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Paglia F, Caporlingua A, Armocida D, Rizzo F, Santoro A, D'angelo L. Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: A free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery. Neurocirugia (Astur : Engl Ed) 2022; 33:219-226. [PMID: 36084958 DOI: 10.1016/j.neucie.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/18/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures. METHODS For each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella. RESULTS For the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (n=3), inexpert (n=3) and the entire group of observers (n=6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor. CONCLUSIONS The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.
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Affiliation(s)
- Francesco Paglia
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, Italy
| | | | - Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, Italy.
| | - Francesca Rizzo
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, Italy
| | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, Italy
| | - Luca D'angelo
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, Italy
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Armocida D, Marzetti F, Pesce A, Caporlingua A, D'Angelo L, Santoro A. Purely Meningeal Intracranial Relapse of Melanoma Brain Metastases After Surgical Resection and Immunotherapy as a Unique Disease Progression Pattern: Our Experience and Review of the Literature. World Neurosurg 2020; 134:150-154. [PMID: 31751613 DOI: 10.1016/j.wneu.2019.10.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND We present a case of 72-year-old man with a history of metastatic melanoma diagnosed in 2015 presenting a stable disease in treatment with dabrafenib. CASE DESCRIPTION The patient had been surgically treated for a presumed intracranial parietooccipital metastasis. He presented 1 month later with a meningeal lesion associated with a subdural hematoma. A second surgical treatment confirmed the diagnosis of meningeal recurrence of metastatic melanoma. CONCLUSIONS The most recent literature lacks studies defining the clinical phenomena of an early recurrence of intracranial melanoma with de novo involvement of dural compartment in patients in treatment with a target immunotherapy. The aim of this present study is to report a case of early recurrence of intracranial melanoma metastases with evidence of fast immunohistochemical and macroscopical mutation of pathologic elements, with an analysis of literature that shows the lack of well-described occurrences.
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Affiliation(s)
- Daniele Armocida
- Azienda Ospedaliero-Universitaria "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy.
| | - Francesco Marzetti
- Azienda Ospedaliero-Universitaria "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Alessandro Pesce
- A. O. "Sant'Andrea"-Neurosurgery Division, Sapienza University, Rome NESMOS Department, Rome, Italy
| | - Alessandro Caporlingua
- Azienda Ospedaliero-Universitaria "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Luca D'Angelo
- Azienda Ospedaliero-Universitaria "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Antonio Santoro
- Azienda Ospedaliero-Universitaria "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy
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Peschillo S, Caporlingua A, Resta MC, Peluso JPP, Burdi N, Sourour N, Diana F, Guidetti G, Clarençon F, Bloemsma GC, Di Maria F, Donatelli M, Resta M. Endovascular Treatment of Large and Giant Carotid Aneurysms with Flow-Diverter Stents Alone or in Combination with Coils: A Multicenter Experience and Long-Term Follow-up. Oper Neurosurg (Hagerstown) 2019; 13:492-502. [PMID: 28838114 DOI: 10.1093/ons/opx032] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although flow diverters (FDs) have been widely accepted by neurointerventionists, their safety has yet to be fully defined. Stratification by aneurysm size and location is essential for correct evaluation of treatment outcomes and risks of flow diversion. OBJECTIVE To compare neurological and anatomic outcomes and evaluate the risk of complications after endovascular treatment of large or giant internal carotid artery (ICA) aneurysms with FD/FDs alone or together with coil embolization. METHODS We reviewed all patients with large or giant, ruptured or unruptured ICA aneurysms who underwent endovascular treatment with flow diversion alone (group A) or with concomitant coiling (group B) in 4 international institutions between 2010 and 2015. Anatomic outcome was evaluated using the Byrne scale on digital subtraction angiography and/or angioMRI and/or angioCT scans 3, 6, 12, and 24 months postoperatively. RESULTS We collected 44 patients with large or giant ICA aneurysms. Four patients (9%) presented with aneurysmal subarachnoid hemorrhage (SAH). FD/FDs were used alone in 26 patients and in combination with coil embolization in the 18 remaining patients. The mortality rate due to procedure-related and/or neurological complications was 2.2%. Twelve months after the procedure, 88.6% (n = 39) of patients had a favorable neurological outcome. One year after the procedure, the aneurysm was completely occluded in 72.7% of patients: 61.5% (16/18) in group A and 88.9% (16/26) in group B. CONCLUSION Clinical outcomes and rates of intraoperative and postoperative complications did not differ significantly between the groups. Better anatomic results using FD/FDs combined with coils were documented 6 months after the procedure; this option seems to provide a higher aneurysm occlusion rate and reduce the need for retreatment.
