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Pennisi G, D'Ercole M, Izzo A, Polli FM, Rapisarda A, Papacci F, Olivi A, Montano N. Change of Clinical and Radiologic Parameters after Minimally Invasive Decompression in Patients with Lumbar Spinal Stenosis: A Prospective Study with Long-term Follow-up. J Neurol Surg A Cent Eur Neurosurg 2024; 85:14-20. [PMID: 35901813 DOI: 10.1055/a-1911-8864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The impact of minimally invasive decompression (MID) techniques on spinopelvic parameters and on the sagittal alignment remains a controversial topic. Here we studied the changes in clinical and radiologic parameters and their relationships in a series of lumbar spinal stenosis (LSS) submitted to MID with a minimum follow-up (FU) of 24 months. METHODS We prospectively collected clinical and radiologic data of 20 consecutive patients who were evaluated preoperatively, at the 6-month FU, and at the 24-month FU. Visual analog scale (VAS) for back and leg pain, Oswestry disability index (ODI), neck disability index (NDI), sagittal vertical axis (SVA), C7 slope (C7S), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed for each patient. Moreover, the percentage variation of clinical and radiologic factors at the 24-month FU compared with the preoperative factors was calculated to perform correlation studies among these variables. RESULTS We reported a significant improvement of all clinical parameters. A significant increase of LL and SS and a significant decrease of PT and SVA were observed. The preoperative values of ODI, LL, SS, PT, and SVA significantly affect the 24-month FU values, and the percentage improvement of SVA at the 24-month FU compared with the preoperative values was significantly related to the percentage improvement of LL. CONCLUSIONS MID is clinically effective in patients with LSS and improves the spinopelvic parameters and the global sagittal balance of the spine. The preoperative spinal alignment affects the spinal alignment at FU. The improvement of SVA was strictly related to the improvement of LL.
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Affiliation(s)
- Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Papacci
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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Sturiale CL, Rapisarda A, Albanese A. Clipping of Anterior Circulation Aneurysms: Operative Instructions and Safety Rules for Young Cerebrovascular Surgeons. Adv Tech Stand Neurosurg 2024; 50:201-229. [PMID: 38592532 DOI: 10.1007/978-3-031-53578-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Due to the constant development of the technique, in the last 30 years, the endovascular treatment of the intracranial aneurysms (IAs) has gradually superseded the traditional surgery in the majority of centers. However, clipping still represents the best treatment for some anterior circulation IAs according to their angioarchitectural, topographical, and hemodynamic characteristics. Thus, the identification of residual indications for clipping and the maintenance of training programs in vascular neurosurgery appear nowadays more important than ever. MATERIALS AND METHODS We reviewed our last 10-year institutional experience of ruptured and unruptured IAs clipping. We appraised in detail all technical refinements we adopted during this time span and analyzed the difficulties we met in teaching the aneurysm clipping technique to residents and fellows. Then, we described the algorithm of safety rules we used to teach young neurosurgeons how to surgical approach anterior circulation IAs and develop a procedural memory, which may intervene in all emergency situations. RESULTS We identified seven pragmatic technical key points for clipping of the most frequent anterior circulation IAs and constructed a didactic approach to teach young cerebrovascular surgeons. In general, they concern craniotomy; cisternostomy; obtaining proximal control; cranial nerve, perforator, and vein preservation; necessity of specific corticectomy; aneurysm neck dissection; and clipping. CONCLUSION In the setting of an IA clipping, particularly when ruptured, the young cerebrovascular surgeon needs to respect an algorithm of safety rules, which are essential not only to avoid major complications, but they may intervene during the difficulties helping to manage potentially life-tethering conditions.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Battistelli M, Polli FM, D'Alessandris QG, D'Ercole M, Izzo A, Rapisarda A, Montano N. An Overview of Recent Advances in Anterior Cervical Decompression and Fusion Surgery. Surg Technol Int 2023; 43:sti43/1732. [PMID: 38171486 DOI: 10.52198/23.sti.43.ns1732] [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: 01/27/2024]
Abstract
Anterior cervical diskectomy and fusion (ACDF) has evolved significantly in the last few years with the aim of enhancing effectiveness and safety while reducing hospitalization and healthcare-related costs. Transitioning from iliac crest autografts to allografts minimizes donor-site complications like pain, infections, and hematoma. Allograft options, such as polyetheretherketone (PEEK) and tantalum, vary in their osteoinductive properties and elastic modulus, influencing fusion rates, time, and the rate of subsidence. Recently introduced zero-profile cages offer bone fixation through screws, resulting in reduced blood loss, improved spinal alignment, and decreased complications like dysphagia and adjacent segment disease. Intraoperative neuromonitoring (IONM) has gained widespread use. The North American Spine Society (NASS) 2023 recommendations endorse IONM in cervical deformity corrections and myelopathy cases. Insufficient studies hinder clear radiculopathy recommendations, but emerging research supports IONM for patients at greater risk of C5 nerve root injury or positional injury. Advancements in hemostatic agents, such as gelatin sponges, oxidized cellulose, and fibrin sealants, contribute to safety by reducing postoperative hematoma rates and eliminating the need for drainage. Innovations like the exoscope, endoscope, and computed-tomography (CT) navigation have transformed surgical practices. Exoscopes are emerging as an alternative to microscopes, offering benefits like a smaller footprint, adjustable positioning, lower costs, and shared intraoperative views for educational purposes. The use of endoscope offers the possibility of performing a minimally invasive technique with improved results in terms of cosmesis and patient-perceived outcome. CT navigation can be useful in high-risk procedures, such as cervical plate placement for major instability. This paper provides an overview of cutting-edge technologies in ACDF surgery, emphasizing cage materials and designs, safety measures, and operating room advancements. It also highlights areas for future research, underlining the procedure's continuous evolution.
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Affiliation(s)
- Marco Battistelli
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Maria Polli
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuela D'Ercole
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Montano N, Rapisarda A, D'Alessandris QG, D'Ercole M, Izzo A. The importance of pre-operative neuroanatomical study in the surgical treatment of trigeminal neuralgia associated with multiple sclerosis. Front Neuroanat 2023; 17:1276977. [PMID: 38020210 PMCID: PMC10643865 DOI: 10.3389/fnana.2023.1276977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Nicola Montano
- Neurosurgery Section, Department of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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D'Ercole M, Izzo A, Fuggetta F, Rapisarda A, Burattini B, Montano N. The impact of strategies to manage the COVID-19 pandemic on patients with intrathecal baclofen therapy. J Neurosurg Sci 2023; 67:605-608. [PMID: 34342200 DOI: 10.23736/s0390-5616.21.05410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The activities related to intrathecal baclofen (ITB) therapy could not be interrupted at the outbreak of COVID-19 pandemic due to possible life-threatening related complications such as withdrawal and over dosage syndromes. In this study we reported the different adopted strategies to manage patients with an ITB implanted infusion pump during the pandemic period and studied the impact of these strategies on experiences reported from patients and their caregivers, assessed through a specific survey. METHODS Thirty-five patients (mean age: 43.71±12.33 years) were included. Their clinical and medical data were recorded and observed from March 2020 to March 2021 and different strategies implemented in order to limit patients and providers risk of exposure to COVID-19. The impact of these strategies was assessed trough a survey that was performed after the first two months of pandemic (coinciding with the period of general lockdown) and after one year from the pandemic onset. RESULTS We observed a statistically significant improvement of the following items: difficulties in reaching medical clinic (P=0.0072), continuation of physical therapy (P=0.0021) and feelings of anxiety in medical conditions (P=0.0006). Considering the difficulties in communications with the medical staff we obtained optimal scores both at the beginning of pandemic and after one year from the pandemic onset without significant difference. CONCLUSIONS Our survey showed that the adopted strategies provided a feeling of confidence and safety among ITB patients and their caregivers during the COVID-19 pandemic. We think that a clear communication is always of paramount importance to manage these patients.
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Affiliation(s)
- Manuela D'Ercole
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Izzo
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filomena Fuggetta
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Benedetta Burattini
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nicola Montano
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
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Agosti E, Zeppieri M, De Maria L, Mangili M, Rapisarda A, Ius T, Spadea L, Salati C, Tel A, Pontoriero A, Pergolizzi S, Angileri FF, Fontanella MM, Panciani PP. Surgical Treatment of Spheno-Orbital Meningiomas: A Systematic Review and Meta-Analysis of Surgical Techniques and Outcomes. J Clin Med 2023; 12:5840. [PMID: 37762781 PMCID: PMC10531637 DOI: 10.3390/jcm12185840] [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: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Spheno-orbital meningiomas (SOMs) are rare tumors arising from the meninges surrounding the sphenoid bone and orbital structures. Surgical resection is the primary treatment approach for SOMs. Several surgical approaches have been described during the decades, including microsurgical transcranial (MTAs), endoscopic endonasal (EEAs), endoscopic transorbital (ETOAs), and combined approaches, and the choice of surgical approach remains a topic of debate. PURPOSE This systematic review and meta-analysis aim to compare the clinical and surgical outcomes of different surgical approaches used for the treatment of SOMs, discussing surgical techniques, outcomes, and factors influencing surgical decision making. METHODS A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on the role of surgery for the treatment of SOMs until 2023. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. RESULTS A total of 59 studies comprising 1903 patients were included in the systematic review and meta-analysis. Gross total resection (GTR) rates ranged from 23.5% for ETOAs to 59.8% for MTAs. Overall recurrence rate after surgery was 20.7%. Progression-free survival (PFS) rates at 5 and 10 years were 75.5% and 49.1%, respectively. Visual acuity and proptosis improvement rates were 57.5% and 79.3%, respectively. Postoperative cranial nerve (CN) focal deficits were observed in 20.6% of cases. The overall cerebro-spinal fluid (CSF) leak rate was 3.9%, and other complications occurred in 13.9% of cases. MTAs showed the highest GTR rates (59.8%, 95%CI = 49.5-70.2%; p = 0.001) but were associated with increased CN deficits (21.0%, 95%CI = 14.5-27.6%). ETOAs had the lowest GTR rates (23.5%, 95%CI = 0.0-52.5%; p = 0.001), while combined ETOA and EEA had the highest CSF leak rates (20.3%, 95%CI = 0.0-46.7%; p = 0.551). ETOAs were associated with better proptosis improvement (79.4%, 95%CI = 57.3-100%; p = 0.002), while anatomical class I lesions were associated with better visual acuity (71.5%, 95%CI = 63.7-79.4; p = 0.003) and proptosis (60.1%, 95%CI = 38.0-82.2; p = 0.001) recovery. No significant differences were found in PFS rates between surgical approaches. CONCLUSION Surgical treatment of SOMs aims to preserve visual function and improve proptosis. Different surgical approaches offer varying rates of GTR, complications, and functional outcomes. A multidisciplinary approach involving a skull base team is crucial for optimizing patient outcomes.
