1
|
Chiacchiaretta P, Perrucci MG, Caulo M, Navarra R, Baldiraghi G, Rolandi D, Luzzi S, Del Maestro M, Galzio R, Ferretti A. Correction: A Dedicated Tool for Presurgical Mapping of Brain Tumors and Mixed-Reality Navigation During Neurosurgery. J Digit Imaging 2023; 36:764-765. [PMID: 36513886 DOI: 10.1007/s10278-022-00750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Piero Chiacchiaretta
- Department of Psychological, Health and Territory Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy.
- Advanced Computing Core, Center for Advanced Studies and Technology (CAST), University "G. d'Annunzio"of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy.
- SerVE Srl, Via Falcone e Borsellino, 26, 65129, Pescara, Italy.
| | - Mauro Gianni Perrucci
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy
- SerVE Srl, Via Falcone e Borsellino, 26, 65129, Pescara, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy
- SerVE Srl, Via Falcone e Borsellino, 26, 65129, Pescara, Italy
| | | | - Gaia Baldiraghi
- SerVE Srl, Via Falcone e Borsellino, 26, 65129, Pescara, Italy
| | - Davide Rolandi
- SerVE Srl, Via Falcone e Borsellino, 26, 65129, Pescara, Italy
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia - Strada Nuova, 65, 27100, Pavia, Italy
| | - Mattia Del Maestro
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia - Strada Nuova, 65, 27100, Pavia, Italy
| | - Renato Galzio
- Maria Cecilia Hospital, Via Corriera, 1, 48033, Cotignola, RA, Italy
| | - Antonio Ferretti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy
- SerVE Srl, Via Falcone e Borsellino, 26, 65129, Pescara, Italy
| |
Collapse
|
2
|
Bianco A, Del Maestro M, Fanti A, Airoldi C, Fleetwood T, Crobeddu E, Cossandi C. Use of fluorescein sodium-assisted intraoperative sample validation to maximize the diagnostic yield of stereotactic brain biopsy: progress toward a new standard of care? J Neurosurg 2023; 138:358-366. [PMID: 36303472 DOI: 10.3171/2022.4.jns212954] [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: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In patients with contraindication to open resection, histological diagnosis is obtained through a stereotactic biopsy (SB). Missed diagnoses and sampling errors are important limitations of SB; therefore, various ways have been proposed to increase the diagnostic yield (DY). Intraoperative histopathology can obtain a DY exceeding 98% but with several drawbacks, namely prolonged operative times and logistic concerns. The objective of this study was to evaluate whether intraoperative validation of samples with fluorescein sodium can obtain a high DY with the same ease of use as standard SB. METHODS One hundred three consecutive cases of frameless neuronavigated SB performed at the authors' center from May 2013 to June 2021 were included. Two groups were compared: 46 patients underwent standard nonassisted SB (nSB), and 57 patients underwent fluorescein sodium-assisted SB (fSB). Data were collected retrospectively before 2017 and prospectively thereafter. DY, operative time, and rate of complications were compared between the two groups. The surgical technique for fSB was standardized, and a novel classification system for intraoperative fluorescence findings was developed. RESULTS Statistically significant differences between the two groups were identified. The DY of the fSB group (100%, 95% CI 93.73%-100%) was significantly greater than that of the nSB group (89.13%, 95% CI 80.14%-98.13%) (p = 0.0157). No statistically significant differences were observed in terms of mean operative time (p = 0.7104), intraoperative complications (p = 0.999), or postoperative complications (p = 0.5083). CONCLUSIONS Compared with standard nSB, fSB showed a significantly higher DY and similar surgical time and rate of complications. The ease of use, wide diagnostic spectrum, and low cost make fluorescein sodium preferable to other fluorophores. The present study strengthens the limited data in the literature indicating routine use of fSB. The proposed workflow suggests that fSB should be the standard of care for contrast-enhanced cases. Intraoperative histopathology should be limited to nonenhancing cases, and nSB should be avoided. Future prospective multicenter studies will be useful for further validation of our findings.
Collapse
Affiliation(s)
- Andrea Bianco
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Mattia Del Maestro
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Andrea Fanti
- 2Department of Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Chiara Airoldi
- 3Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; and
| | - Thomas Fleetwood
- 4Department of Neurology, Maggiore della Carità University Hospital, Novara, Italy
| | - Emanuela Crobeddu
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Christian Cossandi
- 1Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| |
Collapse
|
3
|
Galzio RJ, Del Maestro M, Pagkou D, Caulo M, Asioli S, Righi A, Fabbri VP, Luzzi S. First documented case of intracranial falcine malignant peripheral nerve sheath tumor: illustrative case. J Neurosurg Case Lessons 2021; 2:CASE21255. [PMID: 36131576 PMCID: PMC9589474 DOI: 10.3171/case21255] [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] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/24/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The authors reported the first documented case of intracranial extraaxial nonneurofibromatosis type 1-related nontriton malignant peripheral nerve sheath tumor (MPNST) originating from the falx cerebri. OBSERVATIONS A 34-year-old man with headache, short-term memory deficit, postural instability, and blurred vision presented with a large heterogenous contrast-enhanced intraventricular cystic lesion originating from the free margin of the falx cerebri. The patient received surgery using the right posterior interhemispheric approach. Gross total resection was performed, and the inferior border of the falx cerebri was resected. The postoperative course was uneventful. Histological examination revealed hypercellular foci of neoplastic spindle cells with hyperchromatic and wavy nuclei. Hence, a diagnosis of MPNST was made based on concomitant immunochemistry findings, including mouse double minute 2 homolog focal positivity and geographic loss of H3K27me3. The patient received adjuvant radiotherapy, and recurrence was not observed. LESSONS Intracranial MPNSTs are extremely rare tumors, typically originating from the cranial nerves in the posterior cranial fossa. An even rarer variant of these tumors, referred to as malignant intracerebral nerve sheath tumors, may directly arise from the brain parenchyma. The authors reported the first case of an intracranial MPNST originating from the dura mater of the falx cerebri, acting as an extraaxial lesion with prevalent expansion in the right ventricle.
Collapse
Affiliation(s)
| | | | - Diamantoula Pagkou
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Caulo
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Sofia Asioli
- Department of Neuroscience and Clinical Sciences, University of Chieti, Italy
| | - Alberto Righi
- Department of Biomedical and Neuromotor Sciences (DIBINEM)-Surgical Pathology Section, University of Bologna, Italy
| | | | - Sabino Luzzi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; and
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
4
|
Luzzi S, Giotta Lucifero A, Martinelli A, Maestro MD, Savioli G, Simoncelli A, Lafe E, Preda L, Galzio R. Supratentorial high-grade gliomas: maximal safe anatomical resection guided by augmented reality high-definition fiber tractography and fluorescein. Neurosurg Focus 2021; 51:E5. [PMID: 34333470 DOI: 10.3171/2021.5.focus21185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI)-based high-definition fiber tractography (HDFT) and sodium fluorescein (F) in high-grade glioma (HGG) surgery have not been investigated in detail. In this study, the authors aimed to evaluate the safety and efficacy profiles of HDFT-F microscope-based AR cytoreductive surgery for newly diagnosed supratentorial HGGs. METHODS Data of patients with newly diagnosed supratentorial HGGs who underwent surgery using the AR HDFT-F technique were reviewed and compared with those of a cohort of patients who underwent conventional white-light surgery assisted by infrared neuronavigation. The safety and efficacy of the techniques were reported based on the postoperative Neurological Assessment in Neuro-Oncology (NANO) scores, extent of resection (EOR), and Kaplan-Meier curves, respectively. The chi-square test was conducted for categorical variables. A p value < 0.05 was considered statistically significant. RESULTS A total of 54 patients underwent surgery using the AR HDFT-F technique, and 63 underwent conventional white-light surgery assisted by infrared neuronavigation. The mean postoperative NANO scores were 3.8 ± 2 and 5.2 ± 4 in the AR HDFT-F group and control group, respectively (p < 0.05). The EOR was higher in the AR HDFT-F group (p < 0.05) than in the control group. With a mean follow-up of 12.2 months, the rate of progression-free survival (PFS) was longer in the study group (log-rank test, p = 0.006) than in the control group. Moreover, the complication rates were 9.2% and 9.5% in the study and control groups, respectively. CONCLUSIONS Overall, AR HDFT-F-assisted surgery is safe and effective in maximizing the EOR and PFS rate for patients with newly diagnosed supratentorial HGGs, and in optimizing patient functional outcomes.
