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Lofrese G, Cultrera F, Ricciardi L, Visani J, Tosatto L, Ruggiero M, Haznedari N, Menetti F. Preoperative elastoplasty of aggressive vertebral hemangiomas in elderly patients: a new strategy for reducing intraoperative bleeding and complications. Eur Spine J 2024:10.1007/s00586-024-08201-0. [PMID: 38491218 DOI: 10.1007/s00586-024-08201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Preoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty. METHODS Three elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters. RESULTS With its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH's epidural components thanks to XperCT-guidance. CONCLUSION When facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH's angioarchitecture, significantly reducing tumor.
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Affiliation(s)
- Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luca Ricciardi
- Neurosurgery Division, Sapienza University, Via di Grottarossa 1035, Rome, Italy.
| | - Jacopo Visani
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luigino Tosatto
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Nicolò Haznedari
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Federico Menetti
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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De Bonis P, Musio A, Mongardi L, La Marca F, Lofrese G, Visani J, Cavallo MA, Scerrati A. Transpars approach for L5-S1 foraminal and extra-foraminal lumbar disc herniations: technical note. J Neurosurg Sci 2023; 67:213-218. [PMID: 33297610 DOI: 10.23736/s0390-5616.20.05165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The short pars and the narrowed surgical corridor for far lateral L5S1 herniation make the transpars approach challenging. The aim of this study is to determine the feasibility, efficacy, and safety of the transpars microscopic approach for the treatment of L5-S1 foraminal and extraforaminal lumbar disc herniation. METHODS From 2015 to 2019, patients with L5-S1 far lateral lumbar disc herniation were prospectively recruited. Drug intake, working days lost, NRS-leg, NRS-back, nerve-root palsy, Oswestry disability-index, Macnab criteria were recorded before surgery and at follow-up. Patients were seen at 1-6-12 months after surgery. Lumbar dynamic X-rays were performed at 6-12 months after surgery and again at 2-4 years after surgery. Key-steps of surgery are described. RESULTS Fourteen patients were enrolled. NRS-leg and NRS-back scores significantly improved (from 7.93 to 1.43 and from 3.2 to 0.6, respectively; P<0.0001). Oswestry Score significantly decreased (from 63.14 to 19.36 at 12 months; P<0.0001). L5 Root palsy improved in all cases (from 3.72/5 to 5/5; P<0.0001). At 12-months, excellent or good outcome (Macnab criteria) was achieved in 12 (85.7%) and 2 (14.3%) patients, respectively. All patients who were not retired returned to work within 30 days after surgery. No recurrence, instability or re-operations occurred. CONCLUSIONS The trans pars microscopic approach is feasible, safe, and effective for L5-S1 foraminal and extraforaminal disc herniation. During surgery, the key-point is the oblique working angle, directed caudally, parallel to L5 pedicle. The iliac crest does not seem to constitute an obstacle.
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Affiliation(s)
- Pasquale De Bonis
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy -
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy -
| | - Antonio Musio
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Frank La Marca
- Department of Neurosurgery, Henry Ford Allegiance, Jackson, MS, USA
| | - Giorgio Lofrese
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Jacopo Visani
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Michele A Cavallo
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Alba Scerrati
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
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Lofrese G, Scerrati A, Balsano M, Bassani R, Cappuccio M, Cavallo MA, Cofano F, Cultrera F, De Iure F, Biase FD, Donati R, Garbossa D, Menegatti M, Olivi A, Palandri G, Raco A, Ricciardi L, Spena G, Tosatto L, Visani J, Visocchi M, Zona G, De Bonis P. Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience. Global Spine J 2022; 12:1751-1760. [PMID: 33590802 PMCID: PMC9609533 DOI: 10.1177/2192568220988272] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter. OBJECTIVES diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. METHODS Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. RESULTS 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel (P = 0.12) to the burr (P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level (P = 0.15). Use of curved chisel reduced the surgical times (P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more (P = 0.04) and shorter waiting times for surgery (P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. CONCLUSION The "age of DISH" counts more than patients' age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.
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Affiliation(s)
- Giorgio Lofrese
- Neurosurgery Division, “M. Bufalini”
Hospital, Cesena, Italy
| | - Alba Scerrati
- Department of Neurosurgery, S. Anna
University Hospital, Ferrara, Italy,Department of Morphology, Surgery and
Experimental Medicine, University of Ferrara, Ferrara, Italy,Alba Scerrati, Faculty of Medicine and
Surgery, University of Ferrara, Via Aldo Moro, 8, Ferrara, Italy.