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Affiliation(s)
- Edoardo Agosti
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (E.A.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Piazzale S. Maria Della Misericordia 15, 33100 Udine, Italy
| | - Lucio De Maria
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (E.A.)
| | - Marcello Mangili
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (E.A.)
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria Della Misericordia 15, 33100 Udine, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Piazzale S. Maria Della Misericordia 15, 33100 Udine, Italy
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department University Hospital of Udine, p.le S. Maria Della Misericordia 15, 33100 Udine, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Filippo Flavio Angileri
- Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, 98125 Messina, Italy
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (E.A.)
| | - Pier Paolo Panciani
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy; (E.A.)
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Benato A, Menna G, Rapisarda A, Polli FM, D’Ercole M, Izzo A, D’Alessandris QG, Montano N. Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072664. [PMID: 37048747 PMCID: PMC10095101 DOI: 10.3390/jcm12072664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The management of symptomatic lumbar synovial cysts (LSC) is still a matter of debate. Previous systematic reviews did not stratify data according to different treatment techniques or incompletely reported comparative data on patients treated with lumbar posterior decompression (LPD) and lumbar decompression and fusion (LDF). The aim of our study was to compare LPD and LDF via a systematic review and meta-analysis of the existing literature. The design of this study was in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review questions were as follows: among patients suffering from symptomatic lumbar synovial cysts (population) and treated with either posterior lumbar decompression or posterior decompression with fusion (intervention), who gets the best results (outcome), in terms of cyst recurrence, reoperation rates, and improvement of postoperative symptoms (comparison)? The search of the literature yielded a total of 1218 results. Duplicate records were then removed (n = 589). A total of 598 articles were screened, and 587 records were excluded via title and abstract screening; 11 studies were found to be relevant to our research question and were assessed for eligibility. Upon full-text review, 5 were excluded because they failed to report any parameter separately for both LPD and LDF. Finally, 6 studies for a total of 657 patients meeting the criteria stated above were included in the present investigation. Our analysis showed that LDF is associated with better results in terms of lower postoperative back pain and cyst recurrence compared with LPD. No differences were found in reoperation rates and complication rates between the two techniques. The impact of minimally invasive decompression techniques on the different outcomes in LSC should be assessed in the future and compared with instrumentation techniques.
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Affiliation(s)
- Alberto Benato
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Grazia Menna
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Maria Polli
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Manuela D’Ercole
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Izzo
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Quintino Giorgio D’Alessandris
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Baroni S, Rapisarda A, Gentili V, Burattini B, Moretti G, Sarlo F, Izzo A, D'Ercole M, Olivi A, Urbani A, Montano N. CSF neuron-specific enolase as a biomarker of neurovascular conflict severity in drug-resistant trigeminal neuralgia: a prospective study in patients submitted to microvascular decompression. Neurol Sci 2023; 44:1319-1325. [PMID: 36564658 DOI: 10.1007/s10072-022-06573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although neurovascular conflict (NVC) is the most widely accepted cause of trigeminal neuralgia (TN), few articles have analyzed molecular and biochemical mechanisms underlying TN. In the present study, we dosed neuron-specific enolase (NSE) on serum and CSF samples of 20 patients submitted to microvascular decompression (MVD) and correlated these findings with the type of NVC. METHODS Blood samples were obtained preoperatively and 48 h after MVD. CSF from trigeminal cistern was intraoperatively obtained. NSE levels were measured using the Diasorin kit (LIAISON®NSE). NVC was classified as "contact" or "trigeminal nerve distortion/indentation" or "trigeminal root atrophy" based on MRI and intraoperative findings. Clinical outcome was measured by acute pain relief (APR) and Barrow Neurological Institute (BNI) scale at last available follow-up (FU; 6.40 ± 5.38 months). RESULTS APR was obtained in all patients. A statistically significant BNI reduction was obtained at latest FU (p < 0.0001). Serum NSE levels significantly decreased following MVD (from 12.15 ± 3.02 ng/mL to 8.95 ± 2.83 ng/mL, p = 0.001). The mean CSF NSE value was 48.94 ng/mL, and the mean CSF/serum NSE rate was 4.18 with a strong correlation between these two variables (p = 0.0008). CSF NSE level in "trigeminal root atrophy" group was significantly higher compared to "contact" (p = 0.0045) and "distortion/indentation" (p = 0.010) groups. CONCLUSION NSE levels seem to be related to the etiopathology and severity of NVC. A significant reduction of serum NSE levels could be related to the resolution of the NVC and clinical TN improvement.
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Affiliation(s)
- Silvia Baroni
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS. Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vanessa Gentili
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benedetta Burattini
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS. Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giacomo Moretti
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Sarlo
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS. Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Andrea Urbani
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS. Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
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Rapisarda A, Battistelli M, Izzo A, D'Ercole M, D'Alessandris QG, Polli FM, Santi S, Martinelli R, Montano N. Outcome Comparison of Drug-Resistant Trigeminal Neuralgia Surgical Treatments-An Umbrella Review of Meta-Analyses and Systematic Reviews. Brain Sci 2023; 13:brainsci13040530. [PMID: 37190495 DOI: 10.3390/brainsci13040530] [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: 03/07/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
Medical treatment for trigeminal neuralgia (TN) is not always a feasible option due to a lack of full response or adverse effects. Open surgery or percutaneous procedures are advocated in these cases. Several articles have compared the results among different techniques. Nevertheless, the findings of these studies are heterogeneous. Umbrella reviews are studies sitting at the peak of the evidence pyramid. With this umbrella review, we provided a systematic review of the outcomes of the surgical procedures used for TN treatment. Only systematic reviews and meta-analyses were included following the PRISMA guidelines. Ten articles were enrolled for qualitative and quantitative assessment. Level of evidence was quantified using a specific tool (AMSTAR-2). Results were heterogenous in terms of outcome and measurements. Microvascular decompression (MVD) appeared to be the most effective procedure both in the short-term (pain relief in 85-96.6% of cases) and long-term follow-up (pain relief in 64-79% of cases), although showed the highest rate of complications. The results of percutaneous techniques were similar but radiosurgery showed the highest variation in term of pain relief and a higher rate of delayed responses. The use of the AMSTAR-2 tool to quantify the evidence level scored three studies as critically low and seven studies as low-level, revealing a lack of good quality studies on this topic. Our umbrella review evidenced the need of well-designed comparative studies and the utilization of validated scales in order to provide more homogenous data for pooled-analyses and meta-analyses in the field of TN surgical treatment.
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Affiliation(s)
- Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Marco Battistelli
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Samuele Santi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Renata Martinelli
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Dasic D, Signorelli F, Ligarotti GKI, D'Onofrio GF, Rapisarda A, Syrmos N, Chibbaro S, Visocchi M, Ganau M. Cystic Dilatation of the Ventriculus Terminalis: Examining the Relevance of the Revised Operative Classification Through a Systematic Review of the Literature, 2011-2021. Acta Neurochir Suppl 2023; 135:399-404. [PMID: 38153500 DOI: 10.1007/978-3-031-36084-8_61] [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] [Indexed: 12/29/2023]
Abstract
The literature features limited evidence on the natural history of the cystic dilatation of the ventriculus terminalis (CDVT) and its response to treatment. The goal of this study is to ascertain which impact the revised operative classification of CDVT had on the management of patients diagnosed over the past 10 years.Ten new clinical articles presenting a total of 30 cases of CDVT were identified and included for qualitative analysis. Two take-home messages can be identified: (1) Adequate consideration should be given to designing national pathways for referral to tertiary centers with relevant expertise in the management of lesions of the conus medullaris, and (2) we suggest that type Ia should be, at least initially, treated conservatively, whereas we reckon that the signs and symptoms described in types Ib, II, and III seem to benefit, although in some patients only partially, from surgical decompression in the form of cystic fenestration, cyst-subarachnoid shunting, or both.While the level of evidence gathered in this systematic review remains low because the literature on CDVT consists only of retrospective studies based on single-center series (level of evidence 4 according to the Oxford Centre for Evidence-Based Medicine (OCEBM)), the strength of recommendation for adopting the revised operative classification of CDVT is moderate.
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Affiliation(s)
- Davor Dasic
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Ginevra Federica D'Onofrio
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Salvatore Chibbaro
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | | | - Mario Ganau
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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D'Ercole M, Tufo T, Izzo A, Rapisarda A, Polli FM, Signorelli F, Olivi A, Visocchi M, Montano N. Percutaneous Balloon Compression for Trigeminal Neuralgia. A Comparative Study Between the Fluoroscope Guided and Neuronavigated Technique. Acta Neurochir Suppl 2023; 135:157-160. [PMID: 38153464 DOI: 10.1007/978-3-031-36084-8_25] [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] [Indexed: 12/29/2023]
Abstract
Percutaneous balloon compression (PBC) is a safe and effective procedure in the treatment of trigeminal neuralgia (TN) due to its simplicity, low cost and the possibility of being repeated in case of pain recurrence. Foramen ovale (FO) cannulation is accomplished with the assistance of intraoperative C-arm fluoroscopy. Recently, several authors have reported successful application of intraoperative CT navigation as well. The reported advantages of CT navigation are linked to better spatial orientation and the low rate of attempts for FO cannulation. However, these advantages should be considered in the face of concerns regarding increased radiation dose to the patient and its possible adverse effects. Here we compared the fluoroscopic guided and neuronavigated PBC techniques in terms of efficacy and radiological exposure. We retrospectively analyzed 37 patients suffering for TN and submitted to PBC. We observed a significant improvement of pain at 1 month FU compared with the pre-operative in both groups (p < 0.0001 and p < 0.0001, respectively). A significant increase in radiation exposure was found in the neuronavigated group compared with the fluoroscopy group (p < 0.0001). We suggest the use of neuronavigated PBC only in selected cases, such as patients with multiple previous operations, in whom a difficult access can be pre-operatively hypothesized.
