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Martinoni M, Pozzati E, Acciarri N, Bacci A, Cuoci A, Sturiale C, Bortolotti C. A Rare Case of Supratentorial Cavernous Angioma Associated with Arterialized Developmental Venous Anomaly. Asian J Neurosurg 2019; 14:901-903. [PMID: 31497124 PMCID: PMC6703005 DOI: 10.4103/ajns.ajns_128_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The association of cavernous malformations and developmental venous anomalies (DVA) is well known, but the presence of arterial fistulous connection with the main venous collector has been reported in the literature only once. We report the unusual case of a hemorrhagic cavernous angioma associated with DVA characterized by a fine arterial supply to the main venous collector. During surgery, after the excision of the cavernous angioma, few small arterial feeders were found entering the main channel of the venous developmental anomaly. The presence of an arterial fistulous connection with the main venous collector of a DVA may be a possible mechanism involved in a higher bleeding potential of cavernous angioma.
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Affiliation(s)
- Matteo Martinoni
- Division of Neurosurgery, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
| | - Eugenio Pozzati
- Division of Neurosurgery, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
| | - Nicola Acciarri
- Division of Neurosurgery, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
| | - Antonella Bacci
- Division of Neuroradiology, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
| | - Andrea Cuoci
- Division of Neurosurgery, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
| | - Carmelo Sturiale
- Division of Neurosurgery, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
| | - Carlo Bortolotti
- Division of Neurosurgery, IRCCS Institute of Neurological Science of Bologna, Bellaria Hospital, Bologna, Italy
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Badaloni F, Pozzati E, Marucci G, Fiaschi P, Fioravanti A. Primary Cardiac High-grade Myxofibrosarcoma Presenting with Multiple Brain Metastases: A Case Report. Cureus 2017; 9:e1866. [PMID: 29375952 PMCID: PMC5773267 DOI: 10.7759/cureus.1866] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Herein we describe the case of a young patient who presented with a recent history of epilepsy due to multiple brain lesions; he did not complain about any cardiopulmonary impairments. The patient died as a consequence of hemorrhagic progression of brain metastatic disease. Regardless of a thorough investigation, the heart tumor remained occult. Primary cardiac tumors are very rare entities. Most of these are benign, but approximately 25% are malignant, and the majority of these are sarcomas. Myxofibrosarcoma and osteosarcoma are exceptionally rare. To date, we find only small series of cardiac myxofibrosarcoma, and to our knowledge, this one exceptionally presented with multiple brain metastatic lesions without cardiopulmonary symptoms.
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Affiliation(s)
- Filippo Badaloni
- Department of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Eugenio Pozzati
- Department of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Gianluca Marucci
- Neuropathology Unit, IRCCS Foundation "carlo Besta" Neurological Institute, Milan, Italy
| | - Pietro Fiaschi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
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Barbara C, Pozzati E, Marucci G, Joechler M, Pisoni L, Bellei E, Leonardi M, Masetti L. Effects of Glubran Acrylic Glue on the Subarachnoid Surface in Swine. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090501800503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glubran2 is a cyanoacrylate-based synthetic glue modified by addition of a second monomer. Among its many advantages over traditional cyanoacrylate products, Glubran2 has a much lower thermal polymerization temperature than that of cyanoacrylates used for cutaneous application. For many years, the new glue has been widely used in neuroradiology endovascular treatments. Our study aimed to assess the use of Glubran2 to treat possible complications arising during the embolization of aneurysms or vascular malformations like AVM or fistulae. A complication encountered in some of these cases is rupture of the vessel wall by the microguide or perforation of the aneurysmal sac by the coils used for embolization. This complication could be overcome by injecting Glubran2 into the rupture point but this would put the glue directly in contact with the subarachnoid space and possibly reach adjacent brain tissue. The aim of this experimental study was to place the glue in direct contact with brain tissue to ascertain its immediate compatibility and tolerability in vivo and any ensuing tissue damage. Three swine underwent neurosurgical procedures and survived for different times after which they were slaughtered and their brains explanted and sent for macroscopic and microscopic investigation by the Pathological Anatomy Service. As a whole, Glubran2 was well tolerated in vivo and did not cause major damage in direct contact with brain tissue.
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Affiliation(s)
| | | | - G. Marucci
- Servizio di Anatomia, Istologia e Citologia Patologica, Ospedale Bellaria; Bologna
| | | | | | - E. Bellei
- Borsista Post Dottorato, Università degli Studi di Bologna; Italy
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Franceschi E, Bartolotti M, Tosoni A, Bartolini S, Sturiale C, Fioravanti A, Pozzati E, Galzio R, Talacchi A, Volpin L, Morandi L, Danieli D, Ermani M, Brandes AA. The effect of re-operation on survival in patients with recurrent glioblastoma. Anticancer Res 2015; 35:1743-1748. [PMID: 25750337] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Treatment options for glioblastoma (GBM) at recurrence have limited efficacy. Re-surgery has been used for confirmation of recurrent disease and to provide relief of symptoms but the real impact on survival is unknown. PATIENTS AND METHODS A retrospective analysis was performed for GBM patients followed between 01/2005 and 06/2010 at our Institution. RESULTS Two hundred and thirty-two patients with recurrent GBM were evaluated. One hundred and two patients (44%) were treated with re-surgery followed by chemotherapy and 130 patients (56%) with chemotherapy alone. In multivariate analysis, no significant effect of re-surgery was found, with age (p=0.001), MGMT methylation (p=0.002) and PFS at 6 months (p=0.0001) being significant prognostic factors. CONCLUSION Second surgery might have a limited impact in the clinical course of recurrent GBM patients.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Marco Bartolotti
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alicia Tosoni
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Stefania Bartolini
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Carmelo Sturiale
- Department of Neurosurgery, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Eugenio Pozzati
- Department of Neurosurgery, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Renato Galzio
- Department of Health Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Talacchi
- Section of Neurosurgery, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, University Hospital, Verona, Italy
| | - Lorenzo Volpin
- Department of Neuroscience and Neurosurgery, San Bortolo Hospital, Vicenza, Italy
| | - Luca Morandi
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital, Bologna, Italy
| | | | - Mario Ermani
- Department of Neurosciences, Statistic and Informatic Unit, Azienda Ospedale-Università, Padova, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
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Pozzati E, Martinoni M, Marucci G, Bacci A. Erratum. The Neuroradiology Journal 27: 452-455, 2014 - doi: 10.15274/NRJ-2014-10060 - www.centauro.it. Olfactory Neuroblastoma and Olfactory Ventricle. Neuroradiol J 2014; 27:633. [PMID: 25260211 DOI: 10.15274/nrj-2014-10084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/12/2022] Open
Abstract
Unfortunately, the affiliation of the author name, Antonella Bacci, was incorrectly listed as Antonella Bacci(1) instead of Antonella Bacci(3), and the affiliations were incorrectly listed as (1) Department of Neurosurgery, IRCCS Neurological Research Hospital; Bologna, Italy - (2) Section of Pathology "M. Malpighi", Bellaria Hospital, Azienda USL of Bologna, Bologna, Italy instead of (1) Department of Neurosurgery, (3) Department of Neuroradiology, IRCCS Neurological Research Hospital; Bologna, Italy. (2) Section of Pathology "M. Malpighi", Bellaria Hospital, Azienda USL of Bologna, Bologna, Italy in the original publication of this paper.
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Affiliation(s)
- Eugenio Pozzati
- Department of Neurosurgery, IRCCS Neurological Research Hospital; Bologna, Italy
| | - Matteo Martinoni
- Department of Neurosurgery, IRCCS Neurological Research Hospital; Bologna, Italy
| | - Gianluca Marucci
- Section of Pathology "M. Malpighi", Bellaria Hospital, Azienda USL of Bologna, Bologna, Italy
| | - Antonella Bacci
- Department of Neuroradiology, IRCCS Neurological Research Hospital; Bologna, Italy
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Pozzati E, Martinoni M, Marucci G, Bacci A. Olfactory neuroblastoma and olfactory ventricle. A case report. Neuroradiol J 2014; 27:452-5. [PMID: 25196619 DOI: 10.15274/nrj-2014-10060] [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] [Received: 02/10/2014] [Accepted: 05/18/2014] [Indexed: 01/19/2023] Open
Abstract
A case of dumbbell nasal and intracerebral olfactory neuroblastoma (ONB) related to possible seeding through an "olfactory ventricle" in the olfactory bulb and nerve is reported. This anatomic variant was recognized at operation for the first time: it consists of a hollow cavity within the olfactory bulb and nerve which may be connected to the subventricular zone of the frontal horn of the lateral ventricle. Better scrutiny of this structure is necessary in view of its possible interference with the course and diffusion of ONBs.