| | - Massimo Balsano
- Regional Spinal Department, UOC
Ortopedia A, AOUI, Verona, Italy
| | - Roberto Bassani
- Spine Surgery II, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Michele Cappuccio
- Department of Spine Surgery, Ospedale
Maggiore “C.A. Pizzardi,” Bologna, Italy
| | - Michele A. Cavallo
- Department of Neurosurgery, S. Anna
University Hospital, Ferrara, Italy,Department of Morphology, Surgery and
Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Cofano
- Department of Neuroscience “Rita Levi
Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy
| | | | - Federico De Iure
- Department of Spine Surgery, Ospedale
Maggiore “C.A. Pizzardi,” Bologna, Italy
| | | | - Roberto Donati
- Neurosurgery Division, “M. Bufalini”
Hospital, Cesena, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi
Montalcini,” Neurosurgery Unit, University of Turin, Turin, Italy
| | - Marta Menegatti
- Department of Neurosurgery, S. Anna
University Hospital, Ferrara, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Department of Neuroscience,
Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Palandri
- Department of Neurologic Surgery, Institute of Neurological Sciences of Bologna IRCCS, Bologna, Italy
| | - Antonino Raco
- UOC di Neurochirurgia, Azienda
Ospedaliera Sant’Andrea, Sapienza, Roma, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione
di Culto e Religione Cardinal G. Panico, Tricase, Italy
| | | | - Luigino Tosatto
- Neurosurgery Division, “M. Bufalini”
Hospital, Cesena, Italy
| | - Jacopo Visani
- Department of Neurosurgery, S. Anna
University Hospital, Ferrara, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Department of Neuroscience,
Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluigi Zona
- Section of Neurosurgery, IRCCS
Ospedale Policlinico San Martino, Genoa, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, S. Anna
University Hospital, Ferrara, Italy,Department of Morphology, Surgery and
Experimental Medicine, University of Ferrara, Ferrara, Italy
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Rasulić L, Đjurašković S, Lakićević N, Lepić M, Savić A, Grujić J, Mićić A, Radojević S, Córdoba-Mosqueda ME, Visani J, Puzović V, Kovačević V, Vitošević F, Mandić-Rajčević S, Knezevic S. Etiological and epidemiological characteristics of surgically treated radial nerve lesions: A 20-year single-center experience. Front Surg 2022; 9:942755. [PMID: 36204344 PMCID: PMC9530258 DOI: 10.3389/fsurg.2022.942755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionRadial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the etiology and exact mechanism of the nerve impairment is of great importance for appropriate management of these patients, and there are only a few papers that focused on these features in patients with surgically treated radial nerve lesions. The lack of studies presenting the etiology and injury mechanisms of surgically treated radial nerve lesions may be due to a relatively small number of specialized referral centers, dispersion to low-flow centers, and a greater focus on the surgical treatment outcomes.AimThe aim of this study was to describe the etiological and epidemiological characteristics of patients with surgically treated radial nerve lesions of various origins.MethodsThis retrospective study evaluated 147 consecutive patients with radial nerve lesion, treated in the department during the last 20 years, from January 1, 2001, until December 31, 2020.ResultsThe majority of patients belonged to the working population, and 70.1% of them were male. Most commonly, the etiology of nerve lesion was trauma (63.3%) or iatrogenic injury (28.6%), while the less common origin was idiopathic (4.1%) or neoplastic (4.1%). The most frequent location of the lesion was in the upper arm, followed by the elbow and forearm. Fracture-related contusion was the most common mechanism (29.9%), followed by postoperative fibrosis (17.7%), lacerations (17.7%), and compression (15.6%).ConclusionBased on the fact that traumatic or iatrogenic injuries constitute the majority of cases, with their relevant mechanisms and upper arm predomination, it is crucial to raise awareness and understanding of the radial nerve injuries among orthopedic surgeons to decrease the numbers of these patients and properly preserve or treat them within the initial surgery.
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Affiliation(s)
- Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
- Correspondence: Lukas Rasulić
| | - Slavko Đjurašković
- Clinic for Neurosurgery, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Novak Lakićević
- Clinic for Neurosurgery, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Milan Lepić
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksa Mićić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Jacopo Visani
- Department of Neurosurgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Vojin Kovačević
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic for Neurosurgery, Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Filip Vitošević
- Interventional Neuroradiology Department, Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Saša Knezevic
- Center for Anesthesiology, Resuscitation and Pain Therapy, University Clinical Centre of Serbia, Belgrade, Serbia
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Sacco C, Olivi S, Visani J, Donati R, Veronesi V, Mencarani C, Capone C, Bizzocchi G, Kiekens C, De Bonis P, Scerrati A, Staffa G. Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report. Microsurgery 2022; 42:577-585. [PMID: 35484858 DOI: 10.1002/micr.30891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/13/2022] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extensively described, type of procedure to be chosen is not standardized and few studies have determined the functional outcome of those procedure and their impact on QOL is still poorly assessed. We report a preliminary retrospective study regarding feasibility and functional outcomes of nerve transfer procedures including bilateral brachialis nerve on anterior interosseous nerve (AIN) and supinator branch on posterior interosseous nerve (PIN) for hand reanimation following SCI focusing on the impact of these procedures on QOL. METHODS We performed a retrospective study involving patient sustained SCI and underwent nerve transfer of brachialis branch from musculocutaneous nerve on AIN and supinator branch from the trunk of the radial nerve on the PIN. We included 11 patients (14 limbs) with traumatic SCI resulting in C4 level tetraplegia in five patients, C5 in four and C6 and C7 in one case each, with a median age of 31.5 years underwent surgery at a median of 10 months after injury; including both transfers in 10 cases and AIN reanimation only in one. Functional assessment including medical research council (MCR) grade, graded redefined assessment of strength sensation and prehension (GRASSP) and spinal cord independence measure (SCIM) were performed at least 12 months follow up. RESULTS Thirteen PIN innervated muscles achieved an MRC score ≥3/5 whereas AIN supplied muscles in 5 out of 15. GRASSP qualitative measure improved from a baseline value of 1 to 2, while quantitative measure passed from 1 to 3 after 12 months; the difference was statistically significant (p = .005 and p = .008, respectively). SCIM self-care sub-score also statistically significant improved from 3 to 4 at 12 months (p = .016). No complication or donor morbidity occurred. CONCLUSIONS Functional performance has been significantly improved by nerve transfer procedures 1 year after surgery. Nerve transfers may represent a valuable option for the restoration of the hand function in patients with tetraplegia with minor or no morbidity.
