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Corvino S, Kassam A, Piazza A, Corrivetti F, Spiriev T, Colamaria A, Cirrottola G, Cavaliere C, Esposito F, Cavallo LM, Iaconetta G, de Notaris M. Open-door extended endoscopic transorbital technique to the paramedian anterior and middle cranial fossae: technical notes, anatomomorphometric quantitative analysis, and illustrative case. Neurosurg Focus 2024; 56:E7. [PMID: 38560942 DOI: 10.3171/2024.1.focus23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The superior eyelid endoscopic transorbital approach (SETOA) provides a direct and short minimally invasive route to the anterior and middle skull base. Nevertheless, it uses a narrow corridor that limits its angles of attack. The aim of this study was to evaluate the feasibility and potential benefits of an "extended" conservative variant of the "standard" endoscopic transorbital approach-termed "open-door"-to enhance the exposure of lesions affecting the paramedian aspect of the anterior and middle cranial fossae. METHODS First, the authors described the technical nuances of the open-door extended transorbital approach (ODETA). Next, they documented its morphometric advantages over standard SETOA. Finally, they provided a clinical-anatomical application to demonstrate enhanced exposure and better angles of attack to treat lesions occupying the paramedian anterior and middle cranial fossae. Five adult cadaveric specimens (10 sides) initially underwent standard SETOA and then extended open-door SETOA (ODETA to the paramedian anterior and middle fossae). The adjunct of hinge-orbitotomy, through three surgical steps and straddling the frontozygomatic suture, converted conventional SETOA to its extended open-door variant. CT scans were performed before dissection and uploaded to the neuronavigation system for quantitative analysis. The angles of attack on the axial plane that addressed four key landmarks, namely the tip of the anterior clinoid process (ACP), foramen rotundum (FR), foramen ovale (FO), and trigeminal impression (TI), were calculated for both operative techniques and compared. RESULTS Hinge-orbitotomy of the extended open-door SETOA resulted in several surgical, functional, and esthetic advantages: it provided wider axial angles of attack for each of the target points, with a gain angle of 26.68° ± 1.31° for addressing the ACP (p < 0.001), 29.50° ± 2.46° for addressing the FR (p < 0.001), 19.86° ± 1.98° for addressing the FO (p < 0.001), and 17.44° ± 2.21° for addressing the lateral aspect of the TI (p < 0.001), while hiding the skin scar, avoiding temporalis muscle dissection, preserving flap vascularization, and decreasing the rate of bone infection and degree of orbital content retraction. CONCLUSIONS The extended open-door technique may be specifically suited for selected patients affected by paramedian anterior and middle fossae lesions, with prevalent anteromedial extension toward the anterior clinoid, the foremost compartment of the cavernous sinus and FR and not completely controlled with the pure endoscopic transorbital approach.
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Affiliation(s)
- Sergio Corvino
- 1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
- 2Department of Neuroscience and Reproductive and Odontostomatological Sciences, PhD Program in Neuroscience, Università degli Studi di Napoli "Federico II," Naples, Italy
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
| | - Amin Kassam
- 4Department of Neurosciences, Intent Medical Group, Northshore University Neurosciences Institute, Arlington Heights, Illinois
| | - Amedeo Piazza
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
- 5Department of Neurosurgery, "Sapienza" University of Rome, Italy
| | - Francesco Corrivetti
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
- 6Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Salerno, Italy
| | - Toma Spiriev
- 7Department of Neurosurgery, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
| | | | | | | | - Felice Esposito
- 1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Luigi Maria Cavallo
- 1Department of Neuroscience and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Giorgio Iaconetta
- 10Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Matteo de Notaris
- 3Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Italy
- 10Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
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Ius T, Montemurro N, Lombardi G, Berardinelli J, Romano A, Barresi V, Cerretti G, Guarnera A, Tel A, Cavallo LM, Pasqualetti F, Feletti A. Decoding the puzzle: A multidisciplinary systematic review of adult brainstem glioma. Crit Rev Oncol Hematol 2024; 196:104261. [PMID: 38395241 DOI: 10.1016/j.critrevonc.2024.104261] [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: 08/06/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Adult brainstem gliomas (BSGs) are a group of rare central nervous system tumors with varying prognoses and controversial standard treatment strategies. To provide an overview of current trends, a systematic review using the PRISMA guidelines, Class of evidence (CE) and strength of recommendation (SR), was conducted. The review identified 27 studies. Surgery was found to have a positive impact on survival, particularly for focal lesions with CE II SR C. Stereotactic image-guided biopsy was recommended when resective surgery was not feasible with CE II and SR B. The role of systemic treatments remains unclear. Eight studies provided molecular biology data. This review gathers crucial literature on diagnosis and management of adult BSGs. It provides evidence-based guidance with updated recommendations for diagnosing and treating, taking into account recent molecular and genetic advancements. The importance of brain biopsy is emphasized to optimize treatment using emerging genetic-molecular findings and explore potential targeted therapies.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department University Hospital of Udine, Italy.
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Andrea Romano
- Department of Neuroradiology, NESMOS S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessia Guarnera
- Department of Neuroradiology, NESMOS S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department University Hospital of Udine, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Pasqualetti
- Division of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Italy
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Pivonello C, Patalano R, Simeoli C, Montò T, Negri M, Amatrudo F, Di Paola N, Larocca A, Crescenzo EM, Pirchio R, Solari D, de Angelis C, Auriemma RS, Cavallo LM, Colao A, Pivonello R. Circulating myomiRNAs as biomarkers in patients with Cushing's syndrome. J Endocrinol Invest 2024; 47:655-669. [PMID: 37682493 PMCID: PMC10904409 DOI: 10.1007/s40618-023-02184-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Impairment of skeletal muscle mass and strength affects 40-70% of patients with active Cushing's syndrome (CS). Glucocorticoid excess sustains muscle atrophy and weakness, while muscle-specific microRNAs (myomiRs) level changes were associated with muscle organization and function perturbation. The aim of the current study is to explore changes in circulating myomiRs in CS patients compared to healthy controls and their involvement in IGFI/PI3K/Akt/mTOR pathway regulation in skeletal muscle. METHODS C2C12, mouse myocytes, were exposed to hydrocortisone (HC), and atrophy-related gene expression was investigated by RT-qPCR, WB and IF to assess HC-mediated atrophic signalling. miRNAs were evaluated in HC-treated C2C12 by PCR Arrays. MyomiRs significantly overexpressed in C2C12 were investigated in 37 CS patients and 24 healthy controls serum by RT-qPCR. The anti-anabolic role of circulating miRNAs significantly upregulated in CS patients was explored in C2C12 by investigating the IGFI/PI3K/Akt/mTOR pathway regulation. RESULTS HC induced higher expression of atrophy-related genes, miR-133a-3p, miR-122-5p and miR-200b-3p in C2C12 compared to untreated cells. Conversely, the anabolic IGFI/PI3K/Akt/mTOR signalling was reduced and this effect was mediated by miR-133a-3p. In CS patients miR-133a-3p and miR-200b-3p revealed higher circulating levels (p < 0.0001, respectively) compared to controls. ROC curves for miR-133a-3p (AUC 0.823, p < 0.0001) and miR-200b-3p (AUC 0.850, p < 0.0001) demonstrated that both myomiRs represent potential biomarkers to discriminate between CS and healthy subjects. Pearson's correlation analysis revealed that circulating levels of miR-133a-3p are directly correlated with 24 h urinary-free cortisol level (r = 0.468, p = 0.004) in CS patients. CONCLUSIONS HC induces atrophic signals by miR-133a-3p overexpression in mouse myocytes and humans. Circulating miR-133a-3p is promising biomarkers of hypercortisolism.
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Affiliation(s)
- C Pivonello
- Department of Public Health, Federico II University, Naples, Italy
| | - R Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - C Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - T Montò
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - M Negri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - F Amatrudo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - N Di Paola
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - A Larocca
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - E M Crescenzo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - R Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - D Solari
- Department of Neuroscience, Division of Neurosurgery, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - C de Angelis
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - R S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - L M Cavallo
- Department of Neuroscience, Division of Neurosurgery, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy.
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy.
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Berardinelli J, Solari D, di Maria D, Parbonetti G, Cavallo LM, de Notaris M. Case Report of Indocyanine Green Endoscopy for Intrasellar Pituitary Adenoma Resection. World Neurosurg 2024; 183:14. [PMID: 38070734 DOI: 10.1016/j.wneu.2023.12.008] [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: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
Indocyanine green (ICG) angiography has become an established technology in many surgical fields, as well as in neurosurgery with the first application of microscope-integrated indocyanine angiography, which dates to 2003.1 More recently we observed the integration of ICG into endoscopic visualization (e-ICG), which resulted in different applications during the endoscopic endonasal approach ranging from evaluation of intranasal flap perfusion to differentiation of pituitary neuroendocrine tumors from normal gland or even as a predictive factor of postoperative visual function after expanded approaches.2-8 A 49-year-old woman was admitted to our hospital after a 1-year history of amenorrhea and radiologic finding of an intrasellar lesion. The clinical picture was compatible with a nonfunctioning pituitary neuroendocrine tumor, and the mass was completely removed by means of an endoscopic endonasal approach with intraoperative use of e-ICG (Video 1). A 25 mg intravenous bolus of ICG was injected immediately after completion of the sphenoid phase of the approach. ICG was visualized with a dedicated ICG-integrated endoscope coupled to an IMAGE1 S camera system set on Chroma enhancement mode. Near-infrared excitation of fluorescence (780-820 nm) was obtained using a D-light P Cold Light Fountain. At follow-up, the patient experienced resolution of her symptoms, without residues or relapses on control magnetic resonance. This case sheds light on some possible applications and advantages of e-ICG, including visualization of internal carotid arteries before the sellar opening, individuation of the pituitary gland, its distinction from the adenomatous tissue, and the possible evaluation of its degree of compression.
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Affiliation(s)
- Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy.
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Domenico di Maria
- Department of Medical Sciences, Otorhinolaryngology Operative Unit, "G. Rummo" Hospital, Benevento, Italy
| | - Giovanni Parbonetti
- Department of Neurosciences, Neurosurgery Operative Unit, "G. Rummo" Hospital, Benevento, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Matteo de Notaris
- Unit of Neurosurgery, University Hospital "San Gionanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy; Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
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5
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Corrivetti F, Guizzardi G, Bove I, Enseñat J, Prats-Galino A, Solari D, Cavallo LM, Iaconetta G, Di Somma A, de Notaris M. Transorbital Exposure of the Internal Carotid Artery: A Detailed Anatomic and Quantitative Roadmap for Safe Successful Surgery. Oper Neurosurg (Hagerstown) 2024; 26:314-322. [PMID: 37815220 DOI: 10.1227/ons.0000000000000943] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The superior eyelid endoscopic transorbital approach has rapidly gained popularity among neurosurgeons for its advantages in the treatment, in a minimally invasive fashion, of a large variety of skull base pathologies. In this study, an anatomic description of the internal carotid artery (ICA) is provided to identify risky zones related to lesions that may be approached using this technique. In this framework, a practical roadmap can help the surgeon to avoid potentially life-threatening iatrogenic vascular injuries. METHODS Eight embalmed adult cadaveric specimens (16 sides) injected with a mixture of red latex and iodinate contrast underwent superior eyelid transorbital endoscopic approach, followed by interdural dissection of the cavernous sinus, extradural anterior clinoidectomy, and anterior petrosectomy, to expose the entire "transorbital" pathway of the ICA. Furthermore, the distance of each segment of the ICA explored by means of the superior eyelid endoscopic transorbital approach was quantitatively analyzed using a neuronavigation system. RESULTS We exposed 4 distinct ICA segments and named the anatomic window in which they are displayed in accordance with the cavernous sinus triangles distribution of the middle cranial fossa: (1) clinoidal (Dolenc), (2) infratrochlear (Parkinson), (3) anteromedial (Mullan), and (4) petrous (Kawase). Critical anatomy and key surgical landmarks were defined to further identify the main danger zones during the different steps of the approach. CONCLUSION A detailed knowledge of the reliable surgical landmarks of the course of the ICA as seen through an endoscopic transorbital route and its relationship with the cranial nerves are essential to perform a safe and successful surgery.
