Fainardi E, Saia V, Pracucci G, Padroni M, Renieri L, Nencini P, Inzitari D, Morosetti D, Sallustio F, Vallone S, Bigliardi G, Zini A, Longo M, Francalanza I, Bracco S, Vallone IM, Tassi R, Bergui M, Naldi A, Saletti A, De Vito A, Gasparotti R, Magoni M, Castellan L, Serrati C, Menozzi R, Scoditti U, Causin F, Pieroni A, Puglielli E, Casalena A, Sanna A, Ruggiero M, Cordici F, Di Maggio L, Duc E, Cosottini M, Giannini N, Sanfilippo G, Zappoli F, Cavallini A, Cavasin N, Critelli A, Ciceri E, Plebani M, Cappellari M, Chiumarulo L, Petruzzellis M, Terrana A, Cariddi LP, Burdi N, Tinelli A, Auteri W, Silvagni U, Biraschi F, Nicolini E, Padolecchia R, Tassinari T, Filauri P, Sacco S, Pavia M, Invernizzi P, Nuzzi NP, Marcheselli S, Amistà P, Russo M, Gallesio I, Craparo G, Mannino M, Mangiafico S, Toni D. Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset. Stroke 2020; 51:2051-2057. [DOI: 10.1161/strokeaha.119.027974] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and Purpose:
To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice.
Methods:
From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours.
Results:
Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients).
Conclusions:
This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
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Affiliation(s)
- Ilaria Casetta
- Clinica Neurologica, University of Ferrara, (I.C., M.P.)
| | | | - Valentina Saia
- Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S.)
| | - Giovanni Pracucci
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Marina Padroni
- Clinica Neurologica, University of Ferrara, (I.C., M.P.)
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.)
| | - Patrizia Nencini
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Domenico Inzitari
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Daniele Morosetti
- Diagnostic Imaging and Interventional Radiology Unit (D.M.), University of Rome Tor Vergata
| | | | - Stefano Vallone
- Interventional Neuroradiology Unit (S.V.), Ospedale Civile “S.Agostino-Estense”, AOU Modena
| | - Guido Bigliardi
- Stroke Unit (G.B.), Ospedale Civile “S.Agostino-Estense”, AOU Modena
| | - Andrea Zini
- Neurology and Stroke Unit, Maggiore Hospital, Bologna (A.Z.)
| | - Marcello Longo
- Interventional Neuroradiology Unit, Policlinico G Martino, Messina (M.L.)
| | | | - Sandra Bracco
- Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.)
| | - Ignazio M. Vallone
- Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.)
| | - Rossana Tassi
- Stroke Unit, University Hospital “S. Maria delle Scotte”, Siena (R.T.)
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza—Molinette, Turin (M.B.)
| | - Andrea Naldi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin (A.N.)
| | - Andrea Saletti
- Interventional Neuroradiology Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.S.)
| | - Alessandro De Vito
- Stroke Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.D.V.)
| | | | | | - Lucio Castellan
- Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova (L.C.)
| | - Carlo Serrati
- Neurology and Stroke Unit, IRCCS San Martino-IST, Genova (C.S.)
| | - Roberto Menozzi
- Interventional Neuroradiology Unit (R.M.), University Hospital, Parma
| | | | | | - Alessio Pieroni
- Stroke Unit and Neurosonology Lab (A.P.), Padua University Hospital
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile “Mazzini”, Teramo
| | | | - Antioco Sanna
- Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena
| | - Maria Ruggiero
- Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena
| | | | - Luca Di Maggio
- Interventional Radiology and Neuroradiology Unit (L.D.M), San Giovanni Bosco Hospital, Torino
| | - Enrica Duc
- Neurology Unit (E.D.), San Giovanni Bosco Hospital, Torino
| | | | | | - Giuseppina Sanfilippo
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.)
| | - Federico Zappoli
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.)
| | | | - Nicola Cavasin
- Neuroradiology Unit (N.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre
| | - Adriana Critelli
- Neurology Unit (A.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre
| | | | | | | | | | | | - Alberto Terrana
- Neuroradiology Unit (A.T.), AOU Circolo, ASST-Settelaghi, Varese
| | | | - Nicola Burdi
- Interventional Radiology (N.B.), Ospedale SS. Annunziata, Taranto
| | | | - William Auteri
- Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.)
| | - Umberto Silvagni
- Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.)
| | | | - Ettore Nicolini
- Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.)
| | | | - Tiziana Tassinari
- Neurology and Stroke Unit (T.T.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure
| | - Pietro Filauri
- Interventional Neuroradiology Unit, PO SS. Filippo e Nicola, Avezzano (P.F.)
| | - Simona Sacco
- Department of Applied Clinical Sciences e Biotechnology, University of L’Aquila, L’Aquila (S.S.)
| | - Marco Pavia
- Neuroradiology Unit (M.P.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Paolo Invernizzi
- Neurology Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Nunzio P. Nuzzi
- Interventional Neuroradiology Unit (N.P.N.), Humanitas Research Hospital, Rozzano
| | - Simona Marcheselli
- Urgent Neurology and Stroke Unit (S.M.), Humanitas Research Hospital, Rozzano
| | - Pietro Amistà
- Interventional Neuroradiology Unit (P.A.), S. Maria della Misericordia Hospital, Rovigo
| | - Monia Russo
- Stroke Unit (M.R.), S. Maria della Misericordia Hospital, Rovigo
| | - Ivan Gallesio
- Neuroradiology Unit, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria (I.G.)
| | - Giuseppe Craparo
- Interventional Neuroradiology Unit (G.C.), Ospedale Civico-A.R.N.A.S., Palermo
| | | | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.)
| | - Danilo Toni
- Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.)
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Augelli R, Ciceri E, Ghimenton C, Zoccatelli G, Bucci A, Nicolato A, Beltramello A, Pinna G, Ricciardi GK. Magnetic resonance diffusion-tensor imaging metrics in High Grade Gliomas: Correlation with IDH1 gene status in WHO 2016 era. Eur J Radiol 2019; 116:174-179. [PMID: 31153561 DOI: 10.1016/j.ejrad.2019.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/10/2019] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate any possible correlation between the presence of Isocitrate DeHydrogenase 1 mutation (IDH1m) and specific DTI (Diffusion Tensor Imaging) metrics, such as Fractional Anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD) and Axial Diffusivity (AD). METHODS We retrospectively analyzed 47 patients who underwent an advanced-MR study with DTI followed by surgical intervention with a subsequent histologic diagnosis of High-Grade Glioma (HGG) and immunohistochemical evaluation of IDH1 (Isocitrate DeHydrogenase) mutation status. For each DTI metrics we measured the ratio between tumor and normal tissue and we evaluated the correlation with IDH1 mutation. RESULTS We observed a positive correlation with IDH1 status and RD and MD data. No correlation was demonstrated between IDH1 status and FA and AD. DISCUSSION Our results support the hypothesis that the number of residual axonal fibers, extracellular matrix composition and the presence of colliquated tissue, may together contribute to a global RD increase in HGG, with a relatively higher increase in IDH1m tumors. CONCLUSIONS Our data are in favor of a need for multimodal advance evaluation of HGG. DTI metrics help to analyze IDH1 mutation status, in order to better characterize the lesions and to tailor treatment and follow up.
