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Pesce A, Palmieri M, Pietrantonio A, Ciarlo S, Salvati M, Pompucci A. Resection of supratentorial high-grade gliomas availing of neuronavigation matched intraoperative ultrasound and Fluorescein: How far is it safe to push the resection? World Neurosurg X 2024; 23:100379. [PMID: 38645511 PMCID: PMC11027571 DOI: 10.1016/j.wnsx.2024.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Background High-Grade Gliomas are the most common primary brain malignancies and despite the multimodal treatment, and the increasing amount of adjuvant treatment options the overall prognosis remains dismal. The present investigation aims to analyze the safety profile of the use of intraoperative ultrasounds (Io-US) in a homogeneous and matched cohort of patients suffering from High-grade gliomas (HGG) operated on with or without the aid of Io-US and Fluorescein in specific relation to the incidence of neurological and functional status sequelae. Methods and materials A retrospective analysis was performed on 74 patients affected by HGG. 22 patients were treated with Io-US matched with neuronavigational system (Group A); 15 patients were treated both with the use of Io-US and Fluorescein matched with neuronavigational system (Group B); 37 patients were treated with the use of the neuronavigational system only (Group C). Primary endpoints were the extent of resection and functional outcome (measured with Karnofski Performance Status). Results Significative differences were observed in terms of a higher extent of resection in Group B. In a multivariate analysis, this data appears to be independent of the location (eloquent/non-eloquent) of the lesion and from its histology. Regarding functional outcomes, no differences were detected between the two groups. Conclusions The present study is the first that analyzes the simultaneous use of Io-US and Fluorescein, and the results demonstrate that these two instruments together could improve the extent of resection in HGG while ensuring good outcomes in terms of functional status.
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Affiliation(s)
- Alessandro Pesce
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Mauro Palmieri
- Università“La Sapienza” di Roma, Neurosurgery Division - Roma, Viale del Policlinico 155, 00161, Roma, RM, Italy
| | - Andrea Pietrantonio
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Silvia Ciarlo
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome “Tor Vergata”, 00133, Rome, RM, Italy
| | - Angelo Pompucci
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
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Scalia G, Priola SM, Ranganathan S, Venkataram T, Orestano V, Marrone S, Chaurasia B, Maugeri R, Iacopino DG, Strigari L, Salvati M, Umana GE. Assessing the impact of mixed reality-assisted informed consent: A study protocol. Surg Neurol Int 2024; 15:88. [PMID: 38628537 PMCID: PMC11021117 DOI: 10.25259/sni_1021_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background Informed consent is a crucial aspect of modern medicine, but it can be challenging due to the complexity of the information involved. Mixed reality (MR) has emerged as a promising technology to improve communication. However, there is a lack of comprehensive research on the impact of MR on medical informed consent. The proposed research protocol provides a solid foundation for conducting future investigations and developing MR-based protocols that can enhance patients' understanding and engagement in the decision-making process. Methods This study will employ a randomized controlled trial design. Two arms will be defined: MR-assisted informed consent (MRaIC) as the experimental arm and conventional informed consent (CIC) as the control arm consent, with 52 patients in each group. The protocol includes the use of questionnaires to analyze the anxiety levels and the awareness of the procedure that the patient is going to perform to study the impact of MRaIC versus CIC before medical procedures. Results The study will evaluate the impact of MR on patients' information comprehension, engagement during the process of obtaining informed consent, emotional reactions, and consent decisions. Ethical concerns will be addressed. Conclusion This study protocol provides a comprehensive approach to investigate the impact of MR on medical informed consent. The findings may contribute to a better understanding of the effects of MR on information comprehension, engagement during the process of obtaining informed consent, psychological experience, consent decisions, and ethical considerations. The integration of MR technology has the potential to enhance surgical communication practices and improve the informed consent process.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Sugery, Garibaldi Hospital, Catania, Italy
| | - Stefano Maria Priola
- Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Sruthi Ranganathan
- Department of Medicine, University of Cambridge, Cambridge CB2 OQQ, United Kingdom
| | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Valeria Orestano
- Psychology Center Orestano-Pittera, “l’Intreccio” Association, San Giovanni la Punta (CT), Italy
| | - Salvatore Marrone
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Lidia Strigari
- Department of Medical Physics, University Hospital of Bologna, Bologna, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
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Marrone S, Scalia G, Strigari L, Ranganathan S, Travali M, Maugeri R, Costanzo R, Brunasso L, Bonosi L, Cicero S, Iacopino DG, Salvati M, Umana GE. Improving mixed-reality neuronavigation with blue-green light: a comparative multimodal laboratory study. Neurosurg Focus 2024; 56:E7. [PMID: 38163345 DOI: 10.3171/2023.10.focus23598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study aimed to rigorously assess the accuracy of mixed-reality neuronavigation (MRN) in comparison with magnetic neuronavigation (MN) through a comprehensive phantom-based experiment. It introduces a novel dimension by examining the influence of blue-green light (BGL) on MRN accuracy, a previously unexplored avenue in this domain. METHODS Twenty-nine phantoms, each meticulously marked with 5-6 fiducials, underwent CT scans as part of the navigation protocol. A 3D model was then superimposed onto a 3D-printed plaster skull using a semiautomatic registration process. The study meticulously evaluated the accuracy of both navigation techniques by pinpointing specific markers on the plaster surface. Precise measurements were then taken using digital calipers, with navigation conducted under three distinct lighting conditions: indirect white light (referred to as no light [NL]), direct white light (WL), and BGL. The research enlisted two operators with distinct levels of experience, one senior and one junior, to ensure a comprehensive analysis. The study was structured into two distinct experiments (experiment 1 [MN] and experiment 2 [MRN]) conducted by the two operators. Data analysis focused on calculating average and median values within subgroups, considering variables such as the type of lighting, precision, and recording time. RESULTS In experiment 1, no statistically significant differences emerged between the two operators. However, in experiment 2, notable disparities became apparent, with the senior operator recording longer times but achieving higher precision. Most significantly, BGL consistently demonstrated a capacity to enhance accuracy in MRN across both experiments. CONCLUSIONS This study demonstrated the substantial positive influence of BGL on MRN accuracy, providing profound implications for the design and implementation of mixed-reality systems. It also emphasized that integrating BGL into mixed-reality environments could profoundly improve user experience and performance. Further research is essential to validate these findings in real-world settings and explore the broader potential of BGL in a variety of mixed-reality applications.
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Affiliation(s)
- Salvatore Marrone
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Gianluca Scalia
- 2Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Catania
| | - Lidia Strigari
- 3Department of Medical Physics, IRCCS Azienda University Hospital of Bologna, Italy
| | | | - Mario Travali
- 5Department of Diagnostic Imaging, Neuroradiology Unit, Cannizzaro Hospital, Catania
| | - Rosario Maugeri
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Roberta Costanzo
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Lara Brunasso
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Lapo Bonosi
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Salvatore Cicero
- 6Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania; and
| | - Domenico Gerardo Iacopino
- 1Department of Biomedicine, Neurosciences and Advanced Diagnostics, Neurosurgery Unit, School of Medicine, University of Palermo
| | - Maurizio Salvati
- 7Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Emanuele Umana
- 6Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania; and
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Scalia G, Ferini G, Marrone S, Salvati M, Yamamoto V, Kateb B, Schulte R, Forte S, Umana GE. Unexpected Transient Glioblastoma Regression in a Patient Previously Treated with Bacillus Calmette-Guérin Therapy: A Case Report and Immunomodulatory Effects Hypothesis. J Pers Med 2023; 13:1661. [PMID: 38138888 PMCID: PMC10744726 DOI: 10.3390/jpm13121661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Glioblastoma multiforme (GBM) is a highly aggressive brain tumor with limited treatment options and poor prognosis. Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, has been used as an immunotherapeutic agent in bladder cancer and has shown non-specific beneficial effects. This report presents a unique case of GBM regression following BCG therapy for bladder cancer, suggesting the potential systemic immunomodulatory effects of BCG on GBM. (2) Case Presentation: A 67-year-old male with a history of bladder cancer treated with BCG presented with neurological symptoms. Imaging revealed two GBM lesions, and surgery was performed to remove one. Subsequently, the patient experienced complete tumor regression after initial stability. (3) Conclusions: This case highlights the potential of BCG or other immunotherapies in GBM treatment and underscores the need for further research. Understanding the immunomodulatory effects of BCG on GBM could lead to innovative therapies for this devastating disease; although, overcoming the immune evasion mechanisms in the brain is a significant challenge. Further investigation is warranted to explore this promising avenue of research.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, 95123 Catania, Italy
| | - Gianluca Ferini
- Department of Radiation Oncology, Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy;
| | - Salvatore Marrone
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy;
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Vicky Yamamoto
- University of Southern California-Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA;
| | - Babak Kateb
- Brain Mapping Foundation, Los Angeles, CA 90272, USA;
| | - Reinhard Schulte
- School of Medicine, Loma Linda University, Loma Linda, CA 11085, USA;
| | - Stefano Forte
- Genomics and Experimental Oncology Unit, Istituto Oncologico del Mediterraneo, 95029 Viagrande, Catania, Italy;
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Gamma Knife and Trauma Center, Cannizzaro Hospital, 95126 Catania, Italy;
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Colopi A, Fuda S, Santi S, Onorato A, Cesarini V, Salvati M, Balistreri CR, Dolci S, Guida E. Impact of age and gender on glioblastoma onset, progression, and management. Mech Ageing Dev 2023; 211:111801. [PMID: 36996926 DOI: 10.1016/j.mad.2023.111801] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, while its frequency in pediatric patients is 10-15%. For this reason, age is considered one of the major risk factors for the development of GBM, as it correlates with cellular aging phenomena involving glial cells and favoring the process of tumor transformation. Gender differences have been also identified, as the incidence of GBM is higher in males than in females, coupled with a worse outcome. In this review, we analyze age- and gender- dependent differences in GBM onset, mutational landscape, clinical manifestations, and survival, according to the literature of the last 20 years, focusing on the major risk factors involved in tumor development and on the mutations and gene alterations most frequently found in adults vs young patients and in males vs females. We then highlight the impact of age and gender on clinical manifestations and tumor localization and their involvement in the time of diagnosis and in determining the tumor prognostic value.
