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De Simone M, Zoia C, Choucha A, Kong DS, De Maria L. The Transorbital Approach: A Comprehensive Review of Targets, Surgical Techniques, and Multiportal Variants. J Clin Med 2024; 13:2712. [PMID: 38731240 DOI: 10.3390/jcm13092712] [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: 04/05/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
The transorbital approach (TOA) is gaining popularity in skull base surgery scenarios. This approach represents a valuable surgical corridor to access various compartments and safely address several intracranial pathologies, both intradurally and extradurally, including tumors of the olfactory groove in the anterior cranial fossa (ACF), cavernous sinus in the middle cranial fossa (MCF), and the cerebellopontine angle in the posterior cranial fossa (PCF). The TOA exists in many variants, both from the point of view of invasiveness and from that of the entry point to the orbit, corresponding to the four orbital quadrants: the superior eyelid crease (SLC), the precaruncular (PC), the lateral retrocanthal (LRC), and the preseptal lower eyelid (PS). Moreover, multiportal variants, consisting of the combination of the transorbital approach with others, exist and are relevant to reach peculiar surgical territories. The significance of the TOA in neurosurgery, coupled with the dearth of thorough studies assessing its various applications and adaptations, underscores the necessity for this research. This extensive review delineates the multitude of target lesions reachable through the transorbital route, categorizing them based on surgical complexity. Furthermore, it provides an overview of the different transorbital variations, both standalone and in conjunction with other techniques. By offering a comprehensive understanding, this study aims to enhance awareness and knowledge regarding the current utility of the transorbital approach in neurosurgery. Additionally, it aims to steer future investigations toward deeper exploration, refinement, and exploration of additional perspectives concerning this surgical method.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy
| | - Cesare Zoia
- UOC of Neurosurgery, Ospedale Moriggia Pelascini, Gravedona e Uniti, 22015 Gravedona, Italy
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France
- Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, 13005 Marseille, France
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Lucio De Maria
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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Zoia C, Stienen MN, Zaed I, Menna G, Aldea CC, Bartek J, Bauer M, Belo D, Drosos E, Freyschlag CF, Kaprovoy S, Lepic M, Lippa L, Mohme M, Motov S, Schwake M, Spiriev T, Stengel FC, Torregrossa F, Raffa G, Gandía-Gonzalez ML. The prevalence of imposter syndrome among neurosurgeons in Europe: An EANS YNC survey. Brain Spine 2024; 4:102816. [PMID: 38666069 PMCID: PMC11043838 DOI: 10.1016/j.bas.2024.102816] [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: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Introduction Imposter syndrome (IS), characterized by persistent doubts about one's abilities and fear of exposure as a fraud, is a prevalent psychological condition, particularly impacting physicians. In neurosurgery, known for its competitiveness and demands, the prevalence of IS remains high. Research question Recognizing the limited literature on IS within the neurosurgical community, this European survey aimed to determine its prevalence among young neurosurgeons and identify associated factors. Material and methods The survey, conducted by the Young Neurosurgeon Committee of the European Association of Neurosurgical Societies, gathered responses from 232 participants. The survey included demographics, the Clance Imposter Phenomenon Survey (CIPS), and an analysis of potential compensatory mechanisms. Results Nearly 94% of respondents exhibited signs of IS, with the majority experiencing moderate (36.21%) or frequent (40.52%) symptoms. Analyses revealed associations between IS and factors such as level of experience, sex, and board-certification. Discussion and conclusion The findings suggest a significant prevalence of IS among young neurosurgeons, with notable associations with sex and level of experience. Compensatory mechanisms, such as working hours, article reading, and participation in events, did not show significant correlations with IS. Notably, male sex emerged as an independent protective factor against frequent/intense IS, while reading more than five articles per week was identified as a risk factor. The identification of protective and risk factors, particularly the influence of gender and reading habits, contributes valuable insights for developing targeted interventions to mitigate IS and improve the well-being of neurosurgeons.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - Martin N. Stienen
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital, St.Gallen, St.Gallen, Switzerland
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Grazia Menna
- Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina C. Aldea
- Department of Neurosurgery, Cluj County Emergency Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Jiri Bartek
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden & Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Marlies Bauer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | - Milan Lepic
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Laura Lippa
- Department of Neurosurgery, ASST Ospedale Niguarda, Milano, Italy
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Motov
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital, St.Gallen, St.Gallen, Switzerland
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Germany
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | - Felix C. Stengel
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital, St.Gallen, St.Gallen, Switzerland
| | - Fabio Torregrossa
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery and Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, MN, USA
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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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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Zoia C, Maiorano E, Borromeo S, Mantovani G, Spena G, Pagella F. Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series. Brain Spine 2024; 4:102770. [PMID: 38510598 PMCID: PMC10951755 DOI: 10.1016/j.bas.2024.102770] [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] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Introduction Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery. Research question The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies. Material and methods We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes. Results 39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months). Discussion and conclusion Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Moriggia Pelascini Hospital, Gravedona e Uniti, Italy
| | - Eugenia Maiorano
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Sara Borromeo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Fabio Pagella
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Somma T, Bove I, Vitulli F, Solari D, Bocchino A, Palmiero C, Scala MR, Zoia C, Cappabianca P, Esposito F. Gender gap in deep brain stimulation for Parkinson's disease: preliminary results of a retrospective study. Neurosurg Rev 2024; 47:63. [PMID: 38263479 PMCID: PMC10806036 DOI: 10.1007/s10143-024-02290-7] [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: 11/12/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment of PD for both women and men. However, discussions have been reported about the impact of STN-DBS surgery in PD. The aim of our study is to identify differences between men and women in terms of pre- and post-DBS symptoms and try to explain the possible causes. In the current study, we evaluated the gender impact on STN-DBS in PD at the Department of Neurosurgery of University of Naples "Federico II" from 2013 to 2021. Motor and non-motor symptoms were evaluated. To compare the data before and after surgery and between the genders, Wilcoxon-Mann-Whitney tests were performed. A total of 43 patients with PD were included; of them, 17 (39%) were female. Baseline evaluation revealed no gender differences in the age of onset (p = 0.87). Not significant differences were noted in the Unified Parkinson's Disease Rating Scale (UPDRS) pre-surgery score, but if we consider UPDRS subscores of motor examination, significant clinical improvement was reported in both male and female in terms of UPDRS pre- and post-surgery (p < 0.001). STN-DBS is a highly effective treatment for motor and non-motor symptoms of PD for both women and men but our study hints towards gender-specific outcomes in motor domains. Improving our knowledge in this field can allow us to implement strategies to identify new directions in the development of an adequate treatment of PD in terms of surgical intervention and in consideration of the gender.
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Affiliation(s)
- Teresa Somma
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Ilaria Bove
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy.
| | - Francesca Vitulli
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Domenico Solari
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea Bocchino
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Carmela Palmiero
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Maria Rosaria Scala
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Cesare Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona Ed Uniti, Italy
| | - Paolo Cappabianca
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Department of Neurological Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
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Zoia C, Mantovani G, Aldea C, Bartek J, Bauer M, Belo D, Drosos E, Kaprovoy S, Stengel F, Lepic M, Lippa L, Mohme M, Motov S, Schwake M, Spiriev T, Torregrossa F, Thomé C, Meling TR, Raffa G. Neurosurgical fellowship in Europe: It's time to cooperate - A call from the EANS Young Neurosurgeons' Committee. Brain Spine 2023; 4:102734. [PMID: 38510596 PMCID: PMC10951695 DOI: 10.1016/j.bas.2023.102734] [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] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Jiri Bartek
- Karolinska University Hospital, Stockholm, Sweden
| | - Marlies Bauer
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | | | | | - Laura Lippa
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Toma Spiriev
- Acibadem CityClinic University Hospital Tokuda, Sofia, Bulgaria
| | | | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Torstein R Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Italy
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Zoia C, Mastantuoni C, Solari D, de Notaris M, Corrivetti F, Spena G, Cavallo LM. Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study. Brain Spine 2023; 4:102719. [PMID: 38163002 PMCID: PMC10753433 DOI: 10.1016/j.bas.2023.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
Introduction The transorbital route has been proposed for addressing orbital and paramedian skull base lesions. It can be complemented by further marginotomies, as per "extended-transorbital approach" and combined with others ventro-basal approaches featuring the concept of "multiportal surgery". Nevertheless, it cannot address some anatomical regions like the clinoid, carotid bifurcation and the Sylvian fissure. Therefore, we propose a combined transorbital and a supraorbital approach, attainable by a single infra-brow incision, and we called it "Uniportal multicorridor" approach. Research question The aim of our study is to verify its feasibility and deep anatomical targets through a cadaveric study. Materials and methods Anatomic dissections were performed at the Laboratory of ICLO Teaching and Research Center (Verona, Italy) on four formalin-fixed cadaveric heads injected with colored neoprene latex (8 sides). A stepwise dissection of the supraorbital and transorbital approaches (with an infra-brow skin incision) to the anterior tentorial incisura, clinoid area, lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure is described. Results We analyzed the anatomic areas reached by the transorbital corridor dividing them as follow: lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure; while the anatomic areas addressed by the supraorbital craniotomy were the clinoid area and the anterior tentorial incisura. Conclusions The described uniportal multi-corridor approach combines a transorbital corridor and a supraorbital craniotomy, providing a unique intra and extradural control over the anterior, middle, and posterior fossa, tentorial incisura and the Sylvian fissure, via an infra-brow skin incision.