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Affiliation(s)
- Raffaele Augelli
- Neuroradiology Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy.
| | - Elisa Ciceri
- Neuroradiology Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
| | - Claudio Ghimenton
- Pathology Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
| | - Giada Zoccatelli
- Neuroradiology Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
| | - Alessandra Bucci
- Neuroradiology Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
| | - Antonio Nicolato
- Neurosurgery Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
| | - Alberto Beltramello
- Radiology Department, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar, Verona, Italy
| | - Giampietro Pinna
- Neurosurgery Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
| | - Giuseppe K Ricciardi
- Neuroradiology Departments, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Borgo Trento, Verona, Italy
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14
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Bersano A, Bedini G, Nava S, Acerbi F, Sebastiano DR, Binelli S, Franceschetti S, Faragò G, Grisoli M, Gioppo A, Ferroli P, Bruzzone MG, Riva D, Ciceri E, Pantaleoni C, Saletti V, Esposito S, Nardocci N, Zibordi F, Caputi L, Marzoli SB, Zedde ML, Pavanello M, Raso A, Capra V, Pantoni L, Sarti C, Pezzini A, Caria F, Dell' Acqua ML, Zini A, Baracchini C, Farina F, Sanguigni S, De Lodovici ML, Bono G, Capone F, Di Lazzaro V, Lanfranconi S, Toscano M, Di Piero V, Sacco S, Carolei A, Toni D, Paciaroni M, Caso V, Perrone P, Calloni MV, Romani A, Cenzato M, Fratianni A, Ciusani E, Prontera P, Lasserve ET, Blecharz K, Vajkoczy P, Parati EA. GEN-O-MA project: an Italian network studying clinical course and pathogenic pathways of moyamoya disease-study protocol and preliminary results. Neurol Sci 2019; 40:561-570. [PMID: 30604336 DOI: 10.1007/s10072-018-3664-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/27/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results. METHODS Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies. RESULTS Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed. CONCLUSION An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy.
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Affiliation(s)
- Anna Bersano
- Cerebrovascular Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
| | - Gloria Bedini
- Laboratory of Cellular Neurobiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Nava
- Laboratory of Cellular Neurobiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Neurosurgical Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Davide Rossi Sebastiano
- Neurophysiopathology Department and Epilepsy Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Simona Binelli
- Neurophysiopathology Department and Epilepsy Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvana Franceschetti
- Neurophysiopathology Department and Epilepsy Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Diagnostic Imaging Department & Interventional Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marina Grisoli
- Neuroradiological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Diagnostic Imaging Department & Interventional Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daria Riva
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Ciceri
- Neuroradiological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pantaleoni
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Veronica Saletti
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Esposito
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nardo Nardocci
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Zibordi
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luigi Caputi
- Cerebrovascular Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | | | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Valeria Capra
- Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Leonardo Pantoni
- L.Sacco Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Cristina Sarti
- NEUROFARBA Department Neuroscience Section, University of Florence, Florence, Italy
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Filomena Caria
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Maria Luisa Dell' Acqua
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Modena, Italy
| | - Andrea Zini
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, University Hospital of Modena, Modena, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy
| | - Filippo Farina
- Stroke Unit and Neurosonology Laboratory, Department of Neurological Sciences, University of Padua School of Medicine, Padua, Italy
| | - Sandro Sanguigni
- Department of Neurology, General Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | | | - Giorgio Bono
- Stroke Unit Circolo Hospital and Macchi Foundation, Varese Hospital, Varese, Italy
| | - Fioravanti Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Silvia Lanfranconi
- Department of Neuroscience and Sensory Organs, Neurology Unit, Maggiore Policlinico Hospital Foundation IRCCS Ca' Granda, Milan, Italy
| | - Massimiliano Toscano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Simona Sacco
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - Antonio Carolei
- Department of Neurology, Avezzano Hospital, University of L'Aquila, L'Aquila, Italy
| | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Patrizia Perrone
- Stroke Unit Legnano Hospital ASST Ovest Milanese, Legnano, Italy
| | | | - Alfredo Romani
- IRCCS Foundation C. Mondino Neurological Institute, Pavia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy
| | - Alessia Fratianni
- Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy
| | - Emilio Ciusani
- Laboratory of Clinical Investigations, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Prontera
- Neonatology Unit and Prenatal Diagnosis (P.P.), Medical Genetic Unit, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Elisabeth Tournier Lasserve
- Inserm UMR-S1161, Génétique et Physiopathologie des Maladies Cérébro-vasculaires, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Kinga Blecharz
- Department of Neurosurgery, Charite Universitätsmedizin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charite Universitätsmedizin, Berlin, Germany
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Baglivo V, Cao B, Mwangi B, Bellani M, Perlini C, Lasalvia A, Dusi N, Bonetto C, Cristofalo D, Alessandrini F, Zoccatelli G, Ciceri E, Dario L, Enrico C, Francesca P, Mazzi F, Paolo S, Balestrieri M, Soares JC, Ruggeri M, Brambilla P. Hippocampal Subfield Volumes in Patients With First-Episode Psychosis. Schizophr Bull 2018; 44:552-559. [PMID: 29897598 PMCID: PMC5890476 DOI: 10.1093/schbul/sbx108] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Hippocampal abnormalities have been largely reported in patients with schizophrenia and bipolar disorder, and are considered to be involved in the pathophysiology of the psychosis. The hippocampus consists of several subfields but it remains unclear their involvement in the early stages of psychosis. Aim The aim of this study was to investigate volumetric alterations in hippocampal subfields in patients at the first-episode psychosis (FEP). Methods Magnetic resonance imaging (MRI) data were collected in 134 subjects (58 FEP patients; 76 healthy controls [HC]). A novel automated hippocampal segmentation algorithm was used to segment the hippocampal subfields, based on an atlas constructed from ultra-high resolution imaging on ex vivo hippocampal tissue. The general linear model was used to investigate volume differences between FEP patients and HC, with age, gender and total intracranial volume as covariates. Results We found significantly lower volumes of bilateral CA1, CA4, and granule cell layer (GCL), and of left CA3, and left molecular layer (ML) in FEP patients compared to HC. Only the volumes of the left hippocampus and its subfields were significantly lower in FEP than HC at the False Discovery Rate (FDR) of 0.1. No correlation was found between hippocampal subfield volume and duration of illness, age of onset, duration of medication, and Positive and Negative Syndrome Scale (PANSS). Conclusion We report abnormally low volumes of left hippocampal subfields in patients with FEP, sustaining its role as a putative neural marker of psychosis onset.
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Affiliation(s)
- Valentina Baglivo
- Unit of Psychiatry, Department of Medicine, University of Udine, Udine, Italy
| | - Bo Cao
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Marcella Bellani
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Verona, Italy
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Cinzia Perlini
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
- Department of Public Health and Community Medicine, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Verona, Italy
| | - Nicola Dusi
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Verona, Italy
- InterUniversity Centre for Behavioural Neurosciences (ICBN), University of Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | | | - Giada Zoccatelli
- Neuroradiology Department, Azienda Ospedaliera Universitaria, Verona, Italy
| | - Elisa Ciceri
- Neuroradiology Department, Azienda Ospedaliera Universitaria, Verona, Italy
| | - Lamonaca Dario
- Department of Psychiatry, CSM AULSS 21 Legnago, Verona, Italy
| | - Ceccato Enrico
- Department of Mental Health, Hospital of Montecchio Maggiore, Vicenza, Italy
| | | | | | | | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine, University of Udine, Udine, Italy
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Mirella Ruggeri
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Verona, Italy
- Section of Psychiatry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Brambilla
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - GET UP Group
- Unit of Psychiatry, Department of Medicine, University of Udine, Udine, Italy
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Acerbi F, Farago G, Broggi M, Cavallo C, Ranieri M, Caldiera V, Ciceri E, Ferroli P. Indocyanine Green Videoangiographic-Guided Cannulation of the Superior Ophthalmic Vein for Endovascular Treatment of Carotid-Cavernous Fistulas. Turk Neurosurg 2018; 27:832-836. [PMID: 27593848 DOI: 10.5137/1019-5149.jtn.18213-16.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Direct exposure and cannulation of the superior ophthalmic vein (SOV) provides an alternative access to reach the cavernous sinus for carotid-cavernous fistula (CCF) embolization, when classic transvenous routes through the inferior petrosal sinus (IPS) or facial vein are not feasible. We have used indocyanine green (ICG)-videoangiography to study intraoperatively the flow inside the SOV in two cases of indirect CCF. In this paper, we report the operative technique and the result of ICG videoangiographic-guided cannulation of the SOV for endovascular treatment of CCF. Two male patients, of 59 and 66 years of age respectively, presented at our Institution with right decreased visual acuity, persistent binocular diplopia and painful ophthalmoplegia, chemosis and proptosis, due to right unilateral indirect CCF fistula. The endovascular transvenous approach failed in one case due to thrombosis of the inferior petrosal sinus (IPS) and the extreme tortuosity of the angular vein. In the other case, it was considered unfeasible due to an unfavourable vascular angioarchitecture. For this reason, an ICG videoangiographic-guided cannulation of the SOV, followed by endovascular obliteration of the CCF, was performed. CCF was cured in both cases with this approach. No additional neurological deficits and no complications due to SOV cannulation were registered during the hospital stay. There were no fistula recurrences during the mean follow-up of 18 months. ICG-videoangiography is a simple, fast and cost-effective technique that can be reliably applied in SOV cannulation for subsequent indirect CCF embolization.