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Affiliation(s)
- Ambra Colopi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Serena Fuda
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Samuele Santi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Angelo Onorato
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Valeriana Cesarini
- Department of Biomedicine, Institute of Translational Pharmacology-CNR, Rome, Italy
| | - Maurizio Salvati
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Corso Tukory 211, 90134 Palermo, Italy
| | - Susanna Dolci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Eugenia Guida
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
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6
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Palmieri M, Frati A, D'Andrea G, Santoro A, Salvati M, Pesce A. Editorial: Novel techniques and technologies in spine surgery: New approaches for the traumatic, oncologic, and aging spine. Front Surg 2023; 10:1155636. [PMID: 36891550 PMCID: PMC9986538 DOI: 10.3389/fsurg.2023.1155636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
- Mauro Palmieri
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy
| | - Alessandro Frati
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy.,Neurosurgery, IRCCS-"Neuromed", Pozzilli, Italy
| | | | - Antonio Santoro
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Pesce
- Neurosurgery Division, A.O. "Santa Maria Goretti", Latina, Italy
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7
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Pesce A, Armocida D, Fiorentino F, Ciarlo S, La Pira B, Salvati M, Frati A, Pompucci A, Palmieri M. Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark. Tomography 2022; 8:2164-2170. [PMID: 36136877 PMCID: PMC9498924 DOI: 10.3390/tomography8050181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Calvarial metastases are a relatively rare entity, with an overall incidence of 3-4%. Among these cases, metastases arising from salivary gland cancers are even rarer; in fact, large studies regarding salivary gland tumors showed that brain metastases are observed in 0.8% of the cases. Generally, bone metastases have been described in proximity to primary tumors, while bloodstream-disseminated lesions are often located inside the brain parenchyma. During every surgical step, traction on lower-lying infiltrated tissues must be avoided in order to successfully remove the lesion. This case report presents the first ever case of a 67-year-old woman affected by submandibular gland undifferentiated adenocarcinoma metastasis with a full-thickness involvement of the calvarium, pachy- and leptomeninges.
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Affiliation(s)
- Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Daniele Armocida
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
| | | | - Silvia Ciarlo
- Neurosurgery Department, A.O.U. ‘Mater Domini’, Università degli Studi ‘Magna Greacia’ di Catanzaro, 88100 Catanzaro, Italy
| | - Biagia La Pira
- Neurosurgery Department, Azienda Ospedaliera Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome ‘‘Tor Vergata”, 00133 Rome, Italy
| | - Alessandro Frati
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
- IRCCS—“Neuromed”, Via Atinense 18, 86077 Pozzilli, Italy
| | - Angelo Pompucci
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Mauro Palmieri
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
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8
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Palmisciano P, Ferini G, Watanabe G, Conching A, Ogasawara C, Scalia G, Bin-Alamer O, Haider AS, Passanisi M, Maugeri R, Hoz SS, Baldoncini M, Campero A, Salvati M, Cohen-Gadol AA, Umana GE. Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review. Curr Oncol 2022; 29:4842-4855. [PMID: 35877244 PMCID: PMC9319499 DOI: 10.3390/curroncol29070384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Gina Watanabe
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Andie Conching
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (G.W.); (A.C.); (C.O.)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95122 Catania, Italy;
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maurizio Passanisi
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Experimental Biomedicine & Clinical Neuroscience, Azienda Ospedaliera Universitaria Policlinico, 90127 Palermo, Italy;
| | - Samer S. Hoz
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina; (S.S.H.); (A.C.)
| | - Matias Baldoncini
- Department of Neurological Surgery, San Fernando Hospital, Buenos Aires B1646, Argentina;
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina; (S.S.H.); (A.C.)
| | - Maurizio Salvati
- Department of Neurosurgery, Neuromed, IRCCS, Sapienza University of Rome, 86077 Pozzilli, Italy;
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Giuseppe E. Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
- Correspondence: ; Tel.: +39-38-0332-5479
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9
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Armocida D, Catapano A, Palmieri M, Arcidiacono UA, Pesce A, Cofano F, Picotti V, Salvati M, Garbossa D, D’Andrea G, Santoro A, Frati A. The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie. Brain Sci 2022; 12:brainsci12070817. [PMID: 35884624 PMCID: PMC9313316 DOI: 10.3390/brainsci12070817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
- Correspondence: ; Tel.: +39-393-287-4496
| | - Antonia Catapano
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Umberto Aldo Arcidiacono
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Pesce
- Neurosurgery Unit, Ospedale Santa Maria Goretti, Via Guido Reni 1, 04100 Latina, LT, Italy;
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Veronica Picotti
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Maurizio Salvati
- Policlinico Tor Vergata, University Tor Vergata of Rome, Viale Oxford, 81, 00133 Roma, RM, Italy;
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco, 15, 10126 Torino, TO, Italy; (F.C.); (D.G.)
| | - Giancarlo D’Andrea
- Neurosurgery Department of Fabrizio Spaziani Hospital, Via Armando Fabi, 03100 Frosinone, FR, Italy; (V.P.); (G.D.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00135 Rome, RM, Italy; (A.C.); (M.P.); (U.A.A.); (A.S.)
| | - Alessandro Frati
- IRCCS “Neuromed”, Neurosurgeon Consultant, Via Atinense, 18, 86077 Pozzilli, IS, Italy;
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10
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Palmisciano P, Ogasawara C, Ogasawara M, Ferini G, Scalia G, Haider AS, Bin Alamer O, Salvati M, Umana GE. Endocrine disorders after primary gamma knife radiosurgery for pituitary adenomas: A systematic review and meta-analysis. Pituitary 2022; 25:404-419. [PMID: 35349010 DOI: 10.1007/s11102-022-01219-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Gamma Knife radiosurgery (GKRS) is feasible for pituitary adenomas, but post-surgery GKRS may cause severe hormone deficits. We reviewed the literature on primary GKRS for pituitary adenoma focusing on radiation-induced hormone deficiencies. METHODS PubMed, Web-of-Science, Scopus, and Cochrane were searched upon the PRISMA guidelines to include studies describing primary GKRS for pituitary adenomas. Pooled-rates of GKRS-induced hormone deficiencies and clinical-radiological responses were analyzed with a random-effect model meta-analysis. RESULTS We included 24 studies comprising 1381 patients. Prolactinomas were the most common (34.2%), and 289 patients had non-functioning adenomas (20.9%). Median tumor volume was 1.6cm3 (range, 0.01-31.3), with suprasellar extension and cavernous sinus invasion detected in 26% and 31.1% cases. GKRS was delivered with median marginal dose 22.6 Gy (range, 6-49), maximum dose 50 Gy (range, 25-90), and isodose line 50% (range, 9-100%). Median maximum point doses were 9 Gy (range, 0.5-25) to the pituitary stalk, 7 Gy (range, 1-38) to the optic apparatus, and 5 Gy (range, 0.4-12.3) to the optic chiasm. Pooled 5 year rates of endocrine normalization and local tumor control were 48% (95%CI 45-51%) and 97% (95%CI 95-98%). 158 patients (11.4%) experienced endocrinopathies at a median of 45 months (range, 4-187.3) after GKRS, with pooled 5-year rates of 8% (95%CI 6-9%). GKRS-induced hormone deficiencies comprised secondary hypothyroidism (42.4%) and hypogonadotropic hypogonadism (33.5%), with panhypopituitarism reported in 31 cases (19.6%). CONCLUSION Primary GKRS for pituitary adenoma may correlate with lower rates of radiation-induced hypopituitarism (11.4%) than post-surgery GKRS (18-32%). Minimal doses to normal pituitary structures and long-term endocrine follow-up are of primary importance.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi", Catania, Italy
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, TX, USA
| | - Othman Bin Alamer
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maurizio Salvati
- Department of Neurosurgery, IRCCS, Sapienza University of Rome, NeuromedPozzilli, Italy
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy.