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Affiliation(s)
- Cesare Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Ciro Mastantuoni
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, “San Pio” Hospital, Benevento, Italy
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Francesco Corrivetti
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | | | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy
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La Rocca G, Auricchio AM, Mazzucchi E, Ius T, Della Pepa GM, Altieri R, Pignotti F, Gessi M, De Santis V, Zoia C, Sabatino G. Intracranial dural based marginal zone MALT-type B-cell lymphoma: a case - Based update and literature review. Br J Neurosurg 2023; 37:1480-1486. [PMID: 34180316 DOI: 10.1080/02688697.2021.1941760] [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: 01/21/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Dural based Marginal Zone MALT-type B-Cell Lymphoma (MZBCL) is an intracranial tumor that can mimicking meningioma both from a clinical and a radiological point of view. A standard treatment protocol is still lacking. Aim of the present work is to provide an update of the present literature regarding this rare neoplasia. PATIENTS AND METHODS We report the case of a patient with a dural-based lesion mimicking a meningioma of the tentorium. After surgical treatment, the diagnosis was of MZBCL. A literature review is performed to highlight the typical characteristics of this rare intracranial lesion and to define the best therapeutic approach. RESULTS Literature review included 38 articles describing 126 cases of intracranial dural-based MZBCL. No clinical trial has been found. Clinical and histopathological features are properly collected to provide a guide for future cases. Different treatment options have been attempted. Combination of surgery with adjuvant radiation therapy is the most used option. CONCLUSIONS MZBCL should be considered in differential diagnosis for dural-based intracranial lesion. Surgery followed by radiation therapy is the most reported treatment. As a consequence of the rarity of this disease, of its indolent progression and of the lack of adequate follow-up, it is not possible to define it is the best treatment option.
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Affiliation(s)
- G La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - A M Auricchio
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - E Mazzucchi
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - T Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia, University Hospital, Italy, Udine
| | - G M Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - R Altieri
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G.Rodolico" University Hospital, Catania, Italy
| | - F Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - M Gessi
- Department of Neuro-Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - V De Santis
- Institute of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
- Unit of Orthopedics, Mater Olbia Hospital, Olbia, Italy
| | - C Zoia
- Unit of Neurosurgery, Fondazione Policlinico San Matteo Pavia IRCCS, Pavia, Italy
| | - G Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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9
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Robertson FC, Stapleton CJ, Coumans JVCE, Nicolosi F, Vooijs M, Blitz S, Guerrini F, Spena G, Giussani C, Zoia C, Nahed BV. Applying objective metrics to neurosurgical skill development with simulation and spaced repetition learning. J Neurosurg 2023; 139:1092-1100. [PMID: 36905658 DOI: 10.3171/2023.1.jns222651] [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: 11/27/2022] [Accepted: 01/18/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Surgical skills laboratories augment educational training by deepening one's understanding of anatomy and allowing the safe practice of technical skills. Novel, high-fidelity, cadaver-free simulators provide an opportunity to increase access to skills laboratory training. The neurosurgical field has historically evaluated skill by subjective assessment or outcome measures, as opposed to process measures with objective, quantitative indicators of technical skill and progression. The authors conducted a pilot training module with spaced repetition learning concepts to evaluate its feasibility and impact on proficiency. METHODS The 6-week module used a simulator of a pterional approach representing skull, dura mater, cranial nerves, and arteries (UpSurgeOn S.r.l.). Neurosurgery residents at an academic tertiary hospital completed a video-recorded baseline examination, performing supraorbital and pterional craniotomies, dural opening, suturing, and anatomical identification under a microscope. Participation in the full 6-week module was voluntary, which precluded randomizing by class year. The intervention group participated in four additional faculty-guided trainings. In the 6th week, all residents (intervention and control) repeated the initial examination with video recording. Videos were evaluated by three neurosurgical attendings who were not affiliated with the institution and who were blinded to participant grouping and year. Scores were assigned via Global Rating Scales (GRSs) and Task-based Specific Checklists (TSCs) previously built for craniotomy (cGRS, cTSC) and microsurgical exploration (mGRS, mTSC). RESULTS Fifteen residents participated (8 intervention, 7 control). The intervention group included a greater number of junior residents (postgraduate years 1-3; 7/8) compared to the control group (1/7). External evaluators had internal consistency within 0.5% (kappa probability > Z of 0.00001). The total average time improved by 5:42 minutes (p < 0.003; intervention, 6:05, p = 0.07; control, 5:15, p = 0.001). The intervention group began with lower scores in all categories and surpassed the comparison group in cGRS (10.93 to 13.6/16) and cTSC (4.0 to 7.4/10). Percent improvements for the intervention group were cGRS 25% (p = 0.02), cTSC 84% (p = 0.002), mGRS 18% (p = 0.003), and mTSC 52% (p = 0.037). For controls, improvements were cGRS 4% (p = 0.19), cTSC 0.0% (p > 0.99), mGRS 6% (p = 0.07), and mTSC 31% (p = 0.029). CONCLUSIONS Participants who underwent a 6-week simulation course showed significant objective improvement in technical indicators, particularly individuals who were early in their training. Small, nonrandomized grouping limits generalizability regarding degree of impact; however, introducing objective performance metrics during spaced repetition simulation would undoubtedly improve training. A larger multiinstitutional randomized controlled study will help elucidate the value of this educational method.
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Affiliation(s)
- Faith C Robertson
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J Stapleton
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean-Valery C E Coumans
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Federico Nicolosi
- 2Department of Medicine and Surgery, Neurosurgery, University of Milano-Bicocca, Milan, Italy
| | - Manuela Vooijs
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- 3Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Sarah Blitz
- 4Harvard Medical School, Boston, Massachusetts
| | - Francesco Guerrini
- 5Department of Surgical Sciences, Unit of Neurosurgery, Santa Maria Goretti Hospital, Latina, Italy
| | - Giannantonio Spena
- 6Head and Neck Department, Neurosurgery Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Carlo Giussani
- 2Department of Medicine and Surgery, Neurosurgery, University of Milano-Bicocca, Milan, Italy
- 7Department of Neurosurgery, Foundation IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Cesare Zoia
- 6Head and Neck Department, Neurosurgery Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Brian V Nahed
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Balak N, Tsianaka E, Zoia C, Sekhar A, Ganau M. Editorial: From simulation to the operating theatre: new insights in translational surgery. Front Med Technol 2023; 5:1282248. [PMID: 37810948 PMCID: PMC10552562 DOI: 10.3389/fmedt.2023.1282248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Türkiye
| | - Eleni Tsianaka
- Neurosurgery Department, Kuwait Hospital, Sabah Al Salem, Kuwait
| | - Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Amitendu Sekhar
- Department of Neurosurgery, Bahrain Defence Force Royal Medical Services Military Hospital, West Riffa, Bahrain
| | - Mario Ganau
- Nuffield Department of Neurosciences, University of Oxford, Oxford, United Kingdom
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Zoia C, Mantovani G, Müther M, Suero Molina E, Scerrati A, De Bonis P, Cornelius J, Roche P, Tatagiba M, Jouanneau E, Manet R, Schroeder H, Cavallo L, Kasper E, Meling T, Mazzatenta D, Daniel R, Messerer M, Visocchi M, Froelich S, Bruneau M, Spena G. Through the orbit and beyond: Current state and future perspectives in endoscopic orbital surgery on behalf of the EANS frontiers committee in orbital tumors and the EANS skull base section. Brain Spine 2023; 3:102669. [PMID: 37720459 PMCID: PMC10500473 DOI: 10.1016/j.bas.2023.102669] [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] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
Introduction Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery. Research question Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection. Material and methods A PRISMA based literature search was performed to select the most relevant papers on the topic. Results Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery. Discussion and conclusion This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.
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Affiliation(s)
- C. Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - G. Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - M. Müther
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - E. Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - A. Scerrati
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - P. De Bonis
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - J.F. Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - P.H. Roche
- Department of Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - M. Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - E. Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - R. Manet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - H.W.S. Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Germany
| | - L.M. Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Policlinico Federico II University Hospital, Italy
| | - E.M. Kasper
- Department of Neurosurgery, Steward Medical Group, Brighton, USA
| | - T.R. Meling
- Department of Neurosurgery, The National Hospital, Rigshospitalet, Copenhagen, Denmark
| | - D. Mazzatenta
- Department of Neurosurgery, Neurological Sciences Institut IRCCS, Bologna, Italy
| | - R.T. Daniel
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Messerer
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland
| | - M. Visocchi
- Department of Neurosurgery, Institute of Neurosurgery Catholic University of Rome, Italy
| | - S. Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M. Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G. Spena
- Neurosurgery Unit, IRCSS San Matteo Hospital, Pavia, Italy
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12
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Raffa G, Spiriev T, Zoia C, Aldea CC, Bartek Jr J, Bauer M, Ben-Shalom N, Belo D, Drosos E, Freyschlag CF, Kaprovoy S, Lepic M, Lippa L, Rabiei K, Schwake M, Stengel FC, Stienen MN, Gandía-González ML. The use of advanced technology for preoperative planning in cranial surgery - A survey by the EANS Young Neurosurgeons Committee. Brain Spine 2023; 3:102665. [PMID: 38021023 PMCID: PMC10668051 DOI: 10.1016/j.bas.2023.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023]
Abstract
Introduction Technological advancements provided several preoperative tools allowing for precise preoperative planning in cranial neurosurgery, aiming to increase the efficacy and safety of surgery. However, little data are available regarding if and how young neurosurgeons are trained in using such technologies, how often they use them in clinical practice, and how valuable they consider these technologies. Research question How frequently these technologies are used during training and clinical practice as well as to how their perceived value can be qualitatively assessed. Materials and methods The Young Neurosurgeons' Committee (YNC) of the European Association of Neurosurgical Societies (EANS) distributed a 14-items survey among young neurosurgeons between June 1st and August 31st, 2022. Results A total of 441 responses were collected. Most responders (42.34%) received "formal" training during their residency. Planning techniques were used mainly in neuro-oncology (90.86%), and 3D visualization of patients' DICOM dataset using open-source software was the most frequently used (>20 times/month, 20.34% of responders). Software for 3D visualization of patients' DICOM dataset was the most valuable technology, especially for planning surgical approach (42.03%). Conversely, simulation based on augmented/mixed/virtual reality was considered the less valuable tool, being rated below sufficiency by 39.7% of responders. Discussion and conclusion Training for using preoperative planning technologies in cranial neurosurgery is provided by neurosurgical residency programs. Software for 3D visualization of DICOM datasets is the most valuable and used tool, especially in neuro-oncology. Interestingly, simulation tools based on augmented/virtual/mixed reality are considered less valuable and, therefore, less used than other technologies.
