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Maiuri F, Corvino S, Corazzelli G, Del Basso De Caro M. Single versus multiple reoperations for recurrent intracranial meningiomas. J Neurooncol 2024:10.1007/s11060-024-04673-8. [PMID: 38656725 DOI: 10.1007/s11060-024-04673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To identify the risk factors and management of the multiple recurrences and reoperations for intracranial meningiomas. METHODS Data of a neurosurgical series of 35 patients reoperated on for recurrent intracranial meningiomas were reviewed. Analyzed factors include patient age and sex, tumor location, extent of resection, WHO grade, Ki67-MIB1 and PR expression at initial diagnosis, time to recurrence; pattern of regrowth, extent of resection, WHO grade and Ki67-MIB1 at first recurrence were also analyzed. All these factors were stratified into two groups based on single (Group A) and multiple reoperations (Group B). RESULTS Twenty-four patients (69%) belonged to group A and 11 (31%) to group B. The age < 65 years, male sex, incomplete resection at both initial surgery and first reoperation, and multicentric-diffuse pattern of regrowth at first recurrence are risk factors for multiple recurrences and reoperations. In group B, the WHO grade and Ki67-MIB1 increased in further recurrences in 54% and 64%, respectively. The time to recurrence was short in 7 cases (64%), whereas 4 patients (36%) further recurred after many years. Eight patients (73%) are still alive after 7 to 22 years and 2 to 4 reoperations. CONCLUSION The extent of resection and the multicentric-diffuse pattern of regrowth at first recurrence are the main risk factors for multiple recurrences and reoperations. Repeated reoperations might be considered even in patients with extensive recurrent tumors before the anaplastic transformation occurs. In such cases, even partial tumor resections followed by radiation therapy may allow long survival in good clinical conditions.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, 80131, Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, 80131, Naples, Italy.
| | - Giuseppe Corazzelli
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, 80131, Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University "Federico II" of Naples, 80131, Naples, Italy
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Corvino S, Maiuri F. Letter to the Editor Regarding "Beyond the Surgical Margin: Patterns of Recurrence in World Health Organization Grade 2 Intracranial Meningiomas". World Neurosurg 2024; 184:356. [PMID: 38590066 DOI: 10.1016/j.wneu.2023.12.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy.
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy
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Maiuri F, Corvino S, Corazzelli G, Berardinelli J, Di Crescenzo RM, Del Basso De Caro M. Time to Recurrence of Intracranial Meningiomas from a Monoinstitutional Surgical Series. World Neurosurg 2024:S1878-8750(24)00300-0. [PMID: 38417623 DOI: 10.1016/j.wneu.2024.02.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Meningiomas show variable tendency to recur. While risk factors of recurrence have been largely investigated in literature, a paucity of data is available on the time to recurrence. Our purpose was to identify main factors affecting the time to recurrence to assist preoperative treatment decision-making strategy and to define a tailored clinical and neuroradiological follow-up. METHODS Data of 35 patients with intracranial meningioma recurrences have been retrospectively reviewed. Demographic (patient age at initial diagnosis and sex), radiologic (meningioma location, pattern of regrowth and topography of recurrences at first reoperation), pathologic (WHO grade and Ki67-MIB1 at initial surgery and at first reoperation, progesterone receptor [PR] expression), and surgical (extent of resection at initial surgery according to Simpsons grading system, number of reoperations) factors were analyzed. RESULTS Time to recurrence ranged from 20 to 120 months. Extent of resection at initial surgery was Simpson grade I in 7 patients (20%), grade II in 10 (28.5%), grade III in 14 (40%), and grade IV in 4 (11.5%). Longer median time to recurrence was observed for skull base localization (P < 0.01), Simpson grades I and II versus grades III (P = 0.01) and IV (P = 0.02), values of Ki67-MIB1 ≤ 4% (P = 0.001), and PR > 60% (P = 0.03); conversely, sex, age, number of reoperations, unchanged/progression of Ki67, and/or World Health Organization grade between first surgery and reoperation did not correlate in statistically significant way with time to recurrence. CONCLUSIONS The extent of resection and the Ki67-MIB1 represent the most important factors predicting shorter recurrence time of intracranial meningiomas. Patients with incomplete (Simpson grades III and IV) resection and high Ki67-MIB1 values, especially at non-skull base localization and with low PR values, require a closer short-term clinical and radiologic follow-up in the first years after surgery.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy.
| | - Giuseppe Corazzelli
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy
| | - Jacopo Berardinelli
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy
| | - Rosa Maria Di Crescenzo
- Department of Advanced Biomedical Sciences, Section of Pathology, University "Federico II" of Naples, Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University "Federico II" of Naples, Naples, Italy
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Mirian C, Jensen LR, Juratli TA, Maier AD, Torp SH, Shih HA, Morshed RA, Young JS, Magill ST, Bertero L, Stummer W, Spille DC, Brokinkel B, Oya S, Miyawaki S, Saito N, Proescholdt M, Kuroi Y, Gousias K, Simon M, Moliterno J, Prat-Acin R, Goutagny S, Prabhu VC, Tsiang JT, Wach J, Güresir E, Yamamoto J, Kim YZ, Lee JH, Koshy M, Perumal K, Baskaya MK, Cannon DM, Shrieve DC, Suh CO, Chang JH, Kamenova M, Straumann S, Soleman J, Eyüpoglu IY, Catalan T, Lui A, Theodosopoulos PV, McDermott MW, Wang F, Guo F, Góes P, de Paiva Neto MA, Jamshidi A, Komotar R, Ivan M, Luther E, Souhami L, Guiot MC, Csonka T, Endo T, Barrett OC, Jensen R, Gupta T, Patel AJ, Klisch TJ, Kim JW, Maiuri F, Barresi V, Tabernero MD, Skyrman S, Broechner A, Bach MJ, Law I, Scheie D, Kristensen BW, Munch TN, Meling T, Fugleholm K, Blanche P, Mathiesen T. The importance of considering competing risks in recurrence analysis of intracranial meningioma. J Neurooncol 2024; 166:503-511. [PMID: 38336917 PMCID: PMC10876814 DOI: 10.1007/s11060-024-04572-y] [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: 11/25/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The risk of recurrence is overestimated by the Kaplan-Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan-Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. METHODS We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan-Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. RESULTS Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan-Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). CONCLUSION The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.
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Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lasse Rehné Jensen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tareq A Juratli
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
- Department of Neurosurgery, Laboratory of Translational Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, USA
| | - Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Sverre H Torp
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian, University of Science and Technology (NTNU), Laboratory Centre, St. Olavs Hospital, NO-7491, Trondheim, Norway
- Department of Pathology, Laboratory Centre, St. Olavs Hospital, NO-7030, Trondheim, Norway
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jacob S Young
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Stephen T Magill
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Illinois, USA
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University and Città Della Salute E Della Scienza University Hospital of Turin, Turin, Italy
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | | | - Benjamin Brokinkel
- Department of Neurosurgery, University of Münster, Münster, Germany
- Institute for Neuropathology, University of Münster, Münster, Germany
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center/University, Saitama, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Martin Proescholdt
- Department of Neurosurgery, University Regensburg Medical Center, Regensburg, Germany
| | - Yasuhiro Kuroi
- Department of Neurosurgery, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Matthias Simon
- Department of Neurosurgery, Bethel Clinic University of Bielefeld Medical Center, Bielefeld, Germany
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine Yale New Haven Hospital, Smilow Cancer Hospital, New Haven, USA
| | | | - Stéphane Goutagny
- Department of Neurosurgery, Université Paris Cité, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Illinois, USA
| | - John T Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Stritch School of Medicine, Illinois, USA
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Matthew Koshy
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Illinois, USA
| | - Karthikeyan Perumal
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mustafa K Baskaya
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Donald M Cannon
- Department of Radiation Oncology Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dennis C Shrieve
- Department of Radiation Oncology Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Maria Kamenova
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Sven Straumann
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Ilker Y Eyüpoglu
- Department of Neurosurgery, Division of Neuro-Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Tony Catalan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Austin Lui
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Philip V Theodosopoulos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael W McDermott
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Division of Neurosurgery, Miami Neuroscience Institute, Miami, FL, USA
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pedro Góes
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | - Aria Jamshidi
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Michael Ivan
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Evan Luther
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | - Tamás Csonka
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Tohoku, Japan
| | | | - Randy Jensen
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Tejpal Gupta
- Department of Radiation Oncology ACTREC, Tata Memorial Centre, HBNI Kharghar, Navi Mumbai, 410210, India
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX , USA
| | - Tiemo J Klisch
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX , USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Francesco Maiuri
- Department of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - María Dolores Tabernero
- Instituto de Investigación Biomédica de Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Simon Skyrman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Broechner
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
| | - Bjarne Winther Kristensen
- Department of Pathology, Bartholin Institute, Rigshospitalet, Copenhagen University Hospital , Copenhagen, Denmark
- Department of Clinical Medicine and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Torstein Meling
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Neurological Surgery, Istituto Nazionale Neurologico "C.Besta", Milan, Italy
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Blanche
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Corvino S, Del Basso De Caro M, Franca RA, Corazzelli G, Della Monica R, Chiariotti L, Maiuri F. Atypical Teratoid/Rhabdoid Tumor of the Nervous System in Adults: Location-Related Features and Outcome. World Neurosurg 2023; 179:e404-e415. [PMID: 37659753 DOI: 10.1016/j.wneu.2023.08.107] [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: 08/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumor (AT/RT) of the nervous system is a rare and highly malignant neoplasm, mainly affecting children, first recognized as a pathologic entity in 1996 and added to the World Health Organization Classification of the Tumors of the Central Nervous System in 2000. AT/RT is even rarer among adults and is associated with a worse prognosis. The aim of the present study was to analyze the different tumor features according to the location in adults. METHODS A comprehensive and detailed literature review of AT/RTs in adults was made. The demographic, management, and outcome data associated with tumor location were analyzed and compared; histopathologic and molecular features were also discussed. Furthermore, we added our personal case with brain hemispheric localization and reported a progression-free survival of 103 months after gross total resection and adjuvant radiotherapy showing a peculiar histopathologic pattern. RESULTS Female sex is mainly affected by AT/RT on median localizations, both intracranial and spinal, and by all sellar region cases. Gross total resection is mainly achieved among lateral compared with median localizations. Combined radiotherapy and chemotherapy is the most adopted adjuvant treatment in all tumor localizations and is related to better outcome. Postoperative death is reported only among sellar region localizations, whereas brain hemispheric cases show the best overall survival. CONCLUSIONS AT/RTs show different and peculiar features according to their location, which significantly affects the outcome; precise knowledge of them helps the neurosurgeon in planning the best strategy for treatment.