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11
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Bruzzaniti P, Lapolla P, D'Amico A, Zancana G, Katsev M, Relucenti M, Familiari G, Mingoli A, D'Andrea G, Frati A, Salvati M, Santoro A, Familiari P. En Bloc Resection of Solitary Brain Metastasis: The Role of Perilesional Edema. In Vivo 2022; 36:1274-1284. [PMID: 35478118 PMCID: PMC9087063 DOI: 10.21873/invivo.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The treatment of solitary brain metastasis is a challenging intervention since the incidence increases and prognosis is poor. This study investigated the role of perilesional edema in the overall mass effect of solitary brain metastasis. PATIENTS AND METHODS We conducted a retrospective analysis on 88 patients with single supratentorial brain metastasis and concomitant perilesional edema undergoing en bloc resection. Each patient was evaluated for perilesional brain edema grading. We stratified patients into three groups based on the size of the metastatic lesion and the extent of perilesional edema. RESULTS The grade of perilesional edema at 30 days after surgical removal did not correlate with the maximum diameter of the metastasis (Pearson's correlation 0.098, p=0.494). In patients with a maximal metastatic diameter ≤2 cm, the grade of perilesional edema before surgical treatment was 1.63 (STD 0.43), while 30 days after removal it was significantly reduced; 0.47 (STD 0.26), p<0.001. CONCLUSION The overall mass effect of solitary supratentorial brain metastases is not correlated to the size of the lesion and the grade of the associated perilesional edema should be considered. Surgical en bloc resection can be considered the first choice of treatment in the presence of solitary metastasis ≤2 cm in maximal diameter but with high-grade edema, since this treatment reduces the overall mass effect.
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Affiliation(s)
- Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, U.K
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Alessia D'Amico
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
- Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Division of Grottaferrata, Rome, Italy
| | - Giuseppa Zancana
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Michael Katsev
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Michela Relucenti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Familiari
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | | | - Alessandro Frati
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata", Rome, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
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12
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Armocida D, Arcidiacono UA, Palmieri M, Pesce A, Cofano F, Picotti V, Salvati M, D’Andrea G, Garbossa D, Santoro A, Frati A. Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality. Diagnostics (Basel) 2022; 12:diagnostics12020351. [PMID: 35204442 PMCID: PMC8871449 DOI: 10.3390/diagnostics12020351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group (<65) and 152 in the elderly. The two subgroups did not present significant differences concerning biological characteristics of tumor, localization, diameters, lesion and edema volumes and surgical radicality. Despite these comparable data, elderly presented with a significantly lower Karnofsky Performance status value on admission and remained consistently lower during the follow-up. We establish instead that there is no intrinsic correlation to the presence of IM and no significant increased risk of complications or recurrence in elderly patients, but rather only an increased risk of reduced performance status with mortality related to the comorbidity of the patient, primarily cardiovascular disease, and an intrinsic frailty of the aged population.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
- Correspondence: ; Tel.: +39-393-287-4496
| | - Umberto Aldo Arcidiacono
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
| | | | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy; (F.C.); (D.G.)
| | - Veronica Picotti
- Neurosurgery Department, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy; (V.P.); (G.D.)
| | - Maurizio Salvati
- Policlinico Tor Vergata, University Tor Vergata of Rome, 00133 Rome, Italy;
| | - Giancarlo D’Andrea
- Neurosurgery Department, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy; (V.P.); (G.D.)
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy; (F.C.); (D.G.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
| | - Alessandro Frati
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy; (U.A.A.); (M.P.); (A.S.); (A.F.)
- IRCCS “Neuromed”, 86077 Pozzilli, Italy
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13
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Umana GE, Salvati M, Fricia M, Passanisi M, Corbino L, Cicero S, Nicoletti GF, Tomasi SO, Winkler PA, Scalia G. A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation. J Neurol Surg A Cent Eur Neurosurg 2021; 83:368-376. [PMID: 34911088 DOI: 10.1055/s-0041-1739220] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed. METHODS A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases with the following Mesh terms: [(remote) AND (intracerebral hemorrhage or cerebral hematoma or cerebral infarction or cerebellar hemorrhage or cerebellar hematoma or cerebellar infarction) AND (chronic subdural hematoma)]. RESULTS The literature search yielded 35 results, and 25 articles met our inclusion criteria: 22 articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study. Age was reported in all 37 patients, 26 males (70.3%) and 11 females (29.7%), with a male-to-female ratio of 2.4:1. The mean age at diagnosis was 64.6 years (range: 0.25-86 years). Only in 5 cases (13.5%) did the ICH occur contralaterally to the previously drained cSDH. The rapidity of drainage can lead to several types of intracranial hemorrhages, caused by a too rapid change in the cerebral blood flow (CBF) and/or tears of bridging veins. The average time interval between cSDH drainage and neurologic deterioration was 71.05 hours (range: 0-192 hours). CONCLUSIONS RICH following cSDH represents a rare occurrence and a serious complication, associated with elevated morbidity. Careful monitoring of drain speed after cSDH evacuation surgery is recommended, and minimally invasive techniques such as twist drill craniostomy are suggested, especially for massive cSDHs.
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Affiliation(s)
| | - Maurizio Salvati
- Human Neurosciences Department, Università degli Studi di Roma La Sapienza Facoltà di Medicina e Odontoiatria, Roma, Italy.,Department of Neurosurgery, NEUROMED, Pozzilli, Molise, Italy
| | - Marco Fricia
- Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | - Maurizio Passanisi
- Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy
| | - Leonardo Corbino
- Department of Neurosurgery, Azienda Ospedaliera Cannizzaro, Catania, Sicilia, Italy
| | | | | | | | - Peter A Winkler
- Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
| | - Gianluca Scalia
- Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Sicilia, Italy
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14
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Becelli R, Palmieri M, Facchini V, Armocida D, Pesce A, Kapitonov A, Zappalà M, Colangeli W, Bozza F, Salvati M, Santoro A, Frati A. Management of frontal sinus fractures: A comprehensive review and treatment algorithm from Sapienza university of Rome. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Pesce A, Armocida D, Paglia F, Palmieri M, Frati A, D'Andrea G, Salvati M, Santoro A. IDH Wild-type Glioblastoma Presenting with Seizure: Clinical Specificity, and Oncologic and Surgical Outcomes. J Neurol Surg A Cent Eur Neurosurg 2021; 83:351-360. [PMID: 34794192 DOI: 10.1055/s-0041-1735515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients. METHODS We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs. RESULTS A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival. CONCLUSIONS The typical patient with IDH-WT GBM with SaO is a young (<55 year) male without a history of headache. The lesion is typically small to medium in size and located in the temporoparietal dominant lobe, with a high tendency to involve the SVZ.
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Affiliation(s)
| | - Daniele Armocida
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Francesco Paglia
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Mauro Palmieri
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Division of Neurosurgery, Department of Human Neurosciences, "Sapienza" University, Rome, Italy.,IRCCS "Neuromed" Pozzilli (IS), Italy
| | | | - Maurizio Salvati
- IRCCS "Neuromed" Pozzilli (IS), Italy.,Department of Mental and Neurological, Dental and Sensory Organs Health, Tor Vergata University, Rome Italy
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16
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Armocida D, Pesce A, Santoro A, Salvati M, Frati A. Letter to the Editor: "The Neurosurgical Perspective for the 2021 WHO Classification of Tumors of the Central Nervous System: A Missed Opportunity?". World Neurosurg 2021; 155:203-204. [PMID: 34724739 DOI: 10.1016/j.wneu.2021.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniele Armocida
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy.