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Affiliation(s)
- Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem CityClinic Tokuda Hospital Sofia, Bulgaria
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina C. Aldea
- Department of Neurosurgery, Cluj County Emergency Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Jiri Bartek Jr
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Marlies Bauer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Netanel Ben-Shalom
- Department of Neurosurgery, Rabin Medical Center, Belinson Campus, Petah Tikva, Israel
| | - Diogo Belo
- Neurosurgery Department, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
| | | | | | - Stanislav Kaprovoy
- Burdenko Neurosurgical Center, Department of Spinal and Peripheral Nerve Surgery, Department of International Affairs, Moscow, Russia
| | - Milan Lepic
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Laura Lippa
- Dept of Neurosurgery, ASST Ospedale Niguarda, Milano, Italy
| | - Katrin Rabiei
- Institution of Neuroscience & Physiology, Sahlgrenska Academy, Gothenberg, Sweden
- Art Clinic Hospitals, Gothenburg, Sweden
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Germany
| | - Felix C. Stengel
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery and Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Maria L. Gandía-González
- Department of Neurosurgery, Hospital Universitario La Paz, Idipaz, Madrid, Spain
- University Autonomous of Madrid, Spain
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Mattogno PP, Zoli M, D’Alessandris QG, Bongetta D, Caccavella VM, Rigante M, Della Pepa GM, Mazzatenta D, Lauretti L, Olivi A, Spena G, Zoia C. Ultra-Early Treatment of Neurosurgical Emergencies with Endoscopic Endonasal Approach: Experience from Three Italian Referral Centers. J Clin Med 2023; 12:5471. [PMID: 37685541 PMCID: PMC10487769 DOI: 10.3390/jcm12175471] [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: 08/02/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE the aim of this multicenter study is to preliminarily assess the role of the Endoscopic Endonasal Approach (EEA) in ultra-early (i.e., within 12 h) management of selected neurosurgical emergencies in terms of clinical and radiological outcomes. METHODS 26 patients affected by sellar/parasellar pathologies with rapid progression of symptoms were managed with EEA within 12 h from diagnosis in three Italian tertiary referral Centers from January 2016 to December 2019. Both clinical and radiological data have been collected preoperatively as well as post-operatively in order to perform retrospective analysis. RESULTS The average time from admission to the operating room was 5.5 h (±2.3). The extent of resection was gross-total in 20 (76.9%), subtotal in 6 (23.1%) patients. One patient experienced re-bleeding after a subtotal removal of a hemorrhagic lesion. Patients with a longer time from admission (>4 h) to the operatory room (OR) experienced stable impairment of the visual acuity (p = 0.033) and visual field (p = 0.029) in the post-operative setting. CONCLUSIONS The Endoscopic Endonasal Approach represents a safe, effective technique that can be efficiently used with good results in the management of selected neurosurgical emergencies in centers with adequate experience.
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Affiliation(s)
- Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Matteo Zoli
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Institute of Neurological Sciences of Bologna, 40121 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40121 Bologna, Italy
| | | | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, 20100 Milan, Italy
| | - Valerio Maria Caccavella
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Mario Rigante
- Department of Otolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Diego Mazzatenta
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Institute of Neurological Sciences of Bologna, 40121 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40121 Bologna, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00100 Rome, Italy
| | - Giannantonio Spena
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Cesare Zoia
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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14
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Zoia C, Todeschini G, Lovati E, Lucotti P, Iannalfi A, Bongetta D, Di Sabatino A, Riva G, Cavallo I, Orlandi E, Spena G. Evaluation of endocrinological sequelae following particle therapy performed on anterior skull base lesions in the adult population. Surg Neurol Int 2023; 14:293. [PMID: 37680918 PMCID: PMC10481810 DOI: 10.25259/sni_41_2023] [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: 01/13/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
Background Radiotherapy has increasingly assumed a central role in the multidisciplinary treatment of skull base lesions. Unfortunately, it is often burdened by relevant radio-induced damage to the pituitary function and the surrounding structures and systems. Patients who were treated with radiotherapy around the sellar region especially have a high risk of developing radio-induced hypopituitarism. Particle therapy has the potential advantage of delivering a higher radiation dose to the target while potentially sparing the sellar region and pituitary function. The aim of this study is to evaluate the pituitary function in adult patients who have undergone hadron therapy for anterior skull base lesions involving or surrounding the pituitary gland. Methods This is a retrospective, observational, and noncontrolled study. We evaluated pituitary and peripheral hormone levels in all patients referring to National Center for Oncological Hadrontherapy, Pavia, Italy for anterior skull base tumors. Furthermore, we performed a magnetic resonance imaging for every follow-up to evaluate potential tumoral growth. Results We evaluated 32 patients with different tumoral lesions with a mean follow-up of 27.9 months. The mean hadron therapy (HT) dose was 60 ± 14 Gray, with a mean dose per fraction of 2.3 ± 2.1 Gray. Six patients were treated with carbon ions and 26 with protons. Pituitary hormone alteration of some kind was reported for six patients. No patient experienced unexpected severe adverse events related to particle therapy. Conclusion Particle radiotherapy performed on anterior skull base lesions has proved to cause limited damage to pituitary function in the adult population.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Giada Todeschini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Elisabetta Lovati
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Pietro Lucotti
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Iacopo Cavallo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
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Pagella F, Maiorano E, Turri-Zanoni M, Ferrari M, Carena P, Zoia C, Czaczkes C, Conti C, Schreiber A, Battaglia P, Emanuelli E, Pelucchi S, Bignami M, Nicolai P, Castelnuovo P. The role of the osteoplastic flap in the endoscopic era: a retrospective multicentre experience on revision surgery. Acta Otorhinolaryngol Ital 2023; 43:S34-S40. [PMID: 37698098 PMCID: PMC10159640 DOI: 10.14639/0392-100x-suppl.1-43-2023-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Objective To retrospectively review the experience of five tertiary-care university hospitals on frontal sinus revision surgery with osteoplastic flap (OPF). Methods Descriptive analysis of patients who underwent frontal sinus surgery with OPF after one or more endoscopic procedures for benign and inflammatory pathologies from 2000 to 2022. Clinical charts were reviewed for demographics, indications, clinical presentation, previous frontal procedures, OPF technique and outcomes. Results Of the 124 patients who underwent an OPF procedure, 33 met inclusion criteria. With a mean of 2.1 previous endoscopic surgeries, Draf III was the most common former procedure. In 30 (91%) cases OPF was part of a combined procedure. The most common indications were inverted papilloma (61%), mucocele (9%) and chronic rhinosinusitis (6%). Frontal outflow stenosis (36%) and mucocele (9%) were the most frequent complications observed. Improvement of overall symptoms and patient satisfaction after the OPF procedure were recorded. Conclusions Even in the endoscopic era, OPF still represents a paramount procedure that should be included in the rhino-surgeon's armamentarium, in particular in patients with challenging pathologies and anatomy when previous endoscopic endonasal attempts have failed.
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Affiliation(s)
- Fabio Pagella
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Italy
| | - Paolo Carena
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Czaczkes
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Carlo Conti
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology, Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Enzo Emanuelli
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Italy
- Unit of Otolaryngology, AULSS 2 - Marca Trevigiana, Treviso, Italy
| | - Stefano Pelucchi
- Ear-Nose-Throat & Audiology Unit, University of Ferrara, Ferrara, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Department of Surgery, ASST Lariana, University of Insubria, Como, Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
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16
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Solari D, d'Avella E, Agresta G, Catapano D, D'Ecclesia A, Locatelli D, Massimi L, Mazzatenta D, Spena G, Tamburrini G, Zoia C, Zoli M, Cinalli G, Cappabianca P, Cavallo LM. Endoscopic endonasal approach for infradiaphragmatic craniopharyngiomas: a multicentric Italian study. J Neurosurg 2023; 138:522-532. [PMID: 35901705 DOI: 10.3171/2022.5.jns212974] [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: 12/30/2021] [Accepted: 05/20/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Infradiaphragmatic craniopharyngiomas (ICs) represent a distinct subtype, harboring a sellar-suprasellar origin and generally growing in the extra-arachnoidal space contained by the diaphragma sellae. They have been considered ideal for surgical removal through the transsphenoidal approach since the 1960s. The authors present a multicentric national study, intending to selectively analyze IC behavior and the impact of the transsphenoidal endoscopic endonasal approach (EEA) on surgical outcomes. METHODS Craniopharyngiomas that were intraoperatively recognized as infradiaphragmatic and removed with standard EEA between 2000 and 2021 at 6 Italian neurosurgical departments were included in the study. Clinical, radiological, and surgical findings and outcomes were evaluated and reviewed. RESULTS In total, 84 patients were included, with 45.23% identified as pediatric cases and 39.28% as having recurrent tumors. The most common presenting symptoms were endocrine (75%), visual (59.52%), and hypothalamic (26.19%) disorders. ICs were classified as extending below (6 intrasellar and 41 occupying the suprasellar cistern) or above (26 obliterating the anterior recesses of the third ventricle and 11 extending up to the foramina of Monro) the chiasmatic cistern. Gross-total resection (GTR) was achieved in 54 cases (64.28%). Tumor extension above the chiasmatic cistern and calcifications were associated with lower likelihood of GTR. The cumulative rate of postoperative complications was 34.53%, with CSF leak being the most common (14.28%). Endocrine, visual, and hypothalamic functions deteriorated postoperatively in 41/78 patients (52.56%), 5/84 (5.95%), and 14/84 (16.67%), respectively. Twenty-eight patients (33.33%) had recurrence during follow-up (mean 63.51 months), with a mean 5-year progression-free survival (PFS) rate of 58%. PFS was greater in patients who achieved GTR than patients with other extent of resection. CONCLUSIONS This is the largest series in the literature to describe ICs removed with standard EEA, without the need for additional bone and dural opening over the planum sphenoidale. EEA provides a direct route to ICs, the opportunity to manage lesions extending up to the third ventricle without breaching the diaphragma, and high rates of GTR and satisfactory clinical outcomes. Increased surgical complexity and morbidity should be expected in patients with extensive suprasellar extension and involvement of the surrounding vital neurovascular structures.