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Affiliation(s)
- Simone Peschillo
- Department of Neurology and Psychia-try, Endovascular Neurosurgery/Interven-tional Neuroradiology, 'Sapienza' Univers-ity of Rome, Rome, Italy
| | - Alessandro Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Maria Chiara Resta
- Department of Neuroradiology, Policlinico of Bari, University of Bari, Bari, Italy
| | | | - Nicola Burdi
- Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy
| | - Nader Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Francesco Diana
- Department of Neurology and Psychiatry, Interven-tional Neuroradiology, 'Sapienza' Univers-ity of Rome, Rome, Italy
| | - Giulio Guidetti
- Department of Neurology and Psychiatry, Interven-tional Neuroradiology, 'Sapienza' Univers-ity of Rome, Rome, Italy
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Federico Di Maria
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Massimo Donatelli
- Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy
| | - Maurizio Resta
- Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy
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D'Angelo L, Paglia F, Caporlingua A, Sampirisi L, Guidetti G, Santoro A. Atypical Manifestation of Direct Low-Flow Carotid-Cavernous Fistula: Case Report and Review of the Literature. World Neurosurg 2019; 125:456-460. [DOI: 10.1016/j.wneu.2019.02.027] [Citation(s) in RCA: 4] [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: 01/17/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
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Caporlingua A, Prior A, Cavagnaro MJ, Winston G, Oliveira DL, Sadwhani SD, Arias GA, Schwalb JN, Akhbari M, Evins AI, Bernardo A. The Intracranial and Intracanalicular Optic Nerve as Seen Through Different Surgical Windows: Endoscopic Versus Transcranial. World Neurosurg 2019; 124:522-538. [DOI: 10.1016/j.wneu.2019.01.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
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Prelaj A, Rebuzzi SE, Caffarena G, Giròn Berrìos JR, Pecorari S, Fusto C, Caporlingua A, Caporlingua F, Di Palma A, Magliocca FM, Salvati M, Tomao S, Bianco V. Therapeutic approach in glioblastoma multiforme with primitive neuroectodermal tumor components: Case report and review of the literature. Oncol Lett 2018; 15:6641-6647. [PMID: 29616127 DOI: 10.3892/ol.2018.8102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 01/16/2018] [Indexed: 01/05/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive malignant glioma that is treated with first-line therapy, using surgical resection followed by local radiotherapy and concomitant/adjuvant temozolomide (TMZ) treatment. GBM is characterised by a high local recurrence rate and a low response to therapy. Primitive neuroectodermal tumour (PNET) of the brain revealed a low local recurrence rate; however, it also exhibited a high risk of cerebrospinal fluid (CSF) dissemination. PNET is treated with surgery followed by craniospinal irradiation (CSI) and platinum-based chemotherapy in order to prevent CSF dissemination. GBM with PNET-like components (GBM/PNET) is an emerging variant of GBM, characterised by a PNET-like clinical behaviour with an increased risk of CSF dissemination; it also may benefit from platinum-based chemotherapy upfront or following failure of GBM therapy. The results presented regarding the management of GBM/PNET are based on case reports or case series, so a standard therapeutic approach for GBM/PNET is not defined, constituing a challenging diagnostic and therapeutic dilemma. In this report, a case of a recurrent GBM/PNET treated with surgical resection and radiochemotherapy as Stupp protocol, and successive platinum-based chemotherapy due to the development of leptomeningeal dissemintation and an extracranial metastasis, is discussed. A review of the main papers regarding this rare GBM variant and its therapeutic approach are also reported. In conclusion, GBM/PNET should be treated with a multimodal approach including surgery, chemoradiotherapy, and/or the early introduction of CSI and platinum-based chemotherapy upfront or at recurrence.