| | | | - Antonio Santoro
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Maurizio Salvati
- Division of Neurosurgery, Policlinico Tor Vergata, University Tor Vergata of Rome, Rome, Italy
| | - Alessandro Frati
- A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy; Division of Neurosurgery, IRCCS "Neuromed", Pozzilli, Italy
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17
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Blumenschein G, Eggert T, Shetty A, Janát-Amsbury M, Kouros-Mehr H, Bhatia A, Gupta V, Tiso S, Salvati M, Boyer M. P11.02 Targeting the Tumor Neovasculature in Lung Cancer: A Phase I Study of AMG 160 in Subjects With Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Umana GE, Scalia G, Yagmurlu K, Mineo R, Di Bella S, Giunta M, Spitaleri A, Maugeri R, Graziano F, Fricia M, Nicoletti GF, Tomasi SO, Raudino G, Chaurasia B, Bellocchi G, Salvati M, Iacopino DG, Cicero S, Visocchi M, Strigari L. Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement. Front Neurosci 2021; 15:690705. [PMID: 34194297 PMCID: PMC8236630 DOI: 10.3389/fnins.2021.690705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background External ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement. Methods We used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using plaster models. The data set inclusion criteria were volumetric head CT scan, without midline shift, of patients older than 18. Evans' index was used to quantify the ventricle's size. We excluded patients with slit ventricles, midline shift, skull fractures, or complex skull malformations. The proximal end of the device was tested on the cadaver. Results The cadaveric tests proved that a surgeon could use the device without any external help. The multimodal simulation showed Kakarla grade 1 in all cases but one (grade 2) on both sides, after right and left EVD placement. The mean Evans' index was 0.28. The geometric principles that explain the device's efficacy can be summarized by studying the properties of circumference and chord. The contact occurs, for each section considered, at the extreme points of the chord. Its axis, perpendicular to the plane tangent to the spherical surface at the entry point, corresponds to the direction of entry of the catheter guided by the instrument. Conclusion According to our multimodal simulation on cadavers, 3D computer-based simulation, 3D plaster modeling, 3D neuronavigation, and augmented reality, the device promises to offer safer and effective EVD placement. Further validation in future clinical studies is recommended.
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Affiliation(s)
- Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Rosalia Mineo
- MT Ortho Srl, Aci Sant'Antonio, Catania, Italy.,DICAR, University of Catania, Catania, Italy
| | - Simone Di Bella
- MT Ortho Srl, Aci Sant'Antonio, Catania, Italy.,DICAR, University of Catania, Catania, Italy
| | | | - Angelo Spitaleri
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Francesca Graziano
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy.,Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Marco Fricia
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Giovanni Federico Nicoletti
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy
| | - Santino Ottavio Tomasi
- Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria
| | - Giuseppe Raudino
- Department of Neurosurgery, Humanitas University, Catania, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Gianluca Bellocchi
- Department of Otorhinolaryngology, San Camillo Forlanini Hospital, Rome, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Massimiliano Visocchi
- Craniovertebral Junction Operative Unit, Master CVJ Surgical Approach Research Center, Institute of Neurosurgery, Policlinic "A. Gemelli", Catholic University, Rome, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS University Hospital of Bologna, Bologna, Italy
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19
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Relucenti M, Familiari P, Iacopino G, Bruzzaniti P, Miglietta S, Salvati M, Li X, Chen R, D'Andrea G, Frati A, Di Gioia C, Pernazza A, Della Rocca C, Familiari G, Santoro A. RET/PTC3 translocation in a rare hemorrhagic brain metastasis of papillary thyroid cancer post Chernobyl radiation affects vessels ultrastructure. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Salvati M, Armocida D, Pesce A, Palmieri M, Venditti E, D'Andrea G, Frati A, Santoro A. No prognostic differences between GBM-patients presenting with postoperative SMA-syndrome and GBM-patients involving cortico-spinal tract and primary motor cortex. J Neurol Sci 2020; 419:117188. [PMID: 33075591 DOI: 10.1016/j.jns.2020.117188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The supplementary motor area (SMA) is involved in several aspects of motor control and its can be associated to a contralateral motor deficit and speech disorders. After the resection of low-grade gliomas, this syndrome is diffusely reported but it is rarely investigated in high-grade gliomas. SMA deficits may resolve completely or with minor sequelae within weeks. Whether this condition of transient deficit affects survival, was not previously investigated, and is not currently understood. OBJECTIVE The study aimed to perform an accurate investigation concerning the real clinical and prognostic impact of the postoperative SMA syndrome in order to shed light over its relationship to survival parameters and postoperative functional status of the patients. METHODS We performed a retrospective review of a series of 176 surgically treated patients suffering from Glioblastomas. Tumors classified as Group A: Involving the SMA and Group B: Lesion located outside and distal to the SMA but in anatomical relationship to primary motor cortices (PM1) or corticospinal tract (CST), in order to investigate differences concerning immunohistochemical and molecular profiles in regard to the survival parameters. RESULTS Although lesions involving SMA demonstrated a significantly higher volume in respect to their general counterparts they did not significantly differ in concerns to the molecular patterns, pre and postoperative KPS scores and in PFS and OS findings. CONCLUSIONS In our cohort SMA-syndrome is reversible and therefore guarantees a satisfactory functional status at follow-up, apparently not compromising survival when compared to other lesions affecting the primary or cortical motor area -spinal tract.
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Affiliation(s)
- Maurizio Salvati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed", Pozzilli (IS), Italy
| | - Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.
| | - Alessandro Pesce
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed", Pozzilli (IS), Italy
| | - Mauro Palmieri
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | - Emiliano Venditti
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | | | | | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
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Tomasi SO, Umana GE, Scalia G, Rubio-Rodriguez RL, Cappai PF, Capone C, Raudino G, Chaurasia B, Salvati M, Jorden N, Winkler PA. Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins. Front Neuroanat 2020; 14:596167. [PMID: 33384587 PMCID: PMC7771049 DOI: 10.3389/fnana.2020.596167] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.
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Affiliation(s)
- Santino Ottavio Tomasi
- Department of Neurological Surgery, Christian Doppler Klinik, Salzburg, Austria.,Paracelsus Medical University, Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibald", Catania, Italy
| | - Roberto Luis Rubio-Rodriguez
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,Department of Otolaryngology- Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Pier Francesco Cappai
- Department of Neurosurgery, Azienda Ospedaliera G. Brotzu, Universitá degli Studi di Sassari, Sassari, Italy
| | - Crescenzo Capone
- Department of Peripheral Nerve Surgery, Azienda Unità Sanitaria Locale Romagna, Ospedale Civile di Faenza, Faenza, Italy
| | - Giuseppe Raudino
- Department of Neurosurgery, Istituto di Ricovero e Cura ad Alta Specializzazione Policlinico di Monza, Monza, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
| | - Nicolas Jorden
- Radiologie und Nuklearmedizin Dachau, Karlsfeld, Germany
| | - Peter A Winkler
- Department of Neurological Surgery, Christian Doppler Klinik, Salzburg, Austria.,Paracelsus Medical University, Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
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22
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Giugliano M, Scafa AK, Chiarella V, Di Bartolomeo A, Bruzzaniti P, D'Andrea G, Salvati M, Santoro A. Entrapment of the temporal horn: case series and systematic review of literature. J Neurosurg Sci 2020; 65:532-540. [PMID: 33297607 DOI: 10.23736/s0390-5616.20.05111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Entrapment of the temporal horn (ETH) is a form of focal, obstructive hydrocephalus. Etiology and clinical presentation are diversified. Though known since 1947, standard treatment has not yet been defined. The objective of our study was to perform a systematic review on ETH. Data from patients treated at our Institution from 2008 to 2019 were retrospectively collected and analyzed. A systematic PRISMA review of literature was also performed using PubMed and Google Scholar. 121 cases (mean age 41 years; M/F ratio 1/1) were analyzed. In 65 (vs 56) cases (53.7% vs 46.3%) ETH was not surgery related. Headache was the most common symptom (42%). "Major" treatments were (1) ventriculoperitoneal/ventriculoatrial shunt (42 cases, 34.7%), and (2) endoscopic ventriculocisternostomy (12 cases, 9.9%). In the first group, no perioperative complications were found, 39 patients (92.9%) had a favorable outcome, 3 patients (7.1%) died for the underlying disease, 4 cases (9.5%) went through revision; also considering the cases in which another procedure was performed as definitive treatment, shunt failures were 6 (13.6%). In the second group, 1 case (8.3%) developed a deep intracerebral hemorrhage, 11 cases (91.6%) had a favorable long-term outcome, 1 case (8.3%) had a favorable short-term outcome; also considering the cases in which another procedure was performed as definitive treatment, endoscopic ventriculocisternostomy failures were 6 (37.5%). Described as uncommon, ETH is probably underestimated. Early diagnosis and appropriate treatment are critical. VP shunt is still the most commonly performed treatment. Further randomized clinical trials are, however, needed to establish the gold standard.