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Affiliation(s)
- Francesco Corrivetti
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno , Italy
| | - Giulia Guizzardi
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Ilaria Bove
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Giorgio Iaconetta
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno , Italy
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Matteo de Notaris
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno , Italy
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno , Italy
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento , Italy
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Bove I, Solari D, Colangelo M, Fabozzi GL, Esposito F, Tranfa F, Cappabianca P, Cavallo LM. Analysis of visual impairment score in a series of 48 tuberculum sellae meningiomas operated on via the endoscopic endonasal approach. J Neurosurg 2024; 140:696-704. [PMID: 37878006 DOI: 10.3171/2023.7.jns23437] [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: 02/23/2023] [Accepted: 07/14/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Tuberculum sellae meningioma (TSM) represents a complex skull base tumor. The primary goals of surgical treatment are represented by maximal safe resection and visual recovery; therefore, appropriate patient selection is critical to optimize results. In the last 2 decades, the endoscopic endonasal approach (EEA) has appeared as a successful and viable strategy for the management of these tumors. The authors identified preoperative factors associated with extent of resection and visual outcome after EEA for TSM. METHODS In this retrospective cohort study, the authors analyzed patients who underwent extended endoscopic endonasal surgery for TSM between January 2005 and April 2022 at the Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. Tumor size, vessel encasement, and optic canal involvement were classified according to University of California, San Francisco, score. Visual acuity and visual fields were analyzed according to the visual impairment score (VIS), defined as a four-level classification: grade 1 (VIS 0-25), grade 2 (VIS 26-50), grade 3 (VIS 51-75), and grade 4 (VIS 76-100). Ophthalmological functions were tested preoperatively and during the early postoperative period (within 6 months after surgery) and late postoperative period. RESULTS A total of 48 patients were enrolled. Forty-one (85.4%) patients experienced blurred vision or visual field defect as a presenting sign. Gross-total resection was achieved in 40 (83.3%), near-total resection in 2 (4.2%), and subtotal resection in 6 (12.5%). Visual defect improved in 82.9% (34/41) of cases, 12.2% (5/41) had no significant changes, and 2.4% (1/41) had worsened visual defect. The mean change in VIS was 42% (95% CI 58.77-31.23). Visual outcome was poorer when preoperative VIS (VIS-pre) was greater than 25 (p = 0.02). Six postoperative CSF leaks occurred (12.5%), and 1 patient (2.1%) required revision surgery. CONCLUSIONS The EEA is a safe and effective approach for TSM removal, with the advantage of preserving optic apparatus vascularization, and can promote gross-total resection and visual improvement. The authors have defined four categories based on VIS that relate to postoperative outcome: the lower the VIS-pre, the higher the rate of postoperative VIS improvement. This finding may be useful for predicting a patient's visual outcome at the preoperative stage.
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Affiliation(s)
- Ilaria Bove
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Domenico Solari
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Manuel Colangelo
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Gianluca Lorenzo Fabozzi
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Felice Esposito
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Fausto Tranfa
- 2Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Ophthalmology, University of Naples Federico II, Naples, Italy
| | - Paolo Cappabianca
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
| | - Luigi Maria Cavallo
- 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples Federico II, Naples, Italy; and
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Corvino S, Piazza A, Spiriev T, Tafuto R, Corrivetti F, Solari D, Cavallo LM, Di Somma A, Enseñat J, de Notaris M, Iaconetta G. The Sellar Region as Seen from Transcranial and Endonasal Perspectives: Exploring Bony Landmarks Through New Surface Photorealistic Three-Dimensional Model Reconstruction for Neurosurgical Anatomy Training. World Neurosurg 2024:S1878-8750(24)00219-5. [PMID: 38342178 DOI: 10.1016/j.wneu.2024.02.022] [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: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Virtual reality-based learning of neuroanatomy is a new feasible method to explore, visualize, and dissect interactively complex anatomic regions. We provide a new interactive photorealistic three-dimensional (3D) model of sellar region microsurgical anatomy that allows side-by-side views of exocranial and endocranial surfaces to be explored, with the aim of assisting young neurosurgery residents in learning microsurgical anatomy of this complex region. METHODS Four head specimens underwent an endoscopic endonasal approach extended to the anterior and posterior skull base to expose the main bony anatomic landmarks of the sellar region. The same bony structures were exposed from a transcranial perspective. By using a photogrammetry method, multiple photographs from both endocranial and exocranial perspectives, different for angulations and depth, were captured, fused, and processed through dedicated software. RESULTS All relevant bony structures were clearly distinguishable in the 3D model reconstruction, which provides several benefits in neuroanatomy learning: first, it replicates bony structures with high degrees of realism, accuracy, and fidelity; in addition, it provides realistic spatial perception of the depth of the visualized structures and their anatomic relationships; again, the 3D model is interactive and allows a 360° self-guided tour of the reconstructed object, so that the learner can read the bones and their anatomic relationship from all desired points of view. CONCLUSIONS Detailed knowledge of key surgical landmarks representing keyholes and/or anatomic structures to not violate is mandatory for safer surgery, especially for a complex region such as the skull base. Highly accurate virtual and functional neurosurgical models, such as photogrammetry, can generate a realistic appearance to further improve surgical simulators and learn neuroanatomy.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy; Department of Neuroscience and Reproductive and Odontostomatological Sciences, Program in Neuroscience, Università degli Studi di Napoli "Federico II", Naples, Italy; Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Amedeo Piazza
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy; Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Toma Spiriev
- Department of Neurosurgery, Acibadem Cityclinic University Hospital Tokuda, Sofia, Bulgaria
| | - Roberto Tafuto
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy; Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Francesco Corrivetti
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy; Department of Neurosurgery, San Luca Hospital, Salerno, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain; Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Matteo de Notaris
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy; Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
| | - Giorgio Iaconetta
- Neurosurgical Clinic A.O.U. "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
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d'Avella E, Somma T, Fabozzi GL, Committeri U, Romano A, Cappabianca P, Cavallo LM. Endoscopic transorbital and transcranial multiportal resection of a sphenoorbital meningiomas with custom bone 3D printing reconstruction: Case report. Head Neck 2024; 46:E18-E25. [PMID: 37994687 DOI: 10.1002/hed.27582] [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: 05/29/2023] [Revised: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Sphenoorbital meningiomas (SOM) harbor intrinsic features that render their surgical management and the reconstruction of the resulting bony defect overtly challenging. METHODS A 70-year-old woman, harboring a long-standing left frontotemporal bony swelling conservatively managed, presented with progressive left proptosis. Radiological features were consistent with an en plaque SOM. A one-step multiportal transcranial and endoscopic transorbital approach (TOA) with custom bone three-dimensional (3D) printing reconstruction using polymethylmethacrylate (PMMA) was scheduled. RESULTS Postoperative functional and aesthetic results were excellent, with proptosis and calvarian deformity resolution. Tumor subtotal resection was achieved. Histopathological diagnosis confirmed a transitional meningioma (WHO grade I). CONCLUSIONS The endoscopic TOA, isolated or as part of a multiportal strategy, has entered the surgical armamentarium for the treatment of SOMs. A customized PMMA cranioplasty can be considered a possible option for the reconstruction of large bony defects in a one-step fashion.
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Affiliation(s)
- Elena d'Avella
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Gianluca Lorenzo Fabozzi
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Umberto Committeri
- Division of Maxillofacial Surgery Unit, Department of Neurosciences and Reproductive and Dental Sciences, Federico II University of Naples, Naples, Italy
| | - Antonio Romano
- Division of Maxillofacial Surgery Unit, Department of Neurosciences and Reproductive and Dental Sciences, Federico II University of Naples, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
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d'Avella E, Vitulli F, Berardinelli J, Cinalli G, Solari D, Cappabianca P, Cavallo LM. Systematic review of transcranial and endoscopic endonasal approaches for craniopharyngiomas in children: is there an evolution? J Neurosurg Pediatr 2024; 33:73-84. [PMID: 37948683 DOI: 10.3171/2023.9.peds23117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The optimal surgical approach for pediatric craniopharyngiomas (CPs) remains a matter of debate, with selection bias classically precluding a fair comparison of outcomes between the transcranial approach (TCA) and endoscopic endonasal approach (EEA). The purpose of this systematic review was to analyze the current role of EEA in the treatment of pediatric CPs and to determine whether, upon expansion of its indications, a comparison with TCA is valid. METHODS A systematic review of English-language articles published between February 2010 and June 2022 was performed to identify studies in the MEDLINE (PubMed) and Embase databases reporting on the resection of pediatric CPs. Included were articles reporting on pediatric CPs removed through TCA or EEA. Case reports, review articles, and earlier or less comprehensive series by the same center were excluded. Baseline characteristics and outcomes were analyzed. Prediction intervals (PIs), heterogeneity (Q, I2, and τ2 statistics), and publication bias (funnel plot analysis) were assessed. RESULTS A total of 835 patients underwent TCA (18 articles) and 403 patients underwent EEA (19 articles). Preoperatively, the mean patient age (p = 0.055, PI = 5.05-15.11), visual impairment (p = 0.08, PI = 19.1-90.5, I2 = 80%), and hypothalamic syndrome (p = 0.17, PI = 6.5-52.2, I2 = 62%) did not significantly differ between the EEA and TCA groups. Endocrine deficit (anterior pituitary deficit [p < 0.001, PI = 16.5-92.9, I2 = 81%] and diabetes insipidus [p < 0.001, PI = 6.3-60.6, I2 = 43%]) was more frequent in the EEA group. Hydrocephalus and signs/symptoms of raised intracranial pressure were significantly higher (p < 0.001, PI = 5.2-73.3, I2 = 70% vs p < 0.001, PI = 4.6-73, I2 = 62%, respectively) in the TCA group. Recurrent lesions (p = 0.52, PI = 2.7-87.3, I2 = 13%), tumor size (p = 0.25, PI = 22.1-56.8), third ventricle involvement (p = 0.053, PI = 10.9-81.3, I2 = 69%), and hypothalamic involvement (p = 0.06, PI = 8.5-83.6, I2 = 79%) did not differ significantly between the approaches. EEA was preferred (p = 0.006, PI = 26.8-70.8, I2 = 40%) for sellar-suprasellar CPs, whereas TCA was preferred for purely suprasellar CPs (p = 0.007, PI = 13.5-81.1, I2 = 61%). There was no difference between the approaches for purely intrasellar lesions (p = 0.94, PI = 0-62.7, I2 = 26%). The breadth of PIs, I2 values, and analysis of publication bias showed substantial variability among the pooled data, hindering the possibility of outcome meta-analyses. CONCLUSIONS With the adoption of extended approaches, the use of EEA became appropriate for a wider spectrum of pediatric CPs, with associated excellent outcomes. Although a fair comparison between outcomes in the EEA and TCA groups was hindered because of the differences in patient populations and tumor subtypes, given the increased versatility of EEA and improved expertise in its use, surgeons can now select the optimal surgical approach based on the unique benefits and drawbacks of each pediatric CP.
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Affiliation(s)
- Elena d'Avella
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy; and
| | - Francesca Vitulli
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy; and
| | - Jacopo Berardinelli
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy; and
| | - Giuseppe Cinalli
- 2Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Domenico Solari
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy; and
| | - Paolo Cappabianca
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy; and
| | - Luigi Maria Cavallo
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, "Federico II" University, Naples, Italy; and
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Zoia C, Mastantuoni C, Solari D, de Notaris M, Corrivetti F, Spena G, Cavallo LM. Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study. Brain Spine 2023; 4:102719. [PMID: 38163002 PMCID: PMC10753433 DOI: 10.1016/j.bas.2023.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
Introduction The transorbital route has been proposed for addressing orbital and paramedian skull base lesions. It can be complemented by further marginotomies, as per "extended-transorbital approach" and combined with others ventro-basal approaches featuring the concept of "multiportal surgery". Nevertheless, it cannot address some anatomical regions like the clinoid, carotid bifurcation and the Sylvian fissure. Therefore, we propose a combined transorbital and a supraorbital approach, attainable by a single infra-brow incision, and we called it "Uniportal multicorridor" approach. Research question The aim of our study is to verify its feasibility and deep anatomical targets through a cadaveric study. Materials and methods Anatomic dissections were performed at the Laboratory of ICLO Teaching and Research Center (Verona, Italy) on four formalin-fixed cadaveric heads injected with colored neoprene latex (8 sides). A stepwise dissection of the supraorbital and transorbital approaches (with an infra-brow skin incision) to the anterior tentorial incisura, clinoid area, lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure is described. Results We analyzed the anatomic areas reached by the transorbital corridor dividing them as follow: lateral wall of the cavernous sinus, middle temporal fossa, posterior fossa, and Sylvian fissure; while the anatomic areas addressed by the supraorbital craniotomy were the clinoid area and the anterior tentorial incisura. Conclusions The described uniportal multi-corridor approach combines a transorbital corridor and a supraorbital craniotomy, providing a unique intra and extradural control over the anterior, middle, and posterior fossa, tentorial incisura and the Sylvian fissure, via an infra-brow skin incision.