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Affiliation(s)
- Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Tufo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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D'Onofrio GF, Rapisarda A, Signorelli F, Ganau M, Chibbaro S, Montano N, Polli FM, Visocchi M. Toward the End of the Funnel: The Ventriculus Terminalis-The State of Art of an Ancient Entity with a Recent History. Acta Neurochir Suppl 2023; 135:395-397. [PMID: 38153499 DOI: 10.1007/978-3-031-36084-8_60] [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] [Indexed: 12/29/2023]
Abstract
PURPOSE The ventriculus terminalis (VT), also called the fifth ventricle, is a small cavity containing cerebrospinal fluid (CSF) that is in the conus medullaris in continuity with the central canal of the spinal cord. In adults, persistent VT is a very rare entity, and the diagnosis is incidental in most cases. Rarely, VT may become symptomatic for still-uncertain reasons but most often for its cystic dilatation. The management of these selected cases is still controversial and sometimes associated with unsatisfactory outcomes. METHODS We performed a critical review of the existing literature on the management of symptomatic VT in adults. The etiology, pathophysiology, and treatment of VT are presented and discussed, focusing on the best timing for surgery. RESULTS Conservative management, marsupialization, or the placement of a T drain have been reported. The existing classifications describe the most correct approach for each clinical presentation, but scarce importance has been given to the delay from symptoms' onset to surgical treatment. CONCLUSION Although different cases have been described in the literature, this rare pathology remains unknown to most neurosurgeons.
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Affiliation(s)
| | - Alessandro Rapisarda
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Francesco Signorelli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Nicola Montano
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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Izzo A, D'Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Visocchi M, Montano N. Spinal Cord High-Frequency Stimulation. The Current Experience and Future Directions. Acta Neurochir Suppl 2023; 135:203-207. [PMID: 38153470 DOI: 10.1007/978-3-031-36084-8_31] [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] [Indexed: 12/29/2023]
Abstract
Spinal cord stimulation (SCS) is a neuromodulation technology that has emerged as a valid treatment for chronic intractable neuropathic pain. After conventional tonic SCS, new waveforms of stimulation, like high frequency (HF), have proved that they can provide safe and effective pain relief. In addition, SCS is now being utilized more broadly as a potential treatment for a range of indications, including motor disorders and spasticity. Our study presents a retrospective analysis of 20 patients with heterogenous aetiologies of neuropathic pain treated with HF stimulation, after a standardized protocol in a temporary trial. We observed a significant improvement in pain relief according to comparisons of numerical rating scale (NRS) scores before the procedure, after the clinical trial and at latest follow-up. Two unusual clinical cases were also reported, and the pertinent literature was discussed.
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Affiliation(s)
- Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filomena Fuggetta
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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Silvestri M, Signorelli F, Rapisarda A, D'Onofrio GF, Visocchi M. Tuberculum Sellae Meningioma: Report of Two Cases and Literature Review of Limits of the Transcranial and Endonasal Endoscopic Approaches. Acta Neurochir Suppl 2023; 135:75-79. [PMID: 38153452 DOI: 10.1007/978-3-031-36084-8_13] [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] [Indexed: 12/29/2023]
Abstract
BACKGROUND Tuberculum sellae (TS) meningioma is one of the most frequent meningiomas of the anterior skull base. Herein we perform a review of the literature concerning the preferred surgical approaches to TS meningiomas; in addition, we describe two explicative cases, operated on by our group using different approaches, with the aim to critically revise surgical indications and contraindications. METHODS In October 2021, two female patients with tuberculum sellae meningioma were treated at the Policlinico Gemelli of Rome. The patients presented with visual deterioration. Surgery was performed using the fronto-temporal approach and transsphenoidal approach. The visual function before and after surgery was evaluated as the main outcome parameter of the surgical treatment of these tumors. CONCLUSIONS Tuberculum sellae meningioma can be safely resected using the transcranial approach and the transsphenoidal endoscopic approach with preservation and even improvement of visual function after surgery. The relationship of the tumor with the optic nerves, optic canal, and anterior cerebral artery complex are important issues that have to be considered when dealing with tuberculum sellae meningioma. Both transcranial and endonasal approaches, in experienced hands, can allow complete resection of the lesion.
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Affiliation(s)
- Martina Silvestri
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Ginevra Federica D'Onofrio
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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15
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Polli FM, Rapisarda A, Trungu S, Forcato S, Montano N, Signorelli F, Visocchi M, Olivi A. Atlantoaxial Anterior Transarticular Screw Fixation: Indications and Surgical Technique. Acta Neurochir Suppl 2023; 135:273-277. [PMID: 38153481 DOI: 10.1007/978-3-031-36084-8_42] [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] [Indexed: 12/29/2023]
Abstract
Posterior atlantoaxial screw fixation is a widely adopted therapeutic option for C1-C2 instability secondary to fractures or dislocation, degenerative diseases, or tumors at this level. Anterior transarticular screw fixation (ATSF) is an effective alternative to the posterior approaches, presenting several advantages despite being scarcely known and rarely chosen.In this chapter, we describe the ATSF step by step, illustrating its variations reported in literature, and we critically analyze the several advantages and contraindications of this technique. Moreover, we provide a list of tips and tricks on the surgical procedure, including critical operating room settings-the result of more than 10 years of experience in the field by a senior author.ATSF is a valid strategy for the treatment of different diseases occurring at the level of the atlantoaxial complex that needs consideration. Given the significant learning curve of this strategy, some hints may be essential to begin introducing this technique in the personal armamentarium of a spine surgeon so that they can perform ATSF safely and effectively.
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Affiliation(s)
- Filippo Maria Polli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Rapisarda
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Sokol Trungu
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy
| | | | - Nicola Montano
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Alessandro Olivi
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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di Bonaventura R, Caccavella VM, Latour K, Rapisarda A, Gessi M, Montano N, Visocchi M, Olivi A, Polli FM. Spinal Epidural Atypical Meningioma: Case Report and Review of the Literature. Acta Neurochir Suppl 2023; 135:369-373. [PMID: 38153495 DOI: 10.1007/978-3-031-36084-8_56] [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] [Indexed: 12/29/2023]
Abstract
Spinal atypical meningiomas are rare, and those whose main extension is in the epidural space are anecdotal. Here, we report a case of a young woman presenting with sensory disturbances and a radiological diagnosis of a dorsal epidural sleeve-like mass. The surgical resection of the lesion allowed the decompression of the spinal cord and led to the histopathological diagnosis of atypical meningioma. At the 3-month follow-up, her neurological recovery was complete. Because of the gross total removal of the lesion, adjuvant radiotherapy was not performed: At the 2-year follow-up, no recurrence of disease was detected. A comprehensive literature review was performed, and just two more case reports on epidural atypical meningiomas were found in the English literature. Through this case report and literature review, we described a rare manifestation of spinal meningioma that entered into a differential diagnosis for extradural spinal lesions, such as secondary malignancies.
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Affiliation(s)
- Rina di Bonaventura
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Valerio Mario Caccavella
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Kristy Latour
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Gessi
- Institute of Pathologic Anatomy, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
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Rapisarda A, Pennisi G, Montano N, Della Pepa GM, Ricciardi L, De-Giorgio F, Visocchi M, Olivi A, Polli FM. Atlantoaxial Joint Distraction and Fusion with DTRAX Intra-Articular Cages: A Cadaveric Feasibility Study and Review of the Pertinent Literature. World Neurosurg 2022; 166:153-158. [PMID: 35917923 DOI: 10.1016/j.wneu.2022.07.077] [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: 06/12/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Atlantoaxial joint distraction is a key procedure for the treatment of selected patients affected by basilar invagination (BI). In recent years, several authors have reported various techniques of distraction and fixation of the C1-C2 joint using different types of intra-articular spacers, with or without posterior fixation. We review the pertinent literature and propose a feasibility study on the use of a new device for the distraction of the C1-C2 joint aimed to the descent of the dens out of the foramen magnum suggesting its application on selected cases of BI. METHODS The GL-DTRAX Cervical Cage-SE is a cage approved by the Food and Drug Administration for distraction and fixation of subaxial cervical spine. Five adult cadaveric specimens were dissected surgically to evaluate the feasibility of DTRAX insertion inside the C1-C2 joint through a posterior approach. RESULTS The cages were uneventfully set into the C1-C2 intra-articular space of all samples without the need to sacrifice C2 nerve roots and ganglia. Postoperative cervical computed tomography scanning confirmed the correct fitting of the devices in every sample. CONCLUSIONS This cadaveric study highlights the feasibility of the DTRAX cage as a C1-C2 intra-articular device producing a substantial distraction of atlantoaxial complex and suggesting a possible therapeutic role in selected cases of BI.
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Affiliation(s)
- Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Luca Ricciardi
- Department of Neurosurgery, Sant'Andrea Hospital, Rome, Italy
| | - Fabio De-Giorgio
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione IRCSS Policlinico Universitario A. Gemelli, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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18
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Menna G, Rapisarda A, Izzo A, D’Ercole M, D’Alessandris QG, Olivi A, Montano N. Surgical and Clinical Outcomes of Microvascular Decompression: A Comparative Study between Young and Elderly Patients. Brain Sci 2022; 12:brainsci12091216. [PMID: 36138952 PMCID: PMC9496765 DOI: 10.3390/brainsci12091216] [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: 08/11/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Microvascular decompression (MVD) is the only etiological technique for the treatment of trigeminal neuralgia (TN). Whilst there is a consensus MVD is likely effective regardless of age, the elderly population is thought to be more prone to have a higher rate of surgical complication, morbidity, and mortality. The main objective of our single-center, retrospective study was to analyze the surgical and clinical outcomes of MVD in TN elderly patients. From a surgical series of patients with TN who had undergone MVD from April 2018 to April 2022, 76 patients who matched the inclusion criteria were divided into two groups: twenty-five (32.9%) patients were older than 65 years and included in the elderly group, while the remaining fifty-one (61.1%) patients were below 65 years included in the non-elderly one. There were no differences between the groups in terms of acute pain relief (APR), Barrow Neurological Index (BNI) at follow-up, complications, and recurrence rate. In multivariate analysis (Cox proportional hazards regression analysis) the presence of an offending artery with nerve root distortion/indentation emerged as the only independent prognostic factor for pain-free survival (p = 0.0001). Our data endorse MVD as a safe and effective surgical procedure also for elderly patients with TN.
