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Falco J, Broggi M, Rubiu E, Schiariti M, Restelli F, Mazzapicchi E, La Corte E, Ferroli P, Acerbi F. The Application of Sodium Fluorescein in Resection of Medulloblastoma Under YELLOW 560 Filter: Feasibility and Preliminary Results of a Monocentric Cohort and Systematic Review. World Neurosurg 2024; 183:e386-e394. [PMID: 38154682 DOI: 10.1016/j.wneu.2023.12.105] [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: 08/26/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Maximizing surgical resection of medulloblastoma (MB) affects overall survival; nevertheless, surgical resection remains a because of the infiltrative behavior of this tumor. Several dyes have been tested for improving tumor visualization; however, few reports with different protocols of fluorophores use are available and the results are inconsistent. Hence, we report our experience with sodium fluorescein in MB surgery, aiming to assess the role of this technique on the extent of resection. Furthermore, we performed a literature review of this topic. METHODS Fluorescence characteristics, extent of resection, and clinical outcome were analyzed in 9 consecutively operated patients with MB. A comprehensive literature search and review for English-language articles concerning fluorescein application in MB was conducted. RESULTS In our cohort, no side effect related to fluorescein occurred; all tumors presented with an intense or moderate yellow-green enhancement, and fluorescein was judged fundamental in distinguishing tumors from viable tissue in 7 of 9 cases. Gross total resection or near-total resection (i.e., a residual tumor volume <1.5 cm3) was achieved in 8 patients. The review explored the different techniques and surgical interpretations as well as surgical radicality; we did not find a homogenous protocol for fluorescein injection in the published articles. Fluorescence appeared moderate or intense in almost all cases, with a high percentage of usefulness and consensual achievement of a high rate of gross total resection. CONCLUSIONS Based on these results, we can infer that fluorescein-guided surgical resection is a safe and valuable method for patients with MB.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy; Department of Neurosurgery, Experimental Microsurgical Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Falco J, Broggi M, Rubiu E, Restelli F, Pollo B, Schiariti M, Lanteri P, Stanziano M, LA Corte E, Mazzapicchi E, Vetrano IG, Ferroli P, Acerbi F. What have we learned in fluorescein-guided resection of brain metastases? An update after 79 consecutive cases. J Neurosurg Sci 2023:S0390-5616.23.06134-9. [PMID: 37971496 DOI: 10.23736/s0390-5616.23.06134-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Cerebral metastasis (CM) is the most common malignancy affecting the brain. Individualized treatment of CM still represents a challenge for neuro-oncological teams: in patient eligible for surgery, complete tumor removal is the most relevant predictor of overall survival (OS) and neurological outcome. The development of surgical microscopes harboring specific filter able to elicit the fluorescent response from sodium fluorescein (SF) has facilitated fluorescein-guided microsurgery and the identification of pathological tumor tissue, especially at the tumor margins. In this study, we analyzed the effect of SF on the visualization and resection of a large monoinstitutional cohort of CM. METHODS Surgical database of FLUOCERTUM study (Besta Institute, Milan, Italy) was retrospectively reviewed to find CM surgically removed with a fluorescein-guided technique from March 2016 to December 2022. SF was intravenously injected (5 mg/kg) immediately after induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW560 filter (Carl Zeiss Meditec, Oberkochen, Germany). In the most recent cases, biopsies at the tumor margins were performed to evaluate the ability of fluorescein to discriminate between fluorescent and nonfluorescent tissue at the lesion borders. RESULTS Seventy-nine patients were included; most of them showed a bright, diffuse fluorescent staining that markedly enhanced tumor visibility; 11 melanomas presented a specific faint enhancement of the black pigmented central nodule with high fluorescence at tumor boundaries. Only in a minimal percentage of cases (N.=4-5.1%), fluorescein enhancement was tenuous, thus not providing a significant help during tumor resection. Altogether, in more than 90% of cases, SF was considered useful in the identification of tumoral tissue and in achieving a high rate of CM resection; thus, gross total resection was achieved in 96.2% (N.=76) of patients and in no case the detection of tumor remnants was an unexpected event. The resulted sensitivity and specificity of fluorescein in identifying tumor tissue at the tumor margin was 88.9% with a predictive positive value of 88.9%. No adverse event was registered during the postoperative course. CONCLUSIONS The use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of CM, suggesting a role in improving the extent of resection of these lesions.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Emanuele Rubiu
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Bianca Pollo
- Unit of Neuropathology, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Paola Lanteri
- Department of Neurophysiology, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Mario Stanziano