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Affiliation(s)
- Marco Giugliano
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Rome, Italy
| | - Anthony K Scafa
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Rome, Italy -
| | - Vito Chiarella
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Rome, Italy
| | | | - Placido Bruzzaniti
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Rome, Italy
| | - Giancarlo D'Andrea
- Department of Neurosurgery, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - Maurizio Salvati
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Rome, Italy
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Armocida D, Frati A, Salvati M, Santoro A, Pesce A. Is Ki-67 index overexpression in IDH wild type glioblastoma a predictor of shorter Progression Free survival? A clinical and Molecular analytic investigation. Clin Neurol Neurosurg 2020; 198:106126. [PMID: 32861131 DOI: 10.1016/j.clineuro.2020.106126] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/29/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ki-67 proliferation index is widely used for differentiating between high and low-grade gliomas, but differentiating between the same grade IV appears to be more problematic, and the point about its prognostic value for GBM patients remains unclear. To reduce the possibility to find a marked histological heterogeneity, and may contain areas that could be diagnosed as lower grade, in this study we considered a large group of patients with IDH wild-type Glioblastoma (IDH-WT GBM) and we have analyzed previously reported prognostic factors, in regards to their relationship with the Ki-67 expression index. METHODS We explore the prognostic impact of ki-67 index status in 127 patients affected by IDH-WT GBM. We therefore analyzed clinical characteristics, tumor genetics, dimension and clinical outcomes. We selected a total of 127 patients affected by newly diagnosed IDH-WT GBM who underwent surgery, radiation, and chemotherapy in our Institution in the period ranging between January 2014 and December 2016 RESULTS: The volume of the lesion had a strong association with the Ki67 overexpression. In particular lesions whose volume was greater than 45 cm3, presented a higher percentage of Ki67 expression demonstrating that greater tumors are more likely associated to higher values of Ki67 percentages. On a multivariate analysis, it was possible to outline that Ki67 was significant a predictor of shorter PFS independently from the age of the patients, the volume of the lesion and preoperative KPS. CONCLUSIONS There is a correlation between percentage staining of Ki-67 and OS in our cohort of patients with IDH-WT GBM. This is only the third observational study documenting a positive correlation between Ki-67 and overall survival in GBM and the first one demonstrates that percentage Ki-67 staining >20 % predicts poorer progression free survival in IDH-WT GBM.
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Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.
| | | | - Maurizio Salvati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy; IRCCS "Neuromed" Pozzilli (IS), Italy
| | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
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24
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Armocida D, Pesce A, Di Giammarco F, Frati A, Salvati M, Santoro A. Histological, molecular, clinical and outcomes characteristics of Multiple Lesion Glioblastoma. A retrospective monocentric study and review of literature. Neurocirugia (Astur) 2020; 32:114-123. [PMID: 32564972 DOI: 10.1016/j.neucir.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Multiple lesion glioblastoma (M-GBM) represent a group of GBM patients in which there exist multiple foci of tumor enhancement. The prognosis is poorer than that of single-lesion GBM patients, but this actually is a controversial data. Is unknown whether multifocality has a genetic and molecular basis. Our specific aim is to identify the molecular characteristics of M-GBM by performing a comprehensive multidimensional analysis. METHODS The surgical, radiological and clinical outcomes of patients that underwent surgery for GBM at our institution for 2 years have been retrospectively reviewed. We compared the overall survival (OS), progression free survival and extent of resection (EOR) between M-GBM tumors (type I) and S-GBM (single contrast-enhancing lesion, type II). RESULTS A total of 177 patients were included in the final cohort, 12 patients had M-GBM and 165 patients had S-GBM. Although patients with M-GBM had higher tumor volumes and midline location, the EOR was not different between both type of lesions. Higher percentage of tumors with EGFR overexpression was detected in M-GBM. PFS and OS was significantly shorter in M-GBM. CONCLUSIONS Considering no differences in EOR, patients with M-GBM showed shorter PFS and OS in comparison with S-GBM. Evidences about the M-GBM origin as a multifocal lesion because its molecular profile are suggested.
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Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.
| | - Alessandro Pesce
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | | | - Alessandro Frati
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
| | | | - Antonio Santoro
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy
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25
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Salvati M, Tariciotti L, Brunetto GM, Gallo G, Santoro F, Frati A, Santoro A. Glioblastoma: Molecular profile and immunophenotypic analysis as prognostic tools for tailored therapy and decision making in a recent surgical series. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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26
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Pesce A, Palmieri M, Cofano F, Iasanzaniro M, Angelini A, D'Andrea G, Monticelli M, Zeppa P, Santonio FV, Zenga F, Salvati M, Santoro A, Garbossa D, Frati A. Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial. J Clin Neurosci 2020; 77:41-48. [PMID: 32409219 DOI: 10.1016/j.jocn.2020.05.047] [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: 11/17/2019] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 01/22/2023]
Abstract
Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.
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Affiliation(s)
| | - Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy.
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Manuela Iasanzaniro
- A.O.U. "Sant'Andrea", Anesthesia and Intensive Care Unit, "Sapienza" University, Italy
| | - Albina Angelini
- A.O.U. "Sant'Andrea", Anesthesia and Intensive Care Unit, "Sapienza" University, Italy
| | - Giancarlo D'Andrea
- Department of Neurosurgery, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - Matteo Monticelli
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Filippo Veneziani Santonio
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Salvati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Rome, Italy; A.O.U "Policlinico Umberto I", Neurosurgery Unit, Rome, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
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Salvati M, Bruzzaniti P, Relucenti M, Nizzola M, Familiari P, Giugliano M, Scafa AK, Galletta S, Li X, Chen R, Barbaranelli C, Frati A, Santoro A. Retrospective and Randomized Analysis of Influence and Correlation of Clinical and Molecular Prognostic Factors in a Mono-Operative Series of 122 Patients with Glioblastoma Treated with STR or GTR. Brain Sci 2020; 10:brainsci10020091. [PMID: 32050461 PMCID: PMC7071604 DOI: 10.3390/brainsci10020091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/29/2020] [Accepted: 02/07/2020] [Indexed: 02/08/2023] Open
Abstract
Glioblastoma is a solid, infiltrating, and the most frequent highly malignant primary brain tumor. Our aim was to find the correlation between sex, age, preoperative Karnofsky performance status (KPS), presenting with seizures, and extent of resection (EOR) with overall survival (OS), progression-free survival (PFS), and postoperative KPS, along with the prognostic value of IDH1, MGMT, ATRX, EGFR, and TP53 genes mutations and of Ki67 through the analysis of a single-operator series in order to avoid the biases of a multi-operator series, such as the lack of homogeneity in surgical and adjuvant nonsurgical treatments. A randomized retrospective analysis of 122 patients treated by a single first operator at Sapienza University of Rome was carried out. After surgery, patients followed standard Stupp protocol treatment. Exclusion criteria were: (1) patients with primary brainstem and spinal cord gliomas and (2) patients who underwent partial resections (resection < 90%) or a biopsy exclusively for diagnostic purposes. Statistical analysis with a simultaneous regression model was carried out through the use of SPSS 25® (IBM). Results showed statistically significant survival increase in four groups: (1) patients treated with gross total resection (GTR) (p < 0.030); (2) patients with mutation of IDH1 (p < 0.0161); (3) patients with methylated MGMT promoter (p < 0.005); (4) patients without EGFR amplification or EGFRvIII mutation (p < 0.035). Higher but not statistically significant survival rates were also observed in: patients <75 years, patients presenting with seizures at diagnosis, patients affected by lesions in noneloquent areas, as well as in patients with ATRX gene mutation and Ki-67 < 10%.
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Affiliation(s)
- Maurizio Salvati
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
| | - Placido Bruzzaniti
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
- Correspondence: ; Tel.: +39-3349753520
| | - Michela Relucenti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Science, “La Sapienza” University of Rome, 00161 Rome, Italy;
| | - Mariagrazia Nizzola
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
| | - Pietro Familiari
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
| | - Marco Giugliano
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
| | - Anthony Kevin Scafa
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
| | - Santi Galletta
- UOSD of Neurophysiopathology and DISMOV, AOU G Martino, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Xiaobo Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Dingjiaqiao 87, Nanjing 210009, China; (X.L.); (R.C.)
| | - Rui Chen
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Dingjiaqiao 87, Nanjing 210009, China; (X.L.); (R.C.)
| | - Claudio Barbaranelli
- Department of Psychology, Faculty of Medicine and Psychology “La Sapienza” University of Rome, 00189 Rome, Italy;
| | - Alessandro Frati
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, 86077 Isernia, Italy;
| | - Antonio Santoro
- Department of Neurological Sciences, Neurosurgey, “La Sapienza” University of Rome, 00161 Rome, Italy; (M.S.); (M.N.); (P.F.); (M.G.); (A.K.S.); (A.S.)
