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Umana GE, Tomasi SO, Palmisciano P, Scalia G, Da Ros V, Al-Schameri R, Priola SM, Brunasso L, Giammalva GR, Paolini F, Costanzo R, Bonosi L, Gerardi RM, Maugeri R, Strigari L, Stieg PE, Esposito G, Lawton MT, Griessenauer CJ, Winkler PA. Intracranial Venous Alteration in Patients With Aneurysmal Subarachnoid Hemorrhage: Protocol for the Prospective and Observational SAH Multicenter Study (SMS). Front Surg 2022; 9:847429. [PMID: 35449549 PMCID: PMC9018107 DOI: 10.3389/fsurg.2022.847429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundArterial vasospasm has been ascribed as the responsible etiology of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage (aSAH), but other neurovascular structures may be involved. We present the protocol for a multicenter, prospective, observational study focused on analyzing morphological changes in cerebral veins of patients with aSAH.Methods and AnalysisIn a retrospective arm, we will collect head arterial and venous CT angiograms (CTA) of 50 patients with aSAH and 50 matching healthy controls at days 0–2 and 7–10, comparing morphological venous changes. A multicenter prospective observational study will follow. Patients aged ≥18 years of any gender with aSAH will be enrolled at 9 participating centers based on the predetermined eligibility criteria. A sample size of 52 aSAH patients is expected, and 52 healthy controls matched per age, gender, and comorbidities will be identified. For each patient, sequential CTA will be conducted upon admission (day 0–2), at 7–10 days, and at 14–21 days after aSAH, evaluating volumes and morphology of the cerebral deep veins and main cortical veins. One specialized image collecting center will analyze all anonymized CTA scans, performing volumetric calculation of targeted veins. Morphological venous changes over time will be evaluated using the Dice coefficient and the Jaccard index and scored using the Boeckh–Behrens system. Morphological venous changes will be correlated to clinical outcomes and compared between patients with aSAH and healthy-controls, and among groups based on surgical/endovascular treatments for aSAH.Ethics and DisseminationThis protocol has been approved by the ethics committee and institutional review board of Ethikkommission, SALK, Salzburg, Austria, and will be approved at all participating sites. The study will comply with the Declaration of Helsinki. Written informed consent will be obtained from all enrolled patients or their legal tutors. We will present our findings at academic conferences and peer-reviewed journals.Approved Protocol Version and RegistrationVersion 2, 09 June 2021.
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Affiliation(s)
- Giuseppe E. Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
- *Correspondence: Giuseppe E. Umana
| | - S. Ottavio Tomasi
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance “Garibaldi”, Catania, Italy
| | - Valerio Da Ros
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Rahman Al-Schameri
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Stefano M. Priola
- Division of Neurosurgery Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Lara Brunasso
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Giuseppe Roberto Giammalva
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Federica Paolini
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Roberta Costanzo
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Lapo Bonosi
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Rosa Maria Gerardi
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Rosario Maugeri
- Post-graduate Residency Programme in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neuroscience, School of Medicine, Neurosurgical Clinic, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, United States
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael T. Lawton
- Departments of Neurosurgery and Neurobiology, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Christoph J. Griessenauer
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Peter A. Winkler
- Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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Tomasi SO, Umana GE, Scalia G, Raudino G, Graziano F, Palmisciano P, Priola SM, Cappai PF, Capone C, Lawrence PM, Erös CA, Martin KD, Chaurasia B, Maugeri R, Iacopino G, Da Ros V, Lawton MT, Griessenauer CJ, Winkler PA. The Superficial Anastomosing Veins of the Human Brain Cortex: A Microneurosurgical Anatomical Study. Front Surg 2022; 8:817002. [PMID: 35083275 PMCID: PMC8784509 DOI: 10.3389/fsurg.2021.817002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In this microneurosurgical and anatomical study, we characterized the superficial anastomosing veins of the human brain cortex in human specimens. Material and Methods: We used 21 brain preparations fixed in formalin (5%) that showed no pathological changes and came from the autopsy sections. The superficial veins were dissected out of the arachnoid with the aid of a surgical microscope. Results: We dissected nine female and 12 male brain specimens, with an average age of 71 ± 11 years (range 51–88 years). We classified the superficial veins in five types: (I) the vein of Trolard as the dominat vein; (II) the vein of Labbé as the dominant vein; (III) a dominant sylvian vein group, and the veins of Trolard and Labbé nonexistent or only rudimentary present without contact to the Sylvian vein group; (IV) very weak sylvian veins with the veins of Trolard and Labbé codominant; and V) direct connection of Trolard and Labbé bypassing the Sylvian vein group. The vein of Trolard was dominant (Type I) in 21.4% and the vein of Labbé (Type II) in 16.7%. A dominant sylvian vein group (Type III) was found in 42.9%. Type IV and Type V were found in 14.3 and 4.7% respectively. Conclusion: No systematic description or numerical distribution of the superior anastomotic vein (V. Trolard) and inferior anastomotic vein (V. Labbé) has been found in the existing literature. This study aimed to fill this gap in current literature and provide data to neurosurgeons for the practical planning of surgical approaches.
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Affiliation(s)
- S. Ottavio Tomasi
- Christian Doppler Clinic, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- *Correspondence: S. Ottavio Tomasi
| | | | | | | | | | | | - Stefano M. Priola
- Division of Neurosurgery Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | - Crescenzo Capone
- Department of Neurosurgery, University Hospital Zürich, Zurich, Switzerland
| | - Peter M. Lawrence
- Department of Neurosurgery, Barrow Neurological Institute (BNI), Phoenix, AZ, United States
| | - Christian A. Erös
- Department of Neurosurgery, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Bipin Chaurasia
- Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
| | - Rosario Maugeri
- Department of Neurosurgery, University of Palermo, Palermo, Italy
| | - Gerardo Iacopino
- Department of Neurosurgery, University of Palermo, Palermo, Italy
| | - Valerio Da Ros
- Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute (BNI), Phoenix, AZ, United States
| | - Christoph J. Griessenauer
- Christian Doppler Clinic, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter A. Winkler
- Christian Doppler Clinic, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Tomasi SO, Umana GE, Raudino G, Scalia G, Ganau M, Winkler PA. In Reply: Neurosurgery and Coronavirus (COVID-19) Epidemic: Doing Our Part. Neurosurg Open 2021; 1:okaa011. [PMID: 34632390 PMCID: PMC7499736 DOI: 10.1093/neuopn/okaa011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Ottavio Tomasi
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria
| | | | - Giuseppe Raudino
- Department of Neurosurgery Istituto di Ricovero e Cura ad alta specializzazione Policlinico di Monza Monza, Italy
| | - Gianluca Scalia
- Neurosurgery Unit Highly Specialized Hospital and of National Importance "Garibaldi" Catania, Italy
| | - Mario Ganau
- Division of Neurosciences Oxford University Hospitals NHS Foundation Trust Oxford, United Kingdom
| | - Peter A Winkler
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria
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Tomasi SO, Umana GE, Scalia G, Winkler PA. In Reply: Rongeurs, Neurosurgeons, and COVID-19: How Do We Protect Health Care Personnel During Neurosurgical Operations in the Midst of Aerosol-Generation From High-Speed Drills? Neurosurgery 2020; 87:E166. [PMID: 32385489 PMCID: PMC7239171 DOI: 10.1093/neuros/nyaa213] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Ottavio Tomasi
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy Christian Doppler Klinik Salzburg, Austria
| | | | - Gianluca Scalia
- Division of Neurosurgery Department of Biomedical and Dental Sciences and Morpho-Functional Imaging University of Messina Messina, Italy
- Department of Neurosurgery Highly Specialized Hospital of National Importance “Garibaldi” Catania, Italy
| | - Peter A Winkler
- Department of Neurological Surgery Christian Doppler Klinik Paracelsus Medical University Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy Christian Doppler Klinik Salzburg, Austria