Collapse
Affiliation(s)
- Sabino Luzzi
- 1Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.,2Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Alice Giotta Lucifero
- 1Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia
| | - Andrea Martinelli
- 3Department of Science and High Technology, University of Insubria, Como
| | - Mattia Del Maestro
- 4PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia
| | - Gabriele Savioli
- 4PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.,5Emergency Department, IRCCS Policlinico San Matteo, Pavia; and
| | - Anna Simoncelli
- 6Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia; and
| | - Elvis Lafe
- 6Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia; and
| | - Lorenzo Preda
- 6Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia; and
| | - Renato Galzio
- 7Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
5
|
Pagkou D, Del Maestro M, Luzzi S, Morbini P, Foroglou N, Galzio RJ. Acute-onset diplopia from intracranial hypertension due to torcular herophili obstruction by an hemorrhagic intradiploic epidermoid cyst. Surg Neurol Int 2021; 12:100. [PMID: 33880205 PMCID: PMC8053460 DOI: 10.25259/sni_578_2020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Epidermoid cysts are benign slow-growing congenital lesions, constituting approximately 1% of all cranial tumors. Most of these lesions are located intradurally, while about 10-25% of them are located within the diploic spaces. Intradiploic epidermoid cysts are usually discovered incidentally and may remain asymptomatic for many years, but in rare instances, they may grow intracranially and produce brain compression. Sometimes, intradiploic epidermoid cysts may occlude the main cranial venous sinuses causing intracranial hypertension. CASE DESCRIPTION We present the case of a 24-year-old male harboring a paramedian right occipital intradiploic cyst with erosion of both outer and inner bony tables, which occluded the torcular herophili producing a worsening symptomatology with acute-onset diplopia from right sixth cranial nerve palsy; the patient also presented bilateral papilledema, but only reported mild headache and dizziness. Neuroradiological studies evidentiated a lesion compatible with intradiploic epidermoid cyst with intralesional hemorrhagic component, overlying and almost completely occluding the torcular herophili. Considering the fast worsening of symptomatology and the evidence of intracranial hypertension, the patient was operated on immediately after completion of clinical and radiological assessment. The lesion was radically removed with almost immediate reversal of signs and symptoms. Histopathology confirmed the diagnosis of epidermoid cyst with intralesional hemorrhagic components. CONCLUSION Intradiploic epidermoid cysts may cause intracranial hypertension by occlusion of main cranial venous sinuses; intralesional hemorrhage may act as precipitating factor in occlusion of the torcular herophili, producing rapidly worsening intracranial hypertension, which requires prompt surgical treatment to reverse symptomatology. Radical surgical resection is necessary to avoid recurrence.
Collapse
Affiliation(s)
- Diamantoula Pagkou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Morbini
- Department of Molecular Medicine, Unit of Pathological Anatomy, University of Pavia, Pavia, Lombardia, Italy
| | - Nikolaos Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Renato Juan Galzio
- Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Province of Ravenna, Italy
| |
Collapse
|
6
|
Luzzi S, Giotta Lucifero A, Elsawaf Y, Elbabaa SK, Del Maestro M, Savioli G, Galzio R, Gragnaniello C. Pulsatile cerebrospinal fluid dynamics in Chiari I malformation syringomyelia: Predictive value in posterior fossa decompression and insights into the syringogenesis. J Craniovertebr Junction Spine 2021; 12:15-25. [PMID: 33850377 PMCID: PMC8035583 DOI: 10.4103/jcvjs.jcvjs_42_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/08/2020] [Accepted: 12/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Pathophysiological mechanisms underlying the syringomyelia associated with Chiari I malformation (CM-1) are still not completely understood, and reliable predictors of the outcome of posterior fossa decompression (PFD) are lacking accordingly. The reported prospective case-series study aimed to prove the existence of a pulsatile, biphasic systolic–diastolic cerebrospinal fluid (CSF) dynamics inside the syrinx associated with CM-1 and to assess its predictive value of patients' outcome after PFD. Insights into the syringogenesis are also reported. Methods: Fourteen patients with symptomatic CM-1 syringomyelia underwent to a preoperative neuroimaging study protocol involving conventional T1/T2 and cardiac-gated cine phase-contrast magnetic resonance imaging sequences. Peak systolic and diastolic velocities were acquired at four regions of interest (ROIs): syrinx, ventral, and dorsal cervical subarachnoid space and foramen magnum region. Data were reported as mean ± standard deviation. After PFD, the patients underwent a scheduled follow-up lasting 3 years. One-way analysis of variance with Bonferroni Post hoc test of multiple comparisons was performed P was <0.001. Results: All symptoms but atrophy and spasticity improved. PFD caused a significant velocity changing of each ROI. Syrinx and premedullary cistern velocities were found to be decreased within the 1st month after PFD (<0.001). A caudad and cephalad CSF jet flow was found inside the syrinx during systole and diastole, respectively. Conclusion: Syrinx and premedullary cistern velocities are related to an early improvement of symptoms in patients with CM-1 syringomyelia who underwent PFD. The existence of a biphasic pulsatile systolic–diastolic CSF pattern inside the syrinx validates the “transmedullary” theory about the syringogenesis.
Collapse
Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Neurosurgery Unit, University of Pavia, Pavia, Italy.,Department of Surgical Sciences, Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Neurosurgery Unit, University of Pavia, Pavia, Italy
| | - Yasmeen Elsawaf
- Department of Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Samer K Elbabaa
- Department of Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Mattia Del Maestro
- Department of Surgical Sciences, Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gabriele Savioli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato Galzio
- Department of Neurosurgery, Maria Cecilia Hospital, Cotignola, Italy
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Luzzi S, Del Maestro M, Galzio R. Posterior Circulation Aneurysms: A Critical Appraisal of a Surgical Series in Endovascular Era. Acta Neurochir Suppl 2021; 132:39-45. [PMID: 33973027 DOI: 10.1007/978-3-030-63453-7_6] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The advent of the endovascular era has apparently decreased the role of microneurosurgery for many of the posterior circulation aneurysms. This study consists of a critical appraisal of a retrospective surgical series regarding posterior circulation aneurysms, targeted to define whether microneurosurgery still has a role for some of these. In 28 years, 157 aneurysms were surgically treated, 98 of which ruptured. The Average patient age was 56.7 ± 14.2 years, while in hemorrhagic cases, the mean Hunt-Hess score was 2.17 ± 0.8. Basilar tip, vertebral artery and proximal posterior inferior cerebellar artery were the most frequently involved sites. The treatment consisted of 128 clippings, 19 trappings, 7 wrappings, and 3 bypasses. A total exclusion was achieved in 88.5% of the aneurysms. An average follow-up of 67.1 ± 61.3 months proved no recurrences. The best results were observed in patients <65 years old who harbored small-to-regular aneurysms of the basilar tip, distal cerebellar arteries, or vertebral artery.Clipping proved to be a definitive and durable treatment for a large part of posterior circulation aneurysms, whereas bypass allows for treating aneurysms not amenable for coiling, stenting, or clipping. The present study confirms that microneurosurgery continues to have a paramount role within neurovascular pathology.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. .,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
8
|
Abstract
The advent of flow diverter (FD) stents has apparently reduced the role of microneurosurgery for paraclinoid aneurysms despite sparse high-quality evidence about their long-term effects.The present study critically reviews the overall results of a microneurosurgical series of 57 paraclinoid aneurysms.Of these aneurysms, 47.4% were regular in size while 19.3 were giant. Barami type I was predominant. In 21 aneurysms a hemorrhagic onset occurred. Pterional approach with intradural anterior clinoidectomy was preferred by far. Clipping was possible in 91.2% of aneurysms and a high-flow bypass was the choice in five cases. An mRS of 0-2 was achieved in 77.3% of patients, typically <50 years old.Visual field appeared improved or unchanged in 36.3% and 63.6% of the symptomatic patients, respectively. In 76.1% of incidental aneurysms, campimetry was unaffected by surgery.A complete aneurysm exclusion was achieved in 93% of cases using a single procedure. No recurrences were documented on an average follow-up of 54.1 ± 34 months.Microneurosurgery is still a valuable, definitive, and durable option for Barami type Ia, Ib, or II paraclinoid aneurysm, especially in patients <50 years old and visually symptomatic. Conditions other than these are ideal candidates for FD stents.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. .,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
9
|
Del Maestro M, Rampini AD, Mauramati S, Giotta Lucifero A, Bertino G, Occhini A, Benazzo M, Galzio R, Luzzi S. Dye-Perfused Human Placenta for Vascular Microneurosurgery Training: Preparation Protocol and Validation Testing. World Neurosurg 2020; 146:e854-e864. [PMID: 33197635 DOI: 10.1016/j.wneu.2020.11.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human placenta is recognized as a valuable vascular microneurosurgery training model because of its abundant availability, ethical acceptance, and analogous vasculature with other vessels of the human body; however, human placenta laboratory preparation techniques are not well described in the literature. This study outlines a detailed and standardized laboratory protocol for preparation of a color-perfused human placenta model. Survey-based validation of the model is also reported herein. METHODS The protocol involved cleaning and cannulation of the umbilical vein and arteries, irrigation with heparin, and storage at 3°C or freezing at -18°C. Before use, arteries were perfused with carmine/cochineal, and veins were perfused with methylthioninium chloride. A questionnaire with 5 questions was administered to 40 participants among attending or resident neurosurgeons, otolaryngologists, and maxillofacial surgeons on 4 consecutive microsurgical courses to assess the reliability of the placenta model. Trainees were divided into 3 groups based on their experience. A χ2 test was used to identify differences between groups. RESULTS Forty-two placentas were considered appropriate for training and were successfully perfused with dyes. Thirty-three participants completed the questionnaire, of which most, especially advanced and intermediate participants, indicated the placenta as a valuable, accurate, and reproducible model. No differences were observed among the groups. CONCLUSIONS The human placenta is an excellent tool for vascular microneurosurgery laboratory training. Color perfusion enhances the reliability of this model, which was validated by most surgeons, regardless of their experience.