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Affiliation(s)
- Francesco Acerbi
- Fondazione IRCCS Instituto Neurologico Carlo Besta, Department of Neurosurgery, Milan, Italy
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Gioppo A, Faragò G, Giannitto C, Caputi L, Saladino A, Acerbi F, Ciceri E. Sacral dural arteriovenous fistulas: a diagnostic and therapeutic challenge – single-centre experience of 13 cases and review of the literature. J Neurointerv Surg 2017; 10:415-421. [DOI: 10.1136/neurintsurg-2017-013307] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/03/2022]
Abstract
BackgroundSacral dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities of the spine characterised by slowly progressive symptoms that can mimic different myelopathy disorders.ObjectTo report our single Institution experience with sacral DAVFs.MethodsWe retrospectively reviewed the clinical records of patients admitted from 1 January 2006 to 31 December 2016 with a diagnosis of sacral DAVFs, treated by endovascular embolisation or surgical clipping. Clinical presentation, imaging characteristics, treatment results and follow-up were analysed.ResultsWe identify 13 patients with sacral DAVFs supplied by lateral sacral arteries. Clinical presentation was characterised by different degrees of motor weakness and sphincter disturbances. In all patients, spinal MRI showed spinal cord hyperintensities with enhancement and prominent perimedullary vessels. Selective internal iliac angiography was mandatory to identify the exact location of the fistula. A complete embolisation was achieved in eight patients performing a single endovascular embolisation and in three patients performing a single surgical disconnection: two patients required combined procedures. Follow-up imaging showed a complete resolution of the spinal cord hyperintensities in 81% of patients and a reduction of the intramedullary enhancement in 91%. Gait improvement was observed in 73% of patients, while remaining stable in 27%. Sphincter disturbances improved in 36% of patients and remained stable in 64%.ConclusionAwareness of sacral location of DAVFs is critical because standard spinal angiography will not identify sacral supplies, unless internal iliac arteries are properly examined. In our experience, the endovascular treatment show results comparable to surgery when the fistula point is correctly disconnected.
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Giordan E, Brinjikji W, Ciceri E, Lanzino G. Arteriovenous fistulae of the filum terminale. J Neurointerv Surg 2017; 10:191-197. [DOI: 10.1136/neurintsurg-2017-013309] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/09/2017] [Accepted: 08/24/2017] [Indexed: 01/12/2023]
Abstract
Filum terminale arteriovenous fistulae are a rare type of arteriovenous shunt generally characterized by a single direct communication between the artery of the filum terminale and a single draining vein. These intradural arteriovenous shunts are three times more common in men than women (mean age 55 years). Symptoms are related to venous congestion, vascular hypertension, and a putative chronic steal phenomenon which result in spinal cord ischemia and myelopathy. Interestingly, hemorrhage has never been reported as a mode of presentation. MRI demonstrates increased flow voids and T2 changes involving the conus and the lower spinal cord, and these findings are not dissimilar from those seen with the more common type 1 spinal dural arteriovenous fistulae. Thus conventional spinal angiography is necessary for a definitive diagnosis and to localize exactly the site of the fistula. Both surgical interruption of the fistula and endovascular embolization are safe and effective therapeutic modalities. However, because of the very small caliber of the feeding artery, endovascular therapy is often not feasible; and thus, surgery remains the method more commonly utilized for their treatment. Definitive treatment consists of obliteration of the direct arteriovenous shunt. In this review, we describe the anatomy, pathophysiology, clinical presentation, imaging, and treatment options of these less common intradural arteriovenous shunts.
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Diwadkar VA, Bellani M, Chowdury A, Savazzi S, Perlini C, Marinelli V, Zoccatelli G, Alessandrini F, Ciceri E, Rambaldelli G, Ruggieri M, Altamura AC, Marzi CA, Brambilla P. Erratum to: Activations in gray and white matter are modulated by uni-manual responses during within and inter-hemispheric transfer: effects of response hand and right-handedness. Brain Imaging Behav 2017; 12:1220. [PMID: 28940149 DOI: 10.1007/s11682-017-9768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The original version of this article unfortunately contained a mistake. The family name of Paolo Brambilla was incorrectly spelled as Bambilla.
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Affiliation(s)
- Vaibhav A Diwadkar
- Brain Imaging Research Division, Department of Psychiatry & Behavioral Neurosciences, Wayne State University School of Medicine, Suite 5B, 3901 Chrysler Drive, Detroit, MI, 48201, USA.
| | - Marcella Bellani
- Department of Public Health and Community Medicine, Section of Psychiatry and Section of Clinical Psychology, University of Verona, 37129, Verona, Italy
| | - Asadur Chowdury
- Brain Imaging Research Division, Department of Psychiatry & Behavioral Neurosciences, Wayne State University School of Medicine, Suite 5B, 3901 Chrysler Drive, Detroit, MI, 48201, USA
| | - Silvia Savazzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,National Institute of Neuroscience-Verona, Verona, Italy
| | - Cinzia Perlini
- Department of Public Health and Community Medicine, Section of Psychiatry and Section of Clinical Psychology, University of Verona, 37129, Verona, Italy
| | - Veronica Marinelli
- Department of Public Health and Community Medicine, Section of Psychiatry and Section of Clinical Psychology, University of Verona, 37129, Verona, Italy
| | - Giada Zoccatelli
- Neuroradiology Department, Azienda Ospedaliera Universitaria Integrata di Verona, 37126, Verona, Italy
| | - Franco Alessandrini
- Neuroradiology Department, Azienda Ospedaliera Universitaria Integrata di Verona, 37126, Verona, Italy
| | - Elisa Ciceri
- Neuroradiology Department, Azienda Ospedaliera Universitaria Integrata di Verona, 37126, Verona, Italy
| | - Gianluca Rambaldelli
- Department of Public Health and Community Medicine, Section of Psychiatry and Section of Clinical Psychology, University of Verona, 37129, Verona, Italy
| | - Mirella Ruggieri
- Department of Public Health and Community Medicine, Section of Psychiatry and Section of Clinical Psychology, University of Verona, 37129, Verona, Italy
| | - A Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo A Marzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,National Institute of Neuroscience-Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Neurosciences, University of Texas at Houston, Houston, TX, USA
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Gioppo A, Faragò G, Caldiera V, Caputi L, Cusin A, Ciceri E. Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature. World Neurosurg 2017; 107:1050.e1-1050.e7. [PMID: 28826865 DOI: 10.1016/j.wneu.2017.08.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. We present a rare case of a medial tentorial DAVF successfully managed via transarterial embolization using SQUID liquid polymer. CASE DESCRIPTION A 60-year-old woman presented with a history of left progressive hearing loss and tinnitus for >1 year. Cerebral angiography demonstrated the presence of a medial tentorial DAVF with multiple arterial feeders, including the artery of Davidoff and Schechter; reverse venous outflow was observed in the inferior sagittal sinus and in multiple cortical veins. The patient underwent transarterial embolization with SQUID liquid polymer, an embolic agent that provides 2 different viscous formulations to cast the DAVF. The procedure went well without any complication, and the patient regained her preoperative status. In the postprocedural period, the patient experienced complete resolution of tinnitus. At 6 months, she remained asymptomatic, and cerebral angiography confirmed complete, stable occlusion of the fistula and normalization of cerebral deep venous outflow. CONCLUSIONS Medial tentorial DAVFs are considered the most complex DAVFs because of their location and extensive vascular supply. Our literature review focused on endovascular treatment of tentorial DAVFs to highlight the usefulness of new embolic agents in management of these diseases. To our knowledge, we report the first successful use of SQUID liquid polymer in management of a tentorial DAVF.