- Unit of Neuroradiology, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Emanuele LA Corte
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy -
- Laboratory of Experimental Microsurgical, Department of Neurosurgery, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
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Bonomo G, Bussone G, Gans A, Iess G, Bonomo R, Restelli F, Falco J, Mazzapicchi E, Stanziano M, Amato A, Broggi M, Acerbi F, Ferroli P, Schiariti M. Small spheno-ethmoidal meningoencephalocele versus ethmoidal mucocele in spontaneous intracranial hypotension. Brain Spine 2023; 3:102676. [PMID: 38021026 PMCID: PMC10668106 DOI: 10.1016/j.bas.2023.102676] [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: 06/21/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023]
Abstract
Background Meningoencephalocele is defined as an abnormal sac of brain tissue and meninges extending beyond natural skull margins, often leading to cerebrospinal fluid (CSF) leakage. When this condition arises in the spheno-ethmoidal region, the diagnosis becomes more challenging as it can be mistaken for other nasal pathologies, such as mucocele. Research question We show in this case report a non-congenital sphenoethmoidal meningoencephalocele causing rhinoliquoral fistula and spontaneous intracranial hypotension. Results this 65-year-old woman presented with sporadic rhinoliquorrhoea associated with orthostatic headache, nausea and dizziness. Brain MRI revealed a small lesion of an ethmoidal sinus, which was successfully treated with endoscopic endonasal surgery. Histology confirmed the presence of meningoencephalic tissue positive for S100 protein on immunohistochemistry. Conclusions When dealing with lesions of the paranasal sinuses in contact with the anterior skull base, rhinoliquorrhoea presence suggests meningoencephalocele. In dubious cases, a proper workup, including a thorough clinical history and neurological examination, specific imaging, and a direct search of CSF-like markers, is essential to support the differential diagnosis. In such cases, a transnasal endoscopic surgical approach is recommended to obtain a final histological diagnosis and to perform eventual dural plastic surgery.
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Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
- Department of Neurological Surgery, Policlinico “G. Rodolico-S. Marco” University Hospital, Catania, Italy
| | - Gennaro Bussone
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Alessandro Gans
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Roberta Bonomo
- Department of Neurology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- School of Medicine and Surgery, Kore University of Enna, Enna, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- Neurosciences Department “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Alessia Amato
- Department of Child Neuropsychiatry, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
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Acerbi F, Broggi M, Ferroli P, Falco J. Fluorescein-guided resection of a left frontal pre-rolandic cerebral metastasis: how I do it. Acta Neurochir (Wien) 2023; 165:2519-2524. [PMID: 37284838 DOI: 10.1007/s00701-023-05635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cerebral metastases (CM) are the most common intracranial tumors; several studies have underlined the fundamental role of neurosurgical lesion removal. METHOD We describe the surgical resection of a left frontal single metastasis. We attempted to achieve a radical resection under the intraoperative guidance of fluorescein, with the aid of intraoperative neurological monitoring. This technique can be applied to each contrast enhancing, intra-axial, infiltrative lesion. CONCLUSION Fluorescein-guided surgery is a valuable tool in CM surgery to increase the rate of resection; further prospective evaluation of the role of fluorescein in this field is in planning, aiming to study the prognostic impact.
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Affiliation(s)
- Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy.
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
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Ferroli P, Schiavolin S, Mariniello A, Acerbi F, Restelli F, Schiariti M, LA Corte E, Falco J, Levi V, Dimeco F, Assietti R, Bongetta D, Colombo EV, Bellocchi S, Sangiorgi S, Bistazzoni S, Polosa M, Orru MI, Spena G, Bernucci C, Sicignano AM, Fanti A, Brembilla C, Resmini B, Costi E, Cenzato M, Talamonti G, Bottini G, Scarpa P, Bollani A, Querzola M, Palmas G, DE Gonda F, Bosio L, Egidi M, Tardivo V, Fioravanti A, Subacchi S, Fontanella M, Biroli A, Cereda C, Panciani PP, Bergomi R, Pertichetti M, Tancioni F, Bona A, Tartara FA, Fornari M, Pessina F, Lasio G, Cardia A, Servadei F, Riva M, Casarotti A, Giussani C, Fiori L, Mazzoleni F, Vaiani S, Carrabba G, DI Cristofori A, Sganzerla EP, Vimercati A, Isella V, Mauri I, Incerti M, Sicuri G, Miramonti V, Stefini R, Spagnoli D, Piparo M, Grimod G, Regazzoni R, Vismara D, Mazzeo L, Monti E, Franzin A, Vivaldi O, Maietti A, Pini E, Servello D, Zekaj E, DE Michele S, Locatelli M, Borsa S, Grimoldi N, Caroli M, Tariciotti L, Abete-Fornara G, Vitale M, Leonardi M, Broggi M. Towards a common language in neurosurgical outcome evaluation: the NEON (NEurosurgical Outcome Network) proposal. J Neurosurg Sci 2023; 67:263-272. [PMID: 36951933 DOI: 10.23736/s0390-5616.23.05968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The