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Affiliation(s)
- Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Corazzelli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Rosa Della Monica
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II" of Naples, Naples, Italy
| | - Lorenzo Chiariotti
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II" of Naples, Naples, Italy
| | - Francesco Maiuri
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy.
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Maiuri F, Del Basso de Caro M. Update on the Diagnosis and Management of Meningiomas. Cancers (Basel) 2023; 15:3575. [PMID: 37509238 PMCID: PMC10377680 DOI: 10.3390/cancers15143575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
This series of five articles (one original article and four reviews) focuses on the most recent and interesting research studies on the biomolecular and radiological diagnosis and the surgical and medical management of meningiomas [...].
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, 80131 Naples, Italy
| | - Marialaura Del Basso de Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, School of Medicine, University "Federico II" of Naples, 80131 Naples, Italy
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Maiuri F, Corvino S. Meningiomas of the rolandic region: risk factors for motor deficit and role of intra-operative monitoring. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05630-6. [PMID: 37277557 DOI: 10.1007/s00701-023-05630-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Meningiomas of the rolandic region are associated to high risk of postoperative motor deficits. This study discusses the factors affecting motor outcome and recurrences from the analysis of a monoinstitutional case series and eight studies from a literature review. METHODS Data of 75 patients who underwent surgery for meningioma of the rolandic region were retrospectively reviewed. The analyzed factors included tumor location and size, clinical presentation, magnetic resonance imaging (MRI) and surgical findings, brain-tumor interface, extent of resection, postoperative outcome and recurrence. Eight studies from literature on rolandic meningiomas treated with or without intraoperative monitoring (IOM) were reviewed with the aim to define the impact of IOM on the extent of resection and motor outcome. RESULTS Among the 75 patients of the personal series, the meningioma was on the brain convexity in 34 (46%), at the parasagittal region in 28 (37%) and at the falx in 13 (17%). The brain-tumor interface was preserved in 53 cases (71%) at MRI and in 56 (75%) at surgical exploration. Simpson grade I resection was obtained in 43% of patients, grade II in 33%, grade III in 15% and grade IV in 9%. The motor function worsened postoperatively in 9 among 32 cases with preoperative deficit (28%) and in 5 among 43 with no preoperative deficit (11.5%); definitive motor deficit was evidenced in overall series at follow-up in 7 (9.3%). Patients with meningioma with lost arachnoid interface had significant higher rates of worsened postoperative motor deficit (p = 0.01) and seizures (p = 0.033). Recurrence occurred in 8 patients (11%). The analysis of the 8 reviewed studies (4 with and 4 without IOM) shows in the group without IOM higher rates of Simpson grades I and II resection (p = 0.02) and lower rates of grades IV resection (p = 0.002); no significant differences in postoperative immediate and long-term motor deficits were evidenced between the two groups. CONCLUSIONS Data from literature review show that the use of IOM does not affect the postoperative motor deficit Therefore, its role in rolandic meningiomas resection remains to be determined and will be defined in further studies.
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Affiliation(s)
- Francesco Maiuri
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", School of Medicine, Via Pansini, 5, 80131, Naples, Italy.
| | - Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", School of Medicine, Via Pansini, 5, 80131, Naples, Italy
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Maiuri F, Corvino S, Lorenzetti M, Franca RA, Esposito F, Del Basso De Caro M. Intracranial Meningiomas in Patients Aged ≥80 Years: Pathological Features and Surgical Problems. World Neurosurg 2023; 173:e498-e508. [PMID: 36841531 DOI: 10.1016/j.wneu.2023.02.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Patients aged >80 years frequently have intracranial meningiomas. In the present study, we have discussed the pathological features, comorbidities, and surgical complications for this age group from a surgical series and literature review. METHODS In the present study, we reviewed a surgical series of 354 intracranial meningiomas and compared the oldest age group (age, ≥80 years) of 17 patients with 73 patients aged 70-79 years and 264 patients aged <70 years. From a literature review, we selected 10 studies of meningiomas in patients aged ≥80 years. The analyzed factors included sex, meningioma location, World Health Organization grade, Ki-67 MIB1, progesterone receptor expression, comorbidities, American Society of Anesthesiologists class, Karnofsky performance scale score, postoperative complications, and death. RESULTS Patients aged ≥80 years had had higher rates of World Health Organization grade II meningioma, higher rates of Ki-67 expression of >4% and <20%, and progesterone receptor expression <15%. Of the postoperative complications, only neurological deficits and acute bronchopneumonia were significantly more frequent in patients aged ≥80 years. The incidence of intracerebral hematoma, lung embolism, acute heart ischemia, and death were not significantly different between the patients aged ≥80 years and those aged 70-79 years and <70 years. CONCLUSIONS Patients aged ≥80 years must be considered a true elderly group with higher rates of comorbidities. The very old age is not a limitation to surgery; however, careful patient selection is necessary. In addition, for the oldest age group, the surgical decision should not be delayed because of advancing age.
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Affiliation(s)
- Francesco Maiuri
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy.
| | - Sergio Corvino
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Marco Lorenzetti
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomorphological Sciences, Section of Pathology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Felice Esposito
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomorphological Sciences, Section of Pathology, School of Medicine, University of Naples "Federico II", Naples, Italy
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Mariniello G, Bonavolontà G, Tranfa F, Iuliano A, Corvino S, Teodonno G, Maiuri F. Management of the skull base invasion in spheno-orbital meningiomas. Br J Neurosurg 2023:1-8. [PMID: 36593639 DOI: 10.1080/02688697.2022.2161472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The tumor invasion of the skull base structures is very frequent in spheno-orbital meningiomas. The aim of the present study is to evaluate the invasion rate of skull base structures and the best surgical approach and management. METHODS The surgical series of 80 spheno-orbital meningiomas was reviewed. The tumors were classified according to the intraorbital location with respect to the optic nerve axes into three types: I-lateral: II-medial; III-diffuse. The invasion of the orbital apex, optic canal, superior orbital fissure, anterior clinoid, ethmoid-sphenoid sinuses, and infratemporal fossa was evaluated. The rate and extension of involvement of these structures was correlated with the intraorbital location and the surgical approach. The preoperative ophtalmological symptoms and signs and their outcome were also evaluated. RESULTS Proptosis was found in 79 patients (97%), variable decrease of the visual function in 47 patients (59%), and deficits of the eye movements in 28(35%). The invasion of the optic canal (74%), superior orbital fissure (65%), anterior clinoid (60%), and orbital apex (59%) was more frequently found, whereas the tumor extension into the ethmoid-sphenoid sinuses (4%) and infratemporal fossa (4%) was rare. Types II and III meningiomas showed significantly higher involvement of the skull base structures than type I ones, which only had 15% invasion of the optic canal. Remission or significant improvement of the visual function occurred postoperatively in 24 among 47 cases (51%), with a higher rate for type I meningiomas vs. other types (p = 0.021, p = 0.019) and worsening in 7 (15%). CONCLUSIONS Spheno-orbital meningiomas growing in the lateral orbital compartment show no involvement of the skull base structures excepting the optic canal as compared to those growing medially or diffusely. The surgical resection of tumor invading the skull base structures should be more extensive as possible, but the risk of optic and oculomotor deficits must be avoided.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Giulio Bonavolontà
- Ophthalmological Clinic, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Fausto Tranfa
- Ophthalmological Clinic, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Adriana Iuliano
- Ophthalmological Clinic, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Giuseppe Teodonno
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
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Mariniello G, Corvino S, Corazzelli G, Maiuri F. Cervical epidural abscess complicated by a pharyngoesophageal perforation after anterior cervical spine surgery for subaxial spondylodiscitis. Surg Neurol Int 2023; 14:102. [PMID: 37025524 PMCID: PMC10070333 DOI: 10.25259/sni_114_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 04/08/2023] Open
Abstract
Background The anterior approach to the cervical spine is safe and effective, but not without risks. The pharyngoesophageal perforation (PEP) is a rare but potentially life-threatening complication of this surgical route. A prompt diagnosis and adequate treatment are crucial for the prognosis; nevertheless, there is no unique consent about the best management. Case Description A 47-year-old woman was referred to our neurosurgical unit for clinical and neuroradiological signs of multilevel cervical spine spondylodiscitis, which was conservatively treated with long-term antibiotic therapy and cervical immobilization after computed tomography-guided biopsy. Nine months later, when the infection was resolved, the patient underwent C3-C6 spinal fusion with anterior plate and screws through anterior approach to the cervical spine for degenerative vertebral changes causing severe myelopathy, and C5- C6 retrolisthesis with instability. Five days after surgical procedure, the patient developed a pharyngoesophageal-cutaneous fistula, detected through wound drainage, and confirmed by swallowing contrast study, without systemic signs of infection. The PEP was conservatively treated, with antibiotic therapy and parenteral nutrition, and it was monitored through seriate swallowing contrast and magnetic resonance studies up to the complete resolution. Conclusion The PEP is a potentially fatal complication of the anterior cervical spine surgery. We suggest an accurate intraoperative control of the pharyngoesophageal's tract integrity at the end of the surgical procedure and a longtime follow-up, because the risk of occurrence is up to several years after surgery.
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Affiliation(s)
- Giuseppe Mariniello
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Sergio Corvino
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
- Corresponding author: Giuseppe Corazzelli, Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy.
