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Peraio S, Mantovani G, Araceli T, Mongardi L, Noris A, Fino E, Formica F, Piccinini L, Melani F, Lenge M, Scalise R, Battini R, Di Rita A, D'Incerti L, Appleton T, Cavallo MA, Guerrini R, Giordano F. Unilateral deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) for the treatment of post-traumatic tremor in children: a multicentre experience. Childs Nerv Syst 2024:10.1007/s00381-024-06380-1. [PMID: 38573550 DOI: 10.1007/s00381-024-06380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) is a validated technique for the treatment of essential tremor (ET) in adults. Conversely, its use for post traumatic tremor (PTT) and in paediatric patients is still debated. We evaluated the efficacy of Vim-DBS for lesional tremor in three paediatric patients with drug-resistant post-traumatic unilateral tremor. METHODS We retrospectively collected data regarding three patients with unilateral tremor due to severe head injury, with no MRI evidence of basal ganglia lesions. The three patients underwent stereotactic frame-based robot-assisted DBS of Vim contralateral to the tremor side. RESULTS Mean follow-up was 48 months (range: 36-60 months). Tremor was reduced in all patients with a better control of voluntary movements and improvement of functional status (mean FIM scale improvement + 7 points). No surgical complications occurred. CONCLUSION Unilateral contralateral DBS of Vim could be efficacious in post-traumatic tremor, even in paediatric patients and should be offered in PTT drug-resistant patients.
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Affiliation(s)
- Simone Peraio
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giorgio Mantovani
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Tommaso Araceli
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Lorenzo Mongardi
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Alice Noris
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Edoardo Fino
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Francesca Formica
- Istituto Medea "La Nostra Famiglia" IRCCS, Bosisio Parini, LC, Italy
| | - Luigi Piccinini
- Istituto Medea "La Nostra Famiglia" IRCCS, Bosisio Parini, LC, Italy
| | - Federico Melani
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy
| | - Matteo Lenge
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Roberta Scalise
- Istituto Stella Maris - IRCCS - University of Pisa, Pisa, Italy
| | - Roberta Battini
- Istituto Stella Maris - IRCCS - University of Pisa, Pisa, Italy
| | - Andrea Di Rita
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ludovico D'Incerti
- Department of Radiology, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | | | - Renzo Guerrini
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Flavio Giordano
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
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Lofrese G, Trungu S, Scerrati A, De Bonis P, Cultrera F, Mongardi L, Montemurro N, Piazza A, Miscusi M, Tosatto L, Raco A, Ricciardi L. Two-Level Corpectomy and Fusion vs. Three-Level Anterior Cervical Discectomy and Fusion without Plating: Long-Term Clinical and Radiological Outcomes in a Multicentric Retrospective Analysis. Life (Basel) 2023; 13:1564. [PMID: 37511938 PMCID: PMC10381458 DOI: 10.3390/life13071564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/23/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) represent effective alternatives in the management of multilevel cervical spondylotic myelopathy (CSM). A consensus on which of these techniques should be used is still missing. METHODS The databases of three centers were reviewed (January 2011-December 2018) for patients with three-level CSM, who underwent three-level ACDF without plating or two-level ACCF with expandable cage (VBRC) or mesh (VBRM). Demographic data, surgical strategy, complications, and implant failure were analyzed. The Neck Disability Index (NDI), the Visual Analog Scale (VAS), and the cervical lordosis were compared between the two techniques at 3 and 12 months. Logistic regression analyses investigated independent factors influencing clinical and radiological outcomes. RESULTS Twenty-one and twenty-two patients were included in the ACDF and ACCF groups, respectively. The median follow-up was 18 months. ACDFs were associated with better clinical outcomes at 12 months (NDI: 8.3% vs. 19.3%, p < 0.001; VAS: 1.3 vs. 2.6, p = 0.004), but with an increased risk of loss of lordosis correction ≥ 1° (OR = 4.5; p = 0.05). A higher complication rate in the ACDF group (33.3% vs. 9.1%; p = 0.05) was recorded, but it negatively influenced only short-term clinical outcomes. ACCFs with VBRC were associated with a higher risk of major complications but ensured better 12-month lordosis correction (p = 0.002). No significant differences in intraoperative blood loss were noted. CONCLUSIONS Three-level ACDF without plating was associated with better clinical outcomes than two-level ACCF despite worse losses in lordosis correction, which is ideal for fragile patients without retrovertebral compressions. In multilevel CSM, the relationship between the degree of lordosis correction and clinical outcome advantages still needs to be investigated.
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Affiliation(s)
| | - Sokol Trungu
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
- Neurosurgery Unit, Cardinale G. Panico Hospital, 73039 Tricase, Italy
| | - Alba Scerrati
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | | | - Lorenzo Mongardi
- Department of Neurosurgery, S. Anna University Hospital, 44124 Ferrara, Italy
| | | | - Amedeo Piazza
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | - Massimo Miscusi
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | | | - Antonino Raco
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
| | - Luca Ricciardi
- NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy
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Bellantonio D, Bolondi G, Cultrera F, Lofrese G, Mongardi L, Gobbi L, Sica A, Bergamini C, Viola L, Tognù A, Tosatto L, Russo E, Santonastaso DP, Agnoletti V. Erector spinae plane block for perioperative pain management in neurosurgical lower-thoracic and lumbar spinal fusion: a single-centre prospective randomised controlled trial. BMC Anesthesiol 2023; 23:187. [PMID: 37254058 DOI: 10.1186/s12871-023-02130-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/09/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Erector spinae plane block is a locoregional anaesthetic technique widely used in several different surgeries due to its safety and efficacy. The aim of this study is to assess its utility in spinal degenerative and traumatic surgery in western countries and for patients of Caucasian ethnicity. METHODS Patients undergoing elective lower-thoracic and lumbar spinal fusion were randomised into two groups: the case group (n = 15) who received erector spinae plane block (ropivacaine 0.4% + dexamethasone 4 mg, 20 mL per side at the level of surgery) plus postoperative opioid analgesia, and the control group (n = 15) who received opioid-based analgesia. RESULTS The erector spinae plane block group showed significantly lower morphine consumption at 48 h postoperatively, lower need for intraoperative fentanyl (203.3 ± 121.7 micrograms vs. 322.0 ± 148.2 micrograms, p-value = 0.021), lower NRS score at 2, 6, 12, 24, and 36 h, and higher satisfaction rates of patients (8.4 ± 1.2 vs. 6.0 ± 1.05, p-value < 0.0001). No differences in the duration of the hospitalisation were observed. No erector spinae plane block-related complications were observed. CONCLUSIONS Erector spinae plane block is a safe and efficient opioid-sparing technique for postoperative pain control after spinal fusion surgery. This study recommends its implementation in everyday practice and incorporation as a part of multimodal analgesia protocols. TRIAL REGISTRATION The study was approved by the local ethical committee of Romagna (CEROM) and registered on ClinicalTrials.gov (NCT04729049). It also adheres to the principles outlined in the Declaration of Helsinki and the CONSORT 2010 guidelines.
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Affiliation(s)
- Daniele Bellantonio
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Giuliano Bolondi
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy.
| | - Francesco Cultrera
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Giorgio Lofrese
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Lorenzo Mongardi
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Luca Gobbi
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Andrea Sica
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Carlo Bergamini
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Lorenzo Viola
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | - Andrea Tognù
- Anesthesia Unit, Istituto Ortopedico Rizzoli, Via Nazionale Ponente 5, Argenta, FE, 44011, Italy
| | - Luigino Tosatto
- Neurosurgery Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, 47521, Italy
| | - Emanuele Russo
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
| | | | - Vanni Agnoletti
- Anesthesia Unit - Ospedale Bufalini, viale Ghirotti 286, Cesena, FC, 47521, Italy
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Mongardi L, Belaroussi Y, Kara M, Le Petit L, Gimbert E, Kerdiles G, De Courson H, Wavasseur T, Liguoro D, Vignes JR, Jecko V, Roblot P. When to discharge patients following a neuronavigation-assisted brain biopsy for supratentorial lesion? A single-center experience. Clin Neurol Neurosurg 2023; 229:107727. [PMID: 37119654 DOI: 10.1016/j.clineuro.2023.107727] [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: 01/04/2023] [Revised: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE Most brain biopsies are performed using the frame-based stereotactic technique and several studies describe the time taken and rate of complications, often allowing an early discharge. In comparison, neuronavigation-assisted biopsies are performed under general anesthesia and their complications have been poorly described. We examined the complication rate and determined which patients will worsen clinically. METHODS All adults who underwent a neuronavigation-assisted brain biopsy for a supratentorial lesion from Jan, 2015, to Jan, 2021, in the Neurosurgical Department of the University Hospital Center of Bordeaux, France, were analyzed retrospectively in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. The primary outcome of interest was short-term (7 days) clinical deterioration. The secondary outcome of interest was the complication rate. RESULTS The study included 240 patients. The median postoperative Glasgow score was 15. Thirty patients (12.6 %) showed acute postoperative clinical worsening, including 14 (5.8 %) with permanent neurological worsening. The median delay was 22 h after the intervention. We examined several clinical combinations that allowed early postoperative discharge. A preoperative Glasgow prognostic score of 15, Charlson Comorbidity Index ≤ 3, preoperative World Health Organization Performance Status ≤ 1, and no preoperative anticoagulation or antiplatelet treatment predicted postoperative worsening (negative predictive value, 96.3 %). CONCLUSION Optical neuronavigation-assisted brain biopsies might require longer postoperative observation than frame-based biopsies. Based on strict preoperative clinical criteria, we consider to plan postoperative observation for 24 h a sufficient hospital stay for patients who undergo these brain biopsies.