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Affiliation(s)
- Cesare Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Ciro Mastantuoni
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, “San Pio” Hospital, Benevento, Italy
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Francesco Corrivetti
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | | | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita Degli Studi di Napoli Federico II, Naples, Italy
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Ius T, Lombardi G, Baiano C, Berardinelli J, Romano A, Montemurro N, Cavallo LM, Pasqualetti F, Feletti A. Surgical Management of Adult Brainstem Gliomas: A Systematic Review and Meta-Analysis. Curr Oncol 2023; 30:9772-9785. [PMID: 37999129 PMCID: PMC10670486 DOI: 10.3390/curroncol30110709] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/20/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
The present review aims to investigate the survival and functional outcomes in adult high-grade brainstem gliomas (BGSs) by comparing data from resective surgery and biopsy. MEDLINE, EMBASE and Cochrane Library were screened to conduct a systematic review of the literature, according to the PRISMA statement. Analysis was limited to articles including patients older than 18 years of age and those published from 1990 to September 2022. Case reports, review articles, meta-analyses, abstracts, reports of aggregated data, and reports on multimodal therapy where surgery was not the primary treatment were excluded. The ROBINS-I tool was applied to evaluate the risk of bias. Six studies were ultimately considered for the meta-analysis. The resective group was composed of 213 subjects and the bioptic group comprised 125. The analysis demonstrated a survival benefit in those patients in which an extensive resection was possible (STR HR 0.59 (95% CI 0.42, 0.82)) (GTR HR 0.63 (95% CI 0.43, 0.92)). Although surgical resection is associated with increased survival, the significantly higher complication rate makes it difficult to recommend surgery instead of biopsy for BSGs. Future investigations combining volumetric data and molecular profiles could add important data to better define the proper indication between resection and biopsy.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, 33100 Udine, Italy;
| | - Giuseppe Lombardi
- Department of Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.B.); (L.M.C.)
| | - Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.B.); (L.M.C.)
| | - Andrea Romano
- Department of Neuroradiology, NESMOS S.Andrea Hospital, University Sapienza, 00189 Rome, Italy;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, 56123 Pisa, Italy;
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.B.); (L.M.C.)
| | | | - Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, 37129 Verona, Italy;
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Cavallo LM, Solari D, d'Avella E, Colangelo M, Cappabianca P. Endoscopic Endonasal Approach for Tuberculum Sellae Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e273. [PMID: 37846141 DOI: 10.1227/ons.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/14/2023] [Indexed: 10/18/2023] Open
Abstract
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE Ideal indications for tuberculum sellae meningiomas (TSM) removal through endoscopic endonasal approach (EEA) are midline tumors (<3.5 cm), possibly with no optic canal invasion and no vessels encasement. The EEA is favored by a wide tuberculm sellae (TS) angle and a deep sella at the sphenoid sinus (SS). 1 Adequate removal of paranasal structures provides a wider surgical corridor ensuring exposure at the suprasellar area and safe instruments manuevrability. 2. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT The endoscopic transtuberculum transplanum approach allows for wide suprasellar intradural exposure. 3 Removal of the supraoptic recess (SOR) provides further lateral extension over the planum sphenoidale (PS) and proper management of dural involvement at the optic canal. 4. ESSENTIAL STEPS OF THE PROCEDURE The patients have consented to the procedure. Bone removal starts at the upper sella and TS and is extended anteriorly over the PS and laterally, upon needs, at the SORs. On dural opening, tumor devascularization, dedressing, debulking, and dissection are run. Skull base reconstruction is performed using the 3F technique. 5. PITFALLS/AVOIDANCE OF COMPLICATIONS In those cases with vessel encasement, possibility of achieving total resection has to be balanced with risk of vascular injury. 6 Optic canal dural invasion precludes tumor total removal; however, bony decompression is maximal using the EEA. Concerning postoperative cerebrospinal fluid fistula, nowadays the rates have dropped to <2%. VARIANTS AND INDICATIONS FOR THEIR USE A wider skull base osteodural opening allows for the removal of selected meningiomas extending to the PS and cribriform plate.
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Affiliation(s)
- Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Napoli "Federico II," Naples, Italy
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De Rosa A, Guizzardi G, Moncada M, Roldán P, Ferrés A, Topczewski TE, Somma T, Cavallo LM, González J, Enseñat J, Di Somma A. In Reply to the Letter to the Editor Regarding "Ultrasound-Oriented Surgical Planning ("UOSP") for Intracranial Lesions: A Systematic Integration to the Standard Preoperative Planning". World Neurosurg 2023; 178:277. [PMID: 37803668 DOI: 10.1016/j.wneu.2023.07.087] [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: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | | | - Marina Moncada
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Pedro Roldán
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Abel Ferrés
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | | | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Josep González
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain.
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De Rosa A, Mosteiro A, Guizzardi G, Roldán P, Torales J, Matas Fassi J, Cavallo LM, Solari D, Prats-Galino A, Di Somma A, Enseñat J. Endoscopic transorbital resection of the temporal lobe: anatomic qualitative and quantitative study. Front Neuroanat 2023; 17:1282226. [PMID: 37818154 PMCID: PMC10560990 DOI: 10.3389/fnana.2023.1282226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023] Open
Abstract
Objective Starting from an anatomic study describing the possibility of reaching the temporal region through an endoscopic transorbital approach, many clinical reports have now demonstrated the applicability of this strategy when dealing with intra-axial lesions. The study aimed to provide both a qualitative anatomic description of the temporal region, as seen through a transorbital perspective, and a quantitative analysis of the amount of temporal lobe resection achievable via this route. Material and methods A total of four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise description of the resection of the temporal lobe through a transorbital perspective is provided. Qualitative anatomical descriptions and quantitative analysis of the amount of the resection were evaluated by means of pre- and post-dissection CT and MRI scans, and three-dimensional reconstructions were made by means of BrainLab®Software. Results The transorbital route gives easy access to the temporal region, without the need for extensive bone removal. The resection of the temporal lobe proceeded in a subpial fashion, mimicking what happens in a surgical scenario. According to our quantitative analysis, the mean volume removed was 51.26%, with the most superior and lateral portion of the temporal lobe being the most difficult to reach. Conclusion This anatomic study provides qualitative and quantitative details about the resection of the temporal lobe via an endoscopic transorbital approach. Our results showed that the resection of more than half of the temporal lobe is possible through this surgical corridor. While the anterior, inferior, and mesial portions of the temporal lobe were easily accessible, the most superior and lateral segment was more difficult to reach and resect. Our study serves as an integration to the current anatomic knowledge and clinical practice knowledge highlighting and also as a starting point for further anatomic studies addressing more selected segments of the temporal lobe, i.e., the mesial temporal region.
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Affiliation(s)
- Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | | | | | - Pedro Roldán
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Jorge Torales
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Jessica Matas Fassi
- Department of Ophthalmology, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
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Corvino S, Armocida D, Offi M, Pennisi G, Burattini B, Mondragon AV, Esposito F, Cavallo LM, de Notaris M. The anterolateral triangle as window on the foramen lacerum from transorbital corridor: anatomical study and technical nuances. Acta Neurochir (Wien) 2023; 165:2407-2419. [PMID: 37479917 PMCID: PMC10477108 DOI: 10.1007/s00701-023-05704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/25/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Neurosurgical indications for the superior eyelid transorbital endoscopic approach (SETOA) are rapidly expanding over the last years. Nevertheless, as any new technique, a detailed knowledge of the anatomy of the surgical target area, the operative corridor, and the specific surgical landmark from this different perspective is required for a safest and successful surgery. Therefore, the aim of this study is to provide, through anatomical dissections, a detailed investigation of the surgical anatomy revealed by SETOA via anterolateral triangle of the middle cranial fossa. We also sought to define the relevant surgical landmarks of this operative corridor. METHODS Eight embalmed and injected adult cadaveric specimens (16 sides) underwent dissection and exposure of the cavernous sinus and middle cranial fossa via superior eyelid endoscopic transorbital approach. The anterolateral triangle was opened and its content exposed. An extended endoscopic endonasal trans-clival approach (EEEA) with exposure of the cavernous sinus content and skeletonization of the paraclival and parasellar segments of the internal carotid artery (ICA) was also performed, and the anterolateral triangle was exposed. Measurements of the surface area of this triangle from both surgical corridors were calculated in three head specimens using coordinates of its borders under image-guide navigation. RESULTS The drilling of the anterolateral triangle via SETOA unfolds a space that can be divided by the course of the vidian nerve into two windows, a wider "supravidian" and a narrower "infravidian," which reveal different anatomical corridors: a "medial supravidian" and a "lateral supravidian," divided by the lacerum segment of the ICA, leading to the lower clivus, and to the medial aspect of the Meckel's cave and terminal part of the horizontal petrous ICA, respectively. The infravidian corridor leads medially into the sphenoid sinus. The arithmetic means of the accessible surface area of the anterolateral triangle were 45.48 ± 3.31 and 42.32 ± 2.17 mm2 through transorbital approach and endonasal approach, respectively. CONCLUSION SETOA can be considered a minimally invasive route complementary to the extended endoscopic endonasal approach to the anteromedial aspect of the Meckel's cave and the foramen lacerum. The lateral loop of the trigeminal nerve represents a reliable surgical landmark to localize the lacerum segment of the ICA from this corridor. Nevertheless, as any new technique, a learning curve is needed, and the clinical feasibility should be proven.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy.
- PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy.
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, 00185, Rome, Italy
| | - Martina Offi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy - Division of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - Giovanni Pennisi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy - Division of Neurosurgery, Catholic University of Rome, Rome, Italy
| | - Benedetta Burattini
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy - Division of Neurosurgery, Catholic University of Rome, Rome, Italy
| | | | - Felice Esposito
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, 80131, Naples, Italy
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, 82100, Benevento, Italy
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
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Corvino S, Villanueva-Solórzano PL, Offi M, Armocida D, Nonaka M, Iaconetta G, Esposito F, Cavallo LM, de Notaris M. A New Perspective on the Cavernous Sinus as Seen through Multiple Surgical Corridors: Anatomical Study Comparing the Transorbital, Endonasal, and Transcranial Routes and the Relative Coterminous Spatial Regions. Brain Sci 2023; 13:1215. [PMID: 37626571 PMCID: PMC10452901 DOI: 10.3390/brainsci13081215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly due to the neurovascular structures that it contains; therefore, a detailed knowledge of its anatomy is mandatory for surgical unlocking. In this study, we compared the anatomy of this region from different endoscopic and microsurgical operative corridors, further focusing on the corresponding anatomic landmarks encountered along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors, and to provide indications regarding the optimal approach according to the lesion's location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA), and microsurgical transcranial fronto-temporo-orbito-zygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space were described and compared from these surgical perspectives. Results: The oculomotor triangle can be clearly exposed only by the FTOZ approach. Unlike EEEA, for the exposure of the clinoid triangle content, the anterior clinoid process removal is required for FTOZ and SETOA. The supra- and infratrochlear as well as the anteromedial and anterolateral triangles can be exposed by all three corridors. The most recently introduced SETOA allowed for the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed for the disclosure of the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan's triangle, in a minimally invasive fashion. Through the anterolateral triangle, the transorbital corridor allowed us to expose the lateral 180 degrees of the Vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA at the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel's cave. Conclusions: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of the tumor with cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered to be a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes for the exposure of selected lesions of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
- PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy
| | - Pedro L. Villanueva-Solórzano
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City 14269, Mexico;
| | - Martina Offi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy;
- Division of Neurosurgery, Catholic University of Rome, 00153 Rome, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, 00185 Rome, Italy;
| | - Motonobu Nonaka
- Department of Neurosurgery, Kochi University Hospital, 185-1, Oko-cho, Kohasu, Kochi 783-8505, Japan;
| | - Giorgio Iaconetta
- Neurosurgical Clinic A.O.U. “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Felice Esposito
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Università di Napoli “Federico II”, 80131 Naples, Italy; (S.C.); (L.M.C.)
| | - Matteo de Notaris
- Neurosurgery Operative Unit, Department of Neuroscience, Coordinator Neuroanatomy Section Italian Society of Neurosurgery, G. Rummo Hospital, 82100 Benevento, Italy;
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Ugga L, Franca RA, Scaravilli A, Solari D, Cocozza S, Tortora F, Cavallo LM, De Caro MDB, Elefante A. Neoplasms and tumor-like lesions of the sellar region: imaging findings with correlation to pathology and 2021 WHO classification. Neuroradiology 2023; 65:675-699. [PMID: 36799985 PMCID: PMC10033642 DOI: 10.1007/s00234-023-03120-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2023]
Abstract
The sellar region represents a complex anatomical area, composed of multiple structures of different embryological derivation, including the skull base and the pituitary gland, along with vascular, nervous, and meningeal structures. Masses arising in this region include benign and malignant lesions arising from the pituitary gland itself, but also from vestigial embryological residues or surrounding tissues, that may require different therapeutic approaches. While assessing sellar region masses, the combination of clinical presentation and imaging features is fundamental to define hypotheses about their nature. MR represents the imaging modality of choice, providing information about the site of the lesion, its imaging features, and relation with adjacent structures, while CT is useful to confirm the presence of lesion calcifications or to reveal tumor invasion of bony structures. The aim of this pictorial review is to provide an overview of the common neoplasms and tumor-like conditions of the sellar region, according to the 2021 WHO Classification of Tumors of the Central Nervous System (fifth edition), with an emphasis on the radiologic-pathologic correlation. After a brief introduction on the anatomy of this region and the imaging and pathological techniques currently used, the most relevant MRI characteristics, clinical findings, and pathological data, including histologic and molecular features, will be shown and discussed, with the aim of facilitating an appropriate differential diagnosis among these entities.
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Affiliation(s)
- Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Alessandra Scaravilli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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18
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Corvino S, Guizzardi G, Sacco M, Corrivetti F, Bove I, Enseñat J, Colamaria A, Prats-Galino A, Solari D, Cavallo LM, Di Somma A, de Notaris M. The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: neurosurgical audit and multiportal anatomic quantitative investigation. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05498-6. [PMID: 36752892 DOI: 10.1007/s00701-023-05498-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The petroclival region represents the "Achille's heel" for the neurosurgeons. Many ventral endoscopic routes to this region, mainly performed as isolated, have been described. The aim of the present study is to verify the feasibility of a modular, combined, multiportal approach to the petroclival region to overcome the limits of a single approach, in terms of exposure and working areas, brain retraction and manipulation of neurovascular structures. METHODS Four cadaver heads (8 sides) underwent endoscopic endonasal transclival, transorbital superior eyelid and contralateral sublabial transmaxillary-Caldwell-Luc approaches, to the petroclival region. CT scans were obtained before and after each approach to rigorously separate the contribution of each osteotomy and subsequentially to build a comprehensive 3D model of the progressively enlarged working area after each step. RESULTS The addition of the contralateral transmaxillary and transorbital corridors to the extended endoscopic endonasal transclival in a combined multiportal approach provides complementary paramedian trajectories to overcome the natural barrier represented by the parasellar and paraclival segments of the internal carotid artery, resulting in significantly greater area of exposure than a pure endonasal midline route (8,77 cm2 and 11,14 cm2 vs 4,68 cm2 and 5,83cm2, extradural and intradural, respectively). CONCLUSION The use of different endoscopic "head-on" trajectories can be combined in a wider multiportal extended approach to improve the ventral route to the most inaccessible petroclival regions. Finally, by combining these approaches and reiterating the importance of multiportal strategy, we quantitatively demonstrate the possibility to reach "far away" paramedian petroclival targets while preserving the neurovascular structures.