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Affiliation(s)
- Arsela Prelaj
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Sara Elena Rebuzzi
- Department of Medical Oncology Unit 1, IRCCS AOU San Martino-IST, I-16132 Genoa, Italy
| | - Giovanni Caffarena
- Department of Neurosurgery, IRCCS AOU San Martino-IST, I-16132 Genoa, Italy
| | - Julio Rodrigo Giròn Berrìos
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Silvia Pecorari
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Carmela Fusto
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Alessandro Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Federico Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Annamaria Di Palma
- Department of Radiotherapy, San Pietro Hospital, Fatebenefratelli, I-00189 Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Gynecology, Obstetrics and Urology, Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, IRCCS Neuromed, I-86077 Pozzilli, Italy
| | - Silverio Tomao
- Department of Radiological Sciences, Oncology and Pathology, 'Sapienza' University of Rome, I-04100 Latina, Italy
| | - Vincenzo Bianco
- Department of Medical Oncology Unit A, Policlinico Umberto I, 'Sapienza' University of Rome, I-00161 Rome, Italy
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Lenzi J, Nardone A, Passacantilli E, Caporlingua A, Lapadula G, Caporlingua F. Posterior Cervical Transfacet Fusion with Facetal Spacer for the Treatment of Single-Level Cervical Radiculopathy: A Randomized, Controlled Prospective Study. World Neurosurg 2017; 100:7-14. [PMID: 28065872 DOI: 10.1016/j.wneu.2016.12.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/24/2016] [Accepted: 12/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-level cervical radiculopathy may be treated conservatively with cervical tractions. Posterior cervical transfacet fusion with a facetal spacer is a viable option. The aim of the present study is to compare posterior cervical transfacet fusion with conservative physical treatment in single-level cervical radiculopathy. METHODS A total of 80 patients were randomized in 2 groups, a surgical group in which patients were given posterior cervical transfacet fusion and a traction group in which patients were treated conservatively with mechanical cervical tractions. Visual analog scale for arm and neck, Neck Disability Index, and Short Form-36 (SF-36) questionnaires were administered preoperatively and after treatment up to 12 months. RESULTS After treatment, visual analog scale arm scores were greater in traction group (4.7 vs. 1.5 the day after treatment) and at follow-up controls (traction group vs. surgical group: 5.3 vs. 0.6 at 1 month, 3.6 vs. 0.3 at 6 months, 1.8 vs. 0.2 at 12 months). Neck Disability Index scores were lower in the surgical group (surgical group vs. traction group: 4.4 vs. 20.3 at 1 month, 1.3 vs. 10.5 at 6 months). SF-36 scores were greater in the surgical group (surgical group vs. traction group: 96 vs. 70 at 1 month, 96.5 vs. 82.6 at 6 months). Neck disability index and SF-36 scores were superimposable between the groups at 12-month follow-up. No adjacent-segment arthrosis or late complications were reported at 1-year follow-up in the surgical group. CONCLUSIONS posterior cervical transfacet fusion is a safe and effective procedure to treat single-level cervical radiculopathy.
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Affiliation(s)
- Jacopo Lenzi
- Neurological Center of Latium, Neurosurgery, Rome, Italy
| | | | | | - Alessandro Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Gennaro Lapadula
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Federico Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
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Lenzi J, Caporlingua F, Caporlingua A, Anichini G, Nardone A, Passacantilli E, Santoro A. Relevancy of positive trends in mortality and functional recovery after surgical treatment of acute subdural hematomas. Our 10-year experience. Br J Neurosurg 2016; 31:78-83. [PMID: 27596026 DOI: 10.1080/02688697.2016.1226253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Among traumatic brain injuries, acute subdural hematoma (aSDH) is considered one of the most devastating still retaining poor surgical outcomes in a considerable percentage of affected patients. However, according to results drawn from published samples of aSDH patients, overall mortality and functional recovery have been progressively ameliorating during the last decades. METHODS We present a retrospective analysis of 316 consecutive cases of post-traumatic aSDH operated on between 2003 and 2011 at our institution. RESULTS Mortality was 67% (n = 212); a useful recovery was achieved in 16.4% cases (n = 52). Age >65 years, a preoperative Glasgow coma scale (GCS) ≤ 8, specific pre-existing medical comorbidities (hypertension, heart diseases) were found to be strong indicators of unfavorable outcomes and death during hospitalization. CONCLUSION Our results, compared with those of the inherent literature, led the authors to question both the "aggressiveness" of neurosurgical care indications in certain subpopulations of patients being known to fare worse or even die regardless of the treatment administered and the relevance of the results concerning mortality and functional recovery reported by third authors.
