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Lawson McLean A, Vetrano IG, Lawson McLean AC, Conti A, Mertens P, Müther M, Nemir J, Peschillo S, Santacroce A, Sarica C, Tuleasca C, Zoia C, Régis J. Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework. Brain Spine 2024; 4:102794. [PMID: 38601776 PMCID: PMC11004717 DOI: 10.1016/j.bas.2024.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
Introduction The field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery. Research question To assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges. Materials and methods Analysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee. Results We explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers. Discussion and conclusion The potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna C. Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
| | - Alfredo Conti
- UOC Neurochirurgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Patrick Mertens
- Department of Neurosurgery, University Hospital of Neurology and Neurosurgery, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Jakob Nemir
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, Zagreb, Croatia
| | - Simone Peschillo
- Endovascular Neurosurgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- European Radiosurgery Center Munich, Munich, Germany
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontatio, Canada
| | - Constantin Tuleasca
- Lausanne University Hospital (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne, Switzerland
| | - Cesare Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - Jean Régis
- Aix Marseille University, Department of Functional Neurosurgery, CHU Timone, Marseille, France
| | - EANS Frontiers in Neurosurgery Committee
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- UOC Neurochirurgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Department of Neurosurgery, University Hospital of Neurology and Neurosurgery, Hospices Civils de Lyon, University Lyon 1, Lyon, France
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, Zagreb, Croatia
- Endovascular Neurosurgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- European Radiosurgery Center Munich, Munich, Germany
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontatio, Canada
- Lausanne University Hospital (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne, Switzerland
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
- Aix Marseille University, Department of Functional Neurosurgery, CHU Timone, Marseille, France
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La Corte E, Gelmi CAE, Bertolini G, Ruggiero F, Younus I, Sturiale C, Mazzatenta D, Conti A, Aspide R. Giuseppe Dagnini (1866-1928): Discoverer of the Trigemino-Cardiac Reflex and Practical Implications in Neurosurgery and Other Medical Specialties. World Neurosurg 2024; 186:116-121. [PMID: 38521222 DOI: 10.1016/j.wneu.2024.03.086] [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: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
The authors present the life and art of Giuseppe Dagnini, a renowned Italian physician who was born in Bologna in 1866. He was the chief of the Maggiore Hospital in Bologna and authored valuable scientific works on the trigemino-cardiac reflex which is still applied in modern clinical practice. Dr. Dagnini firstly described the reflex in 1908 postulating that stimulation of one of the 3 branches of the trigeminal nerve triggers the afferent pathway in lowering heart rate. The authors also provide a modern outlook on the clinical implications of the TCR in neurosurgery, neuroanesthesia, and other medical specialties.
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Affiliation(s)
- Emanuele La Corte
- Neurosurgery and Neurotraumatology Unit, Department of Neurosciences, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | | | - Giacomo Bertolini
- Neurosurgery Unit, Head and Neck Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Federica Ruggiero
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Maxillofacial Surgery Operative Unit, Bellaria-Maggiore Hospital, Azienda Unità Sanitaria Locale di Bologna, Italy
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carmelo Sturiale
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Vornetti G, Renzetti B, Vara G, Tonon C, Lodi R, Conti A, Serchi E, Donti A, Mariucci E, Spinardi L. Vertebral artery dissection caused by atlantoaxial dislocation in a patient with Marfan syndrome. Am J Med Genet A 2024; 194:e63467. [PMID: 37933544 DOI: 10.1002/ajmg.a.63467] [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: 07/19/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/08/2023]
Abstract
A small number of case reports have documented a link between atlantoaxial dislocation (AAD) and vertebral artery dissection (VAD), but this association has never been described in patients with hereditary connective tissue disorders. We present a case of an 18-year-old female patient, diagnosed with Marfan syndrome since the age of one, who underwent brain MRA for intracranial aneurysm screening revealing tortuosity of the internal carotid and vertebral arteries as well as atlantoaxial dislocation. Since the patient was asymptomatic, a wait-and-see approach was chosen, but a follow-up MRA after 18 months showed the appearance of a dissecting pseudoaneurysm of the V3 segment of the left vertebral artery. Despite the patient being still asymptomatic, it was decided to proceed with C1-C2 stabilization to prevent further vascular complications. Follow-up imaging showed realignment of the atlantoaxial joint and reduction of the dissecting pseudoaneurysm of the left vertebral artery. In our patient, screening MRA has led to the discovery of asymptomatic arterial and skeletal abnormalities which, if left untreated, might have led to severe cerebrovascular complications. Therefore, AAD correction or close monitoring with MRA should be provided to MFS patients with this craniovertebral junction anomaly, even if asymptomatic.
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Affiliation(s)
- Gianfranco Vornetti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Benedetta Renzetti
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Giulio Vara
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Caterina Tonon
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Raffaele Lodi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Elena Serchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Andrea Donti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Luca Spinardi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Bombino A, Magnani M, Conti A. A Promising Breakthrough: The Potential of VORASIDENIB in the Treatment of Low-grade Glioma. Curr Mol Pharmacol 2024; 17:CMP-EPUB-138883. [PMID: 38425121 DOI: 10.2174/0118761429290327240222061812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Gliomas are common malignant brain tumors characterized by diffuse brain infiltration. World Health Organization grade II and grade III diffuse gliomas are considered lower-grade gliomas (LGGs) and have isocitrate dehydrogenase (IDH) mutations. LGGs are challenging due to their infiltrative nature, making them capable of progressing into higher-grade malignancies. Vorasidenib is a novel therapeutic agent targeting mutant IDH1/2, sparking interest in the field. MECHANISM OF ACTION Vorasidenib inhibits mutant IDH1/2 through a unique mechanism, reducing the production of the oncometabolite 2-hydroxyglutarate (2-HG). This alteration affects key enzymes and DNA methylation, impacting tumor growth and invasion. Preclinical Evidence: Preclinical studies show vorasidenib's efficacy in inhibiting mutant IDH1/2 and 2-HG production in glioma models. It suppresses tumor growth, making it a potential treatment option. CLINICAL EVIDENCE Early clinical trials demonstrate vorasidenib's clinical activity in non-enhancing gliomas. It reduces 2-hydroxyglutarate levels and tumor cell proliferation, with an objective response rate and prolonged progression-free survival. The drug's safety profile is favorable. Challenges and Future Directions: Challenges include identifying predictive biomarkers and optimizing sequencing or combinations with existing therapies. Further research is needed to establish long-term effectiveness, evaluate side effects, and explore combinations with immunotherapy. CONCLUSION orasidenib significantly advances LGG treatment, targeting a prevalent mutation and slowing tumor growth. Promising preclinical and clinical evidence and manageable side effects suggest its potential impact on LGG management. However, more research, including large trials, is needed to confirm its efficacy and role in treatment.
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Affiliation(s)
- Alice Bombino
- Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marcello Magnani
- Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alfredo Conti
- Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy, Dipartimento di Scienze Biomediche e NeuroMotorie (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Scibilia A, Rustici A, Linari M, Zenesini C, Belotti LMB, Dall’Olio M, Princiotta C, Cuoci A, Aspide R, Migliorino E, Moneti M, Sturiale C, Castioni CA, Conti A, Bortolotti C, Cirillo L. Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience. Front Neurol 2024; 15:1286862. [PMID: 38426166 PMCID: PMC10901988 DOI: 10.3389/fneur.2024.1286862] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background The management of patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is burdened by an unfavorable prognosis even with aggressive treatment. The aim of the present study is to investigate the risk factors affecting 30-day mortality in poor-grade aSAH patients. Methods We performed a retrospective analysis of a prospectively collected database of poor-grade aSAH patients (World Federation of Neurosurgical Societies, WFNS, grades IV and V) treated at our institution from December 2010 to December 2020. For all variables, percentages of frequency distributions were analyzed. Contingency tables (Chi-squared test) were used to assess the association between categorical variables and outcomes in the univariable analysis. Multivariable analysis was performed by using the multiple logistic regression method to estimate the odds ratio (OR) for 30-day mortality. Results A total of 149 patients were included of which 32% had WFNS grade 4 and 68% had WFNS grade 5. The overall 1-month mortality rate was 21%. On univariable analysis, five variables were found to be associated with the likelihood of death, including intraventricular hemorrhage (IVH ≥ 50 mL, p = 0.005), the total amount of intraventricular and intraparenchymal hemorrhage (IVH + ICH ≥ 90 mL, p = 0.019), the IVH Ratio (IVH Ratio ≥ 40%, p = 0.003), posterior circulation aneurysms (p = 0.019), presence of spot sign on initial CT scan angiography (p = 0.015).Nonetheless, when the multivariable analysis was performed, only IVH Ratio (p = 0.005; OR 3.97), posterior circulation aneurysms (p = 0.008; OR 4.05) and spot sign (p = 0.022; OR 6.87) turned out to be independent predictors of 30-day mortality. Conclusion The risk of mortality in poor-grade aSAH remains considerable despite maximal treatment. Notwithstanding the limitations of a retrospective study, our report highlights some neuroradiological features that in the emergency setting, combined with leading clinical and anamnestic parameters, may support the multidisciplinary team in the difficult decision-making process and communication with family members from the earliest stages of poor-grade aSAH. Further prospective studies are warranted.
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Affiliation(s)
- Antonino Scibilia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Arianna Rustici
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI di Neuroradiologia Ospedale Maggiore, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Marta Linari
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità di Epidemiologia e Biostatistica, Bologna, Italy
| | | | - Massimo Dall’Olio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy
| | - Ciro Princiotta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy
| | - Andrea Cuoci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Raffaele Aspide
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Anestesia e Rianimazione, Bologna, Italy
| | - Ernesto Migliorino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Anestesia e Rianimazione, Bologna, Italy
| | - Manuel Moneti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Anestesia e Rianimazione, Bologna, Italy
| | - Carmelo Sturiale
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Carlo Alberto Castioni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Anestesia e Rianimazione, Bologna, Italy
| | - Alfredo Conti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Carlo Bortolotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Luigi Cirillo
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy
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Magnani M, Rustici A, Zoli M, Tuleasca C, Chaurasia B, Franceschi E, Tonon C, Lodi R, Conti A. Connectome-Based Neurosurgery in Primary Intra-Axial Neoplasms: Beyond the Traditional Modular Conception of Brain Architecture for the Preservation of Major Neurological Domains and Higher-Order Cognitive Functions. Life (Basel) 2024; 14:136. [PMID: 38255752 PMCID: PMC10817682 DOI: 10.3390/life14010136] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the therapeutical advancements in the surgical treatment of primary intra-axial neoplasms, which determined both a significative improvement in OS and QoL and a reduction in the incidence of surgery-induced major neurological deficits, nowadays patients continue to manifest subtle post-operative neurocognitive impairments, preventing them from a full reintegration back into social life and into the workforce. The birth of connectomics paved the way for a profound reappraisal of the traditional conception of brain architecture, in favour of a model based on large-scale structural and functional interactions of a complex mosaic of cortical areas organized in a fluid network interconnected by subcortical bundles. Thanks to these advancements, neurosurgery is facing a new era of connectome-based resections, in which the core principle is still represented by the achievement of an ideal onco-functional balance, but with a closer eye on whole-brain circuitry, which constitutes the foundations of both major neurological functions, to be intended as motricity; language and visuospatial function; and higher-order cognitive functions such as cognition, conation, emotion and adaptive behaviour. Indeed, the achievement of an ideal balance between the radicality of tumoral resection and the preservation, as far as possible, of the integrity of local and global brain networks stands as a mandatory goal to be fulfilled to allow patients to resume their previous life and to make neurosurgery tailored and gentler to their individual needs.
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Affiliation(s)
- Marcello Magnani
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, 40123 Bologna, Italy;
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
| | - Arianna Rustici
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOSI Neuroradiologia, Ospedale Maggiore, 40138 Bologna, Italy
| | - Matteo Zoli
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40121 Bologna, Italy
| | - Constantin Tuleasca
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland;
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, 1015 Lausanne, Switzerland
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Enrico Franceschi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Oncologia Sistema Nervoso, 40139 Bologna, Italy;
| | - Caterina Tonon
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40123 Bologna, Italy
| | - Raffaele Lodi
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40123 Bologna, Italy
| | - Alfredo Conti
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, 40123 Bologna, Italy;
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, 40123 Bologna, Italy; (A.R.); (M.Z.); (C.T.); (R.L.)
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Atallah O, Almealawy YF, Awuah WA, Conti A, Chaurasia B. Is simultaneous occurrence of meningioma and glioblastoma a mere coincidence? Clin Neurol Neurosurg 2024; 236:108099. [PMID: 38215500 DOI: 10.1016/j.clineuro.2023.108099] [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: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND It is extremely unusual for multiple tumors to arise from different cell types and occur at the same time inside the brain. It is still unknown whether or not the coexistence of meningioma and glioblastoma is connected in any way or if their simultaneous appearance is merely a coincidence. OBJECTIVE We conduct a comprehensive literature review on cases of concurrent meningioma and glioblastoma occurrence to elucidate the underlying concepts that may constitute this coexistence. METHODS We searched for articles on the topic of glioblastoma coexisting with meningioma in Google Scholar, PubMed, and Scopus. First, the initial literature searches were conducted for study selection and the data collection processes. After evaluating the title and abstract, the papers were selected. RESULTS We analyzed 21 studies describing 23 patients who had both glioblastoma and meningioma. There were ten male patients (47.6 %) and thirteen female patients (61.9 %). The mean age of patients at diagnosis was 61 years old (the range 30 to 86). In 17 cases, both tumors were in the same hemisphere (80.9 %). In 5 cases, they were in the other hemisphere (23.8 %), and in one case, the glioblastoma was in the left hemisphere and the olfactory meningioma was In 5 cases, they were in the other hemisphere (23.8 %), and in one case, the glioblastoma was in the left hemisphere and the olfactory meningioma was in the anterior cranial fossa. In 61.9 % of cases, headache was the predominant symptom. CONCLUSION Understanding the unique challenges posed by the coexistence of glioblastoma and meningioma is crucial for developing effective treatment strategies. Further investigation into the underlying molecular mechanisms and genetic factors involved in this rare occurrence could pave the way for personalized therapies tailored to each patient's specific needs.
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Affiliation(s)
- Oday Atallah
- Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany.
| | - Yasser F Almealawy
- Department of Neurosurgery, University of Kufa, Kufa, Iraq; Department of Neurosurgery,Global Neurosurgical Alliance, Tucson, AZ, USA.
| | | | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Universit_a di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
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Peters DR, Asher A, Conti A, Schiappacasse L, Daniel RT, Levivier M, Tuleasca C. Single fraction and hypofractionated radiosurgery for perioptic meningiomas-tumor control and visual outcomes: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:287. [PMID: 37897519 DOI: 10.1007/s10143-023-02197-9] [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: 04/27/2023] [Revised: 08/21/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
Perioptic meningiomas, defined as those that are less than 3 mm from the optic apparatus, are challenging to treat with stereotactic radiosurgery (SRS). Tumor control must be weighed against the risk of radiation-induced optic neuropathy (RION), as both tumor progression and RION can lead to visual decline. We performed a systematic review and meta-analysis of single fraction SRS and hypofractionated radiosurgery (hfRS) for perioptic meningiomas, evaluating tumor control and visual preservation rates. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we reviewed articles published between 1968 and December 8, 2022. We retained 5 studies reporting 865 patients, 438 cases treated in single fraction, while 427 with hfRS. For single fraction SRS, the overall rate of tumor control was 95.1%, with actuarial rates at 5 and 10 years of 96% and 89%, respectively; tumor progression was 7.7%. The rate of visual stability was 90.4%, including visual improvement in 29.3%. The rate of visual decline was 9.6%, including blindness in 1.2%. For hfRS, the overall rate of tumor control was 95.6% (range 92.1-99.1, p < 0.001); tumor progression was 4.4% (range 0.9-7.9, p = 0.01). Overall rate of visual stability was 94.9% (range 90.9-98.9, p < 0.001), including visual improvement in 22.7% (range 5.0-40.3, p = 0.01); visual decline was 5.1% (range 1.1-9.1, p = 0.013). SRS is an effective and safe treatment option for perioptic meningiomas. Both hypofractionated regimens and single fraction SRS can be considered.