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Affiliation(s)
- Sergio Corvino
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Giulia Guizzardi
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Matteo Sacco
- Department of Neurosurgery, "Riuniti" Hospital, Foggia, Italy
| | - Francesco Corrivetti
- Department of Neurosurgery, San Luca Hospital, Vallo Della Lucania, Salerno, Italy.,Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Ilaria Bove
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Joaquim Enseñat
- Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain. .,Departments of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Matteo de Notaris
- Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy.,Neurosurgery Operative Unit, Department of Neuroscience, "San Pio" Hospital, Benevento, Italy
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19
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Solari D, d'Avella E, Agresta G, Catapano D, D'Ecclesia A, Locatelli D, Massimi L, Mazzatenta D, Spena G, Tamburrini G, Zoia C, Zoli M, Cinalli G, Cappabianca P, Cavallo LM. Endoscopic endonasal approach for infradiaphragmatic craniopharyngiomas: a multicentric Italian study. J Neurosurg 2023; 138:522-532. [PMID: 35901705 DOI: 10.3171/2022.5.jns212974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/20/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Infradiaphragmatic craniopharyngiomas (ICs) represent a distinct subtype, harboring a sellar-suprasellar origin and generally growing in the extra-arachnoidal space contained by the diaphragma sellae. They have been considered ideal for surgical removal through the transsphenoidal approach since the 1960s. The authors present a multicentric national study, intending to selectively analyze IC behavior and the impact of the transsphenoidal endoscopic endonasal approach (EEA) on surgical outcomes. METHODS Craniopharyngiomas that were intraoperatively recognized as infradiaphragmatic and removed with standard EEA between 2000 and 2021 at 6 Italian neurosurgical departments were included in the study. Clinical, radiological, and surgical findings and outcomes were evaluated and reviewed. RESULTS In total, 84 patients were included, with 45.23% identified as pediatric cases and 39.28% as having recurrent tumors. The most common presenting symptoms were endocrine (75%), visual (59.52%), and hypothalamic (26.19%) disorders. ICs were classified as extending below (6 intrasellar and 41 occupying the suprasellar cistern) or above (26 obliterating the anterior recesses of the third ventricle and 11 extending up to the foramina of Monro) the chiasmatic cistern. Gross-total resection (GTR) was achieved in 54 cases (64.28%). Tumor extension above the chiasmatic cistern and calcifications were associated with lower likelihood of GTR. The cumulative rate of postoperative complications was 34.53%, with CSF leak being the most common (14.28%). Endocrine, visual, and hypothalamic functions deteriorated postoperatively in 41/78 patients (52.56%), 5/84 (5.95%), and 14/84 (16.67%), respectively. Twenty-eight patients (33.33%) had recurrence during follow-up (mean 63.51 months), with a mean 5-year progression-free survival (PFS) rate of 58%. PFS was greater in patients who achieved GTR than patients with other extent of resection. CONCLUSIONS This is the largest series in the literature to describe ICs removed with standard EEA, without the need for additional bone and dural opening over the planum sphenoidale. EEA provides a direct route to ICs, the opportunity to manage lesions extending up to the third ventricle without breaching the diaphragma, and high rates of GTR and satisfactory clinical outcomes. Increased surgical complexity and morbidity should be expected in patients with extensive suprasellar extension and involvement of the surrounding vital neurovascular structures.
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Affiliation(s)
- Domenico Solari
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
| | - Elena d'Avella
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
| | - Gianluca Agresta
- 2Division of Neurosurgery, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Domenico Catapano
- 3Division of Neurosurgery, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Aurelio D'Ecclesia
- 4ENT Operative Unit, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
| | - Davide Locatelli
- 2Division of Neurosurgery, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Luca Massimi
- 5Section of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Diego Mazzatenta
- 6Department of Biomedical and Neuromotor Sciences, University of Bologna, IRCCS Institute of Neurological Sciences of Bologna, "Bellaria" Hospital, Bologna, Italy
| | - Giannantonio Spena
- 7Division of Neurosurgery, Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Gianpiero Tamburrini
- 5Section of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Cesare Zoia
- 7Division of Neurosurgery, Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and
| | - Matteo Zoli
- 6Department of Biomedical and Neuromotor Sciences, University of Bologna, IRCCS Institute of Neurological Sciences of Bologna, "Bellaria" Hospital, Bologna, Italy
| | - Giuseppe Cinalli
- 8Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Paolo Cappabianca
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
| | - Luigi Maria Cavallo
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II," Naples, Italy
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20
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Bove I, Franca RA, Ugga L, Solari D, Elefante A, De Caro MLDB, Cavallo LM. The "chameleon" sellar lesions: a case report of unexpected sellar lesions. Front Neurol 2023; 14:1149858. [PMID: 37168664 PMCID: PMC10164933 DOI: 10.3389/fneur.2023.1149858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction The sellar region and its boundaries represent a challenging area, harboring a variety of tissues of different linings. Therefore, a variety of diseases can arise or involve in this area (i.e., neoplastic or not). A total of three challenging cases of "chameleon" sellar lesions treated via EEA were described, and the lesions mimicked radiological features of common sellar masses such as craniopharyngiomas and/or pituitary adenomas, and we also report a literature review of similar cases. Methods A retrospective analysis of three primary cases was conducted at the Università degli Studi di Napoli Federico II, Naples, Italy. Clinical information, radiological examinations, and pathology reports were illustrated. Results A total of three cases of so-called "chameleon" sellar lesions comprising two men and one woman were reported. Based on the intraoperative finding and pathological examination, we noticed that case 1 had suprasellar glioblastoma, case 2 had a primary neuroendocrine tumor, and case 3 had cavernous malformation. Conclusion Neurosurgeons should consider "unexpected" lesions of the sellar/suprasellar region in the preoperative differential diagnosis. A multidisciplinary approach with the collaboration of neurosurgeons, neuroradiologists, and pathologists plays a fundamental role. The recognition of unusual sellar lesions can help surgeons with better preoperative planning; so an endoscopic endonasal approach may represent a valid surgical technique to obtain decompression of the optic apparatus and vascular structures and finally a pathological diagnosis.
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Affiliation(s)
- Ilaria Bove
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
- *Correspondence: Ilaria Bove
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples “Federico II”, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | | | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
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Onorini N, Spennato P, Mirone G, Vitulli F, Solari D, Cavallo LM, Cinalli G. Surgical Approaches to the Third Ventricle: An Update. Adv Tech Stand Neurosurg 2023; 48:207-249. [PMID: 37770686 DOI: 10.1007/978-3-031-36785-4_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The third ventricle is located in the deepest part of the brain and is delimited by both telencephalic and diencephalic structures. Its location makes every surgical procedure inside or around it quite challenging, due to the distance from the surface to the fragility of the neurovascular structures that is necessary to dissect before entering its cavity and to the narrow surgical corridors through which it is necessary to work. Its geometric localization inside the cranial cavity and the anatomical relationship with the interhemispheric fissure offers nevertheless to the surgeon an impressive variety of surgical approaches, which allow to reach every millimeter of the third ventricle lumen. Mastering properly all these approaches requires an impressive anatomical knowledge, the best available technology, and most refined technical skills, making the surgery of the third ventricle a point of excellence in the evolution of each neurosurgeon. The development of neuronavigation and neuroendoscopy has been a revolution in neurosurgery in the last 20 years and offered special advantages for the surgery of the third ventricle. In fact, the narrow corridors of approach make the precision of the neuronavigation and the enlightenment and magnification of the neuroendoscopy especially useful to reach the third ventricle cavity and working inside or around it. This chapter reviews the history of the surgery of the third ventricle and offers an update of the variety of surgical corridors identified and of the technology now available to properly work through them and inside the third ventricle cavity.
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Affiliation(s)
- Nicola Onorini
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Giuseppe Mirone
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Francesca Vitulli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
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22
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de Divitiis O, d'Avella E, Fabozzi GL, Cavallo LM, Solari D. Surgeon's Eyes on the Relevant Surgical Target. Acta Neurochir Suppl 2023; 135:5-11. [PMID: 38153441 DOI: 10.1007/978-3-031-36084-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The resolution of the naked eye has been a challenge for the neurosurgical endeavor since the very first attempts of cranial surgery, and advances have been achieved over the centuries, driven by a synergism between the application of emerging technology into the surgical environment and the expansion of the capabilities of neurosurgery. The understanding of the principles of the optical properties of lenses by Abbè (1840-1905) led to the introduction of loupes in the surgical practice, increasing the visual performance during macroscopic procedures. Modern neurosurgery began with the possibility of illumination and magnification of the surgical field as provided by the microscope. Pioneering contributions from Donaghy and Yasargil opened the way to the era of minimalism with reduction of operative corridors and surgical trauma through the adoption of the microsurgical technique. Almost at the same time, engineering mirabilia of Hopkins in terms of optics and lenses allowed for introduction of rigid and flexible endoscopes as a viable tool in neurosurgery. Nowadays, neurosurgeons are aware of and confident using effective and modern tools of visualization in their armamentarium. Herein we present a cogent review of the evolution of visualization tools in neurosurgery, with a special glimpse into the current development and future achievements.
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Affiliation(s)
- Oreste de Divitiis
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Elena d'Avella
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gianluca Lorenzo Fabozzi
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
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23
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d'Avella E, Solari D, Cavallo LM. In Reply to the Letter to the Editor Regarding "The Fate of Fat Graft in Extended Endoscopic Transtuberculum-Transplanum Approaches". World Neurosurg 2023; 169:120. [PMID: 36585094 DOI: 10.1016/j.wneu.2022.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Elena d'Avella
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy.
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy
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De Rosa A, Di Somma A, Mosteiro A, Ferrés A, Reyes LA, Roldan P, Torné R, Torales J, Solari D, Cavallo LM, Enseñat J, Prats-Galino A. Superior eyelid endoscopic transorbital approach to the tentorial area: A qualitative and quantitative anatomic study. Front Surg 2022; 9:1007447. [PMID: 36338650 PMCID: PMC9634414 DOI: 10.3389/fsurg.2022.1007447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/30/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Superior eyelid endoscopic transorbital approach (SETOA) is nowadays gaining progressive application in neurosurgical scenarios. Both anatomic and clinical reports have demonstrated the possibility of taking advantage of the orbital corridor as a minimally invasive route to reach anterior and middle cranial fossae and manage selected surgical lesions developing in these areas. The aim of this paper is to further shed light on other anatomic regions of the skull base as seen from a transorbital perspective, namely, the posterior cranial fossa and tentorial area, describing technical feasibility and steps in reaching this area through an extradural-transtentorial approach and providing quantitative evaluations of the "working area" obtained through this route. Material and methods Four cadaveric heads (eight sides) were dissected at the Laboratory of Surgical Neuroanatomy (LSNA) of the University of Barcelona, Spain. A stepwise dissection of the transorbital approach to the tentorial area was described. Qualitative anatomical descriptions and quantitative analyses of working were evaluated by using pre- and postdissections CT and MRI scans, and three-dimensional reconstructions were made using Amira software. Results With the endoscopic transorbital approach, posterior cranial fossa dura was reached by an extradural middle cranial fossa approach and drilling of the petrous apex. After clipping the superior petrosal sinus, the tentorium was divided and cut. An endoscope was then introduced in the posterior cranial fossa at the level of the tentorial incisura. Qualitative analysis provided a description of the tentorial and petrosal surfaces of the cerebellum, middle tentorial incisura, cerebellopontine fissures, and, after arachnoid dissection, by a 30° endoscopic visualization, the posterior aspect of the cerebellomesencephalic fissure. Quantitative analysis of the "working area" obtained after bone removal was also provided. Conclusions This anatomic qualitative and quantitative study sheds light on the anatomy of the posterior cranial fossa contents, such as the tentorial area and incisura, as seen through a transorbital perspective. The first aim of the article is to enrich the anatomical knowledge as seen through this relatively new corridor and to provide quantitative details and insights into the technical feasibility of reaching these regions in a surgical scenario.
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Affiliation(s)
- Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain,Correspondence: Alberto Di Somma
| | | | - Abel Ferrés
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | | | - Pedro Roldan
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Ramon Torné
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Jorge Torales
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain,Research Group of Clinical Neurophysiology, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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25
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Guizzardi G, Mosteiro A, Hoyos J, Ferres A, Topczewski T, Reyes L, Alobid I, Matas J, Cavallo LM, Cappabianca P, Enseñat J, Prats-Galino A, Di Somma A. Endoscopic Transorbital Approach to the Middle Fossa: Qualitative and Quantitative Anatomic Study. Oper Neurosurg (Hagerstown) 2022; 23:e267-e275. [PMID: 36106937 DOI: 10.1227/ons.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The endoscopic superior eyelid transorbital route to the skull base is gaining progressive popularity in the neurosurgical community. OBJECTIVE To evaluate the anatomy of the middle cranial fossa from this novel ventral perspective to reach the skull base through the transorbital route and to show limits for possible safe middle fossa drilling from the transorbital route. METHODS Anatomic study was performed; 5 cadaveric specimens (ie, 10 sides) and 2 dry skulls (ie, 4 sides) were dissected. RESULTS To obtain a functional result, there are boundaries that correspond to neurovascular structures that traverse, enter, or leave the middle fossa that must be respected: inferiorly, the lateral pterygoid muscle; medially, the Gasserian ganglion and the lateral border of the foramen rotundum; laterally, the foramen spinosum with the middle meningeal artery; superiorly, the lesser sphenoid wing; posteriorly, the anterior border of the foramen ovale. Average bone resected was 6.49 ± 0.80 cm3 which is the 63% of total middle fossa floor. The mean axial surgical length calculated was 3.85 cm (3.18-5.19 cm) while the mean sagittal surgical length was 5.23 cm (4.87-6.55 cm). The mean horizontal angle of approach was 38.14° (32.87°-45.63°), while the mean vertical angle of approach was 18.56° (10.81°-26.76°). CONCLUSION Detailed anatomy of the middle cranial fossa is presented, and herewith we demonstrated that from the endoscopic superior eyelid transorbital approach removal of middle cranial fossa floor is possible when anatomic landmarks are respected.