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
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Maiuri F, Mariniello G, Corvino S, Meglio V, Ahmed Franca R, Del Basso De Caro M. Solitary fibrous tumor of the middle cranial fossa: Literature review and case report. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2022.101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Corvino S, Mariniello G, Corazzelli G, Franca RA, Del Basso De Caro M, Della Monica R, Chiariotti L, Maiuri F. Brain Gliomas and Ollier Disease: Molecular Findings as Predictive Risk Factors? Cancers (Basel) 2022; 14:cancers14143464. [PMID: 35884525 PMCID: PMC9324397 DOI: 10.3390/cancers14143464] [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: 06/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Ollier disease (OD) is a rare nonhereditary type of dyschondroplasia characterized by multiple enchondromas, with typical onset in the first decade of life. Surgery is the only curative treatment for primary disease and its complications. Patients with OD are at risk of malignant transformation of enchondromas and of occurrence of other neoplasms. Methods: A wide literature review disclosed thirty cases of glioma associated with OD, most of them belonging to the pre-molecular era. Our own case was also included. Demographic, clinical, pathologic, molecular, management, and outcome data were analyzed and compared to those of sporadic gliomas. Results: Gliomas associated with OD more frequently occur at younger age, present higher rates of multicentric lesions (49%), brainstem localizations (29%), and significantly lower rates of glioblastomas (7%) histotype. The IDH1 R132H mutation was detected in 80% of gliomas of OD patients and simultaneously in enchondromas and gliomas in 100% of cases. Conclusions: The molecular data suggest a higher risk of occurrence of glioma in patients with enchondromas harboring the IDH1 R132H mutation than those with the IDH1 R132C mutation. Thus, we suggest considering the IDH1 R132H mutation in enchondromas of patients with OD as a predictive risk factor of occurrence of glioma.
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Affiliation(s)
- Sergio Corvino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (G.M.); (G.C.); (F.M.)
- Correspondence: ; Tel.: +39-3927524046
| | - Giuseppe Mariniello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (G.M.); (G.C.); (F.M.)
| | - Giuseppe Corazzelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (G.M.); (G.C.); (F.M.)
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Section of Pathology, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (R.A.F.); (M.D.B.D.C.)
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (R.A.F.); (M.D.B.D.C.)
| | - Rosa Della Monica
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (R.D.M.); (L.C.)
| | - Lorenzo Chiariotti
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (R.D.M.); (L.C.)
| | - Francesco Maiuri
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples “Federico II”, 80131 Naples, Italy; (G.M.); (G.C.); (F.M.)
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Pirozzi M, Caterino M, Facchini S, Zotta A, Messina G, Rauso R, Sica A, Sciano D, Facchini G, Orditura M, Somma T, Maiuri F, Cappabianca P, Ciardiello F, Fasano M. Regorafenib beyond the Second Line in Relapsed Glioblastoma: A Case Report and Literature Review. Case Rep Oncol 2022; 15:642-647. [PMID: 35949909 PMCID: PMC9294966 DOI: 10.1159/000524954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
Glioblastoma multiforme (GBM) is one of the most frequent and aggressive primary tumors in the central nervous system, representing more than 60% of all brain tumors in adults. Primary GBM remains incurable with a poor prognosis both for limited therapeutic alternatives and for a high risk of progression or recurrence. In fact, at recurrence, the few treatment options available, and often characterized by limited effectiveness, have always been an Achilles' heel. The recent approval of second line of regorafenib, a multikinase inhibitor, has given hope after several years of darkness for new therapies in the treatment of GBM. Indeed, in the REGOMA trial, a phase 2 study, regorafenib was the first drug to show a statistically significant improvement in median overall survival compared with lomustine group, usually used in the second-line treatment after temozolomide failure. We report a case of a 43-year-old patient affected by GBM in treatment with regorafenib in third line of therapy with good disease control and long PFS.
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Affiliation(s)
- Mario Pirozzi
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Marianna Caterino
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Sergio Facchini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Alessia Zotta
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Gaetana Messina
- Thoracic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Raffaele Rauso
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialists, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Donato Sciano
- Trauma Center Unit, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Gaetano Facchini
- ASL NA2 NORD, Oncology Operative Unit, “Santa Maria delle Grazie” Hospital, Pozzuoli, Italy
| | - Michele Orditura
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Morena Fasano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy
- *Morena Fasano,
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Mariniello G, Corvino S, Sgulò F, Guadagno E, Del Basso De Caro M, Maiuri F. Intradural cauda equina metastases from renal cell carcinoma. Interdisciplinary Neurosurgery 2022. [DOI: 10.1016/j.inat.2021.101397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Mariniello G, de Divitiis O, Corvino S, Strianese D, Iuliano A, Bonavolontà G, Maiuri F. Recurrences of spheno-orbital meningiomas: risk factors and management. World Neurosurg 2022; 161:e514-e522. [DOI: 10.1016/j.wneu.2022.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
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16
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Corvino S, Mariniello G, Corazzelli G, Franca R, Caro MBD, Maiuri F. Spinal cervical extradural hemangioblastoma. J Craniovertebr Junction Spine 2022; 13:192-197. [PMID: 35837434 PMCID: PMC9274673 DOI: 10.4103/jcvjs.jcvjs_146_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/08/2022] [Indexed: 12/04/2022] Open
Abstract
Spinal cervical extradural and intra-extradural hemangioblastomas are exceptional, with only nine reported cases. This study reviews the diagnostic and surgical problems of this rare entity. Two female patients, aged 80 years and 25 years, respectively, one with Von Hippel–Lindau disease (VHLD), experienced brachial pain and weakness. On magnetic resonance imaging, a dumbbell intra-extraspinal hemangioblastoma was evidenced. The surgical resection through posterior laminectomy resulted in clinical remission of brachial pain and weakness. The magnetic resonance aspect of a dumbbell lesion suggests a neurogenic tumor; the correct preoperative diagnosis is possible in individuals with VHLD. The surgical problems include high tumor vascularity, vertebral artery control, and nerve root preservation. However, the surgical excision results in clinical remission.
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Carbone L, Somma T, Iorio GG, Vitulli F, Conforti A, Raffone A, Bove I, Pagano S, Pontillo M, Carbone IF, Farina A, Maruotti GM, Maiuri F, Cappabianca P, Alviggi C. Meningioma during pregnancy: what can influence the management? A case series and review of the literature. J Matern Fetal Neonatal Med 2021; 35:8767-8777. [PMID: 34822317 DOI: 10.1080/14767058.2021.2004585] [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] [Indexed: 10/19/2022]
Abstract
Purpose: Meningioma is a benign tumor, more frequent in female population. During pregnancy, distinguishing a meningioma from other common conditions presenting with similar symptoms (headache, vomiting, visual impairment) is challenging. Moreover, the management must consider not only maternal but also fetal health. The rarity of the condition does not allow to define the features to which look in order to stratify the risk for the need of surgery during pregnancy. We reported three cases of meningioma in pregnant women treated at our department and reviewed those previously reported in the literature. The aim of this review is to evaluate which factors are more determinant in such management.Methods: Electronic databases were searched from year 2000 until June 2020, to identify clinical studies on management of meningioma diagnosed during pregnancy. The primary outcome was surgical timing. Secondary outcomes were delivery methods, maternal and neonatal outcomes.Results: Surgery after pregnancy is more frequently performed in PR + tumor (p-value 0.038) and with HA (p-value 0.0445), as well as in meningioma diagnosed during the third trimester, compared to those diagnosed before (p-value 0.0012). Surgery during pregnancy was more frequent in patients with visual loss (p-value 0.006). No significant differences were found in surgical management, according to age, WHO grade, tumor location, lesion diameter and ER positivity. Delivery method is independent from both hormonal receptor status and main symptoms, but women who had neurosurgery during pregnancy delivered more frequently with spontaneous vaginal delivery (p-value <0.01).Conclusion: The decision regarding surgical timing of meningioma diagnosed during pregnancy depends on PR + and impending symptoms as visual loss or headache. It seems that timing of neurosurgery does not affect the delivery method. A multidisciplinary approach is always useful to perform a rapid and appropriate diagnosis and to better evaluate pros and cons of surgery during pregnancy and following management both for maternal and fetal wellness.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Teresa Somma
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Giuseppe Gabriele Iorio
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Francesca Vitulli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Ilaria Bove
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Serena Pagano
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Martina Pontillo
- Department of Public Health, School of Medicine, Federico II University, Naples, Italy
| | - Ilma Floriana Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Farina
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Francesco Maiuri
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Paolo Cappabianca
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, School of Medicine, Federico II University, Naples, Italy
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Maiuri F, Mariniello G, Corvino S, Somma T, Guadagno E, Teodonno G, Del Basso De Caro M, Cappabianca P. Cavernous Malformations to Be Investigated for Familiarity: The Role of Ki67 MIB1. World Neurosurg 2021; 155:e75-e82. [PMID: 34389524 DOI: 10.1016/j.wneu.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Familial forms of cavernous malformations (CMs) often occur as multiple lesions. Nevertheless, the presence of a single CM does not exclude the familiarity. The aim of this study is to establish which patients who undergo surgery for a single cerebral cavernous malformation (CCM), with no family history at initial diagnosis, should be investigated for familiarity through genetic testing and counseling. METHODS Eight families with 2 or more members affected by CCM have been studied. A control group of sporadic cases operated on, with no family history and followed up 10 years or more, was also included. Analyzed factors were patient age and sex, location, number and size of the lesions, associated developmental venous anomaly, presence of epileptic seizures, symptomatic hemorrhage, focal neurological deficits, and documented growth of the malformation and Ki67 MIB1 proliferation index. RESULTS The familial group of CCMs showed higher incidence of pediatric patients (P = 0.01), more frequent occurrence of multiple lesions (P = 0.0004), higher rate of large CCMs, and symptomatic hemorrhage; besides, all 3 cases with documented growth belonged to the familial group (14%). The expression of Ki67 MIB1 was positive in 79% of the familial cases versus 0% in the sporadic ones (P < 0.00001). CONCLUSIONS Patients with CCM and no known family history at the time of the initial diagnosis who present specific features should be studied by genetic screening. The Ki67 MIB1 is a useful biomarker in favor of familial occurrence and may be studied in all patients with CMs to define the indication to the genetic tests.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy.
| | - Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Teresa Somma
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Section of Pathology, University "Federico II" of Naples, Naples, Italy
| | - Giuseppe Teodonno
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University "Federico II" of Naples, Naples, Italy
| | - Paolo Cappabianca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
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Maiuri F, Mariniello G, de Divitiis O, Esposito F, Guadagno E, Teodonno G, Barbato M, Del Basso De Caro M. Progesterone Receptor Expression in Meningiomas: Pathological and Prognostic Implications. Front Oncol 2021; 11:611218. [PMID: 34336636 PMCID: PMC8320886 DOI: 10.3389/fonc.2021.611218] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/17/2021] [Indexed: 12/21/2022] Open
Abstract
Background The progesterone receptor (PR) is variably expressed in most meningiomas and was found to have prognostic significance. However, the correlation with patient age, tumor location, time to recurrence, and pattern of regrowth has scarcely been discussed. Methods A surgical series of 300 patients with meningiomas is reviewed. The PR expression was classified as: 0. absent; 1. low (<15%); 2. moderately low (16-50%); 3. moderately high (51-79%); 4. high (≥80%). The PR values were correlated with the patient age and sex, meningioma location, WHO grade, Ki-67 MIB1, recurrence rate, pattern of recurrence (local-peripheral versus multicentric diffuse), and time to recurrence. Results The PR expression has shown lower rate of high expression in the elderly group (p = 0.032) and no sex difference (including premenopausal versus postmenopausal women), higher expression in medial skull base and spinal versus other locations (p = 0.0036), inverse correlation with WHO grade and Ki67-MIB1 (p < 0.0001). Meningiomas which recurred showed at initial surgery higher rates of low or moderately low PR expression than the non-recurrent ones (p = 0.0004), whereas the pattern of regrowth was not significant. Higher rates of PR values ≥80% were found in cases with time to recurrence >5 years (p = 0.036). Conclusion The higher PR expression in medial skull base meningiomas, the significant correlation with the time to recurrence, the lack of difference of PR expression between premenopausal and postmenopausal women and between local-peripheral versus multicentric-diffuse recurrences are the most relevant unreported findings of this study. The rate of PR expression must be included in the routine pathological diagnosis of meningiomas because of its prognostic significance.
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Affiliation(s)
- Francesco Maiuri
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
| | - Giuseppe Mariniello
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
| | - Oreste de Divitiis
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
| | - Felice Esposito
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
| | - Elia Guadagno
- Section of Pathology, Department of Advanced Biomorphological Sciences, University "Federico II", Naples, Italy
| | - Giuseppe Teodonno
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
| | - Marcello Barbato
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
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Mariniello G, Maiuri F. Letter: Mini-Pterional Craniotomy and Extradural Clinoidectomy for Clinoid Meningioma: Optimization of Exposure Using Augmented Reality Template: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E75. [PMID: 33270104 DOI: 10.1093/ons/opaa353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppe Mariniello
- Department of Neuroscience and Reproductive Sciences and Dentistry Section of Neurosurgery University of Naples "Federico II" School of Medicine Naples, Italy
| | - Francesco Maiuri
- Department of Neuroscience and Reproductive Sciences and Dentistry Section of Neurosurgery University of Naples "Federico II" School of Medicine Naples, Italy
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Mariniello G, Corvino S, Teodonno G, Pagano S, Maiuri F. Postoperative Lemierre’s syndrome: a previously unreported complication of transoral surgery. Illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE20118. [PMID: 35855218 PMCID: PMC9245783 DOI: 10.3171/case20118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Lemierre’s syndrome is a rare but potentially life-threatening clinical condition characterized by bacteremia and thrombophlebitis of the internal jugular vein, usually secondary to oropharyngeal infection and often caused by Fusobacterium necrophorum; rarely, it occurs after surgical procedures. The most common clinical presentation includes acute pharyngitis, high fever, and neck pain. The diagnosis is based on blood culture and cranial and cervical spine computed tomography (CT)/magnetic resonance imaging (MRI) with contrast. Antibiotic therapy for 3–6 weeks is the mainstay of treatment, while the use of anticoagulant drugs is controversial.
OBSERVATIONS
The authors describe a case of Lemierre’s syndrome that occurred after transoral surgery. The patient underwent a combined surgical approach from above (transoral) and below (anterolateral transcervical) to the upper cervical spine for the resection of a large anterior osteophyte causing dysphagia, globus sensation, and dysphonia. Three weeks after the surgical procedure, she developed fever and severe neck pain.
LESSONS
The aim of this paper is to consider Lemierre’s syndrome as a possible complication after the transoral approach, underlining the importance of its early diagnosis and with a suggestion to perform cranial and cervical spine CT or MRI venous angiography in patients who undergo surgery with a transoral approach and exhibit local or systemic signs of infection such as neck pain, persistent fever, and positive blood culture results.
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Maiuri F, Cavallo LM, Corvino S, Teodonno G, Mariniello G. Anterior cervical osteophytes causing dysphagia: Choice of the approach and surgical problems. J Craniovertebr Junction Spine 2021; 11:300-309. [PMID: 33824560 PMCID: PMC8019107 DOI: 10.4103/jcvjs.jcvjs_147_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: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Anterior cervical osteophytes (ACOs) may rarely cause dysphagia, dysphonia, and dyspnea. Symptomatic ACOs are most commonly located between C3 and C7, whereas those at higher cervical (C1-C2) levels are rarer. We report a case series of 4 patients and discuss the best surgical approach according to the ostheophyte location and size, mainly for those located at C1-C2, and the related surgical problems. Materials and Methods Four patients (two males and two females) aged from 57 to 72 years were operated on for ACOs, causing variable dysphagia (and dyspnea with respiratory arrest in one). Three patients with osteophytes between C3 and C5 were approached through antero-lateral cervical approach, and one with a large osteophyte between C1 and C3-C4 level underwent a two-stage transcervical and transoral approach. All had significant postoperative improvement of dysphagia. Results The patient operated on though the transoral approach experienced postoperative flogosis of the prevertebral tissues and occipital muscles and thrombosis of the right jugular vein and transverse-sigmoid sinuses (Lemierre syndrome). Conclusion The transoral approach is the best surgical route to resect C1 and C2 ACOs, whereas the endoscopic endonasal approach is not indicated. The anterior transcervical approach is easier to resect osteophytes at C3, as well as those located below C3. A combined transoral and anterior cervical approach may be necessary for multilevel osteophytes.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Giuseppe Teodonno
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
| | - Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University "Federico II", Naples, Italy
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Maiuri F, Mariniello G, Somma T, Guadagno E, Corvino S, Pagano S, Orlando V, Del Basso De Caro M. Meningiomas in Premenopausal Women: Role of the Hormone Related Conditions. Front Oncol 2020; 10:556701. [PMID: 33363003 PMCID: PMC7759676 DOI: 10.3389/fonc.2020.556701] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/09/2020] [Indexed: 01/31/2023] Open
Abstract
Background Several epidemiological and pathological findings suggest that the female sex hormones may influence the development of meningiomas. However, the role of pregnancy, oral contraceptives, and fertilization therapies is still controversial. Methods From the surgical series of 354 patients with meningiomas operated between 2006 and 2019, the group of 72 premenopausal women was separately considered. The tumor location, WHO grade, Ki67-labeling index (LI), progesterone receptor (PR) expression, and histological types were studied in premenopausal women with and without hormone-related conditions were compared. Results In this premenopausal group, 24 patients had hormone-related conditions, including use of oral contraceptives in 16, intrauterine fertilization in one, pregnancy in three, and tumors of the female reproductive system in four. The group of patients with hormone-related conditions, as compared to that with no hormone related conditions, showed slightly lower median age (38 versus 43 years) and no significant difference of meningioma location WHO grade, Ki 67-Li, PR expression and histological type. The clinical onset during pregnancy in three patients and tumor growth during contraceptive progesterone therapy in two others were evidenced. Conclusion The biological behavior of meningiomas and their pathological findings, including PR expression, are not correlated with the different hormone related conditions in premenopausal female patients. Contraceptives and fertilization therapies, mainly with progesterone, should be avoided in patients with meningiomas.
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Affiliation(s)
- Francesco Maiuri
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Giuseppe Mariniello
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Teresa Somma
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Elia Guadagno
- Section of Pathology, Department of Advanced Biomorphological Sciences, University "Federico II", Naples, Italy
| | - Sergio Corvino
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Serena Pagano
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Valentina Orlando
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
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Ius T, Somma T, Altieri R, Angileri FF, Barbagallo GM, Cappabianca P, Certo F, Cofano F, D'Elia A, Della Pepa GM, Esposito V, Fontanella MM, Germanò A, Garbossa D, Isola M, La Rocca G, Maiuri F, Olivi A, Panciani PP, Pignotti F, Skrap M, Spena G, Sabatino G. Is age an additional factor in the treatment of elderly patients with glioblastoma? A new stratification model: an Italian Multicenter Study. Neurosurg Focus 2020; 49:E13. [PMID: 33002864 DOI: 10.3171/2020.7.focus20420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately half of glioblastoma (GBM) cases develop in geriatric patients, and this trend is destined to increase with the aging of the population. The optimal strategy for management of GBM in elderly patients remains controversial. The aim of this study was to assess the role of surgery in the elderly (≥ 65 years old) based on clinical, molecular, and imaging data routinely available in neurosurgical departments and to assess a prognostic survival score that could be helpful in stratifying the prognosis for elderly GBM patients. METHODS Clinical, radiological, surgical, and molecular data were retrospectively analyzed in 322 patients with GBM from 9 neurosurgical centers. Univariate and multivariate analyses were performed to identify predictors of survival. A random forest approach (classification and regression tree [CART] analysis) was utilized to create the prognostic survival score. RESULTS Survival analysis showed that overall survival (OS) was influenced by age as a continuous variable (p = 0.018), MGMT (p = 0.012), extent of resection (EOR; p = 0.002), and preoperative tumor growth pattern (evaluated with the preoperative T1/T2 MRI index; p = 0.002). CART analysis was used to create the prognostic survival score, forming six different survival groups on the basis of tumor volumetric, surgical, and molecular features. Terminal nodes with similar hazard ratios were grouped together to form a final diagram composed of five classes with different OSs (p < 0.0001). EOR was the most robust influencing factor in the algorithm hierarchy, while age appeared at the third node of the CART algorithm. The ability of the prognostic survival score to predict death was determined by a Harrell's c-index of 0.75 (95% CI 0.76-0.81). CONCLUSIONS The CART algorithm provided a promising, thorough, and new clinical prognostic survival score for elderly surgical patients with GBM. The prognostic survival score can be useful to stratify survival risk in elderly GBM patients with different surgical, radiological, and molecular profiles, thus assisting physicians in daily clinical management. The preliminary model, however, requires validation with future prospective investigations. Practical recommendations for clinicians/surgeons would strengthen the quality of the study; e.g., surgery can be considered as a first therapeutic option in the workflow of elderly patients with GBM, especially when the preoperative estimated EOR is greater than 80%.