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Affiliation(s)
- Domenico Solari
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
| | - Elena d'Avella
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
| | - Gianluca Agresta
- 2Division of Neurosurgery, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Domenico Catapano
- 3Division of Neurosurgery, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Aurelio D'Ecclesia
- 4ENT Operative Unit, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Davide Locatelli
- 2Division of Neurosurgery, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Luca Massimi
- 5Section of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Diego Mazzatenta
- 6Department of Biomedical and Neuromotor Sciences, University of Bologna, IRCCS Institute of Neurological Sciences of Bologna, "Bellaria" Hospital, Bologna, Italy
| | - Giannantonio Spena
- 7Division of Neurosurgery, Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Gianpiero Tamburrini
- 5Section of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Cesare Zoia
- 7Division of Neurosurgery, Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Matteo Zoli
- 6Department of Biomedical and Neuromotor Sciences, University of Bologna, IRCCS Institute of Neurological Sciences of Bologna, "Bellaria" Hospital, Bologna, Italy
| | - Giuseppe Cinalli
- 8Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Paolo Cappabianca
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
| | - Luigi Maria Cavallo
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
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Tartara F, Armocida D, Cofano F, Guerrini F, Viganò M, Zoia C, Boeris D, Garbossa D. The Use of Intraventricular Instillation of Vancomycin to Prevent External Ventricular Drainage Related Infection: A Clinical Prospective Study. World Neurosurg 2022; 167:e527-e532. [PMID: 35977680 DOI: 10.1016/j.wneu.2022.08.048] [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: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND External ventricular drainage (EVD)-related infection (ERI) represents an important condition with potential high morbidity with significant impact on patient outcomes. Prophylactic systemic antibiotics are routinely administered to patients with EVD, but they do not significantly lower the incidence of ERIs. Intraventricular treatment with vancomycin appeared to be safe and effective, but most reports are case-reports/-series and retrospective studies. METHODS A prospective non-randomized case-control study was conducted in a consecutive series of 116 patients treated with EVD insertion. The study includes the group of patients treated with intrathecal vancomycin (Group A, 62 patients) compared with the control group treated with daily intravenous cefazolin (Group B, 54 patients). RESULTS No statistically significant differences were found between the 2 groups with regard to the duration of catheterization and occurrence of ERI during hospitalization. EVD was replaced in 16 cases (25.8%) in group A and in 12 cases (22.2%) in the control group B (P 0.67). Three cases (4.8%) of ERI have been found in group A and 5 (9.3%) in the control group (P = 0.34). All reported cases of infection in group A were caused by gram-negative agents; on the opposite, cases of infections in the control group B were caused above all by gram-positive bacteria with a statistical difference (P = 0.03). CONCLUSIONS In this first prospective study on this topic, we found that intrathecal Vancomycin administration in EVDs does not reduce the occurrence of ERI compared with intravenous cefazolin prophylaxis, but induces selection of gram-negative bacteria.
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Affiliation(s)
| | - Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, Rome (RM), Italy.
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin (TO), Italy; Spine Surgery Unit, Humanitas Gradenigo, Turin (TO), Italy
| | | | - Marco Viganò
- Orthopedic Biotechnology Lab, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Cesare Zoia
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Boeris
- ASST Grande Ospedale Metropolitano Niguarda, Milano (MI), Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin (TO), Italy
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Bongetta D, Zoia C. Editorial: Training and education in neurosurgery: Challenges and strategies for the next ten years. Front Surg 2022; 9:984208. [PMID: 36051704 PMCID: PMC9424647 DOI: 10.3389/fsurg.2022.984208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Correspondence: Cesare Zoia
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Zaed I, Bongetta D, Della Pepa GM, Zoia C, Somma T, Zoli M, Raffa G, Menna G. The prevalence of imposter syndrome among young neurosurgeons and residents in neurosurgery: a multicentric study. Neurosurg Focus 2022; 53:E9. [DOI: 10.3171/2022.4.focus2216] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Imposter syndrome (IS) occurs when high-achieving individuals have a pervasive sense of self-doubt combined with fear of being exposed as a fraud, despite objective measures of success. This is one of the main causes of burnout among professionals, threatening their mental health and general well-being. The prevalence and severity of IS among neurosurgery residents and young neurosurgeons has not been yet studied. The primary outcomes of this study were the prevalence and severity of IS.
METHODS
An anonymous cross-sectional survey including both a demographic questionnaire (Clance Imposter Phenomenon Survey) and compensatory mechanisms was distributed to young neurosurgeons and residents in neurosurgery in Italy.
RESULTS
A total of 103 responses were collected. The prevalence rate was 81.6%. Among the respondents with IS, 42.7% showed moderate signs, 27.2% frequent, and only 11.7% had an intense symptomatology. Level of education, female sex, and academic achievements were all identified as predictive factors of IS.
CONCLUSIONS
A total of 81.6% of respondents reported potentially significant levels. The implications of IS on both the outcomes in patients and the well-being of neurosurgeons should be evaluated in future studies.
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Affiliation(s)
- Ismail Zaed
- Division of Neurosurgery, ASST Ovest Milanese, Legnano Hospital, Milan
| | | | - Giuseppe Maria Della Pepa
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna; and
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Italy
| | - Grazia Menna
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome
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20
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Bongetta D, Zoia C, Agosti E, Doglietto F, Fiorindi A, Spena G, Fontanella MM, Giussani CG. Epidemiology-based evaluation of trends in treatment for ruptured intracranial aneurysms in Italy. J Neurosurg Sci 2022:S0390-5616.22.05755-1. [PMID: 35416461 DOI: 10.23736/s0390-5616.22.05755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In recent years there have been significant advances in the diagnosis, management and treatment of intracranial aneurysms (IAs) in Italy. Changes in prevalence of several epigenetic risk factors in the population as well as in environmental factors may have influenced the epidemiological burden of this disease. No long-term, population-based study about the incidence of treated ruptured IAs (rIAs) in Italy has yet been reported in literature. METHODS A long-term (January 2015 - December 2020), nationwide epidemiology study was performed by using discharge data collected by the Italian National Agency for Regional Healthcare Services with a particular focus on the treatment incidence of rIAs. A sub-analysis per macro-areas (north, center, and south and islands) was also performed, including the data about regional healthcare systems organization. The prevalence of common epigenetic and environmental risk factors has been also assessed. RESULTS Over 6 years, the mean incidence of rIAs treatment was 2.7 x 100.000 per year (ds ± 0.1; range: 2.6-2.9). In 2020, there was a significant north-south decreasing gradient in incidence (north vs center vs south and islands: 3.4 vs 2.4 vs 1.8 x 100.000/year; all p<0.001). There were no meaningful differences between macro-areas in terms of access to emergency care and number of neurosurgical wards per population. The rate of unruptured IAs (uIAs) treatment did not show a correlation to that of ruptured ones. Minor regional differences were retrieved for high-risk hypertension as well as for alcohol abuse prevalence. Air pollutants and temperature charts showed a north-south gradient similar to that of the incidence in the treated rIAs. CONCLUSIONS The mean incidence of treated rIAs was stable over the 2015-2020 period in Italy. A north-south decreasing gradient in rIAs treatment incidence was reported. Neither the Regional healthcare organizations nor the rate of uIAs treatment were significant factors explaining the regional differences in the incidence of rIAs treatment. Minor differences in epigenetic and environmental risk factors may be synergistically involved.
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Affiliation(s)
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Neurosurgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Alessandro Fiorindi
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Neurosurgery Unit, Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Marco M Fontanella
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Neurosurgery Unit, Spedali Civili, University of Brescia, Brescia, Italy
| | - Carlo G Giussani
- Neurosurgery Unit, Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan, Italy
- Neurosurgery Unit, Department of Neuroscience, ASST Monza, Ospedale San Gerardo, Monza, Italy
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21
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Uccella S, Mongelli F, Majno-Hurst P, Pavan LJ, Uccella S, Zoia C, Uccella L. Psychological Impact of the Very Early Beginning of the COVID-19 Outbreak in Healthcare Workers: A Bayesian Study on the Italian and Swiss Perspectives. Front Public Health 2022; 10:768036. [PMID: 35400074 PMCID: PMC8987285 DOI: 10.3389/fpubh.2022.768036] [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: 08/31/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background We investigated the COVID19-related psychological impact on healthcare workers in Italy and in Italian-speaking regions of Switzerland, three weeks after its outbreak. All professional groups of public hospitals in Italy and Switzerland were asked to complete a 38 questions online survey investigating demographic, marital and working status, presence of stress symptoms and need for psychological support. Results Within 38 h a total of 3,038 responses were collected. The subgroup analysis identified specific categories at risk according to age, type of work and region of origin. Critical care workers, in particular females, reported an increased number of working hours, decline in confidence in the future, presence of stress symptoms and need for psychological support. Respondents reporting stress symptoms and those with children declared a higher need for psychological support. Conclusions The large number of participants in such a short time indicates for a high interest on topic among health-care workers. The COVID19 outbreak has been experienced as a repeated trauma for many health-care professionals, especially among female nurses' categories. Early evidence of the need of implementating short and long-term measures to mitigate impact of the emotional burden of COVID-19 pandemic are still relevant.