aim of this study was to achieve a consensus on the minimum set of outcome measures and predictors to be used in the neurosurgical practice and on the timing of outcome assessment. METHODS A consensus building approach was employed. All neurosurgical departments in Lombardy (Italy) were invited to participate by the Carlo Besta Neurologic Institute IRCCS Foundation. Three workshops were organized during which a multidisciplinary group called Neurosurgical Outcome Network (NEON) was created and the methodology to select outcome measures, predictors, and timing of outcome assessment was established. Eight working groups were created for the different neurosurgical diseases (neuro-oncological, skull base, vascular, traumatic, spinal, peripheral nervous system, malformation, functional) and 8 workshops were organized to identify the outcome measures and predictors specific for each of the neurosurgical diseases based on the experts' clinical practice and the existing literature. RESULTS A total of 20 neurosurgical departments participated in this study. Specific outcome measures, predictors and the timing of outcome assessment were identified for each of the 8 neurosurgical diseases. Moreover, a list of variables common to all pathologies were identified by the NEON group as further data to be collected. CONCLUSIONS A consensus on the minimum set of outcome measures and predictors and the timing of outcome assessments for 8 neurosurgical diseases was achieved by a group of neurosurgeons of the Lombardy region, called NEON. These sets could be used in future studies for a more homogeneous data collection and as a starting point to reach further agreement also at national and international level.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy -
| | - Arianna Mariniello
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuele LA Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Dimeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
- Department of Neurological Surgery, John Hopkins Medical School, Baltimore, MD, USA
| | - Roberto Assietti
- Neurosurgery Unit, ASST Fatebenefratelli-Sacco, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, ASST Fatebenefratelli-Sacco, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Elena V Colombo
- Neurosurgery Unit, ASST Fatebenefratelli-Sacco, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Silvio Bellocchi
- Neurosurgery Unit, Department of Surgery, ASST Lariana-S. Anna Hospital, Como, Italy
| | - Simone Sangiorgi
- Neurosurgery Unit, Department of Surgery, ASST Lariana-S. Anna Hospital, Como, Italy
| | - Simona Bistazzoni
- Neurosurgery Unit, Department of Surgery, ASST Lariana-S. Anna Hospital, Como, Italy
| | - Maria Polosa
- Neurosurgery Unit, Department of Surgery, ASST Lariana-S. Anna Hospital, Como, Italy
| | - Maria I Orru
- Neurosurgery Unit, Department of Surgery, ASST Lariana-S. Anna Hospital, Como, Italy
| | - Giannantonio Spena
- Department of Neurosurgery, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Claudio Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Angelo M Sicignano
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Fanti
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Carlo Brembilla
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Bruno Resmini
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emanuele Costi
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Cenzato
- Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Talamonti
- Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriella Bottini
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- NeuroMi - Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Pina Scarpa
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Bollani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Querzola
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Palmas
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico DE Gonda
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Valtellina e Alto Lario, Hospital of Sondalo, Sondalo, Sondrio, Italy
| | - Lorenzo Bosio
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Valtellina e Alto Lario, Hospital of Sondalo, Sondalo, Sondrio, Italy
| | - Marcello Egidi
- Department of Neurosurgery, San Carlo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Valentina Tardivo
- Department of Neurosurgery, San Carlo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, Azienda Socio Sanitaria Territoriale Cremona, Ospedale di Cremona, Cremona, Italy
| | - Sara Subacchi
- Department of Neurosurgery, Azienda Socio Sanitaria Territoriale Cremona, Ospedale di Cremona, Cremona, Italy
| | - Marco Fontanella
- Neurosurgery Unit, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Biroli
- Neurosurgery Unit, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Cereda
- Neurosurgery Unit, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Pier Paolo Panciani
- Neurosurgery Unit, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Bergomi
- Neurosurgery Unit, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marta Pertichetti
- Neurosurgery Unit, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Flavio Tancioni
- Department of Neurosurgery, ICCS Istituto Clinico Città Studi, Milan, Italy
| | - Alberto Bona
- Department of Neurosurgery, ICCS Istituto Clinico Città Studi, Milan, Italy
| | - Fulvio A Tartara
- Department of Neurosurgery, ICCS Istituto Clinico Città Studi, Milan, Italy
| | | | - Federico Pessina