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Affiliation(s)
- David R Peters
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA.
- Department of Neurosurgery, Atrium Health, Charlotte, NC, USA.
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Anthony Asher
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
- Department of Neurosurgery, Atrium Health, Charlotte, NC, USA
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Unit of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bellaria Hospital, Bologna, Italy
| | - Luis Schiappacasse
- Radiation Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roy T Daniel
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
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9
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Conti A, Magnani M, Tuleasca C. Commentary: Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases. Neurosurgery 2023; 93:e93-e94. [PMID: 37712711 DOI: 10.1227/neu.0000000000002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna , Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna , Italy
| | - Marcello Magnani
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna , Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna , Italy
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne , Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne , Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne , Switzerland
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10
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Conti A. In regard to: "Dosimetric predictive factors for facial nerve paralysis after Cyberknife stereotactic radiotherapy for vestibular schwannomas: A single institution experience of 88 patients". Radiother Oncol 2023; 187:109796. [PMID: 37422269 DOI: 10.1016/j.radonc.2023.109796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/07/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di BolognaIRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Biomorfologia e Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy.
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11
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Garufi G, Ricciardo G, Conti A, Cardali SM. Intramedullary sclerosing meningioma: operative video. Neurosurg Focus Video 2023; 9:V10. [PMID: 37854649 PMCID: PMC10581006 DOI: 10.3171/2023.7.focvid2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 10/20/2023]
Abstract
Sclerosing meningiomas (SMs) represent a rare histological variant of meningiomas, first described in 1989 as invasive bulking masses of whorling collagen bundles with a minimum percentage of meningothelia-resembling cells, and they are often misdiagnosed. The literature reports only 30 cases of SMs, with only two of them being intramedullary. The authors present the case of a patient with a cervical intramedullary SM who presented with gait disturbances, sensory deficits, weakness in four extremities, and hyperreflexia. The surgery was performed under neurophysiological monitoring and after administration of sodium fluorescein, which allowed us to discriminate the exact myelotomy point. Intramedullary SMs are very rare entities whose correct management may result in a good outcome.
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Affiliation(s)
- Giada Garufi
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Italy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Giuseppe Ricciardo
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Italy
| | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Italy
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12
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Lecce E, Nuccio S, Del Vecchio A, Conti A, Nicolò A, Sacchetti M, Felici F, Bazzucchi I. Sensorimotor integration is affected by acute whole-body vibration: a coherence study. Front Physiol 2023; 14:1266085. [PMID: 37772061 PMCID: PMC10523146 DOI: 10.3389/fphys.2023.1266085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction: Several whole-body vibration (WBV) effects on performance have been related to potential changes in the neural drive, motor unit firing rate, and sensorimotor integration. In the present paper, motor unit coherence analysis was performed to detect the source of neural modulation based on the frequency domain. Methods: Thirteen men [25 ± 2.1 years; Body Mass Index (BMI) = 23.9 ± 1.3 kg m2; maximal voluntary force (MVF): 324.36 ± 41.26 N] performed sustained contractions of the Tibialis Anterior (TA) at 10%MVF before and after acute WBV. The vibrating stimulus was applied barefoot through a platform to target the TA. High-Density surface Electromyography (HDsEMG) was used to record the myoelectrical activity of TA to evaluate coherence from motor unit cumulative spike-trains (CSTs). Results: Mean coherence showed a significant decrease in the alpha and low-beta bandwidths (alpha: from 0.143 ± 0.129 to 0.132 ± 0.129, p = 0.035; low-beta: from 0.117 ± 0.039 to 0.086 ± 0.03, p = 0.0001), whereas no significant changes were found in the other ones (p > 0.05). The discharge rate (DR) and the Force Covariance (CovF%) were not significantly affected by acute WBV exposure (p > 0.05). Discussion: According to the significant effects found in alpha and low-beta bandwidths, which reflect sensorimotor integration parameters, accompanied by no differences in the DR and CovF%, the present results underlined that possible neural mechanisms at the base of the previously reported performance enhancements following acute WBV are likely based on sensorimotor integration rather than direct neural drive modulation.
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Affiliation(s)
- E. Lecce
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - S. Nuccio
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - A. Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Faculty of Engineering, Zentralinstitut für Medizintechnik (ZIMT), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - A. Conti
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - A. Nicolò
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - M. Sacchetti
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - F. Felici
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
| | - I. Bazzucchi
- Department of Movement, Human, and Health Sciences, Laboratory of Exercise Physiology, University of Rome “Foro Italico”, Rome, Italy
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13
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Carretta A, Zoli M, Martinoni M, Rustici A, Conti A, Mazzatenta D, Palandri G. Isolated entrapment of the lateral ventricle after neuroendoscopic resection of colloid cysts: single - center experience and management. Clin Neurol Neurosurg 2023; 232:107890. [PMID: 37480784 DOI: 10.1016/j.clineuro.2023.107890] [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: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND A minimally invasive option of colloid cyst surgical treatment is endoscopic resection, well validated in various reports and clinical practice. A rare complication of the surgical treatment, previously reported only once in literature, is the entrapment of the lateral ventricle. In this study we aim to outline our experience in the management of this occurrence, hypothesizing possible etiopathogenetic causes. METHODS Among patients who underwent neuroendoscopic resection for a colloid cysts at our Institution between 2013 and 2022, cases who developed a postoperative lateral ventricle entrapment were retrospectively reviewed and included. Clinical history, imaging and treatment were reported. RESULTS Among 34 patients treated for a colloid cysts, two (5.9 %) patients developed an ipsilateral ventricular entrapment with dilation from two to five months after the resection. Both patients were substantially asymptomatic and neurologically intact, and therefore treated conservatively. One case underwent complete spontaneous radiological resolution one month later, and the other one has remained neurological asymptomatic at follow-up. CONCLUSIONS Isolated asymptomatic ventricular entrapment with significant dilation after endoscopic colloid cyst resection is a rare occurrence which can be plausibly caused by scar tissue at the level of the foramen of Monro. Because they can have an indolent course with spontaneous resolution, conservative treatment is a viable option, with strict radiological and clinical follow - up. Given the rarity of the occurrence, further studies with larger cohorts are warranted to confirm the etiopathogenetic hypothesis and validate the clinical management.
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Affiliation(s)
- Alessandro Carretta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy.
| | - Matteo Zoli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Arianna Rustici
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
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14
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Acker G, Nachbar M, Soffried N, Bodnar B, Janas A, Krantchev K, Kalinauskaite G, Kluge A, Shultz D, Conti A, Kaul D, Zips D, Vajkoczy P, Senger C. Corrigendum: What if: a retrospective reconstruction of resection cavity stereotactic radiosurgery to mimic neoadjuvant stereotactic radiosurgery. Front Oncol 2023; 13:1213759. [PMID: 37621687 PMCID: PMC10446757 DOI: 10.3389/fonc.2023.1213759] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/05/2023] [Indexed: 08/26/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2023.1056330.].
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Affiliation(s)
- Gueliz Acker
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Marcel Nachbar
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Nina Soffried
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Bohdan Bodnar
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Anastasia Janas
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Kiril Krantchev
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Anne Kluge
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - David Shultz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - David Kaul
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Zips
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
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15
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Rustici A, Vari F, Sturiale C, Conti A, Scibilia A, Bortolotti C, Agati R, Tonon C, Lodi R, Mazzatenta D, Zoli M, Princiotta C, Dall’Olio M, Cirillo L. The angio-architectural features of brain arteriovenous malformations: is it possible to predict the probability of rupture? Neuroradiol J 2023; 36:427-434. [PMID: 36533312 PMCID: PMC10588602 DOI: 10.1177/19714009221140479] [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: 07/20/2023] Open
Abstract
BACKGROUND Hemorrhage is the most devastating complication of brain arteriovenous malformations (bAVMs), and to date, there is still concern about the needing for treatment in case of unruptured and asymptomatic bAVM. In fact, the morbidity and mortality of treatments may exceed that of the AVM's natural history. None of the classifications and scores for bAVM allows to predict the risk of bleeding. In this study, we aimed to identify the angio-architectural characteristics of brain AVMs associated with bleeding. METHODS We retrospectively evaluated all consecutive patients diagnosed with cerebral AVMs, between January 2010 and December 2019 from our prospective bAVM database. Univariate and multivariate logistic regression analysis were used to evaluate relationships between angio-architectural features of ruptured and unruptured bAVMs. RESULTS Of the 143 retrieved bAVMs, 65 were unruptured and 78 were ruptured. The univariate logistic regression analysis demonstrated statistically significant differences into angio-architectural features of unruptured and ruptured bAVMs. The multivariate logistic regression analysis fitted well (p =.113) with a good discrimination capacity (ROC = 0.83) of three independent angio-architectural features mainly related to bleeding in bAVMs: a smaller diameter of the nidus (p < .001), the absence of venous drainage alterations (p = .047), of the presence of prenidal aneurysms (p = .005). CONCLUSIONS In our study, several features resulted related to an increased probability of rupture for bAVMs, among which the more relevant were a small diameter of the nidus, the absence of venous drainage alterations, and the presence of prenidal aneurysms.
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Affiliation(s)
- Arianna Rustici
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Francesca Vari
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Carmelo Sturiale
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy
| | - Antonino Scibilia
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy
| | - Carlo Bortolotti
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy
| | - Raffaele Agati
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neuroradiologia con Tecniche Ad Elevata Complessità, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi, Bologna, Italia
| | - Matteo Zoli
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neurochirurgia, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi, Bologna, Italia
| | - Ciro Princiotta
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
| | - Massimo Dall’Olio
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
| | - Luigi Cirillo
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neuroradiologia con Tecniche Ad Elevata Complessità, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi, Bologna, Italia
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
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16
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Peters DR, Halimi F, Ozduman K, Levivier M, Conti A, Reyns N, Tuleasca C. Resection of the contrast-enhancing tumor in diffuse gliomas bordering eloquent areas using electrophysiology and 5-ALA fluorescence: evaluation of resection rates and neurological outcome-a systematic review and meta-analysis. Neurosurg Rev 2023; 46:185. [PMID: 37498398 PMCID: PMC10374773 DOI: 10.1007/s10143-023-02064-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
Independently, both 5-aminolevulinic acid (5-ALA) and intraoperative neuromonitoring (IONM) have been shown to improve outcomes with high-grade gliomas (HGG). The interplay and overlap of both techniques are scarcely reported in the literature. We performed a systematic review and meta-analysis focusing on the concomitant use of 5-ALA and intraoperative mapping for HGG located within eloquent cortex. Using PRISMA guidelines, we reviewed articles published between May 2006 and December 2022 for patients with HGG in eloquent cortex who underwent microsurgical resection using intraoperative mapping and 5-ALA fluorescence guidance. Extent of resection was the primary outcome. The secondary outcome was new neurological deficit at day 1 after surgery and persistent at day 90 after surgery. Overall rate of complete resection of the enhancing tumor (CRET) was 73.3% (range: 61.9-84.8%, p < .001). Complete 5-ALA resection was performed in 62.4% (range: 28.1-96.7%, p < .001). Surgery was stopped due to mapping findings in 20.5% (range: 15.6-25.4%, p < .001). Neurological decline at day 1 after surgery was 29.2% (range: 9.8-48.5%, p = 0.003). Persistent neurological decline at day 90 after surgery was 4.6% (range: 0.4-8.7%, p = 0.03). Maximal safe resection guided by IONM and 5-ALA for high-grade gliomas in eloquent areas is achievable in a high percentage of cases (73.3% CRET and 62.4% complete 5-ALA resection). Persistent neurological decline at postoperative day 90 is as low as 4.6%. A balance between 5-ALA and IONM should be maintained for a better quality of life while maximizing oncological control.
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Affiliation(s)
- David R Peters
- Department of Neurosurgery, Atrium Health, Charlotte, NC, USA.
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Floriana Halimi
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Koray Ozduman
- Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Alfredo Conti
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicolas Reyns
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
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Pezzo G, Billi A, Carminati E, Conti A, De Gori P, Devoti R, Lucente FP, Palano M, Petracchini L, Serpelloni E, Tavani S, Chiarabba C. Seismic source identification of the 9 November 2022 M w 5.5 offshore Adriatic sea (Italy) earthquake from GNSS data and aftershock relocation. Sci Rep 2023; 13:11474. [PMID: 37455269 DOI: 10.1038/s41598-023-38150-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
The fast individuation and modeling of faults responsible for large earthquakes are fundamental for understanding the evolution of potentially destructive seismic sequences. This is even more challenging in case of buried thrusts located in offshore areas, like those hosting the 9 November 2022 Ml 5.7 (Mw 5.5) and ML 5.2 earthquakes that nucleated along the Apennines compressional front, offshore the northern Adriatic Sea. Available on- and offshore (from hydrocarbon platforms) geodetic observations and seismological data provide robust constraints on the rupture of a 15 km long, ca. 24° SSW-dipping fault patch, consistent with seismic reflection data. Stress increase along unruptured portion of the activated thrust front suggests the potential activation of longer portions of the thrust with higher magnitude earthquake and larger surface faulting. This unpleasant scenario needs to be further investigated, also considering their tsunamigenic potential and possible impact on onshore and offshore human communities and infrastructures.