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Affiliation(s)
- Andrea Gioppo
- Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy; Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy
| | - Giuseppe Faragò
- Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy.
| | - Valentina Caldiera
- Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy
| | - Luigi Caputi
- Cerebrovascular Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy
| | - Alberto Cusin
- Department of Neurosurgery 1, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy
| | - Elisa Ciceri
- Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy; Department of Neuroradiology, Azienda Ospedaliera Universitaria Integrata Borgo Trento, Verona, Italy
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Bedini G, Blecharz KG, Nava S, Vajkoczy P, Alessandri G, Ranieri M, Acerbi F, Ferroli P, Riva D, Esposito S, Pantaleoni C, Nardocci N, Zibordi F, Ciceri E, Parati EA, Bersano A. Vasculogenic and Angiogenic Pathways in Moyamoya Disease. Curr Med Chem 2016; 23:315-45. [PMID: 26861126 DOI: 10.2174/092986732304160204181543] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/27/2015] [Accepted: 12/12/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) is a slowly progressing steno-occlusive cerebrovascular disease. The typical moyamoya vessels, which originate from an initial stenosis of the internal carotid, highlight that increased and/or abnormal angiogenic, vasculogenic and arteriogenic processes are involved in the disease pathophysiology. OBJECTIVE Herein, we summarize the current knowledge on the most important signaling pathways involved in MMD vessel formation, particularly focusing on the expression of growth factors and function of endothelial progenitor cells (EPCs). METHODS AND RESULTS Higher plasma concentrations of vascular endothelial growth factor, matrix metalloproteinase, hepatocyte growth factor, and interleukin-1β were reported in MMD. A specific higher level of basic fibroblast growth factor was also found in the cerebrospinal fluid of these patients. Finally, the number and the functionality of EPCs were found to be increased. In spite of the available data, the approaches and findings reported so far do not give an evident correlation between the expression levels of the aforementioned growth factors and MMD severity. Furthermore, the controversial results provided by studies on EPCs, do not permit to understand the true involvement of these cells in MMD pathophysiology. CONCLUSION Further studies should thus be implemented to extend our knowledge on processes regulating both the arterial stenosis and the excessive formation of collateral vessels. Moreover, we suggest advances of integrated approaches and functional assays to correlate biological and clinical data, arguing for the development of new therapeutic applications for MMD.
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Affiliation(s)
- Gloria Bedini
- Laboratory of Cellular Neurobiology, Neurology Unit, UCV, Neurological Institute "C. Besta" IRCCS Foundation, Via Celoria 11, Milan 20133, Italy.
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Abstract
Gli autori descrivono un caso di ipotensione liquorale essenziale con sindrome clinica ad esordio acuto, costituita da cefalea gravativa che si riduceva parzialmente in decubito orizzontale, regredita in cinque mesi. Vari esami RM dimostrarono la presenza di un ispessimento durale con accentuazione dopo contrasto, sia in sede endocranica che a livello cervicale, ed anche un sottile e circoscritto scollamento durale con lievi fenomeni emorragici; alla remissione clinica si accompagnò la normalizzazione del quadro neuroradiologico. Vengono discussi i possibili meccanismi patogenetici delle alterazioni durali alla luce dell'anatomia degli strati profondi della dura e ne vengono sottolineati gli aspetti radiologici.
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Affiliation(s)
| | - L. D'Incerti
- Divisione di Neuroradiologia, Istituto Nazionale Neurologico «C. Besta»; Milano
| | - E. Ciceri
- Divisione di Neuroradiologia, Istituto Nazionale Neurologico «C. Besta»; Milano
| | - M. Savoiardo
- Divisione di Neuroradiologia, Istituto Nazionale Neurologico «C. Besta»; Milano
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Abstract
Le encefalopatie mitocondriali sono un gruppo eterogeneo di malattie, in parte ancora in corso di definizione, per cui è sempre necessaria una conferma biochimica. Alcune malattie mitocondriali, come i difetti della β- ossidazione degli acidi grassi, possono causare gravi squilibri metabolici con ipoglicemia e coma che si ripercuotono in modo aspecifico sul sistema nervoso centrale determinando quadri di sofferenza cerebrale diffusa. Altre malattie mitocondriali determinano danni più specifici sul SNC. Nella prima infanzia la malattia più caratteristica è la malattia di Leigh, che determina alterazioni principalmente nel tegmento pontino e mesencefalico e nei nuclei della base. Alcuni casi presentano lesioni caratteristiche nei nuclei subtalamici, altri presentano reperti più aspecifici e diffusi simili a quadri di leucodistrofia. In età più tardiva (seconda infanzia o età adulta) la malattia più interessante dal punto di vista neuroradiologico è il MELAS, che presenta lesioni cortico-sottocorticali nelle regioni posteriori con distribuzione non tipicamente vascolare, sopra e sottotentoriali, che tuttavia possono essere ricondotte ai territori più distali dei vasi. Calcificazioni nei nuclei della base sono presenti in circa la metà dei casi. Un'altra encefalopatia mitocondriale dell'età giovanile o adulta è la sindrome di Kearns-Sayre, in cui la RM può dimostrare alterazioni nel tronco, nei talami, nei nuclei della base e nella sostanza bianca sottocorticale. Alterazioni nel neostriato possono essere osservate nelle sindromi distoniche associate ad atrofia ottica di Leber. Non sono descritte invece lesioni specifiche nel MERRF, in cui atrofia ed alterazioni della sostanza bianca sono state occasionalmente osservate. Esistono infine casi che presentano quadri clinici e neuroradiologici intermedi tra le varie sindromi mitocondriali. L'obiettivo di questa revisione è dimostrare alcuni aspetti tipici delle sindromi più comuni e indicare quali aspetti neuroradiologici, a volte inattesi, devono suggerire l'ipotesi di encefalopatia mitocondriale, permettendo cosi di indirizzare in modo corretto ulteriori indagini diagnostiche.
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Affiliation(s)
| | | | - G. Uziel
- Divisione di Neuropediatria, Istituto Nazionale Neurologico ‘C. Besta»; Milano
| | | | - C. Antozzi
- Divisione Malattie Neuromuscolari, Istituto Nazionale Neurologico ‘C. Besta»; Milano
| | - M. Zeviani
- Divisione di Biochimica e Genetica, Istituto Nazionale Neurologico ‘C. Besta»; Milano
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Faragò G, Caldiera V, Antozzi C, Bellino A, Innocenti A, Ciceri E. Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation. Eur Radiol 2016; 27:2200-2205. [DOI: 10.1007/s00330-016-4551-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
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Kallmes DF, Brinjikji W, Boccardi E, Ciceri E, Diaz O, Tawk R, Woo H, Jabbour P, Albuquerque F, Chapot R, Bonafe A, Dashti SR, Delgado Almandoz JE, Given C, Kelly ME, Cross DT, Duckwiler G, Razack N, Powers CJ, Fischer S, Lopes D, Harrigan MR, Huddle D, Turner R, Zaidat OO, Defreyne L, Pereira VM, Cekirge S, Fiorella D, Hanel RA, Lylyk P, McDougall C, Siddiqui A, Szikora I, Levy E. Aneurysm Study of Pipeline in an Observational Registry (ASPIRe). Interv Neurol 2016; 5:89-99. [PMID: 27610126 DOI: 10.1159/000446503] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. MATERIALS AND METHODS We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. RESULTS One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). CONCLUSIONS Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months.