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Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Yaniss Belaroussi
- ISPED, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Clinical and Epidemiological Research Unit, France; Institut Bergonié, Inserm CIC1401, Clinical and Epidemiological Research Unit, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Mohammed Kara
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Laetitia Le Petit
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Gaëlle Kerdiles
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Hugues De Courson
- ISPED, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Clinical and Epidemiological Research Unit, France; Institut Bergonié, Inserm CIC1401, Clinical and Epidemiological Research Unit, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Thomas Wavasseur
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Dominique Liguoro
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Jean-Rodolphe Vignes
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Vincent Jecko
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France; University of Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146 rue Léo Saignat, 33076 Bordeaux cedex, France
| | - Paul Roblot
- Neurosurgery Department A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; Laboratory of Anatomy, University of Bordeaux, 33000 Bordeaux, France; Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France.
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De Bonis P, Musio A, Mongardi L, La Marca F, Lofrese G, Visani J, Cavallo MA, Scerrati A. Transpars approach for L5-S1 foraminal and extra-foraminal lumbar disc herniations: technical note. J Neurosurg Sci 2023; 67:213-218. [PMID: 33297610 DOI: 10.23736/s0390-5616.20.05165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The short pars and the narrowed surgical corridor for far lateral L5S1 herniation make the transpars approach challenging. The aim of this study is to determine the feasibility, efficacy, and safety of the transpars microscopic approach for the treatment of L5-S1 foraminal and extraforaminal lumbar disc herniation. METHODS From 2015 to 2019, patients with L5-S1 far lateral lumbar disc herniation were prospectively recruited. Drug intake, working days lost, NRS-leg, NRS-back, nerve-root palsy, Oswestry disability-index, Macnab criteria were recorded before surgery and at follow-up. Patients were seen at 1-6-12 months after surgery. Lumbar dynamic X-rays were performed at 6-12 months after surgery and again at 2-4 years after surgery. Key-steps of surgery are described. RESULTS Fourteen patients were enrolled. NRS-leg and NRS-back scores significantly improved (from 7.93 to 1.43 and from 3.2 to 0.6, respectively; P<0.0001). Oswestry Score significantly decreased (from 63.14 to 19.36 at 12 months; P<0.0001). L5 Root palsy improved in all cases (from 3.72/5 to 5/5; P<0.0001). At 12-months, excellent or good outcome (Macnab criteria) was achieved in 12 (85.7%) and 2 (14.3%) patients, respectively. All patients who were not retired returned to work within 30 days after surgery. No recurrence, instability or re-operations occurred. CONCLUSIONS The trans pars microscopic approach is feasible, safe, and effective for L5-S1 foraminal and extraforaminal disc herniation. During surgery, the key-point is the oblique working angle, directed caudally, parallel to L5 pedicle. The iliac crest does not seem to constitute an obstacle.
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Affiliation(s)
- Pasquale De Bonis
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy -
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy -
| | - Antonio Musio
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Frank La Marca
- Department of Neurosurgery, Henry Ford Allegiance, Jackson, MS, USA
| | - Giorgio Lofrese
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Jacopo Visani
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Michele A Cavallo
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Alba Scerrati
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
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D’Andrea M, Musio A, Colasanti R, Mongardi L, Fuschillo D, Lofrese G, Tosatto L. A novel, reusable, realistic neurosurgical training simulator for cerebrovascular bypass surgery: Iatrotek ® bypass simulator validation study and literature review. Front Surg 2023; 10:1048083. [PMID: 36843992 PMCID: PMC9947354 DOI: 10.3389/fsurg.2023.1048083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Background Microanastomosis is a challenging technique requiring continuous training to be mastered. Several models have been proposed, but few effectively reflect a real bypass surgery; even fewer are reusable, most are not easily accessible, and the setting is often quite long. We aim to validate a simplified, ready-to-use, reusable, ergonomic bypass simulator. Methods Twelve novice and two expert neurosurgeons completed eight End-to-End (EE), eight End-to-Side (ES), and eight Side-to-Side (SS) microanastomoses using 2-mm synthetic vessels. Data on time to perform bypass (TPB), number of sutures and time required to stop potential leaks were collected. After the last training, participants completed a Likert Like Survey for bypass simulator evaluation. Each participant was assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). Results When comparing the first and last attempts, an improvement of the mean TPB was registered in both groups for the three types of microanastomosis. The improvement was always statistically significant in the novice group, while in the expert group, it was only significant for ES bypass. The NOMAT score improved in both groups, displaying statistical significance in the novices for EE bypass. The mean number of leakages, and the relative time for their resolution, also tended to progressively reduce in both groups by increasing the attempts. The Likert score expressed by the experts was slightly higher (25 vs. 24.58 by the novices). Conclusions Our proposed bypass training model may represent a simplified, ready-to-use, reusable, ergonomic, and efficient system to improve eye-hand coordination and dexterity in performing microanastomoses.
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Affiliation(s)
- Marcello D’Andrea
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Antonio Musio
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy,Correspondence: Antonio Musio
| | | | - Lorenzo Mongardi
- Department of Ferrara – Neurosurgery, Sant ‘Anna University Hospital, Ferrara, Italy
| | - Dalila Fuschillo
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
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Roblot P, Lefevre E, David R, Pardo PL, Mongardi L, Denat L, Tourdias T, Liguoro D, Jecko V, Vignes JR. Skin landmarks as ideal entry points for ventricular drainage, a radiological study. Surg Radiol Anat 2022; 44:1385-1390. [PMID: 36151224 DOI: 10.1007/s00276-022-03019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Ventricular drainage remains a usual but challenging procedure for neurosurgical trainees. The objective of the study was to describe reliable skin landmarks for ideal entry points (IEPs) to catheterize brain ventricles via frontal and parieto-occipital approaches. METHODS We included 30 subjects who underwent brain MRI and simulated the ideal catheterization trajectories of lateral ventricles using anterior and posterior approaches and localized skin surface IEPs. The optimal frontal target was the interventricular foramen and that for the parieto-occipital approach was the atrium. We measured the distances between these IEPs and easily identifiable skin landmarks. RESULTS The frontal IEP was localized to 116.8 ± 9.3 mm behind the nasion on the sagittal plane and to 39.7 ± 4.9 mm lateral to the midline on the coronal plane. The ideal catheter length was estimated to be 68.4 ± 6.4 mm from the skin surface to the interventricular foramen. The parieto-occipital point was localized to 62.9 ± 7.4 mm above the ipsilateral tragus on the coronal plane and to 53.1 ± 9.1 mm behind the tragus on the axial plane. The ideal catheter length was estimated to be 48.3 ± 9.6 mm. CONCLUSION The IEP for the frontal approach was localized to 11 cm above the nasion and 4 cm lateral to the midline. The IEP for the parieto-occipital approach was 5.5 cm behind and 6 cm above the tragus. These measurements lightly differ from the classical descriptions of Kocher's point and Keen's point and seem relevant to neurosurgical practice while using an orthogonal insertion.