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giovanni Lasio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Cardia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Franco Servadei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Riva
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Giussani
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Leonardo Fiori
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Fabio Mazzoleni
- Department of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Simona Vaiani
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Giorgio Carrabba
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Andrea DI Cristofori
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Erik P Sganzerla
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Alberto Vimercati
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Valeria Isella
- Neuropsychology Center, Neurology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Ilaria Mauri
- Neuropsychology Center, Neurology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Michele Incerti
- Unit of Neurosurgery, Polyclinic of Monza, Monza, Monza-Brianza, Italy
| | - Giovanni Sicuri
- Department of Neurosurgery, ASST Ovest Milanese, Legnano, Italy
| | - Valentina Miramonti
- Clinical Psychology Unit, Neurosurgical Unit, Head and Neck Neuroscience Department, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Roberto Stefini
- Department of Neurosurgery, ASST Ovest Milanese, Legnano, Italy
| | - Diego Spagnoli
- Department of Neurosurgery, Moriggia-Pelascini Hospital, Gravedona, Como, Italy
| | - Maurizio Piparo
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Gianluca Grimod
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Rossana Regazzoni
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Daniela Vismara
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Lucio Mazzeo
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Emanuele Monti
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Alberto Franzin
- Neurosurgery, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Oscar Vivaldi
- Neurosurgery, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Alessandra Maietti
- Specialist Rehabilitation Unit, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Elisa Pini
- Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Domenico Servello
- Department of Functional Neurosurgery, Tourette Center, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Edvin Zekaj
- Department of Functional Neurosurgery, Tourette Center, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sara DE Michele
- Tourette Center, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Marco Locatelli
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Borsa
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nadia Grimoldi
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Manuela Caroli
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Leonardo Tariciotti
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgia Abete-Fornara
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Vitale
- Spinal Surgery Unit, Ospedale Villa Maria, Rimini, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Chiapparini L, Opancina V, Erbetta A, Pollo B, Broggi M, Ciceri E. Case 310: Posterior Epidural Migration of a Lumbar Disk Herniation. Radiology 2023; 306:e212607. [PMID: 36689345 DOI: 10.1148/radiol.212607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
HISTORY A 49-year-old man presented with right foot drop, bilateral cruralgia mainly on the left side, and genital and perianal hypoesthesia, which started suddenly 12 days before. After onset of symptoms, the patient also experienced an accidental fall at home, resulting in a left fibular fracture, which was treated with reduction and with seven-hole plate Synthes Locking Compression Plate at the orthopedic clinic. The neurologic examination showed paresthesias on the posterior aspect of both thighs and crural regions that was worse on the left side, hypoesthesia in the L5 root region on the right side, and right foot drop. There was no urinary retention or fecal incontinence. The patient denied past surgery, back trauma, heavy manual labor, hypermobility, or any other remarkable medical history. The patient was afebrile. Laboratory results on the 1st day of hospitalization showed increased C-reactive protein level (0.62 mg/dL; reference range, 0.0-0.5 mg/dL), elevated erythrocyte sedimentation rate (60 mm/h; reference range, 0-20 mm/h), and increased aspartate transaminase (38 U/L [0.63 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), alanine transaminase (70 U/L [1.17 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), and high lymphocyte (4.55 × 103/mL; reference range, [1.0-3.0] ×103/mL), and neutrophil (8.79 × 103/mL; reference range, [2.0-7.0] × 103/mL) levels. Absence of coagulopathy was demonstrated by normal coagulation values (international normalized ratio, 1.19; reference value, 0.80-1.25; activated partial thromboplastin time ratio, 0.88 second; reference range, 0.79-1.27 seconds). Electroneurography showed marked hypoevocable F response in the right tibia. Electromyography indicated severe reduction of muscle recruitment pertaining to right L4, L5, and S1 nerve territory and, to a lesser extent, of muscles pertaining to L3 territory bilaterally in the absence of spontaneous denervation. Unenhanced CT and contrast-enhanced MRI of the lumbosacral spine were performed.