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Affiliation(s)
| | | | - Edoardo Boccardi
- Department of Neuroradiology, Niguarda Ca' Granda Hospital of Milan, Milan, Italy
| | - Elisa Ciceri
- Department of Radiology, Istituto Neurologico Carlo Besta, Milan, Italy
| | - Orlando Diaz
- Department of Radiology, Houston Methodist Hospital, Houston, Tex., USA
| | - Rabih Tawk
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Fla., USA
| | - Henry Woo
- Departments of Neurosurgery at Stony Brook University, Stony Brook, N.Y., USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa., USA
| | | | - Rene Chapot
- Neurointerventional Services, Department of Interventional Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Alain Bonafe
- Department of Radiology, CHU Montpellier, Montpellier, France
| | - Shervin R Dashti
- Department of Neurosurgery, Norton Neuroscience Institute, Norton Healthcare, Louisville, Ky., USA
| | - Josser E Delgado Almandoz
- Department of Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minn., USA
| | - Curtis Given
- Neurointerventional Services, Baptist Health Lexington, Lexington, Ky., USA
| | - Michael E Kelly
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask., Canada
| | - DeWitte T Cross
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
| | - Gary Duckwiler
- Department of Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA
| | - Nasser Razack
- Neurointerventional Associates, P.A., St. Petersburg, Fla., USA
| | - Ciaran J Powers
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Demetrius Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Ill., USA
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama, Birmingham, Ala., USA
| | - Daniel Huddle
- Swedish Medical Center/RIA Neurovascular, Englewood, Colo., USA
| | - Raymond Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, S.C., USA
| | - Osama O Zaidat
- Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA
| | - Luc Defreyne
- Department of Interventional Radiology, Ghent University Hospital, Gent, Belgium
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network and Departments of Medical Imaging and Surgery, University of Toronto, Toronto, Ont., Canada
| | - Saruhan Cekirge
- Department of Radiology, Koru Hospital and Bayindir Hospitals, Ankara, Turkey
| | - David Fiorella
- Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, N.Y., USA
| | - Ricardo A Hanel
- Stroke and Cerebrovascular Surgery, Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, Fla., USA
| | - Pedro Lylyk
- Department of Neurosurgery, Clinica La Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - Cameron McDougall
- Endovascular Neurosurgery, Barrow Neurological Institute, Phoenix, Ariz., USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo Neurosurgery, Buffalo, N.Y., Phoenix, Ariz., USA
| | - Istvan Szikora
- Department of Neurointerventional Services, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Elad Levy
- Department of Neurosurgery, University at Buffalo Neurosurgery, Buffalo, N.Y., Phoenix, Ariz., USA
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26
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Bersano A, Morbin M, Ciceri E, Bedini G, Berlit P, Herold M, Saccucci S, Fugnanesi V, Nordmeyer H, Faragò G, Savoiardo M, Taroni F, Carriero M, Boncoraglio Giorgio B, Perucca L, Caputi L, Parati Eugenio A, Kraemer M. The diagnostic challenge of Divry van Bogaert and Sneddon Syndrome: Report of three cases and literature review. J Neurol Sci 2016; 364:77-83. [DOI: 10.1016/j.jns.2016.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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Faragò G, Caldiera V, Tempra G, Ciceri E. Republished: Advanced digital subtraction angiography and MR fusion imaging protocol applied to accurate placement of flow diverter device. J Neurointerv Surg 2015; 8:e5. [DOI: 10.1136/neurintsurg-2014-011428.rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/04/2022]
Abstract
In recent years there has been a progressive increase in interventional neuroradiology procedures, partially due to improvements in devices, but also to the simultaneous development of technologies and radiological images. Cone beam CT (Dyna-CT; Siemens) is a method recently used to obtain pseudo CT images from digital subtraction angiography (DSA) with a flat panel detector. Using dedicated software, it is then possible to merge Dyna-CT images with images from a different source. We report here the usefulness of advanced DSA techniques (Syngo-Dyna CT, three-dimensional DSA iPilot) for the treatment of an intracranial aneurysm with a flow diverter device. Merging MR and Dyna-CT images at the end of the procedure proved to be a simple and rapid additional method of verifying the success of the intervention.
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Faragò G, Caldiera V, Tempra G, Ciceri E. Advanced digital subtraction angiography and MR fusion imaging protocol applied to accurate placement of flow diverter device. BMJ Case Rep 2015; 2015:bcr-2014-011428. [PMID: 25576504 DOI: 10.1136/bcr-2014-011428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/04/2022] Open
Abstract
In recent years there has been a progressive increase in interventional neuroradiology procedures, partially due to improvements in devices, but also to the simultaneous development of technologies and radiological images. Cone beam CT (Dyna-CT; Siemens) is a method recently used to obtain pseudo CT images from digital subtraction angiography (DSA) with a flat panel detector. Using dedicated software, it is then possible to merge Dyna-CT images with images from a different source. We report here the usefulness of advanced DSA techniques (Syngo-Dyna CT, three-dimensional DSA iPilot) for the treatment of an intracranial aneurysm with a flow diverter device. Merging MR and Dyna-CT images at the end of the procedure proved to be a simple and rapid additional method of verifying the success of the intervention.
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Affiliation(s)
- Giuseppe Faragò
- Department of Interventional Neuroradiology, Foundation Neurological Institution 'C Besta', Milan, Italy
| | - Valentina Caldiera
- Department of Interventional Neuroradiology, Foundation Neurological Institution 'C Besta', Milan, Italy
| | - Giovanni Tempra
- Department of Interventional Neuroradiology, Foundation Neurological Institution 'C Besta', Milan, Italy
| | - Elisa Ciceri
- Department of Interventional Neuroradiology, Foundation Neurological Institution 'C Besta', Milan, Italy
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Caputi L, Ghielmetti F, Faragò G, Longaretti F, Lamperti M, Anzola GP, Carriero MR, Charbel FT, Bruzzone MG, Parati E, Ciceri E. Cerebrovascular reactivity by quantitative magnetic resonance angiography with a Co₂ challenge. Validation as a new imaging biomarker. Eur J Radiol 2014; 83:1005-1010. [PMID: 24721002 DOI: 10.1016/j.ejrad.2014.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/03/2014] [Accepted: 03/06/2014] [Indexed: 11/16/2022]
Abstract
Assessment of cerebrovascular reactivity (CVR) is essential in cerebrovascular diseases, as exhausted CVR may enhance the risk of cerebral ischemic events. Transcranial Doppler (TCD) with a vasodilatory stimulus is currently used for CVR evaluation. Scanty data are available for Quantitative Magnetic Resonance Angiography (QMRA), which supplies higher spatial resolution and quantitative cerebral blood flow values. Aims of our pilot study were: (a) to assess safety and feasibility of CO2 administration during QMRA, (b) evaluation of CVR under QMRA compared to TCD, and (c) quantitative evaluation of blood flow from the major intracranial arterial vessels both at rest and after CO2. CVR during 5% CO2 air breathing was measured with TCD as a reference method and compared with QMRA. Fifteen healthy subjects (age 60.47 ± 2.24; male 11/15) were evaluated at rest and during CO2 challenge. Feasibility and safety of QMRA under CO2 were ensured in all subjects. CVR from middle cerebral artery territory was not statistically different between TCD and MRI (p>0.05). Mean arterial pressure (MAP) and heart rate (HR) increased during QMRA and TCD (MAP p=0.007 and p=0.001; HR p=0.043 and p=0.068, respectively). Blood flow values from all intracranial vessels increased after CO2 inhalation (p<0.001). CO2 administration during QMRA sessions is safe and feasible. Good correlation in terms of CVR was obtained comparing TCD and QMRA. Blood flow values significantly increased from all intracranial arterial vessels after CO2. Studies regarding CVR in physiopathological conditions might consider the utilization of QMRA both in routine clinical settings and in research projects.