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Armocida D, Pesce A, Di Giammarco F, Frati A, Santoro A, Salvati M. Long Term Survival in Patients Suffering from Glio-blastoma Multiforme: A Single-Center Observational Cohort Study. Diagnostics (Basel) 2019; 9:diagnostics9040209. [PMID: 31801254 PMCID: PMC6963741 DOI: 10.3390/diagnostics9040209] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/08/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Glioblastomas (GBM) are generally burdened, to date, by a dismal prognosis, although long term survivors have a relatively significant incidence. Our specific aim was to determine the exact impact of many surgery-, patient- and tumor-related variables on survival parameters. Methods: The surgical, radiological and clinical outcomes of patients have been retrospectively reviewed for the present study. All the patients have been operated on in our institution and classified according their overall survival in long term survivors (LTS) and short term survivors (STS). A thorough review of our surgical series was conducted to compare the oncologic results of the patients in regard to: (1) surgical-(2) molecular and (3) treatment-related features. Results: A total of 177 patients were included in the final cohort. Extensive statistical analysis by means of univariate, multivariate and survival analyses disclosed a survival advantage for patients presenting a younger age, a smaller lesion and a better functional status at presentation. From the histochemical point of view, Ki67 (%) was the strongest predictor of better oncologic outcomes. A stepwise analysis of variance outlines the existence of eight prognostic subgroups according to the molecular patterns of Ki67 overexpression and epidermal growth factor receptor (EGFR), p53 and isocitrate dehydrogenase (IDH) mutations. Conclusions: On the grounds of our statistical analyses we can affirm that the following factors were significant predictors of survival advantage: Karnofsky performance status (KPS), age, volume of the lesion, motor disorder at presentation and/or a Ki67 overexpression. In our experience, LTS is associated with a gross total resection (GTR) of tumor correlated with EGFR and p53 mutations with regardless of localization, and poorly correlated to dimension. We suppose that performing a standard molecular analysis (IDH, EGFR, p53 and Ki67) is not sufficient to predict the behavior of a GBM in regards to overall survival (OS), nor to provide a deeper understanding of the meaning of the different genetic alterations in the DNA of cancer cells. A fine molecular profiling is feasible to precisely stratify the prognosis of GBM patients.
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Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135 Roma, Italy; (F.D.G.); (A.S.)
- Correspondence: ; Tel.: +39-3932874496
| | - Alessandro Pesce
- IRCCS “Neuromed” Pozzilli (IS), Università Sapienza of Rome, 00135 Roma, Italy; (A.P.); (A.F.); (M.S.)
| | - Federico Di Giammarco
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135 Roma, Italy; (F.D.G.); (A.S.)
| | - Alessandro Frati
- IRCCS “Neuromed” Pozzilli (IS), Università Sapienza of Rome, 00135 Roma, Italy; (A.P.); (A.F.); (M.S.)
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135 Roma, Italy; (F.D.G.); (A.S.)
| | - Maurizio Salvati
- IRCCS “Neuromed” Pozzilli (IS), Università Sapienza of Rome, 00135 Roma, Italy; (A.P.); (A.F.); (M.S.)
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Abstract
Aims and background Classical multiple sclerosis plaques usually have typical features on gadolinium-enhanced MRI scan. This non-neoplastic demyelinating process of the central nervous system generally does not produce focal space-occupying lesions associated with ring enhancement. However, atypical appearance of demyelinating lesions simulating a brain tumor is a possible well-known phenomenon. Methods We present our experience with 4 cases of multiple sclerosis indistinguishable clinically and neuroradiologically from a cerebral tumor. All patients underwent surgery. Results Histological examinations of all cases were positive for multiple sclerosis plaques. Conclusions The presented cases demonstrate the importance of considering a demyelinating disease in the differential diagnosis of a tumor-like brain lesion.
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Affiliation(s)
- Emanuela Caroli
- Department of Neurological Sciences, Neurosurgery, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.
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Piccirilli M, Bistazzoni S, Gagliardi FM, Landi A, Santoro A, Giangaspero F, Salvati M. Treatment of Glioblastoma Multiforme in Elderly Patients. Clinico-therapeutic Remarks in 22 Patients Older than 80 Years. Tumori 2019. [DOI: 10.1177/030089160609200203] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report our remarks on 22 patients, 80 years of age and older, who were treated for glioblastoma multiforme. The 16 patients who underwent a multimodality treatment (surgery + radiotherapy + chemotherapy) had an average survival of 16.7 months versus the 5.8 months of the 8 patients treated with biopsy followed by radiotherapy and/or chemotherapy (log-rank test, P <0.001). Moreover, we point out the importance of MGMT hypermethylation as a significant prognostic factor: the 9 patients with nonmethylated MGMT had a mean survival of 7.7 months vs 17.9 months of the 13 patients with the MGMT promoter methylated (log-rank test, P = 0.0006). Several studies have pointed out age as an important negative factor for the outcome of elderly patients affected by glioblastoma multiforme. Elderly patients with a diagnosis of glioblastoma multiforme are thus generally excluded from clinical trials of treatment for the neoplasm, because it is a common opinion that the prognosis for such patients is particularly poor. On the contrary, according to our clinical and surgical experience, we firmly believe that patients older than 80 years with a histologically proven diagnosis of glioblastoma multiforme and in good health conditions (Karnofsky performance status >60) should be treated in the same way as younger patients.
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Affiliation(s)
- Manolo Piccirilli
- Neurosurgery, Department of Neurological Sciences, University “La Sapienza”, Rome
| | | | | | - Alessandro Landi
- Neurosurgery, Department of Neurological Sciences, University “La Sapienza”, Rome
| | - Antonio Santoro
- Neurosurgery, Department of Neurological Sciences, University “La Sapienza”, Rome
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Taglieri L, Saccoliti F, Nicolai A, Peruzzi G, Madia VN, Tudino V, Messore A, Di Santo R, Artico M, Taurone S, Salvati M, Costi R, Scarpa S. Discovery of a pyrimidine compound endowed with antitumor activity. Invest New Drugs 2019; 38:39-49. [PMID: 30900116 DOI: 10.1007/s10637-019-00762-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/28/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023]
Abstract
Recently, some synthetic nitrogen-based heterocyclic molecules, such as PJ34, have shown pronounced antitumor activity. Therefore, we designed and synthesized new derivatives characterized by a nitrogen-containing scaffold and evaluated their antiproliferative properties in tumor cells. We herein report the effects of three newly synthesized compounds on cell lines from three different human cancers: triple-negative breast cancer, colon carcinoma and glioblastoma. We found that two of these compounds did not affect proliferation, while the third significantly inhibited replication of the three cell lines. Moreover, this third molecule at 20 μM led to the upregulation of p21 and p27 and blockage of the cell cycle at G0/G1; in addition, it induced apoptosis in all three cell lines when used at higher concentrations (30-50 μM). The results demonstrate that this compound is a potent inhibitor of replication, an inducer of apoptosis and a negative regulator of cell cycle progression for cancer cells of different histotypes. Our data suggest a potential role for this new molecule as an interesting and powerful tool for new approaches in treating various cancers.
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Affiliation(s)
- Ludovica Taglieri
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Francesco Saccoliti
- Dipartimento di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Alice Nicolai
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
- Department of Sensory Organs, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giovanna Peruzzi
- Italian Institute of Technology, Center for Life Nanoscience@Sapienza, Viale Regina Elena 324, 00161, Rome, Italy
| | - Valentina Noemi Madia
- Dipartimento di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Valeria Tudino
- Dipartimento di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Antonella Messore
- Dipartimento di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Roberto Di Santo
- Dipartimento di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marco Artico
- Department of Sensory Organs, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Samanta Taurone
- Department of Sensory Organs, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maurizio Salvati
- Department of Human Neurosciences, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Roberta Costi
- Dipartimento di Chimica e Tecnologie del Farmaco, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Susanna Scarpa
- Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy
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Frati A, Pesce A, Palmieri M, Iasanzaniro M, Familiari P, Angelini A, Salvati M, Rocco M, Raco A. Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience. World Neurosurg 2019; 121:e882-e891. [DOI: 10.1016/j.wneu.2018.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 12/17/2022]
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Prelaj A, Rebuzzi SE, Grassi M, Salvati M, D'Elia A, Buttarelli F, Ferrara C, Tomao S, Bianco V. Non-conventional fotemustine schedule as second-line treatment in recurrent malignant gliomas: Survival across disease and treatment subgroup analysis and review of the literature. Mol Clin Oncol 2018; 10:58-66. [PMID: 30655978 PMCID: PMC6313958 DOI: 10.3892/mco.2018.1746] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/26/2018] [Indexed: 02/03/2023] Open
Abstract
Fotemustine (FTM) is a treatment option in recurrent malignant gliomas (MGs) after first-line Stupp treatment. The efficacy and the safety of fractionated FTM schedule proposed by Addeo et al was analysed in the present study in recurrent MGs patients. A retrospective analysis on 40 recurrent MGs patients and second-line fractionated FTM chemotherapy was performed. Response evaluation was assessed using RANO criteria and safety was assessed using CTCAE v.4.03. Subgroup analyses based on MGMT methylation, resurgery and reirradiation were performed. A review of the literature was also performed. The results revealed 5 partial responses (13%) and 19 stable diseases (47%) with a disease-control rate of 60%. Median progression-free survival (PFS) was 4 months, with a PFS of 33% at 6 months and 13% at 1 year. The median overall survival (OS) was 9 months and OS at 6 months was of 55% and at 1 year of 30%. Methylated patients experienced longer mPFS (6 vs. 3 months; p=0.004) and mOS (10 vs. 4 months; p<0.0001) compared with unmethylated patients. Patients treated with reirradiation experienced longer mPFS (5 vs. 3.5 months; p=0.48) and mOS (10 vs. 5 months; p=0.11). No survival benefit with resurgery was observed. Furthermore, the fractioned schedule was well tolerated, only 15% of patients developed severe myelotoxicities. Considering the present findings, fractionated FTM schedule is an efficient second-line option for MGs associated with an acceptable myelotoxicity profile. Additionally, MGMT methylation is associated with improved survival outcomes. However, this study highlights the requirement for further prospective randomized studies on resurgery and reirradiation.