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Affiliation(s)
- Luisa Chiapparini
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Valentina Opancina
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Alessandra Erbetta
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Bianca Pollo
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Morgan Broggi
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Elisa Ciceri
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
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7
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Ferroli P, Restelli F, Bertolini G, Monti E, Falco J, Bonomo G, Tramacere I, Pollo B, Calatozzolo C, Patanè M, Schiavolin S, Broggi M, Acerbi F, Erbetta A, Esposito S, Mazzapicchi E, La Corte E, Vetrano IG, Broggi G, Schiariti M. Are Thalamic Intrinsic Lesions Operable? No-Man's Land Revisited by the Analysis of a Large Retrospective, Mono-Institutional, Cohort. Cancers (Basel) 2023; 15:cancers15020361. [PMID: 36672311 PMCID: PMC9856718 DOI: 10.3390/cancers15020361] [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: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Thalamic gliomas represent a heterogeneous subset of deep-seated lesions for which surgical removal is advocated, although clear prognostic factors linked to advantages in performance status or overall survival are still lacking. We reviewed our Institutional Cancer Registry, identifying patients who underwent surgery for thalamic gliomas between 2006 and 2020. Associations between possible prognostic factors such as tumor volume, grade, the extent of resection and performance status (PS), and overall survival (OS) were evaluated using univariate and multivariate survival analyses. We found 56 patients: 31 underwent surgery, and 25 underwent biopsy. Compared to biopsy, surgery resulted positively associated with an increase in the OS (hazard ratio, HR, at multivariate analysis 0.30, 95% confidence interval, CI, 0.12-0.75). Considering the extent of resection (EOR), obtaining GTR/STR appeared to offer an OS advantage in high-grade gliomas (HGG) patients submitted to surgical resection if compared to biopsy, although we did not find statistical significance at multivariate analysis (HR 0.53, 95% CI 0.17-1.59). Patients with a stable 3-month KPS after surgery demonstrated to have a better prognosis in terms of OS if compared to biopsy (multivariate HR 0.17, 95% CI, 0.05-0.59). Age and histological grades were found to be prognostic factors for this condition (p = 0.04 and p = 0.004, respectively, chi-square test). Considering the entire cohort, p53 positivity (univariate HR 2.21, 95% CI 1.01-4.82) and ATRX positivity (univariate HR 2.69, 95% CI 0.92-7.83) resulted associated with a worse prognosis in terms of OS. In this work, we demonstrated that surgery aimed at tumor resection might offer a stronger survival advantage when a stable 3-month KPS after surgery is achieved.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2394-2309; Fax: +39-02-7063-5017
| | - Giacomo Bertolini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele Monti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Neurological Surgery, Policlinico “G. Rodolico–S. Marco”, University Hospital, 95123 Catania, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Bianca Pollo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Chiara Calatozzolo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Monica Patanè
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Silvia Schiavolin
- Public Health and Disability Unit–Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alessandra Erbetta
- Unit of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Silvia Esposito
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Neurosurgery, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- IEN Foundation, 20100 Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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8
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Bonomo G, Gans A, Mazzapicchi E, Rubiu E, Alimonti P, Eoli M, Paterra R, Pollo B, Iess G, Restelli F, Falco J, Acerbi F, Schiariti MP, Ferroli P, Broggi M. Sporadic spinal psammomatous malignant melanotic nerve sheath tumor: A case report and literature review. Front Oncol 2023; 13:1100532. [PMID: 36910634 PMCID: PMC9998981 DOI: 10.3389/fonc.2023.1100532] [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: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Sporadic Spinal Psammomatous Malignant Melanotic Nerve Sheath Tumor (SSP-MMNST) is a rare subgroup of peripheral nerve sheath tumors arising along the spine. Only a few reports of SSP-MMNST have been described. In this paper, we review the literature on SSP-MMNST focusing on clinical, and diagnostic features, as well as investigating possible pathogenetic mechanisms to better implement therapeutic strategies. We also report an illustrative case of a young female presenting with cervicobrachial pain due to two SSP-MMNSTs arising from C5-6 right spinal roots. Case description We report a case of a 28-year-old woman presenting with right arm weakness and dysesthesia. Clinical examination and neuroimaging were performed, and, following surgical removal of both lesions, a histological diagnosis of SSP-MMNST was obtained. Results The literature review identified 21 eligible studies assessing 23 patients with SSP-MMNST, with a mean onset age of 41 years and a slight male gender preference. The lumbar district was the most involved spinal segment. Gross-total resection (GTR) was the treatment of choice in all amenable cases, followed in selected cases with residual tumor by adjuvant radiotherapy or chemotherapy. The metastatic and recurrence rates were 31.58% and 36.8%, respectively. Conclusion Differently from common schwannomas, MMNST represents a rare disease with known recurrence and metastatization propensity. As reported in our review, SSP-MMNST has a greater recurrence rate when compared to other forms of spinal MMNST, raising questions about the greater aggressiveness of the former. We also found that residual disease is related to a higher risk of systemic disease spreading. This metastatic potential, usually associated with primary lumbar localization, is characterized by a slight male prevalence. Indeed, whenever GTR is unachievable, considering the higher recurrence rate, adjuvant radiation therapy should be taken into consideration.