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Affiliation(s)
- Eugenio Pozzati
- Department of Neurosurgery, IRCCS Neurological Research Hospital; Bologna, Italy -
| | - Matteo Martinoni
- Department of Neurosurgery, IRCCS Neurological Research Hospital; Bologna, Italy
| | - Gianluca Marucci
- Department of Pathological Anatomy, IRCCS Neurological Research Hospital; Bologna, Italy
| | - Antonella Bacci
- Department of Neurosurgery, IRCCS Neurological Research Hospital; Bologna, Italy
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Martinoni M, Toni F, Lefosse M, Pozzati E, Marliani AF, Mascari C. Endoscopic treatment of a fourth ventricle arachnoid cyst via the third ventricle: a case report. Neurosurgery 2014; 10 Suppl 2:E374-7; discussion E377-8. [PMID: 24589562 DOI: 10.1227/neu.0000000000000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Arachnoid cysts within the fourth ventricle have rarely been reported in the literature. Different procedures have been performed to restore a normal cerebrospinal fluid dynamic or pressure, including shunting and partial or complete excision of the cyst by open microsurgery. Cerebrospinal fluid shunts give only partial improvement of symptoms and are prone to malfunctions. The microsurgical excision of the cyst seems to offer the best chance of success. CLINICAL PRESENTATION We report the case of a fourth ventricle arachnoid cyst successfully treated with a complete endoscopic cerebral procedure via the third ventricle. CONCLUSION Endoscopic fenestration of fourth ventricle arachnoid cysts may be considered an effective neurosurgical treatment.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Sciences of Bologna, *Departments of Neurosurgery and ‡Neuroradiology, Bellaria Hospital, Bologna, Italy
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Simonazzi G, Curti A, Rapacchia G, Gabrielli S, Pilu G, Rizzo N, Pozzati E. Symptomatic cerebral cavernomas in pregnancy: a series of 6 cases and review of the literature. J Matern Fetal Neonatal Med 2013; 27:261-4. [DOI: 10.3109/14767058.2013.809417] [Citation(s) in RCA: 7] [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] [Indexed: 11/13/2022]
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Franceschi E, Tosoni A, Morandi L, Cerasoli S, Lanza G, Depenni R, Gamboni A, Dazzi C, Marucci G, Gardini G, Pozzati E, Urbini B, Dascola I, Bartolini S, Biasini C, Carpeggiani P, Zunarelli E, Silini EM, Ermani M, Brandes AA. A large prospective Italian population study (Project of Emilia-Romagna Region in Neuro-Oncology; PERNO) in newly diagnosed GBM patients (pts): Outcome analysis and correlations with MGMT methylation status in the elderly population. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2021] [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: 11/20/2022] Open
Abstract
2021 Background: The role of temozolomide concurrent with and adjuvant to radiotherapy (RT/TMZ) in elderly pts with GBM remains unclear. We therefore evaluated the efficacy of this approach in pts >70 years in the context of the Project of Emilia-Romagna Region in Neuro-Oncology (PERNO), the first Italian prospective observational population-based study in neuro-oncology. Methods: The criteria for selecting pts enrolled in the PERNO study were: age >70 years; PS 0-3; histologically confirmed GBM; postoperative radiotherapy after surgery; residence in the Emilia Romagna region. Data were collected prospectively. Results: Pts accrual, started on January 1 2009, was closed, as planned, on December 31 2010. In the pts enrolled (n=53), median overall survival (mOS) was 11.1 months (95% CI: 8.8 - 13.5); survival rates at 1-, 2- and 3-years were 41.5% (95% CI: 28.2 – 54.8%), 15.2% (95% CI: 4.8 – 25.6%) and 6.1% (95%CI: 0 – 15.9%), respectively. Twenty-eight pts received RT/TMZ, and 25 pts RT alone. mOS was 11.6 months (95% CI: 8.6 – 14.6) following RT/TMZ and 9.3 months (95% CI: 8.1 – 10.6) following RT alone. mOS for pts with MGMT methylated status (n = 17) was 13.5 months (95% CI: 7.7 – 19.2), being 17.2 months (95% CI: 11.5 - 22.9) in those treated with RT/TMZ (n = 6) and 8.8 months (95% CI: 2 – 15.6) in those treated with RT alone (n = 11, p = 0.09). Elderly pts with MGMT unmethylated status (n = 25) had a mOS of 8.5 months (95% CI: 6 – 11, p = 0.014), being 8.5 months (95% CI: 2.3 – 14.7) in pts treated with RT/TMZ (n =10), and 8 months (95% CI: 3 – 12.9) in those treated with RT (n = 15, p = 0.55). Conclusions: RT/TMZ appears to be more effective in prolonging the mOS of elderly pts in those with MGMT methylation status (17.2 vs 8.5 months), and seem to perform better than TMZ alone, for which mOS was 9.7 months in the Nordic phase III trial. These findings underline the value of the ongoing randomized EORTC 26062-22061/NCIC CE.6 phase III comparing RT/TMZ with short course RT alone.
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Affiliation(s)
- Enrico Franceschi
- Medical Oncology Department, Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy
| | - Alicia Tosoni
- Medical Oncology Department, Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy
| | - Luca Morandi
- Department of Haemathology and Oncological Sciences Section of Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Serenella Cerasoli
- Department of Human Pathology, AUSL Cesena Bufalini Hospital, Cesena, Italy
| | - Giovanni Lanza
- Department of Experimental and Diagnostic Medicine, Section of Anatomic Pathology, Ferrara, Italy
| | - Roberta Depenni
- Oncology, Haematology and Respiratory Diseases Department, University Hospital of Modena, Modena, Italy
| | | | - Claudio Dazzi
- Department of Oncology and Hematology, General Hospital, Ravenna, Italy
| | - Gianluca Marucci
- Section of Pathology, Department of Haematology and Oncology, University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Giorgio Gardini
- Department of Pathology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Eugenio Pozzati
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Benedetta Urbini
- Clinical Oncology Unit, St Anna University Hospital, Ferrara, Italy
| | - Isabella Dascola
- Neurosurgery Department, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Stefania Bartolini
- Medical Oncology Department, Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy
| | - Claudia Biasini
- Department of Oncology and Hematology, Oncology Unit, Azienda Ospedaliera Guglielmo da Saliceto, Piacenza, Italy
| | - Paolo Carpeggiani
- Neuroradiology Department, Nuovo Ospedale Civile S. Agostino Estense, Azienda USL, Modena, Italy
| | - Elena Zunarelli
- Pathology Department, Azienda Ospedaliero-Universitaria, Policlinico, Modena, Italy
| | | | - Mario Ermani
- Neurosciences Department, Statistic and Informatic Unit, Azienda Ospedale-Università, Padova, Italy
| | - Alba Ariela Brandes
- Medical Oncology Department, Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy
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Nanney AD, Adel JG, Smith TR, Chandler JP, Kimmell KT, Walter K, Zacharia BE, Deibert C, Malone HR, Sonabend AM, Neugut AI, Spencer B, Bruce JN, Wang Y, Li S, Zhang Z, Chen X, You G, Yang P, Yan W, Bao Z, Yao K, Liu Y, Wang L, Jiang T, Farhoud MK, Ruge MI, Brandes AA, Ermani M, Fioravanti A, Andreoli A, Pozzati E, Bacci A, Bartolini S, Poggi R, Crisi G, Franceschi E, Recinos PF, Grabowski MM, Nowacki AS, Thompson N, Vogelbaum MA, Sun P, Krueger D, Liu Z, Kohrman M, Dagens AB, Rachinger W, Kunz M, Eigenbrod S, Lutz J, Tonn JC, Kreth FW, Duong HT, Chaloner C, Bordo G, Eisenberg A, Rosenthal K, Sim MS, Boasberg P, Faries MB, Hamid O, Kelly DF, Kreth FW, Thon N, Simon M, Westphal M, Schackert G, Nikkhah G, Hentschel B, Pietsch T, Reifenberger G, Weller M, Tonn JC, Ironside S, Perry J, Tsao M, Mainprize T, Keith J, Laperrierre N, Paszat L, Sahgal A, Hoover JM, Nwojo M, Puffer R, Parney IF, Tanaka S, Nakada M, Hayashi Y, Hamada JI, Lee IY, Ekram T, Jain R, Scarpace L, Omodon M, Rock J, Rosenblum M, Kalkanis S, Amankulor NM, Kim JH, Tabar V, Peck KK, Holodny AI, Gutin PH, Kim CY, Kim YH, Kim T, Kim IK, Kim JW, Kim YH, Han JH, Park CK, Kim DG, Jung HW, Nonaka M, Bamba Y, Kanemura Y, Nakajima S. NEUROSURGICAL TREATMENTS. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos230] [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: 11/13/2022] Open
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Giulioni M, Martinoni M, Naldi I, Bisulli F, Pozzati E, Tinuper P. Successful removal and reimplant of vagal nerve stimulator device after 10 years. Ann Indian Acad Neurol 2012; 15:128-9. [PMID: 22566727 PMCID: PMC3345590 DOI: 10.4103/0972-2327.94997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/05/2010] [Indexed: 11/15/2022] Open
Abstract
The number of implanted vagal nerve stimulators is growing and the need for removal or revision of the devices will become even more frequent. A significant concern about Vagus Nerve Stimulation (VNS) therapy is the presence of the spiral stimulating electrodes, wrapped around the nerve, once treatment is considered ineffective or is no longer desired. Our purpose is to demonstrate the feasibility of complete removal and replacement of the vagal nerve stimulator electrodes using microsurgical technique even after a long period, without damaging the nerve. We attempted removal and replacement of spiral stimulating electrodes from a patient who received a 10-year long VNS therapy for drug-resistant epilepsy. Our results indicate that the spiral electrodes may be safely removed from the vagus nerve, even after several years. The reversibility of lead implantation may enhance the attractiveness of VNS therapy. Furthermore, with a correct microsurgical technique, it is possible to respect the normal anatomy and functionality of vagal nerve and to reimplant a new VNS system with all its components, maintaining the same therapeutic efficacy after many years.