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Affiliation(s)
- Grazia Menna
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Manuela D’Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Alessandro Olivi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
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Rapisarda A, Baroni S, Gentili V, Moretti G, Burattini B, Sarlo F, Olivi A, Urbani A, Montano N. The role of biomarkers in drug-resistant trigeminal neuralgia: a prospective study in patients submitted to surgical treatment. Neurol Sci 2022; 43:4425-4430. [PMID: 35226213 DOI: 10.1007/s10072-022-05971-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Molecular mechanisms underlying trigeminal neuralgia (TN) have been poorly understood. Recently, different biomarkers have been studied in several chronic neuropathic diseases or in neuronal damage, but their role in TN has not yet been investigated. Here, we firstly analyzed the serum levels of the neuron-specific enolase (NSE) (as an index of neuronal tissue damage) in TN patients submitted to surgical treatment. Different cytokines and interleukins related to inflammation were also studied. METHODS Blood samples from 40 patients were prospectively collected preoperatively and after the surgical procedure, namely microvascular decompression (MVD) and percutaneous balloon compression (PBC). Serum levels of uric acid, NSE, ferritin, CRP, IL-2R, and IL-6 were studied. The acute pain relief (APR) and the pre- and postoperative BNI were used to evaluate the clinical outcome. RESULTS Overall, we obtained an APR in 87.5% of patients and a significant reduction of BNI after surgery (p < 0.0001). We observed a significant reduction of postoperative NSE values in the group of patients undergoing MVD (p = 0.0055) and a significant increase of postoperative NSE values in patients undergoing PBC (p < 0.05). Furthermore, in the group of patients undergoing MVD, we found a significant postoperative increase of CRP (p < 0.0001), ferritin (p = 0.001), and IL-6 (p = 0.01) values. The only patient who did not respond to MVD had NSE levels unchanged. CONCLUSION Our results suggest the hypothesis that TN would be related to the neural damage instead of the systemic inflammatory status and indicate NSE as a possible biomarker of response in patients submitted to MVD.
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Affiliation(s)
- Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Silvia Baroni
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vanessa Gentili
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Moretti
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benedetta Burattini
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Francesca Sarlo
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Andrea Urbani
- Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Catholic University of the Sacred Heart, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
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20
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Dallagiovanna C, Reschini M, Somigliana E, Rapisarda A, Boito S, Pezone M, Accurti V, Ferrara G, Persico N. P-356 Clinical implications of first-trimester ultrasound dating in singleton pregnancies obtained through in vitro fertilization. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.335] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Is there a correspondence between ultrasound estimation of gestational age (GAUS) and its calculation based on embryo transfer date (GAIVF), in in-vitro fertilization (IVF) pregnancies?
Summary answer
GAUS and GAIVF are not overlapping, being the first mildly greater than the latter, maybe due to anticipated ovulation and fertilization or accelerated embryo development.
What is known already
In IVF pregnancies the precise date of conception is known. However, it is possible that some factors (such as a time delay between conception and implantation, an early in-vitro embryo development, and the maternal environment itself with its altered hormonal milieu) may influence the early stages of embryonic development. Data regarding first-trimester fetal development in IVF pregnancies are in fact conflicting and both underestimation and overestimation of the true GA were reported when traditional charts were used for ultrasound pregnancy dating.
Study design, size, duration
A retrospective study was performed, including all singleton IVF pregnancies who underwent the first-trimester ultrasound scan for the screening of aneuploidies between January 2014 and June 2019. For each pregnancy GA was determined using two alternative methods: one based on the date of embryo transfer (GAIVF), and one based on ultrasound measurement of crown-rump length (CRL) (GAUS). GA were compared to search for any discrepancy. The impact of pregnancy dating on obstetric outcome was evaluated.
Participants/materials, setting, methods
All women with singleton pregnancies conceived by conventional IVF or intracytoplasmic sperm injection (ICSI), who performed first-trimester ultrasound scan for the screening of aneuploidies at the Department of Obstetrics and Gynecology ‘L. Mangiagalli', Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, were included. Exclusion criteria were as follows: multiple pregnancy (i.e., the evidence of more than one gestational sac at the first ultrasound scan), abnormal karyotype and/or congenital malformations detected either in pre- or postnatal period.
Main results and the role of chance
Overall, 249 women were selected: 111 pregnancies (45%) by conventional IVF, and 138 (55%) by ICSI. Among the included women, 127 (51%) pregnancies resulted from frozen-thawed embryo transfer. At first trimester ultrasound scan, the discrepancy in days between GAUS and GAIVF was ≥ 4 days in 32 cases (13%, 95%CI: 9-18%). It ranged within 2 and 3 days in 100 cases (40%, 95%CI: 34-47%). In 117 cases (47%, 95%CI: 41-53%) GAUS and GAIVF overlapped or showed a discrepancy of ± 1 day. Comparing GAUS and GAIVF at first trimester ultrasound scan, the median values of GA were 88 [86 - 91] days and 87 [85 - 90] days, respectively (p < 0.001). The median difference was 1 [0 - 2] days, with GAUS systematically higher than GAIVF. This discrepancy persisted when subgroups were analyzed comparing different IVF procedures (conventional IVF versus ICSI, cleavage versus blastocyst transfer, frozen versus fresh transfer). The overall duration of pregnancy differed, with median values of 274 [269 - 281] days in GAUS group and 273 [268 - 280] days in GAIVF group, (p > 0.001). No impact of the dating method on obstetric outcomes was observed, being no differences in the rate of preterm birth or abnormal fetal growth.
Limitations, reasons for caution
This is a retrospective study and thus exposed to the inaccuracies of this study design. Moreover, being a single-centre study, the sample size is relatively small. Finally, ultrasound evaluations were performed by multiple operators: although they are all certified, there is some inter-individual variability that may impact on the results.
Wider implications of the findings
Despite a known date of conception, it is difficult to assume that the oocyte retrieval date precisely resembles the date of natural ovulation and conception. IVF seems to anticipate fertilization. On these bases, it would be advisable to date IVF pregnancies using GAUS to realign them to natural pregnancies.
Trial registration number
Not Applicable
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Affiliation(s)
- C Dallagiovanna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Clinica Regina Elena, PMA Procreazione Medicalmente Assistita , Milano, Italy
| | - M Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Clinica Regina Elena, PMA Procreazione Medicalmente Assistita , Milano, Italy
| | - E Somigliana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Clinica Regina Elena, PMA Procreazione Medicalmente Assistita , Milano, Italy
| | - A Rapisarda
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Service , Milano, Italy
| | - S Boito
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Service , Milano, Italy
| | - M.G Pezone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Service , Milano, Italy
| | - V Accurti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Service , Milano, Italy
| | - G Ferrara
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Service , Milano, Italy
| | - N Persico
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Service , Milano, Italy
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21
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Rapisarda A, Ktari O, Marco G, Polli FM. Giant Inflammatory Cervical Ganglion Due to Ectopic Rib Head: Report of a Rare Diagnosis Mimicking a Cervical Schwannoma. World Neurosurg 2022; 164:251-252. [PMID: 35568122 DOI: 10.1016/j.wneu.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
Cervical schwannomas may be common in patients with cervicobrachialgia. We report a case of an apparent C8 schwannoma in a 55-year-old female that was discovered to be an inflammatory enlarged cervical ganglion. Such a rare presentation may be explained by the particular conformation of the left C7-Th1 neuroforamen, compressed by an ectopic cranially located first rib head, which was visible only with a cervical computed tomography scan. No similar finding is reported in the literature, and this interesting case may provide new insight into the differential diagnosis of cervical spinal lesions.
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Affiliation(s)
- Alessandro Rapisarda
- Department of Neurosurgery, UOC Pathology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Omar Ktari
- Department of Neurosurgery, UOC Pathology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gessi Marco
- UOS Neuropathology, UOC Pathology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, UOC Pathology Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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22
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Caccavella VM, Giordano M, Colicchio G, Izzo A, D’Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Montano N. Palliative surgery for drug resistant epilepsy in adult patients. A systematic review of the literature and a pooled analysis of outcomes. World Neurosurg 2022; 163:132-140.e1. [DOI: 10.1016/j.wneu.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
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23
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Auricchio AM, Mazzucchi E, Rapisarda A, Sabatino G, Della Pepa GM, Visconti G, Salgarello M, Olivi A, La Rocca G. Chimeric Anterolateral Thigh Flap in Skull Base Reconstruction: A Case-Based Update and Literature Review. Brain Sci 2021; 11:brainsci11081076. [PMID: 34439694 PMCID: PMC8393429 DOI: 10.3390/brainsci11081076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Oncologic and traumatic neurosurgery may have to cope with the issue of skull base defects, which are associated with increased risk of meningitis, epidural abscess and cerebro-spinal fluid (CSF) leak. The aim of skull base reconstruction is to repair the dural exposure and to separate the intracranial contents from the nonsterile sino-nasal cavities and extracranial space. Currently, many different surgical techniques have been described, and one of the most performed is the use free flap. In the present paper we performed a case-based update and literature review of the use of chimeric anterolateral thigh free flap harvested from rectus femoris, reporting the case of a 68-year-old man with recurrent spheno-ethmoidalis plane meningioma.
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Affiliation(s)
- Anna Maria Auricchio
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
- Correspondence:
| | - Alessandro Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Giuseppe Maria Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
| | - Giuseppe Visconti
- UOC Chirurgia Plastica, Dipartimento Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.V.); (M.S.)
| | - Marzia Salgarello
- UOC Chirurgia Plastica, Dipartimento Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.V.); (M.S.)
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (A.M.A.); (A.R.); (G.S.); (G.M.D.P.); (A.O.); (G.L.R.)