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Affiliation(s)
- Giulia Guizzardi
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Alejandra Mosteiro
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jhon Hoyos
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Abel Ferres
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Thomaz Topczewski
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Reyes
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jessica Matas
- Clinic Institute of Ophthalmology (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alberto Di Somma
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Clinic Institute of Ophthalmology (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain.,Laboratory of Surgical Neuroanatomy, Universitat de Barcelona, Barcelona, Spain
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26
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Baiano C, Somma T, Franca RA, Di Costanzo M, Scala MR, Cretella P, Esposito F, Cavallo LM, Cappabianca P, Solari D. Evolution in endoscopic endonasal approach for the management of hypothalamic–pituitary region metastasis: A single-institution experience. Front Oncol 2022; 12:975738. [PMID: 35965539 PMCID: PMC9366217 DOI: 10.3389/fonc.2022.975738] [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: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionEndonasal endoscopic surgery has changed the treatment perspectives for different lesions of the hypothalamic–pituitary region. The metastases of the hypothalamic–pituitary region represent 0.4% of all intracranial metastatic tumors and account for only 1.8% of surgically managed pituitary lesions. The aim of tshis study is to describe a single-center institutional experience with 13 cases of hypothalamic–pituitary metastasis focused on presurgical workup, the evolution of the surgical technique, and postsurgical management according to our protocols, showing effects on progression-free and overall survival rates for this relatively uncommon location.Material and MethodsWe retrospectively reviewed the whole series of patients that received the endoscopic endonasal approach at the Division of Neurosurgery at the University of Naples “Federico II” undergoing surgery from January 1997 to December 2021. We identified 13 cases whose pathology reports revealed a metastatic lesion. Statistical analysis was performed to determine the Kaplan–Meier survival function and assess for log-rank differences in survival based on gender, surgical treatment, and postoperative therapy (p-value < 0.02*).ResultsThe pathology report disclosed lung adenocarcinoma (six cases, 46%), breast adenocarcinoma (two cases, 15.4%), clear cell renal carcinoma (one case, 7%), melanoma (one case, 7%), colorectal adenocarcinoma (one case, 7%), uterine cervix carcinoma (one case, 7%), and follicular thyroid carcinoma (one case, 7%). A standard endoscopic endonasal approach was performed in 10 patients (76.9%), while an extended endonasal procedure was performed in only three cases (23%). Biopsy was the surgical choice in five patients with infiltrative and invasive lesions and a poor performance status (38%), while in the cases where neurovascular decompression was necessary, a subtotal resection was achieved in five patients (38%) and partial resection in three patients (23%). Recovery of visual field defect was observed in six of seven patients with visual loss (85.7%), improvement of oculomotor nerve palsy occurred in four of seven patients with this defect (57.1%), while the impairment of oculomotor palsy was observed in three patients (42.9%). Visual function was stable in the other patients. The median progression-free survival and overall survival were 14 and 18 months, respectively. There were statistically significant differences in PFS and OS in patients who underwent adjuvant radiotherapy (p=0.019 is referred to OS and p=0.017 to PFS, respectively; p-value = 0.02).ConclusionsThe endoscopic endonasal approach is a viable approach for the management of hypothalamic–pituitary metastases as this surgery provides an adequate opportunity to obtain tissue sample and neurovascular decompression, both being crucial for continuing the integrated adjuvant therapy protocols.
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Affiliation(s)
- Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
- *Correspondence: Cinzia Baiano,
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Raduan Ahmed Franca
- Pathology Section, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Marianna Di Costanzo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Maria Rosaria Scala
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Pasquale Cretella
- Pathology Section, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
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27
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Fabozzi GL, d’Avella E, Burroni M, Romano A, Cavallo LM, Solari D. Endoscopic transorbital eyelid approach for the removal of an extraconal cavernous venous malformation: Case report. Front Surg 2022; 9:954530. [PMID: 35937596 PMCID: PMC9349361 DOI: 10.3389/fsurg.2022.954530] [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: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Cavernous venous malformations (CVMs) are one of the most common benign primary orbital lesions in adults and the second most frequent cause of unilateral proptosis. Extraconal location is extremely rare, representing a favorable condition as compared to intraconal, as lesions at this level often adhere to orbital muscles and optic nerve. Herein, we report the case of a 50-year-old patient, who came to our attention because of progressive painless right axial proptosis. Magnetic resonance images were consistent with an extraconal CVM, occupying the superior temporal compartment of the orbit. Successful removal of the lesion was achieved through an endoscopic transorbital eyelid approach. The present case confirms the safety and efficacy of the endoscopic transorbital eyelid approach.
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Affiliation(s)
- Gianluca Lorenzo Fabozzi
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| | - Elena d’Avella
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
- Correspondence: Elena d’Avella
| | - Matias Burroni
- Department of Neurosurgery, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - Antonio Romano
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Maxillofacial Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
| | - Domenico Solari
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, Naples, Italy
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28
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Martinoni M, Miccoli G, Riccioli LA, Santoro F, Bertolini G, Zenesini C, Mazzatenta D, Conti A, Cavallo LM, Palandri G. Idiopathic Aqueductal Stenosis: Late Neurocognitive Outcome in ETV Operated Adult Patients. Front Neurol 2022; 13:806885. [PMID: 35463152 PMCID: PMC9021920 DOI: 10.3389/fneur.2022.806885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of the present study is to evaluate a neurocognitive outcome in patients affected by late-onset idiopathic aqueductal stenosis (LIAS) who underwent endoscopic third ventriculostomy (ETV).Materials and MethodsA prospective study was conducted between January 2015 and December 2017 in a series of 10 consecutive adult patients referred to the Neurosurgery Department of IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. All the adult patients admitted with absence of CSF flow through the aqueduct in phase-contrast (PC)—MRI sequences or a turbulence void signal in T2—weighted images in midsagittal thin-slice MR sequences underwent a specific neuroradiological, neurological, and neurocognitive assessment pre- and postoperatively.ResultsAll patients affected by gait and sphincter disturbances improved after ETV. Attentive and executive functions as well as visuo-spatial memory and verbal executive functions improved in several patients. Similarly, the affective and behavioral scales improved in almost 50% of the patients. No major complications have been recorded, and no patients required a second surgery for shunt placement.ConclusionEndoscopic third ventriculostomy represents a safe and effective surgical procedure for the treatment of LIAS. In addition to neurological improvement, we demonstrated also postoperative neurocognitive improvement mainly in attentive and executive functions, visuo-spatial memory, verbal executive functions, and behavioral and affective domains.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanni Miccoli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- *Correspondence: Giovanni Miccoli
| | - Luca Albini Riccioli
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Santoro
- Neurology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giacomo Bertolini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- Epidemiology and Biostatistics Service, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alfredo Conti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Maria Cavallo
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Baiano C, Della Monica R, Franca RA, Del Basso De Caro ML, Cavallo LM, Chiariotti L, Ius T, Jouanneau E, Somma T. Atypical Teratoid Rhabdoid Tumor: A Possible Oriented Female Pathology? Front Oncol 2022; 12:854437. [PMID: 35433419 PMCID: PMC9010824 DOI: 10.3389/fonc.2022.854437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Atypical teratoid rhabdoid tumor is a rare lesion that occurs mainly in children can be supratentorial or infratentorial and it accounts for 1-2% of pediatric brain tumors and over 10% of central nervous system (CNS) tumors in infants, with a male preponderance up to 3 years of age, more than 50% of these occur in the cerebellum. In this report we describe four new cases of sellar AT/RTs underwent endoscopic endonasal approach and different adjuvant therapies. Our aim is to report the clinical, radiological and pathological features of these rare lesions, focusing on the possibility to perform an early diagnosis and appropriate therapeutic strategy.
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Affiliation(s)
- Cinzia Baiano
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
- *Correspondence: Cinzia Baiano,
| | - Rosa Della Monica
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | | | | | - Luigi Maria Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Lorenzo Chiariotti
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Tamara Ius
- Division of Neurosurgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Emmanuel Jouanneau
- Division of Neurosurgery, Hopital Neurologique “Pierre Wertheimer”, Lyon, France
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
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30
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Scarano E, Solari D, Riccio E, Arianna R, Somma T, Cavallo LM, Romano F, Colao A, Di Somma C. Craniopharyngioma and Metabolic Syndrome: A 5-Year Follow-Up Single-Center Experience. Front Neurol 2022; 13:783737. [PMID: 35356458 PMCID: PMC8959765 DOI: 10.3389/fneur.2022.783737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with craniopharyngioma often have comorbidities, such as obesity and hypopituitarism. These two conditions affect each other and worsen the quality of life of patients, which lead to a higher risk of morbidity and mortality. In addition, abdominal obesity, measured as waist circumference (WC), is together with other parameters [arterial hypertension, hyperglycemia, hypertriglyceridemia, and reduced levels of high-density lipoprotein (HDL) cholesterol], one of the components of metabolic syndrome (MS). Each one of these morbidities occurs in patients with craniopharyngioma more frequently than in the remaining population. On these bases, we evaluated metabolic parameters in patients with craniopharyngioma at the time of diagnosis and after a 5-year follow-up, which compares these data with those of age-, gender-, WC-, and body mass index (BMI)-matched controls. In addition, we evaluated the prevalence of MS according to IDF criteria (MS-IDF) and the prevalence of MS according to ATP III (MS-ATPIII) criteria in patients and controls at baseline and after 5 years. We recruited 20 patients with craniopharyngioma (age 38.5 ± 15 years, 10 M) and 20 age-, gender-, WC- and BMI-matched controls (age 34.16 ± 13.19 years, 10 M). In all patients and controls, we evaluated the following: anthropometric features [height, weight, BMI, WC, hip circumference (HC) and waist-to-hip ratio (WHR)], systolic blood pressure (SBP) and diastolic blood pressure (DBP), lipid profile [total cholesterol (TC), HDL, low-density lipoprotein (LDL) cholesterol, triglycerides (TG)], and blood glucose at baseline and after 5 years. The prevalence of MS, according to IDF and ATPIII criteria, was calculated in the two groups at baseline and after 5 years. According to our results, at baseline, patients with craniopharyngioma had a worse metabolic profile than controls and a higher prevalence of MS. Besides, at a 5-year follow-up, patients still had impaired metabolic characteristics and more frequent MS (according to IDF and ATPIII criteria) when compared to controls. These data confirm that MS in patients with craniopharyngioma is unresponsive to life-changing interventions and to a common pharmacological approach. Other factors may be involved in the evolution of these conditions; so, further studies are needed to establish the correct management of these patients.
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Affiliation(s)
- Elisabetta Scarano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Enrico Riccio
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rossana Arianna
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Fiammetta Romano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University of Naples Federico II, Naples, Italy
| | - Carolina Di Somma
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University of Naples Federico II, Naples, Italy
- *Correspondence: Carolina Di Somma
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Corrivetti F, de Notaris M, Di Somma A, Dallan I, Enseñat J, Topczewski T, Solari D, Cavallo LM, Cappabianca P, Prats-Galino A. "Sagittal Crest": Definition, Stepwise Dissection, and Clinical Implications From a Transorbital Perspective. Oper Neurosurg (Hagerstown) 2022; 22:e206-e212. [PMID: 35239519 DOI: 10.1227/ons.0000000000000131] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The recent development of the superior eyelid endoscopic transorbital approach (SETOA) offered a new route for the management of cavernous sinus and middle cranial fossa tumors. As a result, a constant anatomic landmark of the surgical pathway after drilling the medial edge of the greater sphenoid wing (GSW) is represented by a triangular-shaped bone ridge appearing as a "crest." OBJECTIVE To perform an anatomic study to define this surgical landmark, named the "sagittal crest" (SC) as seen from the transorbital endoscopic view. METHODS Four adult cadaveric specimens (8 sides) were dissected performing an endoscopic transorbital approach to the middle fossa and the SC was removed to perform interdural opening of the cavernous sinus. Computed tomography scans were made before and after removal of the SC to perform quantitative analysis and building a 3-dimensional model of the bone resection of the GSW via the SETOA. RESULTS The SC is a bone ridge triangle shaping dorsally the superior orbital fissure resulting as the residual fragment after drilling the lateral aspect of the greater sphenoid wing. Predissection and postdissection computed tomography scans allowed to objectively assess SC features and dimensions (mean 1.08 ± 0.2 cm). CONCLUSION The SC is a constant anatomic landmark constituted of the residual medial portion of the GSW. Complete resection of this key landmark provides adequate working space and appears to be mandatory during SETOA to guide the subsequent interdural dissection of the lateral wall of cavernous sinus.