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Affiliation(s)
- Carlo Sacco
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Silvia Olivi
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Jacopo Visani
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy.,Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Roberto Donati
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Vanni Veronesi
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Camilla Mencarani
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Crescenzo Capone
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Gianluca Bizzocchi
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | | | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Guido Staffa
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
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Mongardi L, Visani J, Mantovani G, Vitali C, Ricciardi L, Giordano F, Cavallo MA, Lofrese G, D'andrea M, Roblot P, De Bonis P, Scerrati A. Long term results of Dorsal Root Entry Zone (DREZ) lesions for the treatment of intractable pain: A systematic review of the literature on 1242 cases. Clin Neurol Neurosurg 2021; 210:107004. [PMID: 34739884 DOI: 10.1016/j.clineuro.2021.107004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Different Dorsal root entry zone (DREZ) lesion techniques have been reported as effective treatment for intractable painful conditions, though with contradictory results. Overall, good results were reported especially in specific conditions, such as pain due to brachial plexus avulsion, spinal cord injuries and oncological pain management. However, data on long term results in different clinical conditions are still missing. OBJECTIVE This study aims to systematically review the pertinent literature to evaluate indications, clinical outcomes, and complications of DREZ lesion (DREZotomy), in chronic pain management. METHODS A systematic literature review was conducted according to the PRISMA statement. Papers on DREZotomy for chronic pain in cancer, brachial plexus avulsion, spinal cord injury, post herpetic neuralgia, and phantom limb pain were considered for eligibility. For each category we further identified two sub-group according to the length of follow up: medium term and long term follow up (more than 3 years) respectively. RESULTS 46 papers, and 1242 patients, were included in the present investigation. When considering long term results DREZotomy provided favorable clinical outcomes in brachial plexus avulsion and spinal cord injury, in 60.8% and 55.8% of the cases respectively. Conversely, the success rate was 35.3% in phantom limb pain and 28.2% in post herpetic neuralgia. A poor clinical outcome was reported in over than 25% of the patients suffering from phantom limb pain, post herpetic neuralgia and spinal cord injury. The mean complications rate was 23.58%. While BPA and SCI patients presented stable improvement over time, good outcomes among PHN and PLP groups dropped by - 46.2%; and - 14.7% at long term follow up respectively. CONCLUSION DREZotomy seems to be an effective treatment for chronic pain conditions, especially for brachial plexus avulsion, spinal cord injury and intractable cancer/post-radiation pain. According to the low level of evidence of the pertinent literature, further studies are strongly recommended, to better define potential benefits and limitations of this technique.
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Affiliation(s)
- Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy.
| | - Jacopo Visani
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Giorgio Mantovani
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Costanza Vitali
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, LE, Italy
| | - Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Michele Alessandro Cavallo
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | | | | | - Paul Roblot
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
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Scerrati A, De Bonis P, Zamboni P, Dones F, Fontanella M, Cenzato M, Visani J, Bianchi F, Zanin L, Cavallo MA, Sturiale CL. A New Insight in Nonaneurysmal Subarachnoid Hemorrhage: the Potential Role of the Internal Jugular Veins. J Neurol Surg A Cent Eur Neurosurg 2021; 83:344-350. [PMID: 34687035 DOI: 10.1055/s-0041-1733895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Causes of the nonaneurysmal subarachnoid hemorrhage (na-SAH) are still debated. Many studies confirmed the possible involvement of the intracranial venous system, in particular variants of the basal vein of Rosenthal. STUDY OBJECT The aim of this study is to investigate the role of extracranial venous system, in particular the jugular drainage, in the na-SAH pathophysiology. MATERIALS AND METHODS This is a multicenter retrospective study including patients suffering from na-SAH who were radiologically screened to exclude vascular malformations. The course of the internal jugular veins was evaluated to reveal any stenosis (caliber reduction >80%). Particular attention was paid at the passage between the styloid process and the arch of C1 to detect possible compression. As a control group, we enrolled patients who underwent CT angiograms and/or cerebral DSAs in the past 2 years. RESULTS We included 194 patients. The na-SAH group consisted of 94 patients, whereas the control group consisted of 100 patients. Fifty patients of the control group underwent a CT angiography for an ischemic cerebrovascular disease or trauma and 50 patients for an SAH due to a ruptured aneurysm. A significant jugular stenosis was found in 49 (52.1%) patients in the na-SAH group and in 18 (18%) patients in the control group. At univariate and multivariate analysis, the difference was statistically significant (p < 0.0001). CONCLUSIONS This is the first study investigating the correlation between jugular stenosis and the occurrence of na-SAH. The impaired venous outflow due to reduced venous caliber could result in an engorgement of the upstream intracranial veins with transient hypertensive phases facilitating ruptures. Further larger prospective studies are necessary to confirm these data.