Collapse
Affiliation(s)
- Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Angela Dele Rampini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Simone Mauramati
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Bertino
- Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Occhini
- Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Otorhinolaryngology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
10
|
Luzzi S, Gragnaniello C, Giotta Lucifero A, Marasco S, Elsawaf Y, Del Maestro M, Elbabaa SK, Galzio R. Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note. Neurol Res 2020; 43:110-125. [PMID: 33054694 DOI: 10.1080/01616412.2020.1831303] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To report the results of a retrospective series and a technical note about the anterolateral approach for the treatment of the rotational occlusion syndrome (ROS) involving the subaxial V2 segment of the vertebral artery (VA). METHODS We retrospectively reviewed the data of a cohort of patients that underwent an anterolateral approach to decompress the VA as they suffered from ROS secondary to a subaxial compression. A dynamic study with ultrasonography, CT, MRI, and catheter-based angiography were obtained in all cases. Severe symptomatology and cerebellar-brainstem strokes were indications for surgery. The anterolateral approach involved a pre-sternocleidomastoid precarotid exposure. The retro-longus colli and pre-scalenic corridors were used to access the C5-C6 and C3-C4 segment, respectively, and to perform the decompression. RESULTS Twelve patients were treated. Recurrent drop attacks were present in all cases. Osteophytes at C5 and C6 were the most common causes of subaxial VA compression. Anterior decompression stand-alone was performed in all but 1 patient. A recurrent laryngeal nerve palsy and a numbness of the C5 nerve root were the only complications observed, both transient. A satisfactory untethering of the VA with a complete recovery was achieved in all patients, apart from those with severe infratentorial strokes. DISCUSSION READ Anterolateral approach allows for an effective and safe treatment of the ROS involving the subaxial portion of the VA. Retro-longus colli and pre-scalenic corridors, developed through a precarotid exposure, have an anatomical rationale in decreasing the risks of complications. Decompression stand-alone is adequate in almost the totality of cases.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago , Chicago, IL, USA
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy
| | - Stefano Marasco
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy
| | - Yasmeen Elsawaf
- Department of Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children , Orlando, FL, USA
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo , Pavia, Italy.,School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia , Pavia, Italy
| | - Samer K Elbabaa
- Department of Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children , Orlando, FL, USA
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital , Cotignola, Italy
| |
Collapse
|
11
|
Esposito V, di Russo P, Del Maestro M, Ciavarro M, Vangelista T, De Angelis M, Fava A, Morace R. The Interhemispheric Transgenual Approach for Microsurgical Removal of Third Ventricle Colloid Cysts. Technical Note. World Neurosurg 2020; 142:197-205. [DOI: 10.1016/j.wneu.2020.06.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 11/16/2022]
|
12
|
Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Galzio R. Surgical Management of Giant Intracranial Aneurysms: Overall Results of a Large Series. World Neurosurg 2020; 144:e119-e137. [PMID: 32949801 DOI: 10.1016/j.wneu.2020.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 06/07/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review and discuss surgical treatment options for giant intracranial aneurysms (GIAs), focusing on indications, technical aspects, and results, along with some illustrative cases. METHODS We reviewed the data of 82 consecutive patients surgically managed between January 2000 and December 2019 for treatment of a GIA. RESULTS Male sex and hemorrhage at presentation were prevalent. The average follow-up was 81.2 ± 45 months. The anterior circulation was involved in 76.8% of GIAs. If the GIA showed a clear neck, minimal atherosclerosis, or intrasaccular thrombosis, and ≤2 branches arising from the neck, it was reconstructed. This procedure was possible in 78% of cases. The technique also involved temporary clipping, remodeling, and thrombectomy, as well as fragmentation techniques. Angioarchitectural features other than these techniques underwent bypass and aneurysm trapping. Most bypasses were extracranial to intracranial and high flow. Flow capacity, collateral circulation, and availability of the donor vessel mainly affected the choice of the type of bypass. Overall, successful exclusion of the GIA was 91.4%. The need for retreatment and complication rate were 3.6% and 19.5%, respectively. A good overall outcome (modified Rankin Scale score 0-3) was achieved in 84.2% of patients, and mortality was 10%. CONCLUSIONS Microneurosurgical techniques still maintain a significant role for most GIAs, with a high durability and acceptable rate of morbidity and mortality. Clip reconstruction is the first-line surgical treatment option, whereas bypass is indicated in cases of planned or unplanned sacrifice of the parent artery to prevent long-term ischemic complications.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
13
|
Luzzi S, Gragnaniello C, Marasco S, Lucifero AG, Del Maestro M, Bellantoni G, Galzio R. Subaxial Vertebral Artery Rotational Occlusion Syndrome: An Overview of Clinical Aspects, Diagnostic Work-Up, and Surgical Management. Asian Spine J 2020; 15:392-407. [PMID: 32898967 PMCID: PMC8217850 DOI: 10.31616/asj.2020.0275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
Extrinsic compression of the subaxial vertebral artery (VA) may cause rotational occlusion syndrome (ROS) and contribute to vertebrobasilar insufficiency potentially leading to symptoms and in severe cases, to posterior circulation strokes. The present literature review aimed to report the main clinical findings, diagnostic work-up, and surgical management of the subaxial VA-ROS, the diagnosis of which can be difficult and is often underestimated. An illustrative case is also presented. A thorough literature search was conducted to retrieve manuscripts that have discussed the etiology, diagnosis, and treatment of ROS. Total 41 articles were selected based on the best match and relevance and mainly involved case reports and small cases series. The male/female ratio and average age were 2.6 and 55.6±11 years, respectively. Dizziness, visual disturbances, and syncope were the most frequent symptoms in order of frequency, while C5 and C6 were the most affected levels. Osteophytes were the cause in >46.2% of cases. Dynamic VA catheter-based angiography was the gold standard for diagnosis along with computed tomography angiography. Except in older patients and those with prohibitive comorbidities, anterior decompressive surgery was always performed, mostly with complete recovery, and zero morbidity and mortality. A careful neurological evaluation and dynamic angiographic studies are crucial for the diagnosis of subaxial VA-ROS. Anterior decompression of the VA is the cure of this syndrome in almost all cases.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Stefano Marasco
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe Bellantoni
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| |
Collapse
|
14
|
Luzzi S, Giotta Lucifero A, Marasco S, Del Maestro M, Bellantoni G, Gragnaniello C. Targeting of renin-angiotensin system in COVID-19 patients affected by stroke: Emerging concerns about detrimental vs. benefit effect. Interdiscip Neurosurg 2020; 22:100822. [PMID: 32835018 PMCID: PMC7347486 DOI: 10.1016/j.inat.2020.100822] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 01/13/2023]
Abstract
Objective The present short report summarizes some clinical characteristics of six patients affected by stroke while being on angiotensin-converting enzyme (ACE)2 inhibitors and angiotensin II receptor blockers (ARBs) before and during COVID-19. Methods Medical charts and images of six patients affected by stroke while being on ACE-Is and ARBs therapy before and during COVID-19 outbreak in Lombardy region, Italy, were reviewed. Results Three patients had a dural sinus thrombosis, whereas the remaining suffered by an arterial ischemia, which was a middle cerebral artery occlusion in one case, and a posterior-inferior cerebellar artery occlusion in the remaining two. All patients showed clinical features typical of SARS-CoV-2 infection and positive chest CT scan, and were treated with ACE-Is as needed. Hypercoagulability panel was negative in any case. A recovery was achieved in all cases, although in a variable manner. Conclusions Whether or not and in which manner the pharmacomodulation of the renin-angiotensin system may had affect the clinical course of the reported six COVID-19 patients affected by stroke has to be still clarified. An urgent need of randomized clinical trials aimed to assess the safety profile and neuroprotective properties of ACE-Is and ARBs in COVID-19 patients diagnosed with stroke does exists.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74 - 27100 Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19 - 27100 Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74 - 27100 Pavia, Italy
| | - Stefano Marasco
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74 - 27100 Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19 - 27100 Pavia, Italy
- School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74 - 27100 Pavia, Italy
| | - Giuseppe Bellantoni
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19 - 27100 Pavia, Italy
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL 60607, USA
| |
Collapse
|
15
|
Savioli G, Ceresa IF, Ciceri L, Sciutti F, Belliato M, Iotti GA, Luzzi S, Del Maestro M, Mezzini G, Lafe E, Simoncelli A, Ricevuti G, Manzoni F, Bressan MA. Mild head trauma in elderly patients: experience of an emergency department. Heliyon 2020; 6:e04226. [PMID: 32671238 PMCID: PMC7347629 DOI: 10.1016/j.heliyon.2020.e04226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/21/2020] [Revised: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. MATERIAL AND METHODS We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. RESULTS We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The "elderly population" was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). CONCLUSIONS These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding.