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Affiliation(s)
- Francesco Corrivetti
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento, Italy.,Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento, Italy.,Laboratory of Neuroscience, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Iacopo Dallan
- Otorhinolaryngology, Audiology and Phoniatrics Operative Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Thomas Topczewski
- Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Domenico Solari
- Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
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Iacovazzo C, de Bonis C, Sara R, Marra A, Buonanno P, Vargas M, Cavallo LM, Servillo G. Insulin-like growth factor-1 as predictive factor of difficult laryngoscopy in patients with GH-producing pituitary adenoma: A pilot study. J Clin Neurosci 2021; 94:54-58. [PMID: 34863462 DOI: 10.1016/j.jocn.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/23/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Growth hormone (GH)-producing pituitary tumors account for 10 to 15% of pituitary tumors. The hypersecretion of GH may induce changes in the airway anatomy through the activation of Insulin-like Growth factor 1(IGF-1) pathway. We sought investigate the role IGF-1 as a potential predictive factor of difficult laryngoscopy in patients with GH-producing pituitary adenoma. METHODS This study was a single center retrospective study. We included 33 patients undergoing transsphenoidal resection of GH-producing pituitary. We recorded demographic data, el-Ganzouri risk index (EGRI) and modified Look-Evaluate-Mallampati-Obstruction-Neck mobility (mLEMON) score, and pituitary hormone plasma levels. We performed ordinal logistic regression to analyze the relationship between IGF-1 and EGRI, mLEMON, and Cormack-Lehane Grade score and a multiple logistic regression to test the capability of EGRI, mLEMON and IGF-1 levels to predict Cormack-Lehane score. Receiver operating curve (ROC), area under the curve (AUC), and cut-off value of IGF-1 were calculated. RESULTS Only 14 (42.8%) and 12 (36.36%) patients showed predictive factors of difficult intubation according to EGRI and mLEMON score, respectively. IGF-1 significantly correlated with Cormack-Lehane (p = 0.005879) but not with mLEMON and EGRI (p = 0.3080 and 0.4146, respectively). In multiple regression model IGF-1 correlated only with Cormack-Lehane grade (p = 0.0089). Area under ROC was 0.8571 and cut-off value of IGF-1 was 186.15 ng/ml. CONCLUSION Higher IGF-1 levels correlate with the probability of having a higher Cormack-Lehane score; classical bedside scores, such as mLEMON and EGRI, were not able to predict difficult laryngoscopy in our population.
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Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Clemmaria de Bonis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Rosario Sara
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Ng S, Messerer M, Engelhardt J, Bruneau M, Cornelius JF, Cavallo LM, Cossu G, Froelich S, Meling TR, Paraskevopoulos D, Schroeder HWS, Tatagiba M, Zazpe I, Berhouma M, Daniel RT, Laws ER, Knosp E, Buchfelder M, Dufour H, Gaillard S, Jacquesson T, Jouanneau E. Aggressive pituitary neuroendocrine tumors: current practices, controversies, and perspectives, on behalf of the EANS skull base section. Acta Neurochir (Wien) 2021; 163:3131-3142. [PMID: 34365544 DOI: 10.1007/s00701-021-04953-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022]
Abstract
Aggressive pituitary neuroendocrine tumors (APT) account for 10% of pituitary tumors. Their management is a rapidly evolving field of clinical research and has led pituitary teams to shift toward a neuro-oncological-like approach. The new terminology "Pituitary neuroendocrine tumors" (PitNet) that was recently proposed to replace "pituitary adenomas" reflects this change of paradigm. In this narrative review, we aim to provide a state of the art of actual knowledge, controversies, and recommendations in the management of APT. We propose an overview of current prognostic markers, including the recent five-tiered clinicopathological classification. We further establish and discuss the following recommendations from a neurosurgical perspective: (i) surgery and multi-staged surgeries (without or with parasellar resection in symptomatic patients) should be discussed at each stage of the disease, because it may potentialize adjuvant medical therapies; (ii) temozolomide is effective in most patients, although 30% of patients are non-responders and the optimal timeline to initiate and interrupt this treatment remains questionable; (iii) some patients with selected clinicopathological profiles may benefit from an earlier local radiotherapy and/or chemotherapy; (iv) novel therapies such as VEGF-targeted therapies and anti-CTLA-4/anti-PD1 immunotherapies are promising and should be discussed as 2nd or 3rd line of treatment. Finally, whether neurosurgeons have to operate on "pituitary adenomas" or "PitNets," their role and expertise remain crucial at each stage of the disease, prompting our community to deal with evolving concepts and therapeutic resources.
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Di Somma C, Scarano E, Barrea L, Solari D, Riccio E, Arianna R, Cavallo LM, Romano F, Di Benedetto E, Rodriguez A, de Alteriis G, Colao A. Craniopharyngioma, Chronotypes and Metabolic Risk Profile. Nutrients 2021; 13:nu13103444. [PMID: 34684445 PMCID: PMC8538918 DOI: 10.3390/nu13103444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
Aim: To investigate the potential association among Craniopharyngioma (CP), chronotypes and metabolic risk profile. Subjects and Methods: The study population included 28 patients (46.4% males; 42.6 ± 15.8 years) and 28 controls, age, gender and BMI matched (46.4% males; 46.5 ± 12.9 years). In this study sample, we evaluated: anthropometric measurements (waist circumference, WC; BMI), plasma glucose, lipid profile, and systolic (SBP) and diastolic (DBP) blood pressure. Morningness-Eveningness was measured with the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ), which included 19 questions about preferred sleep time and daily performance. Results: in both patients and controls grade I obesity was detected in 15 subjects (53.6%), grade II obesity in 13 subjects (46.4%). In the patient group, the mean score of chronotype was 47.8 ± 12.6. In particular, 9 patients (32.1%) exhibited the morning chronotype, 6 (21.4%) the intermediate chronotype and 13 (46.4.%) the evening chronotype. No significant difference was found in gender and age among the chronotype categories. Patients with the evening chronotype had higher blood pressure values and worse metabolic parameters than those with the morning chronotype. In the control group, the mean score of the chronotype was 57.6 ± 9.5. In particular, 16 (57.1%) subjects exhibited the morning chronotype, 10 (35.7%) the intermediate chronotype and only 2 (7.1.%) the evening chronotype. The prevalence of intermediate and evening chronotypes was higher in females than males (p = 0.021), while males have a higher prevalence of the morning chronotype. Subjects with intermediate and evening chronotypes had worse metabolic parameters than those with the morning chronotype. In patients, the chronotype score was inversely correlated to WC, BMI, SBP, DBP, plasma glucose, total cholesterol, triglycerides, LDL cholesterol and positively correlated with HDL cholesterol. No correlation was found between age and chronotype. In controls, the chronotype score was inversely correlated to WC, BMI, plasma glucose, total cholesterol, LDL cholesterol. No correlation was found among chronotype and age, blood pressure, triglycerides, HDL cholesterol. Considering the whole population of the study (patients and controls), at logistic regression the chronotype score was significantly associated with the presence of CP. Conclusions: for the first time thus far, our study puts the light on the association of the CP with chronotypes and metabolic alterations in this disease, which are the main determinants of the reduced quality of life, higher morbidity and mortality in this setting of patients. This finding suggests that alterations of chronotype might represent an adjunctive risk for CP patients and a possible target for their integrate management.
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Affiliation(s)
- Carolina Di Somma
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
- Cattedra Unesco “Educazione Alla Salute e allo Sviluppo Sostenibile”, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746-3779
| | - Elisabetta Scarano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Luigi Barrea
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80125 Naples, Italy; (D.S.); (L.M.C.)
| | - Enrico Riccio
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Rossana Arianna
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80125 Naples, Italy; (D.S.); (L.M.C.)
| | - Fiammetta Romano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Elea Di Benedetto
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Alice Rodriguez
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Giulia de Alteriis
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (E.S.); (L.B.); (E.R.); (R.A.); (F.R.); (E.D.B.); (A.R.); (G.d.A.); (A.C.)
- Cattedra Unesco “Educazione Alla Salute e allo Sviluppo Sostenibile”, Federico II University, 80131 Naples, Italy
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D 'avella E, Fazzolari B, Cappelletti M, Delitala A, Solari D, Somma T, Cavallo LM, Diviitis OD, Prats-Galino A. Anatomical Assessment of the Endoscopic Assisted Lateral Supraorbital Approach and Endoscopic Endonasal Transclival Approach to Basilar Apex Aneurysms. Turk Neurosurg 2021; 31:671-679. [PMID: 34505636 DOI: 10.5137/1019-5149.jtn.28775-19.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To assess the feasibility of using an endoscopic-assisted lateral supraorbital (LSO) approach and an endoscopic endonasal transclival approach (EETA) for basilar apex (BAX) aneurysms. MATERIAL AND METHODS Ten cases with LSO approaches, with or without posterior clinoidectomy and endoscopic assistance, and 10 cases with EETA, with or without drilling of the dorsum sellae, were performed on 20 cadaveric heads. Anatomical exposure and surgical freedom at the BAX were evaluated. RESULTS Anatomical exposure provided by the LSO approach was limited to the BAX and ipsilateral posterior cerebral artery (PCA) and increased with a mean value of 5.0 mm after posterior clinoidectomy; the basilar artery, contralateral PCA, and superior cerebellar arteries (SCAs) were visualized in all cases. Accordingly, surgical freedom was larger. Endoscopic assistance provided a significant increase in basilar artery exposure; however, surgical freedom did not increase markedly. The main advantage of EETA was the greatest exposure of the basilar artery. With drilling of the dorsum sellae, anatomical exposure increased by a mean value of 3.4 mm, and provided the greatest amount of surgical freedom and visualization of the basilar artery terminal bifurcation and of the SCAs in all cases. CONCLUSION The endoscopic-assisted LSO approach and the EETA may represent a feasible approach for treatment of BAX aneurysms lying within 5.0 mm below and within 3.4 mm above the dorsum sellae.
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Affiliation(s)
- Elena D 'avella
- Univerità degli Studi di Napoli ?Federico II?, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy
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Vitulli F, D’Avella E, Solari D, Franca RA, Romano A, Bonavolontà P, Cavallo LM. Primary ectopic orbital craniopharyngioma. Acta Neurochir (Wien) 2021; 164:1979-1984. [PMID: 34467436 DOI: 10.1007/s00701-021-04969-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Craniopharyngiomas (CP) ectopic localizations off the midline outside the sellar-suprasellar region are very rare and most often associated to secondary tumor dissemination, being primary ectopic CPs extremely unusual. We herein report the first case of a primary ectopic craniopharyngioma within the orbit. A 15-year-old patient presented with progressive right ptosis, proptosis, and retro ocular pain. Magnetic resonance imaging (MRI) showed a predominantly cystic lesion, occupying the superolateral right corner of the orbit, outside the intraconal space with no evidence of intracranial involvement. An endoscopic transorbital eyelid approach was adopted. Pathology report disclosed a primary ectopic craniopharyngioma.
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Ceraudo M, Cavallo LM, Rossi DC, Solari D, Anania P, Canevari FR, Prior A, Cappabianca P, Zona G. Role of Anterior Nasal Packing in Endoscopic Skull Base Surgery: Italian Survey. World Neurosurg 2021; 154:e406-e415. [PMID: 34280536 DOI: 10.1016/j.wneu.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nowadays, the endoscopic endonasal approach to sellar and parasellar region tumors is a common technique in neurosurgery, and surgical nuances, complications, and management strategies are shared in a multidisciplinary setting between neurosurgeons and ear, nose, and throat surgeons. Due to the heterogeneity of its variations, the role of the anterior nasal packing in endoscopic endonasal approach to the skull base surgery (EESBS) has not yet been unanimously accepted and no consensus or guidelines on its use exist. MATERIALS AND METHODS A survey containing 10 questions about indications, management advantages, and pitfalls of the use of anterior nasal packing in EESBS was created by using an online open-source tool (SurveyMonkey). The questionnaire was sent to 39 Italian neurosurgical departments, which routinely adopt the endoscopic endonasal approach. RESULTS Almost half of 39 selected centers (19; 48.7%) answered our survey. The main results can be summarized as 1) anterior nasal packing after EESBS is considered useful by 84% of participants, 2) prevention of epistaxis is the principal indication for anterior nasal packing, 3) the type of approach and skull base reconstruction influence the use of anterior nasal packing, and 4) nasal discomfort is considered the principal negative aspect of nasal packing. CONCLUSIONS Our study identified that anterior nasal packing is commonly adopted in certain conditions, namely when extensive nasal dissection is performed. Furthermore, the choice to adopt or not the anterior nasal packing should be tailored taking in account specific conditions, such as acromegaly and Cushing disease. It represents an important factor in reducing postoperative sinonasal complications of EESB.