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Affiliation(s)
- Alba Scerrati
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Paolo Zamboni
- Department of Vascular Surgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Flavia Dones
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Marco Fontanella
- Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Brescia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Ospedale Niguarda Ca Granda, Milano, Lombardia, Italy
| | - Jacopo Visani
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Federico Bianchi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Zanin
- Department of Neurosurgery, University of Brescia, Brescia, Lombardia, Italy
| | - Michele Alessandro Cavallo
- Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Scerrati A, Visani J, Ricciardi L, Dones F, Rustemi O, Cavallo MA, De Bonis P. To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review. Neurosurg Focus 2021; 49:E7. [PMID: 33002869 DOI: 10.3171/2020.7.focus20237] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population. METHODS The authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were "chronic subdural hematoma," "conservative treatment/management," "pharmacological treatment," "non-surgical," "tranexamic acid," "dexamethasone," "corticosteroid," "glucocorticoid," "middle meningeal artery," "endovascular treatment," and "embolization." RESULTS The authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment. CONCLUSIONS The results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.
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Affiliation(s)
- Alba Scerrati
- 1Department of Morphology, Anatomy and Experimental Medicine, University of Ferrara.,2Department of Neurosurgery, Sant'Anna University Hospital, Ferrara
| | - Jacopo Visani
- 2Department of Neurosurgery, Sant'Anna University Hospital, Ferrara
| | - Luca Ricciardi
- 3Department of Neurosurgery, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Lecce; and
| | - Flavia Dones
- 2Department of Neurosurgery, Sant'Anna University Hospital, Ferrara
| | - Oriela Rustemi
- 4Department of Neurosurgery, San Bortolo Hospital, Vicenza, Italy
| | - Michele Alessandro Cavallo
- 1Department of Morphology, Anatomy and Experimental Medicine, University of Ferrara.,2Department of Neurosurgery, Sant'Anna University Hospital, Ferrara
| | - Pasquale De Bonis
- 1Department of Morphology, Anatomy and Experimental Medicine, University of Ferrara.,2Department of Neurosurgery, Sant'Anna University Hospital, Ferrara
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Scerrati A, Germano' A, Montano N, Visani J, Cacciola F, Raffa G, Ghetti I, Pignotti F, Cavallo MA, Olivi A, de Bonis P. Factors affecting functional outcome after anterior cervical discectomy and fusion: A multicenter study. J Craniovertebr Junction Spine 2021; 12:144-148. [PMID: 34194160 PMCID: PMC8214232 DOI: 10.4103/jcvjs.jcvjs_1_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background Although anterior cervical discectomy and fusion (ACDF) represents a standardized procedure for surgical treatment of a cervical herniated disc, several variables could affect patients' clinical and radiological outcome. We evaluated the impact of sex, age, body mass index (BMI), myelopathy, one- or two-level ACDF, and the use of postoperative collars on functional and radiological outcomes in a large series of patients operated for ACDF. Materials and Methods Databases of three institutions were searched, resulting in the enrollment of 234 patients submitted to one- or two-level ACDF from January 2013 to December 2017 and followed as outpatients at 6- and 12-month follow-up. The impact of variables on functional and radiological outcomes was evaluated using univariate and multivariate logistic regression analysis. Results At univariate analysis, female sex, higher BMI, two-level ACDF, and postoperative collar correlated with a significantly worse early and late Neck Disability Index (NDI). Multivariate analysis showed that male patients had a lower risk of worse early (P = 0.01) and late NDIs (P = 0.009). Patients with myelopathy showed better early NDI (P = 0.004). Cervical collar negatively influenced both early and late NDIs (P < 0.0001), with a higher risk of early nonfusion (P = 0.001) but a lower risk of late nonfusion (P = 0.01). Patients operated for two-level ACDF have a worse early NDI (P = 0.005), a worse late NDI (P = 0.01), and a higher risk of early nonfusion (P = 0.048). BMI and age did not influence outcome. Conclusions Female sex, two-level surgery, and the use of postoperative collars significantly correlate with worse functional outcomes after one- or two-level ACDF.