Collapse
Affiliation(s)
- Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Luca Ciceri
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabio Sciutti
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirko Belliato
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Sabino Luzzi
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Mezzini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Elvis Lafe
- Neuro Radiodiagnostic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Simoncelli
- Neuro Radiodiagnostic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Federica Manzoni
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | |
Collapse
|
16
|
Savioli G, Ceresa IF, Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Marasco S, Manzoni F, Ciceri L, Gelfi E, Ricevuti G, Bressan MA. Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists. Medicina (Kaunas) 2020; 56:E308. [PMID: 32585829 PMCID: PMC7353902 DOI: 10.3390/medicina56060308] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022]
Abstract
Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.
Collapse
Affiliation(s)
- Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (L.C.); (E.G.); (M.A.B.)
- Department of Clinical-Surgical, PhD School in Experimental Medicine, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Iride Francesca Ceresa
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (L.C.); (E.G.); (M.A.B.)
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (S.L.); (A.G.L.); (S.M.)
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Cristian Gragnaniello
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL 60656, USA;
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (S.L.); (A.G.L.); (S.M.)
| | - Mattia Del Maestro
- Department of Clinical-Surgical, PhD School in Experimental Medicine, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Marasco
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (S.L.); (A.G.L.); (S.M.)
| | - Federica Manzoni
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Luca Ciceri
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (L.C.); (E.G.); (M.A.B.)
| | - Elia Gelfi
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (L.C.); (E.G.); (M.A.B.)
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, Italy, -Saint Camillus International University of Health Sciences-Rome-Italy, 27100 Pavia, Italy;
| | - Maria Antonietta Bressan
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (L.C.); (E.G.); (M.A.B.)
| |
Collapse
|
17
|
Canzi P, Avato I, Marconi S, Del Maestro M, Lucifero AG, Magnetto M, Carlotto E, Auricchio F, Luzzi S, Benazzo M. A 3D printed custom-made mask model for frameless neuronavigation during retrosigmoid craniotomy. A preclinical cadaveric feasibility study. Ann Ital Chir 2020; 9:S2239253X20032843. [PMID: 32573486] [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: 06/11/2023]
Abstract
BACKGROUND A 3D printing custom-made mask model was tested in terms of feasibility and accuracy for frameless neuronavigation during retrosigmoid approach. METHODS A virtual 3D model of a cadaveric injected head was obtained from a high-resolution Computed Tomography (CT) scan and 3D Printed (3DP). The course of the transverse and sigmoid sinus was marked. A transparent custommade 3DP mask model was created as a cast of 3D model. The area of the lateral sinuses was grooved to allow the surgeon to use the mask as a template to draw the course of the sinuses on the patient skull. A right retrosigmoid approach was performed on formalin-fixed injected cadaveric head. Inion and other conventional landmarks were used to mark the course of the sinuses. 3DP mask was used to re-mark the course of the sinuses. The mismatch between the landmarks-based and 3DP mask-based track was assumed as a measure of the accuracy of the 3DP mask model. RESULTS 3DP mask model resulted precise, feasible, easy and fast to use. A perfect interlocking with the retrosigmoid area was noted. Mismatch between the landmarks-based and 3DP mask-based track was of 4 and 6 mm for transverse and sigmoid sinus, respectively. CONCLUSION 3DP custom-made mask model is feasible, easily reproducible and reliable for the implementation of a frameless neuronavigation during retrosigmoid approach. Its accuracy is greater than that of the bone landmark neuronavigation. In selected cases, 3DP mask can be a valid option to image-guided optical or electromagnetic tracking systems. KEY WORDS 3D Printing, Neuronavigation, Retrosigmoid Approach, Sigmoid Sinus, Transverse Sinus.
Collapse
|
18
|
Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Iotti GA, Luzzi S, Del Maestro M, Mezzini G, Giotta Lucifero A, Lafe E, Simoncelli A, Manzoni F, Cobianchi L, Mosconi M, Cuzzocrea F, Benazzo F, Ricevuti G, Bressan MA. Trauma Coagulopathy and Its Outcomes. ACTA ACUST UNITED AC 2020; 56:medicina56040205. [PMID: 32344710 PMCID: PMC7230692 DOI: 10.3390/medicina56040205] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/17/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022]
Abstract
Background and Objectives: Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. Material and Methods: We conducted a prospective, monocentric, observational study of all patients (n = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Results: Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was >10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE <−6. Conclusions: Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion (p = 0.016) requirements and need hospitalization (p = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) (p = 0.000) and a greater number of anatomical districts involved (p = 0.000). Head trauma (p = 0.000) and abdominal trauma (p = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy (p = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.
Collapse
Affiliation(s)
- Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Correspondence:
| | - Iride Francesca Ceresa
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| | - Sarah Macedonio
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| | - Sebastiano Gerosa
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| | - Mirko Belliato
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.B.); (G.A.I.)
| | - Giorgio Antonio Iotti
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.B.); (G.A.I.)
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (G.M.); (A.G.L.)
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Gianluca Mezzini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (G.M.); (A.G.L.)
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (G.M.); (A.G.L.)
| | - Elvis Lafe
- Neuro Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.L.); (A.S.)
| | - Anna Simoncelli
- Neuro Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.L.); (A.S.)
| | - Federica Manzoni
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Lorenzo Cobianchi
- General Surgery Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Mario Mosconi
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.M.); (F.C.); (F.B.)
| | - Fabrizio Cuzzocrea
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.M.); (F.C.); (F.B.)
| | - Francesco Benazzo
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.M.); (F.C.); (F.B.)
| | - Giovanni Ricevuti
- Department of Internal Medicine and Therapeutics, Cellular Pathophysiology and Clinical immunology Laboratory, University of Pavia, 27100 Pavia, Italy;
| | - Maria Antonietta Bressan
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| |
Collapse
|
19
|
Luzzi S, Del Maestro M, Elbabaa SK, Galzio R. Letter to the Editor Regarding "One and Done: Multimodal Treatment of Pediatric Cerebral Arteriovenous Malformations in a Single Anesthesia Event". World Neurosurg 2020; 134:660. [PMID: 32059273 DOI: 10.1016/j.wneu.2019.09.166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Ph.D. School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Samer K Elbabaa
- Pediatric Neurosurgery, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
20
|
Zoia C, Lombardi F, Fiore MR, Montalbetti A, Iannalfi A, Sansone M, Bongetta D, Valvo F, Del Maestro M, Luzzi S, Galzio RJ. Sacral solitary fibrous tumour: surgery and hadrontherapy, a combined treatment strategy. Rep Pract Oncol Radiother 2020; 25:241-244. [PMID: 32025222 DOI: 10.1016/j.rpor.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/24/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cesare Zoia
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Lombardi
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Andrea Montalbetti
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Sansone
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Renato Juan Galzio
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| |
Collapse
|
21
|
Antonosante A, Brandolini L, d’Angelo M, Benedetti E, Castelli V, Maestro MD, Luzzi S, Giordano A, Cimini A, Allegretti M. Autocrine CXCL8-dependent invasiveness triggers modulation of actin cytoskeletal network and cell dynamics. Aging (Albany NY) 2020; 12:1928-1951. [PMID: 31986121 PMCID: PMC7053615 DOI: 10.18632/aging.102733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Abstract
Glioblastoma (GB) is the most representative form of primary malignant brain tumour. Several studies indicated a pleiotropic role of CXCL8 in cancer due to its ability to modulate the tumour microenvironment, growth and aggressiveness of tumour cell. Previous studies indicated that CXCL8 by its receptors (CXCR1 and CXCR2) induced activation of the PI3K/p-Akt pathway, a crucial event in the regulation of cytoskeleton rearrangement and cell mobilization. Human GB primary cell culture and U-87MG cell line were used to study the effects of CXCR1 and CXCR2 blockage, by a dual allosteric antagonist, on cell migration and cytoskeletal dynamics. The data obtained point towards a specific effect of autocrine CXCL8 signalling on GB cell invasiveness by the activation of pathways involved in cell migration and cytoskeletal dynamics, such as PI3K/p-Akt/p-FAK, p-cortactin, RhoA, Cdc42, Acetylated α-tubulin and MMP2. All the data obtained support the concept that autocrine CXCL8 signalling plays a key role in the activation of an aggressive phenotype in primary glioblastoma cells and U-87MG cell line. These results provide new insights about the potential of a pharmacological approach targeting CXCR1/CXCR2 pathways to decrease migration and invasion of GB cells in the brain parenchyma, one of the principal mechanisms of recurrence.