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Affiliation(s)
- G Pezzo
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Nazionale Terremoti, Rome, Italy.
| | - A Billi
- Consiglio Nazionale Delle Ricerche, IGAG, Rome, Italy
| | - E Carminati
- Dip. Scienze Della Terra, Sapienza Università di Roma, Rome, Italy
| | - A Conti
- Consiglio Nazionale Delle Ricerche, IGAG, Rome, Italy
| | - P De Gori
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Nazionale Terremoti, Rome, Italy
| | - R Devoti
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Nazionale Terremoti, Rome, Italy
| | - F P Lucente
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Nazionale Terremoti, Rome, Italy
| | - M Palano
- Consiglio Nazionale Delle Ricerche, IGAG, Rome, Italy
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Etneo, Catania, Italy
| | - L Petracchini
- Consiglio Nazionale Delle Ricerche, IGAG, Rome, Italy
| | - E Serpelloni
- Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Bologna, Bologna, Italy
| | - S Tavani
- Consiglio Nazionale Delle Ricerche, IGAG, Rome, Italy
- DISTAR, Università Degli Studi di Napoli "Federico II", Naples, Italy
| | - C Chiarabba
- Istituto Nazionale di Geofisica e Vulcanologia, Osservatorio Nazionale Terremoti, Rome, Italy
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, Viglietta E, Hendriks E, Bonci EA, Sá-Marta E, Ortega EN, Gomez EGL, Joviliano EE, Clune E, Horwell E, Mains E, Vasarhelyi E, Caruana EJ, Nevins EJ, Yenli EMTA, Baili E, Lostoridis E, Morgan E, Shiban E, Latif E, Tampaki EC, Ezenwa E, Irune E, Borg E, Eisa E, Gialamas E, Parvez E, Theophilidou E, Toma EA, Arnaoutoglou E, Samadov E, Kantor E, Ulman EA, Colak E, Cassinotti E, Bannone E, Sarjanoja E, Yates E, Vincent E, Lun EWY, Cerovac E, Dif ES, Alkhalifa E, Daketsey E, Fayad EA, Sheikh E, Pontecorvi E, Cammarata E, La Corte E, Rausa E, Odai ED, Guasch E, Cano-Trigueros E, Uldry E, Ros EP, Matthews E, Donmez EE, Giorgakis E, Kapetanakis E, Stamatakis E, Bua E, Schneck E, Nachelleh EA, Ofori EO, Akin E, Gönüllü E, Kirkan EF, Çelik E, Wong E, Capozzi E, Pinotti E, Colás-Ruiz E, González E, Fekaj E, Ohazurike E, Kebede E, Erginöz E, Duran EES, Scott E, Aytac E, Albanese E, Castro EJ, Albayadi E, Kriem E, Siddig E, Otify E, El Tayeb EEABH, Hong EH, Saguil E, Belzile E, Tuyishime E, Panieri E, Martínez EG, Myriokefalitaki E, Wong EG, Samara E, Agbeno EK, Drozdov E, Tokidis E, Shah FA, Barra F, Carbone F, Ferreli F, Marino F, Martinelli F, D'acapito F, Masciello F, Bàmbina F, Issa F, Salameh FT, Kethy F, Mahmood F, Gareb F, Idrees F, Karimian F, Ashraf F, Haji F, Inayat F, Begum F, Nabil F, Rosa F, Haider F, Parray F, Calculli F, Ferracci F, Saraceno F, Coppola F, Coccolini F, Fusini F, Migliorelli F, Pecoraro F, Alconchel F, Coimbra FJF, Trivik-Barrientos F, Naegele F, Almarshad F, Agresta F, Fleming F, Mendoza-Moreno F, Brzeszczyński F, Carannante F, Wu F, Aljanadi F, Hayati F, Campo F, Sorbi F, Milana F, Takeda FR, Shekleton F, Gessler F, Recker F, Grama F, Cherbanyk F, Faponle F, Angelis F, Calabretto F, Gaino F, Toia F, Bianco F, Bussu F, Cammarata F, Castagnini F, Colombo F, Ferrara F, Fleres F, Guerrera F, Litta F, Mongelli F, Pata F, Roscio F, Mulita F, Ardura F, Tejero-Pintor FJ, Calvo FJR, Escobedo FJB, Camacho FJB, Odicino F, Schmitt F, Bloemers F, Hölzle F, Gyamfi FE, Messner F, Koh F, Cáceres F, Smolle-Juettner FM, Herman F, Ayeni F, Djedovic G, De Oliveira GP, Rodrigues G, Wagner G, Bellio G, Giarratano G, Capolupo GT, Budd G, Marom G, Poillucci G, Thiruchandran G, Nicholson G, Groot G, Hoey G, Bass GA, Sachdev G, Agarwal G, Aggarwal G, Cormio G, Mazzarella G, Perrone G, Osterhoff G, Singer G, Dejeu G, Fowler G, Garas G, Gradinariu G, Theodoropoulos G, Tzimas G, Babis G, Wong GKC, Cross GWV, Micha G, Chrysovitsiotis G, Koukoulis G, Peros G, Tsoulfas G, Kapetanios G, Karagiannidis G, Verras GI, Ekwen G, Perrotta G, Petruzzi G, Bertelli G, Calini G, Fiacchini G, Pirola GM, Dolci G, Mendiola G, Baiocchi GL, Palini GM, Prucher GM, D'andrea G, Maggiore G, Cassese G, Franceschini G, Pellino G, Saponaro G, Pattacini GC, Pantuso G, Iannella G, Bonsaana GB, Lever G, Brachini G, Giraudo G, Lisi G, Russo GI, Aprea G, Pascale G, Tomasicchio G, Sandri GBL, Armatura G, Turri G, Zaccaria G, Barugola G, Lantone G, Gasparini G, Iacob G, Sozzi G, Zancana G, Mercante G, Bianco G, Brisinda G, Consorti G, Currò G, Giannaccare G, Palomba G, Pascarella G, Rotunno G, Spriano G, Vizzielli G, Cucinella G, Sica G, Campisi G, Baiocchi G, Guerra GR, Pacheco GMF, Atis G, Augustin G, Šantak G, Chauhan GS, Branagan G, Harris G, Stewart GD, Padmore G, Kocher GJ, Di Franco G, De Jesus Labrador Hernandez G, Christodoulidis G, Neal-Smith G, Yim G, Piozzi GN, Claret G, Yanowsky-Reyes G, Dhaity GD, Cakmak GK, Mohamed G, Kucuk GO, Ancans G, Banipal GS, De Bacco Marangon G, Laporte G, Martinez-Mier G, Recinos G, V GMM, Benshetrit G, Vijgen G, Pickett G, Rodriguez HA, Shiwani H, Derilo H, Awad H, El Assaad H, Raji HO, Hardgrave H, Karakullukcu HK, Abdussalam HO, Mustafa H, Parwaiz H, Khan H, Arbab H, Naga H, Salem H, Ulgur HS, Perez-Chrzanowska H, Greenlee H, Javanmard-Emamghissi H, Lederhuber H, Osman H, Adamou H, Majid HJ, Van Goor H, Spiers HVM, Manesh HF, Mushtaq H, Aljaaly H, Hasan HB, Ahmed HTA, Martinez-Said H, Aguado HJ, Consani H, Chaplin H, Mohan H, Van Vliet H, Lohse HAS, Shah H, Claireaux H, Lule H, Juara H, Abozied H, Bayo HL, Alibrahim H, Kroon HM, Ulman H, Khan H, Yonekura H, Abou-Taleb H, Wong HYF, Carpenter H, Majd HS, Zenha H, Mayer HF, Elghadban H, Abdou H, Elfeki H, Yusefi H, Gomez-Fernandez H, Horsfall HL, Meleiro H, Sungurtekin H, Junior HFL, Moloo H, Bayhan H, Şevi̇k H, Embarek H, Hamid HKS, Pradeep IHDS, Donkin I, Ateca IV, Jafarov I, Salisu I, Abdalaal I, Garzali IU, Sall I, Adebara I, Aghadi I, Ugwu I, Zapardiel I, Reis I, Nwafor I, Fakhradiyev I, Surya IU, Robo I, Njokanma I, Iannone I, Khan I, Correia I, Königsrainer I, Seiwerth I, Linero IB, Kadiri I, Florian IA, Tzima I, Akrida I, Baloyiannis I, Gerogiannis I, Katsaros I, Tsakiridis I, Valioulis I, Negoi I, Yadev I, De Haro Jorge I, Vázquez IO, Dajti I, Russo IS, Afzal I, Wasserman I, Chukwu I, Gracia I, Oliver IM, Hughes I, Mondi I, Ncogoza I, Bsisu I, Rashid I, Balasubramanian I, Omar I, Dominguez-Rosado I, Smati I, Vokshi I, Al-Badawi IA, Saleh IA, Pilkington I, Kirac I, Trostchansky I, Gawron IM, Trebol J, Martellucci J, Andreuccetti J, Abou-Khalil J, Shah J, Manickavasagam J, De Alarcón JR, Mihanovic J, O'riordan J, Archer J, Ashcroft J, Blair J, Hamill J, Munthali J, Park J, Parry J, Ryan J, Tomlinson J, Wheeler J, Wilkins J, Balogun JA, Hodgetts JM, Vatish J, Žatecký J, Dziakova J, Martin J, Beatty JW, Stijns J, Faiz J, Ripollés-Melchor J, Mata J, Vásquez JAG, Mitra JK, Tuech JJ, Mvukiyehe JP, Fallah JM, Díaz JT, Vishnoi JR, Van Den Eynde J, Rickard J, Rolinger J, Kaplowitz J, Meyer J, Reid J, Rossaak J, Smelt J, Thomas JJ, Reyes JAS, Davies J, Luc J, Alonso JAM, Hajiioannou J, Querney J, Van Acker J, Pu JJ, Cama J, Simoes J, Cozens J, Barbosa-Breda J, Ribeiro J, De Haro J, Nigh J, Bowen J, Pollok JM, Strotmann JJ, Doerner J, Edwards J, Green J, Massoud J, Mcgrath J, Squiers J, Street J, Windsor J, Santoshi JA, Meara JG, Abebrese JT, Reilly JJ, Zabaleta J, Phillips J, Herron J, Horsnell J, Dawson J, Sheen J, Kauppila JH, Konsten J, Raurich-Leandro J, Romera JS, Nuñez J, Gass JM, Blanco J, Calvache JA, Iturralde JLF, D’addino JL, Hermosa JMG, Guillen JRO, Beristain-Hernandez JL, Sole-Sedeno JM, Vives JMM, Attwood J, Furey J, Hadaya J, Mckay J, Meilak J, Natale J, Shalhoub J, Jung J, Arthur J, Kealey J, Wright J, Moreau J, Miskovic J, Juloski J, Bauset JCC, Segura-Sampedro JJ, Cisneros JRT, Gomez-Rosado JC, Arneja J, Heider J, Fernández JD, Plata-Bello J, Villanueva J, Olaogun J, Hing JX, Košir JA, Daruwalla J, Yeung J, Wormald J, Seyi-Olajide J, Rani J, Wong KY, Hristova K, Kajal K, Algarni K, Theivendran K, Futaba K, Elsayem K, Kapur K, Bailey K, El-Boghdadly K, Ataya K, Lacorbiniere K, Shah K, Tellez KSM, Szyluk K, Rangasamy K, Iyengar K, Szabómihályová K, Atkinson K, Camargo-Parra K, Galliard K, Dickson K, Singh K, Qader K, Hasan K, Spellar K, Feeney K, Ajenifuja K, Oh KE, Okunade K, Adanu K, Bateman K, Saracoglu K, Ho KW, Enwerem K, Mishra K, Verhoeff K, Bensoltane K, Larabi K, Hamdan KH, Nadi K, Fozo K, Abdelwahab K, Al-Sayaghi K, Dajani K, Algahtany K, Abdel-Galil K, Ahmed K, Bajunaid K, Bhatti K, Sofi K, Abdulsalam K, Tamoos K, Dzhumabaev K, Samo KA, Purich K, Madhvani K, Qin KR, Underwood K, Senanayake KJ, Augestad KM, Sigamoney K, Apostolou K, Bouchagier K, Bouliaris K, Bramis K, Gousias K, Lasithiotakis K, Paraskevopoulos K, Perivoliotis K, Roditis K, Stamatis K, Stroumpoulis K, Paraskevas KI, Govindarajan KK, Šimko K, Olson KA, Khobragade K, Seah KM, Kishore K, Ayad K, Papavasiliou K, Angelou K, Paniagua LC, Czako L, Ching LVK, Rai L, Gupta L, Ismail L, Mbodi L, Dasanayake L, Schröder L, Baiyewu LA, Fortuna L, Fernandez LG, Vivancos LG, Jack L, Keçi L, Lavalle L, Leonard L, Shelmerdine L, Vaassen L, Hasan L, Lazarou L, Tzelves L, Matos L, Siragusa L, Licari L, Lima LS, Solaini L, Lichman L, Moral LT, Cabeza L, Kaplan L, Valeanu L, Kaman L, Karout L, Pieteris L, Chan L, Grüßer L, Zamora L, Catarzi L, Rampersad L, Anyanwu LJ, Cheung LK, Rodríguez LV, Andreani L, Cobianchi L, Petagna L, Howse L, Gonzalez LE, Bains L, Vohra L, Ansaloni L, Bertolaccini L, Ferrario L, Orecchia L, Tirloni L, Zanin L, Morelli L, Scaravilli L, Locatello LG, García LD, Vida L, Carbone L, Heindl LM, Bonavina L, Conti L, Marano L, Verre L, Conte LE, Boccalatte L, Tellez LGS, Loureiro L, Sánchez-Guillén L, Tallon-Aguilar L, Nakano L, Alvarez-Lozada LA, Gonzalez LAS, Flórez LJG, Capitan-Morales LC, Kowalski LP, Widmer LW, Harper L, Render L, Wheldon L, Abdur-Rahman L, Doğan L, Prusty L, Katsiaras L, Gourbault L, Siddiqui MT, Saleh M, Karthigeyan M, Rodriguez M, Chowdhury M, Nagappa M, Sultania M, Bashir M, Alam M, Elshahawy MAM, Elfiky M, Loubani M, Marei M, Mewafy M, Alali M, Nassar MA, Alobied M, Bilfaqirah M, Ahmad M, Rius M, Manangi M, Dornseifer MD, Tripathi M, S M, Sokolov M, Pigeolet M, Alonso MD, Losada M, Carretero MM, Tousidonis M, Cotovio MD, Wijeyaratne M, Boira MA, Franza M, Albdour M, Alkhatieb M, Déserts MDD, Niewiera M, Vallve-Bernal M, Kavanagh MM, Migliore M, Calabrò M, Martino MD, Reicher M, Baia M, Caricato M, Clementi M, De Zuanni M, Fiore M, Giacometti M, Inama M, Maestri M, Materazzo M, Sparavigna M, Pascale MM, Nemeth M, Serra M, Fahim MMF, Soucheiron MC, Papadoliopoulou M, Wittmann M, Sotiropoulou M, García-Conde M, Ranucci MC, Amo MDAD, Boedo MJM, Velázquez MJM, Pissaridou MK, Petersen ML, Sacras ML, Modolo MM, Caubet MM, Di Nuzzo MM, Ntalouka MP, Menna MP, Aguilera-Arevalo ML, Rela M, Capuano M, Hollyman M, Olivos M, Sacdalan MD, Raphael MC, Takkenberg M, Bortul M, Cabrera M, Castaño M, D'oria M, Giuffrida M, Laborde MM, Rodriguez-Lopez M, Trejo-Avila M, Papa MV, Ghobrial M, Kryzauskas M, Anwer M, Cheetham M, Davies M, Higgins M, Siboe M, Tarle M, Velten M, Wurm M, Süleyman M, Bauer M, O’dwyer M, Caretto M, De La Rosa-Estadella M, Fragoso M, Serra ML, Merayo M, Golet MR, Martínez-Sánchez MI, Domingo MMA, Gosselink M, Batstone M, Reichert M, Salö M, Soljic M, Zambon M, Angeles MA, Abdulkhaleq M, Abdelkarim M, Alsefri M, Iwasaki M, Shiota M, Veroux M, Molina-Corbacho M, Frasson M, Serenari M, De Pastena M, Desio M, Risaliti M, Rottoli M, Bence M, Chan M, Watson M, Wiles M, Boisson