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
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24
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Della Pepa GM, Chiesa S, Rapisarda A, D'Alessandris QG, Bonaventura RD, Pallini R, Olivi A. Letter: Adjuvant Radiotherapy Versus Watchful Waiting for World Health Organization Grade II Atypical Meningioma: A Single-Institution Experience. Neurosurgery 2021; 89:E277-E278. [PMID: 34382646 DOI: 10.1093/neuros/nyab283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/27/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Silvia Chiesa
- Department of Radiation Oncology Fondazione Policlinico Universitario A. Gemelli IRCSS Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery Fondazione Policlinico Universitario A. Gemelli IRCSS Rome, Italy
| | | | - Rina Di Bonaventura
- Department of Neurosurgery Fondazione Policlinico Universitario A. Gemelli IRCSS Rome, Italy
| | - Roberto Pallini
- Department of Neurosurgery Fondazione Policlinico Universitario A. Gemelli IRCSS Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery Fondazione Policlinico Universitario A. Gemelli IRCSS Rome, Italy
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25
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Buscemi A, Coco M, Rapisarda A, Frazzetto G, Di Rosa D, Feo S, Piluso M, Presente LP, Campisi SS, Desirò P. Tongue stretching: technique and clinical proposal. J Complement Integr Med 2021; 19:487-491. [PMID: 34364317 DOI: 10.1515/jcim-2020-0101] [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] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The tongue is an organ with multiple functions, from sucking to phonation, from swallowing to postural control and equilibrium. An incorrect position or mechanics of the tongue can causes sucking problems in the newborn or atypical swallowing in the adult, with repercussions on the position of the head and neck, up to influencing upright posture and other problems. Tongue dysfunctions are quite frequent (10-15%) in the population. For the manual therapist, this frequency indicates one to two subjects every 30 patients. Exercises have been proposed to improve the tone and strength of the swallowing muscles but the results are not so clear in the literature. The aim of this study is to describe and provide a tongue muscle normalization technique that helps the manual therapist in the treatment of problems related to it. METHODS The literature has been investigated through pubmed, Google scholar of the last 10 years, the keywords used and combined with the Boolean operators AND and OR, are: "tongue, tongue habits, tongue diseases, taste disorder, neck pain, posture, postural balance, atypical swallowing, muscle stretching exercise, tissue expansion, soft tissue therapy, osteopathic manipulative treatment". RESULTS AND CONCLUSIONS The technique is possible to be executed even in a sitting position, in the case the patient is unable to assume a supine position, the subject should provides immediate feedback that allows the therapist to understand if the technique has been correctly executed. The simplicity of execution and application of the technique makes it a possible and immediate therapeutic tool in the clinical setting.
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Affiliation(s)
- Andrea Buscemi
- Department of Research, Italian Osteopathy Study Center, Catania, Italy.,Horus Social Cooperative, Ragusa, Italy
| | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | | | | | | | | | | | | | - Paolo Desirò
- Fascia Didactics, Osteopathic Spine Center Education, Bologna, Italy
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26
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Pluchino A, Biondo AE, Giuffrida N, Inturri G, Latora V, Le Moli R, Rapisarda A, Russo G, Zappalà C. Author Correction: A novel methodology for epidemic risk assessment of COVID-19 outbreak. Sci Rep 2021; 11:15719. [PMID: 34321537 PMCID: PMC8316884 DOI: 10.1038/s41598-021-94234-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- A Pluchino
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy.
| | - A E Biondo
- Dipartimento di Economia e Impresa, Università di Catania, Catania, Italy
| | - N Giuffrida
- Dipartimento di Ingegneria Civile e Architettura, Università di Catania, Catania, Italy
| | - G Inturri
- Dipartimento di Ingegneria Elettrica Elettronica e Informatica, Università di Catania, Catania, Italy
| | - V Latora
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy.,Complexity Science Hub Vienna, Vienna, Austria.,School of Mathematical Sciences, Queen Mary University of London, London, E1 4NS, UK.,The Alan Turing Institute, The British Library, London, NW1 2DB, UK
| | - R Le Moli
- Dipartimento di Medicina Clinica e Sperimentale ‑ UO di Endocrinologia ‑ Ospedale Garibaldi Nesima, Università di Catania, Catania, Italy
| | - A Rapisarda
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy.,Complexity Science Hub Vienna, Vienna, Austria
| | - G Russo
- Dipartimento di Matematica e Informatica, Università di Catania, Catania, Italy
| | - C Zappalà
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy
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27
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Montano N, Rapisarda A. The role of neurovascular conflict in patients with multiple sclerosis and trigeminal neuralgia. Cephalalgia 2021; 41:1409-1410. [PMID: 34256652 DOI: 10.1177/03331024211027359] [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: 11/16/2022]
Affiliation(s)
- Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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28
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Buscemi A, Campisi SS, Frazzetto G, Petriliggieri J, Martino S, Ambramo P, Rapisarda A, Maldonato NM, Di Corrado D, Coco M. What Does the Body Communicate With Postural Oscillations? A Clinical Investigation Hypothesis. Front Psychol 2021; 12:668192. [PMID: 34220640 PMCID: PMC8241913 DOI: 10.3389/fpsyg.2021.668192] [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: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
The evolution of the foot and the attainment of the bipedia represent a distinctive characteristic of the human species. The force of gravity is dissipated through the tibial astragalic joints, and the movement of the ankle is manifested on a sagittal plane. However, this is in contrast with other studies that analyze the straight station in bipodalic support of the body. According to these studies, the oscillations of the body dissipated by the articulation of the ankle are greater on a frontal plane than on a sagittal plane. Probably, this can be deduced by analyzing the concept of "cone of economy (COE) and equilibrium;" a cone that has its base with the oscillations described by the 360° movement performed by the head and has its apex that supports polygon defined by the tibio-astragalic articulation. The purpose of this study was to evaluate a kind of communication between the oscillations of the COE and equilibrium and the main sphere of somatic dysfunction (structural, visceral, or cranial sacral), assessing the reliability of the "fascial compression test." The implications of this connection have been considered, while grounding the hypothesis in the ability of the human body to maintain its center of mass (COM) with minimum energy expenditure and with minimum postural influence. At the same time, the fascial compression test provides a dominant direction of fascial compartments in restriction of mobility.
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Affiliation(s)
- Andrea Buscemi
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | - Santi Scirè Campisi
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | - Giulia Frazzetto
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | | | - Simona Martino
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | - Pierluca Ambramo
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | | | - Nelson Mauro Maldonato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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29
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Rapisarda A, Ioannoni E, Izzo A, Montano N. What Are the Results and the Prognostic Factors of Motor Cortex Stimulation in Patients with Facial Pain? A Systematic Review of the Literature. Eur Neurol 2021; 84:151-156. [PMID: 33853065 DOI: 10.1159/000514827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Facial pain (FP) is a type of neuropathic pain which recognizes both central and peripheral causes. It can be difficult to treat because it can often become resistant to pharmacological treatments. Motor Cortex Stimulation (MCS) has been used in selected cases, but the correct indications of MCS in FP have not been fully established. Here we systematically reviewed the literature regarding MCS in FP analysing the results of this technique and studying the possible role of different factors in the prognosis of these patients. METHODS A literature search was performed through different databases (PubMed, Scopus, and Embase) according to PRISMA guidelines using the following terms in any possible combination: "facial pain" or "trigeminal" or "anaesthesia dolorosa" and "motor cortex stimulation." RESULTS 111 articles were reviewed, and 12 studies were included in the present analysis for a total of 108 patients. Overall, at latest follow-up (FU), 70.83% of patients responded to MCS. The preoperative VAS significantly decreased at the latest FU (8.83 ± 1.17 and 4.31 ± 2.05, respectively; p < 0.0001). Younger age (p = 0.0478) and a peripheral FP syndrome (p = 0.0006) positively affected the definitive implantation rate on univariate analysis. Younger age emerged as a factor strongly associated to a higher probability to go to a definitive MCS implant on multivariate analysis (p = 0.0415). CONCLUSION Our results evidenced the effectiveness of MCS in treating FP. Moreover, the younger age emerged as a positive prognostic factor for definitive implantation. Further studies with longer FU are needed to better evaluate the long-term results of MCS.
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Affiliation(s)
- Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Ioannoni
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Pluchino A, Biondo AE, Giuffrida N, Inturri G, Latora V, Le Moli R, Rapisarda A, Russo G, Zappalà C. A novel methodology for epidemic risk assessment of COVID-19 outbreak. Sci Rep 2021; 11:5304. [PMID: 33674627 PMCID: PMC7935987 DOI: 10.1038/s41598-021-82310-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
We propose a novel data-driven framework for assessing the a-priori epidemic risk of a geographical area and for identifying high-risk areas within a country. Our risk index is evaluated as a function of three different components: the hazard of the disease, the exposure of the area and the vulnerability of its inhabitants. As an application, we discuss the case of COVID-19 outbreak in Italy. We characterize each of the twenty Italian regions by using available historical data on air pollution, human mobility, winter temperature, housing concentration, health care density, population size and age. We find that the epidemic risk is higher in some of the Northern regions with respect to Central and Southern Italy. The corresponding risk index shows correlations with the available official data on the number of infected individuals, patients in intensive care and deceased patients, and can help explaining why regions such as Lombardia, Emilia-Romagna, Piemonte and Veneto have suffered much more than the rest of the country. Although the COVID-19 outbreak started in both North (Lombardia) and Central Italy (Lazio) almost at the same time, when the first cases were officially certified at the beginning of 2020, the disease has spread faster and with heavier consequences in regions with higher epidemic risk. Our framework can be extended and tested on other epidemic data, such as those on seasonal flu, and applied to other countries. We also present a policy model connected with our methodology, which might help policy-makers to take informed decisions.
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Affiliation(s)
- A Pluchino
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy.
| | - A E Biondo
- Dipartimento di Economia e Impresa, Università di Catania, Catania, Italy
| | - N Giuffrida
- Dipartimento di Ingegneria Civile e Architettura, Università di Catania, Catania, Italy
| | - G Inturri
- Dipartimento di Ingegneria Elettrica Elettronica e Informatica, Università di Catania, Catania, Italy
| | - V Latora
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy
- Complexity Science Hub Vienna, Vienna, Austria
- School of Mathematical Sciences, Queen Mary University of London, London, E1 4NS, UK
- The Alan Turing Institute, The British Library, London, NW1 2DB, UK
| | - R Le Moli
- Dipartimento di Medicina Clinica e Sperimentale - UO di Endocrinologia - Ospedale Garibaldi Nesima, Università di Catania, Catania, Italy
| | - A Rapisarda
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy
- Complexity Science Hub Vienna, Vienna, Austria
| | - G Russo
- Dipartimento di Matematica e Informatica, Università di Catania, Catania, Italy
| | - C Zappalà
- Dipartimento di Fisica e Astronomia "Ettore Majorana", INFN Sezione di Catania, Università di Catania, Catania, Italy
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Mattogno PP, Sturiale CL, Rapisarda A, Olivi A, Albanese A. Strategies for Optic Pathways Decompression for Extra-Axial Tumors or Intracranial Aneurysms: A Technical Note. J Neurol Surg A Cent Eur Neurosurg 2021; 82:475-483. [PMID: 33641136 DOI: 10.1055/s-0040-1720991] [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: 10/22/2022]
Abstract
BACKGROUND Different types of skull base tumors and intracranial aneurysms may lead to compression of the optic pathways. Since most of them are biologically benign conditions, the first aim of surgery is preservation of optic nerves rather than the oncologic radicality. MATERIALS AND METHODS Based on the progressive technical refinements coming from our institutional experience of optic nerve compression from aneurysms and extra-axial tumors, we analyzed the surgical steps to release nerves and chiasm during tumor debulking and aneurysm clipping. RESULTS We distinguished vascular and tumor lesions according to the main direction of optic nerve compression: lateral to medial, medial to lateral, inferior to superior, and anterior to posterior. We also identified four fundamental sequential maneuvers to release the optic nerve, which are (1) falciform ligament (FL) section, (2) optic canal unroofing, (3) anterior clinoid process drilling, and (4) optic strut removal. The FL section is always recommended when a gentle manipulation of the optic nerve is required. Optic canal unroofing is suggested in case of lateral-to-medial compression (i.e., clinoid meningiomas), medial-to-lateral compression (i.e., tuberculum sellae meningiomas), and inferior-to-superior compression (i.e., suprasellar lesions). Anterior clinoidectomy and optic strut removal may be necessary in case of lateral-to-medial compression from paraclinoid aneurysms or meningiomas. CONCLUSIONS Preservation of the visual function is the main goal of surgery for tumors and aneurysms causing optic nerve compression. This mandatory principle guides the approach, the timing, and the technical strategy to release the optic nerve, and is principally based on the direction of the compression vector.