Collapse
Affiliation(s)
- Andrea Antonosante
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Michele d’Angelo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Elisabetta Benedetti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Vanessa Castelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Sabino Luzzi
- San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Antonio Giordano
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, Philadelphia, PA 19122, USA
| | - Annamaria Cimini
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, Temple University, Philadelphia, PA 19122, USA
| | | |
Collapse
|
22
|
Canzi P, Avato I, Marconi S, Del Maestro M, Lucifero AG, Magnetto M, Carlotto E, Auricchio F, Luzzi S, Benazzo M. A 3D printed custom-made mask model for frameless neuronavigation during retrosigmoid craniotomy. A preclinical cadaveric feasibility study. Ann Ital Chir 2020; 91:526-533. [PMID: 32588834] [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: 06/11/2023]
Abstract
BACKGROUND A 3D printing custom-made mask model was tested in terms of feasibility and accuracy for frameless neuronavigation during retrosigmoid approach. METHODS A virtual 3D model of a cadaveric injected head was obtained from a high-resolution Computed Tomography (CT) scan and 3D Printed (3DP). The course of the transverse and sigmoid sinus was marked. A transparent custommade 3DP mask model was created as a cast of 3D model. The area of the lateral sinuses was grooved to allow the surgeon to use the mask as a template to draw the course of the sinuses on the patient skull. A right retrosigmoid approach was performed on formalin-fixed injected cadaveric head. Inion and other conventional landmarks were used to mark the course of the sinuses. 3DP mask was used to re-mark the course of the sinuses. The mismatch between the landmarks-based and 3DP mask-based track was assumed as a measure of the accuracy of the 3DP mask model. RESULTS 3DP mask model resulted precise, feasible, easy and fast to use. A perfect interlocking with the retrosigmoid area was noted. Mismatch between the landmarks-based and 3DP mask-based track was of 4 and 6 mm for transverse and sigmoid sinus, respectively. CONCLUSION 3DP custom-made mask model is feasible, easily reproducible and reliable for the implementation of a frameless neuronavigation during retrosigmoid approach. Its accuracy is greater than that of the bone landmark neuronavigation. In selected cases, 3DP mask can be a valid option to image-guided optical or electromagnetic tracking systems. KEY WORDS 3D Printing, Neuronavigation, Retrosigmoid Approach, Sigmoid Sinus, Transverse Sinus.
Collapse
|
23
|
Affiliation(s)
- Sabino Luzzi
- 1University of Pavia, Italy; and.,2Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Renato Galzio
- 1University of Pavia, Italy; and.,2Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
24
|
Luzzi S, Zoia C, Rampini AD, Elia A, Del Maestro M, Carnevale S, Morbini P, Galzio R. Lateral Transorbital Neuroendoscopic Approach for Intraconal Meningioma of the Orbital Apex: Technical Nuances and Literature Review. World Neurosurg 2019; 131:10-17. [DOI: 10.1016/j.wneu.2019.07.152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 12/01/2022]
|
25
|
Luzzi S, Crovace AM, Del Maestro M, Giotta Lucifero A, Elbabaa SK, Cinque B, Palumbo P, Lombardi F, Cimini A, Cifone MG, Crovace A, Galzio R. The cell-based approach in neurosurgery: ongoing trends and future perspectives. Heliyon 2019; 5:e02818. [PMID: 31844735 PMCID: PMC6889232 DOI: 10.1016/j.heliyon.2019.e02818] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/26/2019] [Revised: 10/11/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Examination of the current trends and future perspectives of the cell-based therapies in neurosurgery. METHODS A PubMed/MEDLINE-based systematic review has been performed combining the main Medical Subject Headings (MeSH) regarding the cell- and tissue-based therapies with the "Brain", "Spinal Cord", "Spine" and "Skull" MeSH terms. Only articles in English published in the last 10 years and pertinent to neurosurgery have been selected. RESULTS A total of 1,173 relevant articles have been chosen. Somatic cells and gene-modification technologies have undergone the greatest development. Immunotherapies and gene therapies have been tested for the cure of glioblastoma, stem cells mainly for brain and spinal cord traumatic injuries. Stem cells have also found a rationale in the treatment of the cranial and spinal bony defects, and of the intervertebral disc degeneration, as well.Most of the completed or ongoing trials concerning the cell-based therapies in neurosurgery are on phase 2. Future perspectives involve the need to overcome issues related to immunogenicity, oncogenicity and routes for administration. Refinement and improvement of vector design and delivery are required within the gene therapies. CONCLUSION The last decade has been characterised by a progressive evolution of neurosurgery from a purely mechanical phase to a new biological one. This trend has followed the rapid and parallel development of translational medicine and nanotechnologies.The introduction of new technologies, the optimisation of the already existing ones, and the reduction of costs are among the main challenges of the foreseeable future.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74, Pavia, 27100, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19, Pavia, 27100, Italy
| | - Alberto Maria Crovace
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Piazza G. Cesare, 11 – Policlinico di Bari, Bari, 70124, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19, Pavia, 27100, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74, Pavia, 27100, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74, Pavia, 27100, Italy
| | - Samer K. Elbabaa
- Pediatric Neurosurgery, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, 1222 S. Orange Avenue, 2nd Floor, MP 154, Orlando, FL, 32806, USA
| | - Benedetta Cinque
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Building Delta 6, via Coppito, L'Aquila, 67100, Italy
| | - Paola Palumbo
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Building Delta 6, via Coppito, L'Aquila, 67100, Italy
| | - Francesca Lombardi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Building Delta 6, via Coppito, L'Aquila, 67100, Italy
| | - Annamaria Cimini
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Building Delta 6, via Coppito, L'Aquila, 67100, Italy
| | - Maria Grazia Cifone
- Department of Life, Health & Environmental Sciences, University of L'Aquila, Building Delta 6, via Coppito, L'Aquila, 67100, Italy
| | - Antonio Crovace
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Piazza G. Cesare, 11 – Policlinico di Bari, Bari, 70124, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74, Pavia, 27100, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19, Pavia, 27100, Italy
| |
Collapse
|
26
|
Luzzi S, Giotta Lucifero A, Del Maestro M, Marfia G, Navone SE, Baldoncini M, Nuñez M, Campero A, Elbabaa SK, Galzio R. Anterolateral Approach for Retrostyloid Superior Parapharyngeal Space Schwannomas Involving the Jugular Foramen Area: A 20-Year Experience. World Neurosurg 2019; 132:e40-e52. [PMID: 31520759 DOI: 10.1016/j.wneu.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/28/2019] [Accepted: 09/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Schwannomas encompassing the superior parapharyngeal space are challenging lesions because of the anatomical complexity of this region and the frequent involvement of the neurovascular structures of the jugular foramen. The purpose of this study is to report the technical aspects and the advantages of the anterolateral approach, here proposed for schwannomas of this complex area. METHODS The main steps of the anterolateral approach are described in detail, along with the results of a consecutive series of 38 patients with a retrostyloid superior parapharyngeal schwannoma involving the jugular foramen operated on by means of this route between 1999 and 2019. RESULTS The supine position is generally preferred. The medial border of the sternocleidomastoid muscle, mastoid tip, and superior nuchal line are the landmarks for the hockey-stick skin incision. The accessory nerve is retrieved and mobilized cranially. Detachment of the sternocleidomastoid, digastric, and nuchal muscles allows for a 180° exposure of the extracranial side of the jugular foramen. Three working corridors, namely the pre-carotid, pre-jugular, and retro-jugular, allow access to the deeper part of the jugular foramen area and the superior parapharyngeal space. In the present series, a gross total resection was achieved in 89.4% of the patients. Three recurrences occurred after an average follow-up of 80.5 ± 51 months. CONCLUSIONS The anterolateral approach is highly effective in the treatment of retrostyloid superior parapharyngeal space schwannomas involving the jugular foramen. Its simplicity of execution, versatility, and very low morbidity are among its main strengths.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giovanni Marfia
- Experimental Neurosurgery and Cell Therapy Laboratory, Neurosurgery Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Institute of Aerospace Medicine, Italian Air Force, Milan, Italy
| | - Stefania Elena Navone
- Experimental Neurosurgery and Cell Therapy Laboratory, Neurosurgery Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Matias Baldoncini
- Microsurgical Neuroanatomy Laboratory-LaNeMic- II Division of Anatomy, Medicine School, University of Buenos Aires, Buenos Aires, Argentina; Department of Neurological Surgery, San Fernando Hospital, Buenos Aires, Argentina
| | - Maximiliano Nuñez
- Department of Neurosurgery, Hospital El Cruce, Buenos Aires, Argentina
| | - Alvaro Campero
- Servicio de Neurocirugía, Universidad Nacional de Tucumán, Tucumán, Argentina; Department of Neurosurgery, Hospital Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | - Samer K Elbabaa
- Pediatric Neurosurgery, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
27
|
Zoia C, Bongetta D, Dorelli G, Luzzi S, Maestro MD, Galzio RJ. Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature. Surg Neurol Int 2019; 10:76. [PMID: 31528414 PMCID: PMC6744740 DOI: 10.25259/sni-132-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 07/18/2018] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Cavernomas arising in the region of the optic apparatus are extremely rare, accounting for <1% of all the central nervous system cavernomas. Most patients are affected by acute visual disturbances related to hemorrhagic events. A prompt resection of the lesion together with a decompression of the optic apparatus may lead to a functional improvement. Almost all patients reported in literature were treated by means of a craniotomy, whereas only few papers described the use of a transnasal approach. Case Description: We report the case of a 53-year-old woman with a hemorrhagic, cavernous malformation of the optic chiasm region and we discuss the technical nuances of the endoscopic transnasal approach we employed. We also review literature for patients with cavernomas treated with a transsphenoidal approach. In our case, the patient underwent the gross-total resection of the lesion through a fully endoscopic transnasal route and the visual disturbances improved immediately after the operation. The ventral access allowed an adequate exposure of the chiasm/anterior circulation complex, thus avoiding an excessive dissection and retraction of neurovascular structures. Moreover, with the aid of angled scopes, we were able to identify the frail vascular supply of the chiasm by employing the suprachiasmatic corridor as well as the infrachiasmatic one. We stress the need for a careful reconstruction of the skull base to avoid a postoperative cerebrospinal fluid leak. Conclusions: With the evolution and spreading of the neuroendoscopic techniques, in selected cases, we advocate the use of the transnasal route for the removal of cavernomas arising in the region of the anterior optic pathways.