M, Berselli M, Capobianco M, Di Bartolomeo M, Fehervari M, Pacilli M, Romano M, Zizzo M, Domanin M, Montuori M, Podda M, Zago M, Dzogbefia M, Frountzas M, Thaw MH, Al-Juaifari M, Gharat M, Mohamed M, Hannan MJ, Venketeswaran M, Chisthi M, Dessalegn M, Kaplan M, Çakıcı MÇ, Ulutaş ME, Hassan M, Elsadek M, Mengesha MG, Gómez ME, Elbadawy MA, Pitcher M, Tanal M, Tokocin M, Ergenç M, Çelik MN, Bareka M, Pekcici MR, Cappuccio M, Dasa M, Dewan M, El Boghdady M, Ezeanochie M, Greenhalgh M, Jenkinson M, Kelly M, Spartalis M, Zyskowski M, Racine M, De Cillia M, Chu MJJ, Mallmann MR, Zhu MZL, Klimovskij M, Vailas M, Kisielewski M, Adamina M, Campanelli M, Carvello M, Ammendola M, Manigrasso M, Scopelliti M, White M, Collins ML, Chevallay M, Borges MF, Mayo-Yáñez M, Melo MR, Ruiz-Marín M, Eiras MAF, Cunha MF, Pertea M, Slavchev M, Davidescu M, Prieto M, Agapov M, Gahwagi M, Prats MC, Rudic M, Verbic MS, Kostusiak M, Stoleriu MG, Lucas MA, Barone M, Ahmad M, Alemu MAA, Fatima M, Ida M, Sahu M, Muhaisen M, Salem M, Emara MM, Oludara M, Sotudeh M, Kassab MB, Abdelkhalek M, Alsori M, Anwar M, El-Kassas M, Elbahnasawy M, Eldabaa M, Rabie M, Hassanin MA, Thaha MA, Ali MSM, Alhamid M, Almoshantaf MB, Keramati MR, Bafaquh M, Abuzaid M, Al-Shehari M, Alharthi M, Alkahlan M, Alwash M, Alyousef M, Amir M, Basendowah M, Deputy M, Jibreel M, Alam MS, Alsharif M, Issahalq MD, Omer MEA, Abubakar MK, Draman MR, Elnour MAE, Eltayeb M, Castillo MN, Jawad M, Raut M, Ghalleb M, Katsura M, Lebe M, Abbas M, Abdelrahman M, Shalaby M, Farhan-Alanie M, Farooq M, Musadaq M, Arshad M, Anjum MA, Usman M, Chaudhary MA, Raza MA, Karim MFSA, Chaudhary MH, Janjua MH, Khokhar MI, Malik MIK, Pirzada MT, Younis MU, Elhadi M, Suer MS, Ergenç M, Binnawara M, Emmanuel M, Abbasi M, Naimzada MD, Kulimbet M, Kusunoki M, Eugene M, Chauhan M, Shokor MA, Aljiffry M, Kalın M, Kurawa M, Dincer MB, Tolani MA, Soytas M, Yakubu M, Usman MI, Aremu M, Paranyak M, Talat N, Kausar N, Dudi-Venkata N, Bazzi N, Hasan NB, Van Wyk NN, Shaban N, Almgla N, Kandevani NY, Alzerwi N, Alvarez N, Motas N, Rincón NAR, Blencowe N, Simon N, Aghtarafi N, Ghuman NK, Sharma N, Wijekoon N, Kumar N, Hassan N, Onyemaechi N, Prijović N, Özçay N, Goel N, Segaren N, Sharma N, Kalyva N, Palacios NM, Alonso NFP, Onyeagwara N, Petrucciani N, Daddi N, Lightfoot N, Power N, Segaren N, Starr N, Dreger NM, Cillara N, Colucci N, Eardley N, Tartaglia N, Zanini N, Bacalbasa N, Campuzano N, Mouawad N, Federico NSP, Tamini N, Mariani NM, Beasley N, Adu-Aryee NA, Burlov N, Dimitrokallis N, Gouvas N, Machairas N, Memos N, Thomakos N, Tsakiridis N, Schizas N, Börner N, Theochari N, Al-Saadi N, Glass N, Horesh N, R NE, Gahlot N, Ismail N, Aljirdabi N, Maria NUH, Trabulsi N, Akeel N, Borges N, Moda N, Redondo NV, Nyarko OO, Ginghina O, Enciu O, Okere O, Ekwunife OH, Quadri O, Ogundoyin O, Tucker O, Mateo-Sierra O, Azzis O, Ojewuyi O, Habeeb O, Idowu O, Elebute O, Agboola O, Ladipo-Ajayi O, Oyinloye O, Adebola O, Ekor O, Ogundoyin O, Salamanca O, Vergara-Fernandez O, Wafi O, Aladawi O, Bahassan OM, Tammo Ö, Ozkan OF, Williams OM, Salami O, Akinajo O, Sakhov O, Gallo O, Sole OM, Milella O, Alser O, Bettar OA, Alomar O, Osman OS, Aisuodionoe-Shadrach O, Basnayake O, Bozbiyik O, Hodges O, Ojo O, Yanık Ö, Mutlu ÖPZ, Kazan O, Calavia P, García PR, Urriza PV, Lopez PR, Christidis P, Dorovinis P, Kokoropoulos P, Mourmouris P, Papatheodorou P, Garg PK, Patel P, Vassiliu P, Campennì P, De Nardi P, Bernante P, Ubiali P, Baroffio P, Pizzini P, Sapienza P, Myrelid P, Chatzikomnitsa P, Tsiantoula P, Gada P, Avella P, Cianci P, Romero P, Méndez PS, Pazmiño PAF, Coughlin P, Kirchweger P, Pessaux P, Maguire PJ, Petrone P, Cullis P, Köglberger P, Marriott P, Nankivell P, Santos-Costa P, Martins PN, Panahi P, Botelho P, Teixeira P, Escobar P, Vázquez PJG, Gribnev P, Nolte P, Agbonrofo P, Bobak P, Choong P, Elbe P, Hutchinson P, Labib P, Paal P, Pockney P, Reemst P, Szatmary P, Vaughan-Shaw PG, Alexander P, Pucher P, Stather P, Foessleitner P, Winnand P, Zehnder P, Kruse P, Matos PAW, Lapolla P, Cicerchia PM, Solli P, Di Lascio P, Zarif P, Champagne PO, Anoldo P, Bertoglio P, Fransvea P, Familiari P, Lombardi PM, Stogowski PT, Bruzzaniti P, Tripathi P, D'sa P, Salunke P, Shah PA, Punjabi PPP, Christodoulou P, Hamdan Q, Tawalbeh R, Gadelkareem R, Awad R, Callcut R, Clegg R, Choron R, Payne R, Gefen R, Costea R, Drasovean R, Mirica RM, Ravindra R, Fajardo RT, Nunes RL, Aspide R, Lombardi R, Vidya R, Elboraei R, Saaid R, Ghodke R, Gupta R, Sharma RD, Lunevicius R, Kalayarasan R, Mohan R, Singh R, Sivaprakasam R, Seenivasagam RK, Rajendram R, Radulescu RB, Goicea R, Seshadri RA, Sarı R, Nataraja R, Aslam R, Abdelemam R, Shrestha R, Bharathan R, Pellini R, Guevara R, Agarwal R, Vissapragada R, Alharmi RA, Sayyed R, Browning R, Critchley R, Mallick R, Alarabi R, Beron RI, Függer R, Othman R, Saad R, Amores RR, Colombari RC, Radivojević RC, Patrone R, Novysedlák R, Palacios Huatuco RM, Baertschiger R, Liang R, Luckwell R, Escrevente R, Rezende RF, Cruz RP, Lenzi R, Rosati R, Donovan R, Egan R, Morris R, Page R, Seglenieks R, Unsworth R, Wilkin R, Skipworth RJ, Davies RJ, Bezirci R, Talwar R, Azami R, Bohmer R, Crichton R, Fruscio R, Hooker R, Jach R, Parker R, Pillerstorff R, Sinnerton R, Stabler R, O'connell RM, Ragozzino R, Tutino R, Angelico R, Cammarata R, Colasanti R, Macchiavello R, Peltrini R, Pirrello R, Vaschetti R, Pires RE, Papalia R, Arrangoiz R, Hompes R, Mittal R, Salah R, Pinto R, Flumignan R, Callan R, Cuthbert R, Dennis R, Scaramuzzo R, Macías RM, Sánchez R, Ogu R, Ramely R, Sgarzani R, Ramli R, Hillier R, Thumbadoo R, Ooi R, Abdus-Salam R, Masri R, Hodgson R, Mathew R, Wade R, D'archi S, Khan S, Ngaserin S, Kale S, Hassan S, Merghani S, Benamar S, Muhammad S, Badran S, Elsahli S, Heta S, Hammouche S, Baeesa S, Paiella S, Eldeen STEHT, Arkani S, Mittal S, Hirji S, Tebha S, Emile S, Dbouk S, Bandyopadhyay SK, Muhammad S, Olori S, Asirifi SA, Hailu S, Ling S, Newman S, Ross S, Wanjara S, Kumar S, Seneviratne S, Tamburello S, Suarez SB, Ingallinella S, Irshaidat S, Konswa S, Mambrilla S, Nasser S, Parini S, Pitoni S, Ornaghi S, Rodrigues SC, Abdelmohsen S, Aitken S, Tian S, Badiani S, Ahmad S, Swed S, Muthu S, Lakpriya S, Alzahrani S, Mikalauskas S, Lasrado S, Satoskar S, Bawa S, Altiner S, Garcia S, Stevens S, Demir S, Ken-Amoah S, Tranca S, Ziemann S, Awad S, Atici SD, Subramaniam S, Erel S, Jiang S, Efetov S, Efremov S, Katorkin S, Valladares SC, Contreras SM, Meriç S, Zenger S, Safi S, Leventoğlu S, Elsalhawy S, Shaikh S, Sheik S, Islam S, Shamim S, Waqar SH, Ahmad S, Farid S, Seraj SS, Sundarraju S, Karandikar S, Sambhwani S, Chopra S, Chowdhury S, Laura S, Ahmed S, Wason S, Tan SJH, Fraser S, Williams S, Ghozy S, Abdelmawgoud S, Shehata S, Sharma S, Ahmed S, Al-Touny SA, Ramzanali S, Nah SA, Jansen S, Rajan S, Dindyal S, Amin S, Ahmad S, Shoukrie SIM, Karar S, Patkar S, Abdulsalam S, Lin S, Hegde S, Fiorelli S, Quaresima S, Redondo SV, Palmisano S, Ruggiero S, Balogun S, Cais S, Cole S, Federer S, Le Roux S, Ippoliti S, Meneghini S, Viola S, Manfredelli S, Novello S, Gananadha S, Mesli SN, Kale S, Tani SI, Malik S, Anastasiadou S, Boligo S, Esposito S, Valanci S, Xenaki S, Pejkova S, Bandyopadhyay S, Trungu S, Basu S, Alkhatib S, Pérez-Bertólez S, Flores SL, Donoghue S, Lunca S, Orsoo S, Potamianos S, Devarakonda S, Suresh S, Croghan SM, Turi S, Capella S, Lucchini S, Magnone S, Salizzoni S, Scabini S, Scaringi S, Cioffi SPB, Seyfried S, Degener S, Potten S, Taha-Mehlitz S, Ali S, Angamuthu S, Mcaleer S, Knight SR, White S, Mantziari S, Kykalos S, Goh SK, Chowdhury SP, Ibrahim S, Elzwai S, Bansal S, Tripathy S, Amrayev S, Anwar SL, Banerjee S, Thakar S, Saeed S, Venkatappa SK, Das S, Techapongsatorn S, Dube SK, Lee S, González-Suárez S, Henriques S, Konjevoda S, Gisbertz S, Bravo SL, Mannan S, Bukhari SI, Zafar SN, Batista S, Chin SL, Arif T, Lawal TA, Aktokmakyan TV, Osborn T, Szakmany T, Sztipits T, Triantafyllou T, Valadez TAC, Singh T, Khaliq T, Patel T, Fadalla T, Jichi T, Sammour T, Al-Shaiji T, Naggs T, Barišić T, Nikolouzakis T, Bisgin T, Perra T, Uprak TK, Dagklis T, Liakakos T, Sidiropoulos T, Adjeso TJK, Dölker T, Oung T, Aherne T, Diehl T, Pinkney T, Raymond T, Rhomberg T, Schmitz-Rixen T, Madhuri TK, Lohmann TK, Yeoh T, Zaimis T, Bright T, Vilz TO, Glowka TR, Board T, Hardcastle T, Cohnert T, Mahečić TT, William TG, Klatte T, Abbott T, Watcyn-Jones T, Mendes T, Kulis T, Sečan T, Campagnaro T, Frisoni T, Simoncini T, Violante T, Safranovs TJ, Risteski T, Pang T, Akinyemi T, Yotsov T, Laeke T, Kochiyama T, Sholadoye TT, Alekberli T, Ezomike U, Giustizieri U, Grossi U, Köksoy ÜC, Bork U, Kisser U, Ronellenfitsch U, Saeed U, Bracale U, Jayarajah U, Rauf UHA, Bumbasirevic U, Ferrer UMJ, Ahmed U, Bello UM, Jogiat U, Sadia U, Galandarov V, Narayanan V, Calu V, Bianchi V, Ciniero V, Tonini V, Silvestri V, Vijay V, Dewan V, Lohsiriwat V, Thuduvage V, Mousafeiris V, Dragisic V, Sasireka V, Santric V, Kusuma VRM, Kolli VS, Alonso V, De Simone V, Picotti V, Martínez VM, Panduro-Correa V, Kakotkin V, Angulo VP, Turrado-Rodriguez V, Krishnamoorthy V, Ban VS, Shah V, Maiola V, Giordano V, La Vaccara V, Lizzi V, Papagni V, Schiavone V, Satchithanantham V, Garcia-Virto V, Jimenez V, Kumar V, Shelat V, Bhat V, Sodhai V, Graziadei V, Kutuzov V, Stoyanov V, Oktseloglou V, Flis V, Elhassan WAF, Yang W, Soon WC, Tashkandi W, Al-Khyatt W, Mabood W, Bijou W, Wijenayake W, D W, Krawczyk W, Atkins W, Bolton W, White W, Ceelen W, Vagena X, Gozal Y, Baba YI, Subramani Y, Jansen Y, Mittal Y, Kara Y, Zwain Y, Noureldin Y, Alawneh Y, Aydin Y, Lam YH, Tang Y, Lim Y, Dean Y, Tanas Y, Su YX, Fujimoto Y, Altinel Y, Frolova Y, Oshodi Y, Fadel ZT, Zahid Z, Elahi Z, Djama Z, Zaheen Z, Jawad Z, Demetrashvili Z, Gebremeskel Z, Gudisa Z, Alyami Z, Garoufalia Z, Li Z, Zimak Z, Radin Z, Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Conti A, Gambadauro NM, Mantovani P, Picciano CP, Rosetti V, Magnani M, Lucerna S, Tuleasca C, Cortelli P, Giannini G. A Brief History of Stereotactic Atlases: Their Evolution and Importance in Stereotactic Neurosurgery. Brain Sci 2023; 13:brainsci13050830. [PMID: 37239302 DOI: 10.3390/brainsci13050830] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Following the recent acquisition of unprecedented anatomical details through state-of-the-art neuroimaging, stereotactic procedures such as microelectrode recording (MER) or deep brain stimulation (DBS) can now rely on direct and accurately individualized topographic targeting. Nevertheless, both modern brain atlases derived from appropriate histological techniques involving post-mortem studies of human brain tissue and the methods based on neuroimaging and functional information represent a valuable tool to avoid targeting errors due to imaging artifacts or insufficient anatomical details. Hence, they have thus far been considered a reference guide for functional neurosurgical procedures by neuroscientists and neurosurgeons. In fact, brain atlases, ranging from the ones based on histology and histochemistry to the probabilistic ones grounded on data derived from large clinical databases, are the result of a long and inspiring journey made possible thanks to genial intuitions of great minds in the field of neurosurgery and to the technical advancement of neuroimaging and computational science. The aim of this text is to review the principal characteristics highlighting the milestones of their evolution.