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Boss OL, Tomasi SO, Bäurle B, Sgier F, Hausmann ON. Lumbar total disc replacement: correlation of clinical outcome and radiological parameters. Acta Neurochir (Wien) 2013; 155:1923-30. [PMID: 23748926 DOI: 10.1007/s00701-013-1774-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/13/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to correlate various radiological parameters with clinical outcome in patients who had undergone lumbar total disc replacement (TDR). Lumbar TDR is one possible treatment option in patients with low back pain (LBP), offering an alternative to lumbar fusion. Favourable clinical outcome hinges on a number of radiological parameters, such as mobility, sintering, and-most importantly-accurate positioning of the implant. METHODS A total of 46 patients received a prosthetic disc because of degenerative lumbar disc disorders. Follow-up evaluation included analysis of radiographs and subjective rating of the clinical status by the patient using the North American Spine Society (NASS) patient questionnaire, visual analogue scale (VAS) for pain and state of health, and the EuroQol EQ-5D. Radiological follow-up took place after 2 years. Coronal and sagittal positions of the prosthesis, intervertebral disc height, facet joint pressure, mobility, sintering, and calcification were evaluated. Optimal positioning of the prosthesis was defined as a central coronal position and a most dorsal position in the sagittal plane. Based on the radiologically determined placement of the prosthesis, the patient population was divided into three groups, i.e., prosthesis ideally placed (<2 mm), discretely shifted (2-3 mm), or suboptimally placed (>3 mm). RESULTS Overall, 81 % of patients stated that they would undergo the operation again. Health status was stable at a VAS score of 7.04 points 2 years after TDR, compared to 3.97 points before TDR. Mean working capacity had increased from 53 % preoperatively to 88 % 2 years after TDR. Overall, 39 % of the prostheses were rated as ideally positioned, while 13 % were discretely shifted and 48 % were suboptimally placed with respect to one of the radiological criteria. In 80.4 % of patients, follow-up assessment after ≥2 years indicated good mobility at the operated segment, while calcification was noted in 4 % and sintering was detected in 15 % of the implants. CONCLUSIONS Our data indicate poor correlation between clinical outcome and position of the prosthesis. Although 48 % of the implants were suboptimally placed in either the coronal or sagittal plane, most of the patients reached a very good clinical outcome. However, suboptimally placed devices appeared to cause significantly more neurological symptoms in long-term follow-up.
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Affiliation(s)
- Oliver L Boss
- Neuro- and Spine Centre, Hirslanden Clinic St. Anna, St. Anna Strasse 32, 6006, Lucerne, Switzerland
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Tomasi SO, Ghani I, Waldvogel D, Hausmann O. Radicular pain from lumbar canal stenosis in addition to pre-existing phantom limb pain. J Neurol Surg A Cent Eur Neurosurg 2013; 74 Suppl 1:e92-5. [PMID: 23427034 DOI: 10.1055/s-0032-1328952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Phantom limb (PL) is a term used to designate the sensation of the presence of an extremity following amputation, and it may be seen immediately after injury or years later in the part of the body that is deafferented or amputated. Phantom limb pain (PLP) is the term used to describe painful sensations referred to the absent limb. We present a case of a 71-year-old male with spinal claudication from discoligamentous lumbar canal stenosis L3-L4 and L4-L5 with L5 radicular pain in the left PL 13 years after the amputation. The patient had a disappearance of his radicular pain in the left PL following microsurgical lumbar decompression of L3-L4 and L4-L5. This is one of the rare cases reported in the literature in which a radicular pain in the PL disappeared following surgical decompression of the spinal canal.
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Affiliation(s)
- S O Tomasi
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - I Ghani
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - D Waldvogel
- Department of Neurology, Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - O Hausmann
- Department of Neurosurgery, Hirslanden Klinik St. Anna, Luzern, Switzerland
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