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Affiliation(s)
- Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Sturiale CL, Rapisarda A, Marchese E, Puca A, Olivi A, Albanese A. Surgical Treatment of Middle Cerebral Artery Aneurysms: Hints and Precautions for Young Cerebrovascular Surgeons. J Neurol Surg A Cent Eur Neurosurg 2021; 83:75-84. [PMID: 33641137 DOI: 10.1055/s-0040-1720996] [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: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Clipping is still considered the treatment of choice for middle cerebral artery (MCA) aneurysms due to their angioarchitectural characteristics as they are often bifurcation dysplasias, needing a complex reconstruction rather than a simple exclusion. Thus, maintaining this surgical expertise is of paramount importance to train of young cerebrovascular surgeons. To balance for the increasingly limited experience due the worldwide general inclination toward the endovascular approaches, it is important to provide to the young neurosurgeons rules and operative nuances to guide this complex surgery. We describe the technical algorithm we use to teach our residents to approach ruptured and unruptured MCA aneurysms, which may help to develop a procedural memory useful to perform an effective and safe surgery. MATERIALS AND METHODS We reviewed our last 10 years' institutional experience of about 400 cases of ruptured and unruptured MCA aneurysms clipping, analyzing our technical refinements and the difficulties in residents and young neurosurgeons teaching, to establish fundamental key-points and design a didactic algorithm that includes operative instructions and safety rules. RESULTS We recognized seven pragmatic technical key points regarding craniotomy, sylvian fissure opening, basal cisternostomy, proximal vessel control, lenticulostriate arteries preservation, aneurysm neck microdissection, and clipping to use as a didactic algorithm for teaching residents, and as operative instructions for inexperienced neurosurgeons. CONCLUSION In the setting of clipping MCA aneurysms, respect for surgical rules is of paramount importance to perform an effective and safe procedure, ensure the best aneurysm exclusion, and preserve the flow in collaterals and perforators.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alessandro Rapisarda
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Enrico Marchese
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alfredo Puca
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alessandro Olivi
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alessio Albanese
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
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Legninda Sop FY, D'Ercole M, Izzo A, Rapisarda A, Ioannoni E, Caricato A, Olivi A, Montano N. The Impact of Neuronavigation on the Surgical Outcome of Microvascular Decompression for Trigeminal Neuralgia. World Neurosurg 2021; 149:80-85. [PMID: 33621673 DOI: 10.1016/j.wneu.2021.02.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) is considered the only etiological treatment for drug-resistant trigeminal neuralgia (TN). Nonetheless, despite the recent technological advances, the risks associated with MVD remain non-negligible. The aim of this study was to evaluate the impact of using neuronavigation on the surgical outcomes of patients with TN submitted for MVD. METHODS We analyzed 30 consecutive patients (11 men, 19 women) who underwent MVD for TN between January 2019 and December 2019. Patients were divided in 2 groups according to the use of neuronavigation (group A: MVD with neuronavigation; group B: MVD without neuronavigation). The impact of neuronavigation was assessed on the following parameters: craniotomy size, surgical duration, mastoid air cell opening, postoperative cerebrospinal fluid (CSF) leakage and other complications occurrence, and length of hospitalization. The acute pain relief and the Barrow Neurological Institute score at follow-up were used to evaluate the functional outcome. RESULTS The craniotomy size, the surgical duration, and the CSF leak incidence were significantly reduced in group A compared with group B (P = 0.0009, P = 0.0369, and P = 0.0406, respectively). The incidence of mastoid air cell opening, and the length of hospitalization were reduced in group A compared with group B, although these differences were not statistically significant. We obtained an acute pain relief in all cases, and the Barrow Neurological Institute score at follow-up was significantly reduced (P < 0.0001). CONCLUSIONS Neuronavigation is a useful tool that significantly reduced craniotomy size, surgical duration, and CSF leak incidence in patients with TN submitted for MVD. We advise to routinely implement neuronavigation in this type of surgery.
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Affiliation(s)
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anselmo Caricato
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy.
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Trevisi G, Signorelli F, de Waure C, Stifano V, Sturdà C, Rapisarda A, Pompucci A, Mangiola A, Anile C. Intraventricular infusion test accuracy in predicting short- and long-term outcome of iNPH patients: a 10-year update of a three-decade experience at a single institution. Neurosurg Rev 2021; 44:3323-3334. [PMID: 33590367 DOI: 10.1007/s10143-021-01495-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/19/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In a previous work, we found that an Intracranial Elastance Index (IEI) ≥0.3 at ventricular infusion test had a high accuracy in predicting shunt response at 6 and 12 months in idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to verify the accuracy of IEI to predict response to shunt at both short- and long-term follow-up. METHODS Retrospective evaluation of 64 patients undergoing ventriculo-peritoneal shunting for iNPH between 2006 and 2015 based on a positive ventricular infusion test (IEI≥0.3). Patients were classified according to Krauss scale and mRS preoperatively, at 1-year and at last follow-up. An improvement of at least one point at Krauss score or at mRS was considered as a good outcome; unchanged or worsened patients were grouped as poor outcome. RESULTS Mean follow-up was 6.6 years. Improvement at Krauss scale was seen in 62.5% and 64.3% of patients at 1-year and last follow-up, respectively. Patients in good functional status (mRS≤2) increased from 25 in the preoperative period to 57% at both 1-year and last follow-up. IEI was significantly associated with Krauss (p=0.041) and mRS (p=0.036) outcome at last follow-up. Patients with worse preoperative Krauss and mRS had higher chance to improve but higher overall scores after treatment. At ROC curves, IEI showed a good long-term prediction of change in mRS from first year to last follow-up. CONCLUSIONS IEI≥0.3 predicts outcomes at both short- and long-term, with more than 50% of patients being able to look after themselves after 6 years from treatment.
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Affiliation(s)
| | - Francesco Signorelli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Vito Stifano
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Cosimo Sturdà
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Angelo Pompucci
- Neurosurgical Unit, Ospedale Santa Maria Goretti, Latina, Italy
| | - Annunziato Mangiola
- Neurosurgical Unit, Ospedale Spirito Santo, Pescara, Italy.,Department of Neurosciences, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Carmelo Anile
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Della Pepa GM, Menna G, Stifano V, Pezzullo AM, Auricchio AM, Rapisarda A, Caccavella VM, La Rocca G, Sabatino G, Marchese E, Olivi A. Predicting meningioma consistency and brain-meningioma interface with intraoperative strain ultrasound elastography: a novel application to guide surgical strategy. Neurosurg Focus 2021; 50:E15. [PMID: 33386015 DOI: 10.3171/2020.10.focus20797] [Citation(s) in RCA: 10] [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: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Providing new tools to improve surgical planning is considered a main goal in meningioma treatment. In this context, two factors are crucial in determining operating strategy: meningioma-brain interface and meningioma consistency. The use of intraoperative ultrasound (ioUS) elastosonography, a real-time imaging technique, has been introduced in general surgery to evaluate similar features in other pathological settings such as thyroid and prostate cancer. The aim of the present study was to evaluate ioUS elastosonography in the intraoperative prediction of key intracranial meningioma features and to evaluate its application in guiding surgical strategy. METHODS An institutional series of 36 meningiomas studied with ioUS elastosonography is reported. Elastographic data, intraoperative surgical findings, and corresponding preoperative MRI features were classified, applying a score from 0 to 2 to both meningioma consistency and meningioma-brain interface. Statistical analysis was performed to determine the degree of agreement between meningioma elastosonographic features and surgical findings, and whether intraoperative elastosonography was a better predictor than preoperative MRI in assessing meningioma consistency and slip-brain interface, using intraoperative findings as the gold standard. RESULTS A significantly high degree of reliability and agreement between ioUS elastographic scores and surgical finding scores was reported (intraclass correlation coefficient = 0.848, F = 12.147, p < 0.001). When analyzing both consistency and brain-tumor interface, ioUS elastography proved to have a rather elevated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive (LR+) and negative likelihood ratio (LR-). This consideration was true especially for meningiomas with a hard consistency (sensitivity = 0.92, specificity = 0.96, PPV = 0.92, NPV = 0.96, LR+ = 22.00, LR- = 0.09) and for those presenting with an adherent slip-brain interface (sensitivity = 0.76, specificity = 0.95, PPV = 0.93, NPV = 0.82, LR+ = 14.3, LR- = 0.25). Furthermore, predictions derived from ioUS elastography were found to be more accurate than MRI-derived predictions, as demonstrated by McNemar's test results in both consistency (p < 0.001) and interface (p < 0.001). CONCLUSIONS While external validation of the data is needed to transform ioUS elastography into a fully deployable clinical tool, this experience confirmed that it may be integrated into meningioma surgical planning, especially because of its rapidity and cost-effectiveness.