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Affiliation(s)
- Alfredo Conti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Nicola Maria Gambadauro
- Stroke Unit- Barking, Havering and Redbrige University Hospitals NHS Trust, Queen's Hospital, Rom Valley Way, London RM7 0AG, UK
| | - Paolo Mantovani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Canio Pietro Picciano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Vittoria Rosetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Marcello Magnani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Sebastiano Lucerna
- Department of Neurosurgery, AOU "G. Martino", Via Consolare Valeria 1, 98125 Messina, Italy
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Rue du Bugnon 21 CH-1011, 1015 Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Rte Cantonale, 1015 Lausanne, Switzerland
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
| | - Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Via Altura 3, 40123 Bologna, Italy
- Dipartimento di Biomorfologia e. Scienze Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123 Bologna, Italy
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Giannini G, Baldelli L, Leogrande G, Cani I, Mantovani P, Lopane G, Cortelli P, Calandra-Buonaura G, Conti A. Case report: Bilateral double beta peak activity is influenced by stimulation, levodopa concentrations, and motor tasks, in a Parkinson's disease patient on chronic deep brain stimulation. Front Neurol 2023; 14:1163811. [PMID: 37273691 PMCID: PMC10232856 DOI: 10.3389/fneur.2023.1163811] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Subthalamic (STN) local field potentials (LFPs) in the beta band are considered potential biomarkers for closed-loop deep brain stimulation (DBS) in Parkinson's disease (PD). The beta band is further dissected into low-and high-frequency components with somewhat different functions, although their concomitance and association in the single patient is far to be defined. We present a 56-year-old male PD patient undergoing DBS showing a double-beta peak activity on both sides. The aim of the study was to investigate how low-and high-beta peaks were influenced by plasma levodopa (L-dopa) levels, stimulation, and motor performances. Methods A systematic evaluation of raw LFPs, plasma L-dopa levels, and motor tasks was performed in the following four conditions: OFF medications/ON stimulation, OFF medications/OFF stimulation, ON medications/OFF stimulation, and ON medications/ON stimulation. Results The analysis of the LFP spectra suggests the following results: (1) the high-beta peak was suppressed by stimulation, while the low-beta peak showed a partial and not consistent response to stimulation; (2) the high-beta peak is also influenced by plasma L-dopa concentration, showing a progressive amplitude increment concordant with plasma L-dopa levels, while the low-beta peak shows a different behavir; and (3) motor performances seem to impact beta peaks behavior. Conclusion This single exploratory case study illustrates a complex behavior of low-and high-beta peaks in a PD patient, in response to stimulation, L-dopa plasma levels, and motor performances. Our results suggest the importance to investigate patient-specific individual LFP patterns in view of upcoming closed-loop stimulation.
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Affiliation(s)
- Giulia Giannini
- UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Gaetano Leogrande
- Medtronic EMEA Corporate Technology and Innovation, Maastricht, Netherlands
| | - Ilaria Cani
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Lopane
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Acker G, Nachbar M, Soffried N, Bodnar B, Janas A, Krantchev K, Kalinauskaite G, Kluge A, Shultz D, Conti A, Kaul D, Zips D, Vajkoczy P, Senger C. What if: A retrospective reconstruction of resection cavity stereotactic radiosurgery to mimic neoadjuvant stereotactic radiosurgery. Front Oncol 2023; 13:1056330. [PMID: 37007157 PMCID: PMC10062706 DOI: 10.3389/fonc.2023.1056330] [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: 09/28/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Neoadjuvant stereotactic radiosurgery (NaSRS) of brain metastases has gained importance, but it is not routinely performed. While awaiting the results of prospective studies, we aimed to analyze the changes in the volume of brain metastases irradiated pre- and postoperatively and the resulting dosimetric effects on normal brain tissue (NBT). Methods We identified patients treated with SRS at our institution to compare hypothetical preoperative gross tumor and planning target volumes (pre-GTV and pre-PTV) with original postoperative resection cavity volumes (post-GTV and post-PTV) as well as with a standardized-hypothetical PTV with 2.0 mm margin. We used Pearson correlation to assess the association between the GTV and PTV changes with the pre-GTV. A multiple linear regression analysis was established to predict the GTV change. Hypothetical planning for the selected cases was created to assess the volume effect on the NBT exposure. We performed a literature review on NaSRS and searched for ongoing prospective trials. Results We included 30 patients in the analysis. The pre-/post-GTV and pre-/post-PTV did not differ significantly. We observed a negative correlation between pre-GTV and GTV-change, which was also a predictor of volume change in the regression analysis, in terms of a larger volume change for a smaller pre-GTV. In total, 62.5% of cases with an enlargement greater than 5.0 cm3 were smaller tumors (pre-GTV < 15.0 cm3), whereas larger tumors greater than 25.0 cm3 showed only a decrease in post-GTV. Hypothetical planning for the selected cases to evaluate the volume effect resulted in a median NBT exposure of only 67.6% (range: 33.2-84.5%) relative to the dose received by the NBT in the postoperative SRS setting. Nine published studies and twenty ongoing studies are listed as an overview. Conclusion Patients with smaller brain metastases may have a higher risk of volume increase when irradiated postoperatively. Target volume delineation is of great importance because the PTV directly affects the exposure of NBT, but it is a challenge when contouring resection cavities. Further studies should identify patients at risk of relevant volume increase to be preferably treated with NaSRS in routine practice. Ongoing clinical trials will evaluate additional benefits of NaSRS.
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Affiliation(s)
- Gueliz Acker
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Berlin, Germany
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Marcel Nachbar
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Nina Soffried
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Bohdan Bodnar
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Anastasia Janas
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Kiril Krantchev
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Anne Kluge
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - David Shultz
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - David Kaul
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Zips
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
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Conti A, Magnani M, Zoli M, Kockro RA, Tuleasca C, Peschillo S, Umana GE, Tew SW, Jallo G, Garg K, Spetzler RF, Lafuente J, Chaurasia B. Social Media for Global Neurosurgery. Benefits and limitations of a groundbreaking approach to communication and education. Brain Spine 2023; 3:101728. [PMID: 37383446 PMCID: PMC10293234 DOI: 10.1016/j.bas.2023.101728] [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] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction Social media have become ubiquitous and their role in medicine is quickly growing. They provide an open platform by which members share educational material, clinical experiences, and collaborate with educational equity. Research question To characterize the role of social media in neurosurgery, we analyzed metrics of the largest neurosurgical group (Neurosurgery Cocktail), collected relevant data about activities, impact and risks of this groundbreaking technology. Material and methods We extracted Facebook metrics from 60-day time sample, including users demographics and other platform-specific values such as active members and number of posts within 60 days. A quality assessment of the posted material (clinical case reports and second opinions) was obtained establishing four main quality-criteria: privacy violation; quality of imaging; clinical and follow up data. Results By December 2022, the group included 29.524 members (79.8% male), most (29%) between 35 and 44 years of age. Over 100 countries were represented. A total of 787 posts were published in 60 days with an average of 12.7 per day. In 173 clinical cases presented through the platform, some issue with privacy was recorded in 50.9%. The imaging was considered insufficient in 39.3%, clinical data in 53.8%; follow up data were missing in 60.7%. Discussion and conclusion The study provided a quantitative evaluation of impact, flaws and limitations of social medial for healthcare. Flaws were mostly data breach and insufficient quality of case reports. There are actions to correct these flaws that can be easily taken to provide a greater credibility and efficacy to the system.
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Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Marcello Magnani
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Matteo Zoli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna Alma Mater Studiorum Università di Bologna, Via Altura 3, 40123, Bologna, Italy
| | - Ralf A. Kockro
- Centre for Microneurosurgery, Hirslanden Hospital, Zurich, Switzerland
| | - Constantin Tuleasca
- Lausanne University Hospital (CHUV), Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
| | - Simone Peschillo
- Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Giuseppe Emmanuele Umana
- Trauma Centre, Gamma Knife Centre, Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | - Seow Wan Tew
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - George Jallo
- Institute of Brain protection sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Kanwaljeet Garg
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jesus Lafuente
- Department of Neurosurgery, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Lecce E, Nuccio S, Del Vecchio A, Conti A, Nicolò A, Sacchetti M, Felici F, Bazzucchi I. The acute effects of whole-body vibration on motor unit recruitment and discharge properties. Front Physiol 2023; 14:1124242. [PMID: 36895636 PMCID: PMC9988902 DOI: 10.3389/fphys.2023.1124242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Introduction: several studies have reported improved neuromuscular parameters in response to whole-body vibration (WBV). This is likely achieved by modulation of the central nervous system (CNS). Reduced recruitment threshold (RT), which is the % of Maximal Voluntary Force (%MVF) at which a given Motor Unit (MU) is recruited, may be responsible for the force/power improvements observed in several studies. Methods: 14 men (25 ± 2.3 years; BMI = 23.3 ± 1.5 kg m2 MVF: 319.82 ± 45.74 N) performed trapezoidal isometric contractions of the tibialis anterior (TA) at 35-50-70 %MVF before and after three conditions: WBV, STAND (standing posture), and CNT (no intervention). The vibration was applied through a platform for targeting the TA. High-density surface electromyography (HDsEMG) recordings and analysis were used to detect changes in the RT and Discharge Rate (DR) of the MUs. Results: Mean motor unit recruitment threshold (MURT) reached 32.04 ± 3.28 %MVF before and 31.2 ± 3.72 %MVF after WBV, with no significant differences between conditions (p > 0.05). Additionally, no significant changes were found in the mean motor unit discharge rate (before WBV: 21.11 ± 2.94 pps; after WBV: 21.19 ± 2.17 pps). Discussion: The present study showed no significant changes in motor unit properties at the base of neuromuscular changes documented in previous studies. Further investigations are needed to understand motor unit responses to different vibration protocols and the chronic effect of vibration exposure on motor control strategies.
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Affiliation(s)
- E Lecce
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - S Nuccio
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - A Del Vecchio
- Department Artificial Intelligence in Biomedical Engineering, Faculty of Engineering, Zentralinstitut für Medizintechnik (ZIMT), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - A Conti
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - A Nicolò
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - M Sacchetti
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - F Felici
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - I Bazzucchi
- Laboratory of Exercise Physiology, Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
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Pontoriero A, Critelli P, Conti A, Cardali S, Angileri FF, Germanò A, Lillo S, Carretta A, Brogna A, Santacaterina A, Parisi S, Pergolizzi S. The "Combo" radiotherapy treatment for high-risk grade 2 meningiomas: dose escalation and initial safety and efficacy analysis. J Neurooncol 2023; 161:203-214. [PMID: 35927392 DOI: 10.1007/s11060-022-04107-3] [Citation(s) in RCA: 1] [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: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The subgroup "high-risk" WHO grade 2 (hRG2) meningiomas may benefit from adjuvant radiation therapy (RT), but results are still suboptimal with high rates of local progression. A dose escalation using high-conformal RT techniques needs to be evaluated in terms of efficacy and safety. We report the results of a dose-escalation study, named "Combo-RT", combining Intensity Modulated Radiotherapy (IMRT) or Volumetric Arc Therapy (VMAT) with Hypofractionated Stereotactic Radiotherapy (hSRT) boost. PATIENTS AND METHODS From November 2015 to January 2019, we prospectively enrolled 16 patients with hRG2. Seven patients had subtotal resection (STR) and 9 patients had a recurrent tumor. All patients received Combo-RT: LINAC-IMRT/ VMAT on the surgical bed and CyberKnife-hSRT boost on residual/recurrent meningioma Toxicity and initial efficacy were evaluated. RESULTS The median age was 62 years (range, 31-80 years). The median cumulative dose delivered was 46 Gy For IMRT or VMAT and 15 Gy in 3 fractions at a median isodose line of 77% for hSRT. The median cumulative BED and EQD2 were 108.75 Gy and 72.5 Gy respectively. 3-year-PFS was 75% for the whole cohort,100% for patients with STR, and 55.5% for recurrent patients. Negligible toxicities, and stable or improved symptoms during long-term follow-up were observed. Salvage treatment for recurrence was an independent predictor of treatment failure (P = 0.025). CONCLUSIONS With the limitation of a small series of patients, our results suggest that a dose escalation for hRG2 meningiomas, using a Combo-RT approach, is safe and particularly effective in the subgroup of patients with STR. Further studies are warranted.
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Affiliation(s)
- Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Paola Critelli
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Alfredo Conti
- Department of Neurosurgery, Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Alma MaterStudiorum University of Bologna, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Salvatore Cardali
- Neurosurgery Unit - A.O. "Papardo", Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Filippo Flavio Angileri
- Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonino Germanò
- Neurosurgery Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Sara Lillo
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Carretta
- Department of Neurosurgery, Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Alma MaterStudiorum University of Bologna, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Anna Brogna
- Medical Physics Unit - A.O.U. "G. Martino", Radiotherapy Unit - Messina, University of Messina, Messina, Italy
| | - Anna Santacaterina
- Radiation Oncology Unit - A.O. "Papardo", University of Messina, Messina, Italy
| | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
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Loebel F, Pontoriero A, Kluge A, Iatì G, Acker G, Kufeld M, Cacciola A, Pergolizzi S, Vinci S, Lillo S, Xu R, Stromberger C, Budach V, Vajkoczy P, Senger C, Conti A. Image-guided robotic radiosurgery for the treatment of arteriovenous malformations. PLoS One 2022; 17:e0266744. [PMID: 36137082 PMCID: PMC9499208 DOI: 10.1371/journal.pone.0266744] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cerebral arteriovenous malformations (AVMs) are challenging lesions, often requiring multimodal interventions; however, data on the efficacy of stereotactic radiosurgery for cerebral AVMs are limited. This study aimed to evaluate the clinical and radiographic results following robotic radiosurgery, alone or in combination with endovascular treatment, and to investigate factors associated with obliteration and complications in patients with AVM. Methods We retrospectively analyzed the clinical and imaging characteristics of 123 patients with AVMs of all Spetzler-Martin grades treated at two institutions by robotic radiosurgery in single-fraction doses (CyberKnife). Embolization was performed before radiosurgery in a subset of patients to attempt to downgrade the lesions. Factors associated with AVM obliteration and complications (toxicity) were identified via univariate and multivariate analyses. Results The median follow-up time was 48.1 months (range, 3.6–123 months). Five patients were lost to follow-up. The obliteration rate in the 59 patients with a follow-up period exceeding four years was 72.8%. Complete obliteration and partial remission were achieved in 67 (56.8%) and 31 (26.3%) cases, respectively, whereas no change was observed in 20 cases (17.8%). Embolization was performed in 54/123 cases (43.9%). Complete and partial obliteration were achieved in 29 (55.7%) and 14 (26.9%) embolized patients, respectively. In the multivariate analysis, the factors associated with obliteration were age (p = .018) and the Spetzler-Martin grade (p = .041). Treatment-induced toxicity (radiation necrosis and/or edema) was observed in 15 cases (12.7%), rebleeding occurred in three cases (2.5%), and the rate of mortality associated with rebleeding was 1.7%. Conclusions CyberKnife radiosurgery is a valid approach for treating AVMs of all Spetzler-Martin-grades, with satisfactory obliteration rates, low toxicity, and a relatively rare incidence of rebleeding.
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Affiliation(s)
- Franziska Loebel
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
- * E-mail:
| | | | - Anne Kluge
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Gueliz Acker
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Kufeld
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alberto Cacciola
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | | | - Sergio Vinci
- Department of Neuroradiology, University of Messina, Messina, Italy
| | - Sara Lillo
- Department of Radiation Oncology, University of Messina, Messina, Italy
| | - Ran Xu
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Alfredo Conti
- Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS ISNB-Istituto delle Scienze Neurologiche Bologna, Bologna, Italy
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Romanelli P, Tuniz F, Fabbro S, Beltramo G, Conti A. Image-guided LINAC radiosurgery in hypothalamic hamartomas. Front Neurol 2022; 13:909829. [PMID: 36119668 PMCID: PMC9475216 DOI: 10.3389/fneur.2022.909829] [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: 03/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypothalamic hamartomas (HH) are developmental malformations that are associated with mild to severe drug-refractory epilepsy. Stereotactic radiosurgery (SRS) is an emerging non-invasive option for the treatment of small and medium-sized HH, providing good seizure outcomes without neurological complications. Here, we report our experience treating HH with frameless LINAC SRS. Materials and methods We retrospectively collected clinical and neuroradiological data of ten subjects with HH-related epilepsy that underwent frameless image-guided SRS. Results All patients underwent single-fraction SRS using a mean prescribed dose of 16.27 Gy (range 16–18 Gy). The median prescription isodose was 79% (range 65–81 Gy). The mean target volume was 0.64 cc (range 0.26–1.16 cc). Eight patients experienced complete or near complete seizure freedom (Engel class I and II). Five patients achieved complete seizure control within 4 to 18 months after the treatment. Four patients achieved Engel class II outcome, with stable results. One patient had a reduction of seizure burden superior to 50% (Engel class III). One patient had no benefit at all (Engel class IV) and refused further treatments. Overall, at the last follow-up, three patients experience class I, five class II, one class III and one class IV outcome. No neurological complications were reported. Conclusions Frameless LINAC SRS provides good seizure and long-term neuropsychosocial outcome, without the risks of neurological complications inherently associated with microsurgical resection.