Collapse
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Gianluigi Dorelli
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| |
Collapse
|
28
|
Luzzi S, Elia A, Del Maestro M, Elbabaa SK, Carnevale S, Guerrini F, Caulo M, Morbini P, Galzio R. Dysembryoplastic Neuroepithelial Tumors: What You Need to Know. World Neurosurg 2019; 127:255-265. [PMID: 30981794 DOI: 10.1016/j.wneu.2019.04.056] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 03/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE An updated and comprehensive review on dysembryoplastic neuroepithelial tumor (DNET) focusing on differential diagnosis, atypical presentation, seizure outcome, and risk of malignant transformation. METHODS A PubMed/MEDLINE-based literature search has been performed using "dysembryoplastic neuroepithelial tumor" as a keyword. Two treated cases characterized by an atypical presentation have been reviewed. RESULTS Of 1162 articles, 200 relevant studies have been selected. DNET is a benign mixed neuronal-glial tumor causing drug-resistant epilepsy primarily in children and young adults. The typical radiological pattern is a magnetic resonance imaging (MRI) T1-hypointense, T2-, and fluid-attenuated inversion-recovery hyperintense multicystic lesion involving the cerebral cortex with no edema. Contrast enhancement may be present and a focal cortical dysplasia is commonly associated with it. MRI diffusion, perfusion, and spectroscopy have a paramount role in the differential diagnosis. The "specific glioneuronal elements" are pathognomonic. They are positive for S100 protein, synaptofisin, neuronal nuclei, oligodendrocyte transcription factor, neurite outgrowth inhibitor, and microtubule-associated protein 2, but negative for glial fibrillary acidic protein. As opposed to v-myb avian myeloblastosis viral oncogene homolog, isocitrate dehydrogenase-1/isocitrate dehydrogenase-2 mutation and codeletion 1p-19q, fibroblast growth factor receptor 1 and BRAF V600E mutations are present. The effectiveness of surgery on seizure outcome has been established. Rare malignant transformations have been reported, especially in extra-temporal and complex forms. CONCLUSIONS Advanced MRI techniques are fundamental in the differential diagnosis for DNET versus other low-grade gliomas. Immuno-phenotype assessment and search for fibroblast growth factor receptor 1 and BRAF V600E mutations limit the risk of misdiagnoses. A gross total tumor removal is generally associated with a seizure-free outcome. Recurrences and malignant transformations may rarely follow, legitimizing MRI surveillance in cases of subtotal tumor resection.
Collapse
Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; D.E.O.T. Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.
| | - Angela Elia
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Samer K Elbabaa
- Pediatric Neurosurgery Department, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Sergio Carnevale
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Guerrini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Patrizia Morbini
- Unit of Pathological Anatomy, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
29
|
Luzzi S, Del Maestro M, Trovarelli D, De Paulis D, Dechordi SR, Di Vitantonio H, Di Norcia V, Millimaggi DF, Ricci A, Galzio RJ. Endoscope-Assisted Microneurosurgery for Neurovascular Compression Syndromes: Basic Principles, Methodology, and Technical Notes. Asian J Neurosurg 2019; 14:193-200. [PMID: 30937034 PMCID: PMC6417326 DOI: 10.4103/ajns.ajns_279_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Microscopic microvascular decompression (MVD) has a low but not negligible failure rate due to some missed conflicts, especially in case of multiple offending vessels. The reported study is aimed to assess the principles, methodology, technical notes, and effectiveness of the endoscope-assisted (EA) MVD for neurovascular compression syndromes (NVCS) in the posterior fossa. Materials and Methods: A series of 43 patients suffering from an NVCS and undergone to an EA MVD were retrospectively reviewed. Syndromes were trigeminal neuralgia in 25 cases, hemifacial spasm in nine cases, positional vertigo in six cases, glossopharyngeal neuralgia in two cases, and spasmodic torticollis in one case. In all cases, a 0°–30° specially designed endoscope was inserted into the surgical field to find/treat those conflicts missed by the microscopic exploration. Each procedure was judged in terms of the effectiveness of the adjunct of the endoscope according to a three types classification system: Type I – improvement in the visualization of the nerve's root entry/exit zone; Type II – endoscopic detection of one or more conflicts involving the ventral aspects of the nerve and missed by the microscope; Type III – endoscope-controlled release of the neurovascular conflict otherwise difficult to treat under the only microscopic view. Results: A total of 55 conflicts were found and treated. Twenty-eight procedures were classified as Type I, nine as Type II, and six as Type III. All the patients had a full recovery from their symptoms. Conclusions: In selected cases, EA MVD offers some advantages in the detection and treatment of neurovascular conflicts in the posterior fossa.
Collapse
Affiliation(s)
- Sabino Luzzi
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | | | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | | | | | - Valerio Di Norcia
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | | | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
30
|
Luzzi S, Del Maestro M, Elia A, Vincitorio F, Di Perna G, Zenga F, Garbossa D, Elbabaa S, Galzio R. Morphometric and radiomorphometric study of the correlation between the foramen magnum region and the anterior and posterolateral approaches to ventral intradural lesions. Turk Neurosurg 2019; 29:875-886. [DOI: 10.5137/1019-5149.jtn.26052-19.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Bongetta D, Zoia C, Luzzi S, Maestro MD, Peri A, Bichisao G, Sportiello D, Canavero I, Pietrabissa A, Galzio RJ. Neurosurgical issues of bariatric surgery: A systematic review of the literature and principles of diagnosis and treatment. Clin Neurol Neurosurg 2018; 176:34-40. [PMID: 30500756 DOI: 10.1016/j.clineuro.2018.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/11/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is gaining popularity as the treatment of choice of morbid obesity since this condition is constantly increasing over the last decades. Several complications have emerged as the number of surgeries and follow-up data increase. No systematic review of the neurosurgery-related potential complications has been performed to date. Objective of this work is to fill this gap. We reviewed the literature for bariatric surgery-related complications involving the neurosurgical practice. Moreover, we present explicative cases dealing with peri- and post-operative therapeutic precautions. Three pathological mechanisms emerged. The first is related to intracranial pressure alterations and may imply either intracranial hypertension or hypotension syndromes in the operative or post-operative periods. The second is the deficiency of macro- and micro-nutrients which are potential risk factors for neuro- or myelo-encephalopathies, fetal malformations and spine disorders. The third is a dysregulation of both autonomic and endocrine / pituitary control. Neurosurgeons must be aware of the several, multifactorial neurosurgery-related complications of bariatric surgery as their prevalence is likely to be higher in the next few years.
Collapse
Affiliation(s)
- Daniele Bongetta
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Andrea Peri
- General Surgery Unit II, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Germana Bichisao
- Anesthesia and Intensive Care Unit I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Debora Sportiello
- Anesthesia and Intensive Care Unit I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Andrea Pietrabissa
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; General Surgery Unit II, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| |
Collapse
|
32
|
Luzzi S, Gallieni M, Del Maestro M, Trovarelli D, Ricci A, Galzio R. Giant and Very Large Intracranial Aneurysms: Surgical Strategies and Special Issues. Acta Neurochir Suppl 2018; 129:25-31. [PMID: 30171310 DOI: 10.1007/978-3-319-73739-3_4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Giant intracranial aneurysms (GIAs) and very large intracranial aneurysms (VLAs) have a poor natural history because of a high incidence of bleeding and strokes. These lesions always represent a great challenge for neurosurgeons and interventional neuroradiologists because of some peculiar intrinsic features such as size, angioarchitecture, wide neck, mass effect, intraluminal thrombosis, atherosclerotic changes, involvement of branches and perforators, and a frequent need to perform revascularization procedures. The results of a cumulative surgical series of 75 VLAs and GIAs are reported. Thirty-three aneurysms were unruptured. Sixty aneurysms underwent direct surgical treatment consisting of 56 direct clippings, 3 trappings w/o revascularization, and 1 wrapping. Fifteen aneurysms were treated by means of extracranial to intracranial (EC-IC) high-flow bypass. An mRS score ranging between 0 and 2 was observed in 54 patients, whereas an mRS of 3 was seen in 5 patients. Four patients had a severe disability (mRS 4-5) and six patients died. Aneurysm's fragmentation, with stacking and seating clips, thrombectomy, and aneurysmorrhaphy were the techniques most frequently employed. Revascularization options involving EC-IC high-flow bypass were used in cases not amenable for direct treatment. Some technical tips and special issues related to the surgical management of these complex lesions are discussed.