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Affiliation(s)
- Marco Giulioni
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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12
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Paradisi M, Fernández M, Del Vecchio G, Lizzo G, Marucci G, Giulioni M, Pozzati E, Antonelli T, Lanzoni G, Bagnara GP, Giardino L, Calzà L. Ex vivo study of dentate gyrus neurogenesis in human pharmacoresistant temporal lobe epilepsy. Neuropathol Appl Neurobiol 2011; 36:535-50. [PMID: 20609110 DOI: 10.1111/j.1365-2990.2010.01102.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Neurogenesis in adult humans occurs in at least two areas of the brain, the subventricular zone of the telencephalon and the subgranular layer of the dentate gyrus in the hippocampal formation. We studied dentate gyrus subgranular layer neurogenesis in patients subjected to tailored antero-mesial temporal resection including amygdalohippocampectomy due to pharmacoresistant temporal lobe epilepsy (TLE) using the in vitro neurosphere assay. METHODS Sixteen patients were enrolled in the study; mesial temporal sclerosis (MTS) was present in eight patients. Neurogenesis was investigated by ex vivo neurosphere expansion in the presence of mitogens (epidermal growth factor + basic fibroblast growth factor) and spontaneous differentiation after mitogen withdrawal. Growth factor synthesis was investigated by qRT-PCR in neurospheres. RESULTS We demonstrate that in vitro proliferation of cells derived from dentate gyrus of TLE patients is dependent on disease duration. Moreover, the presence of MTS impairs proliferation. As long as in vitro proliferation occurs, neurogenesis is maintained, and cells expressing a mature neurone phenotype (TuJ1, MAP2, GAD) are spontaneously formed after mitogen withdrawal. Finally, formed neurospheres express mRNAs encoding for growth (vascular endothelial growth factor) as well as neurotrophic factors (brain-derived neurotrophic factor, ciliary neurotrophic factor, glial-derived neurotrophic factor, nerve growth factor). CONCLUSION We demonstrated that residual neurogenesis in the subgranular layer of the dentate gyrus in TLE is dependent on diseases duration and absent in MTS.
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Affiliation(s)
- M Paradisi
- BioPharmaNet-DIMORFIPA, and Department of Histology, Embryology and Applied Biology, University of Bologna, Via Tolara di Sopra 50, Bologna, Italy
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Barker CA, Chang M, Lassman AB, Beal K, Chan TA, Hunter K, Grisdale K, Ritterhouse M, Moustakas A, Iwamoto FM, Kreisl TN, Sul J, Kim L, Butman J, Albert P, Fine HA, Chamberlain MC, Alexandru D, Glantz MJ, Kim L, Chamberlain MC, Bota DA, Takahashi K, Ikeda N, Kajimoto Y, Miyatake S, Kuroiwa T, Iwamoto F, Lamborn K, Kuhn J, Wen P, Yung WKA, Gilbert M, Chang S, Lieberman F, Prados M, Fine H, Lu-Emerson C, Norden AD, Drappatz J, Quant EC, Ciampa AS, Doherty LM, LaFrankie DC, Wen PY, Sherman JH, Moldovan K, Yeoh HK, Starke BM, Pouratian N, Shaffrey ME, Schiff D, O'Connor PC, Kroon HA, Recht L, Montano N, Cenci T, Martini M, D'Alessandris QG, Banna GL, Maira G, De Maria R, Larocca LM, Pallini R, Kim CH, Yang MS, Cheong JH, Kim JM, Shonka N, Gilbert M, Alfred Yung WK, Piao Y, Liu J, Bekele N, Wen P, Chen A, Heymach J, de Groot J, Gilbert MR, Wang M, Aldape K, Sorensen AG, Mikkelsen T, Bokstein F, Woo SY, Chmura SJ, Choucair AK, Mehta M, Perez Segura P, Gil M, Balana C, Chacon I, Munoz J, Martin M, Flowers A, Salner A, Gaziel TB, Soerensen M, Hasselbalch B, Poulsen HS, Lassen U, Peyre M, Cartalat-Carel S, Meyronet D, Sunyach MP, Jouanneau E, Guyotat J, Jouvet A, Frappaz D, Honnorat J, Ducray F, Wagle N, Nghiemphu PL, Lai A, Cloughesy TF, Kairouz VF, Elias EF, Chahine GY, Comair YG, Dimassi H, Kamar FG, Parchman AJ, Nock CJ, Bartolomeo J, Norden AD, Drappatz J, Ciampa AS, Doherty LM, LaFrankie DC, Ruland S, Quant EC, Beroukhim R, Wen PY, Graber JJ, Lassman AB, Kaley T, Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W, Buckner JC, Dirier A, Abacioglu U, Okkan S, Pak Y, Guney YY, Aksu G, Soyuer S, Oksuzoglu B, Meydan D, Zincircioglu B, Yumuk PF, Alco G, Keven E, Ucer AR, Tsung AJ, Prabhu SS, Shonka NA, Alistar AT, van den Bent M, Taal W, Sleijfer S, van Heuvel I, Smitt PAS, Bromberg JE, Vernhout I, Porter AB, Dueck AC, Karlin NJ, Hiramatsu R, Kawabata S, Miyatake SI, Kuroiwa T, Easson MW, Vicente MGH, Sahebjam S, Garoufalis E, Guiot MC, Muanza T, Del Maestro R, Kavan P, Smolin AV, Konev A, Nikolaeva S, Shamanskaya Y, Malysheva A, Strelnikov V, Vranic A, Prestor B, Pizem J, Popovic M, Khatua S, Finlay J, Nelson M, Gonzalez I, Bruggers C, Dhall G, Fu BD, Linskey M, Bota D, Walbert T, Puduvalli V, Ozawa T, Brennan CW, Wang L, Squatrito M, Sasayama T, Nakada M, Huse JT, Pedraza A, Utsuki S, Tandon A, Fomchenko EI, Oka H, Levine RL, Fujii K, Ladanyi M, Holland EC, Raizer J, Avram MJ, Kaklamani V, Cianfrocca M, Gradishar W, Helenowski I, McCarthy K, Mulcahy M, Rademaker A, Grimm S, Landolfi JC, Chen S, Peeraully T, Anthony P, Linendoll NM, Zhu JJ, Yao K, Mignano J, Pfannl R, Pan E, Vera-Bolanos E, Armstrong TS, Bekele BN, Gilbert MR, Alexandru D, Glantz MJ, Kim L, Chamberlain MC, Bota DA, Albrecht V, Juerchott K, Selbig J, Tonn JC, Schichor C, Sawale KB, Wolff J, Vats T, Ketonen L, Khasraw M, Kaley T, Panageas K, Reiner A, Goldlust S, Tabar V, Green RM, Woyshner EA, Cloughesy TF, Abe T, Morishige M, Shiqi K, Momii Y, Sugita K, Fukuyoshi Y, Kamida T, Fujiki M, Kobayashi H, Lavon I, Refael M, Zrihan D, Siegal T, Elias EF, Kairouz VF, Chahine GY, Comair YG, Dimassi H, Kamar FG, Tham CK, See SJ, Toh CK, Kang SH, Park KJ, Kim CY, Yu MO, Park CK, Park SH, Chung YG, Park KJ, Yu MO, Kang SH, Cho TH, Chung YG, Sasaki H, Sano K, Nariai T, Uchino Y, Kitamura Y, Ohira T, Yoshida K, Kirson ED, Wasserman Y, Izhaki A, Mordechovich D, Gurvich Z, Dbaly