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Affiliation(s)
- Marco Ceraudo
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II Naples, Italy
| | | | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II Naples, Italy
| | - Pasquale Anania
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Frank Rikki Canevari
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Alessandro Prior
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II Naples, Italy
| | - Gianluigi Zona
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
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Cheng JH, Nie D, Li B, Gui SB, Li CZ, Zhang YZ, Cavallo LM, Zhao P. Clinical features, radiological profiles, pathological features and surgical outcomes of pituicytomas: a report of 11 cases and a pooled analysis of individual patient data. Mil Med Res 2021; 8:39. [PMID: 34210357 PMCID: PMC8252196 DOI: 10.1186/s40779-021-00332-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pituicytoma is an extremely rare low-grade glial tumor that is closely related to the neurohypophysis axis. Most studies of pituicytomas include only several cases. To better understand this disease, we reviewed a series of cases of pituicytomas. The diagnosis and treatment of pituicytoma must be further elucidated. METHODS Eleven patients with pituicytoma admitted to Beijing Tiantan Hospital from 2012 to 2019 were selected. The clinical features, including radiological and histological examination, surgical records and prognosis were reviewed. Sixty-eight other previously published cases of pituicytoma also were used to analyze the predictive factors for the results. The Cox regression model was used for univariate and multivariate analyses. RESULTS Our patients included 5 males (45.5%) and 6 females (54.5%), with a mean age of 49.3 years. The tumor was located in the suprasellar region in 5 patients (45.5%), intrasellar region in 4 patients (36.4%), and intrasellar-suprasellar region in 2 patients (18.2%). All patients were misdiagnosed with other common tumors in the sellar region before the operation. During the operation, gross total resection (GTR) of the tumor was achieved in 6 patients (54.5%), and subtotal resection (STR) was achieved in 5 patients (45.5%). The mean progression-free survival (PFS) time was 29.82 months. Tumor progression after surgical resection occurred in 4 patients (36.4%). Among them, 60.0% of the patients (cases 4, 5, 7) with STR experienced progression, while 16.7% of the patients (case 2) with GTR experienced progression. Combined with the 68 cases in the literature, GTR was an independent risk factor for PFS time (P < 0.05). CONCLUSIONS Pituicytomas are more common in middle-aged people and the sellar region. The clinical manifestations of pituicytomas are different, but no diagnostic clinical features have been identified other than an abnormally abundant blood supply. Currently, GTR is the best approach for the treatment of pituicytomas. More patients and longer follow-up periods were needed to further elucidate the biological features of pituicytomas.
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Affiliation(s)
- Jian-Hua Cheng
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ding Nie
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Bin Li
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Song-Bai Gui
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Chu-Zhong Li
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Ya-Zhuo Zhang
- Department of Cell and Biology, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Universitá Degli Studi di Napoli Federico II, 80142, Naples, Italy
| | - Peng Zhao
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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Giammattei L, di Russo P, Starnoni D, Passeri T, Bruneau M, Meling TR, Berhouma M, Cossu G, Cornelius JF, Paraskevopoulos D, Zazpe I, Jouanneau E, Cavallo LM, Benes V, Seifert V, Tatagiba M, Schroeder HWS, Goto T, Ohata K, Al-Mefty O, Fukushima T, Messerer M, Daniel RT, Froelich S. Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section. Acta Neurochir (Wien) 2021; 163:1639-1663. [PMID: 33740134 DOI: 10.1007/s00701-021-04798-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/26/2020] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. RESULTS The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient's counselling. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the management of PCMs.
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Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France.
| | - P di Russo
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - D Starnoni
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - T Passeri
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - M Bruneau
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - T R Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - M Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - G Cossu
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - J F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - D Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - I Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Jouanneau
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France
| | - L M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, NA, Italy
| | - V Benes
- Department of Neurosurgery, First Medical Faculty, Military University Hospital and Charles University, Prague, Czech Republic
| | - V Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - H W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - T Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - O Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Fukushima
- Department of Neurosurgery, Carolina Neuroscience Institute, Raleigh, NC, USA
| | - M Messerer
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R T Daniel
- Department of Neurosurgery and Gamma Knife Center, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
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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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Tortora F, Negro A, Briganti F, Del Basso De Caro ML, Cavallo LM, Solari D, Somma T, Brunese L, Caranci F. Pituitary magnetic resonance imaging vs. bilateral inferior petrosal sinus sampling: comparison between non-invasive and invasive diagnostic techniques for Cushing's disease-a narrative review. Gland Surg 2020; 9:2260-2268. [PMID: 33447578 DOI: 10.21037/gs-20-654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cushing's syndrome is a pathological clinical condition caused by an exposure of elevated cortisol levels over a long period of time. It is therefore essential to establish what the cause of hypercortisolism is. In most cases (about 80%) the pathological process is due to adrenocorticotropic hormone (ACTH), while in a minor part of the cases (about 20%) the cause is represented by a pathology of the adrenal glands and therefore not related to ACTH. Most patients with ACTH dependent Cushing's syndrome have a pituitary microadenoma; in the remaining cases (30%), the high level of cortisol is linked to an ectopic secretion of ACTH. Surgical removal of the pituitary adenoma represents the treatment of choice in Cushing's disease (CD) patients; it is therefore necessary to identify and precisely locate the pituitary tumour responsible for the secretion of ACTH. Adequate diagnostic information is very often, even with magnetic resonance imaging (MRI), and in these cases we rely on bilateral inferior petrosal sinuses sampling (BIPSS). This procedure is considered the gold standard method for the diagnosis, but like any other diagnostic method it is not free from erroneous results such as false positives or false negatives.
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Affiliation(s)
- Fabio Tortora
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Alberto Negro
- Neuroradiology Unit, Ospedale del Mare, Naples, Italy
| | - Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | | | - Luigi Maria Cavallo
- 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
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Ferdinando Caranci
- Department of Precision Medicine, School of Medicine "Luigi Vanvitelli", University of Campania, Naples, Italy
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Cennamo G, Solari D, Montorio D, Scala MR, Melenzane A, Fossataro F, Somma T, Tranfa F, Cavallo LM. Early vascular modifications after endoscopic endonasal pituitary surgery: The role of OCT-angiography. PLoS One 2020; 15:e0241295. [PMID: 33119707 PMCID: PMC7595382 DOI: 10.1371/journal.pone.0241295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/16/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose The aim of the present study is to analyze the changes in retinal vessel density (VD), using Optical Coherence Tomography Angiography (OCT-A), in patients that received endoscopic endonasal approach for the removal of an intra-suprasellar pituitary adenoma compressing optic chiasm. Methods We evaluated the VD in Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP), Radial Peripapillary Capillary (RPC) and the Foveal Avascular Zone (FAZ) area in a series of fourteen patients (7 males, 7 females, mean age 56 ± 13 years), as compared to healthy controls. We also detected the structural Spectral Domain (SD)-OCT parameters: Ganglion Cell Complex (GCC), Retinal Nerve Fiber Layer (RNFL), visual field parameters (Mean Deviation, Pattern Standard Deviation) and Best Corrected Visual Acuity (BCVA). These measurements were performed prior than surgery and 48 hours after. Results The patients showed a significant decrease in VD of the macular and papillary regions, a significant increase in FAZ area, a significant impairment in SD-OCT, VF parameters and BCVA respect to 14 eyes of 14 healthy controls (p<0.05), at pre-op evaluation. In patients group the VD in SCP, DCP and RPC increased after surgery respect to baseline but the difference turned to be out statistically significant only in RPC (p = 0.003). Also the BCVA (p = 0.040) and the Mean Deviation at visual field (p = 0.015) significantly improved after surgery. While there was a reduction in structural OCT parameters but it was statistically significant only in GCC (p = 0.039). A positive correlation was found between the preoperative VD of the RPC, Mean Deviation, BCVA and the postoperative Mean Deviation (r = 0.426 p = 0.027; r = 0.624 p = 0.001; r = 0.515 p = 0.006). Conclusion OCT-A allows to detect the early changes occurring within 48 hours after surgery showing that the improvement in retinal vessel density could occur before the recovery of the structural OCT parameters and can be a positive predictive factor for the functional recovery.
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Affiliation(s)
- Gilda Cennamo
- Public Health Department, University of Naples "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Daniela Montorio
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Maria Rosaria Scala
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Antonietta Melenzane
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Federica Fossataro
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Fausto Tranfa
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
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Cavallo LM, Mazzatenta D, d'Avella E, Catapano D, Fontanella MM, Locatelli D, Luglietto D, Milani D, Solari D, Vindigni M, Zenga F, Zona G, Cappabianca P. The management of clival chordomas: an Italian multicentric study. J Neurosurg 2020:1-10. [PMID: 32886913 DOI: 10.3171/2020.5.jns20925] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the last 2 decades, the endoscopic endonasal approach in the treatment of clival chordomas has evolved to be a viable strategy to achieve maximal safe resection of this tumor. Here, the authors present a multicentric national study, intending to analyze the evolution of this approach over a 20-year time frame and its contribution in the treatment of clival chordomas. METHODS Clival chordoma cases surgically treated between 1999 and 2018 at 10 Italian neurosurgical departments were included in this retrospective study. Clinical, radiological, and surgical findings, adjuvant therapy, and outcomes were evaluated and compared according to classification in the treatment eras from 1999 to 2008 and from 2009 to 2018. RESULTS One hundred eighty-two surgical procedures were reviewed, with an increase in case load since 2009. The endoscopic endonasal transclival approach (EETA) was performed in 151 of 182 cases (83.0%) and other approaches were performed in 31 cases (17%). There was an increment in the use of EETA, neuronavigation, and Doppler ultrasound after 2008. The overall postoperative complication rate was 14.3% (26 of 182 cases) consisting of 9 CSF leaks (4.9%), 7 intracranial hemorrhages (3.8%), 5 cases of meningitis (2.7%), and 5 cerebral ischemic injuries (2.7%). Gross-total resection (GTR) was achieved in 93 of 182 cases (51.1%). Extent of resection (EOR) improved in the second era of the study. Signs and/or symptoms at presentation worsened in 27 cases (14.8%), and the Katz Index worsened in 10 cases (5.5%). Previous treatment, dural involvement, EETA, and intraoperative Doppler ultrasound correlated with GTR. Patients received adjuvant proton beam radiation in 115 of 182 cases (63.2%), which was administered more in the latter era. Five-year progression-free survival (PFS) and overall survival (OS) were 62.3% and 73.5%, respectively. GTR, EETA, proton beam therapy, and the chondroid subtype correlated with a better survival rate. The mean follow-up was 62 months. CONCLUSIONS Through multicentric data collection, this study encompasses the largest series in the literature of clival chordomas surgically treated through an EETA. An increase in the use of this approach was found among Italian neurosurgical departments together with an improved extent of resection over time. The satisfactory rate of GTR was marked by low surgical morbidity and the preservation of patient quality of life. Surgical outcome was reinforced, in terms of PFS and OS, by the use of proton beam therapy, which was increasingly performed along the period of study.
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Affiliation(s)
- Luigi Maria Cavallo
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| | - Diego Mazzatenta
- 2Department of Biomedical and Neuromotor Sciences, University of Bologna, IRCCS Institute of Neurological Sciences of Bologna, "Bellaria" Hospital, Bologna
| | - Elena d'Avella
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| | - Domenico Catapano
- 3Division of Neurosurgery, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo
| | | | - Davide Locatelli
- 5Division of Neurosurgery, Università degli Studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese
| | | | - Davide Milani
- 7Division of Neurosurgery, Humanitas Research Hospital, Rozzano
| | - Domenico Solari
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
| | - Marco Vindigni
- 8Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine
| | - Francesco Zenga
- 9Department of Neuroscience, "Rita Levi Montalcini", Neurosurgery Unit, University of Turin; and
| | - Gianluigi Zona
- 10Neurosurgery and Neurotraumatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Cappabianca
- 1Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples
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d'Avella E, Guadagno E, Ugga L, Solari D, Cavallo LM. Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis. J Neurol Surg Rep 2020; 81:e46-e51. [PMID: 32818133 PMCID: PMC7428375 DOI: 10.1055/s-0040-1712919] [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: 04/18/2019] [Accepted: 02/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background
We report an extremely unusual case of anterior clinoid process (ACP) metastasis as the first presentation of a signet ring cell carcinoma.
Case Description
A 54-year-old female patient presented with right-sided visual disturbances due to optic nerve compression from a computed tomography (CT)-identified right anterior clinoid bone lesion. Contrast-enhanced magnetic resonance imaging showed an extra-axial, well-bordered enhancing mass extending from the right ACP toward the inner lumen of the optic canal. Pterional approach was adopted to remove the lesion and decompress the optic canal. Histological examination demonstrated a metastasis from a signet ring cell carcinoma. Postoperative CT showed near-total resection of the tumor and decompression of the optic canal. Visual defect remained unchanged.
Conclusion
Metastasis should be considered in the differential diagnosis of the ACP lesions. The early suspicion and identification of this extremely rare pathological entity can be helpful for the prompt management of patients, especially in the absence of any other signs of oncological diseases.