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Affiliation(s)
- Jacopo Lenzi
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Federico Caporlingua
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Alessandro Caporlingua
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Giulio Anichini
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy.,b Department of Neurosurgery , Charing Cross Hospital, Imperial College of London , London , United Kingdom
| | - Antonio Nardone
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Emiliano Passacantilli
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Antonio Santoro
- a Department of Neurology and Psychiatry, Neurosurgery , "Sapienza" University of Rome , Rome , Italy
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Abstract
Nonmissile orbitocranial penetrating brain injuries are uncommonly dealt with in a civilian context. Surgical management is controversial, due to the lack of widely accepted guidelines. A 52-year-old man was hit in his left eye by a metallic foreign body (FB). Head computed tomography (CT) scan showed a left subcortical parietal FB with a considerable hemorrhagic trail originating from the left orbital roof. Surgical treatment was staged; an exenteratio oculi and a left parietal craniotomy to extract the FB under intraoperative CT guidance were performed at post trauma day third and sixth, respectively. A postoperative infectious complication was treated conservatively. The patient retained a right hemiparesis (3/5) and was transferred to rehabilitation in good clinical conditions at day 49th. He had suspended antiepilectic therapy at that time. A case-by-case tailored approach is mandatory to achieve the best outcome in such a heterogeneous nosological entity. Case reporting is crucial to further understand its mechanism and dynamics.
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Affiliation(s)
- Alessandro Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Federico Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Jacopo Lenzi
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
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Peschillo S, Cannizzaro D, Caporlingua A, Missori P. A Systematic Review and Meta-Analysis of Treatment and Outcome of Blister-Like Aneurysms. AJNR Am J Neuroradiol 2016; 37:856-61. [PMID: 26635287 PMCID: PMC7960313 DOI: 10.3174/ajnr.a4606] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/08/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Blister-like aneurysms are uncommon but challenging lesions. Their small size and atypical location often make the diagnosis difficult. Microsurgery and endovascular procedures have been used for their treatment, but there is no consensus on the best treatment technique. We conducted a systematic review and meta-analysis of treatments and outcomes of these vascular lesions. MATERIALS AND METHODS We reviewed English-language articles on "blood blister-like aneurysms" published between January 1997 and November 2014. All studies reporting patients with these aneurysms treated with surgery, endovascular procedures, or combined therapy with data on treatment modalities and clinical and/or angiographic outcomes were selected, including case reports and series. We performed a meta-analysis on the 2 largest treatment groups (surgery and endovascular management). RESULTS Sixty studies with 334 patients met our inclusion criteria. Surgery was performed in 114 patients (34.2%), and endovascular treatment, in 199 patients (59.5%). A combined treatment was used in 19 patients (5.7%). A favorable outcome (mRS 0-2) was reported in 67.4% and 78.9% of patients treated with surgery and with endovascular therapy, respectively (P = .034). CONCLUSIONS Blister-like aneurysms are challenging vascular lesions. The choice of treatment method must be based on the initial clinical presentation and an analysis of the radiologic features of the lesion to select the best technique. Endovascular treatment seems to have lower morbidity and mortality and provides a better outcome compared with surgical approaches. Further prospective studies must be performed to confirm such interesting results.