V, Vymazal J, Tovarys F, Salzberg M, Rochlitz C, Goldsher D, Palti Y, Ram Z, Gutin PH, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Torcuator RG, Ibaoc K, Rafael A, Mariano M, Reardon DA, Peters K, Desjardins A, Sampson J, Vredenburgh JJ, Gururangan S, Friedman HS, Le Rhun E, Kotecki N, Zairi F, Baranzelli MC, Faivre-Pierret M, Dubois F, Bonneterre J, Arenson EB, Arenson JD, Arenson PK, Pierick M, Jensen W, Smith DB, Wong ET, Gautam S, Malchow C, Lun M, Pan E, Brem S, Raizer J, Grimm S, Chandler J, Muro K, Rice L, McCarthy K, Mrugala M, Johnston SK, Chamberlain M, Marosi C, Handisurya A, Kautzky-Willer A, Preusser M, Elandt K, Widhalm G, Dieckmann K, Torcuator RG, Opinaldo P, Chua E, Barredo C, Cuanang J, Grimm S, Phuphanich S, Recht LD, Rosenfeld SS, Chamberlain MC, Zhu JJ, Fadul CE, Swabb EA, Pope C, Beelen AP, Raizer JJ, Kim IH, Park CK, Han JH, Lee SH, Kim CY, Kim TM, Kim DW, Kim JE, Paek SH, Kim IA, Kim YJ, Kim JH, Nam DH, Rhee CH, Lee SH, Park BJ, Kim DG, Heo DS, Jung HW, Desjardins A, Peters KB, Vredenburgh JJ, Friedman HS, Reardon DA, Becker K, Baehring J, Hammond SN, Norden AD, Fisher DC, Wong ET, Cote GM, Ciampa AS, Doherty LM, Ruland SF, LaFrankie DC, Wen PY, Drappatz J, Brandes AA, Franceschi E, Tosoni A, Poggi R, Agati R, Bartolini S, Spagnolli F, Pozzati E, Marucci G, Ermani M, Taillibert S, Guillevin R, Dehais C, Bellanger A, Delattre JY, Omuro A, Taillibert S, Hoang-Xuan K, Barrie M, Guiu S, Chauffert B, Cartalat-Carel S, Taillandier L, Fabbro M, Laigre M, Guillamo JS, Geffrelot J, Rouge TDLM, Bonnetain F, Chinot O, Gil MJ, de las Penas R, Reynes G, Balana C, Perez-Segura P, Garcia-Velasco A, Gallego O, Herrero A, de Lucas CFC, Benavides M, Perez-Martin X, Mesia C, Martinez-Garcia M, Muggeri AD, Cervio A, Rojas M, Arakaki N, Sevlever GE, Diez BD, Muggeri AD, Cerrato S, Martinetto H, Diez BD, Peereboom DM, Brewer CJ, Suh JH, Chao ST, Parsons MW, Elson PJ, Vogelbaum MA, Sade B, Barnett GH, Shonka NA, Yung WKA, Bekele N, Gilbert MR, Kobyakov G, Absalyamova O, Amanov R, Rauschkolb PK, Drappatz J, Batchelor TT, Meyer LP, Fadul CE, Lallana EC, Nghiemphu PL, Kohanteb P, Lai A, Green RM, Cloughesy TF, Mrugala MM, Lee LK, Graham CA, Fink JR, Spence AM, Portnow J, Badie B, Liu X, Frankel P, Chen M, Synold TW, Al Jishi AA, Golan J, Polley MYC, Lamborn KR, Chang SM, Butowski N, Clarke JL, Prados M, Grommes C, Oxnard GR, Kris MG, Miller VA, Pao W, Lassman AB, Renfrow J, DeTroye A, Chan M, Tatter S, Ellis T, McMullen K, Johnson A, Mott R, Lesser GJ, Cavaliere R, Abrey LE, Mason WP, Lassman AB, Perentesis J, Ivy P, Villalona M, Nayak L, Fleisher M, Gonzalez-Espinoza R, Reiner A, Panageas K, Lin O, Liu CM, Deangelis LM, Omuro A, Taylor LP, Ammirati M, Lamki T, Zarzour H, Grecula J, Dudley RW, Kavan P, Garoufalis E, Guiot MC, Del Maestro RF, Maurice C, Belanger K, Moumdjian R, Dufresne S, Fortin C, Fortin MA, Berthelet F, Renoult E, Belair M, Rouleau D, Gallego O, Benavides M, Segura PP, Balana C, Gil MJG, Berrocal A, Reynes G, Garcia JL, Mazarico J, Bague S. Medical and Neuro-Oncology. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s6] [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: 11/13/2022] Open
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Giulioni M, Martinoni M, Rubboli G, Marucci G, Marliani AF, Battaglia S, Badaloni F, Pozzati E, Calbucci F. Temporo-mesial extraventricular neurocytoma and cortical dysplasia in focal temporal lobe epilepsy. J Clin Neurosci 2010; 18:147-8. [PMID: 20851605 DOI: 10.1016/j.jocn.2010.03.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 03/23/2010] [Indexed: 01/12/2023]
Abstract
We describe a 17-year-old boy with a left extraventricular temporo-mesial neurocytoma associated with cortical dysplasia causing focal pharmacoresistant temporal lobe epilepsy. He presented with a long history of medically refractory, temporal complex partial seizures. MRI showed a left temporo-mesial lesion suspect to be a low-grade tumor. Based on the pre-operative non-invasive neurophysiological studies, the patient underwent a left tailored temporal antero-mesial resection. Histopathological examination showed an extraventricular neurocytoma associated with architectural dysplasia (Type 1a) of the temporal pole. The patient was seizure-free at 2 years follow-up. Extraventricular neurocytomas must be considered in the differential diagnosis of the plethora of low-grade tumors associated with focal epilepsy that typically involve the temporal lobe, and are frequently associated with focal cortical dysplasia.
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Affiliation(s)
- Marco Giulioni
- Division of Neurosurgery, Department of Neurosciences, Bellaria Hospital, Via Altura 3, Bologna 40139, Italy.
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Franceschi E, Tosoni A, Pozzati E, Brandes AA. Association between response to primary treatments and MGMT status in glioblastoma. Expert Rev Anticancer Ther 2009; 8:1781-6. [PMID: 18983238 DOI: 10.1586/14737140.8.11.1781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
The median overall survival and, more importantly, the 2-year survival rate of patients with newly diagnosed glioblastoma are increased by the administration of combined temozolomide and radiotherapy, which has recently become the new standard of treatment in patients with a histological confirmation of diagnosis. Moreover, the assessment of O(6)-methylguanine-DNA methyltransferase gene promoter methylation has clarified the impact of this approach, and improved upon the interpretation of doubtful cases after concurrent radiotherapy/temozolomide treatment. Therefore, future strategies in the treatment of glioblastoma patients will include stratification for MGMT methylation status, and various approaches based on epigenetic features are currently under investigation.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Azienda USL Bellaria-Maggiore, Bologna, Italy.