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Affiliation(s)
- Arsela Prelaj
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, I-00161 Rome, Italy
| | - Sara Elena Rebuzzi
- Department of Medical Oncology, Ospedale Policlinico San Martino IST, University of Genoa, I-16132 Genoa, Italy
| | - Massimiliano Grassi
- Department of Medical Oncology, Ospedale Policlinico San Martino IST, University of Genoa, I-16132 Genoa, Italy
| | - Maurizio Salvati
- Neurosurgery Department, IRCCS NEUROMED INM, Neurochirurgia, I-86077 Pozzilli, Italy
| | - Alessandro D'Elia
- Neurosurgery Department, IRCCS NEUROMED INM, Neurochirurgia, I-86077 Pozzilli, Italy
| | - Francesca Buttarelli
- Department of Neurology and Psychiatry 'Sapienza' University of Rome, Policlinico Umberto I, I-00161 Rome, Italy
| | - Carla Ferrara
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, I-00185 Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, I-00161 Rome, Italy
| | - Vincenzo Bianco
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, I-00161 Rome, Italy
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Prelaj A, Rebuzzi SE, Grassi M, Giròn Berrìos JR, Pecorari S, Fusto C, Ferrara C, Salvati M, Stati V, Tomao S, Bianco V. Multimodal treatment for local recurrent malignant gliomas: Resurgery and/or reirradiation followed by chemotherapy. Mol Clin Oncol 2018; 10:49-57. [PMID: 30655977 PMCID: PMC6313879 DOI: 10.3892/mco.2018.1745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/05/2018] [Indexed: 01/26/2023] Open
Abstract
The therapeutic management of recurrent malignant gliomas (MGs) is not determined. Therefore, the efficacy of a multimodal approach and a combination systemic therapy was investigated. A retrospective analysis of 26 MGs patients at first relapse treated with multimodal therapy (chemotherapy plus surgery and/or reirradiation) or chemotherapy alone was performed. Second-line chemotherapy consisted of fotemustine (FTM) in combination with bevacizumab (BEV) (cFTM/BEV) or followed by third-line BEV (sFTM/BEV). Subgroup analyses were performed. Multimodal therapy provided a higher overall response rate (ORR) (73 vs. 47%), disease control rate (DCR) (82 vs. 67%), median progression-free survival (mPFS) (11 vs. 7 months; P=0.08) and median overall survival (mOS) (13 vs. 8 months; P=0.04) compared with chemotherapy. Concomitant FTM/BEV resulted in higher ORR (84 vs. 36%), DCR (92 vs. 57%), mPFS (10 vs. 5 months; P=0.22) and mOS (11 vs. 5.2 months; P=0.15) compared with sFTM/BEV. Methylated patients did not experience additional survival benefits with multimodality treatment but had higher mPFS (10 vs 7.1 months; P=0.33) and mOS (11 vs. 8 months; P=0.33) with cFTM/BEV. Unmethylated patients experienced the greatest survival benefit with the multimodal approach (mPFS: 10 vs. 5 months; mOS 11 vs 6 months; both P=0.02) and cFTM/BEV (mPFS: 5 vs. 2 months; mOS 6 vs. 3.2 months; both P=0.01). In conclusion, in recurrent MGs, multimodal therapy and cFTM/BEV provide survival and response benefits. Methylated patients benefit from a cFTM/BEV but not from a multimodal approach. Notably, unmethylated patients had the highest survival benefit with the two strategies.
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Affiliation(s)
- Arsela Prelaj
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Sara Elena Rebuzzi
- Department of Medical Oncology, Ospedale Policlinico San Martino IST, I-16132 Genoa, Italy
| | - Massimiliano Grassi
- Department of Medical Oncology, Ospedale Policlinico San Martino IST, I-16132 Genoa, Italy
| | - Julio Rodrigo Giròn Berrìos
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Silvia Pecorari
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Carmela Fusto
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, I-00161 Rome, Italy
| | - Carla Ferrara
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, I-00185 Rome, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, IRCCS Neuromed, I-86077 Pozzilli, Italy
| | - Valeria Stati
- Department of Medico-Surgical Sciences and Biotechnologies, 'Sapienza' University of Rome, I-00185 Rome, Italy
| | - Silverio Tomao
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy.,Department of Radiological Sciences, Oncology and Pathology, 'Sapienza' University of Rome, I-04100 Latina, Italy
| | - Vincenzo Bianco
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
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35
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Frati A, Pesce A, Palmieri M, Celniku M, Raco A, Salvati M. Surgical Treatment of the Septuagenarian Patients Suffering From Brain Metastases: A Large Retrospective Observational Analytic Cohort-Comparison Study. World Neurosurg 2018; 114:e565-e572. [DOI: 10.1016/j.wneu.2018.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/24/2022]
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36
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Cimatti M, Salvati M, Caroli E, Frati A, Brogna C, Gagliardi FM. Extremely Delayed Cerebral Metastasis from Renal Carcinoma Report of Four Cases and Critical Analysis of the Literature. Tumori 2018; 90:342-4. [PMID: 15315318 DOI: 10.1177/030089160409000316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Brain metastases from renal carcinoma may appear even a long time after surgical treatment of the primary tumor. The authors present 2 series of patients, one of which has already been published and the other new, for a total of 4 cases of brain metastasis from renal carcinoma with late onset, which occurred 13, 17, 26 and 12 years after primary surgical treatment. The other cases described in the literature were also critically reviewed.
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Affiliation(s)
- Marco Cimatti
- Department of Neurosurgery, IRCCS INM Neuromed, Pozzilli (IS), Italy
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Abstract
We report 3 cases of possible radiation-induced schwannomas observed in our Department. Their salient clinical and pathogenetic features are analyzed and the role of radiation therapy in the oncogenesis of these lesions is discussed. Several cases of radiation-induced tumors, including some of the nervous system, have been reported, but schwannomas have only occasionally been reported in connection with ionizing radiation. The possible adjuvant role of antineoplastic drugs is also discussed, and the literature on this topic is reviewed.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences-Neurosurgery, La Sapienza, University of Rome, Italy
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Salvati M, Cervoni L, Innocenzi G, Bardella L. Prolonged Stabilization of Multiple and Single Brain Metastases from Breast Cancer with Tamoxifen. Report of Three Cases. Tumori 2018; 79:359-62. [PMID: 8116083 DOI: 10.1177/030089169307900516] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer frequently metastasizes to the brain, and such lesions, whether multiple or solitary, have a poor prognosis, despite all efforts to treat them. There have been recent sporadic reports of brain metastases from breast cancer responding for some years to antiestrogens (particularly tamoxifen) or bromocryptine. We report three cases of brain metastasis from cancer – two multiple and one a solitary lesion. The long survival of the patients – two for 5 years and one for 6 years, with more than an acceptable quality of life – should prompt therapeutic trials to test tamoxifen and designed to assess its effects on a sizable number of patients.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences-Neurosurgery, La Sapienza University of Rome, Italy
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Abstract
Aims and background To add a further contribution to the literature supporting the relationship between previous head trauma and development of glioma. Methods We report on four patients who developed brain gliomas in the scar of an old brain injury. Results All cases fulfilled the widely established criteria for brain tumors of traumatic origin. In all of our cases there was radiological evidence of absence of tumor at the time of the injury. Conclusions We believe that in specific cases it is reasonable to acknowledge an etiological association between a severe head trauma and the development of a glioma. This assumption is further sustained if there is radiological and surgical documentation of the absence of neoplasia at the moment of the trauma.