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Affiliation(s)
- Alba Scerrati
- Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Antonino Germano'
- Department of Neurosciences, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Nicola Montano
- Department of Neurosciences, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Jacopo Visani
- Department of Translational Medicine, Ferrara University, Ferrara, Italy
| | - Fabio Cacciola
- Department of Neurosciences, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Giovanni Raffa
- Department of Neurosciences, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Ilaria Ghetti
- Department of Neurosciences, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Fabrizio Pignotti
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Alessandro Olivi
- Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Pasquale de Bonis
- Department of Translational Medicine, Ferrara University, Ferrara, Italy
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Visani J, Mongardi L, Cultrera F, Bonis PD, Lofrese G, Ricciardi L, Scerrati A. Surgical treatment of metastatic pheochromocytomas of the spine: a systematic review. J Integr Neurosci 2021; 20:499-507. [PMID: 34258952 DOI: 10.31083/j.jin2002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/15/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022] Open
Abstract
Metastatic pheochromocytoma of the spine (MPS) represents an extremely rare and challenging entity. While retrospective studies and case series make the body of the current literature and case reports, no systematic reviews have been conducted so far. This systematic review aims to perform a systematic review of the literature on this topic to clarify the status of the art regarding the surgical management of MPS. A systematic review according to PRISMA criteria has been performed, including all studies written in English and involving human participants. 15 papers for a total of 44 patients were finally included in the analysis. The median follow-up was 26.6 months. The most common localization was the thoracic spine (54%). In 30 out of 44 patients (68%), preoperative medications were administered. Open surgery was performed as the first step in 37 cases (84%). Neoadjuvant treatments, including preoperative embolization were reported in 18 (41%) cases, while adjuvant treatments were administered in 23 (52%) patients. Among those patients who underwent primary aggressive tumor removal and instrumentation, 16 out of 25 patients (64%) showed stable disease with no progression at the final follow-up. However, the outcome was not reported in 14 patients. Gross total resection of the tumor and spinal reconstruction appear to offer good long-term outcomes in selected patients. Preoperative alpha-blockers and embolization appear to be useful to enhance hemodynamic stability, avoiding potential detrimental complications.
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Affiliation(s)
- Jacopo Visani
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Pasquale De Bonis
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Giorgio Lofrese
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Neurosurgery Division, M. Bufalini Hospital, Viale Ghirotti 286, 4752 Cesena, Italy
| | - Luca Ricciardi
- Neurosurgery, Department NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Alba Scerrati
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.,Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
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11
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Mongardi L, Visani J, Mantovani G, Olivetti ME, Scerrati A, Cultrera F, Ricciardi L, De Bonis P, Cavallo MA, Lofrese G. Ct guided reference markers for spinal dorsal lesions: A safe and valuable tool impacting intraoperative localization time. J Clin Neurosci 2020; 84:97-101. [PMID: 33358493 DOI: 10.1016/j.jocn.2020.11.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/17/2020] [Accepted: 11/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intraoperative localization of the correct spine level can be challenging when dealing with the thoracic spine; especially in morbidly obese patients and in mid-thoracic spine lesions. Different radiological reference markers techniques for dorsal surgery have been reported without a clear DAP (effective dose), localization and surgical time analysis. PURPOSE The aim of the study is to analyze the radiological reference markers technique in terms of localization time and radiation dose during surgery for dorsal lesions. METHODS We used a radiopaque marker (fiducial) directly positioned before surgery over the lamina or the spinous process using CT scan for precise localization and vertebra count. We prospectively collected data about patients who underwent preoperative thoracic localization between April 2015 and September 2018 at Neurosurgery Department of Ferrara University Hospital. Clinical data as pathology, related surgical technique, radiological exams, localization time and radiation exposure were analyzed. RESULTS 19 patients who underwent preoperative radiopaque marker (fiducial) positioning and 11 patients who underwent fluoroscopy technique were enrolled. No complications related to fiducial placement and no wrong-level occurred. The localization time with the fiducial was reduced dramatically (3 min vs 15 min of the standard technique). The average DAP (effective dose) for the fiducial group was 20 Gy-cm2 compared with 16 Gy-cm2 of the traditional group. CONCLUSION The use of preoperative fiducial for intraoperative localization of the target level in the thoracic spine dramatically reduce the location time without a significantly higher DAP (effective dose).
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Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy.