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Affiliation(s)
- Elena d'Avella
- Department of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Elia Guadagno
- Pathology Unit, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Domenico Solari
- Department of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosurgery, Università degli Studi di Napoli "Federico II," Naples, Italy
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Staartjes VE, Serra C, Zoli M, Mazzatenta D, Pozzi F, Locatelli D, D'Avella E, Solari D, Cavallo LM, Regli L. Multicenter external validation of the Zurich Pituitary Score. Acta Neurochir (Wien) 2020; 162:1287-1295. [PMID: 32172439 DOI: 10.1007/s00701-020-04286-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/04/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Recently, the Zurich Pituitary Score (ZPS) has been proposed as a new quantitative preoperative classification scheme for predicting gross total resection (GTR), extent of resection (EOR), and residual tumor volume (RV) in endoscopic pituitary surgery. We evaluated the external validity of the ZPS. METHODS In three reference centers for pituitary surgery, the ZPS was applied and correlated to GTR, EOR, and RV. Furthermore, its inter-rater agreement was assessed. RESULTS A total of 485 patients (53% male; age, 53.8 ± 15.7) were included. ZPS grades I, II, III, and IV were observed in 110 (23%), 270 (56%), 64 (13%), and 41 (8%) patients, respectively. GTR was achieved in 358 (74%) cases, with mean EOR of 87.6% ± 20.3% and RV of 1.42 ± 2.80 cm3. With increasing ZPS grade, strongly significant decreasing trends for GTR (I, 92%; II, 77%; III, 67%; IV, 15%; p < 0.001) and EOR (I, 93.8%; II, 89.9%; III, 88.1%; IV, 75.4%; p < 0.001) were found. Similarly, RV increased steadily ([cm3] I, 0.16; II, 0.61; III, 2.01; IV, 3.84; p < 0.001). We observed intraclass correlation coefficients of 0.837 (95% CI, 0.804-0.865) for intercarotid distance and 0.964 (95% CI, 0.956-0.970) for adenoma diameter, and Cohen's kappa of 0.972 (95% CI, 0.952-0.992) for the ZPS grades. CONCLUSIONS Application of the ZPS in three external cohorts was successful. The ZPS generalized well in terms of GTR, EOR, and RV; demonstrated excellent inter-rater agreement; and can safely and effectively be applied as a quantitative classification of adenomas with relevance to surgical outcome.
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Affiliation(s)
- Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Matteo Zoli
- Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, Division of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, Division of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Fabio Pozzi
- Division of Neurosurgery, Ospedale di Circolo ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Ospedale di Circolo ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Elena D'Avella
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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Milicevic M, Solari D, Illic R, Frio F, Stanimirovic A, Savic D, Somma T, Cavallo LM, Grujicic D. The Impact of Intraoperative Monitoring on Extent of Resection and Long-Term Neurological Outcomes: A Series of 39 Intramedullary Ependimomas. Turk Neurosurg 2020; 30:252-262. [PMID: 32091124 DOI: 10.5137/1019-5149.jtn.27471-19.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To analyze the impact of intraoperative neurophysiological monitoring (IONM) on the extent of removal and long-term neurological outcomes in a series of grade II ependymomas. MATERIAL AND METHODS We retrospectively reviewed 88 consecutive patients who underwent surgical resection of an intramedullary spinal cord tumor (IMSCT) at the Clinic of Neurosurgery of the Clinical Center of Serbia in Belgrade between January 2012 and December 2017. In all, 39 patients (25 males and 14 females; mean age 46.16 years) with grade II ependymomas were enrolled in this study; the mean follow-up time was 49.84 months. The modified McCormick Scale (mMCS) was used to assess the short- and long-term outcomes, and the patients were divided into two groups based on whether they underwent IONM. RESULTS The gross-total removal rate was 89.7%, and it was not influenced by use of IONM, location or tumor size. Upon admission,43.2% of the patients were dependent (grades IV and V), while 56.8% were independent (grades I, II and III), according to the mMCS. After 3 months of follow-up, 76.9% of the patients maintained or improved their neurological status, but this percentage was reduced after long-term follow-up. CONCLUSION Total surgical resection with good neurological outcomes can be achieved in the vast majority of patients with grade II ependymomas; it is important to emphasize that the use of IONM allows acceptable extent of resection and provides better results in terms of functional outcomes, with lower morbidity rates. Therefore, no correlation was demonstrated between the decrease in the basal amplitudes of IONM and D-waves and poor neurological outcomes.
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Affiliation(s)
- Mihailo Milicevic
- Medical Faculty University of Belgrade, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
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d'Avella E, Solari D, Somma T, Miccoli G, Milicevic M, Cappabianca P, Cavallo LM. The endoscopic endonasal approach for pediatric craniopharyngiomas: the key lessons learned. Childs Nerv Syst 2019; 35:2147-2155. [PMID: 31055620 DOI: 10.1007/s00381-019-04168-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study is to highlight the role of the endoscopic endonasal approach (EEA) in pediatric craniopharyngiomas by reviewing our experience and the key lessons learned from the application of this approach in children. METHODS Between 1998 and 2017, 12 pediatric craniopharyngiomas were treated via EEA at our institution. Demographic data, preoperative assessment, tumor features, surgical results, complications, and recurrences were analyzed. RESULTS Visual defects were the most frequent presenting sign. Seven craniopharyngiomas were infradiaphragmatic, and five were supradiaphragmatic. The EEA was successfully performed in all cases with no complication related to children's sinonasal anatomy. Gross total resection (GTR) rate was of 75%. Endocrinological disturbances improved in one case (20%) and worsened in three (60%). New onset of diabetes insipidus was observed in four (36%) children. Visual defect improved in 91% of cases, with no new postoperative deficit. Postoperative cerebrospinal fluid (CSF) leak occurred in one patient (8%). Three patients (27%) experienced tumor regrowth, and one craniopharyngioma recurred (mean follow-up, 78 months). CONCLUSIONS The EEA offers a straight route to the sellar-suprasellar, making it the ideal approach for pediatric infradiaphragmatic craniopharyngiomas. In supradiaphragmatic craniopharyngiomas, the extended EEA provides a clearer and close-up visualization of the tumor-hypothalamus interface, which can grant better results in terms of quality of life. The pediatric skull base anatomy should not represent a contraindication for the endoscopic technique. Larger series encompassing a wider spectrum of pediatric craniopharyngiomas are needed to further support the benefits of this surgical approach.
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Affiliation(s)
- Elena d'Avella
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Teresa Somma
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Giovanni Miccoli
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Mihailo Milicevic
- Clinical Center of Serbia, Clinic of Neurosurgery, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Paolo Cappabianca
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
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Di Somma A, Torales J, Cavallo LM, Pineda J, Solari D, Gerardi RM, Frio F, Enseñat J, Prats-Galino A, Cappabianca P. Defining the lateral limits of the endoscopic endonasal transtuberculum transplanum approach: anatomical study with pertinent quantitative analysis. J Neurosurg 2019; 130:848-860. [PMID: 29676691 DOI: 10.3171/2017.9.jns171406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/08/2017] [Accepted: 09/25/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The extended endoscopic endonasal transtuberculum transplanum approach is currently used for the surgical treatment of selected midline anterior skull base lesions. Nevertheless, the possibility of accessing the lateral aspects of the planum sphenoidale could represent a limitation for such an approach. To the authors' knowledge, a clear definition of the eventual anatomical boundaries has not been delineated. Hence, the present study aimed to detail and quantify the maximum amount of bone removal over the planum sphenoidale required via the endonasal pathway to achieve the most lateral extension of such a corridor and to evaluate the relative surgical freedom. METHODS Six human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The laboratory rehearsals were run as follows: 1) preliminary predissection CT scans, 2) the endoscopic endonasal transtuberculum transplanum approach (lateral limit: medial optocarotid recess) followed by postdissection CT scans, 3) maximum lateral extension of the transtuberculum transplanum approach followed by postdissection CT scans, and 4) bone removal and surgical freedom analysis (a nonpaired Student t-test). A conventional subfrontal bilateral approach was used to evaluate, from above, the bone removal from the planum sphenoidale and the lateral limit of the endonasal route. RESULTS The endoscopic endonasal transtuberculum transplanum approach was extended at its maximum lateral aspect in the lateral portion of the anterior skull base, removing the bone above the optic prominence, that is, the medial portion of the lesser sphenoid wing, including the anterior clinoid process. As expected, a greater bone removal volume was obtained compared with the approach when bone removal is limited to the medial optocarotid recess (average 533.45 vs 296.07 mm2; p < 0.01). The anteroposterior diameter was an average of 8.1 vs 15.78 mm, and the laterolateral diameter was an average of 18.77 vs 44.54 mm (p < 0.01). The neurovascular contents of this area were exposed up to the insular segment of the middle cerebral artery. The surgical freedom analysis revealed a possible increased lateral maneuverability of instruments inserted in the contralateral nostril compared with a midline target (average 384.11 vs 235.31 mm2; p < 0.05). CONCLUSIONS Bone removal from the medial aspect of the lesser sphenoid wing, including the anterior clinoid process, may increase the exposure and surgical freedom of the extended endoscopic endonasal transtuberculum transplanum approach over the lateral segment of the anterior skull base. Although this study represents a preliminary anatomical investigation, it could be useful to refine the indications and limitations of the endoscopic endonasal corridor for the surgical management of skull base lesions involving the lateral portion of the planum sphenoidale.
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Affiliation(s)
- Alberto Di Somma
- 1Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Jorge Torales
- 2Department of Neurosurgery, Hospital Clinic, Barcelona, Spain; and
| | - Luigi Maria Cavallo
- 1Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Jose Pineda
- 3Laboratory of Surgical NeuroAnatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Spain
| | - Domenico Solari
- 1Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Rosa Maria Gerardi
- 1Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Federico Frio
- 1Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Joaquim Enseñat
- 2Department of Neurosurgery, Hospital Clinic, Barcelona, Spain; and
| | - Alberto Prats-Galino
- 3Laboratory of Surgical NeuroAnatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Spain
| | - Paolo Cappabianca
- 1Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
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Di Somma A, Andaluz N, Cavallo LM, de Notaris M, Dallan I, Solari D, Zimmer LA, Keller JT, Zuccarello M, Prats-Galino A, Cappabianca P. Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective. J Neurosurg 2019; 129:1203-1216. [PMID: 29243982 DOI: 10.3171/2017.4.jns162749] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 10/31/2016] [Accepted: 04/14/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVERecent studies have proposed the superior eyelid endoscopic transorbital approach as a new minimally invasive route to access orbital lesions, mostly in otolaryngology and maxillofacial surgeries. The authors undertook this anatomical study in order to contribute a neurosurgical perspective, exploring the anterior and middle cranial fossa areas through this purely endoscopic transorbital trajectory.METHODSAnatomical dissections were performed in 10 human cadaveric heads (20 sides) using 0° and 30° endoscopes. A step-by-step description of the superior eyelid transorbital endoscopic route and surgically oriented classification are provided.RESULTSThe authors' cadaveric prosection of this approach defined 3 modular routes that could be combined. Two corridors using bone removal lateral to the superior and inferior orbital fissures exposed the middle and anterior cranial fossa (lateral orbital corridors to the anterior and middle cranial base) to unveil the temporal pole region, lateral wall of the cavernous sinus, middle cranial fossa floor, and frontobasal area (i.e., orbital and recti gyri of the frontal lobe). Combined, these 2 corridors exposed the lateral aspect of the lesser sphenoid wing with the Sylvian region (combined lateral orbital corridor to the anterior and middle cranial fossa, with lesser sphenoid wing removal). The medial corridor, with extension of bone removal medially to the superior and inferior orbital fissure, afforded exposure of the opticocarotid area (medial orbital corridor to the opticocarotid area).CONCLUSIONSAlong with its minimally invasive nature, the superior eyelid transorbital approach allows good visualization and manipulation of anatomical structures mainly located in the anterior and middle cranial fossae (i.e., lateral to the superior and inferior orbital fissures). The visualization and management of the opticocarotid region medial to the superior orbital fissure are more complex. Further studies are needed to prove clinical applications of this relatively novel surgical pathway.
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Affiliation(s)
- Alberto Di Somma
- 1Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
| | | | - Luigi Maria Cavallo
- 1Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
| | - Matteo de Notaris
- 3Department of Neuroscience, G. Rummo Hospital, Neurosurgery Operative Unit, Benevento
| | - Iacopo Dallan
- 4First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Domenico Solari
- 1Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
| | - Lee A Zimmer
- 5Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Comprehensive Stroke Center at UC Gardner Neuroscience Institute, Cincinnati, Ohio; and
| | | | | | - Alberto Prats-Galino
- 6Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Cappabianca
- 1Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples
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Ugga L, Cuocolo R, Solari D, Guadagno E, D'Amico A, Somma T, Cappabianca P, Del Basso de Caro ML, Cavallo LM, Brunetti A. Prediction of high proliferative index in pituitary macroadenomas using MRI-based radiomics and machine learning. Neuroradiology 2019; 61:1365-1373. [PMID: 31375883 DOI: 10.1007/s00234-019-02266-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Pituitary adenomas are among the most frequent intracranial tumors. They may exhibit clinically aggressive behavior, with recurrent disease and resistance to multimodal therapy. The ki-67 labeling index represents a proliferative marker which correlates with pituitary adenoma aggressiveness. Aim of our study was to assess the accuracy of machine learning analysis of texture-derived parameters from pituitary adenomas preoperative MRI for the prediction of ki-67 proliferation index class. METHODS A total of 89 patients who underwent an endoscopic endonasal procedure for pituitary adenoma removal with available ki-67 labeling index were included. From T2w MR images, 1128 quantitative imaging features were extracted. To select the most informative features, different supervised feature selection methods were employed. Subsequently, a k-nearest neighbors (k-NN) classifier was employed to predict macroadenoma high or low proliferation index. Algorithm validation was performed with a train-test approach. RESULTS Of the 12 subsets derived from feature selection, the best performing one was constituted by the 4 highest correlating parameters at Pearson's test. These all showed very good (ICC ≥ 0.85) inter-observer reproducibility. The overall accuracy of the k-NN in the test group was of 91.67% (33/36) of correctly classified patients. CONCLUSIONS Machine learning analysis of texture-derived parameters from preoperative T2 MRI has proven to be effective for the prediction of pituitary macroadenomas ki-67 proliferation index class. This might aid the surgical strategy making a more accurate preoperative lesion classification and allow for a more focused and cost-effective follow-up and long-term management.
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Affiliation(s)
- Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy.
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples "Federico II", Naples, Italy
| | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Teresa Somma
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | | | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
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