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Affiliation(s)
- Sara Uccella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, Istituto Giannina Gaslini, Genoa, Italy
- Neonatology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesco Mongelli
- Surgery and Emergency Department, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Pietro Majno-Hurst
- Surgery and Emergency Department, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Luca Jacopo Pavan
- Diagnostic and Interventional Radiology Department, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Cesare Zoia
- Neurosurgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Uccella
- Surgery and Emergency Department, Ospedale Regionale di Lugano, Lugano, Switzerland
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22
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Zoia C, Pagella F, Spena G. Commentary: The "Sagittal Crest": Definition, Stepwise Dissection, and Clinical Implication From a Transorbital Perspective. Oper Neurosurg (Hagerstown) 2022; 22:e213-e214. [PMID: 35302964 DOI: 10.1227/ons.0000000000000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/19/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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23
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Lippa L, Spiriev T, Bartek J, Belo D, Drosos E, Aldea CC, Ben-Shalom N, Freyschlag CF, Kaprovoy S, Lepic M, Rabiei K, Raffa G, Schwake M, Stienen MN, Zoia C, Rasulic L, Gandía-González ML. Nexilia - A reflection from the EANS young neurosurgeons’ committee on Global Neurosurgery and education of upcoming generations of neurosurgeons. Brain and Spine 2022; 2:100901. [PMID: 36248152 PMCID: PMC9559961 DOI: 10.1016/j.bas.2022.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022]
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Saraceno G, Servadei F, Terzi DI Bergamo L, Iaccarino C, Rubiano AM, Zoia C, Raffa G, Hawryluk G, Grotenhuis A, Demetriades AK, Sala F, Belotti F, Zanin L, Doglietto F, Panciani PP, Biroli A, Agosti E, Serioli S, Rasulic L, Bruneau M, Germano IM, Bosnjak R, Thomé C, Regli L, Vukic M, Tessitore E, Schaller K, Chaurasia B, El-Ghandour NMF, DI Ieva A, Bongetta D, Borghesi I, Fazio M, Esene IN, Rosseau G, El Abbadi N, Baccanelli M, Vajkoczy P, Fontanella MM. Do neurosurgeons follow the guidelines? A world-based survey on severe traumatic brain injury. J Neurosurg Sci 2021; 65:465-473. [PMID: 34814649 DOI: 10.23736/s0390-5616.21.05475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is going to be the third-leading cause of death worldwide, according to the WHO. Two European surveys suggested that adherence to brain trauma guidelines is poor. No study has compared compliance between low- (LMICs) and high-income (UHICs) countries. Hence, this study aimed to investigate differences in the management of severe TBI patients, comparing low- and high-income, and adherence to the BTF guidelines. METHODS A web-based survey was spread through the Global Neuro Foundation, different neurosurgical societies, and social media. RESULTS A total of 803 neurosurgeons participated: 70.4 from UHICs and 29.6% from LMICs. Hypertonic was administered as an early measure by the 73% and 65% of the responders in LMICs and UHICs, respectively (P=0.016). An invasive intracranial pressure monitoring was recommended by the 66% and 58% of the neurosurgeons in LMICs and UHICs, respectively (P<0.001). Antiseizure drugs (P<0.001) were given most frequently in LMICs as, against recommendations, steroids (87% vs. 61% and 86% vs. 81%, respectively). In the LMICs both the evacuation of the contusion and decompressive craniectomy were performed earlier than in UHICs (30% vs. 17% with P<0.001 and 44% vs. 28% with P=0.006, respectively). In the LMICs, the head CT control was performed mostly between 12 and 24 hours from the first imaging (38% vs. 23%, P<0.001). CONCLUSIONS The current Guidelines on TBI do not always fit to both the resources and circumstances in different countries. Future research and clinical practice guidelines should reflect the greater relevance of TBI in low resource settings.
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Affiliation(s)
- Giorgio Saraceno
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Franco Servadei
- Humanitas Reasearch Hospital-IRCCS and Humanitas University, Rozzano, Milan, Italy
| | | | - Corrado Iaccarino
- Division of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Andrés M Rubiano
- Neuroscience Institute, El Bosque University, Bogotà, Colombia.,Meditech Foundation, Cali, Colombia
| | - Cesare Zoia
- Department of Neurosurgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Raffa
- Department of Neurosurgery, Messina University Hospital, Messina, Italy
| | - Gregory Hawryluk
- Section of Neurosurgery Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - André Grotenhuis
- Department of Neurosurgery, Radboud University, Nijmegen, the Netherlands
| | | | - Francesco Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, Verona University Hospital, Verona, Italy
| | - Francesco Belotti
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy -
| | - Luca Zanin
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Pier Paolo Panciani
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Biroli
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Agosti
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Simona Serioli
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Lukas Rasulic
- Clinic for Neurosurgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michaël Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miroslav Vukic
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Enrico Tessitore
- Unit of Neurosurgery, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Unit of Neurosurgery, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital and Research Center, Saraiyaganj, Muzaffarpur, Birgunj, Nepal
| | | | - Antonio DI Ieva
- Department of Clinical Medicine, Faculty of Medicine, Human and Health Sciences, Macquarie University, Sydney, Australia
| | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Ignazio Borghesi
- Department of Neurosurgery, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Marco Fazio
- Department of Neurosurgery, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Ignatius N Esene
- Division of Neurosurgery, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Najia El Abbadi
- Department of Neurosurgery, International Cheikh Zaid Hospital, Abulcassis University of Health Sciences, Rabat, Morocco
| | - Matteo Baccanelli
- Department of Neurosurgery, Buenos Aires Italian Hospital, Buenos Aires, Argentina
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Medical University, Berlin, Germany
| | - Marco M Fontanella
- Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Zoli M, Della Pepa GM, Carretta A, Bongetta D, Somma T, Zoia C, Raffa G. Adjuvant radiotherapy in grossly total resected grade II atypical meningiomas. A protective effect on recurrence? A systematic review and meta-analysis. J Neurosurg Sci 2021; 66:240-250. [PMID: 34763391 DOI: 10.23736/s0390-5616.21.05522-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Management of grade II Atypical Meningiomas (AM) remains controversial. Conflicting evidences exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival. EVIDENCE ACQUISITION Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery+ART. Only grossly total resected AMs (Simpson grade 1,2,3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery+ART. EVIDENCE SYNTHESIS 11 studies were considered eligible. 8 were included for the outcome "crude recurrence"; 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery+ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery+ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach. CONCLUSIONS Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone.
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Affiliation(s)
- Matteo Zoli
- Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Bio-Medical and Neuro-Motor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giuseppe M Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy -
| | - Alessandro Carretta
- Department of Bio-Medical and Neuro-Motor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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Ridwan S, Ganau M, Zoia C, Broekman M, Grote A, Clusmann H. Unequal Impact of COVID-19 on Private and Academic Neurosurgical Workforce: Results of an International Survey. Front Surg 2021; 8:749399. [PMID: 34660687 PMCID: PMC8517237 DOI: 10.3389/fsurg.2021.749399] [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: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Since the COVID-19 outbreak several manuscripts regarding neurosurgical practice during this pandemic have been published. Qualitative studies on how the pandemic affected neurosurgeons, with additional focus on their practice, are still scarce. This study's objective was to investigate the impact of COVID-19 on various aspects of the professional and private life of a homogeneous group of international neurosurgeons affiliated to the European Association of Neurosurgical Societies (EANS). Methods: Neurosurgeons from Europe and abroad were invited to participate in an online survey endorsed by the Individual Membership Committee of the EANS. The survey captured a subjective snapshot of the impact of the first wave of the COVID-19 pandemic on EANS members and was advertised through its Institutional website. In addition to departmental data, personal feeling of safety, financial security, local precautions, number of surgeries performed, changes in daily routine, and other practice-related information were inquired. Differences among practice types were closely reviewed. Results: The survey was distributed between April and May 2020: 204 neurosurgeons participated. Participants were typically active EANS members (73%), consultants (57.9%), from university hospitals (64.5%). Elective surgical practice was still ongoing only for 15% of responders, whereas 18.7% of them had already transitioned to COVID-19 and emergency medical services. While 65.7% of participants thought their institutions were adequately prepared, lack of testing for SARS-CoV-2, and scarcity of personal protective equipment were still a matter of concern for most of them. Overall surgical activity dropped by 68% (cranial by 54%, spine by 71%), and even emergencies decreased by 35%. COVID-19 prompted changes in communication in 74% of departments, 44% increased telemedicine by >50%. While most neurosurgeons had concerns about personal and families' health, financial outlook appeared to be gloomy only for private practitioners. Conclusion: The lockdown imposed in many countries by the COVID-19 outbreak called for immediate modification of working routine and resulted in a dramatic decrease of elective surgical procedures. Neurosurgeons share common concerns but were not equally exposed to the personal health and financial dangers of the ongoing pandemic.
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Affiliation(s)
- Sami Ridwan
- Department of Neurosurgery, Klinikum Ibbenbueren, Ibbenbueren, Germany
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marike Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Leiden University Medical Center, Leiden, Netherlands.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Alexander Grote
- Department of Neurosurgery, Bethel Clinic, Bielefeld, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Pagella F, Ugolini S, Zoia C, Matti E, Carena P, Lizzio R, Benazzo M. Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature. ACTA ACUST UNITED AC 2021; 41:S42-S50. [PMID: 34060519 PMCID: PMC8172112 DOI: 10.14639/0392-100x-suppl.1-41-2021-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
The Clivus is a bone that lies in a central position of the skull base, and it is a crucial point that splits and connects different anatomical compartments at the same time. There is significant variability of diseases involving the clivus, from neoplasms to non-neoplastic, inflammatory or traumatic lesions. Each of these is rare in frequency, and this heterogeneity contributes to yield the management even more challenging. Clival pathologies can be asymptomatic or have manifestations ranging from aspecific headache to cranial nerves palsies, till life-threatening complications as cerebrospinal fluid rhinorrhoea, meningitis or brain abscess. There isn’t an univocal endorsement among experts with regard to the best approaches to manage the clivus. The paths described are many, the main division is between the transclival and transcranial lateral approaches. We performed a review of the literature, thus highlighting how authors seem to suggest that the surgical approach shouldn’t be chosen aprioristically, but based on a patient centred analysis, considering the combination of multiple surgical corridors. From diagnosis to surgery and medical therapy, clival pathologies require a team of multidisciplinary experts to ensure the best standard of treatment and higher survival rate.