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Affiliation(s)
- Paul Roblot
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France. .,Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France.
| | - Etienne Lefevre
- Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France
| | - Romain David
- Physical and Rehabilitation Medicine Unit, PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, University of Poitiers, 86000, Poitiers, France
| | - Pier-Luka Pardo
- Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France
| | - Lorenzo Mongardi
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.,Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France
| | - Laurent Denat
- Institute of Bioimaging, University of Bordeaux, 33000, Bordeaux, France
| | - Thomas Tourdias
- Institute of Bioimaging, University of Bordeaux, 33000, Bordeaux, France.,Department of Diagnostic and Therapeutic Neuroimaging, Pellegrin Hospital, Place Amélie-Raba-Léon, 33000, Bordeaux, France
| | - Dominique Liguoro
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.,Laboratory of Anatomy, University of Bordeaux, 33000, Bordeaux, France
| | - Vincent Jecko
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Jean-Rodolphe Vignes
- Department of Neurosurgery A, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.,Laboratory for Experimental Surgery, DETERCA Pr Vignes, University of Bordeaux, Bordeaux, France
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Mongardi L, D'Andrea M, Tosatto L, Volpin M, Cultrera F. Endoscopic third ventriculostomy for the treatment of Blake's pouch cyst in adulthood. Acta Neurol Belg 2022; 122:537-539. [PMID: 33420942 DOI: 10.1007/s13760-020-01591-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Affiliation(s)
- L Mongardi
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124, Ferrara, Italy
| | - M D'Andrea
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy.
| | - L Tosatto
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - M Volpin
- San Marino Neurological Unit, San Marino Hospital, San Marino, Republic of San Marino
| | - F Cultrera
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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Jecko V, Roblot P, Mongardi L, Ollivier M, Piccoli ND, Charleux T, Wavasseur T, Gimbert E, Liguoro D, Chotard G, Vignes JR. Intramedullary Spinal Cord Lesions: A Single-Center Experience. Neurospine 2022; 19:108-117. [PMID: 35378585 PMCID: PMC8987546 DOI: 10.14245/ns.2143190.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/17/2022] [Indexed: 12/20/2022] Open
Abstract
Objective: Spinal cord tumors constitute a small part of spinal surgery owing to their rarity. This retrospective study describes their current management.Methods: Forty-eight patients were treated for an intramedullary tumor between 2014 and 2020 at a single institution. Patients’ files were retrospectively studied. We detailed clinical status according to neurological deficit and ambulatory ability using the modified McCormick Scale, radiological features like number of levels, associated syringomyelia, surgical technique with or without intraoperative electrophysiological monitoring, pathological findings, and postoperative outcome.Results: The median age of this population was 43 years, including 5 patients under 18 years. The median delay before first neurosurgical contact was 3 months after the first clinical complaint. Treatment was gross total resection in 43.8%, subtotal resection in 50.0%, and biopsy in 6.2%. A laminectomy was performed for all the patients except 2 operated using the laminoplasty technique. Pathological findings were ependymoma in 43.8%, hemangioblastoma in 20.8%, and pilocytic astrocytoma in 10.4%. Six patients were reoperated for a tumor recurrence less than 2 years after the first surgical resection. One patient was reoperated for a postoperative cervical kyphosis.Conclusion: Intramedullary tumors are still a challenging disease and they are treated by various surgical techniques. They must be managed in a specialized center including a trained surgical, radiological, electrophysiological, and pathological team. Arthrodesis must be discussed before performing extensive laminectomy to avoid postoperative kyphosis.
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Affiliation(s)
- Vincent Jecko
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Paul Roblot
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Lorenzo Mongardi
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Morgan Ollivier
- Department of Diagnostic and Therapeutic Neuroimaging, Pellegrin Hospital, Bordeaux, France
| | - Natalia Delgado Piccoli
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
- Department of Clinical Neurophysiology, University Hospital of Bordeaux, Bordeaux, France
| | - Thomas Charleux
- Department of Radiotherapy, University Hospital of Bordeaux, Bordeaux, France
| | - Thomas Wavasseur
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
| | - Edouard Gimbert
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Dominique Liguoro
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Guillaume Chotard
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Rodolphe Vignes
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
- Department of Applied Surgical Research and Techniques (DETERCA), University of Bordeaux, Bordeaux, France
- Corresponding Author Jean-Rodolphe Vignes https://orcid.org/0000-0003-0647-8657 Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France
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10
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D'Andrea M, Mongardi L, Cultrera F, Fuschillo D, Peraio S, Roblot P, Musio A, Tosatto L, Giordano F. Calcified Epidural Hematoma after Conservative Treatment of Acute Epidural Hematoma in the Pediatric Population: A Systematic Review. Pediatr Neurosurg 2022; 57:389-395. [PMID: 36167051 DOI: 10.1159/000527241] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute traumatic epidural hematoma (EDH) is a complication in 2-3% of pediatric head injuries. Surgery is mandatory in symptomatic cases; otherwise, conservative treatment is a valid approach, especially in the pediatric population. Ossified epidural hematomas (OEHs) have been reported in the pediatric population as a rare complication of conservative EDH management, although the exact incidence remains unknown. The progressive increase in conservative management may lead to increases in the OEH incidence over the next few years. Our study aimed to systematically review OEH incidence, management strategies, characteristics (thickness, inner/outer calcifications), complication rates, time to surgery after the EDH diagnosis, and clinical outcomes. SUMMARY A systematic review was conducted in accordance with the PRISMA guidelines. Studies reporting diagnoses and clear descriptions of OEH after EDH in pediatric patients were considered eligible. Sixteen studies, including 18 pediatric patients aged 0-18 years, were included. Head trauma was the most common cause of OEH. Seven (38.8%) OEHs were treated less than 1 month after EDH diagnosis. Surgery was performed in 17 cases (94.44%), while 1 asymptomatic case (5.56%) was managed conservatively. KEY MESSAGES Surgery was the most commonly used treatment for OEH. Data for conservative treatment of OEH are limited. Magnetic resonance imaging or ultrasound within the first 2 months, to check for EDH resolution, may be crucial to rule out complications in pediatric patients.
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Affiliation(s)
| | - Lorenzo Mongardi
- Neurosurgery, M. Bufalini Hospital, Cesena, Italy.,Neurosurgery, Sant'Anna University Hospital Ferrara, Ferrara, Italy
| | | | | | - Simone Peraio
- Neurosurgery Department, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Paul Roblot
- Neurosurgery, Chu Pellegrin Hospital, Bordeaux, France
| | - Antonio Musio
- Neurosurgery, M. Bufalini Hospital, Cesena, Italy.,Neurosurgery, Sant'Anna University Hospital Ferrara, Ferrara, Italy
| | | | - Flavio Giordano
- Neurosurgery Department, Children's Hospital A. Meyer, University of Florence, Florence, Italy
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11
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Mongardi L, Visani J, Mantovani G, Vitali C, Ricciardi L, Giordano F, Cavallo MA, Lofrese G, D'andrea M, Roblot P, De Bonis P, Scerrati A. Long term results of Dorsal Root Entry Zone (DREZ) lesions for the treatment of intractable pain: A systematic review of the literature on 1242 cases. Clin Neurol Neurosurg 2021; 210:107004. [PMID: 34739884 DOI: 10.1016/j.clineuro.2021.107004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Different Dorsal root entry zone (DREZ) lesion techniques have been reported as effective treatment for intractable painful conditions, though with contradictory results. Overall, good results were reported especially in specific conditions, such as pain due to brachial plexus avulsion, spinal cord injuries and oncological pain management. However, data on long term results in different clinical conditions are still missing. OBJECTIVE This study aims to systematically review the pertinent literature to evaluate indications, clinical outcomes, and complications of DREZ lesion (DREZotomy), in chronic pain management. METHODS A systematic literature review was conducted according to the PRISMA statement. Papers on DREZotomy for chronic pain in cancer, brachial plexus avulsion, spinal cord injury, post herpetic neuralgia, and phantom limb pain were considered for eligibility. For each category we further identified two sub-group according to the length of follow up: medium term and long term follow up (more than 3 years) respectively. RESULTS 46 papers, and 1242 patients, were included in the present investigation. When considering long term results DREZotomy provided favorable clinical outcomes in brachial plexus avulsion and spinal cord injury, in 60.8% and 55.8% of the cases respectively. Conversely, the success rate was 35.3% in phantom limb pain and 28.2% in post herpetic neuralgia. A poor clinical outcome was reported in over than 25% of the patients suffering from phantom limb pain, post herpetic neuralgia and spinal cord injury. The mean complications rate was 23.58%. While BPA and SCI patients presented stable improvement over time, good outcomes among PHN and PLP groups dropped by - 46.2%; and - 14.7% at long term follow up respectively. CONCLUSION DREZotomy seems to be an effective treatment for chronic pain conditions, especially for brachial plexus avulsion, spinal cord injury and intractable cancer/post-radiation pain. According to the low level of evidence of the pertinent literature, further studies are strongly recommended, to better define potential benefits and limitations of this technique.