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Affiliation(s)
- S Peschillo
- From the Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology (S.P.)
| | - D Cannizzaro
- Neurosurgery (D.C., A.C., P.M.), "Sapienza," University of Rome, Rome, Italy
| | - A Caporlingua
- Neurosurgery (D.C., A.C., P.M.), "Sapienza," University of Rome, Rome, Italy
| | - P Missori
- Neurosurgery (D.C., A.C., P.M.), "Sapienza," University of Rome, Rome, Italy
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11
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Affiliation(s)
- S Peschillo
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology "Sapienza," University of Rome Rome, Italy
| | - D Cannizzaro
- Department of Neurology and Psychiatry, Neurosurgery "Sapienza," University of Rome Rome, Italy
| | - E Di Stasio
- Institute of Biochemistry and Clinical Biochemistry Catholic University of Sacred Heart Rome, Italy
| | - A Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery "Sapienza," University of Rome Rome, Italy
| | - P Missori
- Department of Neurology and Psychiatry, Neurosurgery "Sapienza," University of Rome Rome, Italy
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Peschillo S, Caporlingua A, Caporlingua F, Guglielmi G, Delfini R. Historical Landmarks in the Management of Aneurysms and Arteriovenous Malformations of the Central Nervous System. World Neurosurg 2015; 88:661-671. [PMID: 26555508 DOI: 10.1016/j.wneu.2015.10.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/09/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the history of vascular and endovascular neurosurgery. METHODS A literature research was conducted including historical events from 2000 bc to the twenty-first century ad, and a timetable was filled with information regarding the most representative historical landmarks regarding vascular and endovascular neurosurgery. RESULTS Starting from approaches limited to the cervical carotid artery, vascular neurosurgery gained its way through the intracranial and finally endovascular space thanks to the introduction of both innovative and progressively less invasive procedures. With the invention of cerebral angiography in 1927, Egas Moniz paved the way for modern endovascular neurosurgery. CONCLUSIONS Numerous pioneers have been described through this historical reconstruction. Their genius, effort, dedication, and passion brought a massive contribution to vascular and endovascular neurosurgery as we know it today.
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Affiliation(s)
- Simone Peschillo
- Departments of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, Sapienza University of Rome, Rome, Italy
| | - Alessandro Caporlingua
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
| | - Federico Caporlingua
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Guido Guglielmi
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy; Department of Interventional Neuroradiology, University of California at Los Angeles, Los Angeles, California, USA
| | - Roberto Delfini
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Peschillo S, Caporlingua A, Diana F, Caporlingua F, Delfini R. New therapeutic strategies regarding endovascular treatment of glioblastoma, the role of the blood-brain barrier and new ways to bypass it. J Neurointerv Surg 2015; 8:1078-82. [PMID: 26541791 DOI: 10.1136/neurintsurg-2015-012048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/12/2015] [Indexed: 12/12/2022]
Abstract
The treatment protocols for glioblastoma multiforme (GBM) involve a combination of surgery, radiotherapy and adjuvant chemotherapy. Despite this multimodal approach, the prognosis of patients with GBM remains poor and there is an urgent need to develop novel strategies to improve quality of life and survival in this population. In an effort to improve outcomes, intra-arterial drug delivery has been used in many recent clinical trials; however, their results have been conflicting. The blood-brain barrier (BBB) is the major obstacle preventing adequate concentrations of chemotherapy agents being reached in tumor tissue, regardless of the method of delivering the drugs. Therapeutic failures have often been attributed to an inability of drugs to cross the BBB. However, during the last decade, a better understanding of BBB physiology along with the development of new technologies has led to innovative methods to circumvent this barrier. This paper focuses on strategies and techniques used to bypass the BBB already tested in clinical trials in humans and also those in their preclinical stage. We also discuss future therapeutic scenarios, including endovascular treatment combined with BBB disruption techniques, for patients with GBM.