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Affiliation(s)
- Fabio Pagella
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Italy
| | - Sara Ugolini
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Italy
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Paolo Carena
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Italy
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28
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Balak N, Inan D, Ganau M, Zoia C, Sönmez S, Kurt B, Akgül A, Tez M. A simple mathematical tool to forecast COVID-19 cumulative case numbers. Clin Epidemiol Glob Health 2021; 12:100853. [PMID: 34395949 PMCID: PMC8352661 DOI: 10.1016/j.cegh.2021.100853] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023] Open
Abstract
Objective Mathematical models are known to help determine potential intervention strategies by providing an approximate idea of the transmission dynamics of infectious diseases. To develop proper responses, not only are more accurate disease spread models needed, but also those that are easy to use. Materials and methods As of July 1, 2020, we selected the 20 countries with the highest numbers of COVID-19 cases in the world. Using the Verhulst–Pearl logistic function formula, we calculated estimates for the total number of cases for each country. We compared these estimates to the actual figures given by the WHO on the same dates. Finally, the formula was tested for longer-term reliability at t = 18 and t = 40 weeks. Results The Verhulst–Pearl logistic function formula estimated the actual numbers precisely, with only a 0.5% discrepancy on average for the first month. For all countries in the study and the world at large, the estimates for the 40th week were usually overestimated, although the estimates for some countries were still relatively close to the actual numbers in the forecasting long term. The estimated number for the world in general was about 8 times that actually observed for the long term. Conclusions The Verhulst–Pearl equation has the advantage of being very straightforward and applicable in clinical use for predicting the demand on hospitals in the short term of 4–6 weeks, which is usually enough time to reschedule elective procedures and free beds for new waves of the pandemic patients.
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Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Deniz Inan
- Department of Statistics, Faculty of Arts and Sciences, Marmara University, Istanbul, Turkey
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sinan Sönmez
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Batuhan Kurt
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Ahmet Akgül
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Müjgan Tez
- Department of Statistics, Faculty of Arts and Sciences, Marmara University, Istanbul, Turkey
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Bonomo G, Caldiroli D, Bonomo R, Pugliese R, DiMeco F, Zoia C. Reactivation of COVID-19 in a neurosurgical patient with early neuropsychiatric presentation. Does seroconversion mean immunity? Surg Neurol Int 2021; 12:166. [PMID: 34084594 PMCID: PMC8168796 DOI: 10.25259/sni_831_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background: In the aftermath of COVID-19 outbreak, there is a strong need to find strategies to monitor SARSCoV-2 transmission. While the application of screening techniques plays a major role to this end, there is evidence challenging the real significance of seroconversion. We reported a case of COVID-19 reactivation associated with a neurosurgical operation with early neuropsychiatric involvement presumably promoted by olfactory and gustatory impairment in the first infection. Case Descriptio: A 57-year-old man was referred for a 2-month history of progressive development of imbalance, dizziness, and vomiting. Magnetic resonance imaging showed two bilateral hemispheric cerebellar lesions. In line with our triage protocol, the patient underwent a nasopharyngeal swab for RNA of SARS-CoV-2 detection, which resulted positive. Of note, the patient had reported in the previous month hyposmia and hypogeusia. After a period of 14 days, three new swabs were performed with negative results, leading the way to surgery. In the early post-operative period, the patient manifested acute onset of psychotic symptoms with hyperactive delirium, followed by fever and acute respiratory failure. A chest computed tomography revealed a specific pattern of ground-glass opacities in the lower lobes bilaterally, suggesting a viral pneumonia. Serological tests demonstrated the seroconversion and a new nasopharyngeal swab confirmed SARS-CoV-2 infection. Conclusion: Our report highlights the importance of comprehensive screening assessments in sensitive cases highly susceptible to COVID-19 recurrence.
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Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Italy
| | - Dario Caldiroli
- Neuroanaesthesia and Intensive Care, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Roberta Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaelino Pugliese
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Italy
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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30
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Zoli M, Guaraldi F, Zoia C, La Corte E, Asioli S, Bongetta D, Rustici A, Mazzatenta D. Management of sellar and parasellar tumors becoming symptomatic during pregnancy: a practical algorithm based on multi-center experience and systematic literature review. Pituitary 2021; 24:269-283. [PMID: 33200305 PMCID: PMC7966198 DOI: 10.1007/s11102-020-01107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Sellar/parasellar tumors (SPTs) very rarely become symptomatic during pregnancy. No specific guidelines exist for their management, that is extremely challenging as mother and fetus health can be jeopardized. MATERIALS AND METHODS Data of patients with SPTs becoming symptomatic during pregnancy treated at two Italian referral Centers were retrospectively collected. Systematic literature review was also performed. RESULTS Our series consisted of 6 cases, 3 meningiomas, 1 ACTH-secreting adenoma, 1 pituicytoma and 1 craniopharyngioma. Mean age at presentation was 33.6 ± 6.0 years. Five patients complained of visual disturbances, associated with headache in one case, that occurred between gestation week (GW) 22 and 34. In 5 cases, pregnancy was uneventful with the delivery of a healthy baby between GW 33 and 35, followed by endoscopic surgical tumor exeresis (n = 4) or proton bean therapy (n = 1). Another patient presented with stigmata typical of Cushing's syndrome and rapidly worsening pre-eclampsia, that required pregnancy interruption and adenomectomy. Based on personal and literature cases, a practical algorithm was proposed to help clinicians dealing with these patients. CONCLUSIONS SPTs becoming symptomatic in pregnancy deserve careful monitoring and multidisciplinary management. Overall, wait-and-see approach is suggested, reserving surgery to patients with rapidly progressive/life-threatening situations, significant risk of permanent neurological impairment or malignant lesions.
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Affiliation(s)
- Matteo Zoli
- Pituitary Unit, 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.
| | - Federica Guaraldi
- Pituitary Unit, 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
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele La Corte
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Unit of Anatomic Pathology 'M. Malpighi', Bellaria Hospital, Azienda USL Bologna, Bologna, Italy
| | | | - Arianna Rustici
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Pituitary Unit, 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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31
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Doglietto F, Vezzoli M, Biroli A, Saraceno G, Zanin L, Pertichetti M, Calza S, Agosti E, Aliaga Arias JM, Assietti R, Bellocchi S, Bernucci C, Bistazzoni S, Bongetta D, Fanti A, Fioravanti A, Fiorindi A, Franzin A, Locatelli D, Pugliese R, Roca E, Sicuri GM, Stefini R, Venturini M, Vivaldi O, Zattra C, Zoia C, Fontanella MM. Anxiety in neurosurgical patients undergoing nonurgent surgery during the COVID-19 pandemic. Neurosurg Focus 2020; 49:E19. [PMID: 33260119 DOI: 10.3171/2020.9.focus20681] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has forced many countries into lockdown and has led to the postponement of nonurgent neurosurgical procedures. Although stress has been investigated during this pandemic, there are no reports on anxiety in neurosurgical patients undergoing nonurgent surgical procedures. METHODS Neurosurgical patients admitted to hospitals in eastern Lombardy for nonurgent surgery after the lockdown prospectively completed a pre- and postoperative structured questionnaire. Recorded data included demographics, pathology, time on surgical waiting list, anxiety related to COVID-19, primary pathology and surgery, safety perception during hospital admission before and after surgery, and surgical outcomes. Anxiety was measured with the State-Trait Anxiety Inventory. Descriptive statistics were computed on the different variables and data were stratified according to pathology (oncological vs nononcological). Three different models were used to investigate which variables had the greatest impact on anxiety, oncological patients, and safety perception, respectively. Because the variables (Xs) were of a different nature (qualitative and quantitative), mostly asymmetrical, and related to outcome (Y) by nonlinear relationships, a machine learning approach composed of three steps (1, random forest growing; 2, relative variable importance measure; and 3, partial dependence plots) was chosen. RESULTS One hundred twenty-three patients from 10 different hospitals were included in the study. None of the patients developed COVID-19 after surgery. State and trait anxiety were reported by 30.3% and 18.9% of patients, respectively. Higher values of state anxiety were documented in oncological compared to nononcological patients (46.7% vs 25%; p = 0.055). Anxiety was strongly associated with worry about primary pathology, surgery, disease worsening, and with stress during waiting time, as expected. Worry about positivity to SARS-CoV-2, however, was the strongest factor associated with anxiety, even though none of the patients were infected. Neuro-oncological disease was associated with state anxiety and with worry about surgery and COVID-19. Increased bed distance and availability of hand sanitizer were associated with a feeling of safety. CONCLUSIONS These data underline the importance of psychological support, especially for neuro-oncological patients, during a pandemic.
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Affiliation(s)
- Francesco Doglietto
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Marika Vezzoli
- 2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia
| | - Antonio Biroli
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Giorgio Saraceno
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Luca Zanin
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | - Stefano Calza
- 2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia
| | - Edoardo Agosti
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,4Neurosurgery, University of Insubria, Varese
| | - Jahard Mijail Aliaga Arias
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,5Neurosurgery, Cremona Hospital, Cremona
| | | | | | | | | | | | - Andrea Fanti
- 8Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo
| | | | - Alessandro Fiorindi
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | | | | | - Elena Roca
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | | | | | | | - Oscar Vivaldi
- 9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | - Costanza Zattra
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | - Cesare Zoia
- 10Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia; and
| | - Marco Maria Fontanella
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
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32
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Zoia C, Bongetta D, Luzzi S. Endoscopic Transnasal Odontoidectomy. J Neurol Surg B Skull Base 2020; 82:S10-S11. [PMID: 33717802 PMCID: PMC7935719 DOI: 10.1055/s-0040-1714409] [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: 01/10/2019] [Accepted: 03/08/2020] [Indexed: 10/27/2022] Open
Abstract
Background Odontoidectomy may represent the treatment of choice for symptomatic ventral craniovertebral junction stenosis in selected cases. An endoscopic transnasal approach has been proposed as an alternative to a classic transoral approach. Method We report a case of a patient with a craniovertebral junction stenosis due to the ossification of the posterior ligament. The clinical and radiological records of the patient and a step-by-step description of the surgical technique are presented ( Fig. 1 ). Conclusion Endoscopic transnasal odontoidectomy provides a direct access to the dens and adjacent structures of the anterior upper cervical spine with a less invasive burden on the oropharingeal structures. The link to the video can be found at: https://youtu.be/Ofrk1sFTV9I .