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Affiliation(s)
- Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy.
| | - Jacopo Visani
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgio Mantovani
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Costanza Vitali
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, LE, Italy
| | - Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Michele Alessandro Cavallo
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | | | | | - Paul Roblot
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
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12
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Scerrati A, Mongardi L, Cavallo MA, Labanti S, Simioni V, Ricciardi L, De Bonis P. Awake surgery for skills preservation during a sensory area tumor resection in a clarinet player. Acta Neurol Belg 2021; 121:1235-1239. [PMID: 32372400 DOI: 10.1007/s13760-020-01368-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/24/2020] [Indexed: 01/01/2023]
Abstract
Tumors in primary sensory area are challenging to remove without causing a neurological deficit, especially in musicians who present complex neuronal networks. Indeed, in this kind of patients, somatosensory evoked potentials (SSEPs) are not plenty. We describe our experience for sensory and proprioception preservation in a professional clarinet player undergoing surgery for a right parietal glioblastoma. The patient underwent surgery for a right parietal glioblastoma. Intraoperative monitoring and awake surgery while playing instrument, were performed. During resection, intraoperative stimulation caused a transient impairment of left hand movements, without SSEPs alteration. The resection was stopped anytime there was a movement impairment. We obtained a gross total tumor resection. Patient did not present neurological deficits. Standard neurophysiological monitoring is fundamental but cannot be sufficient. More complex strategies of monitoring, such as awake surgery and playing an instrument could be of help for preserving complex sensory-motor functions.
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Affiliation(s)
| | | | | | | | | | - Luca Ricciardi
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Sapienza, Rome, Italy
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13
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Mongardi L, Dones F. Letter: Management of Sigmoid Sinus Injury: Retrospective Study of 450 Consecutive Surgeries in the Cerebellopontine Angle and Intrapetrous Region. Oper Neurosurg (Hagerstown) 2021; 20:E393. [PMID: 33582799 DOI: 10.1093/ons/opab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery Sant'Anna University Hospital of Ferrara Ferrara, Italy
| | - Flavia Dones
- Neurosurgery Sant'Anna University Hospital of Ferrara Ferrara, Italy
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14
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D'Andrea M, Mongardi L, Fuschillo D, Musio A, Commodaro C, Quilis-Quesada V, Tosatto L. Vermian subtentorial arteriovenous malformation supplied by the artery of Wollschlaeger and Wollschlaeger. Clin Neurol Neurosurg 2021; 206:106670. [PMID: 34015698 DOI: 10.1016/j.clineuro.2021.106670] [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: 11/07/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The artery of Wollschlaeger and Wollschlaeger is a tentorial branch of the superior cerebellar artery: due to its small diameter, it is not usually seen in normal angiograms except when enlarged in the setting of a dural AVF or tentorial meningioma. Its presence has been rarely described in the Literature. CASE REPORT herein we describe the first ever reported case of a vermian subtentorial arteriovenous malformation supplied by the artery of Wollschlaeger and Wollschlaeger in 70 year old female patient. CONCLUSION vermian subtentorial AVMs supplied by the artery of Wollschlaeger and Wollschlaeger are extremely rare vascular malformations. The presence of the artery of Wollschlaeger and Wollschlaeger must be carefully evaluated during preoperative surgical planning due to its key role in the supply of vascular malformation and to decrease the risk of intra operative bleeding during surgery.
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Affiliation(s)
- M D'Andrea
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - L Mongardi
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy.
| | - D Fuschillo
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - A Musio
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 44124, Cona (Ferrara), Italy
| | - C Commodaro
- Neuroradiology Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | | | - L Tosatto
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
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15
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Scerrati A, Norri N, Mongardi L, Dones F, Ricciardi L, Trevisi G, Menegatti E, Zamboni P, Cavallo MA, De Bonis P. Styloidogenic-cervical spondylotic internal jugular venous compression, a vascular disease related to several clinical neurological manifestations: diagnosis and treatment-a comprehensive literature review. Ann Transl Med 2021; 9:718. [PMID: 33987416 PMCID: PMC8106058 DOI: 10.21037/atm-20-7698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Internal jugular vein (IJV) stenosis is associated with several central nervous system disorders such as Ménière or Alzheimer’s disease. The extrinsic compression between the styloid process and the C1 transverse process, is an emerging biomarker related to several clinical manifestations. However, nowadays a limited number of cases are reported, and few information are available about treatment, outcome and complications. Our aim is to collect and identify clinical-radiological characteristics, diagnosis and treatment of the styloidogenic internal jugular venous compression. We performed a comprehensive literature review. Studies reporting patients suffering from extracranial jugular stenosis were searched. For every patient we collected: demography, clinical and radiological characteristics and outcome, type of treatment, complications. Thirteen articles reporting 149 patients were included. Clinical presentation was non-specific. Most frequent symptoms were headache (46.3%), tinnitus (43.6%), insomnia (39.6%). The stenosis was monolateral in 51 patients (45.9%) and bilateral in 60 (54.1%). Anticoagulants were the most common prescribed drug (57.4%). Endovascular treatment was performed in 50 patients (33.6%), surgery in 55 (36.9%), combined in 28 (18.8%). Improvement of general conditions was reported in 58/80 patients (72.5%). Complications were reported in 23% of cases. Jugular stenosis is a complex and often underestimated disease. Conservative medical treatment usually fails while surgical, endovascular or a combined treatment improves general conditions in more than 70% of patients.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Nicoló Norri
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Flavia Dones
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgery, Azienda Ospedaliera Sant'Andrea, Sapienza, Rome, Italy
| | | | - Erica Menegatti
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Neurosurgery Department, Sant'Anna University Hospital, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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16
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Scerrati A, Pangallo G, Dughiero M, Mongardi L, Ricciardi L, Lofrese G, Dones F, Cavallo MA, De Bonis P. Influence of nutritional status on the clinical outcome of patients with chronic subdural hematoma: a prospective multicenter clinical study. Nutr Neurosci 2021; 25:1756-1763. [PMID: 33666524 DOI: 10.1080/1028415x.2021.1895480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Elderly patients present a higher risk of developing chronic subdural hematomas (CSDHs) together with increased risk of malnutrition. The nutritional status may affect outcomes, response to treatments, and prognosis. Influence on other kinds of diseases was investigated showing an increased risk of mortality, morbidity, and adverse outcomes. However, no studies are available on its possible role for the outcome of patients with CSDH. This study aims to evaluate a possible relationship between the nutritional status and the clinical outcome of patients who underwent CSDH surgery. METHODS This is a multicenter prospective study enrolling all patients treated for CSDH. Demographic and clinical data were collected. For nutritional status evaluation, we used the Mini Nutritional Assessment (MNA). Chi-square test was used for comparing clinical variables of patients and logistic regression analysis was used for defining the impact of the aforementioned variables on the clinical outcome. RESULTS We enrolled 178 patients. Modified Rankin scale (mRS) was 0-2 pre-operatively in 23.6% of patients and post-operatively in 61.2% of patients. Total assessment MNA score was >23.5 in 47.8% of patients. Ninety-three patients (52.2%) presented a normal nutritional status, 63 (35.4%) were at risk of malnutrition and 22 (12.4%) were malnourished. The mean follow-up was 2.6 months. Malnourished patients were at higher risk of a worse outcome (OR 81; CI = 9-750). CONCLUSION This study suggests that nutritional status represents a strong predictor of outcome. Our results, albeit preliminary, demonstrated malnutrition is correlated to the risk of worse clinical outcome for patients undergoing surgery for chronic subdural hematoma. Further investigations with wider casuistry and multiple nutritional scores are required to validate our data.