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Affiliation(s)
| | | | | | - Angelo Maria Pezzullo
- 2Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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La Rocca G, Sabatino G, Altieri R, Mazzucchi E, Rapisarda A, Ius T, Garbossa D, Cofano F, Olivi A, Della Pepa GM. Parietal interhemispheric transfalcine transtentorial approach for posterior incisural space lesions: from the lab to the operative room. Neurosurg Rev 2020; 44:1779-1788. [PMID: 32840722 DOI: 10.1007/s10143-020-01375-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
The operative approach to the posterior incisural space is challenging because of its deep location, the surrounding eloquent areas, and the intimate relationship with the deep veins. Several approaches have been proposed to manage the lesions in this region: supratentorial, infratentorial and a combination of them. Brain retraction, injury to the occipital lobe and corpus callosum, and venous bleeding are the principle drawbacks of these routes. We performed anatomical dissection study using 10 embalmed human cadaver specimens injected with colored latex exploring a different route, parietal interhemispheric transfalcine transtentorial (PITT). Then we used a PITT approach on two patients with posterior incisural space (PIS) lesions. The PITT approach led to successful and safe complete removal of PIS lesions in our cases. No complications were reported. The present approach could be a valuable option in case of PIS lesions, especially those associated with downward displacement of the deep venous complex; thanks to the gravity it reduce the complications related to the occipital lobe retraction and manipulation. Moreover, cutting the superior-anterior edge of the tentorium, the sub-tentorial space could be reached.
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Affiliation(s)
- G La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - G Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Roberto Altieri
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy.
| | - E Mazzucchi
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - A Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - T Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia, University Hospital, Udine, Italy
| | - D Garbossa
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - F Cofano
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - A Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - G M Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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La Rocca G, Della Pepa GM, Menna G, Altieri R, Ius T, Rapisarda A, Olivi A, Sabatino G. State of the art of fluorescence guided techniques in neurosurgery. J Neurosurg Sci 2020; 63:619-624. [PMID: 31961115 DOI: 10.23736/s0390-5616.19.04854-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Achieving a safe and extensive neoplasm resection can be considered the main goal of brain tumor surgery. This paper is first aimed at providing an overview of the evolution of those tools serving the purpose. From the dawn of neurosurgery to the present days, major innovations have followed one another. However, those techniques may frequently lack of an instant biological feedback on the true extension and the infiltration of the tumor. Intraoperative fluorescence modalities could indeed fill this gap. Fluorescence guided surgery will be therefore introduced and discussed in this context. Our focus will be on the most common fluorescence techniques used in neurosurgery, namely 5-aminolevulinic acid, sodium fluorescein and in indocyanine green. Mode of action, strengths and weaknesses and level of evidence of each modality will be discussed.
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Affiliation(s)
- Giuseppe La Rocca
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy - .,Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy -
| | - Giuseppe M Della Pepa
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Grazia Menna
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Roberto Altieri
- Department of Neurological Surgery, G. Rodolico Policlinic University Hospital, Catania, Italy.,Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Tamara Ius
- Unit of Neurosurgery, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
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Della Pepa GM, Ius T, Menna G, La Rocca G, Battistella C, Rapisarda A, Mazzucchi E, Pignotti F, Alexandre A, Marchese E, Olivi A, Sabatino G. "Dark corridors" in 5-ALA resection of high-grade gliomas: combining fluorescence-guided surgery and contrast-enhanced ultrasonography to better explore the surgical field. J Neurosurg Sci 2020; 63:688-696. [PMID: 31961118 DOI: 10.23736/s0390-5616.19.04862-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increasing the extent of resection (EOR) is considered a main goal in high grade glioma (HGG) surgery. Significant advancements have been recently made to assist surgery: namely the use of 5-aminolevulinic acid (5ALA) and the application of contrast-enhanced ultrasound (CEUS) embody two of the most recently introduced tools in the neuro-oncology field. A combined approach including the two techniques has been suggested in literature. Our primary aim is to identify in which conditions CEUS final survey has a real impact in a 5-ALA guided context and assess which preoperative tumor characteristics, with specific attention to working corridors can predict strains of the fluorescence guided procedure and hence recommend the use of the combined technique. METHODS Forty-nine HGG glioma surgeries were performed at our institution with the abovementioned protocol between January 2016 and June 2016. Based on preoperative MRI, we stratified glioma characteristics according to three determinants: localization (deep versus superficial), size (<3.5 versus >3.5 cm) and shape (regular versus irregular). RESULTS CEUS modified 5-ALA guided resection in 11 cases (22.45%): this appeared to be associated with statistically significance to deep tumor localization (P=0.04) and irregular/multi-lobulated margins (P=0.003). On the other hand, tumor size alone did not appear as a statistically significant determinant. CONCLUSIONS When dark corridors are presents or when overlying brain parenchyma hinders illumination, drawbacks to the 5-ALA assistance can be expected, hence CEUS final survey has a crucial role of 'refinement'. In those selected cases, an integrated 5ALA+CEUS protocol was shown as advisable in EOR improvement.
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Affiliation(s)
- Giuseppe M Della Pepa
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Grazia Menna
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giuseppe La Rocca
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy.,Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | | | - Alessandro Rapisarda
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Andrea Alexandre
- Institute of Neuroradiology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy.,Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Buscemi A, Martino S, Scirè Campisi S, Rapisarda A, Coco M. Endocannabinoids release after Osteopathic Manipulative Treatment. A brief review. J Complement Integr Med 2020; 18:1-7. [PMID: 32554836 DOI: 10.1515/jcim-2020-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Since 70's, scientific research has analyzed how many acute and chronic issues can affect body systems. In case of depression, chronic pain and overtraining, centrals and peripherals systems act to manage and maintain body adaptations. The aim of this study is to evaluate if the osteopathic treatment can increase the release of Cannabinoid receptor (CB) and promote the linkage with their receptors. CONTENT Documents research is based on PubMed and Google Scholar databases. Keywords used were "osteopathic treatment", "manual therapy", "endocannabinoid", "beta endorphin (BE)", and " CB1" "massage". From 70 articles collected (published in the last 10 years) 52 were excluded as non-relevant to the study aim. SUMMARY The Key points have been the similar results found by different authors during different treatment periods and with different doses. From 22 articles examined, 13 have established positive effects on CB increasing post osteopathic treatment, three articles have indicated the most targeted tissues in which the substances are most expressed, two articles indicate how physical activities produce antalgic effects by increasing CB's values. OUTLOOK As a result of this review, osteopathic manipulation treatment seems to be a valid and effective instrument for the treatment of a series of pathologies such as chronic low back pain, fibromyalgia, spinal cord lesions, myofascial graft point, migraine, GI tract dysfunctions, and depression.
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Affiliation(s)
- Andrea Buscemi
- Department of Research, Center Studies of Osteopathy, Catania, Italy
| | - Simona Martino
- Department of Research, Center Studies of Osteopathy, Catania, Italy
| | | | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania and Research Center on Motor Activities (CRAM), University of Catania Torre Biologica, Via Santa Sofia, 89, 95123, Catania, Italy
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Della Pepa GM, Ius T, La Rocca G, Gaudino S, Isola M, Pignotti F, Rapisarda A, Mazzucchi E, Giordano C, Dragonetti V, Chiesa S, Balducci M, Gessi M, Skrap M, Olivi A, Marchese E, Sabatino G. 5-Aminolevulinic Acid and Contrast-Enhanced Ultrasound: The Combination of the Two Techniques to Optimize the Extent of Resection in Glioblastoma Surgery. Neurosurgery 2020; 86:E529-E540. [PMID: 32186345 DOI: 10.1093/neuros/nyaa037] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The survival benefit in maximizing resection in glioblastomas (GBMs) has been demonstrated by numerous studies. The true limit of infiltration of GBMs has been an overwhelming obstacle, and several technological advances have been introduced to improve the identification of residual tumors. OBJECTIVE To evaluate whether the integration of 5-aminolevulinic acid (5-ALA) with microbubble contrast-enhanced ultrasound (CEUS) improves residual tumor identification and has an impact on the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS). METHODS A total of 230 GBM procedures were retrospectively studied. Cases were stratified according to the surgical procedure into 4 groups: 5-ALA- and CEUS-guided surgeries, 5-ALA-guided surgeries, CEUS-guided surgeries, and conventional microsurgical procedures. RESULTS Patients undergoing conventional microsurgical procedures showed the worst EORs compared to the assisted techniques (5-ALA and CEUS procedures). Both 5-ALA and CEUS techniques improved the EOR compared to conventional microsurgical procedures. However, their combination gave the best results in terms of the EOR (P = .0003). The median EOR% and the number of supramarginal resections are hence superior in the 5-ALA + CEUS + group compared to the others; this observation had consequences on PFS and OS in our series. CONCLUSION In terms of the EOR, the best results can be achieved through a combination of both techniques, where the 5-ALA-guided procedure is followed by a final survey with CEUS. Compared with other intraoperative imaging techniques, CEUS is a real-time, readily repeatable, safe, and inexpensive technique that provides valuable information to the surgeon before, during, and after resection.
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Affiliation(s)
- Giuseppe Maria Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital, Udine, Italy
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Simona Gaudino
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Fabrizio Pignotti
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Carolina Giordano
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Valentino Dragonetti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Silvia Chiesa
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSSl, Catholic University of Rome, Rome, Italy
| | - Mario Balducci
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSSl, Catholic University of Rome, Rome, Italy
| | - Marco Gessi
- Department of Neuro-Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital, Udine, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Montano N, Ioannoni E, Rapisarda A. The risk of mastication weakness after percutaneous balloon compression for the treatment of trigeminal neuralgia. Clin Neurol Neurosurg 2020; 195:105880. [PMID: 32413677 DOI: 10.1016/j.clineuro.2020.105880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Nicola Montano
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Montano N, Rapisarda A, Ioannoni E, Olivi A. Microvascular decompression in patients with trigeminal neuralgia and multiple sclerosis: results and analysis of possible prognostic factors. Acta Neurol Belg 2020; 120:329-334. [PMID: 31792763 DOI: 10.1007/s13760-019-01258-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
We evaluated the results of microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) and multiple sclerosis (MS) and we studied the role of several clinical and surgical factors as possible prognosticators of good outcome. To do this we performed, to our knowledge, the first literature review with a pooled analysis of data. A PubMed search of literature was conducted using the following terms: "microvascular decompression", "trigeminal neuralgia" and "multiple sclerosis". We screened 64 articles. Of them, 7 studies were eligible for this review. As outcome indicators we used the acute pain relief (APR) and the recurrence of pain. An APR was obtained in 71.42% and a recurrence of pain was reported in 26.00% of cases, respectively. At univariate analysis, younger age at surgery (p = 0.0419) and performing MVD as the first treatment (p = 0.0384) were associated to a higher probability of APR. The evidence of an MRI brainstem lesion related to the TN (p = 0.0482) was associated to a lower probability to obtain an APR after MVD. None of the evaluated factors affect the probability of recurrence of pain. At multivariate analysis the evidence of a brainstem MRI lesion related to the TN emerged as a negative prognosticator of APR (p = 0.0169). Our literature pooled analysis showed that MVD is effective in treating patients with MS-related TN. The evidence on MRI of a demyelinating plaque related to the TN is associated with a worse response to MVD. These data could suggest that MVD would be indicated mainly in patients without brainstem MRI lesions.