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Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy.,Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Catania, Italy
| | - Alessandro Gans
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Paolo Alimonti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marica Eoli
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Rosina Paterra
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
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9
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Vetrano IG, Gioppo A, Faragò G, Pinzi V, Pollo B, Broggi M, Schiariti M, Ferroli P, Acerbi F. Hemangioblastomas and Other Vascular Origating Tumors of Brain or Spinal Cord. Adv Exp Med Biol 2023; 1405:377-403. [PMID: 37452946 DOI: 10.1007/978-3-031-23705-8_14] [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: 07/18/2023]
Abstract
Hemangioblastomas (HBs) are highly vascularized, slow-growing, rare benign tumors (WHO grade I). They account for about 2% of intracranial neoplasms; however, they are the most common primary cerebellar tumors in adults. Another frequent seat is the spinal cord (2-10% of primary spinal cord tumors). HBs are constituted by stromal and capillary vascular cells; macroscopically, HBs appear as nodular tumors, with or without cystic components. Although most of the HBs are sporadic (57-75%), they represent a particular component of von Hippel-Lindau disease (VHL), an autosomal dominant syndrome with high penetrance, due to a germline pathogenic mutation in the VHL gene, which is a tumor suppressor with chromosomal location on the short arm of chromosome three. VHL disease determines a variety of malignant and benign tumors, most frequently HBs, renal cell carcinomas, pheochromocytomas/paragangliomas, pancreatic neuroendocrine tumors, and endolymphatic sac tumors. Up to 20% of cases are due to de novo pathogenic variants without a family history. Many epidemiologic details of these tumors, especially the sporadic forms, are not well known. The median age of patients with sporadic HBS is about 40 years. More than two-third of VHL patients develop one or more central nervous system HBs during their lifetime; in case of VHL, patients at first diagnosis are usually younger than the patients with sporadic tumors. The most common presenting signs and symptoms are related to increased intracranial pressure, cerebellar signs, or spinal cord alterations in case of spinal involvement. Magnetic resonance imaging is the gold standard for the diagnosis, assessment, and follow-up of HBs, both sporadic and syndrome-related; angiography is rarely performed because the diagnosis is easily obtained with magnetic resonance. However, the diagnosis of an asymptomatic lesion does not automatically result in therapeutic actions, as the risks of treatment and the onset of possible neurological deficit need to be balanced, considering that HBs may remain asymptomatic and have a static or slow-growing behavior. In such cases, regular follow-up can represent a valid therapeutic option until the patients remain asymptomatic. There are no actual pharmacological therapies that are demonstrated to be effective for HBs. Surgery represents the primary therapeutic approach for these tumors. Observation or radiotherapy also plays a role in the long-term management of patients harboring HBs, especially in VHL; in few selected cases, endovascular treatment has been suggested before surgical removal. This chapter presents a systematic overview of epidemiology, clinical appearance, histopathological and neuroradiological characteristics of central nervous system HBs. Moreover, the genetic and molecular biology of sporadic and VHL HBS deserves special attention. Furthermore, we will describe all the available therapeutic options, along with the follow-up management. Finally, we will briefly report other vascular originating tumors as hemangioendotheliomas, hemangiomas, or angiosarcomas.
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Affiliation(s)
- Ignazio G Vetrano
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Neurovascular Surgery Unit and Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. Celoria 11, 20133, Milan, Italy.
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10
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Broggi M, Zattra CM, Restelli F, Acerbi F, Seveso M, Devigili G, Schiariti M, Vetrano IG, Ferroli P, Broggi G. A Brief Explanation on Surgical Approaches for Treatment of Different Brain Tumors. Adv Exp Med Biol 2023; 1405:689-714. [PMID: 37452959 DOI: 10.1007/978-3-031-23705-8_27] [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: 07/18/2023]
Abstract
The main goal of brain tumor surgery is to achieve gross total tumor resection without postoperative complications and permanent new deficits. However, when the lesion is located close or within eloquent brain areas, cranial nerves, and/or major brain vessels, it is imperative to balance the extent of resection with the risk of harming the patient, by following a so-called maximal safe resection philosophy. This view implies a shift from an approach-guided attitude, in which few standard surgical approaches are used to treat almost all intracranial tumors, to a pathology-guided one, with surgical approaches actually tailored to the specific tumor that has to be treated with specific dedicated pre- and intraoperative tools and techniques. In this chapter, the basic principles of the most commonly used neurosurgical approaches in brain tumors surgery are presented and discussed along with an overview on all available modern tools able to improve intraoperative visualization, extent of resection, and postoperative clinical outcome.
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Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Mirella Seveso
- Neuroanesthesia and Neurointensive Care Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Grazia Devigili
- Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
- Scientific Director, Fondazione I.E.N. Milano, Italy.