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Affiliation(s)
- Pantaleo Romanelli
- Cyberknife Center, Italian Diagnostic Center (CDI), Milan, Italy
- *Correspondence: Pantaleo Romanelli
| | - Francesco Tuniz
- Department of Neurosurgery, ASUFC “Santa Maria della Misericordia”, Udine, Italy
| | - Sara Fabbro
- Department of Neurosurgery, ASUFC “Santa Maria della Misericordia”, Udine, Italy
| | | | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), IRCCS Istituto delle Scienze Neurologiche di Bologna, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
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Conti A. Editorial: Impact of radiotherapy and radiosurgery on neuro-oncology. Front Oncol 2022; 12:978709. [PMID: 35957873 PMCID: PMC9360765 DOI: 10.3389/fonc.2022.978709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 11/21/2022] Open
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Cardali SM, Caffo M, Caruso G, Scalia G, Gorgoglione N, Conti A, Vinci SL, Barresi V, Granata F, Ricciardo G, Garufi G, Raffa G, Germanò A. Cisternostomy for malignant middle cerebral artery infarction: proposed pathophysiological mechanisms and preliminary results. Stroke Vasc Neurol 2022; 7:476-481. [PMID: 35672081 PMCID: PMC9811554 DOI: 10.1136/svn-2021-000918] [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: 02/06/2021] [Accepted: 04/16/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The ischaemic stroke of the territory of the middle cerebral artery represents an event burdened by high mortality and severe morbidity. The proposed medical treatments do not always prove effective. Decompressive craniectomy allows the ischaemic tissue to shift through the surgical defect rather than to the unaffected regions of the brain, thus avoiding secondary damage due to increased intracranial pressure. In this study, we propose a novel treatment for these patients characterised by surgical fenestration of the cisterns of the skull base. METHODS We have treated 16 patients affected by malignant middle cerebral artery ischaemia and treated with cisternostomy between August 2018 and December 2019. The clinical history, neurological examination findings and neuroradiological studies (brain CT, CT angiography, MRI) were performed to diagnose stroke. Clinical examination was recorded on admission and preoperatively using the Glasgow Coma Scale and the National Institutes of Health Stroke Scale. RESULTS The study included 16 patients, 10 males and 6 females. The mean age at surgery was 60.1 years (range 19-73). Surgical procedure was performed in all patients. The patients underwent immediate postoperative CT scan and were in the early hours evaluated in sedation window. In total, we recorded two deaths (12.5%). A functional outcome between mRS 0-3, defined as favourable, was observed in 9 (64.2%) patients 9 months after discharge. A functional outcome between mRS 4-6, defined as poor, was observed in 5 (35.7%) patients 9 months after discharge. CONCLUSIONS The obtained clinical results appear, however, substantially overlapping to decompressive craniectomy. Cisternostomy results in a favourable functional outcome after 9 months. This proposed technique permits that the patient no longer should be undergone cranioplasty thus avoiding the possible complications related to this procedure. The results are certainly interesting but higher case numbers are needed to reach definitive conclusions.
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Affiliation(s)
- Salvatore Massimiliano Cardali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Maria Caffo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Gerardo Caruso
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Gianluca Scalia
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Nicola Gorgoglione
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neuroradiology, University of Messina, Messina, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona, Verona, Italy
| | - Francesca Granata
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neuroradiology, University of Messina, Messina, Italy
| | - Giuseppe Ricciardo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Giada Garufi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Giovanni Raffa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Antonino Germanò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Neurosurgical Clinic, University of Messina, Messina, Italy
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Mitolo M, Zoli M, Testa C, Morandi L, Rochat MJ, Zaccagna F, Martinoni M, Santoro F, Asioli S, Badaloni F, Conti A, Sturiale C, Lodi R, Mazzatenta D, Tonon C. Neuroplasticity Mechanisms in Frontal Brain Gliomas: A Preliminary Study. Front Neurol 2022; 13:867048. [PMID: 35720068 PMCID: PMC9204970 DOI: 10.3389/fneur.2022.867048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Pathological brain processes may induce adaptive cortical reorganization, however, the mechanisms underlying neuroplasticity that occurs in the presence of lesions in eloquent areas are not fully explained. The aim of this study was to evaluate functional compensatory cortical activations in patients with frontal brain gliomas during a phonemic fluency task and to explore correlations with cognitive performance, white matter tracts microstructural alterations, and tumor histopathological and molecular characterization. Methods Fifteen patients with frontal glioma were preoperatively investigated with an MRI study on a 3T scanner and a subgroup underwent an extensive neuropsychological assessment. The hemispheric laterality index (LI) was calculated through phonemic fluency task functional MRI (fMRI) activations in the frontal, parietal, and temporal lobe parcellations. Diffusion-weighted images were acquired for all patients and for a group of 24 matched healthy volunteers. Arcuate Fasciculus (AF) and Frontal Aslant Tract (FAT) tractography was performed using constrained spherical deconvolution diffusivity modeling and probabilistic fiber tracking. All patients were operated on with a resective aim and underwent adjuvant therapies, depending on the final diagnosis. Results All patients during the phonemic fluency task fMRI showed left hemispheric dominance in temporal and parietal regions. Regarding frontal regions (i.e., frontal operculum) we found right hemispheric dominance that increases when considering only those patients with tumors located on the left side. These latter activations positively correlate with verbal and visuo-spatial short-term memory, and executive functions. No correlations were found between the left frontal operculum and cognitive performance. Furthermore, patients with IDH-1 mutation and without TERT mutation, showed higher rightward frontal operculum fMRI activations and better cognitive performance in tests measuring general cognitive abilities, semantic fluency, verbal short-term memory, and executive functions. As for white matter tracts, we found left and right AF and FAT microstructural alterations in patients with, respectively, left-sided and right-side glioma compared to controls. Conclusions Compensatory cortical activation of the corresponding region in the non-dominant hemisphere and its association with better cognitive performance and more favorable histopathological and molecular tumor characteristics shed light on the neuroplasticity mechanisms that occur in the presence of a tumor, helping to predict the rate of post-operative deficit, with the final goal of improving patients'quality of life.
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Affiliation(s)
- Micaela Mitolo
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Matteo Zoli
- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Claudia Testa
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Luca Morandi
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Magali Jane Rochat
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fulvio Zaccagna
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Martinoni
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Santoro
- Neurology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Anatomic Pathology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Filippo Badaloni
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Carmelo Sturiale
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Lodi
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Lim W, Acker G, Hardt J, Kufeld M, Kluge A, Brenner W, Conti A, Budach V, Vajkoczy P, Senger C, Prasad V. Dynamic 18F-FET PET/CT to differentiate recurrent primary brain tumor and brain metastases from radiation necrosis after single-session robotic radiosurgery. Cancer Treat Res Commun 2022; 32:100583. [PMID: 35688103 DOI: 10.1016/j.ctarc.2022.100583] [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: 04/06/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Cyberknife robotic radiosurgery (RRS) provides single-session high-dose radiotherapy of brain tumors with a steep dose gradient and precise real-time image-guided motion correction. Although RRS appears to cause more radiation necrosis (RN), the radiometabolic changes after RRS have not been fully clarified. 18F-FET-PET/CT is used to differentiate recurrent tumor (RT) from RN after radiosurgery when MRI findings are indecisive. We explored the usefulness of dynamic parameters derived from 18F-FET PET in differentiating RT from RN after Cyberknife treatment in a single-center study population. METHODS We retrospectively identified brain tumor patients with static and dynamic 18F-FET-PET/CT for suspected RN after Cyberknife. Static (tumor-to-background ratio) and dynamic PET parameters (time-activity curve, time-to-peak) were quantified. Analyses were performed for all lesions taken together (TOTAL) and for brain metastases only (METS). Diagnostic accuracy of PET parameters (using mean tumor-to-background ratio >1.95 and time-to-peak of 20 min for RT as cut-offs) and their respective improvement of diagnostic probability were analyzed. RESULTS Fourteen patients with 28 brain tumors were included in quantitative analysis. Time-activity curves alone provided the highest sensitivities (TOTAL: 95%, METS: 100%) at the cost of specificity (TOTAL: 50%, METS: 57%). Combined mean tumor-to-background ratio and time-activity curve had the highest specificities (TOTAL: 63%, METS: 71%) and led to the highest increase in diagnosis probability of up to 16% p. - versus 5% p. when only static parameters were used. CONCLUSIONS This preliminary study shows that combined dynamic and static 18F-FET PET/CT parameters can be used in differentiating RT from RN after RRS.
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Affiliation(s)
- Winna Lim
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Gueliz Acker
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; BIH Academy, Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Juliane Hardt
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Center for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine (Foundation) Hannover (TiHo), Buenteweg 2, Hanover 30559, Germany; Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Medical Information Management, Faculty of Information and Communication, University of Applied Sciences Hannover, Germany
| | - Markus Kufeld
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; European Radiosurgery Center Munich, Max Lebsche-Platz 31, Munich 81377, Germany; Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Anne Kluge
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Alfredo Conti
- Department of Biomedical Science and Neuromotor Sciences DIBINEM, Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Via Altura 3, 40139 29 Bologna (BO), Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, Bologna (BO) 40139, Italy
| | - Volker Budach
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany; Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Carolin Senger
- Charité CyberKnife Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany; Department of Nuclear Medicine, University Hospital of Ulm, Ulm 89070, Germany.
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Zoli M, Zenesini C, Bassani G, Colangelo A, Fayel E, Labanca Lima G, Maestri M, Pinto G, Scibilia A, Conti A, Mazzatenta D. Shadows and Lights: Perspectives of Training and Education in Neurosurgery for Undergraduate Students. Front Surg 2022; 9:882063. [PMID: 35662820 PMCID: PMC9160662 DOI: 10.3389/fsurg.2022.882063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Neurosurgical education should start during medical school to involve more students, favoring the recruitment of the most prepared and motivated ones and spreading this subject to the future medical generations. Despite multiple investigations, a dedicated educational plan does not exist. This study aims to assess the undergraduates' interests, needs, and perceptions of this subject. Materials and Methods The survey was structured to collect demographic data of the participants, and to explore their interest in neurosurgery, their consideration of its importance in medical school, their opinions about the role of this subject in medical education, their needs in this training, and, the usefulness of this subject for their future career. Results A total of 156 students participated in the survey. Interest in neurosurgery was shown by 76 (48.7%) participants, however, this subject was also perceived as intimidating by 86 (55.1%). Attending the first 2 years of medical school (p < 0.02), previous interest in neuroscience (p < 0.01), and in a surgical subject (p < 0.01) were the factors associated with a greater interest in this subject. Neurosurgery should be included in all students' education, according to 117 (75.0%) participants and practical operating room training should involve all students, according to 96 (61.5%). The most effective learning methods were considered internship (134, 85.9%), followed by participation in meetings or seminars (113, 72.4%). Online seminars were considered useful by 119 participants (76.3%). Neurosurgery was assessed as a potentially interesting career by 99 students (63.5%), who also considered that it can increase their preparation for other subjects (116, 74.4%). Conclusions Neurosurgery was positively considered by medicals students, who, however, also perceived it as intimidating and hardly approachable. Demonstration that knowledge of neurosurgical concepts can improve their preparation also in general medical settings and, not only in the field of neuroscience, can be useful to promote their interest toward this subject. A combination of lectures and practical internships is considered an effective learning method, which can be fruitfully associated with new technologies.
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Affiliation(s)
- Matteo Zoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- *Correspondence: Matteo Zoli
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epidemiology and Statistics Unit, Bologna, Italy
| | - Gemma Bassani
- School of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Andrea Colangelo
- School of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Elad Fayel
- School of Medicine and Surgery, University of Bologna, Bologna, Italy
| | | | - Matteo Maestri
- School of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Giuseppe Pinto
- School of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Antonino Scibilia
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Palandri G, Carretta A, La Corte E, Giannini G, Martinoni M, Mantovani P, Albini-Riccioli L, Tonon C, Mazzatenta D, Elder BD, Conti A. Open-aqueduct LOVA, LIAS, iNPH: a comparative clinical-radiological study exploring the "grey zone" between different forms of chronic adulthood hydrocephalus. Acta Neurochir (Wien) 2022; 164:1777-1788. [PMID: 35477816 PMCID: PMC9233635 DOI: 10.1007/s00701-022-05215-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
Purpose The definition of chronic adult hydrocephalus encompasses different pathological entities with overlapping characteristics, including long-standing overt ventriculomegaly in adults (LOVA), late-onset idiopathic aqueductal stenosis (LIAS) and idiopathic normal pressure hydrocephalus (iNPH). The aim of our study was to identify preoperative clinical and radiological features peculiar of these diseases providing some pathophysiology inferences on these forms of hydrocephalus. Methods Clinical and radiological preoperative records, type of surgical treatment and clinical outcome of patients with chronic adult hydrocephalus who were surgically treated between 2013 and 2019 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the contribution of each variable to the differential diagnosis. Results In total, 105 patients were included: 18 with LOVA, 23 with LIAS and 64 with iNPH. On multivariate analysis, an enlarged cisterna magna and a more severe ventriculomegaly were associated with the diagnosis of LOVA, while an older age and DESH with iNPH. LIAS patients tend to have an higher prevalence of raised ICP symptoms. Based on that, a clinical and radiological scoring system was developed to distinguish between iNPH and no iNPH cases. A precise cut-off value with a sensitivity of 95.1% and a specificity of 90.6% was identified. Conclusions LOVA, LIAS and iNPH are different forms of chronic adulthood hydrocephalus and present different and peculiar clinical and radiological features, with an impact on the treatment and outcome prediction. The implementation of a clinical-radiological score for differential diagnosis may help the differentiation. Further studies are warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-022-05215-9.
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Affiliation(s)
- Giorgio Palandri
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Alessandro Carretta
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy.