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Affiliation(s)
- Tamara Ius
- 1Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine
| | - Teresa Somma
- 2Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
| | - Roberto Altieri
- 3Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia); Neurological Surgery, Policlinico "G. Rodolico - San Marco" University Hospital, University of Catania
| | | | - Giuseppe Maria Barbagallo
- 3Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia); Neurological Surgery, Policlinico "G. Rodolico - San Marco" University Hospital, University of Catania.,4Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania
| | - Paolo Cappabianca
- 2Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
| | - Francesco Certo
- 3Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia); Neurological Surgery, Policlinico "G. Rodolico - San Marco" University Hospital, University of Catania.,4Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania
| | - Fabio Cofano
- 6Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, University of Turin
| | - Alessandro D'Elia
- 7Department of Neurosurgery "Giampaolo Cantore"-IRCSS Neuromed, Pozzilli
| | | | - Vincenzo Esposito
- 7Department of Neurosurgery "Giampaolo Cantore"-IRCSS Neuromed, Pozzilli.,9Department of Human Neurosciences-"Sapienza" University of Rome
| | - Marco Maria Fontanella
- 10Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Antonino Germanò
- 5Division of Neurosurgery, BIOMORF Department, University of Messina
| | - Diego Garbossa
- 6Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, University of Turin
| | | | - Giuseppe La Rocca
- 8Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome.,13Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Francesco Maiuri
- 2Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
| | - Alessandro Olivi
- 8Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome
| | - Pier Paolo Panciani
- 10Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | - Miran Skrap
- 1Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine
| | | | - Giovanni Sabatino
- 8Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome.,13Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Angileri FF, Sabatino G, Cavallo LM, Pessina F, Ius T, DE Divitiis O, Esposito F, Grimod G, Raffa G, Spena G, Cardali S, Esposito V, GermanÒ A, Maiuri F, Fontanella M, Cenzato M. Natura non facit saltus: a phase 2 proposal to manage brain tumors cases from the Neuro-oncology section of the Italian Society of Neurosurgery (SINch®). J Neurosurg Sci 2020; 65:1-7. [PMID: 32525292 DOI: 10.23736/s0390-5616.20.05054-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Coronavirus (COVID-19) pandemic has fast spread throughout the world in more than 200 countries, resulting in the need for a de-prioritization of elective medical care to face the demands of the global health crisis. Although the acute and catastrophic phase of the pandemic seems to have been left behind, it is also clear that the virus will not disappear soon, and we must live with it for a period of unpredictable length, the COVID-19 era. In this setting, a common coordinated approach to treat patients harboring brain tumors is urgently required to guarantee the best updated oncological care and to reduce the risk of viral infection during hospitalization. The study group on Neuro-oncology of Italian Society of Neurosurgery, SINCh gathered pieces of evidence and data and would like to suggest a practice protocol of care for neurosurgical oncologic procedures in the COVID-19 era. The present document aimed at summarizing current evidence and expert opinions to help neurosurgeons in taking decisions on their patients harboring different brain tumors.
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Affiliation(s)
- Filippo F Angileri
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy -
| | - Giovanni Sabatino
- Unit of Neurosurgery, Department of Neurosciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luigi M Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Tamara Ius
- Unit of Neurosurgery, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Oreste DE Divitiis
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Gianluca Grimod
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Giovanni Raffa
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giannantonio Spena
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Salvatore Cardali
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Vincenzo Esposito
- Sapienza University, Rome, Italy.,G. Cantore Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Antonino GermanÒ
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Maiuri F, Mariniello G, Peca C, Guadagno E, Corvino S, d'Avanzo S, Del Basso De Caro M, de Divitiis O. Multicentric and diffuse recurrences of meningiomas. Br J Neurosurg 2020; 34:439-446. [PMID: 32312105 DOI: 10.1080/02688697.2020.1754335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Meningiomas recur with a rate of 10-32% at 10 years. Several features influence the risk of recurrence.Objective: To define the pathological and surgical features at risk of multicentric-diffuse versus local-peripheral recurrence.Methods: Thirty-three patients operated on for intracranial meningiomas who experienced multicentric-diffuse recurrence were retrospectively analyzed. The data of these patients were compared to those of 50 patients who experienced local-peripheral recurrence. The analyzed factors included age and sex, tumor location and shape, brain-tumor interface, entity of resection, WHO grade, Ki67 MIB1, progesterone receptor (PR) expression, number of reoperations, progression of WHO grade, and outcome.Results: Meningiomas which recurred in multicentric-diffuse pattern showed at initial surgery a significantly higher rate of flat-shaped tumors (p = .0008) and of cases with Ki67 Li ≥ 4% (p = .037) than those which recurred in localized-peripheral pattern, whereas other factors did not significantly differ. Among patients with multicentric-diffuse recurrences, 25 underwent one to three reoperations; 17 among them (66%) are alive with local tumor control or slow progression 2-25 years after the initial surgery versus only 2 out of 8 who did not undergo surgery.Conclusions: Flat-shaped meningiomas and those with Ki67 Li ≥ 4% are at higher risk of multicentric-diffuse recurrence. Multiple reoperations over a period of several years may obtain rather long survivals in selected patients with prevalent intradural, not anaplastic tumors and not too extensive dural infiltration.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Carmela Peca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomorphological Sciences, "Federico II" University School of Medicine, Naples, Italy
| | - Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | - Stefania d'Avanzo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
| | | | - Oreste de Divitiis
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, Naples, Italy
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Maiuri F, Mariniello G, Guadagno E, Barbato M, Corvino S, Del Basso De Caro M. WHO grade, proliferation index, and progesterone receptor expression are different according to the location of meningioma. Acta Neurochir (Wien) 2019; 161:2553-2561. [PMID: 31637512 DOI: 10.1007/s00701-019-04084-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Meningiomas may show a different WHO grade and variable biological and clinical behaviors. The aim of the present study is to assess whether WHO grade, proliferation index, progesterone receptor (PR) expression, histological subtype, neuroradiological features, and the recurrence rate differ depending on the tumor location. METHODS Three hundred meningiomas operated on from 2006 to 2016 were reviewed. The WHO grade (2007 classification), Ki67-MIB1, progesterone receptor expression, and histological subtype were reexamined and correlated to the meningioma location, classified as medial skull base, lateral skull base, non-skull base, and spinal. RESULTS Non-skull base and lateral skull base meningiomas showed significantly higher rates of atypical WHO II forms (34% and 25.5% respectively) than medial skull base (12.5%) and spinal ones (7%) (p = 0.0003) and also higher rates of tumors with Ki67-Li > 4% (42% and 38% vs 22% and 14%) (p = 0.0031). The rate of meningiomas with PR expression ≤ 50% was significantly lower in medial skull base (25%) than in non-skull base (48%) (p = 0.009). Meningothelial and transitional meningiomas were more frequent at the skull base (68.5% and 54.5%, respectively), the fibroblastic subtype at the non-skull base (48.5%), and the psammomatous at the spinal canal (50%) (p < 0.00001). Medial skull base and spinal meningiomas showed significantly lower size (p < 0.00001), lower rates of cases with lost arachnoid interface (p = 0.0022), and significantly lower recurrence rates (p = 0.0035) than lateral skull base and non-skull base meningiomas. CONCLUSION Medial skull base meningiomas show lower size, lower rate of atypical forms, lower Ki67-Li values, and significantly higher PR expression than those at the lateral skull base and non-skull base. This corresponds to lesser aggressiveness and lower recurrence rates.