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Affiliation(s)
- Luigi Caputi
- Department of Cerebrovascular Diseases, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Francesco Ghielmetti
- Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Giuseppe Faragò
- Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Fabio Longaretti
- Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Massimo Lamperti
- Department of Neuroanesthesia and Intensive Care, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Gian Paolo Anzola
- Service of Neurology, S. Orsola Hospital, Fondazione Poliambulanza, Via Vittorio Emanuele II 27, 25122 Brescia, Italy.
| | - Maria Rita Carriero
- Department of Cerebrovascular Diseases, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA.
| | - Maria Grazia Bruzzone
- Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Eugenio Parati
- Department of Cerebrovascular Diseases, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
| | - Elisa Ciceri
- Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
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Montorsi P, Caputi L, Galli S, Ciceri E, Ballerini G, Agrifoglio M, Ravagnani P, Trabattoni D, Pontone G, Fabbiocchi F, Loaldi A, Parati E, Andreini D, Veglia F, Bartorelli AL. Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 2013; 58:1656-63. [PMID: 21982309 DOI: 10.1016/j.jacc.2011.07.015] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [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: 02/04/2011] [Revised: 07/13/2011] [Accepted: 07/19/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The goal of this study was to compare the rate of cerebral microembolization during carotid artery stenting (CAS) with proximal versus distal cerebral protection in patients with high-risk, lipid-rich plaque. BACKGROUND Cerebral protection with filters partially reduces the cerebral embolization rate during CAS. Proximal protection has been introduced to further decrease embolization risk. METHODS Fifty-three consecutive patients with carotid artery stenosis and lipid-rich plaque were randomized to undergo CAS with proximal protection (MO.MA system, n = 26) or distal protection with a filter (FilterWire EZ, n = 27). Microembolic signals (MES) were assessed by using transcranial Doppler during: 1) lesion wiring; 2) pre-dilation; 3) stent crossing; 4) stent deployment; 5) stent dilation; and 6) device retrieval/deflation. Diffusion-weighted magnetic resonance imaging was conducted before CAS, after 48 h, and after 30 days. RESULTS Patients in the MO.MA group had higher percentage diameter stenosis (89 ± 6% vs. 86 ± 5%, p = 0.027) and rate of ulcerated plaque (35% vs. 7.4%; p = 0.019). Compared with use of the FilterWire EZ, MO.MA significantly reduced mean MES counts (p < 0.0001) during lesion crossing (mean 18 [interquartile range (IQR): 11 to 30] vs. 2 [IQR: 0 to 4]), stent crossing (23 [IQR: 11 to 34] vs. 0 [IQR: 0 to 1]), stent deployment (30 [IQR: 9 to 35] vs. 0 [IQR: 0 to 1]), stent dilation (16 [IQR: 8 to 30] vs. 0 [IQR: 0 to 1]), and total MES (93 [IQR: 59 to 136] vs. 16 [IQR: 7 to 36]). The number of patients with MES was higher with the FilterWire EZ versus MO.MA in phases 3 to 5 (100% vs. 27%; p < 0.0001). By multivariate analysis, the type of brain protection was the only independent predictor of total MES number. No significant difference was found in the number of patients with new post-CAS embolic lesion in the MO.MA group (2 of 14, 14%) as compared with the FilterWire EZ group (9 of 21, 42.8%). CONCLUSIONS In patients with high-risk, lipid-rich plaque undergoing CAS, MO.MA led to significantly lower microembolization as assessed by using MES counts.
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Affiliation(s)
- Piero Montorsi
- Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, Italy.
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Maggi L, Faragò G, Mantegazza R, Ciceri E. Percutaneous vertebroplasty in a series of myasthenic patients with steroid-induced symptomatic vertebral fractures. Neurol Sci 2013; 34:773-6. [PMID: 23543381 DOI: 10.1007/s10072-013-1417-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/19/2013] [Indexed: 10/27/2022]
Abstract
Vertebral compression fractures (VFs) are observed in 30-50 % of patients affected by steroid-induced osteoporosis, with consequentially severe back pain and functional limitation. An alternative treatment to medical therapy for pain caused by recent VFs is percutaneous vertebroplasty (PVP). Patients were treated by PVP after careful selection, based on the presence of persistent pain not resolved by standard medical therapy, correlation between pain and level of the VF, and neuroradiological features. We performed PVP in 4 patients with generalized MG associated with recent steroid-induced symptomatic VFs. Relief from pain was very rapid, usually within 24 h, and retained at a 3-month evaluation. No severe complication or MG worsening were observed in the post-operative period. Although clinical indication for PVP is still controversial, in our experience PVP is a useful and safe tool to be considered in the management of recent steroid-induced symptomatic VFs in selected MG patients.
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Affiliation(s)
- Lorenzo Maggi
- Neuroimmunology and Muscle Pathology Unit, Foundation IRCCS Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.
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Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L, De Blasi R, Delehaye L, Di Paola F, Fontana A, Gasparotti R, Guidetti G, Divenuto I, Iannucci G, Isalberti M, Leonardi M, Lupo F, Mangiafico S, Manto A, Menozzi R, Muto M, Nuzzi NP, Papa R, Petralia B, Piano M, Resta M, Padolecchia R, Saletti A, Sirabella G, Bolgè LPV. Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Neuroradiology 2012; 54:1145-52. [PMID: 22569955 DOI: 10.1007/s00234-012-1047-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
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Boncoraglio GB, Parati EA, Ciceri E, Capella GL. Speckled lentiginous nevus: sometimes, but not always, part of a syndrome. Neurol Sci 2012. [DOI: 10.1007/s10072-011-0759-1] [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: 11/24/2022]
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Usai S, Caputi L, Ciceri E, Grazzi L, Carriero MR, Parati E, Bussone G. Caliber Fluctuations of Cervical Internal Carotid Artery and Migraine With Aura: A Possible Vasospasm Detected by Ultrasonographic Examinations. Headache 2009; 49:1068-72. [DOI: 10.1111/j.1526-4610.2009.01433.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gattellaro G, Minati L, Grisoli M, Mariani C, Carella F, Osio M, Ciceri E, Albanese A, Bruzzone MG. White matter involvement in idiopathic Parkinson disease: a diffusion tensor imaging study. AJNR Am J Neuroradiol 2009; 30:1222-6. [PMID: 19342541 DOI: 10.3174/ajnr.a1556] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion tensor imaging (DTI) offers a unique window on the connectivity changes, extending beyond the basal ganglia, which accompany the cognitive symptoms of Parkinson disease (PD). The primary purpose of this study was to assess the microstructural damage to cerebral white matter occurring in idiopathic PD. MATERIALS AND METHODS Our sample included patients with PD without dementia (n = 10; Hoehn and Yahr stages I and II; Unified Parkinson Disease Rating Scale, 20.5 +/- 8.3; and Mini-Mental State Examination, 28.3 +/- 1.5) and age-matched healthy control subjects (n = 10). DTI was performed on a 1.5T scanner, and mean diffusivity (MD) and fractional anisotropy (FA) maps were obtained. Regions of interest (ROIs) were drawn on the major fiber bundles as well as on gray matter nuclei. RESULTS In patients, the MD was increased at borderline significance in the substantia nigra but was unaltered in the thalamus, globus pallidus, putamen, and in the head of the caudate nucleus. The FA and MD were unaltered in the corticospinal tract in the midbrain and at the level of the internal capsule, and in the splenium of the corpus callosum. By contrast, the MD was increased and the FA was decreased in the genu of the corpus callosum and in the superior longitudinal fasciculus; in the cingulum, only the MD was altered. The observed changes were not significantly lateralized. CONCLUSIONS Widespread microstructural damage to frontal and parietal white matter occurs already in the early stages of PD.
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Affiliation(s)
- G Gattellaro
- Neuroradiology Unit, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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Ciceri E. Conservative treatment of ruptured vertebrobasilar dissecting aneurysm: a controversial issue in therapeutical management. Neurol Sci 2008; 29:201. [PMID: 18810591 DOI: 10.1007/s10072-008-0967-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
The authors demonstrate the feasibility of a new procedure to create intracranial interrupted microvascular anastomosis. Self-closing nitinol surgical clips were used for a pericallosal artery–pericallosal artery side-to-side bypass in a 52-year-old man harboring an unruptured large aneurysm located on the right A2 segment. The outflow artery was found to arise from the dome of the aneurysm, which was considered unsuitable for stand-alone clip ligation or coil occlusion. After bypass patency was intraoperatively confirmed using near-infrared indocyanine green videoangiography, the aneurysm and feeding artery were embolized with coils and safely occluded. Both postoperative courses were uneventful. The patient was discharged neurologically intact on the 5th postembolization day. Postprocedure angiography demonstrated no ipsilateral aneurysm filling and excellent bilateral distal outflow from the left anterior cerebral artery.