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Abstract
Recent clinical and experimental evidence has challenged the traditional concept of the venous system as a “passive” element in the genesis and evolution of intracranial vascular malformations. The authors review the clinical and experimental evidence linking the venous system and its anomalies to the genesis of various intracranial vascular malformations, including dural arteriovenous fistulas, cavernous malformations, parenchymal arteriovenous malformations, and capillary telangiectasia. They also describe the potential significance of different associations of these vascular anomalies.
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Affiliation(s)
| | - David J. Daniels
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stylianos K. Rammos
- 3Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Illinois; and
| | - Eugenio Pozzati
- 4Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy
| | - Giuseppe Lanzino
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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17
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Franceschi E, Tosoni A, Ermani M, Spagnolli F, La Torre L, Galzio RJ, Pozzati E, Talacchi A, Benevento F, Brandes AA. Impact of MGMT methylation status on 1p/19q intact anaplastic gliomas. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13003] [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: 11/20/2022] Open
Abstract
e13003 Background: Chromosomes 1p/19q codeletion has been recognized as a prognostic and predictive factor in patients (pts) with grade 3 gliomas. Non-codeleted (intact) anaplastic oligodendroglioma showed a survival comparable to that usually observed in pts with anaplastic astrocytomas; MGMT methylation status, moreover, has been found to be a prognostic factor in glioblastoma and anaplastic gliomas (AG). Methods: A retrospective analysis was made using a database of 253 AG pts followed prospectively between January 1998 and August 2008. We evaluated only pts who met the following inclusion criteria: age ≥ 18 years; PS 0–2; histological diagnosis of AG with 1p/19q intact, as determined by FISH analysis; treatment with postoperative radiotherapy (RT) and chemotherapy (CT); MGMT status determined using methylation specific PCR. The study aim was to evaluate the role of MGMT methylation status in 1p/19q codeleted AG pts. The log-rank test was used to evaluate the significance of the prognostic variables. Results: 67 pts (m/f: 35/32, median age: 41.3 years, range: 18–70 years) were enrolled. Histology was anaplastic oligodendroglioma in 17 pts, anaplastic oligoastrocytoma in 20 pts, and anaplastic astrocytoma in 30 pts; all these pts were 1p19q intact and received surgery, RT, and CT. MGMT status, assessable in 58 pts (86.6%), was methylated in 33 pts (56.9%), and unmethylated in 25 pts (43.1%). Median progression-free survival (PFS) was 32.3 months (95%CI: 9.9–54.7). No enhancement at time of diagnosis (p = 0.003), gross total resection (p = 0.03), age (p = 0.001), and MGMT methylation (p = 0.05) were significantly correlated with better PFS. Median survival was 65.2 months (95% CI: 45–85.3). Only age (p = 0.001) and KPS (p = 0.02) correlated with a better survival. Conclusions: MGMT methylation status may provide adjunctive prognostic information in pts with 1p/19q intact AG, indicating a prolonged PFS in pts harboring MGMT promoter methylation. No significant financial relationships to disclose.
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Affiliation(s)
- E. Franceschi
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - A. Tosoni
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - M. Ermani
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - F. Spagnolli
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - L. La Torre
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - R. J. Galzio
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - E. Pozzati
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - A. Talacchi
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - F. Benevento
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
| | - A. A. Brandes
- Bellaria-Maggiore Hospital, Azienda USL of Bologna, Bologna, Italy; Azienda Ospedale-Università, Padova, Italy; University of L’Aquila, L’Aquila, Italy; University Hospital, Verona, Italy
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Acciarri N, Galassi E, Giulioni M, Pozzati E, Grasso V, Palandri G, Badaloni F, Zucchelli M, Calbucci F. Cavernous malformations of the central nervous system in the pediatric age group. Pediatr Neurosurg 2009; 45:81-104. [PMID: 19307743 DOI: 10.1159/000209283] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 12/15/2008] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The main clinico-diagnostic features, risk factors and associated diseases of cavernous malformations (CMs), also called cavernous angiomas or cavernomas, of the central nervous system (CNS) in children are described, and the most relevant differences compared to the affected adult population are pointed out, focusing on the management of pediatric patients harboring cranial and spinal CMs. MATERIALS This was a retrospective study of a series of 42 children symptomatic for CMs of the cranial and spinal compartments (35 supratentorial brain lesions, 5 infratentorial and 2 in the spinal region) operated on between 1975 and 2005, with a clinical follow-up ranging from 12 to 192 months. The results were compared with those found in the most recent literature dealing with pediatric CMs of the CNS. RESULTS Surgical treatment produced excellent or good results in 69% of our 42 children. Unchanged neurological deficits were observed in 23.8% of cases, while morbidity from surgical procedures was 7.14%. Mortality was absent in this series. These surgical results are comparable with those found in the literature, where morbidity and mortality rates from surgery are 8.8 and 1.13%, respectively, and are mostly associated with procedures for the excision of deep, critically located cavernomas. CONCLUSION CMs represent the most common CNS vascular lesion in children, although their incidence is 4 times lower than that of the adult population. The natural history of pediatric CMs throughout the neuraxis seems to be more aggressive than in adult patients; these lesions have higher rates of growth and hemorrhage, larger dimensions and often atypical radiological pictures at diagnosis. Beside the familial form of the disease, which is more often associated with multiple lesions and an earlier age of clinical presentation, the major risk factor for CMs in children seems to be radiotherapy for CNS tumors. Furthermore, a greater number of CMs coexistent with mixed angiomatous lesions have been reported in children than in adults. Surgical results are related to the preoperative neurological status of the children; symptomatic patients who are operated on early, before they develop severe neurological deficits or long-standing seizures, may achieve the best clinical outcome. Radiosurgery does not seem to be advisable in children as an alternative treatment for deep CMs or those causing epilepsy.
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Affiliation(s)
- Nicola Acciarri
- Department of Neurosurgery, Bellaria Hospital, Via Altura 3, Bologna, Italy.
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Pozzati E, Zucchelli M, Schiavina M, Contini P, Foschini MP. Rapid growth and regression of intracranial meningiomas in lymphangioleiomyomatosis: case report. ACTA ACUST UNITED AC 2007; 68:671-674. [PMID: 17586005 DOI: 10.1016/j.surneu.2006.11.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 03/21/2006] [Accepted: 11/28/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymphangioleiomyomatosis is a progressive interstitial lung disease that affects young women. It has been suggested that estrogens play a role in its evolution, and progesterone therapy is often provided in these cases. CASE DESCRIPTION We present a case of a postmenopausal woman with LAM treated with progesterone; subsequently, rapid growth of multiple intracranial meningiomas was observed. One prominent lesion was excised, and 3 other lesions regressed spontaneously over 2 years. CONCLUSIONS This is a rare case of a non-pregnancy-related regression of meningiomas in a woman affected by LAM. The significance of this association and the hormonal treatment of the disease are discussed.
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Affiliation(s)
- Eugenio Pozzati
- Division of Neurosurgery and Service of Pathology, Bellaria Hospital and Respiratory Pathophysiology, S. Orsola Policlinic, Bologna 40100, Italy.
| | - Mino Zucchelli
- Division of Neurosurgery and Service of Pathology, Bellaria Hospital and Respiratory Pathophysiology, S. Orsola Policlinic, Bologna 40100, Italy
| | - Mario Schiavina
- Division of Neurosurgery and Service of Pathology, Bellaria Hospital and Respiratory Pathophysiology, S. Orsola Policlinic, Bologna 40100, Italy
| | - Paola Contini
- Division of Neurosurgery and Service of Pathology, Bellaria Hospital and Respiratory Pathophysiology, S. Orsola Policlinic, Bologna 40100, Italy
| | - Maria Pia Foschini
- Division of Neurosurgery and Service of Pathology, Bellaria Hospital and Respiratory Pathophysiology, S. Orsola Policlinic, Bologna 40100, Italy
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Pozzati E, Marliani AF, Zucchelli M, Foschini MP, Dall'Olio M, Lanzino G. The neurovascular triad: mixed cavernous, capillary, and venous malformations of the brainstem. J Neurosurg 2007; 107:1113-9. [DOI: 10.3171/jns-07/12/1113] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The four types of cerebrovascular malformations may sometimes be combined and more often occur in pairs; triads are exceptional. The authors present six patients with the clinicoradiographic profile of mixed vascular malformations of the brainstem, including cavernous malformation (CM), capillary telangiectasia, and developmental venous anomaly (DVA).