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Affiliation(s)
- Alba Scerrati
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giulia Pangallo
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Michele Dughiero
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgery Unit, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Flavia Dones
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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17
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Minghetti S, Lenge M, Pisano T, Gori S, Mongardi L, Sestini S, Cavallo MA, Genitori L, Giordano F. Deep Brain Stimulation of Subgenual Cingulate Region for Treatment of an Early-Onset Conversion Disorder with Psychogenic Non-Epileptic Seizures and Prolonged Catatonia: Preliminary Results in One Patient. Stereotact Funct Neurosurg 2021; 99:363-365. [PMID: 33567439 DOI: 10.1159/000513317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Sara Minghetti
- Child Neurology and Psychiatry Department, Children's Hospital A. Meyer, Florence, Italy
| | - Matteo Lenge
- Child Neurology and Psychiatry Department, Children's Hospital A. Meyer, Florence, Italy.,Neurosurgery Department, Children's Hospital A. Meyer, Florence, Italy
| | - Tiziana Pisano
- Child Neurology and Psychiatry Department, Children's Hospital A. Meyer, Florence, Italy,
| | - Sara Gori
- Child Neurology and Psychiatry Department, Children's Hospital A. Meyer, Florence, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, Children's Hospital A. Meyer, Florence, Italy.,Neurosurgery Department, Nuovo Arcispedale di Cona Ferrara, Ferrara, Italy
| | - Stelvio Sestini
- Diagnostic Imaging, Nuclear Medicine Unit Department, Ospedale Misericordia e Dolce, Prato, Italy
| | | | - Lorenzo Genitori
- Neurosurgery Department, Children's Hospital A. Meyer, Florence, Italy
| | - Flavio Giordano
- Neurosurgery Department, Children's Hospital A. Meyer, Florence, Italy
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18
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Ricciardi L, Trungu S, Scerrati A, Mongardi L, Flacco ME, Raco A, Miscusi M, De Bonis P, Sturiale CL. Surgical treatment of intracranial blister aneurysms: A systematic review. Clin Neurol Neurosurg 2021; 202:106550. [PMID: 33588360 DOI: 10.1016/j.clineuro.2021.106550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intracranial blister aneurysms (BAs) are challenging vascular lesions related to high morbidity and mortality rates. Different surgical and endovascular techniques have been proposed to treat BAs; however, there is no consensus on a preferred treatment. OBJECTIVE To systematically review the pertinent literature on clinical and radiological outcomes of different surgical treatments for BAs management, to meta-analyze their clinical and radiological outcomes, and compare these results with those from recent meta-analyses on endovascular treatments for BAs. METHODS The present study was consistently conducted according to the PRISMA guidelines. Five different online medical databases (PubMed, Medline, EMBASE, Scopus, and Web-of-Science) were screened from 2010 through 2020. Papers reporting clinical and radiological outcomes of different surgical treatments for BAs were considered. Event rates were pooled across studies using random-effects meta-analysis. RESULTS A total of 35 studies reporting on 514 patients (534 aneurysms) were included. Aneurysm clipping in 223 patients (45.4%; 95% CI 21.9-53.8), bypass and trapping in 87 (17.7%; 95% CI 1.89-21.6), clipping and wrapping in 82 (16.7%; 95% CI 3.71-19.0), and wrapping in 33 (6.7%; 95% CI 0.0-4.87) were the mostly common performed treatments. Complete occlusion rate was reported in 90.7% of patients. The complication rate was as high as 61.1%, the mortality rate was 7.4%, and the mean mRS at follow-up was 2.5. CONCLUSIONS Our meta-analysis suggests that surgical treatments for BAs are related to higher occlusion, complications and mortality rate than endovascular strategies. However, there is a high-heterogeneity among the included studies and data are poorly reported; so comparing the two type of treatments is unreliable in order to establish which one is better.
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Affiliation(s)
- Luca Ricciardi
- UOC Di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Sapienza, Rome, Italy
| | - Sokol Trungu
- UOC Di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Sapienza, Rome, Italy; UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, LE, Italy
| | - Alba Scerrati
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy; Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy.
| | - Lorenzo Mongardi
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | | | - Antonino Raco
- UOC Di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Sapienza, Rome, Italy
| | - Massimo Miscusi
- UOC Di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Sapienza, Rome, Italy
| | - Pasquale De Bonis
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy; Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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De Bonis P, Cavallo MA, Sturiale CL, Martellucci C, Flacco ME, Dughiero M, Auricchio AM, Ricciardi L, Raco A, Bortolotti C, Tosatto L, D'Andrea M, Ruggiero M, Mongardi L, Zona G, Fiaschi P, Cofano F, Garbossa D, Scerrati A. Incidence of hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 national quarantine in Italy. Clin Neurol Neurosurg 2021; 202:106503. [PMID: 33493878 DOI: 10.1016/j.clineuro.2021.106503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND hemorrhagic cerebrovascular disease due to vascular malformations represents an emergency for neurosurgery and neuro-interventional departments. During the COVID-19 pandemic, a dramatic reduction in the number of hospitalizations for acute myocardial infarction or stroke and a larger time interval from symptom onset to first medical contact have been reported. This study aims to verify the hypothesis that there would also have been a reduction of admissions for hemorrhagic cerebrovascular disease during the Italian lockdown. MATERIAL AND METHOD s A multicenter, observational survey was conducted to collect data on hospital admissions for hemorrhagic cerebrovascular disease due to vascular malformations throughout two-months (March 15th to May 15th); the years 2020 (COVID-19 Italian lockdown), 2019 and 2018 were compared. Cases were identified by ICD-9 codes 430, 431, 432.1, 432.9, 747.81 of each hospital database. The statistical significance of the difference between the event rate of one year versus the others was evaluated using Poisson Means test, assuming a constant population. RESULTS During the 2020 lockdown, the total number of admissions for hemorrhagic cerebrovascular disease was 92 compared with 116 in 2019 and 95 in 2018. This difference was not significant. GCS upon admission was 3-8 in 44 % of cases in 2020 (41 patients), 39.7 % in 2019 (46 patients) and 28 % in 2018 (27 patients). CONCLUSION Reduction of admissions for hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 lockdown was not confirmed. Nevertheless, some patients reached the emergency rooms only several days after symptoms onset, resulting in a worse clinical condition at admission.
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Affiliation(s)
- Pasquale De Bonis
- Neurosurgery Department, S. Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Michele Alessandro Cavallo
- Neurosurgery Department, S. Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | | | | | | | - Michele Dughiero
- Neurosurgery Department, S. Anna University Hospital, Ferrara, Italy
| | | | - Luca Ricciardi
- Neurosurgery, Department NESMOS, Sapienza University of Rome, Rome, Italy
| | - Antonino Raco
- Neurosurgery, Department NESMOS, Sapienza University of Rome, Rome, Italy
| | - Carlo Bortolotti
- Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | | | | | - Lorenzo Mongardi
- Neurosurgery Department, S. Anna University Hospital, Ferrara, Italy
| | | | | | - Fabio Cofano
- Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Diego Garbossa
- Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Alba Scerrati
- Neurosurgery Department, S. Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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D'Andrea M, Mongardi L, Cultrera F, Lenge M, Tosatto L, Giordano F. Long-term outcomes of endoscopic third ventriculostomy for Blake's pouch cyst in adults. Clin Neurol Neurosurg 2021; 202:106502. [PMID: 33529964 DOI: 10.1016/j.clineuro.2021.106502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Affiliation(s)
- M D'Andrea
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - L Mongardi
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy; Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
| | - F Cultrera
- Neurosurgery, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - M Lenge
- Neurosurgery Department, Children's Hospital A. Meyer, University of Florence, Viale Pieraccini 24, Florence 50139, Italy
| | - L Tosatto
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - F Giordano
- Neurosurgery Department, Children's Hospital A. Meyer, University of Florence, Viale Pieraccini 24, Florence 50139, Italy
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21
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Visani J, Mongardi L, Cultrera F, Bonis PD, Lofrese G, Ricciardi L, Scerrati A. Surgical treatment of metastatic pheochromocytomas of the spine: a systematic review. J Integr Neurosci 2021; 20:499-507. [PMID: 34258952 DOI: 10.31083/j.jin2002053] [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: 02/17/2021] [Revised: 03/15/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022] Open
Abstract
Metastatic pheochromocytoma of the spine (MPS) represents an extremely rare and challenging entity. While retrospective studies and case series make the body of the current literature and case reports, no systematic reviews have been conducted so far. This systematic review aims to perform a systematic review of the literature on this topic to clarify the status of the art regarding the surgical management of MPS. A systematic review according to PRISMA criteria has been performed, including all studies written in English and involving human participants. 15 papers for a total of 44 patients were finally included in the analysis. The median follow-up was 26.6 months. The most common localization was the thoracic spine (54%). In 30 out of 44 patients (68%), preoperative medications were administered. Open surgery was performed as the first step in 37 cases (84%). Neoadjuvant treatments, including preoperative embolization were reported in 18 (41%) cases, while adjuvant treatments were administered in 23 (52%) patients. Among those patients who underwent primary aggressive tumor removal and instrumentation, 16 out of 25 patients (64%) showed stable disease with no progression at the final follow-up. However, the outcome was not reported in 14 patients. Gross total resection of the tumor and spinal reconstruction appear to offer good long-term outcomes in selected patients. Preoperative alpha-blockers and embolization appear to be useful to enhance hemodynamic stability, avoiding potential detrimental complications.
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Affiliation(s)
- Jacopo Visani
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Pasquale De Bonis
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Giorgio Lofrese
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Luca Ricciardi
- Neurosurgery, Department NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Alba Scerrati
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
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22
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Giordano F, Lenge M, Donati P, Mongardi L, Di Giacomo G, Mura R, Taverna M, Cini C, Peraio S, Poggi G, Tuccinardi G, Giglio S, Genitori L. Exclusive Neurogenic Bladder and Fecal Incontinency in an Achondroplasic Child Successfully Treated with Lumbar Foraminal Decompression. Pediatr Neurosurg 2021; 56:471-476. [PMID: 34320505 DOI: 10.1159/000517652] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Achondroplasia is a genetic disorder characterized by defects in the development of endochondral bone resulting in skeletal abnormalities like stenosis of the foramen magnum and of the spine, shortened limb bones, and macrocephaly. Congenital spinal stenosis is frequent and due to premature fusion of the pedicles to the laminae. CASE PRESENTATION We report a case of neurogenic bladder and fecal incontinence due to lumbar stenosis successfully treated with L1-L5 partial laminectomy and foraminotomy in a 7-year-old achondroplasic child. DISCUSSION/CONCLUSION To our knowledge, this is the first case report of exclusive neurogenic bladder and fecal incontinence in an achondroplasic child. Neurogenic bladder and fecal incontinence without motor impairment may be early and exclusive clinical findings of lumbar stenosis in children with achondroplasia.