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Affiliation(s)
- S Peschillo
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, 'Sapienza' University of Rome, Rome, Italy
| | - A Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - F Diana
- Department of Radiology, 'Sapienza' University of Rome, Rome, Italy
| | - F Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - R Delfini
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
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Fadda MT, Ierardo G, Ladniak B, Di Giorgio G, Caporlingua A, Raponi I, Silvestri A. Treatment timing and multidisciplinary approach in Apert syndrome. Ann Stomatol (Roma) 2015; 6:58-63. [PMID: 26330906 PMCID: PMC4525098] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Apert syndrome is a rare congenital disorder characterized by craniosynostosis, midface hypoplasia and symmetric syndactyly of hands and feet. Abnormalities associated with Apert syndrome include premature fusion of coronal sutures system (coronal sutures and less frequently lambdoid suture) resulting in brachiturricephalic dismorphism and impaired skull base growth. After this brief explanation it is clear that these anatomical abnormalities may have a negative impact on the ability to perform essential functions. Due to the complexity of the syndrome a multidisciplinary (respiratory, cerebral, maxillo-mandibular, dental, ophthalmic and orthopaedic) approach is necessary in treating the psychological, aesthetic and functional issues. The aim of this paper is to analyse the different functional issues and surgical methods trying to enhance results through a treatment plan which includes different specialities involved in Apert syndrome treatment. Reduced intellectual capacity is associated to the high number of general anaesthesia the small patients are subject to. Therefore the diagnostic and therapeutic treatment plan in these patients has established integrated and tailored surgical procedures based on the patients' age in order to reduce the number of general anaesthesia, thus simplifying therapy for both Apert patients and their family members.
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Affiliation(s)
- Maria Teresa Fadda
- Department of Oral and Maxillofacial Sciences, Maxillofacial Surgery Unit, Policlinico Umberto I, “Sapienza” University of Rome, Italy
| | - Gaetano Ierardo
- Department of Oral and Maxillofacial Sciences, Pediatric Unit, “Sapienza” University of Rome, Italy
| | - Barbara Ladniak
- Department of Oral and Maxillofacial Sciences, Pediatric Unit, “Sapienza” University of Rome, Italy
| | - Gianni Di Giorgio
- Department of Oral and Maxillofacial Sciences, Pediatric Unit, “Sapienza” University of Rome, Italy
| | - Alessandro Caporlingua
- Department of Oral and Maxillofacial Sciences, Maxillofacial Surgery Unit, Policlinico Umberto I, “Sapienza” University of Rome, Italy
| | - Ingrid Raponi
- Department of Oral and Maxillofacial Sciences, Maxillofacial Surgery Unit, Policlinico Umberto I, “Sapienza” University of Rome, Italy
| | - Alessandro Silvestri
- Department of Oral and Maxillofacial Sciences, Orthognathodontic Unit, “Sapienza” University of Rome, Italy
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Peschillo S, Caporlingua A, Cannizzaro D, Resta M, Burdi N, Valvassori L, Pero G, Lanzino G. Flow diverter stent treatment for ruptured basilar trunk perforator aneurysms. J Neurointerv Surg 2014; 8:190-6. [PMID: 25516534 DOI: 10.1136/neurintsurg-2014-011511] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/24/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Basilar trunk perforator (BTP) aneurysms are rare. Treatment options traditionally considered for these uncommon lesions have included direct surgery, endovascular therapy, or conservative management. Flow diverters represent a newer therapeutic option for BTP aneurysms but pitfalls and complications are unknown. We describe three patients with BTP aneurysms treated with flow diverter stents. METHODS All three patients had ruptured BTP aneurysms and, after loading doses of dual antiplatelet agents, underwent treatment with a flow diverter alone (two patients) or in combination with an intracranial stent (one patient). RESULTS Complications directly (two thromboembolic events) or indirectly (one hemorrhage at the external ventricular drain site, probably facilitated by the dual antiplatelet therapy) occurred in all three patients and resulted in permanent morbidity in one case. Imaging follow-up confirmed obliteration in all three patients, and no episodes of rebleeding from the aneurysms were observed at follow-up. CONCLUSIONS Flow diverters are effective in obliterating BTP aneurysms. However, given the challenges and complications encountered, especially in patients with ruptured lesions, their use must be carefully weighed against other available therapeutic modalities, including observation.
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Affiliation(s)
- Simone Peschillo
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, 'Sapienza' University of Rome, Rome, Italy
| | - Alessandro Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Delia Cannizzaro
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Mariachiara Resta
- Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy
| | - Nicola Burdi
- Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy
| | - Luca Valvassori
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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