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Mariniello G, de Divitiis O, Caranci F, Dones F, Maiuri F. Parasellar Schwannomas: Extradural vs Extra-Intradural Surgical Approach. Oper Neurosurg (Hagerstown) 2019; 14:627-638. [PMID: 28961901 DOI: 10.1093/ons/opx174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/12/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Schwannomas of the parasellar region may arise from the trigeminal, oculomotor, trochlear, and abducens nerves. OBJECTIVE To define the tumor origin, location, and dural relationship (extradural vs extra-intradural vs cisternal) on preoperative magnetic resonance imaging (MRI), in order to plan the best surgical approach (purely extradural vs extra-intradural). METHODS Twenty-four patients with parasellar schwannomas who underwent surgery were retrospectively analyzed. Twenty arose from the trigeminal nerve (7 intracavernous and 13 within the Meckel's cave), 3 from the oculomotor nerve, and 1 from the abducens nerve. The preoperative identification of the tumor location (extradural vs extra-intradural vs cisternal) and the nerve of origin was defined on MR sequences. All patients were operated on through a pterional approach (extradural or extra-intradural route). RESULTS The tumor location was correctly defined on MRI in 22 out of 24 cases (92%) and the nerve of origin in 22 (92%). An extradural approach without intradural exploration was performed in all 5 intracavernous trigeminal schwannomas, in 11 out of 13 of the Meckel's cave, and in 2 schwannomas of the oculomotor nerve. Two schwannomas of the Meckel's cave with transgression of the medial dural wall, 1 of the oculomotor nerve, and the abducens nerve schwannoma required an extra-intradural approach. Complete tumor resection was obtained in 19 out of 24 cases (80%). CONCLUSION The pterional extradural approach is sufficient for Dolenc type I and II trigeminal schwannomas, excepting for those transgressing the inner dural layer. Schwannomas of the oculomotor and abducens nerves with cisternal location require an extradural-intradural approach.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Oreste de Divitiis
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Flavia Dones
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences, Reproductive, and Odontostomatologic Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy
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Abstract
Objective: Spinal meningiomas are slow-growing tumors with low recurrence rate after complete resection. The aim of this study is to investigate the risk factors correlated to the recurrence.Material and Methods: Six patients with spinal WHO grade I meningiomas which recurred after complete resection were reviewed and compared to 50 patients with no recurrence; the data were also compared with those of 50 intracranial meningiomas which recurred and 50 which did not recur after complete resection. The investigated factors included age and sex, tumor location and size, type of arachnoid interface, entity of resection (Simpson I or II), tumor consistency and vascularity, histological type, Ki-67 MIB-1, progesterone receptor (PR) and estrogen receptor (ER) expression. The data were statistically analyzed with the Kaplan-Meier method.Results: The statistical analysis showed that the presence of arachnoidal invasion (p = 0.023) and higher Ki-67 LI (p < 0.0001) were the only two significant risk factors for recurrence for both spinal and intracranial meningiomas. Large tumor size (p = 0.012), Simpson grade II resection (p = 0.03) and the absence of PR expression (p < 0.0001) were significant risk factors for recurrence of intracranial but not spinal meningiomas. Finally, age and sex, tumor location, consistency and vascularity, histological type, and ER expression were not correlated to recurrence for both localizations.Conclusions: The proliferation index Ki-67 and the arachnoid invasion are the risk factors for recurrence of spinal meningiomas, whereas tumor size, dural resection and PR expression are not significant. The small tumor size and the limited dural invasion may contribute to explain the lower recurrence rate.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Oreste de Divitiis
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
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Donzelli R, Capone C, Sgulò FG, Mariniello G, Donzelli O, Maiuri F. Microsurgical repair by autografting in traumatic injuries of peripheral nerves: a series of 50 cases. J Neurosurg Sci 2019; 66:208-214. [PMID: 30724052 DOI: 10.23736/s0390-5616.19.04572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peripheral nerve injuries (PNI) with traumatic origin in upper and lower extremities are pathologies with an important quality-of-life considerations. For neurosurgeons, it is mandatory to understand their physiopathological mechanism and a proper treatment. The authors describe a series of 50 patients with traumatic PNI who underwent microsurgical reconstruction by autologous graft between 1993 and 2014. METHODS Patients aged less than 65, who had neurological deficit in a range 3-12 months and severe and persistent nerve injury at electrophysiological examination were included in the study. After grafting, the overall functional recovery of the neurological deficit, the main prognostic factors (age, injured nerve, damage mechanism, gap length and surgical timing) and the postoperative functional outcome were analysed. Neurological and electrophysiological follow-up was at 6-12-24-48 months after surgery. RESULTS The results showed that the best neurological recovery can be found in young patients with cut injuries of the upper limbs and that the outcome mainly depends on involved nerve, lesion type and minimum gap length. Moreover, follow-up for these pathologies should last till 48 months. CONCLUSIONS In the future, these results could be further improved by the rising new techniques of nerve repair and the advances in neurobiology.
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Affiliation(s)
- Renato Donzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University "Federico II", Naples, Italy
| | - Crescenzo Capone
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University "Federico II", Naples, Italy -
| | - Francesco G Sgulò
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University "Federico II", Naples, Italy
| | - Giuseppe Mariniello
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University "Federico II", Naples, Italy
| | - Oleksiy Donzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University "Federico II", Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, University "Federico II", Naples, Italy
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Ricci S, Guadagno E, Bruzzese D, Del Basso De Caro M, Peca C, Sgulò FG, Maiuri F, Di Carlo A. Evaluation of matrix metalloproteinase type IV-collagenases in serum of patients with tumors of the central nervous system. J Neurooncol 2016; 131:223-232. [PMID: 27757720 PMCID: PMC5306235 DOI: 10.1007/s11060-016-2297-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 05/21/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
The basement membrane collagen IV-degrading matrix metalloproteinases -2 and -9 (MMPs) are most often linked to the malignant phenotype of tumor cells by playing a critical role in invasion, metastasis, angiogenesis, and vasculogenesis. We verified the activity of these two MMPs in the sera of patients affected by brain tumors (20 gliomas, 28 meningiomas and 20 metastasis) by zymography. The sera of 25 healthy volunteers with no concomitant illnesses were used for controls. Zymography showed four dominant gelatinolytic bands of 240, 130, 92 (MMP-9) and 72 (MMP-2) kDa. No statistically significant variations of MMP-2 proteolytic activity between patients and healthy individuals were observed. On the contrary, MMP-9 (both monomeric and multimeric forms) lytic activities were significantly higher in tumors specimens compared to healthy controls (p < 0.001). Moreover, MMP-9 immunohistochemistry revealed: (1) a strong reactivity in neoplastic vessels of high-grade gliomas showing an inverse correlation with serum multimeric gelatinolytic activity; (2) a cytoplasmatic reactivity in meningiomas with a significantly increase in atypical meningioma compared with low-grade ones (p = 0.036); (3) a positive correlation between MMP-9 and Ki-67 (Sperman Rho coefficient r = 0.418 and p = 0.034). Our results suggest that serum and tissue MMP-9 might provide clinicians additional objective information in intracranial neoplasms. Finally, it should be possible to use MMP-9 as a target for new forms of therapy. Nevertheless, due to the small number of patients included in the study, the conclusion may not be transferable to the general population and therefore further evaluations are needed.
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Affiliation(s)
- Serena Ricci
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.,Department of Translational Medical Science, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomorphological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomorphological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Carmela Peca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Francesco G Sgulò
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Angelina Di Carlo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.
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Briganti F, Leone G, Marseglia M, Chiaramonte C, Solari D, Caranci F, Cappabianca P, Maiuri F. Mechanical Thrombectomy in the Treatment of Distal Occlusions during Coil Embolization of Ruptured Intracranial Aneurysms. NMC Case Rep J 2016; 3:115-117. [PMID: 28664011 PMCID: PMC5386161 DOI: 10.2176/nmccrj.cr.2016-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
The experience in the management of thromboembolic complications of distal vessels during coil embolization using stent-retrievers in the setting of subarachnoid hemorrhage (SAH) is still limited. We report a case of 58-year-old woman with a ruptured small anterior communicating aneurysm who experienced during coil embolization a thromboembolic occlusion of the upper post-bifurcation branch of the middle cerebral artery. Mechanical thrombectomy with a stent-retriever (Solitaire, Covidien, Neurovascular) resulted in complete recanalization of the occluded branch with no ischemic complication. This case should encourage the use of the Solitaire device as an effective rescue strategy in the treatment of distal artery occlusions in the setting of SAH.
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Affiliation(s)
- Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Giuseppe Leone
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Carmela Chiaramonte
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Ferdinando Caranci
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
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Briganti F, Leone G, Ugga L, Marseglia M, Macera A, Manto A, Delehaye L, Resta M, Resta M, Burdi N, Nuzzi NP, Divenuto I, Caranci F, Muto M, Solari D, Cappabianca P, Maiuri F. Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience. J Neurointerv Surg 2016; 9:70-76. [PMID: 27439887 PMCID: PMC5264236 DOI: 10.1136/neurintsurg-2016-012502] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 05/04/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Abstract
Background Experience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device. Methods 40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed. Results Complete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%). In the other three aneurysms (6%), two cases of asymptomatic in-stent thrombosis and one intraprocedural occlusion of the parent vessel occurred. Technical complications were observed in eight procedures (16%). Permanent morbidity due to acute in-stent thrombosis and consequent ischemic stroke occurred in one patient (2.5%). No delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, or ischemic complications occurred and there were no deaths. Conclusions Endovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis.
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Affiliation(s)
- Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Giuseppe Leone
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy.,Department of Neuroradiology, 'Umberto I' Hospital, Nocera Inferiore, Salerno, Italy
| | - Antonio Macera
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Andrea Manto
- Department of Neuroradiology, 'Umberto I' Hospital, Nocera Inferiore, Salerno, Italy
| | - Luigi Delehaye
- Unit of Interventional Neuroradiology, San Giovanni Bosco Hospital, Naples, Italy
| | - Maurizio Resta
- Department of Radiology and Neuroradiology, 'SS Annunziata' Hospital, Taranto, Italy
| | | | - Nicola Burdi
- Department of Radiology and Neuroradiology, 'SS Annunziata' Hospital, Taranto, Italy
| | - Nunzio Paolo Nuzzi
- Unit of Neuroradiology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ignazio Divenuto
- Department of Radiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Ferdinando Caranci
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Mario Muto
- Neuroradiology Department, Cardarelli Hospital, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, 'Federico II' University, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, 'Federico II' University, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, 'Federico II' University, Naples, Italy
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Guadagno E, Del Basso De Caro M, Pignatiello S, Sciammarella C, Solari D, Cappabianca P, Maiuri F, Dones F. Expression of p40 (∆Np63) protein in meningiomas, an unexpected finding: immunohistochemical study and evaluation of its possible prognostic role. J Neurooncol 2016; 129:405-413. [PMID: 27394131 DOI: 10.1007/s11060-016-2205-y] [Citation(s) in RCA: 5] [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] [Received: 02/05/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
According to the 2007 WHO (World Health Organization) Classification, meningiomas are divided into three grades of malignancy, with different recurrence rate, based exclusively on histopathological parameters. Loss/reduction of PgR (Progesterone Receptor) expression and increased Ki67 L.I. (Labeling Index) have been proven as possible prognostic factors able to predict the relapse of the disease. However, they sometimes result unreliable, especially when discordant. p40 is the short form of the p53 homologue gene p63, also named ∆Np63, and its antibody has recently been introduced as a highly specific diagnostic marker of the squamous cell carcinoma of the lung. Nevertheless its expression has been found in many other unconventional sites (e.g. placenta, urotheluim, etc). Herein we assessed the immuno-expression of p40 protein in a series of 72 meningiomas (35 grade I and 37 grade II) and analyzed its correlation with clinicopathological parameters, overall survival and recurrence free interval. We found that a high p40 score correlated with high histological grade, presence of recurrence, increased Ki67 L.I. and loss/reduction of PgR signal. Moreover, a higher expression of p40 was shown to be a significant prognostic factor for the development of recurrences and resulted a prognostic independent variable in multivariate analysis. Overall, for the first time, we investigated the expression of p40 protein in meningiomas and explored its usefulness as prognostic marker in addition to PgR and Ki67 L.I.