Collapse
Affiliation(s)
- Sabino Luzzi
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Massimo Gallieni
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy.
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | | | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Renato Galzio
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
33
|
Gallieni M, Del Maestro M, Luzzi S, Trovarelli D, Ricci A, Galzio R. Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms: Operative Technique, Reliability, and Feasibility Based on 14 Years of Personal Experience. Acta Neurochirurgica Supplement 2018; 129:19-24. [DOI: 10.1007/978-3-319-73739-3_3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
34
|
Del Maestro M, Luzzi S, Gallieni M, Trovarelli D, Giordano AV, Gallucci M, Ricci A, Galzio R. Surgical Treatment of Arteriovenous Malformations: Role of Preoperative Staged Embolization. Acta Neurochir Suppl 2018; 129:109-113. [PMID: 30171322 DOI: 10.1007/978-3-319-73739-3_16] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Preoperative embolization is complementary to surgery for large brain arteriovenous malformations (AVMs). From January 2005 to December 2015, 69 patients harboring an AVM were managed in our department by the same surgeon (RG). Forty one were ruptured and 65 were supratentorial. Thirty nine smaller AVMs were treated with surgery stand-alone, whereas, for 30 larger malformations, surgery was combined with adjuvant treatment involving preoperative staged embolization and/or, less frequently, radiosurgery. In all patients treated with surgery alone, complete resection of AVM was achieved. A successful preoperative partial endovascular obliteration of AVM was obtained in 24 out of 27 more complex cases, with a zero mortality rate and a very low morbidity. Here, embolization was of a certain utility in the handling of deeper feeders and nidus excision, also facilitating intraoperative hemostasis. In three cases of residuals, radiosurgery was performed. In those patient treated with a combined approach, a good overall outcome, 0-2 modified Rankin Scale (mRS), was achieved in 25 cases. Preoperative embolization proved to be a reasonable option complementary to high-grade AVMs surgery, reducing the frequency of breakthrough hemorrhages, aiding the elimination of deep feeders, and making the nidus dissection easier.
Collapse
Affiliation(s)
- Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (Me.S.V.A.), University of L'Aquila, L'Aquila, Italy.
| | - Sabino Luzzi
- Department of Neurosurgery, "San Salvatore" L'Aquila City Hospital, L'Aquila, Italy
| | - Massimo Gallieni
- Department of Life, Health and Environmental Sciences (Me.S.V.A.), University of L'Aquila, L'Aquila, Italy
| | - Donatella Trovarelli
- Department of Anesthesiology, "San Salvatore" L'Aquila City Hospital, L'Aquila, Italy
| | - Aldo Victor Giordano
- Department of Neuroradiology, "San Salvatore" L'Aquila City Hospital, L'Aquila, Italy
| | - Massimo Gallucci
- Department of Neuroradiology, "San Salvatore" L'Aquila City Hospital, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, "San Salvatore" L'Aquila City Hospital, L'Aquila, Italy
| | - Renato Galzio
- Department of Life, Health and Environmental Sciences (Me.S.V.A.), University of L'Aquila, L'Aquila, Italy
- Department of Neurosurgery, "San Salvatore" L'Aquila City Hospital, L'Aquila, Italy
| |
Collapse
|
35
|
Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Raysi SD, Murrone D, Luzzi S, Galzio RJ. Cortical aneurysms of the middle cerebral artery: A review of the literature. Surg Neurol Int 2017; 8:117. [PMID: 28680736 PMCID: PMC5482160 DOI: 10.4103/sni.sni_50_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 01/31/2016] [Accepted: 03/21/2017] [Indexed: 11/06/2022] Open
Abstract
Background: Middle cerebral artery (MCA) aneurysms constitute from 18–40% of all intracranial aneurysms. They are mainly found in the proximal and bifurcation tracts and only in the 1.1-1.7% of cases they are located in the distal segment. The authors report a case of a ruptured saccular cortical MCA aneurysm with unknown etiology. Case Description: A 53-year-old female was admitted with a sudden severe headache, nausea, vomiting, and a slight left hemiparesis. The computed tomography (CT) scan showed subarachnoid hemorrhage (SAH) in the left sylvian fissure and intracerebral hemorrhage (ICH) in the left posterior parietal area. The CT angiography (CTA) reconstructed with 3D imaging showed a small saccular aneurysm in the M4 segment in proximity of the angular area. A left parieto-temporal craniotomy was performed, the aneurysm was clipped and the ICH evacuated. The motor deficit was progressively recovered. At 3-month follow-up examination, the patient was asymptomatic and feeling well. Conclusions: In our opinion, surgery is the best choice for the treatment of ruptured M4 aneurysms with ICH, because it allows to evacuate the hematoma and to exclude the aneurysm from the intracranial circulation. In addition, we suggest both the use of the neuronavigation technique and of the indocyanine green videoangiography (ICGV) for the aneurismal surgery.
Collapse
Affiliation(s)
- Alessandro Ricci
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | | | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Soheila Dehcordi Raysi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Domenico Murrone
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Sabino Luzzi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| |
Collapse
|
36
|
Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Dehcordi SR, Murrone D, Coletti G, Calvisi G, Galzio RJ. Systemic sclerosis associated with colliquative necrosis in the cerebellum. Surg Neurol Int 2017; 8:44. [PMID: 28480106 PMCID: PMC5402329 DOI: 10.4103/sni.sni_401_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/28/2017] [Indexed: 11/09/2022] Open
Abstract
Background: The scleroderma is a complex autoimmune collagen disorder that can affect many organs simultaneously, as it occurs in the systemic sclerosis (SS), or only the skin, as it occurs in the localized scleroderma (LS). The neurological presentation is extremely uncommon, and even more uncommon are the symptoms of the scleroderma in the cerebellum. Case Description: We report the case of a 56-year-old male with cerebellar lesions mimicking a brain abscess. After surgical excision, the histopathological diagnosis deposed for an ischemic necrosis caused by a vasculopathy. All the bacteriological and viral exams were negative, whereas the rheumatologic tests were compatible with the scleroderma pattern. Conclusion: Up to now, the literature has described only 5 cases of scleroderma in the posterior cranial fossa. The authors report a case of SS causing colliquative necrosis in the cerebellum. Pathogenetic mechanisms, clinical aspects, and radiological features are discussed along with the pertinent literature.
Collapse
Affiliation(s)
- Alessandro Ricci
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Hambra Di Vitantonio
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Soheila Raysi Dehcordi
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Domenico Murrone
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Gino Coletti
- Department of Pathology, San Salvatore city Hospital, L'Aquila, Italy
| | - Giuseppe Calvisi
- Department of Pathology, San Salvatore city Hospital, L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, Italy
| |
Collapse
|
37
|
Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Gallieni M, Dechcordi SR, Marzi S, Galzio RJ. Parasagittal meningiomas: Our surgical experience and the reconstruction technique of the superior sagittal sinus. Surg Neurol Int 2017; 8:1. [PMID: 28217380 PMCID: PMC5288983 DOI: 10.4103/2152-7806.198728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/08/2016] [Indexed: 11/23/2022] Open
Abstract
Background: The radical resection of parasagittal meningiomas without complications and recurrences is the goal of the neurosurgeon. Nowadays, different managements are proposed. This study describes our surgical technique during the lesional excision and the reconstruction of the superior sagittal sinus (SSS). Methods: The total removal (Simpson I and II) of parasagittal meningiomas (WHO grade I and II) was obtained in 75 patients from September 2000 to January 2010. The indocyanine green videoangiography was used before the dural opening and, when necessary, to identify and preserve the cortical veins. The surgery of the SSS was performed in accordance with Sindou's classification, and its reconstruction was achieved through the use of a patch of galea capitis. Results: We had no cases of recurrence and thrombotic occlusion of the SSS in 5 years after the reconstruction. No complications were observed in 65 patients, and no cases of mortality were reported. Neurological focal deficits were observed in 5 patients. A brain swelling and a venous infarction were observed in 1 patient. Only one case of thrombotic occlusion was observed. A cerebrospinal fluid leak was observed in 2 patients, and a systemic complication was found in 1 patient. Conclusion: Several factors contribute to the success of the parasagittal meningioma surgery. We consider the preservation of the cortical veins to be important, and, when possible, we recommend the reconstruction of the anterior third of the SSS. Our experience has led us to believe that until now surgery is a winning choice if practiced by expert hands.