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy.,Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Piazzale Principessa, Milano, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
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33
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Giussani C, Sganzerla E, Spena G, Spagnoli D, Assietti R, Bellocchi S, Vivaldi O, Bernucci C, Magrassi L, Zoia C, Egidi M, DE Gonda F, Locatelli M, Bello L, Incerti M, Servello D, Vitale M, Nicolosi F, Fioravanti A, Fontanella M, Stefini R. Converted neurosurgeons in a converted coronavirus hospital: sharing the experience of a metamorphosis. J Neurosurg Sci 2020; 65:84-85. [PMID: 32972112 DOI: 10.23736/s0390-5616.20.05012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carlo Giussani
- Unit of Neurosurgery, School of Medicine and Surgery, Neuroscience Center, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy - .,Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Monza, San Gerardo Hospital, Monza, Monza-Brianza, Italy -
| | - Erik Sganzerla
- Unit of Neurosurgery, School of Medicine and Surgery, Neuroscience Center, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.,Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Monza, San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Giannantonio Spena
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Diego Spagnoli
- Unit of Neurosurgery, Moriggia Pelascini Hospital, Gravedona, Como, Italy
| | - Roberto Assietti
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Silvio Bellocchi
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Lariana, Sant'Anna Hospital, Como, Italy
| | - Oscar Vivaldi
- Unit of Neurosurgery, Poliambulanza Foundation, Brescia, Italy
| | - Claudio Bernucci
- Unit of Neurosurgery, Azienda Socio Sanitaria Papa Giovanni XXIII, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Magrassi
- Unit of Neurosurgery, IRCCS S. Matteo Polyclinic Foundation, Pavia, Italy.,Unit of Neurosurgery, Department of Clinical-Surgical Diagnostic and Pediatric Sciences, IRCCS S. Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Cesare Zoia
- Unit of Neurosurgery, IRCCS S. Matteo Polyclinic Foundation, Pavia, Italy
| | - Marcello Egidi
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Santi Carlo e Paolo, San Carlo Hospital, Milan, Italy
| | - Federico DE Gonda
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Valtellina e Alto Lario, Hospital of Sondalo, Sondalo, Sondrio, Italy
| | - Marco Locatelli
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Lorenzo Bello
- Unit of Neurosurgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Michele Incerti
- Unit of Neurosurgery, Polyclinic of Monza, Monza, Monza-Brianza, Italy
| | - Domenico Servello
- Unit of Neurosurgery, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Mario Vitale
- Unit of Neurosurgery, Istituto Clinico Città Studi, Milan, Italy
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Antonio Fioravanti
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Cremona, Hospital of Cremona, Cremona, Italy
| | - Marco Fontanella
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Hospital of Brescia, Brescia, Italy.,Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Stefini
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Ovest Milanese, Ospedale Nuovo di Legnano, Legnano, Milan, Italy
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Ganau M, Netuka D, Broekman M, Zoia C, Tsianaka E, Schwake M, Balak N, Sekhar A, Ridwan S, Clusmann H. Neurosurgeons and the fight with COVID-19: a position statement from the EANS Individual Membership Committee. Acta Neurochir (Wien) 2020; 162:1777-1782. [PMID: 32472377 PMCID: PMC7258601 DOI: 10.1007/s00701-020-04360-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Netuka
- Department of Neurosurgery and Neuro-oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Marike Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, & Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eleni Tsianaka
- Department of Neurosurgery, Dar Al Shifa Hospital, Kuwait City, Kuwait
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University Göztepe Education and Research Hospital, Istanbul, Turkey
| | - Amitendu Sekhar
- Department of Neurosurgery, Paras Hospital, Udaipur, Rajasthan India
| | - Sami Ridwan
- Department of Neurosurgery, Paracelsus-Klinik, Osnabrück, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - EANS IM Committee
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Neurosurgery and Neuro-oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, & Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Neurosurgery, Dar Al Shifa Hospital, Kuwait City, Kuwait
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
- Department of Neurosurgery, Istanbul Medeniyet University Göztepe Education and Research Hospital, Istanbul, Turkey
- Department of Neurosurgery, Paras Hospital, Udaipur, Rajasthan India
- Department of Neurosurgery, Paracelsus-Klinik, Osnabrück, Germany
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Pisano P, Lombardi F, Bongetta D, La Rocca G, Della Pepa GM, Zoia C. Primary Intracranial Squamous Cell Carcinoma with a Fatal Course. Asian J Neurosurg 2020; 15:722-725. [PMID: 33145239 PMCID: PMC7591225 DOI: 10.4103/ajns.ajns_148_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/16/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Intracranial squamous cell carcinomas (SCCs) are extremely rare. They can be primary or represent a degeneration of an epidermoid cyst (EC). We report the case of a patient operated, with an endoscopic transnasal approach, for a primary intracranial SCC. The optimal management for patients with primary intracranial SCC or ECs which have undergone malignant degeneration has yet to be identified.
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Affiliation(s)
- Patrizia Pisano
- Department of Surgical Sciences, Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Lombardi
- Department of Surgical Sciences, Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Giuseppe Maria Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Cesare Zoia
- Department of Surgical Sciences, Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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36
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La Rocca G, Della Pepa GM, Gaudino S, Sabatino G, Zoia C, Raffa G, Altieri R, Mazzucchi E. Cortical Laminar Necrosis as a Result of Status Epilepticus After Resection of Parafalcal Meningioma. Surg Technol Int 2020; 36:159-177. [PMID: 32243562] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Status epilepticus during the post-operative period is a rare complication for neurosurgery patients. Acute encephalopathic syndromes can present a diagnostic challenge due to the wide range of possible etiologies, and can also have vastly different outcomes. Posterior reversible encephalopathy syndrome is a rare neurological disorder, usually associated with specific medical conditions, that causes a disturbance of CNS homeostasis, while cortical laminar necrosis (CLN) is an unusual type of infarction characterized by selective necrosis of the cerebral cortex with sparing of the white matter. We present a 45-year-old woman who was operated on for left frontal lesion with radiological features compatible with anterior falx meningioma. Postoperative clinical and electroencephalographic data were compatible with non-convulsive status epilepticus originating from the occipito-mesial area. MRI showed bilateral diffuse temporo-occipital abnormally bright cortex as a consequence of neuronal apoptosis compatible with laminar cortical necrosis, and clinical examination revealed persistent cortical blindness. The pathogenesis of encephalopathic syndromes is still unclear. Non-convulsive status epilepticus should be considered as a possible cause of late recovery of consciousness in neurosurgery patients. Delayed treatment may cause irreversible lesions, including in brain areas far from the surgical field.
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Affiliation(s)
- Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy, Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Giuseppe Maria Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Simona Gaudino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy, Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Cesare Zoia
- Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department. University of Messina, Messina, Italy
| | - Roberto Altieri
- Department of Neurological Surgery, Policlinico "Gaspare Rodolico" University Hospital, Catania, Italy, Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Edoardo Mazzucchi
- Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fontanella MM. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir (Wien) 2020; 162:1221-1222. [PMID: 32222820 PMCID: PMC7103098 DOI: 10.1007/s00701-020-04305-w] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Pierlorenzo Veiceschi
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127, Bergamo, Italy.
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Carlo Besta Institute of Neurology, IRCCS and Foundation, Milan, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Ospedale di Circolo ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Davide Boeris
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco M Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Uccella L, Bongetta D, Fumagalli L, Raffa G, Zoia C. Acute alcohol intoxication as a confounding factor for mild traumatic brain injury. Neurol Sci 2020; 41:2127-2134. [PMID: 32125539 DOI: 10.1007/s10072-020-04313-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute alcohol intoxication is universally considered a risk factor for traumatic brain injury (TBI), therefore an indication for head CT scan. There is no evidence in the literature for this attitude. Aim of this study is to assess the need for head CT scan in acutely alcohol-intoxicated subjects with mTBI and the role of Glasgow coma scale (GCS) score in this kind of patients. METHODS We retrospectively analyzed all 3358 consecutive patients presenting to our department in Switzerland, with TBI as chief complaint between January 2014 and January 2018. RESULTS Alcohol was a statistically significant factor for presentation with a GCS score lower than 15. As for bleedings in mild TBI patients, the results were somewhat contradictory with GCS 15 patients showing a higher percentage of hemorrhages than GCS 14 patients. By dividing alcohol-intoxicated subjects into groups per blood alcohol concentration, the higher was the alcohol level, the lower the GCS score. CONCLUSIONS We can affirm that GCS score is underestimated in acutely intoxicated head trauma patients. In this kind of patient, alcohol is a confounding factor and mild TBI could be safely managed by watchful waiting.