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Affiliation(s)
- Elia Guadagno
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Marialaura Del Basso De Caro
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Sara Pignatiello
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Concetta Sciammarella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Flavia Dones
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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36
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Mariniello G, Malacario F, Dones F, Severino R, Ugga L, Russo C, Elefante A, Maiuri F. Sudden post-traumatic sciatica caused by a thoracic spinal meningioma. Neuroradiol J 2016; 29:390-2. [PMID: 27316567 DOI: 10.1177/1971400916655479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spinal meningiomas usually present with slowly progressive symptoms of cord and root compression, while a sudden clinical onset is very rare. A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. A neurological examination showed paresis of the right quadriceps, tibial and sural muscles, increased bilateral knee and ankle reflexes and positive Babinski sign. Magnetic resonance imaging (MRI) revealed the presence of a spinal T11 meningioma in the left postero-lateral compartment of the spinal canal; at this level, the spinal cord was displaced to the contralateral side with the conus in the normal position. At surgery, a meningioma with dural attachment of the left postero-lateral dural surface was removed. The intervention resulted in rapid remission of both pain and neurological deficits. Spinal meningiomas may exceptionally present with sudden pain and neurological deficits as result of tumour bleeding or post-traumatic injury of the already compressed nervous structures, both in normal patients and in those with conus displacement or tethered cord. In this case, the traumatic impact of the left foot was transmitted to the spine, resulting in stretching of the already compressed cord and of the contralateral lombosacral roots. This case suggests that low thoracic cord compression should be suspected in patients with post-traumatic radicular leg pain with normal lumbar spine MRI.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
| | - Francesca Malacario
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Flavia Dones
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
| | - Rocco Severino
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
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Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, Maiuri F. Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review. Neuroradiol J 2015; 28:365-75. [PMID: 26314872 DOI: 10.1177/1971400915602803] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Flow-diverter devices (FDDs) are new-generation stents placed in the parent artery at the level of the aneurysm neck to disrupt the intra-aneurysmal flow thus favoring intra-aneurysmal thrombosis. OBJECTIVE The objective of this review article is to define the indication and results of the treatment of intracranial aneurysms by FDD, reviewing 18 studies of endovascular treatment by FDDs for a total of 1704 aneurysms in 1483 patients. METHODS The medical literature on FDDs for intracranial aneurysms was reviewed from 2009 to December 2014. The keywords used were: "intracranial aneurysms," "brain aneurysms," "flow diverter," "pipeline embolization device," "silk flow diverter," "surpass flow diverter" and "FRED flow diverter." RESULTS The use of these stents is advisable mainly for unruptured aneurysms, particularly those located at the internal carotid artery or vertebral and basilar arteries, for fusiform and dissecting aneurysms and for saccular aneurysms with large necks and low dome-to-neck ratio. The rate of aneurysm occlusion progressively increases during follow-up (81.5% overall rate in this review). The non-negligible rate of ischemic (mean 4.1%) and hemorrhagic (mean 2.9%) complications, the neurological morbidity (mean 3.5%) and the reported mortality (mean 3.4%) are the main limits of this technique. CONCLUSION Treatment with FDDs is a feasible and effective technique for unruptured aneurysms with complex anatomy (fusiform, dissecting, large neck, bifurcation with side branches) where coiling and clipping are difficult or impossible. Patient selection is very important to avoid complications and reduce the risk of morbidity and mortality. Further studies with longer follow-up are necessary to define the rate of complete occlusion.
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Affiliation(s)
- Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Giuseppe Leone
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Mariano Marseglia
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Giuseppe Mariniello
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Ferdinando Caranci
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Arturo Brunetti
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
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Mariniello G, Peca C, Del Basso De Caro M, Carotenuto B, Formicola F, Elefante A, Maiuri F. Brain gliomas presenting with symptoms of spinal cord metastasis. Neuroradiol J 2015. [PMID: 26216664 DOI: 10.1177/1971400915594534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three patients with brain gliomas (aged 41, 37, and 43 years) presented spinal cord symptoms as first neurological presentation (two cases) or at anaplastic progression (one case). Histologically, two cases were anaplastic (WHO III) astrocytomas and one anaplastic (WHO III) oligodendroglioma. The spinal surgery consisted of partial tumor resection in two cases with localized spinal cord metastasis, and tumor biopsy in another with diffuse spreading to the conus and cauda. Spinal irradiation was performed in one case. The time interval between the spinal surgery and the appearance of brain symptoms was very short (1 month or less). Two patients underwent brain surgery (tumor resection in one and stereotactic biopsy in another). The survival time was very short (2 and 3 months) in the two patients with anaplastic astrocytoma, whereas the patient with anaplastic oligodendroglioma survived 1 year after the spinal surgery. Brain gliomas may exceptionally present with symptoms of a spinal cord metastasis. The magnetic resonance imaging finding of a spinal cord enhancing lesion, particularly if associated with root enhancement, should suggest the presence of a brain glioma. In cases with a localized spinal lesion, an early spinal surgery is advised for both diagnosis and decompression of the nervous structures. However, the clinical outcome is poor and the survival time is short.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences and Reproductive and OdontostomatologicalSciences, Neurosurgical Clinic
| | - Carmela Peca
- Department of Neurosciences and Reproductive and OdontostomatologicalSciences, Neurosurgical Clinic
| | | | - Biagio Carotenuto
- Department of Advanced Biomedical Sciences, Section of Neuroradiology, "Federico II" University School of Medicine, Naples, Italy
| | - Fabiana Formicola
- Department of Advanced Biomedical Sciences, Section of Neuroradiology, "Federico II" University School of Medicine, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Section of Neuroradiology, "Federico II" University School of Medicine, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and OdontostomatologicalSciences, Neurosurgical Clinic
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Briganti F, Leone G, Marseglia M, Cicala D, Caranci F, Maiuri F. p64 Flow Modulation Device in the treatment of intracranial aneurysms: initial experience and technical aspects. J Neurointerv Surg 2015; 8:173-80. [PMID: 25895510 DOI: 10.1136/neurintsurg-2015-011743] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/30/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Experience with the endovascular treatment of cerebral aneurysms by flow diverter devices (FDDs) is limited to four devices (Pipeline, Covidien; FRED, Microvention; Silk, Balt Extrusion; Surpass, Stryker), as reported in different studies. OBJECTIVE To describe the initial experience and the technical innovations of a new-generation FDD (p64 Flow Modulation Device, Phenox, Bochum, Germany). METHODS Between December 2014 and February 2015, six intracranial aneurysms in five patients (four women, one man; mean age 63 years) were treated with the p64 Flow Modulation Device. RESULTS Immediate post-treatment angiography showed reduced flow into all aneurysms. No long-term angiographic data are available. The device may be easily deployed and totally retrieved with a unique mechanical detachment. No periprocedural technical complications occurred. No early or delayed aneurysm rupture, no ischemic or hemorrhagic complications, and no neurological morbidity or death were seen. CONCLUSIONS Treatment of cerebral aneurysms with the p64 Flow Modulation Device is a safe procedure with no technical complications. The mechanical detachment and the 100% retrievability are significant advantages of this new device. However, large prospective studies with long-term clinical and angiographic follow-up are necessary to assess the role of the p64 in the endovascular treatment of intracranial aneurysms.
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Affiliation(s)
- Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Giuseppe Leone
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Mariano Marseglia
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Domenico Cicala
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Ferdinando Caranci
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
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Briganti F, Delehaye L, Leone G, Sicignano C, Buono G, Marseglia M, Caranci F, Tortora F, Maiuri F. Flow diverter device for the treatment of small middle cerebral artery aneurysms. J Neurointerv Surg 2015; 8:287-94. [PMID: 25603808 DOI: 10.1136/neurintsurg-2014-011460] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/29/2014] [Indexed: 11/03/2022]
Abstract
PURPOSE Experience with the endovascular treatment of middle cerebral artery (MCA) aneurysms by flow diverter devices (FDD) is still limited. This study examines the results and complications of FDD for small aneurysms at this location. METHODS From February 2010 to December 2013, 14 patients (10 women; mean age 59 years) with 15 small MCA aneurysms were treated with FDD. All procedures were performed with the Pipeline embolization device (PED). RESULTS Complete occlusion was obtained in 12/15 aneurysms (80%) and partial occlusion in 3 (20%). Among 13 aneurysms with a side branch, this was patent at the angiographic control in 4 cases, showed decreased filling in 6, and was occluded in 3 (with neurological deficits in 2). All PEDs were patent at follow-up. Post-procedural ischemic complications occurred in 4 (27%) procedures with permanent neurological deficit (modified Rankin score 2) in 3 (21%). No early or delayed aneurysm rupture, no subarachnoid or intraparenchymal hemorrhage and no deaths occurred. CONCLUSIONS Endovascular treatment with FDD is a relatively safe treatment for small MCA aneurysms resulting in a high occlusion rate. The findings of this study suggest that complete occlusion after endovascular treatment with FDD can be delayed (>6 months). Ischemic complications may occur as early or delayed, particularly at clopidogrel interruption.