Methods
Five patients (one of whom was a child) suffered from hemorrhage, suggesting that this complex association has a high bleeding potential. Progressive growth, rebleeding, and de novo occurrence of the associated CM were documented in three cases. Magnetic resonance imaging of the brain was obtained in all patients by using one or more of the following modalities: T1-weighted sequences before and after gadolinium administration; T2-weighted sequences; T2-weighted fluid attenuated inversion recovery; T1-weighted fast spin echo; and diffusion weighted, diffusion tensor, and perfusion imaging in three cases.
Results
Three patients were surgically treated with the intention of excising the hemorrhagic lesion, but only two patients had their malformations successfully removed. In the third case, diffuse pontine telangiectasia precluded the safe excision of the CM. Histological examination demonstrated a blended pathological milieu characterized by coalescent telangiectasia and venules associated with loculated endothelial chambers resembling an immature or de novo CM. Three patients were treated conservatively; recurrent minor hemorrhage occurred in one case. The authors found these malformations to be arranged in two basic relationships: CM inside the telangiectasia and CM in the radicles of the DVA. Stenosis of the main venous collector and dilation of the medullary veins were important findings.
Conclusions
The pathogenesis of this malformation may be referred to a developmental deviance of the brainstem capillary–venous network associated with transitional vessels and loculated endothelial vascular spaces related to genetic and acquired origins, probably in a restrictive venous outflow milieu.
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Affiliation(s)
- Eugenio Pozzati
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Anna Federica Marliani
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Mino Zucchelli
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Maria Pia Foschini
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Massimo Dall'Olio
- 1Department of Neurosurgery, Sections of Neuroradiology and Pathology, Bellaria Hospital, Bologna, Italy; and
| | - Giuseppe Lanzino
- 2Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, Illinois
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Tosoni A, Franceschi E, Blatt V, Bartolini S, Magrini E, Spagnolli F, Pozzati E, Nicolardi L, Ermani M, Brandes A. 2507 POSTER Temozolomide (TMZ) concomitant to radiotherapy (RT) plus 12 cycles of maintenance chemotherapy in newly diagnosed GBM: is more better? EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70910-2] [Citation(s) in RCA: 1] [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: 10/22/2022] Open
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Abstract
OBJECTIVE Spinal extramedullary hematomas stemming from cavernous angiomas in the epidural compartment are rare. It is more common for spinal epidural cavernous angiomas to present with slow and progressive myelopathy or radiculopathy. They seldom present with clinical evidence of acute spinal cord or nerve root compression. CLINICAL PRESENTATION Three consecutive cases of acute spinal cavernous angiomas with overt neurological deficits were presented. These presentations included acute onset of neck pain and tetraparesis, bilateral lower extremity pain and paraparesis, and acute sciatic pain with plantar flexor weakness. The lesions were located in the cervical, thoracic, and sacral spine, respectively. The cases included either abrupt lesion enlargement secondary to a pure intralesional hemorrhage or a cavernous hemorrhage that invaded the epidural space. INTERVENTION All patients were treated with either laminotomy or complete resection of the hematoma and cavernoma within 12 hours after admission. CONCLUSION Spontaneous spinal epidural hematomas presented with significant pain and acute spinal cord and nerve root compression may represent the manifestation of a cavernous angioma. Appropriate interpretation of preoperative imaging studies may prevent delay in proper management, especially for patients in whom nerve root deficit is the only clinical expression.
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Affiliation(s)
- Giuseppe Caruso
- Division of Neurosurgery, Villa Maria Cecilia Hospital, Cotignola, Italy
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Pozzati E, Zucchelli M, Marliani AF, Riccioli LA. Bleeding of a familial cerebral cavernous malformation after prophylactic anticoagulation therapy. Case report. Neurosurg Focus 2006; 21:e15. [PMID: 16859253] [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: 05/11/2023]
Abstract
The risk of hemorrhage in cavernous malformations (CMs) depends on lesion, host, and environmental factors. Anticoagulation therapy is a well-known risk factor for intracerebral bleeding, but the occurrence of hemorrhages in patients with CMs has not been reported. Low molecular weight heparin therapy is generally considered to be safe, although significant hemorrhagic complications have recently been reported. The authors report a case of intralesional bleeding in a CM after prophylactic anticoagulation therapy was administered in a patient with the familial form of the disease. The leaky endothelial structure of CMs may constitute an unexpected target of the vascular effects of heparin.
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Affiliation(s)
- Eugenio Pozzati
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy.
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Pozzati E, Zucchelli M, Marliani AF, Riccioli LA. Bleeding of a familial cerebral cavernous malformation after prophylactic anticoagulation therapy. Neurosurg Focus 2006. [DOI: 10.3171/foc.2006.21.1.16] [Citation(s) in RCA: 14] [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] [Indexed: 11/06/2022]
Abstract
✓The risk of hemorrhage in cavernous malformations (CMs) depends on lesion, host, and environmental factors. Anticoagulation therapy is a well-known risk factor for intracerebral bleeding, but the occurrence of hemorrhages in patients with CMs has not been reported. Low molecular weight heparin therapy is generally considered to be safe, although significant hemorrhagic complications have recently been reported. The authors report a case of intralesional bleeding in a CM after prophylactic anticoagulation therapy was administered in a patient with the familial form of the disease. The leaky endothelial structure of CMs may constitute an unexpected target of the vascular effects of heparin.
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Pozzati E, Bortolotti C, Lanzino G. Seeding of a cavernous angioma with Mycoplasma hominis: case report. Neurosurgery 2005; 55:1228; author reply 1228. [PMID: 15791744 DOI: 10.1227/01.neu.0000144046.39917.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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d'Avella D, Servadei F, Scerrati M, Tomei G, Brambilla G, Angileri FF, Massaro F, Cristofori L, Tartara F, Pozzati E, Delfini R, Tomasello F. Traumatic intracerebellar hemorrhage: clinicoradiological analysis of 81 patients. Neurosurgery 2002; 50:16-25; discussion 25-7. [PMID: 11844230 DOI: 10.1097/00006123-200201000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 05/16/2001] [Accepted: 08/07/2001] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We report 81 patients with a traumatic intracerebellar hemorrhagic contusion or hematoma managed between 1996 and 1998 at 13 Italian neurosurgical centers. METHODS Each center provided data about patients' clinicoradiological findings, management, and outcomes, which were retrospectively reviewed. RESULTS A poor result occurred in 36 patients (44.4%). Forty-five patients (55.6%) had favorable results. For the purpose of data analysis, patients were divided into two groups according to their admission Glasgow Coma Scale (GCS) scores. In Group 1 (39/81 cases; GCS score, > or =8), the outcome was favorable in 95% of cases. In Group 2 (42/81 cases; GCS score, <8), the outcome was poor in 81% of cases. Twenty-seven patients underwent posterior fossa surgery. Factors correlating with outcome were GCS score, status of the basal cisterns and the fourth ventricle, associated supratentorial traumatic lesions, mechanism of injury, and intracerebellar clot size. Multivariate analysis showed significant independent prognostic effect only for GCS score (P = 0.000) and the concomitant presence of supratentorial lesions (P = 0.0035). CONCLUSION This study describes clinicoradiological findings and prognostic factors regarding traumatic cerebellar injury. A general consensus emerged from this analysis that a conservative approach can be considered a viable, safe treatment option for noncomatose patients with intracerebellar clots measuring less than or equal to 3 cm, except when associated with other extradural or subdural posterior fossa focal lesions. Also, a general consensus was reached that surgery should be recommended for all patients with clots larger than 3 cm. The pathogenesis, biomechanics, and optimal management criteria of these rare lesions are still unclear, and larger observational studies are necessary.
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Affiliation(s)
- Domenico d'Avella
- Clinica Neurochirurgica, Policlinico Universitario, Via Consolare Valeria 1, Università di Messina, 98100 Messina, Italy.