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Emanuele La Corte
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Neurology Unit (NEUROMET), IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Matteo Martinoni
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Paolo Mantovani
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Luca Albini-Riccioli
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Martinoni M, Miccoli G, Riccioli LA, Santoro F, Bertolini G, Zenesini C, Mazzatenta D, Conti A, Cavallo LM, Palandri G. Idiopathic Aqueductal Stenosis: Late Neurocognitive Outcome in ETV Operated Adult Patients. Front Neurol 2022; 13:806885. [PMID: 35463152 PMCID: PMC9021920 DOI: 10.3389/fneur.2022.806885] [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: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of the present study is to evaluate a neurocognitive outcome in patients affected by late-onset idiopathic aqueductal stenosis (LIAS) who underwent endoscopic third ventriculostomy (ETV).Materials and MethodsA prospective study was conducted between January 2015 and December 2017 in a series of 10 consecutive adult patients referred to the Neurosurgery Department of IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. All the adult patients admitted with absence of CSF flow through the aqueduct in phase-contrast (PC)—MRI sequences or a turbulence void signal in T2—weighted images in midsagittal thin-slice MR sequences underwent a specific neuroradiological, neurological, and neurocognitive assessment pre- and postoperatively.ResultsAll patients affected by gait and sphincter disturbances improved after ETV. Attentive and executive functions as well as visuo-spatial memory and verbal executive functions improved in several patients. Similarly, the affective and behavioral scales improved in almost 50% of the patients. No major complications have been recorded, and no patients required a second surgery for shunt placement.ConclusionEndoscopic third ventriculostomy represents a safe and effective surgical procedure for the treatment of LIAS. In addition to neurological improvement, we demonstrated also postoperative neurocognitive improvement mainly in attentive and executive functions, visuo-spatial memory, verbal executive functions, and behavioral and affective domains.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanni Miccoli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- *Correspondence: Giovanni Miccoli
| | - Luca Albini Riccioli
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Santoro
- Neurology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giacomo Bertolini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- Epidemiology and Biostatistics Service, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alfredo Conti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Maria Cavallo
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Engelhardt M, Kimmel J, Raffa G, Conti A, Picht T. Safety and Tolerability of Accelerated Low-Frequency Repetitive Transcranial Magnetic Stimulation Over the Primary Motor Cortex–A Pilot Study. Front Neurosci 2022; 16:793742. [PMID: 35368274 PMCID: PMC8971658 DOI: 10.3389/fnins.2022.793742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Low-frequency repetitive transcranial magnetic stimulation (rTMS) is capable of inducing changes in the functional organization of underlying brain regions, however, often at the cost of long stimulation protocols over several weeks. As these protocols can be difficult to implement in clinical settings, the aim of the present pilot study was to show the feasibility and safety of an accelerated low-frequency rTMS protocol applying multiple sessions daily. To this purpose, nine healthy subjects received 14 sessions of rTMS (1 Hz, 30 min, 110% RMT) to the hand motor hotspot. Subjects received stimulation for either 14 days once daily [classical rTMS (c-rTMS)], 7 days twice daily (accelerated rTMS; a-rTMS), or sham stimulation for 14 days once daily (s-rTMS). Daily stimulation sessions in the a-rTMS group were delivered with a 90-min break in between. In total, 74% of rTMS sessions in the c-rTMS group, 89% in the a-rTMS group, and 98% in the s-rTMS group were free of any side effects. Brief headaches and fatigue in stimulated muscle groups were the most frequent side effects. All side effects were reported to be at maximum mild and of short duration. Thus, accelerated low-frequency rTMS of the motor cortex seems to be a safe and feasible method, previously shown to induce a functional reorganization of the motor system. By shortening treatment duration in days, this approach can potentially make rTMS protocols more accessible to a wider range of patients.
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Affiliation(s)
- Melina Engelhardt
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité – Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Melina Engelhardt,
| | - Jana Kimmel
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Giovanni Raffa
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Division of Neurosurgery, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), University of Messina, Messina, Italy
| | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence, Matters of Activity, Image Space Material, Humboldt-Universität zu Berlin, Berlin, Germany
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Loebel F, Senger C, Acker G, Conti A, Vajkoczy P, Budach V, Dengler N. 360 CyberKnife Radiosurgery Versus Radiofrequency Thermocoagulation in Patients with Trigeminal Neuralgia With or Without Multiple Sclerosis: A Single-Center Comparison. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_360] [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] [Indexed: 11/19/2022] Open
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Cardali SM, Ricciardo G, Garufi G, Raffa G, Messineo F, Scalia G, Conti A, Germanò A. Fluorescein-guided surgery for intradural spinal tumors: A single-center experience. Brain and Spine 2022; 2:100908. [PMID: 36248155 PMCID: PMC9560644 DOI: 10.1016/j.bas.2022.100908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/14/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Gross total removal has a pivotal role in surgical treatment of intradural spinal tumors. Sodium fluorescein prevents vascular injuries also preserving pial vessels in posterior myelotomy. Fluorescence before the durotomy helps to distinguishing tumor from healthy tissue in intradural lesions. Intraoperative fluorescence is safe and effective, also preserving functional anatomy in tumor removal.
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Affiliation(s)
| | | | - Giada Garufi
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | | | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, Italy
- Corresponding author. Neurosurgery Unit, Highly Specialized Hospital and of National Importance “Garibaldi”, Piazza Santa Maria di Gesù, 5, 95124, Catania, Italy.
| | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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Palandri G, Carretta A, La Corte E, Mazzatenta D, Conti A. Longstanding overt ventriculomegaly in adults (LOVA) with patent aqueduct: surgical outcome and etiopathogenesis of a possibly distinct form of chronic hydrocephalus. Acta Neurochir (Wien) 2021; 163:3343-3352. [PMID: 34491433 PMCID: PMC8599222 DOI: 10.1007/s00701-021-04983-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose Longstanding overt ventriculomegaly in adults (LOVA) represents a form of chronic adulthood hydrocephalus with symptomatic manifestation in late adulthood. Based on the patency of the aqueduct, two different subcohorts of LOVA can be distinguished. Surgical treatments of this condition are also debated. Therefore, we analyzed preoperative characteristics and clinical outcome after different surgical treatments in a subgroup of LOVA patients with a patent aqueduct. Methods Eighteen LOVA patients with a patent aqueduct consecutively treated at our institution between July 2013 and December 2019 were analyzed for this study. Median age was 70 years. Preoperative radiological and clinical features, surgical procedures (ventriculo-peritoneal shunt or endoscopic third ventriculostomy), and outcomes were collected. Successful outcome was qualitatively defined as an improvement or a halt of progression of the presenting symptoms at follow-up, and quantitatively by changes in mRS and iNPHGS scales. Results Twelve patients underwent an ETV as a primary treatment, while 6 underwent VPS. A total of 22.2% of them were lost to follow-up. Median follow-up time was 38 months. Six patients (66.7%) in the ETV cohort achieved a successful outcome after treatment, with a complication rate of 11.1%. Two patients underwent rescue VPS after ETV failure with a good outcome. Four patients (100%) underwent primary VPS and achieved a satisfactory outcome after treatment, with a reported complications rate of 25%. Conclusion LOVA with patent aqueduct represents, in our opinion, a distinct clinical form of chronic hydrocephalus. For this subgroup, as well as for other forms of LOVA, ETV remains an acceptable first-line treatment option considering the good results, and the low complication rate, obtained in those patients and the hypothesis that hydrocephalus is due to an “intracisternal” obstruction.
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Affiliation(s)
- Giorgio Palandri
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Alessandro Carretta
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Emanuele La Corte
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Friso F, Rucci P, Rosetti V, Carretta A, Bortolotti C, Ramponi V, Martinoni M, Palandri G, Zoli M, Badaloni F, Franceschi E, Asioli S, Fabbri VP, Rustici A, Foschini MP, Brandes AA, Mazzatenta D, Sturiale C, Conti A. Is There a Role for Surgical Resection of Multifocal Glioblastoma? A Retrospective Analysis of 100 Patients. Neurosurgery 2021; 89:1042-1051. [PMID: 34662898 DOI: 10.1093/neuros/nyab345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glioblastoma with multiple localizations (mGBMs) can be defined as multifocal, where enhancing lesions present a connection visible on magnetic resonance imaging fluid-attenuated inversion recovery imaging, or multicentric, in the absence of a clear dissemination pathway. OBJECTIVE To evaluate the role of the extent of resection (EOR) in the treatment of mGBMs and its correlation with overall survival (OS) and progression free survival (PFS). METHODS One hundred patients with mGBMs were treated at our Institution between 2009 and 2019. Clinical, radiological, and follow-up data were collected. EOR of the contrast-enhancing part of lesions was classified as gross total resection (GTR, absence of tumor remnant), subtotal resection (STR, residual tumor < 30% of the initial mass), partial resection (PR, residual tumor > 30% of the initial mass), and needle or open biopsy (residual tumor > 75% of the initial mass). RESULTS Approximately 15% of patients underwent GTR, 14% STR, 32% PR, and 39% biopsy. Median OS was 17 mo for GTR, 11 mo for STR, 7 mo for PR, and 5 mo for biopsy. Greater EOR was associated with a significantly longer OS than biopsy. GTR and STR were associated with a longer PFS in Kaplan-Meier survival analyses. After adjusting for age, Karnofsky performance status (KPS), number of lesions, and adjunctive therapy in multivariable Cox regression analyses, GTR, STR, and PR were still associated with OS, but only GTR remained associated with PFS. CONCLUSION Our study suggests that EOR may positively influence survival of patients with mGBM. Surgical resection can be a reasonable option when performance and access to adjuvant treatment can be preserved.
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Affiliation(s)
- Filippo Friso
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Vittoria Rosetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Alessandro Carretta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Carlo Bortolotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Vania Ramponi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy
| | - Filippo Badaloni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Bellaria Hospital, Azienda USL di Bologna, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy.,Unit of Pathology, Department of Biomedical and Neuromotor Sciences (DIBINEM), Azienda USL di Bologna, Alma Mater Studiorum University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Viscardo Paolo Fabbri
- Unit of Pathology, Department of Biomedical and Neuromotor Sciences (DIBINEM), Azienda USL di Bologna, Alma Mater Studiorum University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Arianna Rustici
- Department of Experimental, Diagnostic and Speciality Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria P Foschini
- Unit of Pathology, Department of Biomedical and Neuromotor Sciences (DIBINEM), Azienda USL di Bologna, Alma Mater Studiorum University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Bellaria Hospital, Azienda USL di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy
| | - Carmelo Sturiale
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Engelhardt M, Kimmel J, Raffa G, Conti A, Picht T. Safety and feasibility of accelerated low-frequency repetitive navigated transcranial magnetic stimulation (rnTMS). Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.135] [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] [Indexed: 10/19/2022] Open
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40
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Conti A, Treaba CA, Mehndiratta A, Barletta VT, Mainero C, Toschi N. An interpretable machine learning model to explain the interplay between brain lesions and cortical atrophy in multiple sclerosis. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:3757-3760. [PMID: 34892053 DOI: 10.1109/embc46164.2021.9629526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Multiple Sclerosis (MS) is the most common cause, (after trauma) of neurological disability in young adults in Western countries. While several Magnetic Resonance Imaging (MRI) studies have demonstrated a strong association between the presence of cortical grey matter atrophy and the progression of neurological impairment in MS patients, the neurobiological substrates of cortical atrophy in MS, and in particular its relationship with white matter (WM) and cortical lesions, remain unknown. The aim of this study was to investigate the interplay between cortical atrophy and different types of lesions at Ultra-High Field (UHF) 7 T MRI, including cortical lesions and lesions with a susceptibility rim (a feature which histopathological studies have associated with impaired remyelination and progressive tissue destruction). We combined lesion characterization with a recent machine learning (ML) framework which includes explainability, and we were able to predict cortical atrophy in MS from a handful of lesion-related features extracted from 7 T MR imaging. This highlights not only the importance of UHF MRI for accurately evaluating intracortical and rim lesion load, but also the differential contributions that these types of lesions may bring to determine disease evolution and severity. Also, we found that a small subset of features [WM lesion volume (not considering rim lesions), patient age and WM lesion count (not considering rim lesions), intracortical lesion volume] carried most of the prediction power. Interestingly, an almost opposite pattern emerged when contrasting cortical with WM lesion load: WM lesion load is most important when it is small, whereas cortical lesion load behaves in the opposite way.Clinical Relevance- Our results suggest that disconnection and axonal degeneration due to WM lesions and local cortical demyelination are the main factors determining cortical thinning. These findings further elucidate the complexity of MS pathology across the whole brain and the need for both statistical and mechanistic approaches to understanding the etiopathogenesis of lesions.
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Campolo M, Crupi R, Cordaro M, Cardali SM, Ardizzone A, Casili G, Scuderi SA, Siracusa R, Esposito E, Conti A, Cuzzocrea S. Co-Ultra PEALut Enhances Endogenous Repair Response Following Moderate Traumatic Brain Injury. Int J Mol Sci 2021; 22:ijms22168717. [PMID: 34445417 PMCID: PMC8395716 DOI: 10.3390/ijms22168717] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 12/15/2022] Open
Abstract
This study aimed to assess the neuro-regenerative properties of co-ultramicronized PEALut (Glialia®), composed of palmitoylethanolamide (PEA) and the flavonoid luteolin (Lut), in an in vivo model of traumatic brain injury (TBI) and patients affected by moderate TBI. An increase in neurogenesis was seen in the mice at 72 h and 7 d after TBI. The co-ultra PEALut treatment helped the neuronal reconstitution process to restore the basal level of both novel and mature neurons; moreover, it induced a significant upregulation of the neurotrophic factors, which ultimately led to progress in terms of memory recall during behavioral testing. Moreover, our preliminary findings in a clinical trial suggested that Glialia® treatment facilitated neural recovery on working memory. Thus, co-ultra PEALut (Glialia®) could represent a valuable therapeutic agent for intensifying the endogenous repair response in order to better treat TBI.
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Affiliation(s)
- Michela Campolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Rosalia Crupi
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Marika Cordaro
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | | | - Alessio Ardizzone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Giovanna Casili
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Sarah Adriana Scuderi
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Emanuela Esposito
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
| | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; (M.C.); (R.C.); (M.C.); (A.A.); (G.C.); (S.A.S.); (R.S.); (E.E.)
- Department of Pharmacological and Physiological Science, Saint Louis University, Saint Louis, MO 63104, USA
- Correspondence: ; Tel.: +39-090-6765208
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Conti A, Tuleasca C. Letter: The Zap-X Radiosurgical System in the Treatment of Intracranial Tumors: A Technical Case Report. Neurosurgery 2021; 88:E577-E578. [PMID: 33733278 DOI: 10.1093/neuros/nyab080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna, Italy
- Alma Mater Studiorum University of Bologna Bologna, Italy
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
- Faculty of Biology and Medicine University of Lausanne Lausanne, Switzerland
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Delbon P, Maghin F, Conti A. Medically assisted suicide in Italy: the recent judgment of the Constitutional Court. Clin Ter 2021; 172:193-196. [PMID: 33956035 DOI: 10.7417/ct.2021.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract Medically assisted suicide is considered among the most contro-versial of the current bioethical debate in our Country. In the Italian legal system, we are lacking specific discipline of this practice, as it is covered by the general legal forms applicable to crimes against life. The Constitutional Court, with Decision No. 242/2019, declared the illegitimacy of Art. 580 of the Criminal Code (instigation to suicide), in the part not excluding the punishment of those who facilitates the execution of the intention to commit suicide, independently and freely formed, by a person kept alive by life support and suffering an irreversible disease, source of physical or psychological suffering that the person deems intolerable, but who is fully capable of making free and conscious decisions. The Constitutional Court found that the current regulatory fra-mework concerning the end of life leaves certain situations constitutio-nally worthy of protection and to be balanced with other constitutionally relevant assets without adequate protection. The Court has identified the conditions that can justify third-party assistance in ending the life of a sick person. The judges envisaged the possibility of including this discipline under Law No. 219/2017, but this hypothesis is not shared by the Italian National Bioethics Committee.