| | - Jacopo Visani
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | - Giorgio Mantovani
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | - Maria Elena Olivetti
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | - Alba Scerrati
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
| | | | | | - Pasquale De Bonis
- Neurosurgery, Sant'Anna University Hospital Ferrara, Via Aldo Moro 8, 8-44124 Cona, FE, Italy
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Scerrati A, Visani J, Flacco ME, Ricciardi L, Trungu S, Raco A, Dones F, De Bonis P, Sturiale CL. Endovascular Treatment of Ruptured Intracranial Blister Aneurysms: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2020; 42:538-545. [PMID: 33361375 DOI: 10.3174/ajnr.a6924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Endovascular treatment of blister aneurysms is a promising approach, even though they are vascular lesions challenging to treat due to their angioarchitectural characteristics. PURPOSE Our aim was to investigate clinical and radiologic outcomes after endovascular treatment of ruptured blister aneurysms. DATA SOURCES PubMed, Ovid MEDLINE, Ovid EMBASE, Scopus, and the Web of Science were screened. STUDY SELECTION We performed a comprehensive review of the literature from 2010 to 2019 reporting series of patients with blister aneurysms treated with an endovascular approach. DATA ANALYSIS Event rates were pooled across studies using a random effects meta-analysis. DATA SYNTHESIS A total of 32 studies reporting on 684 patients (707 aneurysms) were included. Stent placement, stent-assisted coiling, and flow diversion were the most commonly described treatments (282, 256, and 155 patients, respectively). The long-term complete occlusion rate was 76.9% (95% CI, 69.2%-83.9%). The perioperative complication rate was 8.9%, and clinical outcome at final follow-up was mRS <2 in 76.6% (95% CI, 68.2%-84.2%) of patients. The mortality rate was 4.7% (95% CI, 2.30%-7.80%). Among the different techniques, stent-assisted coiling is the one that had the higher rate of immediate occlusion (63.4%); however, the occlusion rate at the final follow-up was comparable among the different techniques. LIMITATIONS Different techniques were described and data were reported in a nonhomogeneous way, possibly representing a bias in the present study. CONCLUSIONS This study suggests that endovascular treatment of blister aneurysms is associated with good long-term occlusion rates and reasonable complication and mortality rates. There is no consensus on the best endovascular techniques in blister aneurysm management.
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Affiliation(s)
- A Scerrati
- From the Department of Neurosurgery (A.S., J.V., F.D., P.D.B.), S. Anna University Hospital, Ferrara, Italy.,Departments of Morphology, Surgery, and Experimental Medicine (A.S., P.D.B.)
| | - J Visani
- From the Department of Neurosurgery (A.S., J.V., F.D., P.D.B.), S. Anna University Hospital, Ferrara, Italy
| | - M E Flacco
- Medical Sciences (M.E.F.), University of Ferrara, Ferrara, Italy
| | - L Ricciardi
- Unità operativa di Neurochirurgia (L.R., S.T.), Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Lecce, Italy .,Unità operativa complessa di Neurochirurgia (L.R., S.T., A.R.), Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, Azienda Ospedaliera Sant'Andrea, Sapienza, Rome, Italy
| | - S Trungu
- Unità operativa di Neurochirurgia (L.R., S.T.), Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Lecce, Italy.,Unità operativa complessa di Neurochirurgia (L.R., S.T., A.R.), Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, Azienda Ospedaliera Sant'Andrea, Sapienza, Rome, Italy
| | - A Raco
- Unità operativa complessa di Neurochirurgia (L.R., S.T., A.R.), Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, Azienda Ospedaliera Sant'Andrea, Sapienza, Rome, Italy
| | - F Dones
- From the Department of Neurosurgery (A.S., J.V., F.D., P.D.B.), S. Anna University Hospital, Ferrara, Italy
| | - P De Bonis
- From the Department of Neurosurgery (A.S., J.V., F.D., P.D.B.), S. Anna University Hospital, Ferrara, Italy.,Departments of Morphology, Surgery, and Experimental Medicine (A.S., P.D.B.)
| | - C L Sturiale
- Department of Neurosurgery (C.L.S.), Fondazione Policlinico Universitario A. Gemelli Istituto di ricovero e cura a carattere scientifico, Rome, Italy
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13
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De Bonis P, Musio A, Mantovani G, Pompucci A, Visani J, Lofrese G, Scerrati A. Simplified four-step retropharyngeal approach for the upper cervical spine: technical note. Eur Spine J 2020; 29:2752-2757. [PMID: 32648083 DOI: 10.1007/s00586-020-06521-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/26/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE In this paper, we propose a simplified four-step retropharyngeal approach, whose aim is getting straight to the upper cervical spine minimizing complications. METHODS While the classical retropharyngeal approach includes about 11 steps, ours is a four-step approach: patient positioning, skin-platysma incision, hyoid bone superolateral dissection and retropharyngeal blunt exposure. We avoid several steps of the classical anterior retropharyngeal approach, particularly dissection of submandibular gland, facial veins, external carotid artery and thyroid artery, bellies of the digastric muscle, hypoglossal nerve, thyrohyoid membrane and the internal branch of superior laryngeal nerve. RESULTS We have adopted this technique for five patients: two patients had a C2-C3 herniated disk with myelopathy, two patients had unstable Hangman fracture with no bone fusion after 2-month treatment with rigid collar, and one patient had a C2-C3 osteophyte with dysphagia. The intraoperative time needed for reaching the retropharyngeal space was 15 (first case), 9 (second case), 7 min (third case-illustrative case-and fourth case), 8 min (fifth case). No complications occurred. CONCLUSION Our simplification, avoiding several steps, is simple, effective, safe, and rapid and requires a simple learning curve.