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Affiliation(s)
- Laura Uccella
- Surgery and Emergency Department, Ospedale Civico, Lugano, Switzerland
| | - Daniele Bongetta
- Department of Neurosurgery, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Fumagalli
- Surgery and Emergency Department, Ospedale Civico, Lugano, Switzerland
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Cesare Zoia
- Neurosurgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Zoia C, Lombardi F, Fiore MR, Montalbetti A, Iannalfi A, Sansone M, Bongetta D, Valvo F, Del Maestro M, Luzzi S, Galzio RJ. Sacral solitary fibrous tumour: surgery and hadrontherapy, a combined treatment strategy. Rep Pract Oncol Radiother 2020; 25:241-244. [PMID: 32025222 DOI: 10.1016/j.rpor.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/24/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cesare Zoia
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Lombardi
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Maria Rosaria Fiore
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Andrea Montalbetti
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Sansone
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesca Valvo
- National Center of Oncological Hadrontherapy (CNAO) Clinical Radiotherapy Unit, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Renato Juan Galzio
- Neurosurgery Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
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40
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Zoia C, Lombardi F, Custodi VM, Lovati E, Lucotti P, Iannalfi A, D'ippolito E, Valvo F, Bongetta D. Evaluation of the early endocrinological sequelae after hadron therapy on anterior skull base lesions in the adult population. MINERVA ENDOCRINOL 2019; 45:162-164. [PMID: 31738035 DOI: 10.23736/s0391-1977.19.03071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy -
| | - Francesco Lombardi
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Viola M Custodi
- Neurosurgery Unit, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Elisabetta Lovati
- Endocrinology Unit, Internal Medicine I, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Pietro Lucotti
- Endocrinology Unit, Internal Medicine I, IRCCS San Matteo Polyclinic Hospital and Foundation, Pavia, Italy
| | - Alberto Iannalfi
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Emma D'ippolito
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Clinical Radiotherapy Unit, National Center of Oncological Hadron Therapy (CNAO), Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy
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41
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Luzzi S, Zoia C, Rampini AD, Elia A, Del Maestro M, Carnevale S, Morbini P, Galzio R. Lateral Transorbital Neuroendoscopic Approach for Intraconal Meningioma of the Orbital Apex: Technical Nuances and Literature Review. World Neurosurg 2019; 131:10-17. [DOI: 10.1016/j.wneu.2019.07.152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 12/01/2022]
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Zoia C, Bongetta D, Dorelli G, Luzzi S, Maestro MD, Galzio RJ. Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature. Surg Neurol Int 2019; 10:76. [PMID: 31528414 PMCID: PMC6744740 DOI: 10.25259/sni-132-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Cavernomas arising in the region of the optic apparatus are extremely rare, accounting for <1% of all the central nervous system cavernomas. Most patients are affected by acute visual disturbances related to hemorrhagic events. A prompt resection of the lesion together with a decompression of the optic apparatus may lead to a functional improvement. Almost all patients reported in literature were treated by means of a craniotomy, whereas only few papers described the use of a transnasal approach. Case Description: We report the case of a 53-year-old woman with a hemorrhagic, cavernous malformation of the optic chiasm region and we discuss the technical nuances of the endoscopic transnasal approach we employed. We also review literature for patients with cavernomas treated with a transsphenoidal approach. In our case, the patient underwent the gross-total resection of the lesion through a fully endoscopic transnasal route and the visual disturbances improved immediately after the operation. The ventral access allowed an adequate exposure of the chiasm/anterior circulation complex, thus avoiding an excessive dissection and retraction of neurovascular structures. Moreover, with the aid of angled scopes, we were able to identify the frail vascular supply of the chiasm by employing the suprachiasmatic corridor as well as the infrachiasmatic one. We stress the need for a careful reconstruction of the skull base to avoid a postoperative cerebrospinal fluid leak. Conclusions: With the evolution and spreading of the neuroendoscopic techniques, in selected cases, we advocate the use of the transnasal route for the removal of cavernomas arising in the region of the anterior optic pathways.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Gianluigi Dorelli
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, viale Golgi 19, Pavia, Italy
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Solari D, Zenga F, Angileri FF, Barbanera A, Berlucchi S, Bernucci C, Carapella C, Catapano D, Catapano G, Cavallo LM, D'Arrigo C, de Angelis M, Denaro L, Desogus N, Ferroli P, Fontanella MM, Galzio RJ, Gianfreda CD, Iacoangeli M, Lauretti L, Locatelli D, Locatelli M, Luglietto D, Mazzatenta D, Menniti A, Milani D, Nasi MT, Romano A, Ruggeri AG, Saladino A, Santonocito O, Schwarz A, Skrap M, Stefini R, Volpin L, Wembagher GC, Zoia C, Zona G, Cappabianca P. A Survey on Pituitary Surgery in Italy. World Neurosurg 2019; 123:e440-e449. [DOI: 10.1016/j.wneu.2018.11.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
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Bongetta D, Zoia C, Luzzi S, Maestro MD, Peri A, Bichisao G, Sportiello D, Canavero I, Pietrabissa A, Galzio RJ. Neurosurgical issues of bariatric surgery: A systematic review of the literature and principles of diagnosis and treatment. Clin Neurol Neurosurg 2018; 176:34-40. [PMID: 30500756 DOI: 10.1016/j.clineuro.2018.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is gaining popularity as the treatment of choice of morbid obesity since this condition is constantly increasing over the last decades. Several complications have emerged as the number of surgeries and follow-up data increase. No systematic review of the neurosurgery-related potential complications has been performed to date. Objective of this work is to fill this gap. We reviewed the literature for bariatric surgery-related complications involving the neurosurgical practice. Moreover, we present explicative cases dealing with peri- and post-operative therapeutic precautions. Three pathological mechanisms emerged. The first is related to intracranial pressure alterations and may imply either intracranial hypertension or hypotension syndromes in the operative or post-operative periods. The second is the deficiency of macro- and micro-nutrients which are potential risk factors for neuro- or myelo-encephalopathies, fetal malformations and spine disorders. The third is a dysregulation of both autonomic and endocrine / pituitary control. Neurosurgeons must be aware of the several, multifactorial neurosurgery-related complications of bariatric surgery as their prevalence is likely to be higher in the next few years.
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Affiliation(s)
- Daniele Bongetta
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Italy
| | - Mattia Del Maestro
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, Italy
| | - Andrea Peri
- General Surgery Unit II, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Germana Bichisao
- Anesthesia and Intensive Care Unit I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Debora Sportiello
- Anesthesia and Intensive Care Unit I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Andrea Pietrabissa
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; General Surgery Unit II, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
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45
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Zoia C, Bongetta D, Guerrini F, Alicino C, Cattalani A, Bianchini S, Galzio RJ, Luzzi S. Outcome of elderly patients undergoing intracranial meningioma resection: a single center experience. J Neurosurg Sci 2018; 65:513-517. [PMID: 29808631 DOI: 10.23736/s0390-5616.18.04333-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Higher life expectancy and higher mean age in general population created growing interest in medical and surgical management of meningiomas in elderly. It is well known that, due to possible complications, pre-operative status and comorbidities, expecially in aged people, should be carefully considerated in the decision-making process. We described our experience with this kind of patients and analized the influence of complications on the outcome. METHODS We conducted a monocentric retrospective study to evaluate outcome and complications in elderly patients that underwent intracranial meningioma surgery in our center in a ten year period. Between January 2005 and December 2014, 107 patients - older than 70 years old - were operated for an intracranial meningioma. We excluded patients operated for a recurrent meningioma. We use the Dindo classification modified by Poon to describe complications and the Karnofsky Performance Status Scale and Glasgow Outcome Scale to evaluate the outcome at discharge and after a 6 months period. RESULTS 84 patients did not have postoperative complications, 10 patients had mild postoperative complications, while 13 patients suffered severe postoperative complications. As a group, patients with mild complications presented, six months after surgery, an average Karnofsky Performance Status better than preoperative one. CONCLUSIONS Even though the fragility is considered an important risk factor, surgery for symptomatic intracranial meningiomas should be considered also in elderly patients. The presence of early postoperative mild complications do not seem to worsen the average 6 months- KSP score.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Guerrini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy -
| | - Cristiano Alicino
- Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy
| | - Andrea Cattalani
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simonetta Bianchini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy
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Bongetta D, Zoia C, Pagella F, Gaetani P. Letter to the Editor. Fluorescence-aided evaluation of nasoseptal flap perfusion. J Neurosurg 2018. [PMID: 29521588 DOI: 10.3171/2017.8.jns171818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniele Bongetta
- 1Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and.,2Università degli Studi di Pavia, Italy
| | - Cesare Zoia
- 1Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Fabio Pagella
- 1Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Paolo Gaetani
- 1Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
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Zoia C, Bongetta D, Alicino C, Chimenti M, Pugliese R, Gaetani P. Usefulness of corset adoption after single-level lumbar discectomy: a randomized controlled trial. J Neurosurg Spine 2018; 28:481-485. [PMID: 29424674 DOI: 10.3171/2017.8.spine17370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this paper, the authors sought to verify whether corset adoption could improve the short-term and midterm outcome scores of patients after single-level lumbar discectomy. METHODS A monocentric, randomized controlled trial of 54 consecutive patients who underwent single-level lumbar discectomy at the authors' institution was performed from September 2014 to August 2015. Patients were randomly assigned to use or not use a lumbar corset in the upright position. Patients with previous interventions for disc herniation or with concomitant canal or foraminal stenosis were excluded. The visual analog scale, Oswestry Disability Index, and Roland Morris Disability Questionnaire were used to compare groups at the 1- and 6-month follow-up time points. RESULTS No significant differences between the 2 groups were reported at either time point for any given outcome irrespective of the scale used. CONCLUSIONS Corset adoption does not improve the short-term and midterm outcomes of patients after single-level lumbar discectomy.
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Affiliation(s)
- Cesare Zoia
- 1Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Daniele Bongetta
- 1Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia.,2Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia; and
| | | | - Marcella Chimenti
- 2Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia; and
| | | | - Paolo Gaetani
- 1Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia
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Zoia C, Bongetta D, Pagella F, Antoniazzi ER, Gaetani P. New surgical option for optic nerve sheath meningiomas: fully endoscopic transnasal approach. Can J Ophthalmol 2017; 53:e142-e144. [PMID: 30119808 DOI: 10.1016/j.jcjo.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Cesare Zoia
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
| | - Daniele Bongetta
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Università degli Studi di Pavia, Pavia, Italy
| | - Fabio Pagella
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Paolo Gaetani
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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Bongetta D, Zoia C, Lafe E, Gaetani P. Could Thalidomide Be a Treatment Option for Arteriovenous Malformations? World Neurosurg 2017; 99:802. [DOI: 10.1016/j.wneu.2016.10.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 10/19/2022]
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50
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Zoia C, Bongetta D, Poli JC, Verlotta M, Pugliese R, Gaetani P. Intraregional differences of perioperative management strategy for lumbar disc herniation: is the Devil really in the details? Int J Spine Surg 2017; 11:1. [PMID: 28377859 PMCID: PMC5375018 DOI: 10.14444/4001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study intends to evaluate whether regional common habits or differences in case-volume between surgeons are significative variables in the perioperative management of patients undergoing surgery for lumbar disc herniation. METHODS An e-mail survey was sent to all neurosurgeons working in Lombardy, Italy's most populated region. The survey consisted of 17 questions about the perioperative management of lumbar disc herniation. RESULTS Forty-seven percent (47%) out of 206 Lombard neurosurgeons answered the survey. Although in some respects there is clear evidence in current literature on which is the best practice to adopt for an optimal management strategy, we noticed substantial differences between respondents, not only between hospitals but also between surgeons from the same hospital. Still, no differences were evident in a high vs low case-volume comparison. CONCLUSION We identified no regional clusterization as for practical principles in the perioperative management of lumbar disc herniation and neither was case-volume a significative variable. Other causes may be relevant in the variability between the perioperative management and the outcomes achieved by different specialists.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
- Neurosurgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Jacopo C. Poli
- Neurosurgery Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Mariarosaria Verlotta
- Neurosurgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | | | - Paolo Gaetani
- Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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