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Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Matteo Lenge
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy, .,Department of Neuroscience, Child Neurology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy,
| | - Pierarturo Donati
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Nuovo Ospedale Cona, University of Ferrara, Ferrara, Italy
| | - Gianpiero Di Giacomo
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,Department of Neuroscience, Child Neurology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Regina Mura
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Maria Taverna
- Department of Surgery, Pediatric Urology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Chiara Cini
- Department of Surgery, Pediatric Urology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Simone Peraio
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Giovanni Poggi
- Department of Pediatrics, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Germana Tuccinardi
- Neuroanesthesiology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Sabrina Giglio
- Clinical Genetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
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23
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Mongardi L, Visani J, Mantovani G, Olivetti ME, Scerrati A, Cultrera F, Ricciardi L, De Bonis P, Cavallo MA, Lofrese G. Ct guided reference markers for spinal dorsal lesions: A safe and valuable tool impacting intraoperative localization time. J Clin Neurosci 2020; 84:97-101. [PMID: 33358493 DOI: 10.1016/j.jocn.2020.11.039] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/17/2020] [Accepted: 11/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intraoperative localization of the correct spine level can be challenging when dealing with the thoracic spine; especially in morbidly obese patients and in mid-thoracic spine lesions. Different radiological reference markers techniques for dorsal surgery have been reported without a clear DAP (effective dose), localization and surgical time analysis. PURPOSE The aim of the study is to analyze the radiological reference markers technique in terms of localization time and radiation dose during surgery for dorsal lesions. METHODS We used a radiopaque marker (fiducial) directly positioned before surgery over the lamina or the spinous process using CT scan for precise localization and vertebra count. We prospectively collected data about patients who underwent preoperative thoracic localization between April 2015 and September 2018 at Neurosurgery Department of Ferrara University Hospital. Clinical data as pathology, related surgical technique, radiological exams, localization time and radiation exposure were analyzed. RESULTS 19 patients who underwent preoperative radiopaque marker (fiducial) positioning and 11 patients who underwent fluoroscopy technique were enrolled. No complications related to fiducial placement and no wrong-level occurred. The localization time with the fiducial was reduced dramatically (3 min vs 15 min of the standard technique). The average DAP (effective dose) for the fiducial group was 20 Gy-cm2 compared with 16 Gy-cm2 of the traditional group. CONCLUSION The use of preoperative fiducial for intraoperative localization of the target level in the thoracic spine dramatically reduce the location time without a significantly higher DAP (effective dose).
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Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy.
| | - Jacopo Visani
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | - Giorgio Mantovani
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | - Maria Elena Olivetti
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | - Alba Scerrati
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | | | | | - Pasquale De Bonis
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
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24
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Mongardi L, Rispoli V, Scerrati A, Giordano F, Capone J, Vaudano A, De Bonis P, Morgante F, Picillo M, Cavallo M, Sensi M. Deep brain stimulation of the ventralis oralis anterior thalamic nucleus is effective for dystonic tremor. Parkinsonism Relat Disord 2020; 81:8-11. [DOI: 10.1016/j.parkreldis.2020.09.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
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25
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D'Andrea M, Mongardi L, Fuschillo D, Tosatto L. Type 1 trigeminal neuralgia caused by a SCA secondary branch running through the Vth nerve. Acta Neurol Belg 2020; 120:1481-1482. [PMID: 32770497 DOI: 10.1007/s13760-020-01458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Affiliation(s)
- M D'Andrea
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - L Mongardi
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
| | - D Fuschillo
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - L Tosatto
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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26
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D'Andrea M, Musio A, Fuschillo D, Mongardi L, Riccioni L, Tosatto L. Epidermoid cyst of the anterior clinoid process: report of a unique finding and literature review of the middle cranial fossa locations. Clin Neurol Neurosurg 2020; 200:106381. [PMID: 33302123 DOI: 10.1016/j.clineuro.2020.106381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Epidermoids cysts are relatively rare, benign, congenital tumours, representing from 0.3% to 1.8% of all intracranial lesions. When extradural, they are most commonly reported in the temporal or parietal bones as intradiploic lesions; when intradural their most common location is the cerebellopontine angle and less frequently the middle cranial fossa. Herein we present a unique case of an extradural-intraosseous epidermoid cyst of the anterior clinoid process, integrating our single-case experience into a focused literature review of these lesions, when located in the middle cranial fossa. CASE DESCRIPTION A 49 years old man came to our attention with history of head trauma. Urgent brain CT and elective brain MRI showed imaging suggestive for an anterior clinoid process epidermoid cyst. Through a pterional approach, the lesion was completely removed with microsurgical endoscope assisted technique. MRI at one year follow up showed no recurrence. METHODS Current literature on epidermoid cysts located in middle cranial fossa was reviewed. A total of 22 papers, containing 70 epidermoid cyst were selected for the review. Symptoms at presentation; anatomic location; surgical approach; extent of resection and recurrence; outcome after surgery and at follow up were analysed for each case. CONCLUSIONS In the 70 published cases of middle fossa epidermoid cysts, the majority presented with trigeminal neuralgia. Most of the cases were operated through a pterional approach, while recent literature showed an increasing interest in endonasal endoscopic techniques. Subtotal resection is not a straight predictive value for recurrence; post-operative neurological deficits incidence is low and generally resolve at follow-up.
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Affiliation(s)
| | - Antonio Musio
- Maurizio Bufalini Hospital, Neurosurgery Department, Cesena, Italy.
| | - Dalila Fuschillo
- Maurizio Bufalini Hospital, Neurosurgery Department, Cesena, Italy
| | - Lorenzo Mongardi
- Sant' Anna University Hospital, Ferrara, Neurosurgery Department, Ferrara, Italy
| | - Luca Riccioni
- Maurizio Bufalini Hospital, Pathology Department, Cesena, Italy
| | - Luigino Tosatto
- Maurizio Bufalini Hospital, Neurosurgery Department, Cesena, Italy
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27
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Mongardi L, Dones F, Mantovani G, De Bonis P, Rustemi O, Ricciardi L, Cavallo MA, Scerrati A. Low-Dose Acetylsalicylic Acid in Chronic Subdural Hematomas: A Neurosurgeon's Sword of Damocles. Front Neurol 2020; 11:550084. [PMID: 33133003 PMCID: PMC7550681 DOI: 10.3389/fneur.2020.550084] [Citation(s) in RCA: 2] [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: 05/09/2020] [Accepted: 08/21/2020] [Indexed: 01/17/2023] Open
Abstract
Background: The possible influence of different antithrombotic drugs on outcome after neurosurgical treatment of chronic subdural hematoma (CSDH) is still unclear. Nowadays, no randomized clinical trials are available. A metanalysis including 24 studies for a total of 1,812 pooled patients concluded that antiplatelets and anticoagulations present higher risk of recurrences. On the other hand, several studies highlighted that antithrombotic suspension, timing of surgery, and resumption of these drugs are still debated, and patients taking these present higher risk of thromboembolic events with no excess risk of bleed recurrences or worse functional outcome. Our assumption is that the real hemorrhagic risk related to antithrombotic drug continuation in CSDH may be overrated and the thromboembolic risk for discontinuation underestimated, especially in patients with high cardiovascular risk. Methods: A comprehensive literature review with the search terms “acetylsalicylic acid” and “chronic subdural x” was performed. Clinical status, treatment, time of drug discontinuation, complications (in particular, rebleeding or thromboembolic events), and clinical and radiological outcome at follow-up were evaluated. Results: Five retrospective studies were selected for the review, three of them reporting specifically low-dose acetylsalicylic intake and two of them general antithrombotic drugs for a total of 1,226 patients. Only two papers reported the thromboembolic rate after surgery; in one paper, it is not even divided from other cardiac complications. Conclusion: The literature review does not clarify the best management of low-dose acetylsalicylic in CSDH patients, in particular, concerning the balance between thromboembolic event rates and rebleeding risks. We do believe that CSDH precipitates the worsening of comorbidities with a resulting increased mortality. Further studies clearly evaluating the thromboembolic events are strongly needed to clarify this topic. In this perspective paper, we discuss the difficult choice of low-dose acetylsalicylic acid (LDAA) management in patients suffering from chronic subdural hematoma (CSDH). The balance between hemorrhagic and thromboembolic risks often represents a sword of Damocles for neurosurgeons, especially when dealing with patients with high cardiovascular risk. No guidelines are currently available, and a survey by Kamenova et al. showed that most neurosurgeons discontinue LDAA treatment for at least 7 days in the perioperative period of surgical evacuation of CSDH, even though recent studies show that early LDAA resumption might be safe. Thrombosis prophylaxis is administered by only 60%, even though patients with CSDH are at high risk of developing thromboembolic complications. We would like to bring attention to this controversial issue.