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Affiliation(s)
| | - Elisa Ciceri
- 1Istituto Nazionale Neurologico Carlo Besta; and
| | - Alessandro Addis
- 2Centro di Ricerca ed Applicazioni Biotecnologiche Piera Santambrogio, University of Milano, Italy
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Erbetta A, Salmaggi A, Sghirlanzoni A, Silvani A, Potepan P, Botturi A, Ciceri E, Bruzzone MG. Clinical and radiological features of brain neurotoxicity caused by antitumor and immunosuppressant treatments. Neurol Sci 2008; 29:131-7. [DOI: 10.1007/s10072-008-0924-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 04/28/2008] [Indexed: 10/21/2022]
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DiMeco F, Li KW, Casali C, Ciceri E, Giombini S, Filippini G, Broggi G, Solero CL. MENINGIOMAS INVADING THE SUPERIOR SAGITTAL SINUS. Neurosurgery 2008; 62:1124-35. [DOI: 10.1227/01.neu.0000333779.73940.c4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ciceri E, Recchia S, Dossi C, Yang L, Sturgeon R. Validation of an isotope dilution, ICP-MS method based on internal mass bias correction for the determination of trace concentrations of Hg in sediment cores. Talanta 2008; 74:642-7. [DOI: 10.1016/j.talanta.2007.06.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 06/14/2007] [Accepted: 06/25/2007] [Indexed: 10/23/2022]
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Monticelli D, Ciceri E, Dossi C. Optimization and validation of an automated voltammetric stripping technique for ultratrace metal analysis. Anal Chim Acta 2007; 594:192-8. [PMID: 17586114 DOI: 10.1016/j.aca.2007.05.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 04/20/2007] [Accepted: 05/21/2007] [Indexed: 11/15/2022]
Abstract
A new automated batch method for the determination of ultratrace metals (nanogram per liter level) was developed and validated. Instrumental and chemical parameters affecting the performance of the method were carefully assessed and optimized. A wide range of voltammetric methods under different chemical conditions were tested. Cadmium, lead and copper were determined by anodic stripping voltammetry (ASV), while nickel, cobalt, rhodium and uranium by adsorptive cathodic stripping voltammetry (AdCSV). The figures of merit of all of these methods were determined: very good precision and accuracy were achieved, e.g. relative percentage standard deviation in the 4-13% for ASV and 2-5% for AdCSV. The stripping methods were applied to the determination of cadmium, lead, copper, nickel, cobalt, rhodium and uranium in lake water samples and the results were found to be comparable with ICP-MS data.
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Affiliation(s)
- D Monticelli
- Dipartimento di Scienze Chimiche e Ambientali, Università degli Studi dell'Insubria, Via Valleggio 11, 22100 Como, Italy.
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Ferroli P, Ciceri E, Parati E, Minati L, Broggi G. Obliteration of a giant fusiform carotid terminus-M1 aneurysm after distal clip application and extracranial-intracranial bypass. Case report. J Neurosurg Sci 2007; 51:71-6. [PMID: 17571038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Giant intracranial aneurysms may not be amenable to direct surgical clipping or endovascular coiling because of three critical factors: 1) lack of clear aneurysmal neck; 2) giant size; 3) involvement with critical perforating or branch vessels. Techniques of flow redirection, however, may offer an alternative treatment strategy for these difficult lesions. In this paper, we report on the use of this alternative strategy in the successful treatment of a left giant fusiform carotid terminus-M1 aneurysm in a 16 year-old boy suffering from Ehler-Danlos disease. This patient was admitted to our Institution because his aneurysm was continuing to be increasing in size, despite a previous ligation of his left cervical ICA which was performed at another institution 2 years earlier after the patient had experienced a hemorrhagic stroke. Upon admission, a neurological examination revealed a slight motor aphasia with mild right hemiparesis, remnant of the ancient stroke. Because of its size and the involvement with M1 perforating arteries, a direct aneurysm attack was deemed inadvisable. After an initial ECA-ICA high flow bypass which spontaneously thrombosed, we performed a repeated high flow bypass with the application of a single clip on M1, right distal to the fusiform dilatation. After an uneventful postoperative course, we were unable to observe any new neurological deficits after surgery. A CT scan on postoperative day 1 revealed that the aneurysm had undergone a spontaneous thrombosis which was completely obliterated at the time of a 6-month follow-up angiogram. At that time, the ECA-ICA bypass was found to be patent. In conclusion the alternative of flow alteration strategies can be successfully used in the treatment of aneurysms that cannot be safely trapped or occluded by traditional neurosurgical methods.
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Affiliation(s)
- P Ferroli
- Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy.
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Ferroli P, Biglioli F, Ciceri E, Addis A, Broggi G. SELF-CLOSING U-CLIPS FOR INTRACRANIAL MICROANASTOMOSES IN HIGH-FLOW ARTERIAL BYPASS. Oper Neurosurg (Hagerstown) 2007; 60:ONSE170; discussion ONSE170. [PMID: 17297352 DOI: 10.1227/01.neu.0000232735.45957.1e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Self-closing nitinol U-clips (Medtronic, Inc., Minneapolis, MN) have been used to create vascular microanastomoses by vascular surgeons. This device eliminates the need for suture management and knot tying. Therefore, a high-quality interrupted microvascular anastomosis can be obtained in a shorter period of time. This is the first report of a U-clip intracranial arterial microanastomosis for a high-flow extracranial-intracranial bypass using a radial artery graft. CLINICAL PRESENTATION A 24-year-old woman with a history of chronic headache was admitted to the National Neurological Institute Carlo Besta after a brain computed tomographic scan revealed a giant serpentine aneurysm of her right middle cerebral artery. Magnetic resonance angiography and four-vessel angiography confirmed the diagnosis and ruled out other lesions. INTERVENTION A radial artery graft was used to create a high-flow bypass between the external carotid artery and the postaneurysmal M2 segment of the right middle cerebral artery. Nitinol self-closing U-clips were used for the interrupted intracranial microanastomosis. After intraoperative near-infrared indocyanine green video angiography confirmed the bypass patency, the aneurysm could be trapped. CONCLUSION The postoperative course was uneventful. The patient was discharged on the seventh postoperative day and was neurologically intact. Postoperative angiography documented the successful exclusion of the aneurysm and the presence of revascularization of the distal branches of the right middle cerebral artery through the bypass. This case demonstrates the efficacy of U-clips for intracranial microanastomoses.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, National Neurological Institute Carlo Besta, Milan, Italy.
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Ciceri E, Bruzzone MG. Minor stroke and major vascular occlusion: advanced MRI in cerebrovascular patients. Neurol Sci 2006; 27:153. [PMID: 16897624 DOI: 10.1007/s10072-006-0658-z] [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] [Indexed: 11/25/2022]
Affiliation(s)
- E Ciceri
- Neuroradiological Division, Istituto Nazionale Neurologico C. Besta, I-20133, Milan, Italy.
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DiMeco F, Li KW, Casali C, Ciceri E, Giombini S, Filippini G, Broggi G, Solero CL. Meningiomas invading the superior sagittal sinus: surgical experience in 108 cases. Neurosurgery 2005; 55:1263-72; discussion 1272-4. [PMID: 15574208 DOI: 10.1227/01.neu.0000143373.74160.f2] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [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: 01/30/2004] [Accepted: 08/12/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Radical resection of meningiomas invading the superior sagittal sinus (SSS) presents several hazards. Some surgeons consider SSS invasion a contraindication for complete resection, and others advocate total resection with venous reconstruction. There is a lack of published large series to provide definitive guidelines for the surgical treatment of these complex cases. We report our 15-year experience with surgery of parasagittal meningiomas invading the SSS. METHODS Between 1986 and 2001, 108 patients (73 women, 35 men; age range, 22-83 yr; mean age, 56.2 yr) underwent surgery at the Neurological Institute "C. Besta" of Milan for tumors invading the SSS. Parasagittal meningiomas not invading the SSS were excluded from this series. RESULTS Simpson Grade I to II removal was achieved in 100 patients. Thirty patients with meningiomas totally occluding the SSS had complete resection of the encased portion of the sinus. Histological examination revealed 86 benign (79.6%), 16 atypical (14.8%), and 4 malignant (3.7%) meningiomas along with 2 hemangiopericytomas. There were two perioperative deaths. Serious complications included brain swelling (nine patients; 8.3%) and postoperative hematoma (two patients; 1.85%). Follow-up ranged from 19 to 223 months (mean, 79.5 mo). One patient was lost to follow-up. Tumors recurred in 15 patients (13.9%). After multivariate analysis, histological type, tumor size, and Simpson grade were confirmed as significant independent prognostic factors for recurrence. CONCLUSION On the basis of our results, we conclude that if the sinus is partially invaded, it can be opened to obtain as complete a resection as possible and to attempt to preserve the patency of the sinus. If the sinus is obstructed, the portion of the sinus involved can be resected completely. In both situations, extreme care is vital to preservation of cortical veins, which may offer important collateral drainage. With our approach, good results are achieved and it is not necessary to reconstruct the sinus.