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d’Avella D, Servadei F, Scerrati M, Tomei G, Brambilla G, Angileri FF, Massaro F, Cristofori L, Tartara F, Pozzati E, Delfini R, Tomasello F. Traumatic Intracerebellar Hemorrhage: Clinicoradiological Analysis of 81 Patients. Neurosurgery 2002. [DOI: 10.1227/00006123-200201000-00004] [Citation(s) in RCA: 13] [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] [Indexed: 11/19/2022] Open
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Abstract
BACKGROUND Only few anecdotal reports and small series of thalamic cavernous malformations have been reported. It follows that the clinical behavior and management are poorly understood; in particular, experiences with the surgical treatment of these lesions are scarce. METHODS The clinical course, treatment, and outcome of 12 patients (10 females and 2 males, mean age 36 years) with symptomatic cavernous malformations of the thalamus are reviewed. Eight patients (66%) presented with cerebral hemorrhage, one with progressive neurological deficit and three with hydrocephalus/increased intracranial pressure; associated venous anomalies were found in three cases. Treatment consisted of radical surgery in four cases with progressive neurological decline or recurrent disabling hemorrhage, radiosurgery (one case), evacuation of a chronic satellite hematoma (one case), ventriculoperitoneal shunt for hydrocephalus (one case) and observation (five cases). Operative treatment in four cases included transcallosal, trigonal, and occipital interhemispheric approaches. RESULTS In the surgical group, one patient died, two improved after operation, and one remained the same. Of the patients not operated on radically, one had recurrent hemorrhage 4 months after radiosurgery, one remains stable 8 years after ventriculoperitoneal shunt, and one 3 years after aspiration of a satellite hematoma. Five other patients presenting with thalamic hemorrhage were treated conservatively; recurrent hemorrhage occurred in two cases at 1 month and at 2 years, leaving a mild residual deficit in both cases. Overall, rehemorrhage occurred in four cases (50%) at a mean interval of 18 months after the first bleeding; the annual hemorrhage rate was 6.1%. CONCLUSIONS Thalamic malformations are more likely to be symptomatic from small hemorrhages compared with lesions in the cerebral hemispheres; progressive growth may also occur with third ventricle invasion or caudal extension to the midbrain. Their high-risk location deters heavy-handed management, but they should not be left long untreated. Both surgery and radiosurgery have been used in the management of thalamic cavernomas reported in the literature. Definite surgical indications include progressive neurological decline and recurrent hemorrhages of malformations abutting the ventricular surface or the posterior incisural space; the complex anatomy of the deep venous system and the association with unexpected venous anomalies complicates the removal of these lesions.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Andreoli A, Sturiale C, Pozzati E, Mascari C, Testa C. [Unruptured cerebral aneurysms. What is the risk of rupture? What is the risk connected with a surgical intervention? A contribution to the international ISUIA study: International Study on Unruptured Intracranial Aneurysms]. Recenti Prog Med 1999; 90:249-53. [PMID: 10380551] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- A Andreoli
- Unità Operativa di Neurochirurgia, Ospedale Bellaria-Maggiore, Bologna
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Pozzati E, Musiani M. Cavernous hemangioma. J Neurosurg 1998; 89:498-9. [PMID: 9724134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
OBJECTIVE It has recently been found that patients receiving cerebral irradiation can develop hemorrhagic dysangiogeneses simulating occult vascular malformations. To analyze this connection, we report on five patients with occult cerebrovascular malformations occurring after "standard" or focused irradiation performed for brain tumors in four patients and for a deep-seated cavernous angioma in one patient. METHODS All lesions were within the radiation ports. The time interval between irradiation and the detection of the occult vascular malformations varied from 3 to 9 years; the ratio of female to male patients was 4:1. Four patients were < 15 years old when first irradiated. Four patients presented with acute symptoms (headache, vomiting, focal signs) and one was asymptomatic when the lesions were first detected. Serial magnetic resonance imaging scans were available in four patients and a computed tomographic scan in the other patient. RESULTS The initial appearance was that of a hypointense T1-T2 focus; magnetic resonance imaging then revealed focal or multifocal T1 hyperintensity and T2 mixed signal intensity followed by a late ring of decreased signal intensity. Four patients were operated on and one was under neuroradiological monitoring. Histological features of these lesions included clusters of closely packed vascular spaces resembling cavernous malformations sometimes associated with a thrombosed thick-walled vein with intense hemosiderin deposition and fibroblastic proliferation; telangiectasic changes were also seen in the adjacent brain. CONCLUSION Increased awareness of occult cerebrovascular malformations is necessary, because their occurrence is not infrequent and they have hemorrhagic potential. Children receiving cerebral irradiation are at greater risk of this complication.
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Affiliation(s)
- E Pozzati
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Affiliation(s)
- Eugenio Pozzati
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Nicola Acciarri
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Pozzati E, Acciarri N, Tognetti F, Marliani F, Giangaspero F. Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery 1996; 38:662-9; discussion 669-70. [PMID: 8692382] [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: 02/01/2023] Open
Abstract
In a series of 145 patients with brain cavernous angiomas treated at our hospital in the last 16 years, the angiomas of 18 patients exhibited aggressive biological behavior characterized by recurrent overt bleeding, growth, or de novo appearance. The cavernomas were in the cerebellum in three patients, in the brain stem in one, in the thalamus in four, in the caudate nucleus in two, in the diencephalon in one, and in the white matter of the cerebral hemispheres in seven. Three of these patients suffered from the familial or multiple form of the disease, two were pregnant, three had previously been irradiated for other tumors, and one had been treated by radiosurgery in the past. Overall, new cavernous malformations not previously shown were discovered in six patients. In 10 patients (3 male and 7 female) presenting with recurrent hemorrhages, the mean period of time between bleedings was 11 months (range, 1 wk-3 yr). Eleven patients were treated by definitive surgery, and seven were conservatively treated. One patient with a diencephalic cavernoma died from progressive hypothalamic dysfunction; three patients in the nonsurgical group had repeated symptoms and were left with additional neurological deficits. The outcome of the surgical group was the same (seven patients) or improved (four patients). Risk factors favoring an aggressive behavior included pregnancy, familial or multiple form of the disease, previous whole brain or stereotactic radiotherapy, incomplete removal, brain location, and associated venous malformation. The female preponderance (female to male ratio, 13:5) may also suggest some role of hormonal factors in influencing the biological behavior of cavernous malformations.
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Affiliation(s)
- E Pozzati
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Acciarri N, Giulioni M, Padovani R, Gaist G, Pozzati E, Acciarri R. Orbital cavernous angiomas: surgical experience on a series of 13 cases. J Neurosurg Sci 1995; 39:203-9. [PMID: 8803840] [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: 02/02/2023]
Abstract
Cavernous angiomas of the orbit are benign vascular growths, commonly occurring in adults and usually causing a slowly progressive proptosis from their mass effect. These lesions have behavioural and radiological findings different from those of brain cavernous angiomas, probably due to their particular origin and structure. The authors present a surgical series of 13 patients with orbital cavernous angiomas. Complete excision of lesions, with histological diagnosis, was obtained in all the 13 cases. Results were good in 10 patients, while 2 remained clinically unchanged and another one showed acute visual deterioration after a period of postoperative clinical stabilization. The main clinical and radiological characteristics of orbital cavernous angiomas are analyzed, together with their surgical management.