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Affiliation(s)
- P Delbon
- Forensic Medicine Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Centre of Bioethics Research, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia Italy
| | - F Maghin
- Forensic Medicine Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Conti
- Forensic Medicine Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Centre of Bioethics Research, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia Italy
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Guzzo S, Nazzani S, Vaccaro C, Di Benedetto R, Signorini C, Vizziello D, Conti A, Finkelberg E, Bortolussi G, Acquati P, De Vincetiis C, Carmignani L. Radical nephrectomy and caval thrombectomy with heart beating technique for renal cell cancer with tumor thrombus extension into inferior vena cava and right atrium: A less invasive multidisciplinary approach. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01005-8] [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] [Indexed: 10/20/2022]
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Conti A, Burastero GJ, Hales BJ, Breda D, Alessio M, Burastero SE. IgE reactivity to house dust mite allergen components in sensitized asymptomatic subjects: a role for Der p 20. J BIOL REG HOMEOS AG 2021; 35:669-676. [PMID: 33851528 DOI: 10.23812/21-07-l] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Conti
- Proteome Biochemistry, IRCCS - San Raffaele Scientific Institute, Milan, Italy
| | - G J Burastero
- Proteome Biochemistry, IRCCS - San Raffaele Scientific Institute, Milan, Italy
| | - B J Hales
- Telethon Kids Institute, Center for Child Health Research, University of Western Australia, Perth, Australia
| | - D Breda
- Proteome Biochemistry, IRCCS - San Raffaele Scientific Institute, Milan, Italy
| | - M Alessio
- Proteome Biochemistry, IRCCS - San Raffaele Scientific Institute, Milan, Italy
| | - S E Burastero
- Cellular and Molecular Allergology Unit, IRCCS - San Raffaele Hospital, Milan Italy
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Genovese C, Squeri R, Alessi V, Conti A, D'Amato S, Mazzitelli F, Costa G, Squeri A. Adherence to the three Italian screening in a sample of women (and men) in the Southern Italy. Clin Ter 2021; 171:e75-e79. [PMID: 33346333 DOI: 10.7417/ct.2021.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although scientific evidence shows the numerous benefits of screening programs, in Italy. There is a great disparity between the regional coverage of the North and South despite the screening programs have been activated for several years in all regions even with territorial differences. OBJECTIVE The aim of our study was to evaluate the knowledge and adherence to different screenings in the population, the influence exercised by the local health authority the role of the general practitioner in advising and referring patients to screening tests and the main causes of refuse. MATERIAL AND METHODS The study was carried out, from December 2019 to May 2020, through the administration of anonymous self-filled "ad hoc" questionnaires to women and men over 26 years old. RESULTS in our sample 36% have never performed a breast check and 39% of the interviewees never had a mammogram; for cervical cancer 25% did not ever perform screening and 65% did not have an indication by GP. The worst result was found for colorectal cancer (only 27% of the sample performed the screening). The role of GP was fundamental for and similar to other studies, was fundamental in fact,similar to other studies the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, follwed by lack of time, the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, a lack of time, fear of cancer and embarrassment at visiting a gynaecologist. DISCUSSION AND CONCLUSIONS the study carried out found that despite the knowledge of the oncological disease and the possibilities of prevention is fairly rooted in the population, adherence to the screening is quite inadequate, especially as regards colorectal cancer.
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Affiliation(s)
- C Genovese
- PhD students in Translational Molecular Medicine and Surgery, XXXV cycle, University of Messina - Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
| | - V Alessi
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Messina
| | - A Conti
- Health Management, Lentini Hospital, Sicily
| | - S D'Amato
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Messina
| | - F Mazzitelli
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Messina
| | - G Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina
| | - A Squeri
- Department of Human Pathology of the adult and developmental age "Gaetano Barresi", University of Messina, Italy
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Senger C, Kluge A, Kord M, Zimmermann Z, Conti A, Kufeld M, Kreimeier A, Loebel F, Stromberger C, Budach V, Vajkoczy P, Acker G. Effectiveness and Safety of Robotic Radiosurgery for Optic Nerve Sheath Meningiomas: A Single Institution Series. Cancers (Basel) 2021; 13:cancers13092165. [PMID: 33946405 PMCID: PMC8125730 DOI: 10.3390/cancers13092165] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Optic nerve sheath meningiomas (ONSM) are a rare subtype of meningioma. Only four retrospective studies with 3–21 patients have been published on the treatment of ONSM by radiosurgery. This study represents the largest published series on robotic radiosurgery to date, treating 25 patients with 27 ONSM lesions. Furthermore, hypofractionated radiosurgical treatment proves to be a safe alternative to surgery and fractionated stereotactic radiation with an overall local tumor control rate of 96.0% and stable or improved visual acuity in 90.0% and 10.0% of patients, respectively. We believe that our study makes a significant contribution to the literature, as our results indicate that robotic radiosurgery is a safe and effective treatment for the management of ONSM and offers a potential treatment option that would improve patient care and clinical outcomes. Abstract The role of robotic radiosurgery (RRS) in the treatment of optic nerve sheath meningiomas (ONSM) remains controversial and it is only performed in specialized institutions due to tight dose constraints. We evaluated the effectiveness and safety of RRS in the management of ONSM. Twenty-five patients with 27 ONSM lesions who underwent RRS using the Cyberknife (CK) system were retrospectively analyzed (median age, 47.9 years; 84.0% women). Multisession RRS was used with 4–5 fractions with a cumulative dose of 20.0–25.0 Gy in 84.0% of patients and a single fraction at a dose of 14.0–15.0 Gy in 16% of patients. Prior to RRS, seven (28%) patients experienced blindness on the lesion side. In those patients with preserved vision prior to radiosurgery, the visual acuity remained the same in 90.0% and improved in 10.0% of the patients. Overall local tumor control was 96.0% (mean follow-up period; 37.4 ± 27.2 months). Neither patient age, previous surgery, or the period from the initial diagnosis to RRS showed a dependency on visual acuity before or after radiosurgery. RRS is a safe and effective treatment for the management of ONSM. Hypofractionation of radiosurgery in patients with preserved vision before CK treatment results in stable or improved vision.
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Affiliation(s)
- Carolin Senger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Correspondence: ; Tel.: +49-30-450-557221
| | - Anne Kluge
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Melina Kord
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Zoe Zimmermann
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Alfredo Conti
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Via Altura 3, 40139 Bologna (BO), Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna (BO), Italy
| | - Markus Kufeld
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Anita Kreimeier
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Franziska Loebel
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (A.K.); (M.K.); (A.K.); (C.S.); (V.B.)
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
| | - Peter Vajkoczy
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Gueliz Acker
- Charité Cyberknife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (Z.Z.); (A.C.); (M.K.); (F.L.); (P.V.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité Universitätsmedizin Berlin, BIH Acadamy, Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
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De Maria L, Terzi di Bergamo L, Conti A, Hayashi K, Pinzi V, Murai T, Lanciano R, Burneikiene S, Buglione di Monale M, Magrini SM, Fontanella MM. CyberKnife for Recurrent Malignant Gliomas: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:652646. [PMID: 33854978 PMCID: PMC8039376 DOI: 10.3389/fonc.2021.652646] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Possible treatment strategies for recurrent malignant gliomas include surgery, chemotherapy, radiotherapy, and combined treatments. Among different reirradiation modalities, the CyberKnife System has shown promising results. We conducted a systematic review of the literature and a meta-analysis to establish the efficacy and safety of CyberKnife treatment for recurrent malignant gliomas. METHODS We searched PubMed, MEDLINE, and EMBASE from 2000 to 2021 for studies evaluating the safety and efficacy of CyberKnife treatment for recurrent WHO grade III and grade IV gliomas of the brain. Two independent reviewers selected studies and abstracted data. Missing information was requested from the authors via email correspondence. The primary outcomes were median Overall Survival, median Time To Progression, and median Progression-Free Survival. We performed subgroup analyses regarding WHO grade and chemotherapy. Besides, we analyzed the relationship between median Time To Recurrence and median Overall Survival from CyberKnife treatment. The secondary outcomes were complications, local response, and recurrence. Data were analyzed using random-effects meta-analysis. RESULTS Thirteen studies reporting on 398 patients were included. Median Overall Survival from initial diagnosis and CyberKnife treatment was 22.6 months and 8.6 months. Median Time To Progression and median Progression-Free Survival from CyberKnife treatment were 6.7 months and 7.1 months. Median Overall Survival from CyberKnife treatment was 8.4 months for WHO grade IV gliomas, compared to 11 months for WHO grade III gliomas. Median Overall Survival from CyberKnife treatment was 4.4 months for patients who underwent CyberKnife treatment alone, compared to 9.5 months for patients who underwent CyberKnife treatment plus chemotherapy. We did not observe a correlation between median Time To Recurrence and median Overall Survival from CyberKnife. Rates of acute neurological and acute non-neurological side effects were 3.6% and 13%. Rates of corticosteroid dependency and radiation necrosis were 18.8% and 4.3%. CONCLUSIONS Reirradiation of recurrent malignant gliomas with the CyberKnife System provides encouraging survival rates. There is a better survival trend for WHO grade III gliomas and for patients who undergo combined treatment with CyberKnife plus chemotherapy. Rates of complications are low. Larger prospective studies are warranted to provide more accurate results.
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Affiliation(s)
- Lucio De Maria
- Unit of Neurosurgery, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Alfredo Conti
- Unit of Neurosurgery, Alma Mater Studiorum University of Bologna and IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Kazuhiko Hayashi
- Unit of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Valentina Pinzi
- Unit of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Taro Murai
- Unit of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | - Stefano Maria Magrini
- Unit of Radiation Oncology, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Carducci AL, Agodi A, Ancona C, Angelini P, Bagordo F, Barbone F, Birbaum L, Carreri V, Casuccio A, Conti A, Conversano M, De Donno A, De Giglio O, Desiante F, Di Pietro A, Dogliotti E, Donato F, Fara GM, Fiore M, Forastiere F, Giammanco G, Izzotti A, Montagna MT, Oliveri Conti G, Petronio MG, Sciacca S, Signorelli C, Testai E, Verani M, Vinceti M, Vitale F, Ferrante M, Adani G, Berghella L, Calia C, Calzolari R, Canale A, Castiglione D, Conti A, Copat C, Cristaldi A, Cuffari G, Coronel Vargas G, De Vita E, De Nard F, Federigi I, Filippini T, Grasso A, Leonardi N, Letzgus M, Lo Bianco G, Mazzucco W, Nicolosi I, Orlandi P, Paladino G, Pizzo S, Pousis C, Raffo M, Rivolta S, Scarpitta F, Trani G, Triggiano F, Tumbarello A, Vecchio V, Zuccarello P, Vassallo M. Impact of the environment on the health: From theory to practice. Environ Res 2021; 194:110517. [PMID: 33271142 DOI: 10.1016/j.envres.2020.110517] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.
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Affiliation(s)
- A L Carducci
- Department of Biology, University of Pisa, Italy
| | - A Agodi
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - C Ancona
- Department of Epidemiology of the Regional Health Service, Lazio Region, Rome, Italy
| | - P Angelini
- Public Health Service, Emilia-Romagna Region, Italy
| | - F Bagordo
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Italy
| | - F Barbone
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - L Birbaum
- Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - V Carreri
- Past-President of Italian Society of Hygiene (SItI), Italy
| | - A Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro", University of Palermo, Italy
| | - A Conti
- Regional Agency for Environmental Protection of Sicily, Italy
| | - M Conversano
- Department of Public Health, ASL, Taranto, Italy
| | - A De Donno
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Italy
| | - O De Giglio
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Italy
| | - F Desiante
- Department of Prevention, Local Health Authority of Taranto, Taranto, Italy
| | - A Di Pietro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - E Dogliotti
- Department of Environmental and Health. Istituto Superiore di Sanità. Rome, Italy
| | - F Donato
- Department of Medical and Surgical Specialties, Radiological Sciences, And Public Health, University of Brescia, Italy
| | - G M Fara
- International School of Epidemiology and Preventive Medicine «Giuseppe D'Alessandro», Erice, Trapani, Italy
| | - M Fiore
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - F Forastiere
- Department of Epidemiology of the Regional Health Service, Lazio Region, Rome, Italy
| | - G Giammanco
- International School of Epidemiology and Preventive Medicine «Giuseppe D'Alessandro», Erice, Trapani, Italy
| | - A Izzotti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M T Montagna
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Italy
| | - G Oliveri Conti
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - M G Petronio
- Health and Environment-Department of Prevention, Local Health Authority-Empoli, Florence, Italy
| | - S Sciacca
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - C Signorelli
- University Vita-Salute San Raffaele, Milan, Italy
| | - E Testai
- Istituto Superiore di Sanità, Environment & Health Dept., Rome, Italy
| | - M Verani
- Department of Biology, University of Pisa, Italy
| | - M Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - F Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro", University of Palermo, Italy
| | - M Ferrante
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy.
| | - G Adani
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - L Berghella
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C Calia
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Italy
| | - R Calzolari
- Regional Agency for Environmental Protection of Sicily, Italy
| | - A Canale
- Department of Biology, University of Pisa, Italy
| | - D Castiglione
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - A Conti
- Regional Agency for Environmental Protection of Sicily, Italy
| | - C Copat
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - A Cristaldi
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - G Cuffari
- Regional Agency for Environmental Protection of Sicily, Italy
| | - G Coronel Vargas
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - E De Vita
- Department of Biology, University of Pisa, Italy
| | | | - I Federigi
- Department of Biology, University of Pisa, Italy
| | - T Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Grasso
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - N Leonardi
- University Center for the Protection and Management of Natural Environments and Agrosystems (CUTGANA), University of Catania, Italy
| | | | | | - W Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro", University of Palermo, Italy
| | - I Nicolosi
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - P Orlandi
- Local Health Authority of Rome, Italy
| | - G Paladino
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - S Pizzo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro", University of Palermo, Italy
| | - C Pousis
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Italy
| | - M Raffo
- Local Health Authority of Rome, Italy
| | | | - F Scarpitta
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro", University of Palermo, Italy
| | - G Trani
- Central Health Department of the Friuli Venezia Giulia Region, Trieste, Italy
| | - F Triggiano
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari Aldo Moro, Italy
| | | | - V Vecchio
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - P Zuccarello
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
| | - M Vassallo
- Department of Medical Science, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Italy
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Zoli M, Talozzi L, Martinoni M, Manners DN, Badaloni F, Testa C, Asioli S, Mitolo M, Bartiromo F, Rochat MJ, Fabbri VP, Sturiale C, Conti A, Lodi R, Mazzatenta D, Tonon C. From Neurosurgical Planning to Histopathological Brain Tumor Characterization: Potentialities of Arcuate Fasciculus Along-Tract Diffusion Tensor Imaging Tractography Measures. Front Neurol 2021; 12:633209. [PMID: 33716935 PMCID: PMC7952864 DOI: 10.3389/fneur.2021.633209] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/26/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Tractography has been widely adopted to improve brain gliomas' surgical planning and guide their resection. This study aimed to evaluate state-of-the-art of arcuate fasciculus (AF) tractography for surgical planning and explore the role of along-tract analyses in vivo for characterizing tumor histopathology. Methods: High angular resolution diffusion imaging (HARDI) images were acquired for nine patients with tumors located in or near language areas (age: 41 ± 14 years, mean ± standard deviation; five males) and 32 healthy volunteers (age: 39 ± 16 years; 16 males). Phonemic fluency task fMRI was acquired preoperatively for patients. AF tractography was performed using constrained spherical deconvolution diffusivity modeling and probabilistic fiber tracking. Along-tract analyses were performed, dividing the AF into 15 segments along the length of the tract defined using the Laplacian operator. For each AF segment, diffusion tensor imaging (DTI) measures were compared with those obtained in healthy controls (HCs). The hemispheric laterality index (LI) was calculated from language task fMRI activations in the frontal, parietal, and temporal lobe parcellations. Tumors were grouped into low/high grade (LG/HG). Results: Four tumors were LG gliomas (one dysembryoplastic neuroepithelial tumor and three glioma grade II) and five HG gliomas (two grade III and three grade IV). For LG tumors, gross total removal was achieved in all but one case, for HG in two patients. Tractography identified the AF trajectory in all cases. Four along-tract DTI measures potentially discriminated LG and HG tumor patients (false discovery rate < 0.1): the number of abnormal MD and RD segments, median AD, and MD measures. Both a higher number of abnormal AF segments and a higher AD and MD measures were associated with HG tumor patients. Moreover, correlations (unadjusted p < 0.05) were found between the parietal lobe LI and the DTI measures, which discriminated between LG and HG tumor patients. In particular, a more rightward parietal lobe activation (LI < 0) correlated with a higher number of abnormal MD segments (R = −0.732) and RD segments (R = −0.724). Conclusions: AF tractography allows to detect the course of the tract, favoring the safer-as-possible tumor resection. Our preliminary study shows that along-tract DTI metrics can provide useful information for differentiating LG and HG tumors during pre-surgical tumor characterization.
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Affiliation(s)
- Matteo Zoli
- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lia Talozzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Martinoni
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - David N Manners
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Filippo Badaloni
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Anatomic Pathology Unit, Azienda USL di Bologna, Bologna, Italy
| | - Micaela Mitolo
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fiorina Bartiromo
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Magali Jane Rochat
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carmelo Sturiale
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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