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Della Pepa GM, Marchese E, Pedicelli A, Olivi A, Ricciardi L, Rapisarda A, Skrap B, Sabatino G, La Rocca G. Erratum to ‘Contrast-Enhanced Ultrasonography and Color Doppler: Guided Intraoperative Embolization of Intracranial Highly Vascularized Tumors’ [World Neurosurgery 128 (2019) 547–555]. World Neurosurg 2019; 131:18. [DOI: 10.1016/j.wneu.2019.07.165] [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] [Indexed: 11/30/2022]
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Buscemi A, Pennisi V, Rapisarda A, Pennisi A, Coco M. Efficacy of osteopathic treatment in patients with stable moderate-to-severe chronic obstructive pulmonary disease: a randomized controlled pilot study. J Complement Integr Med 2019; 17:/j/jcim.ahead-of-print/jcim-2018-0128/jcim-2018-0128.xml. [PMID: 31442204 DOI: 10.1515/jcim-2018-0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/27/2018] [Accepted: 04/02/2019] [Indexed: 11/15/2022]
Abstract
Background This randomized controlled pilot study evaluated the efficacy of osteopathic treatment in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) assessed using spirometry, COPD Assessment Test (CAT) and six minutes walking test (6MWT). The main goals were to improve the quality of life of patients with stable moderate-to-severe COPD, and to revise the parameters of the assessment tests, such as spirometry and 6MWT. Methods The study comprised several phases and patients were divided into two groups: group A (controls) received conventional pharmacological treatment with Indacaterol-Glycopyrronium and, while group B (OMT group) received both traditional therapy and osteopathic manipulative treatment (OMT) at different stages of the study. The osteopathic approach focused on maxillary sinus, vertebral-pleural ligaments, phrenic nerves, ribs, pleura, lungs, bronchi, subclavian muscles, and trapezoid and conoid ligaments. Results Overall, 32 patients were randomized and treated. Patients of the OMT group got better improvements in all tests compared to the control group: spirometry: FVC (p<0.5411), total FEV1 (p<0.5061); CAT: OMT (p<0.0005) - controls (p<0.188) 6MWT OMT (p<0.0038) - controls (p<0.5326). The clinical results collected in phase (T3) confirm those obtained in the first sessions; the results of CAT questionnaire (p<0.0005) and 6MWT (p<O, OO38) highlighted score improvements of patients treated with osteopathy compared to patients in the other group. Conclusions The results showed that the patients with COPD who received the conventional pharmacological treatment in association with the OMT therapy demonstrated a good response to the osteopathic treatment, thus leading to significant improvements in their health and wellbeing, and a better daily functioning.
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Affiliation(s)
- Andrea Buscemi
- Study Center of Italian Osteopathy, Catania, Italy
- Horus Social Cooperative, Ragusa, Italy
| | | | | | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences and Research Center on Motor Activities (CRAM), University of Catnia, 95124 Catania CT, Italy
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Buscemi A, Petralia MC, Ramaci T, Rapisarda A, Provazza C, Di Corrado D, Perciavalle V, Perciavalle V, Coco M. Ergojump evaluation of the explosive strength in volleyball athletes pre- and post-fascial treatment. Exp Ther Med 2019; 18:1470-1476. [PMID: 31384337 PMCID: PMC6639914 DOI: 10.3892/etm.2019.7628] [Citation(s) in RCA: 3] [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: 10/08/2017] [Accepted: 12/28/2018] [Indexed: 01/03/2023] Open
Abstract
It has previously been demonstrated that physiological mechanisms are involved in muscle pain and fatigue, as the nociceptive afferents of the fascial system are able to modulate the afferent response of the central nervous system. The purpose of the present study was to evaluate a sample of volleyball players, and investigate whether osteopathic treatment of the lower limb muscle groups improved the explosive force of the limbs, whilst reducing spasms and tension, releasing tissue strain and correcting posture. A randomized control study was performed to evaluate 57 athletes who underwent fascial manipulative treatment to assess if such treatment affected the muscle strength of the lower limbs. The treatment group demonstrated a statistically significant improvement in the squatting jump test (P<0.0001) and in the counter movement jump test (P<0.0001). Furthermore, the control group did not exhibit any improvement in the squatting jump test (P<0.56) or in the counter movement jump test (P<0.32). The results suggested that correction of the fascial system required a minimum time of 30 days in order to obtain an improvement of fascial mechanics and sports performance. Therefore, use of a fascial protocol during athletic training will help improve the balance of the bands and, as a direct consequence, improve the efficiency of the musculoskeletal system, thereby reducing the risk of injury. It would therefore be advisable to perform osteopathic treatment techniques every two months during an athletic season to maintain the balance of the fascial system and obtain the most efficient results.
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Affiliation(s)
- Andrea Buscemi
- Department of Research, Center Studies of Osteopathy, I-95129 Catania, Italy
| | | | - Tiziana Ramaci
- Sciences of Man and of The Society, University Kore of Enna, I-94100 Enna, Italy
| | | | - Carmelo Provazza
- Department of Research, Center Studies of Osteopathy, I-95129 Catania, Italy
| | - Donatella Di Corrado
- Sciences of Man and of The Society, University Kore of Enna, I-94100 Enna, Italy
| | - Vincenzo Perciavalle
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
| | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
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Della Pappa GM, Marchese E, Pedicelli A, Olivi A, Ricciardi L, Rapisarda A, Skrap B, Sabatino G, La Rocca G. Contrast-Enhanced Ultrasonography and Color Doppler: Guided Intraoperative Embolization of Intracranial Highly Vascularized Tumors. World Neurosurg 2019; 128:547-555. [DOI: 10.1016/j.wneu.2019.05.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
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Massimi L, Rapisarda A, Bianchi F, Frassanito P, Tamburrini G, Pelo S, Caldarelli M. Piezosurgery in Pediatric Neurosurgery. World Neurosurg 2019; 126:e625-e633. [DOI: 10.1016/j.wneu.2019.02.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/09/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
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Montano N, Gaudino S, Giordano C, Pignotti F, Ioannoni E, Rapisarda A, Olivi A. Possible Prognostic Role of Magnetic Resonance Imaging Findings in Patients with Trigeminal Neuralgia and Multiple Sclerosis Who Underwent Percutaneous Balloon Compression: Report of Our Series and Literature Review. World Neurosurg 2019; 125:e575-e581. [DOI: 10.1016/j.wneu.2019.01.134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
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Montano N, Rapisarda A, Pignotti F, Gessi M. Prognostic factors in brain metastases from laryngeal squamous cell carcinoma: Case report and review. Surg Neurol Int 2018; 9:179. [PMID: 30221024 PMCID: PMC6130151 DOI: 10.4103/sni.sni_141_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background: Brain metastases from laryngeal squamous cell carcinoma (SCC) are rare, and there are no standardized treatments. Here we reported on a case of brain metastasis from laryngeal SCC and performed a literature review on these cases. Moreover, by plotting Kaplan–Meier curves, we carried out a survival analysis to provide an estimation of overall survival (OS) and to find possible prognostic factors. Case Description: A 65-year-old male was admitted to our department with a large left occipital lesion. Three years ago, the patient had undergone total laryngectomy with bilateral neck dissection with a diagnosis of a poor differentiated SCC. The occipital lesion was totally removed. A diagnosis of a brain metastasis from laryngeal SCC was made. The patient was submitted to adjuvant chemotherapy and radiation therapy. He is in good clinical conditions at 7-month follow-up with a still ongoing chemotherapy. From survival analysis, we have found that surgery and/or radiochemotherapy increase the OS of these patients compared with untreated cases. Moreover, Karnofsky performance status (KPS) score ≥70 and recursive partitioning analysis (RPA) classes I and II were associated with better OS in these patients. Conclusion: Brain metastases from laryngeal SCC are rare. This is the first study in which a survival analysis of these cases has been performed. Surgery and/or radio-chemotherapy increase the survival of these patients compared with untreated cases. Moreover, KPS score and RPA class affect the outcome of these patients.
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Affiliation(s)
- Nicola Montano
- Department of Neurosurgery, Catholic University, Rome, Italy
| | | | | | - Marco Gessi
- Department of Pathology, Catholic University, Rome, Italy
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Giovannenze F, Stifano V, Scoppettuolo G, Damiano F, Pallavicini F, Delogu G, Palucci I, Rapisarda A, Sturdà C, Pompucci A. Incidental intraoperative diagnosis of Mycobacterium abscessus meningeal infection: a case report and review of the literature. Infection 2018; 46:591-597. [PMID: 29687315 DOI: 10.1007/s15010-018-1141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Mycobacterium abscessus, and rapidly growing mycobacteria in general, are rare but increasing causes of central nervous system (CNS) infections. The aim of this study is to highlight the importance of considering these microorganism in the differential diagnosis of CNS infections, obtaining a prompt diagnosis, and improving clinical outcomes. METHODS Case report and literature review. RESULTS We report a case of meningeal infection in a patient who underwent decompressive craniectomy after a craniofacial trauma. The diagnosis was made analyzing a sample obtained during a second operation of cranioplasty. A regimen of amikacin, clarithromycin, and imipenem/cilastatin was started. In the following days, the patient experienced a variety of side effects. So, first clarithromycin was replaced with linezolid, then amikacin was stopped and cefoxitin added to the therapy and at the end all the antibiotics were withdrawn. The patient was discharged in good conditions and a clinical interdisciplinary follow-up was started. After 12 months, the patient is still doing well. After a literature analysis, 15 cases of M. abscessus CNS infections were identified. Various modes of acquisition, underlying disease and therapeutic schemes were evident. CONCLUSIONS Considering the results of the literature analysis and the increasing incidence of M. abscessus, all specialists involved in the management of CNS infection should be aware of the importance of atypical microorganisms in differential diagnosis.
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Affiliation(s)
| | - Vito Stifano
- Department of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy.
| | | | - Fernando Damiano
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | | | - Giovanni Delogu
- Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Ivana Palucci
- Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Cosimo Sturdà
- Department of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Angelo Pompucci
- Department of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy
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