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Affiliation(s)
- Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Luigi Delehaye
- Unit of Interventional Neuroradiology, San Giovanni Bosco Hospital, Naples, Italy
| | - Giuseppe Leone
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Carmine Sicignano
- Unit of Interventional Neuroradiology, San Giovanni Bosco Hospital, Naples, Italy
| | - Giuseppe Buono
- Unit of Interventional Neuroradiology, San Giovanni Bosco Hospital, Naples, Italy
| | - Mariano Marseglia
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Ferdinando Caranci
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Fabio Tortora
- "Magrassi Lanzara" Clinical-Surgical Department, Second University of Naples, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
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Del Basso De Caro M, Guadagno E, Mariniello G, Pettinato G, Maiuri F. P06.01 * PROGESTERONE RECEPTOR EXPRESSION PREDICTS RECURRENCE OF CRANIAL BUT NOT SPINAL MENINGIOMAS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Di Carlo A, Del Basso De Caro M, Peca C, Sgulo F, Maiuri F. P04.12 * URINARY GELATINASE ACTIVITIES (MATRIX METALLOPROTEINASES 2 AND 9) IN HUMAN MENINGIOMA AND GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Briganti F, Napoli M, Leone G, Marseglia M, Mariniello G, Caranci F, Tortora F, Maiuri F. Treatment of intracranial aneurysms by flow diverter devices: long-term results from a single center. Eur J Radiol 2014; 83:1683-90. [PMID: 24985339 DOI: 10.1016/j.ejrad.2014.05.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/28/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2-4 years) of this treatment from a single-center. METHODS From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10mm) in 32 cases (82%), large (11-25mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. RESULTS Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and time of complete occlusion were not correlated with the aneurysm size. MCA aneurysms mainly showed partial occlusion (2/3 cases). Besides, large-neck aneurysms and those with a vessel arising from the sac mainly showed late (>6 months) or partial occlusion. CONCLUSION FDD are a safe and efficacious treatment of intracranial aneurysms, resulting in high occlusion rate and low incidence of complications. It should be the treatment of choice for the large-neck aneurysm of the ICA.
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Donzelli R, Mariniello G, Vitelli M, Capone C, Sgulò F, Dones F, Maiuri F. Reconstruction of artery wall in experimental giant aneurysms. J Neurosurg Sci 2014; 58:103-111. [PMID: 24819487] [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: 06/03/2023]
Abstract
AIM This study describes five experimental techniques for the surgical treatment of giant aneurysms based on the resection of the aneurysm sac and reconstruction of the arterial wall. METHODS The aneurysm was realized with a venous graft implanted with end-to-side anastomosis on the common carotid artery on 50 rabbits (with each technique realized in 10 rabbits). The first two experimental techniques (A and B) involve the reconstruction of the artery wall by a synthetic dural patch and by direct suture reinforced by a venous patch, respectively. In the model C a collateral branch arising from the aneurysm is resected and reimplanted on the parent artery after aneurysm resection. In the experimental model D the arterial defect is closed by a venous patch surrounding the whole arterial wall and sutured with the aid of fibrin glue. In the model E clamping of the parent artery proximal to the aneurysm site and termino-lateral anastomosis with the contralateral artery lead to the thrombosis of the aneurysm fulled only by refluent flow. RESULTS AND CONCLUSION The venous pouch experimental models are useful to realize giant aneurysms. The above described techniques allow to realize the reconstruction of the arterial wall without stenosis and shortening the clamping time.
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Affiliation(s)
- R Donzelli
- Department of Neurosurgical Sciences "Federico II" University of Naples, Naples, Italy -
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45
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Briganti F, Leone G, Napoli M, Lauriola W, Florio F, Maiuri F. Early Fatal Hemorrhage After Endovascular Treatment of a Giant Aneurysm with Flow Diverter Device and Coils. Clin Neuroradiol 2014; 25:201-5. [DOI: 10.1007/s00062-014-0310-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/25/2014] [Indexed: 11/29/2022]
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46
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Mariniello G, Peca C, De Caro MDB, Giamundo A, Donzelli R, Maiuri F. Glioblastoma in the elderly: the impact of advanced age on treatment and survival. J Neurol Surg A Cent Eur Neurosurg 2014; 75:276-81. [PMID: 24390930 DOI: 10.1055/s-0033-1349713] [Citation(s) in RCA: 5] [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] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effects of combined treatments on the outcome and survival of elderly (≥ 65 years) patients with glioblastoma as compared with younger ones. MATERIAL AND METHODS Fifty consecutive elderly (≥ 65 years) patients (group A) who underwent complete or subtotal (> 80%) resection of brain glioblastoma followed by irradiation and chemotherapy with temozolomide between 2004 and 2009 were retrospectively reviewed and compared with 50 glioblastoma patients aged < 65 years, treated in the same period (group B). Patient sex, tumor location, size and side, combined treatments, reoperation, progression-free survival, and overall survival were compared in the two groups by using the Kaplan-Meyer method. RESULTS There were no significant differences between the two groups for tumor location, size and side, and Ki-67 Li. Forty-four of 50 group B patients were treated by the Stupp protocol, whereas all group A patients underwent irradiation and adjuvant temozolomide. Second-line chemotherapy was administrated in 32% of group A and 76% of group B cases, and reoperation was performed in 16% and 36%, respectively. The median survival of the overall series of 100 patients was 15.6 months. Group A patients (≥ 65 years) had a median survival of 14.5 months, significantly lower than group B cases (17 months) (p = 0.02). CONCLUSION Elderly patients with glioblastoma may benefit from combined treatments, including surgery, radiotherapy, and chemotherapy. Although younger patients do survive longer than older ones, the difference of survival is less significant if several criteria of selection to surgery, such as good Karnofsky performance status (KPS), largely resectable tumor, and no significant comorbidity, are respected.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy
| | - Carmela Peca
- Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy
| | - Marialaura Del Basso De Caro
- Department of Biomorphologic and Functional Sciences, Section of Pathology, "Federico II" University School of Medicine, Naples, Italy
| | - Arcangelo Giamundo
- Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy
| | - Renato Donzelli
- Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy
| | - Francesco Maiuri
- Department of Neurosciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Napoli, Italy
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Mariniello G, Bonavolontà G, Tranfa F, Maiuri F. Management of the optic canal invasion and visual outcome in spheno-orbital meningiomas. Clin Neurol Neurosurg 2013; 115:1615-20. [DOI: 10.1016/j.clineuro.2013.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/08/2013] [Accepted: 02/09/2013] [Indexed: 10/27/2022]
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Donzelli R, Maiuri F, Piscopo GA, de Notaris M, Colella A, Divitiis E. Role of extracellular matrix components in facial nerve regeneration: an experimental study. Neurol Res 2013; 28:794-801. [PMID: 17288733 DOI: 10.1179/016164106x110427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the role of extracellular matrix components in nerve regeneration. Matrigel, a complex of extracellular matrix components such as laminin (the most abundant) heparan sulphate proteoglycans (HSPG), type IV collagen and fibronectin, was used. METHODS Forty male rabbits, which had undergone section of the right facial nerve, were later treated by reinnervation through an artificial graft of expanded polytetrafluoroethylene (ePTFE). In 20 animals the tubes of ePTFE were filled with Matrigel; in 20 control animals the tubes were filled with saline solution. RESULTS The Matrigel group showed a better axonal organization and a significantly higher number of regenerated axons in the early phases (at days 15 and 30 respectively) than the control group, whereas the difference of the axons number at day 60 was less significant; besides, the axon diameter and the myelin thickness were not significantly improved by Matrigel. DISCUSSION Our data suggest that Matrigel is an important factor in promoting and enhancing the early phases of the regeneration after nerve injuries. Tree neurite promoting agents, such as laminin, fibronectin and collagen, allow a more systematic and agonized regeneration. Extracellular matrix components may represent a direction guidance for axonal pathway.
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Affiliation(s)
- Renato Donzelli
- Department of Neurosurgery, University 'Federico II' School of Medicine, Naples, Italy.
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Briganti F, Leone G, Briganti G, Orefice G, Caranci F, Maiuri F. Spontaneous resolution of Chiari type 1 malformation. A case report and literature review. Neuroradiol J 2013; 26:304-9. [PMID: 23859287 DOI: 10.1177/197140091302600309] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/10/2013] [Indexed: 11/17/2022] Open
Abstract
We describe a 62-year-old woman who presented with a history of ataxia, dizziness and urinary urgency. Neurological examination disclosed a positive Romberg sign, ataxia and postural instability. A magnetic resonance imaging (MRI) scan showed Chiari type 1 malformation (CM1). Forty-eight months later, the patient was clinically improved and underwent a second MRI examination, which showed complete resolution of the Chiari 1 malformation. Spontaneous resolution of CM1 is exceptionally rare and has to be considered in the radiological and clinical management.
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Affiliation(s)
- F Briganti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Elefante A, Caranci F, Del Basso De Caro ML, Peca C, Guadagno E, Severino R, Mariniello G, Maiuri F. Paravertebral high cervical chordoma. A case report. Neuroradiol J 2013; 26:227-32. [PMID: 23859247 DOI: 10.1177/197140091302600214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/13/2013] [Indexed: 11/17/2022] Open
Abstract
Spinal chordomas are more often located on the midline and are associated with marked destruction of the vertebral bodies. We report a rare case of large cervical (C2-C3) right lateral paravertebral chordoma extending into the spinal canal through a very enlarged intervertebral foramen. The tumor was initially diagnosed as a mucous adenocarcinoma on a percutaneous needle biopsy. However, the neuroradiological features, including the well-defined tumor margins, the regular and sclerosing lytic bone changes with regular enlargement of the intervertebral C2-C3 foramen, were in favor of a more slowly growing lesion, such as schwannoma or neurofibroma. At surgery a well-demarcated capsulated tumor involving the nerve root was partially resected. Histology was in favor of a low-grade chordoma (Ki-67/MIB-1<1%). Postoperative proton beam therapy was also performed. The differential neuroradiological diagnosis is discussed.
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Affiliation(s)
- A Elefante
- Advanced Biomedical Sciences, Section of Neuroradiology, Federico II University, Naples, Italy.
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