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Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery Department, University Hospital S. Anna, Ferrara, Italy
| | - Flavia Dones
- Neurosurgery Department, University Hospital S. Anna, Ferrara, Italy
| | - Giorgio Mantovani
- Neurosurgery Department, University Hospital S. Anna, Ferrara, Italy
| | - Pasquale De Bonis
- Neurosurgery Department, University Hospital S. Anna, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | | | - Luca Ricciardi
- Neurosurgery, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery Department, University Hospital S. Anna, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alba Scerrati
- Neurosurgery Department, University Hospital S. Anna, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Giordano F, Caporalini C, Peraio S, Mongardi L, Buccoliero AM, Cavallo MA, Genitori L, Lenge M, Mura R, Melani F, L'Erario M, Lelli L, Pennica M. Post-mortem histopathology of a pediatric brain after bilateral DBS of GPI for status dystonicus: case report and review of the literature. Childs Nerv Syst 2020; 36:1845-1851. [PMID: 32613424 DOI: 10.1007/s00381-020-04761-w] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the effects of deep brain stimulation (DBS) electrodes on the brain of a dystonic pediatric patient submitted to bilateral DBS of the globus pallidus internus (GPI). METHODS An 8-year-old male patient underwent bilateral DBS of GPI for status dystonicus. He died 2 months later due to multiorgan failure triggered by bacterial pneumonia. A post-mortem pathological study of the brain was done. RESULTS At visual inspection, no grossly apparent softening, hemorrhage, or necrosis of the brain adjacent to the DBS lead tracts was detected. High-power microscopic examination of the tissue surrounding the electrode trajectories showed lymphocyte infiltration, astrocytic gliosis, microglia, macrophages, and clusters of multinucleate giant cells. Significant astrocytosis was confirmed by GFAP staining in the electrode site. The T cell lymphocyte activity was overexpressed with activated macrophages detected with CD3, CD20, CD45, and CD68 stains respectively. There was no gliosis or leukocyte infiltration away from the surgical tracks of the electrodes. CONCLUSION This is the first post-mortem examination of a child's brain after bilateral DBS of GPI. The comparison with adult post-mortem reports showed no significant differences and confirms the safety of DBS implantation in the pediatric population too.
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Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy. .,Functional and Epilepsy Neurosurgery Unit, Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Chiara Caporalini
- Division of Pathology, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Simone Peraio
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna Hospital University of Ferrara, Ferrara, Italy
| | - Anna Maria Buccoliero
- Division of Pathology, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | | | - Lorenzo Genitori
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Matteo Lenge
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,Child Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Regina Mura
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Federico Melani
- Child Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Manuela L'Erario
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Leonardo Lelli
- Diagnostic Imaging Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Michele Pennica
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
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Scerrati A, Labanti S, Lofrese G, Mongardi L, Cavallo MA, Ricciardi L, De Bonis P. Artists playing music while undergoing brain surgery: A look into the scientific evidence and the social media perspective. Clin Neurol Neurosurg 2020; 196:105911. [DOI: 10.1016/j.clineuro.2020.105911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
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30
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Draghi R, Mongardi L, Panzacchi R, Godano U, Barni I, Calbucci F, Borghesi I. Choroid Plexus Cyst of the Fourth Ventricle Associated with Intermittent Obstructive Hydrocephalus. World Neurosurg 2020; 143:152-157. [PMID: 32745653 DOI: 10.1016/j.wneu.2020.07.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Choroid plexus cysts (CPCs) are a type of neuroepithelial cysts, benign lesions located more frequently in the supratentorial compartment. Symptomatic CPCs in the posterior fossa are extremely rare and can be associated with obstructive hydrocephalus. CASE DESCRIPTION A previously healthy elderly woman suffered intermittent attacks of headache and vomiting associated with gait instability. Magnetic resonance imaging documented a large cystic lesion occupying all the fourth ventricle. An endoscope-assisted fenestration of the lesion through a telovelar approach determined only temporary improvement, hence a second surgery with gross total resection of the cyst was performed, with successful long-term clinical and radiologic resolution. Histology revealed CPC. CONCLUSIONS Fourth ventricle symptomatic CPCs are extremely rare lesions, especially in the elderly. Their presence must be carefully evaluated as a possible rare cause of intermittent obstructive hydrocephalus. Even though cyst fenestration with restoration of the cerebrospinal fluid pathway represents the best treatment in the majority of cases, a more aggressive resection is sometimes necessary.
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Affiliation(s)
- Riccardo Draghi
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna University Hospital Ferrara, Cona (Ferrara), Italy.
| | | | - Umberto Godano
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Ilaria Barni
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Fabio Calbucci
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Ignazio Borghesi
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
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Giordano F, Moscheo C, Lenge M, Biagiotti R, Mari F, Sardi I, Buccoliero AM, Mongardi L, Aronica E, Guerrini R, Genitori L. Neurosurgical treatment of subependymal giant cell astrocytomas in tuberous sclerosis complex: a series of 44 surgical procedures in 31 patients. Childs Nerv Syst 2020; 36:951-960. [PMID: 31853898 DOI: 10.1007/s00381-019-04449-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Subependymal giant cell astrocytomas (SEGA) are benign tumors characteristic of tuberous sclerosis complex (TSC) that may cause hydrocephalus. Various treatments are nowadays available as mTOR inhibitors or surgery. Surgery is still a valid option especially for symptomatic and larger tumors. METHODS From January 1994 to December 2015, 31 TSC patients harboring SEGA underwent surgery at the Department of Neurosurgery of the Meyer Pediatric Hospital, Florence. Indications for surgery were tumor size and location, growth and cystization/hemorrhage, and hydrocephalus. Clinical data, preoperative and postoperative MRI, recurrence rate, further surgical procedures, and related complications were analyzed. RESULTS A total of 44 surgeries were performed in 31 TSC patients affected by SEGA, achieving gross total removal (GTR) and subtotal removal (STR), respectively, in 36 and 8 patients. Recurrences occurred in 11 patients; 9 of them underwent further surgical procedures and 2 were treated with mTOR pathway inhibitors. Surgical morbidity and mortality were, respectively, 22.7% and 2.3%. After a mean follow-up of 4.9 years, 90% of patients were tumor-free with good neurological status in 93.3%; twelve (40%) had a ventriculo-peritoneal shunt (VPS) for hydrocephalus. CONCLUSIONS The present series confirms that the surgical approach, combined with mTOR inhibitors, is still a valid option for the treatment of SEGAs.
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Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy.
| | - Carla Moscheo
- Neuro-oncology Unit, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Matteo Lenge
- Department of Neurosurgery, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy.,3. Pediatric Neurology, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Roberto Biagiotti
- Division of Prenatal Diagnosis, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Francesco Mari
- 3. Pediatric Neurology, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Iacopo Sardi
- Neuro-oncology Unit, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Anna Maria Buccoliero
- Pathology Unit, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Sant'Anna Hospital, Via Aldo Moro, Ferrara, 44124, Italy
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Renzo Guerrini
- 3. Pediatric Neurology, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, Children's Hospital A. Meyer, University of Florence, viale Pieraccini 24, Florence, 50139, Italy
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Ricciardi L, Mongardi L, Dones F. Indications and Safety of the Zygomatic Osteotomy in Middle Cranial Fossa Surgery: A Retrospective Cohort Review. J Neurol Surg B Skull Base 2020; 82:e203-e204. [PMID: 34306938 DOI: 10.1055/s-0040-1705166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/22/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Luca Ricciardi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Flavia Dones
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
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33
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Scerrati A, Mongardi L, Visani J, Lofrese G, Cavallo MA, Fiorentino A, De Bonis P. The controversial role of Bevacizumab in the treatment of patients with intracranial meningioma: a comprehensive literature review. Expert Rev Anticancer Ther 2020; 20:197-203. [PMID: 32116057 DOI: 10.1080/14737140.2020.1736567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Meningiomas represent the most common primary intracranial tumors. Today, surgical resection, followed by radiotherapy when indicated, is still the treatment of choice. In recent years, distinct oncogenic pathways have been identified, laying the foundations of new personalized targeted therapies.Areas covered: The aim of this study was to highlight the effects, complications, possible associations with other therapeutic approaches and multi-parametric outcome evaluation of Bevacizumab for the treatment of meningiomas. A literature review according to PRISMA criteria regarding the role of Bevacizumab for the treatment of various WHO grades of meningiomas was performed. 15 relevant papers, including 6 retrospective clinical trial series, 3 prospective trials, and 6 single patient case reports for a total of 134 patients and 211 meningiomas were include.Expert opinion: Because of the lack of strong clinical evidence about improved survival and related toxicity, the use of Bevacizumab for the treatment of meningiomas should be carefully evaluated. Further exploration, ideally with randomized controlled trials, is needed to better define the role of this drug in the treatment of meningiomas.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy.,Neurosurgery Department, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Jacopo Visani
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Pasquale De Bonis
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
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De Bonis P, Visani J, Zauli G, Mongardi L, Zamboni P, Cavallo MA. A Brain Hidden in the Ferrara Cathedral: A Novel Interpretation of a Renaissance Masterpiece. World Neurosurg 2019; 127:486-489. [PMID: 30954742 DOI: 10.1016/j.wneu.2019.03.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/15/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
The aim of present report was to briefly review the history of the anatomical studies during the Italian Renaissance and to outline their relationship to the figurative arts, focusing, in particular, on neuroanatomical studies that have been at the center of the medical and philosophical debate from the 14th to 16th centuries. Therefore, we have presented the interpretation of different Renaissance masterpieces for which some references to brain anatomy have been previously reported. We propose a new interpretation, in neuroanatomical key, of the fresco of the universal judgment in the vault of San Giorgio's Cathedral in Ferrara, Italy, painted around the end of the 16th century.