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Affiliation(s)
- N Acciarri
- Department of Neurosurgery, Bellaria Hospital of Bologna, Italy
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Abstract
Ten patients (six men and four women; mean age, 40 yr) with spontaneous dissection of the basilar artery are reported. Clinically, six were admitted with subarachnoid hemorrhage (SAH) and four were admitted with brain stem ischemia. Angiography demonstrated string sign in four patients, pearl reaction in four, double lumen in one, and arterial ectasia with mural retention of contrast medium in one. Magnetic resonance imaging was performed in two patients. Follow-up angiograms or magnetic resonance angiography in six patients showed spontaneous healing in two patients, improvement in two, progression in one, and no change in one. Nine patients were treated medically, and one underwent selective intravascular occlusion of the dissecting aneurysm. One patient died after further SAH, two remain severely disabled, three have residual neurological deficit, and four are in good clinical condition. The most interesting observations in this series include a relatively good course in a substantial number of patients and low further bleeding potential after SAH, the late "globular" evolution, which may be favorable for reconstructive treatment, and the diagnostic value of associated computed tomographic/angiographic findings. Surgical options in basilar dissection are very poor; in some reported cases, wrapping has been tried with disappointing results. In light of the possibility of spontaneous healing or improvement, wrapping should be reserved for only those patients with recurrent SAH or angiographic progression of the dissection.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
In the last 14 years we have encountered 16 patients with spontaneous intracranial dissections of the vertebrobasilar (VB) system (mean age was 46 years and male/female ratio was 10/6). VB dissections presented in eight cases with subarachnoid bleeding and in eight with brainstem, cerebellar, or cerebral ischemia. Three patients had multiple dissections. Ten dissections occurred in the vertebral artery (two extended to the basilar artery), three in the posterior cerebral artery (one bilateral), two in the basilar artery, and one in the posterior inferior cerebellar artery. The angiographic configuration included "string" sign, "pearl and string" sign, fusiform dilation, and double lumen. The following angiographic evolution (available in 11 cases) was that of complete healing (three cases), partial resolution (five cases), progression (one case), and unimproving (two cases). Three patients died (two due to recurrent subarachnoid hemorrhage): two patients were explored surgically (one had further intravascular therapeutic embolization), and the rest were treated conservatively. Not all dissecting aneurysms fared in the same manner, depending either on the location in the VB circulation or on the variable vascular configuration: treatment should be fitted to the timing of diagnosis.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
Though detected with increasing frequency, intracranial carotid artery dissection remains less common in infancy. We report on 3 otherwise healthy children aged 8, 12 and 15 years who presented with focal headache and stroke secondary to intracranial carotid occlusive disease consistent with arterial dissection. In 2 cases this was precipitated by strenuous physical exertion. The protean angiographic configuration included long tapered narrowing with focal stenosis, beaded narrowing with Moya Moya vascular network and 'string sign'; occlusion of the anterior cerebral artery was always present. Control angiograms revealed complete or partial recanalization in all cases suggesting self-healing dissection. The clinical course was smooth in all patients, and at long-term follow-up (5, 3, and 2 years) they remain in good neurological condition. Although intracranial carotid dissection has a poor reputation, regression to normal and fair outcome may sometimes occur as in the extracranial counterpart, suggesting the existence of benign forms of the disease. Surgical procedures should be weighed against the spontaneous resolution of the lesion.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
A case of cervical intrathecal extramedullary cavernous angioma is presented. The rarity of this lesion in comparison with the more frequent vertebral cavernous angiomas with secondary extension to the epidural space is emphasized. The special features of this case are noted: the acute clinical onset due to recurrent subarachnoid hemorrhages, the visualization only by means of magnetic resonance imaging, and the unusual cervical level. The most debated characteristics of these lesions and the relevant literature are summarized.
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Affiliation(s)
- N Acciarri
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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40
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Abstract
Four young adults with spontaneous dissection of the vertebrobasilar system are reported. Clinically, two patients presented with subarachnoid hemorrhage and two with brain-stem ischemia. In two cases of ruptured arterial dissection of the posterior cerebral artery, angiography demonstrated fusiform and "sausage-like" dilatation of the involved vessel. In two cases of occlusive dissection of the basilar artery, angiography revealed the typical "string sign." All four patients were treated conservatively: three survive in good clinical condition and one remains disabled. Follow-up angiograms showed spontaneous healing of the lesion with return to an almost normal arterial configuration in two cases; residual narrowing corresponding to the dissection was the most notable finding in the other two. It is recommended that, in a subset of neurologically stable patients, angiographic monitoring is undertaken to assess the tendency for spontaneous repair before surgical intervention is planned.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
The CT appearance of two cases of ganglionic cysts of the common peroneal nerve at the knee is reported. In both cases the ganglion appeared as a cystic unenhanced lesion of mucoid density. The radiological findings were confirmed by surgery. The differences in the appearance of intraneural and extraneural ganglia are discussed.
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Affiliation(s)
- P I Gambari
- Department of Radiology, Bellaria Hospital, Bologna, Italy
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Abstract
Clinical features and electrophysiologic studies indicated a lesion of the ulnar nerve in the wrist of a 50-year-old man. CT of this region revealed a ganglion inside Guyon's canal. Surgical exploration disclosed a carpal ganglion compressing the ulnar nerve just proximal to its division.
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Affiliation(s)
- G Giuliani
- Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
We retrospectively studied 19 cases of occlusive cervical carotid dissection encountered at our hospital between 1974 and 1984 and followed for 5-13 (mean 8.2) years to assess the long-term prognosis of the disease. Five patients had transient ischemic attacks, seven had minor stroke, six had major stroke, and one had epileptic seizures. Angiography demonstrated the typical string sign in 17 cases, a double lumen with occlusion in one, and multiple scalloped narrowings with distal occlusion in the other. Three patients died within 1 month and three remain severely disabled (overall mortality and major morbidity 32%), five have permanent deficits, and seven are neurologically intact; the remaining patient was lost to follow-up. Five patients were treated surgically (two had extracranial-intracranial bypass and three had cervical carotid exploration), and the other 14 were treated medically. The overall rate of reopening was 47% with eight of 10 patients demonstrating recanalization on control angiography and another patient demonstrating recanalization at surgery. These nine patients remain clinically stable on follow-up evaluations. However, vascular abnormalities in the healed arteries were notable and include kinking, fibromuscular dysplasia, dissecting aneurysms, intracranial occlusion, and a residual mural defect.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Pozzati E, Tognetti F, Cavallo M, Acciarri N. Extradural hematomas of the posterior cranial fossa. Observations on a series of 32 consecutive cases treated after the introduction of computed tomography scanning. Surg Neurol 1989; 32:300-3. [PMID: 2781461 DOI: 10.1016/0090-3019(89)90234-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A series of 32 patients with posterior fossa epidural hematoma treated after the introduction of computed tomography scanning between 1975 and March 1988 is presented. Sixteen patients harbored "pure" epidural hematomas, whereas 16 had other infratentorial or supratentorial traumatic lesions. Glasgow Coma Scale on admission was 7 or less in 10 patients, 8-12 in 11, and 13-14 in 11. Only six patients had a lucid interval. Thirty patients were treated surgically; two patients with small hematomas were treated conservatively. Overall mortality was 15.6%, with 0% for "pure" and 31.2% for "complicated" posterior fossa epidural hematomas. The value of routine computed tomography scanning is emphasized in cases with occipital skull fracture or when such fracture is found in patients undergoing emergency evacuation of supratentorial hematomas. The pertinent literature is addressed with special regard to the delayed occurrence, associated lesions, and mortality of posterior fossa epidural hematomas and to the role of computed tomography scanning.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Ospedale Bellaria, Bologna, Italy
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Abstract
Abstract
The natural history of cavernous angiomas is poorly understood, and their growth has rarely been documented. We report three cases of cavernous angiomas that grew to large size in 6 years, 2 years, and 2 months, respectively. An initial computed tomographic scan disclosed no abnormalities in one patient and demonstrated two “minimal” lesions in the other two. The mechanisms of growth of these lesions are discussed; subsequent hemorrhages and capsule formation played a major role in their enlargement.
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Affiliation(s)
| | | | - Giacomo Nuzzo
- Service of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Massimo Poppi
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
The natural history of cavernous angiomas is poorly understood, and their growth has rarely been documented. We report three cases of cavernous angiomas that grew to large size in 6 years, 2 years, and 2 months, respectively. An initial computed tomographic scan disclosed no abnormalities in one patient and demonstrated two "minimal" lesions in the other two. The mechanisms of growth of these lesions are discussed; subsequent hemorrhages and capsule formation played a major role in their enlargement.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
The authors report the case of a patient presenting with an acute extradural hematoma and diffuse axonal injury. Control CT scan performed 4 hours later showed the complete resolution of the extradural collection together with increased evidence of shearing injuries. The mechanism of the hematoma resolution may probably be related to the concomitant acute brain swelling.
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Affiliation(s)
- F Servadei
- Division of Neurosurgery, Ospedale Bellaria, Bologna, Italy
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49
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Abstract
We describe five patients with blunt traumatic carotid dissection with delayed clinical presentation that varied from 2 weeks to 6 months. Four patients had severe head injury, and one patient had direct blunt trauma to the neck. Cerebrovascular symptoms developed in four patients. The fifth patient suffered loss of vision as a result of a concurrent giant intracranial dissecting aneurysm. Arteriography demonstrated a "string sign" in two cases and a cervical carotid aneurysm in three; two of the latter also had siphon occlusion, and one of these had a superimposed supraclinoid dissecting aneurysm. One patient was treated by thromboendarterectomy, one by aneurysmorraphy, another by carotid ligation, and the other two patients were treated medically. Mechanisms of injury, forensic problems, and therapeutic options are discussed.
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Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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