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11
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Broggi M, Ferroli P, Schiavolin S, Zattra C, Schiariti M, Acerbi F, Caldiroli D, Raggi A, Vetrano I, Falco J, de Laurentis C, Broggi G. Surgical Complexity and Complications: The Need for a Common Language. Acta Neurochir Suppl 2023; 130:1-12. [PMID: 37548717 DOI: 10.1007/978-3-030-12887-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Quality measurement and outcome assessment have recently caught an attention of the neurosurgical community, but lack of standardized definitions and methodology significantly complicates these tasks. OBJECTIVE To identify a uniform definition of neurosurgical complications, to classify them according to etiology, and to evaluate them comprehensively in cases of intracranial tumor removal in order to establish a new, easy, and practical grading system capable of predicting the risk of postoperative clinical worsening of the patient condition. METHODS A retrospective analysis was conducted on all elective surgeries directed at removal of intracranial tumor in the authors' institution during 2-year study period. All sociodemographic, clinical, and surgical factors were extracted from prospectively compiled comprehensive patient registry. Data on all complications, defined as any deviation from the ideal postoperative course occurring within 30 days of the procedure, were collected with consideration of the required treatment and etiology. A logistic regression model was created for identification of independent factors associated with worsening of the Karnofsky Performance Scale (KPS) score at discharge after surgery in comparison with preoperative period. For each identified statistically significant independent predictor of the postoperative worsening, corresponding score was defined, and grading system, subsequently named Milan Complexity Scale (MCS), was formed. RESULTS Overall, 746 cases of surgeries for removal of intracranial tumor were analyzed. Postoperative complications of any kind were observed in 311 patients (41.7%). In 223 cases (29.9%), worsening of the KPS score at the time of discharge in comparison with preoperative period was noted. It was independently associated with 5 predictive factors-major brain vessel manipulation, surgery in the posterior fossa, cranial nerve manipulation, surgery in the eloquent area, tumor size >4 cm-which comprised MCS with a range of the total score from 0 to 8 (higher score indicates more complex clinical situations). Patients who demonstrated KPS worsening after surgery had significantly higher total MCS scores in comparison with individuals whose clinical status at discharge was improved or unchanged (3.24 ± 1.55 versus 1.47 ± 1.58; P < 0.001). CONCLUSION It is reasonable to define neurosurgical complication as any deviation from the ideal postoperative course occurring within 30 days of the procedure. Suggested MCS allows for standardized assessment of surgical complexity before intervention and for estimating the risk of clinical worsening after removal of intracranial tumor. Collection of data on surgical complexity, occurrence of complications, and postoperative outcomes, using standardized prospectively maintained comprehensive patient registries seems very important for quality measurement and should be attained in all neurosurgical centers.
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Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit - Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Costanza Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Dario Caldiroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit - Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ignazio Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Camilla de Laurentis
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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12
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Falco J, Rubiu E, Broggi M, Farinotti M, Vetrano IG, Schiariti M, Anghileri E, Eoli M, Pollo B, Moscatelli M, Restelli F, Mazzapicchi E, La Corte E, Bonomo G, Gemma M, Broggi G, Ferroli P, Acerbi F. Towards an Established Intraoperative Oncological Favorable Tool: Results of Fluorescein-Guided Resection from a Monocentric, Prospective Series of 93 Primary Glioblastoma Patients. J Clin Med 2022; 12:jcm12010178. [PMID: 36614980 PMCID: PMC9820993 DOI: 10.3390/jcm12010178] [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: 11/11/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
It is commonly reported that maximizing surgical resection of contrast-enhancing regions in patients with glioblastoma improves overall survival. Efforts to achieve an improved rate of resection have included several tools: among those, the recent widespread of fluorophores. Sodium fluorescein is an unspecific, vascular dye which tends to accumulate in areas with an altered blood-brain barrier. In this retrospective analysis of patients prospectively enrolled in the FLUOCERTUM study, we aimed to assess the role of fluorescein-guided surgery on surgical radicality, survival, and morbidity. A retrospective review based on 93 consecutively and prospectively enrolled IDH wild-type glioblastoma patients (2016-2022) was performed; fluorescence characteristics, rate of resection, clinical outcome, and survival were analyzed. No side effect related to fluorescein occurred; all of the tumors presented a strong yellow-green enhancement and fluorescein was judged fundamental in distinguishing tumors from viable tissue in all cases. Gross total resection was achieved in 77 cases out of 93 patients (82.8%). After a mean follow-up time of 17.4 months (3-78 months), the median progression-free survival was 12 months, with a PFS-6 and PFS-12 of 94.2% and 50%, respectively, whereas median overall survival was estimated to be 16 months; survival at 6, 12, and 24 months was 91.8%, 72.3%, and 30.1%, respectively. Based on these results, we can assert that the fluorescein-guided technique is a safe and valuable method for patients harboring a newly diagnosed, untreated glioblastoma.
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Affiliation(s)
- Jacopo Falco
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele Rubiu
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Mariangela Farinotti
- Neuroepidemiology Unit, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ignazio G. Vetrano
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
| | - Marco Schiariti
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elena Anghileri
- Unit of Molecular Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marica Eoli
- Unit of Molecular Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Moscatelli
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elio Mazzapicchi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Bonomo
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Gemma
- Neurointensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giovanni Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Acerbi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
- Correspondence: ; Tel.: +39-02-2394-2309
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13
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Rubiu E, La Corte E, Bonomo G, Restelli F, Falco J, Mazzapicchi E, Broggi M, Schiariti MP, Pollo B, Pinzi V, Bruzzone MG, Di Meco F, Acerbi F, Ferroli P. Diagnostic and surgical management of primary central nervous system angioleiomyoma: A case report and literature review. Front Oncol 2022; 12:1072270. [PMID: 36591470 PMCID: PMC9800865 DOI: 10.3389/fonc.2022.1072270] [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: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Angioleiomyoma (ALM) is a benign smooth muscle neoplasm that mainly occurs in lower extremities subcutaneous tissue and generally affects middle-aged adults. This tumor histotype may rarely localize intracranially, although only a few cases have been described in the literature. We report a case of intracranial ALM, whose differential diagnosis has been particularly challenging, and firstly provide a comprehensive radiological and intra-operative evaluation of a such rare entity. This represents also the first report of the use of intraoperative confocal microscopy in ALM and the first documented short-term recurrence. At this regard, a scoping literature review has been conducted with the aim of presenting the major clinical and diagnostic features along with the proposed therapeutic strategies.