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Affiliation(s)
- Pasquale De Bonis
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy
| | - Jacopo Visani
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy.
| | - Giorgio Zauli
- Division of Anatomy and Histology, Department of Morphology, Surgery, and Experimental Medicine, St. Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy
| | - Paolo Zamboni
- Department of Vascular Surgery, St. Anna University Hospital, Ferrara, Italy
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Iaccarino C, Francesca O, Piero S, Monica R, Armando R, de Bonis P, Ferdinando A, Trapella G, Mongardi L, Cavallo M, Giuseppe C, Franco S. Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature. Acta Neurochir Suppl 2019; 125:279-288. [PMID: 30610334 DOI: 10.1007/978-3-319-62515-7_40] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Surgical stabilization is indicated when high-grade instability or failure of stable reduction are observed. The instability is graded according to the classification system devised by Fielding and Hawkins. Several recommendations for treatment are available in the literature, but there are no common guidelines. In this paper, the authors discuss the need for prompt diagnosis and treatment considerations. CASE DESCRIPTION Five children with Fielding type I-III rotatory subluxation are reported. Three patients were treated with a cervical collar, and one patient was treated with skull traction and sternal-occipital-mandibular immobilizer (SOMI) brace application. Surgical treatment was necessary for one patient after failure of initial conservative management. The intervals between the onset of torticollis and radiological diagnosis ranged from 12 to 90 days. A relationship between an increased grade of instability and delayed diagnosis was observed. CONCLUSION In children with painful torticollis following ENT procedures or nasopharyngeal inflammation, Grisel's syndrome should always be suspected. Cervical magnetic resonance imaging (MRI) allows prompt and safe diagnosis, and a three-dimensional computed tomography (CT) scan provides better classification of the instability. Surgery, which is indicated in cases of high-grade instability or failure of conservative treatment, may be avoided with prompt diagnosis.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery-Neurotraumatology Unit, University Hospital of Parma, Parma, Italy. .,Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Ormitti Francesca
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Spennato Piero
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Rubini Monica
- Division of Paediatric General and Emergency Care Unit, Children's Hospital of Parma, Parma, Italy
| | - Rapanà Armando
- Neurosurgery Unit, Lorenzo Bonomo Hospital, Andria, Italy
| | - Pasquale de Bonis
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Aliberti Ferdinando
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Giorgio Trapella
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Cavallo
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Cinalli Giuseppe
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
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Pascual JM, Prieto R, Castro-Dufourny I, Mongardi L, Rosdolsky M, Strauss S, Carrasco R, Barrios L. Craniopharyngiomas Primarily Involving the Hypothalamus: A Model of Neurosurgical Lesions to Elucidate the Neurobiological Basis of Psychiatric Disorders. World Neurosurg 2018; 120:e1245-e1278. [DOI: 10.1016/j.wneu.2018.09.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023]
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Scerrati A, De Rosa S, Mongardi L, Cavallo MA, Trapella G, De Bonis P. Standard of care, controversies, and innovations in the medical treatment of severe traumatic brain injury. J Neurosurg Sci 2018; 62:574-583. [PMID: 29671294 DOI: 10.23736/s0390-5616.18.04462-4] [Citation(s) in RCA: 6] [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
Severe traumatic brain injury (STBI) is characterized by a primary injury which cannot be reversed and a secondary injury that can be prevented or reversed. Management of STBI patients in intensive care mainly aims at preventing the secondary injury. Treatment aims to: reducing ICP pressure (that can result in an ischemic insult); avoiding hypotension, hyperthermia, or hypoxemia; maintaining a normal electrolytes homeostasis; treating the autonomic dysfunction syndrome, coagulopathies, acute kidney injury and maintaining an adequate nutrition. Many treatment protocols are already well established, while many others are still debated. Moreover, new frontiers in STBI management are represented by the neurovascular regeneration and neurorestoration which are showing very promising results even if most of them still need a clinical validation. In this paper we review standard of care, controversies and innovations in the medical treatment of STBI.
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Affiliation(s)
- Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy -
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Michele A Cavallo
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgio Trapella
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
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Lofrese G, Mongardi L, Cultrera F, Trapella G, De Bonis P. Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes. Acta Neurochir (Wien) 2017; 159:1273-1281. [PMID: 28534073 DOI: 10.1007/s00701-017-3198-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several disc disease nomenclatures and approaches for LDH exist. The traditional midline bone-destructive procedures together with approaches requiring extreme muscular retraction are being replaced by muscle sparing, targeted, stability-preserving surgical routes. The increasing speculation on LDHs and the innovative corridors described to treat them have lead to an extensive production of papers frequently treating the same topic but adopting different terminologies and reporting contradictory results. METHODS The review of such literature somehow confounding gave us the chance to regroup by surgical corridors the vast amount of approaches for LDH differently renamed over time. Likewise, LDHs were simplified in intra-foraminal (ILDH), extra-foraminal (ELDH), and intra-/extra-foraminal (IELDH) in relation to precise anatomical boundaries and extent of bulging disc. RESULTS Through the analysis of the papers, it was possible to identify ideal surgical corridors for ILDHs, ELDHs, and IELDHs, distinguishing for each approach the exposure provided and the technical advantages/disadvantages in terms of muscle trauma, biomechanical stability, and nerve root preservation. A significant disproportion was noted between studies discussing traditional midline approaches or variants of the posterolateral route and those investigating pros and cons of simple or combined alternative corridors. Although rarely discussed, these latter represent valuable strategies particularly for the challenging IELDHs, thanks to the optimal compromise between herniation exposure and bone-muscle preservation. CONCLUSIONS The integration of adequate mastery of traditional approaches together with a greater confidence through unfamiliar surgical corridors can improve the development of combined mini-invasive procedures, which seem promising for future targeted LDH excisions.
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Pascual JM, Mongardi L, Prieto R, Castro-Dufourny I, Rosdolsky M, Strauss S, Carrasco R, Winter E, Mazzarello P. Erratum to: Giovanni Verga (1879-1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s. Neurosurg Rev 2017. [PMID: 28623533 DOI: 10.1007/s10143-017-0871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- José M Pascual
- Department of Neurosurgery, La Princesa University Hospital, C/Diego de León 62, 28006, Madrid, Spain.
| | - Lorenzo Mongardi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | | | | | - Sewan Strauss
- School of Medicine, Technische Universität, Dresden, Germany
| | - Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Eduard Winter
- Anatomical Pathology Collection in the Narrenturm-NHM, Vienna, Austria
| | - Paolo Mazzarello
- Department of Brain and Behavioral Sciences and History Museum, University of Pavía, Pavía, Italy
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40
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Pascual JM., Mongardi L, Prieto R, Castro-Dufourny I, Rosdolsky M, Strauss S, Carrasco R, Winter E, Mazzarello P. Giovanni Verga (1879–1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s. Neurosurg Rev 2017; 40:559-575. [DOI: 10.1007/s10143-017-0864-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/28/2017] [Accepted: 05/12/2017] [Indexed: 12/31/2022]
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De Filippis V, Fabris C, Bacolla A, Bertino E, Migliardi M, Trapani G, Chillemi C, Mombrò M, Mongardi L, Montrucchio F, Garzena E, Costa A. [Screening for congenital hypothyroidism. Results of screening of 20,000 newborn infants]. Minerva Pediatr 1981; 33:289-98. [PMID: 6787404] [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: 01/21/2023]
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