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Affiliation(s)
- Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital, Viale Aldo Moro 8, 44124, Ferrara, Italy
| | - Antonio Musio
- Department of Neurosurgery, Sant'Anna University Hospital, Viale Aldo Moro 8, 44124, Ferrara, Italy.
| | - Giorgio Mantovani
- Department of Neurosurgery, Sant'Anna University Hospital, Viale Aldo Moro 8, 44124, Ferrara, Italy
| | - Angelo Pompucci
- Department of Neurosurgery, Santa Maria Goretti Hospital, Latina, Italy
| | - Jacopo Visani
- Department of Neurosurgery, Sant'Anna University Hospital, Viale Aldo Moro 8, 44124, Ferrara, Italy
| | - Giorgio Lofrese
- Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital, Viale Aldo Moro 8, 44124, Ferrara, Italy
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Scerrati A, Mongardi L, Visani J, Lofrese G, Cavallo MA, Fiorentino A, De Bonis P. The controversial role of Bevacizumab in the treatment of patients with intracranial meningioma: a comprehensive literature review. Expert Rev Anticancer Ther 2020; 20:197-203. [PMID: 32116057 DOI: 10.1080/14737140.2020.1736567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Meningiomas represent the most common primary intracranial tumors. Today, surgical resection, followed by radiotherapy when indicated, is still the treatment of choice. In recent years, distinct oncogenic pathways have been identified, laying the foundations of new personalized targeted therapies.Areas covered: The aim of this study was to highlight the effects, complications, possible associations with other therapeutic approaches and multi-parametric outcome evaluation of Bevacizumab for the treatment of meningiomas. A literature review according to PRISMA criteria regarding the role of Bevacizumab for the treatment of various WHO grades of meningiomas was performed. 15 relevant papers, including 6 retrospective clinical trial series, 3 prospective trials, and 6 single patient case reports for a total of 134 patients and 211 meningiomas were include.Expert opinion: Because of the lack of strong clinical evidence about improved survival and related toxicity, the use of Bevacizumab for the treatment of meningiomas should be carefully evaluated. Further exploration, ideally with randomized controlled trials, is needed to better define the role of this drug in the treatment of meningiomas.
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Affiliation(s)
- Alba Scerrati
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy.,Neurosurgery Department, San Bortolo Hospital, Vicenza, Italy
| | - Lorenzo Mongardi
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Jacopo Visani
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Michele Alessandro Cavallo
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Pasquale De Bonis
- Neurosurgery, Department of Morphology, Surgery and Experimental Medicine, University Hospital S. Anna, Ferrara, Italy
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De Bonis P, Chiccoli M, Visani J, Cavallo MA, Scerrati A. Functional outcome of patients with unstable single- level/ two- level lumbar stenosis treated with decompression plus divergent screws (cortical bone trajectory) or percutaneous convergent pedicle screws. J Neurosurg Sci 2020; 66:576-581. [PMID: 32100520 DOI: 10.23736/s0390-5616.20.04893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this prospective comparative study is to assess the functional outcome in two groups of patients suffering from spinal lumbar instability and treated by decompression and stabilization with posterior lumbar interbody fusion using percutaneous pedicle screws (PCT) or a novel technique of divergent pedicle screws insertion using a cortical bone divergent trajectory (CBT). Functional outcome after surgery has been evaluated using Numeric Rating Scale (NRS), Modified Rankin Scale (MRS), Smiley-Webster Scale, and Oswestry Disability Index (ODI). METHODS Seventy-two consecutive patients were treated at our department from February 2013 to February 2018 for one-two levels unstable stenosis with one year follow-up. Forty-one patients were treated with percutaneous screws and thirty-one patients were treated with divergent cortical bone trajectory screws. Functional outcome and complications were analysed with logistic regression analysis. No funding was received for this research. RESULTS Pain significantly improved in both groups. Charlson Comorbidity Index (CCI>=3) was the only variable associated with increased risk of complications (OR 5.73, p=0.04). Patients with BMI >=27.4 (median value) and patients with percutaneous screws had an increased risk of a worse Smiley-Webster Score (OR=3.675; p=0.029 and OR=3.747; p=0.05, respectively). Patients with BMI >=27.4, patients with percutaneous screws and patients with more comorbidities (CCI>/=3) showed a higher risk of presenting severe/crippling Oswestry Disability Index score (OR=6; p= 0.027, OR=10.747; p=0.04 and OR=6.310; p=0.043, respectively). CONCLUSIONS Cortical bone trajectory screws technique could represent a valid alternative to the traditional percutaneous pedicle screws technique in posterior lumbar interbody fusion.