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Affiliation(s)
- Maurizio Salvati
- Department of Neurosurgery, INM Neuromed IRCCS, Pozzilli, Italy.
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Salvati M, Scarpinati M, Orlando ER, Celli P, Gagliardi FM. Single Brain Metastases from Kidney Tumors. Clinico-Pathologic Considerations on a Series of 29 Cases. Tumori 2018; 78:392-4. [PMID: 1297235 DOI: 10.1177/030089169207800610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-nine cases of single cerebral metastases from renal carcinoma were the object of a retrospective and prospective study covering a period of 15 years (1975–1988). The best diagnostic means were NMR imaging with paramagnetic contrast medium and CAT scans after intravenous injection of a double dose of contrast medium. All patients underwent total surgical removal of the cerebral lesion. Radiotherapy was useful but had less influence on further reproduction than in metastases from tumors of other sites. The median survival was 28.1 months in patients who received radiotherapy and 23 months in the others. No significant difference in survival was found between the group of patients with unknown primary tumors and the other group with diagnosed primary neoplastic disease.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences-Neurosurgery, La Sapienza University of Rome, Italy
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Abstract
Aims and background Radiotherapy is important in the treatment of neoplasm of the central nervous system, but various side effects, particularly neoplastic, have been described. Recently, post-radiation gliomas have been reported. Methods The authors review 88 cases of cerebral glioma following radiotherapy in patients operated for neoplasms of the nervous system, including 6 personal cases of post-radiation gliomas treated in the Neurosurgical Division of the Department of Neurological Sciences, “La Sapienza” University, Rome. The criteria used to define this unusual pathologic association are discussed. Results There was a male predominance. Post-radiation gliomas were particularly malignant, the average dose was 33 Gy, and average free latency was 9.6 years. The first disease was most frequently acute lymphatic leukemia. Conclusions Post-radiation gliomas have particular features but do not present a histologic or clinical behavior different from analogous spontaneous gliomas. The fact that 88 cases have been reported in recent years suggests that a thorough biological, clinical studies be carried out on this association.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Italy
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42
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Abstract
Nine patients with diagnosed breast cancer who developed meningiomas are reported. Articles suggesting that an association of these two tumors is possible. Some authors have noted hormonal sensivity and the presence of hormonal receptors in some meningiomas. Since breast cancer is the most common tumor in women, an association between it and meningiomas might be fortuitous. However, it is important to fully investigate brain lesions in patients with breast cancer so that potentially curable meningiomas are not considered as metastases.
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Affiliation(s)
- M Salvati
- Neurological Mediterranean "Neuromed" Institute, IRCCS, Pozzilli, Isernia, Italy
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Abstract
Thirty-four breast cancer patients with single brain metastases were reviewed: 9 underwent surgical removal only and 25 surgical removal and radiotherapy. A longer survival was seen in patients who underwent surgical removal and radiotherapy, with a mean survival of 28 months. In the 9 patients who did not receive whole brain radiotherapy, the mean survival was 15 months and there was an higher frequency of brain relapse.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences and Neurosurgery, University of Rome La Sapienza, Italy
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Abstract
Radiotherapy is an important modality for the treatment of tumors and arteriovenous malformations affecting the central nervous system, even though several significant side effects have been described (radionecrosis, tumors, etc.). Meningiomas induced by high-dose radiation therapy are uncommon. In this study we describe five cases treated at our institute and review all previously published reports of meningioma occurring after high-dose radiotherapy. These tumors develop mainly in patients irradiated in childhood; their incidence peaks in the second decade of life, there is a predominance in females and a high frequency of malignant forms. Although rare, meningiomas may represent a late complication of radiation treatment. The behavior of the radiation-induced variety of meningioma seems to differ from that of its “spontaneous” counterpart. The use of radiotherapy should be carefully evaluated for relatively benign or congenital lesions which generally affect young patients with a long life expectancy.
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Affiliation(s)
- Maurizio Salvati
- Department of Neurosurgery, INM Neuromed IRCCS, Pozzilli (Is), University of Rome La Sapienza, Italy.
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45
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Piccirilli M, Salvati M, Bistazzoni S, Frati A, Brogna C, Giangaspero F, Frati R, Santoro A. Glioblastoma Multiforme and Breast Cancer: Report on 11 Cases and Clinico-Pathological Remarks. Tumori 2018; 91:256-60. [PMID: 16206651 DOI: 10.1177/030089160509100309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association between breast cancer and glioblastoma multiforme has not been amply analyzed in the literature. We describe 11 female patients with a diagnosis of glioblastoma multiforme who were treated when younger for breast cancer. We believe that this association is not due to chance but rather to genetic changes in hormone status and in particular to sex hormones. Another important point of view is represented by the chemotherapy treatment of breast cancer, which could have a carcinogenic effect and explain the growth of glioblastoma. This consideration, in our opinion, is important, because more effort should be made to understand the pathogenesis of glioblastoma multiforme and to improve the therapeutic approaches.
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Abstract
Aims and background Although systemic metastases from thyroid cancer are relatively frequent, they rarely affect the nervous system and only exceptionally originate from well-differentiated carcinoma. Methods The authors describe 6 cases of solitary brain metastases from thyroid carcinoma, well-differentiated in 3 cases and anaplastic in the other 3 cases. Results Four patients were females and 2 males (M:F ratio, 1:2); average age was 51 yrs (range 48-56). On average, the interval between diagnosis of the thyroid tumor and appearance of the metastasis was 2.8 years (range 1-12 years) and was shorter in the anaplastic forms (1.2 versus 4.4 years). Average survival was 15 months (range 6-48 months); in particular, average survival was longer in patients with well-differentiated carcinoma (9 vs 21 months) as also in those who did not present other metastatic sites (6 vs 24 months). Death was due to systemic progression of the disease in 4 cases and to brain-relapse in the other 2 cases. Conclusions Surgery, radioactive iodine (where uptake is demonstrable), and radiotherapy are the main therapies available for metastases from thyroid carcinoma. However, survival of patients appears to be modified by the type of treatment performed.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences-Neurosurgery, La Sapienza University, Rome, Italy
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47
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Abstract
The authors present 20 cases of likely post-traumatic intracranial meningiomas selected according to the conditions specified in the relevant literature. The relationship between head injury and subsequent development of meningioma remains a controversial and fascinating subject. The etiopathogenetic mechanisms and clinical features of our patients and those of the literature are discussed.
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Affiliation(s)
- Emanuela Caroli
- Department of Neurosurgery, INM Neuromed IRCCS, Pozzilli, Italy
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48
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Abstract
Aims and Backround Ossifying fibroma is a tumor with benign course that rarely affects the cranial bones. Methods The authors report 5 cases of ossifying fibroma of the skull and analyze the clinical course and treatment of this lesione. Results 3 patients were females and 2 males. The mean clinical history was 3.2 years. 4 patients underwent total removal and 1 partial. At mean follow-up of 19 years, all patients who underwent total removal showed improvement of neurological deficit, whereas the patient who underwent partial removal had clinical regrowth. Conclusion The authors conclude that total removal of fibroma should be extended to normal bone and in cases in which total removal is not possible the residue should be checked for regrowth by serial MRI.
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Affiliation(s)
- M Artico
- Department of Neurological Sciences, La Sapienza, University of Rome, Italy
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49
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Abstract
Aims and Background Intramedullary teratoma is an extremely exceptional tumor (5 cases), although a careful review of international literature has shown it to be more frequent (32 cases) than believed. Methods The authors present a personal case with some unusual aspects. Results Our case is unusual not only because it was diagnosed by MRI (only one case has been reported in the literature) but also because surgical removal of the tumor was apparently total (only 4 other cases have been described), with a long follow-up period (4.5 years) and excellent results, in clinical and neuroradiologic terms.
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Affiliation(s)
- R Caruso
- Mediterranean Neurological Neuromed Institute IRCCS, Pozzilli (Is), Italy
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50
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Abstract
Multifocal gliomas fall into four main categories: diffuse, multiple, multicentric and multiple-organ. Multicentric gliomas are uncommon lesions of the central nervous system. Even more so are multicentric gliomas lying both above and below the tentorium (16 cases to date, as far we know). We report a clinical series of 7 cases, including 3 supra-Infratentorial tumors. The distinctive features of multicentric gliomas are mainly the absence of gross or microscopic connections and absence of seeding along easily accessible routes like the cerebrospinal fluid pathways or the median commissures. We consider the pathogenetic hypotheses and problems of diagnosis, especially differential from other multifocal diseases of the central nervous system.
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Affiliation(s)
- Maurizio Salvati
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Piero Andrea Oppido
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Spartaco Artizzu
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Fabio Fiorenza
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
| | - Fabrizio Puzzilli
- Department of Neurological Sciences-Neurosurgery, University of Rome « La Sapienza », Rome
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