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Affiliation(s)
- Francesco DiMeco
- Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, 20133 Milan, Italy.
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Grimaldi D, Mea E, Chiapparini L, Ciceri E, Nappini S, Savoiardo M, Castelli M, Cortelli P, Carriero MR, Leone M, Bussone G. Spontaneous low cerebrospinal pressure: a mini review. Neurol Sci 2005; 25 Suppl 3:S135-7. [PMID: 15549523 DOI: 10.1007/s10072-004-0272-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is a syndrome of low cerebrospinal fluid (CSF) pressure characterised by postural headaches in patients without any history of dural puncture or penetrating trauma. Described by Schaltenbrand in 1938, SIH is thought to result from an occult CSF leak resulting in decreased CSF volume and, consequently, in low CSF pressure. Magnetic resonance imaging of the head and spine has improved the diagnosis of the syndrome showing peculiar radiographic abnormalities including diffuse pachymeningeal enhancement, subdural fluid collections and downward displacement of the cerebral structures. Treatment of SIH headache should start with conservative, non-invasive therapies while epidural blood patch has emerged as the treatment of choice for those symptomatic patients who have failed medical noninvasive approaches.
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Affiliation(s)
- D Grimaldi
- Dipartimento di Neuroscienze, Università di Modena e Reggio Emilia, Italy
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Chiapparini L, Ciceri E, Nappini S, Castellani MR, Mea E, Bussone G, Leone M, Savoiardo M. Headache and intracranial hypotension: neuroradiological findings. Neurol Sci 2004; 25 Suppl 3:S138-41. [PMID: 15549524 DOI: 10.1007/s10072-004-0273-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [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: 10/26/2022]
Abstract
The cardinal and classic features of postural headache and low cerebrospinal fluid (CSF) pressure in intracranial hypotension may not dominate the clinical picture of the syndrome and may be associated with additional various neurological symptoms and signs. Reports of unusual clinical presentations continue to appear in the literature. Despite the considerable variability of the clinical spectrum, neuroradiological studies reveal more constant and characteristic features. Brain MRI findings include intracranial pachymeningeal thickening and post-contrast enhancement, subdural fluid collections and downward displacement or "sagging" of the brain. Spinal MRI findings include collapse of the dural sac with a festooned appearance, intense epidural enhancement owing to dilatation of the epidural venous plexus, and possible epidural fluid collections. In fact, spinal studies may demonstrate CSF leakage from spinal dural defects, which are considered the most common cause of the syndrome. Myelo-MR may suggest the possible point of CSF leakage, by demonstrating an irregular root sleeve; myelo-CT and radioisotope myelocisternography (RMC) are often needed to confirm the point of CSF leakage. Neuroimaging studies are, therefore, essential for suggesting and confirming the diagnosis.
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Affiliation(s)
- L Chiapparini
- Department of Neuroradiology, National Neurological Institute C. Besta, Via Celoria 11, I-20133 Milan, Italy.
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Boncoraglio G, Carriero MR, Chiapparini L, Ciceri E, Ciusani E, Erbetta A, Parati EA. Hyperhomocysteinemia and other thrombophilic risk factors in 26 patients with cerebral venous thrombosis. Eur J Neurol 2004; 11:405-9. [PMID: 15171737 DOI: 10.1111/j.1468-1331.2004.00802.x] [Citation(s) in RCA: 38] [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] [Indexed: 11/29/2022]
Abstract
Despite the continuous description of new conditions pre-disposing for cerebral venous thrombosis (CVT), no apparent cause is found in about 30% of cases. Hyperhomocysteinemia (hyper-Hcy) is an established risk factor for deep venous thrombosis and stroke but has not been clearly associated with increased risk of CVT. We assessed the prevalence of hyper-Hcy and other thrombophilic risk factors in a population of 26 consecutive patients with non-pyogenic CVT, by review of a prospectively maintained database. The prevalences of hyper-Hcy and prothrombin G20210A, factor V G1691A and methylenetetrahydrofolate reductase (MTHFR) C677T mutations in these patients were compared with those in 100 healthy controls and 100 patients with cerebroarterial disease. The prevalence of hyper-Hcy was greater in patients with CVT (10/26, 38.5%) than healthy controls (13/100; OR 4.18, 95% CI 1.58-11.16) and comparable with that in patients with cerebroarterial disease (42/100). No significant differences were found in the prevalences of prothrombin or MTHFR mutation. No factor V mutation was found. Our findings indicate that hyper-Hcy is associated with an increased risk of CVT. Additional prospective cohort studies on large series of patients are required to clarify the time relationship between hyper-Hcy and the thrombotic event.
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Affiliation(s)
- G Boncoraglio
- Department of Neurology, Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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Brock S, Giombini S, Ciceri E. Development and rupture of a de novo basilar artery aneurysm after surgical removal of a cerebellar arteriovenous malformation. Acta Neurochir (Wien) 2003; 145:1117-20. [PMID: 14663570 DOI: 10.1007/s00701-003-0125-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 01/01/2003] [Revised: 01/01/2003] [Accepted: 01/01/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The de novo development of an aneurysm in an previously normal artery is an uncommon event. We describe a patient who developed a de novo bleeding aneurysm of the basilar artery in the three weeks following the surgical removal of a large cerebellar AVM. METHOD-FINDINGS: A 48-year-old man suddenly developed transient headache, vertigo and disturbance of balance. Neuroradiological examinations showed the presence of a large AVM of the right cerebellar hemisphere. The AVM was removed successfully; following the operation there were repeated bleeding episodes at the operating site, requiring surgical evacuation. Three weeks after the AVM removal he suffered from a massive subarachnoid haemorrhage due to the rupture of an aneurysm developed de novo in the basilar artery. INTERPRETATION This is the first reported case, to our knowledge, of a de novo aneurysm developed in an artery hemodynamically related to a surgically removed AVM. This complication was probably due to the postoperative hemodynamic changes in the vessels afferent to the AVM, associated with arterial wall dysplasia.
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Affiliation(s)
- S Brock
- Department of Neurosurgery, Istituto Nazionale Neurologico C. Besta, Milan, Italy.
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Li KW, Ciceri E, Lasio G, Solero CL, DiMeco F. Shunt migration into the sphenoid sinus: case report. Neurosurgery 2003; 53:441-3; discussion 443. [PMID: 12925265 DOI: 10.1227/01.neu.0000073993.14329.4f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Accepted: 03/03/2003] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Shunt catheter migration is a potential complication of cerebrospinal fluid shunting procedures. We report an unusual case of proximal shunt migration into the sphenoid sinus. To our knowledge, there have been no previous reports of shunt migration through the bony structures of the cranial base. CLINICAL PRESENTATION A 41-year-old man who had had a cyst-to-peritoneum shunt placed 21 years earlier for a temporal lobe arachnoid cyst presented with cerebrospinal fluid rhinorrhea. Neuroradiological imaging revealed migration of the shunt catheter through the medial wall of the middle temporal fossa into the sphenoid sinus. INTERVENTION The patient underwent shunt removal and repair of the dural defect. Intraoperatively, the proximal catheter tip was found in the sphenoid sinus with dural and bony erosion. The patient made an uneventful recovery. CONCLUSION We present a unique long-term complication associated with intracranial shunt catheters. We hypothesize that excessive proximal catheter length and chronic cerebrospinal fluid pulsations contributed to migration of the catheter into the sphenoid sinus.
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Affiliation(s)
- Khan W Li
- Department of Neurological Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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