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Affiliation(s)
- Pasquale De Bonis
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy - .,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy -
| | - Michele Chiccoli
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Jacopo Visani
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy
| | - Michele A Cavallo
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alba Scerrati
- Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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16
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Scerrati A, Germanò A, Trevisi G, Visani J, Lofrese G, D'Angelo L, Raffa G, Fazzari E, Mangiola A, Cavallo MA, De Bonis P. Timing of Low-Dose Aspirin Discontinuation and the Influence on Clinical Outcome of Patients Undergoing Surgery for Chronic Subdural Hematoma. World Neurosurg 2019; 129:e695-e699. [DOI: 10.1016/j.wneu.2019.05.252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
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Lofrese G, Cultrera F, Visani J, Nicassio N, Essayed WI, Donati R, Cavallo MA, De Bonis P. Intraoperative Doppler ultrasound as a means of preventing vertebral artery injury during Goel and Harms C1-C2 posterior arthrodesis: technical note. J Neurosurg Spine 2019; 31:824-830. [PMID: 31419805 DOI: 10.3171/2019.5.spine1959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/28/2019] [Indexed: 11/06/2022]
Abstract
Vertebral artery injury (VAI) is a potential catastrophic complication of Goel and Harms C1-C2 posterior arthrodesis. Meticulous study of preoperative spinal CT angiography together with neuronavigation plays a fundamental role in avoiding VAI. Doppler ultrasonography may be an additional intraoperative tool, providing real-time identification of the vertebral artery (VA) and thus helping its preservation.Thirty-three consecutive patients with unstable odontoid fractures underwent Goel and Harms C1-C2 posterior arthrodesis. Surgery was performed with the aid of lateral fluoroscopic control in 16 cases (control group) that was supplemented by Doppler ultrasonography in 17 cases (Doppler group). Two patients in each group had a C1 ponticulus posticus. In the Doppler group, Doppler probing was performed during lateral subperiosteal muscle dissection, stepwise drilling, and tapping. Blood flow velocity in the V3 segment of the VA was recorded before and after posterior arthrodesis. All patients had a 12-month outpatient follow-up, and outcome was assessed using the Smiley-Webster Pain Scale. Neither VAI nor postoperative neurological impairments were observed in the Doppler group. In the control group, VAIs occurred in the 2 patients with C1 ponticulus posticus. In the Doppler group, 1 patient needed intra- and postoperative blood transfusions, and no difference in terms of Doppler signal or VA blood flow velocity was detected before and after C1-C2 posterior arthrodesis. In the control group, 3 patients needed intra- and postoperative blood transfusions.Useful in supporting fluoroscopy-assisted procedures, intraoperative Doppler may play a significant role even during surgeries in which neuronavigation is used, reducing the chance of a mismatch between the view on the neuronavigation screen and the actual course of the VA in the operative field and supplying the additional data of blood flow velocity.
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Affiliation(s)
| | | | - Jacopo Visani
- 2Neurosurgery Division, University Hospital S. Anna, Cona di Ferrara, Italy; and
| | | | - Walid Ibn Essayed
- 3Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pasquale De Bonis
- 2Neurosurgery Division, University Hospital S. Anna, Cona di Ferrara, Italy; and
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De Bonis P, Visani J, Zauli G, Mongardi L, Zamboni P, Cavallo MA. A Brain Hidden in the Ferrara Cathedral: A Novel Interpretation of a Renaissance Masterpiece. World Neurosurg 2019; 127:486-489. [PMID: 30954742 DOI: 10.1016/j.wneu.2019.03.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
The aim of present report was to briefly review the history of the anatomical studies during the Italian Renaissance and to outline their relationship to the figurative arts, focusing, in particular, on neuroanatomical studies that have been at the center of the medical and philosophical debate from the 14th to 16th centuries. Therefore, we have presented the interpretation of different Renaissance masterpieces for which some references to brain anatomy have been previously reported. We propose a new interpretation, in neuroanatomical key, of the fresco of the universal judgment in the vault of San Giorgio's Cathedral in Ferrara, Italy, painted around the end of the 16th century.
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Affiliation(s)
- Pasquale De Bonis
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy
| | - Jacopo Visani
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy.
| | - Giorgio Zauli
- Division of Anatomy and Histology, Department of Morphology, Surgery, and Experimental Medicine, St. Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy
| | - Paolo Zamboni
- Department of Vascular Surgery, St. Anna University Hospital, Ferrara, Italy
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Visani J, Staals EL, Donati D. Treatment of chronic osteomyelitis with antibiotic-loaded bone void filler systems: an experience with hydroxyapatites calcium-sulfate biomaterials. Acta Orthop Belg 2018; 84:25-29. [PMID: 30457496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This is a retrospective study that aims to quantify the problem of chronic osteomyelitis in one of the largest Italian orthopedic centers. Furthermore this study is focused on evaluation of efficacy of bone void filler systems with particular attention to a subgroup of patients treated with PerOssal®. Ninety-seven patients were included in this study between 2008 and 2013 with a minimum follow up of 24 months. A subgroup of 52 patients was treated with curettage plus PerOssal®, another group was treated with curettage only or curettage with other bone void filler systems. Overall we obtained a cure rate of 80,4%, whereas 19,6% had recurrent infection. Looking at the subgroup treated with PerOssal® we found a healing rate of 86,5%, which was significantly higher compared to the other groups. Of the patients with recurrence of infection, those treated with PerOssal® recurred 106 days later than the other patients.
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