Collapse
Affiliation(s)
- Alessandro Ricci
- Department of Neurosurgery, San Salvatore City Hospital L'Aquila, Italy
| | - Hambra Di Vitantonio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore City Hospital L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Massimo Gallieni
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Soheila Raysi Dechcordi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Sara Marzi
- Department of Neurosurgery, San Salvatore City Hospital L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
38
|
Di Vitantonio H, De Paulis D, Del Maestro M, Ricci A, Dechordi SR, Marzi S, Millimaggi DF, Galzio RJ. Dural repair using autologous fat: Our experience and review of the literature. Surg Neurol Int 2016; 7:S463-8. [PMID: 27500007 PMCID: PMC4960926 DOI: 10.4103/2152-7806.185777] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Various materials have been proposed to obliterate dead spaces and to reconstruct dural defects during a neurosurgical approach. This study describes our technique of using the abdominal autologous fat graft and evaluates the complications and characteristics related to the use of this tissue during cranial procedures. Methods: Autologous fat grafts were used in 296 patients with basicranial and convexity extraaxial tumors from April 2005 to January 2015. The adipose tissue was removed from the paraumbilical abdominal region and was transformed into a thin foil. When possible, a watertight suture was made between the dural or bone edge with a fat graft. We always used fibrin glue to reinforce the dural closure. Results: Complications occurred between 2 days and 1 year following procedure. Cerebrospinal fluid leaks were found in 11 cases. No case of mortality, pseudomeningoceles, fistula, infections, bacterial meningitides, or lipoid meningitides was reported. No patient required removal of the graft. No adhesion was observed between the brain and the autologous fat. Other fat-related complications observed were 2 cases of fat necrosis in the abdomen and 2 cases of abdominal hemorrhage. Conclusion: The technique of harvesting and applying fat grafts is fairly simple, although it must be performed meticulously to be effective. Our experience has led us to believe that the use of fat grafts presents low morbidity and mortality. However, a neurosurgeon should never forget the possible late or early complications related to the use of fat grafts.
Collapse
Affiliation(s)
- Hambra Di Vitantonio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Soheila Raysi Dechordi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Sara Marzi
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Daniele F Millimaggi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Renato J Galzio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
39
|
Di Vitantonio H, De Paulis D, Ricci A, Raysi SD, Marzi S, Del Maestro M, Galzio RJ. Angiolymphoid hyperplasia with eosinophilia and entrapment of the ulnar nerve. Surg Neurol Int 2016; 7:S160-3. [PMID: 27069750 PMCID: PMC4802987 DOI: 10.4103/2152-7806.177896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022] Open
Abstract
Background: The angiolymphoid hyperplasia with eosinophilia (ALHE) is a sporadic vasoproliferative lesion of uncertain etiology involving the skin and the subcutaneous tissue. Occasionally, it involves also the large arteries compressing the near nerves. ALHE is commonly confused with Kimura's disease because of their clinical and histological similarities. Case Description: We report a case of a 52-year-old female suffering from a 6-month pain and paresthesias in the fourth and fifth finger of the right hand. The angiography showed a pseudoaneurysm in the proximal third of the right ulnar artery. A complete surgical excision of the vascular lesion was undertaken. The lesion forced the right ulnar nerve. The histopathological diagnosis deposed for ALHE. Conclusion: Up to now, literature has described 8 cases of ALHE involving the arteries, and only one case originating from the ulnar nerve. The authors report a case of a female with ALHE involving the ulnar artery that compressed the ulnar nerve. Clinical aspects, radiological features, surgical treatment, and operative findings are discussed reviewing the pertinent literature.
Collapse
Affiliation(s)
- Hambra Di Vitantonio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Soheila Dehcordi Raysi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Sara Marzi
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
40
|
De Paulis D, Nicosia G, Taddei G, Di Vitantonio H, Gallieni M, Del Maestro M, Dechordi SR, Galzio RJ. Intracranial aneurysms and optic glioma--an unusual combination: a case report. J Med Case Rep 2016; 10:78. [PMID: 27036496 PMCID: PMC4818450 DOI: 10.1186/s13256-016-0869-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coexistence of glial high grade tumors (glioblastoma, anaplastic astrocytoma) and cerebral aneurysms is common but the association with optic glioma is rare. The treatment of these associated lesions is problematic. CASE PRESENTATION A 36-year-old white woman presented to our institution with recurrent attacks of headache. Her preoperative radiological studies revealed a lesion of her left optic nerve with extension to the optic chiasma, an aneurysmatic dilatation of the left carotid bifurcation, a second aneurysm on the left of her middle cerebral artery, and a third one on her right anterior cerebral artery in the A2 tract. A left pterional approach was used to remove the tumor and clip the three aneurysmatic dilatations in a single stage. CONCLUSIONS We report this unusual case of optic glioma associated to multiples aneurysms and review the pertinent literature. An adequate knowledge of this association is mandatory to plan the correct approach to avoid complications.
Collapse
Affiliation(s)
- Danilo De Paulis
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy.
| | - Giancarlo Nicosia
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Graziano Taddei
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Hambra Di Vitantonio
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Massimo Gallieni
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Soheila Raysi Dechordi
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
41
|
Del Maestro M, De Paulis D, Ricci A, Di Cola F, Galzio R. Syringobulbia associated with posterior fossa meningioma: a review of the literature. Childs Nerv Syst 2014; 30:1749-52. [PMID: 24898517 DOI: 10.1007/s00381-014-2457-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 05/23/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Syringomyelia can be defined as a degenerative, progressive and chronic spinal cord disease. Its association with tumors of the posterior cranial fossa (PCF) is a rare condition. METHODS The authors report a rare case of syringobulbia consequent to a meningioma originating from PCF in a 17-year-old female, discussing the pathogenetic mechanism of development and the resolution of the syrinx cavity after surgical procedure. RESULTS The postoperative period was uneventful without complications. At 6-month follow-up, MRI revealed complete tumor removal with resolution of the syrinx cavity. CONCLUSIONS In cases of syringomyelia and tonsillar herniation associated with PCF meningioma, the tumor resection allows to eliminate the mass effect and increases the size of the posterior fossa with the progressive ascent of the cerebellar tonsils and the consequent reduction of their downward movement with systolic pulsation. The re-establishment of a normal anatomical condition led to the gradual disappearance of syrinx and hydrocephalus.
Collapse
Affiliation(s)
- Mattia Del Maestro
- Department of Life, Health & Environmental Sciences (Me.S.V.A.), University of L'Aquila, L'Aquila, Italy
| | | | | | | | | |
Collapse
|
42
|
Murrone D, De Paulis D, Gallieni M, Del Maestro M, Ricci A, Galzio RJ. Giant aneurysm of distal posterior inferior cerebellar artery: a case report and review of the literature. J Med Case Rep 2014; 8:169. [PMID: 24885677 PMCID: PMC4063245 DOI: 10.1186/1752-1947-8-169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Aneurysms in the vertebrobasilar system are rare and in the distal segment of the posterior inferior cerebellar artery they are even less frequent. Giant aneurysms are also rare in the posterior cranial fossa. Giant aneurysms of the distal posterior inferior cerebellar artery generally can have mainly compressive effects on the adjacent structures and they can be mistaken for tumors. CASE PRESENTATION We report the case of a 74-year-old Italian woman who presented with a complaint of dizziness. Her dizziness was found to be a result of aneurysmal dilatation arising from the distal segment of the right posterior inferior cerebellar artery. A mid-line suboccipital craniotomy was performed, and the aneurysm was clipped without post-operative deficits and with improvement in the patient's dizziness. In our present report, we also review the literature and discuss our case with regard to the clinical and radiological features and surgical procedure performed. CONCLUSION To the best of our knowledge, few cases of this type of aneurysm have been described in the literature. Our patient had a good outcome after surgical treatment.
Collapse
Affiliation(s)
- Domenico Murrone
- Department of Neurosurgery, “San Salvatore” City Hospital, via Vetoio, Coppito, L’Aquila 67100, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, “San Salvatore” City Hospital, via Vetoio, Coppito, L’Aquila 67100, Italy
| | - Massimo Gallieni
- Department of Neurosurgery, “San Salvatore” City Hospital, via Vetoio, Coppito, L’Aquila 67100, Italy
| | - Mattia Del Maestro
- Department of Neurosurgery, “San Salvatore” City Hospital, via Vetoio, Coppito, L’Aquila 67100, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, “San Salvatore” City Hospital, via Vetoio, Coppito, L’Aquila 67100, Italy
| | - Renato J Galzio
- Department of Life, Health and Environmental Sciences, University of L’Aquila, via Vetoio, L’Aquila 67100, Italy
| |
Collapse
|