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Affiliation(s)
- Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy,*Correspondence: Giulio Bonomo,
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Department of Radiosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy,University of Milan, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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14
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Falco J, Broggi M, Schiariti M, Vetrano IG, Esposito S, Ferroli P, Acerbi F. The role of sodium fluorescein in pediatric supratentorial intra-axial tumor resection: new insights from a monocentric series of 33 consecutive patients. Childs Nerv Syst 2022; 39:1463-1471. [PMID: 36520160 DOI: 10.1007/s00381-022-05764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Surgical resection represents the mainstay of treatment, in pediatric central nervous system (CNS) tumors, and aggressive resection correlates with prognosis for several histotypes. Sodium fluorescein (SF), a green, water-soluble dye, is used as neurosurgical fluorescent tracer thanks to its property to accumulate in cerebral regions of blood-brain barrier disruption, acting as a valid tool to improve the extent of resection in tumors enhancing at preoperative MRI. Brain neoplasms represent a heterogeneous group of tumors in the pediatric age, constituting the most common solid cancers; they typically show a varying degree of contrast enhancement on MRI. MATERIALS AND METHODS In March 2016, the authors started a prospective, observational trial to evaluate intraoperative fluorescence's characteristics of CNS tumors, the percentage of extent of resection, thanks to fluorescein aid, and side effects related to fluorescein administration. This report is based on a retrospective analysis of a group of 33 consecutive pediatric patients harboring a supratentorial lesion. RESULTS In 17 of 33 (51.5%) procedures, fluorescence was reported as intense; in 14 of 33 (42.4%), moderate; and in 2 of 33 (6.1%), slight. Intraoperative fluorescence corresponds to preoperative-MRI-documented contrast enhancement. In 28 of 33 (84.8%) surgical procedures, SF was considered useful; in 2 of 33 (6.1%), partial useful; and in 3 of 33 (9.1%), not essential because the tumor was already recognizable. No adverse effect to SF administration was registered. CONCLUSION Fluorescein-guided surgery with a dedicated filter on the microscope is a safe and effective technique to improve visualization and resection of different pediatric brain tumors.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Silvia Esposito
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133, Milan, Italy.
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15
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Restelli F, Bonomo G, Monti E, Broggi G, Acerbi F, Broggi M. Safeness of sodium fluorescein administration in neurosurgery: Case-report of an erroneous very high-dose administration and review of the literature. Brain Spine 2022; 2:101703. [PMID: 36605385 PMCID: PMC9808466 DOI: 10.1016/j.bas.2022.101703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
Introduction Sodium Fluorescein has become a validated and widely used fluorescent dye in neuro-oncological surgery, thanks to its ability to accumulate in cerebral with a damaged blood-brain barrier. It concentrates at the tumor site, enhancing the lesion, and helps in the discrimination between tumor and normal brain parenchyma. Research question This dye has a very well described profile of safeness, as a result of several applications in ophthalmology and, in recent years, also in neurosurgery. To date, no reviews are available on collateral effects of sodium fluorescein application in neurosurgery. Material and methods The case of a young woman who underwent a potentially toxic dose (almost 3 g) of sodium fluroescein administration during anesthesia induction for a glioma surgery due to a medical error is presented, along with a review of available articles relates to collateral effects of sodium fluorescein in neurosurgery. Results No toxic clinical phenomena occurred, and the microsurgical procedure was completed, achieving tumor gross total resection. Procedure resulted challenging due to an intense basal hyper-fluorescence, making difficult the visualization of brain tissues and the discrimination between normal brain and tumor. Discussion and conclusions The good clinical and laboratory outcome of this patient further strengthens the idea that fluorescein-guided removal of brain tumors may be considered safe, beyond effective. By now, this is the first report of an erroneous so high dose administration of sodium fluorescein during a neurosurgical procedure and the first review of neurosurgical-reported collateral effects.
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Affiliation(s)
- Francesco Restelli
- Corresponding author. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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16
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Falco J, Broggi M, Vetrano IG, Rubiu E, Schiariti M, Restelli F, Mazzapicchi E, Bonomo G, La Corte E, Ferroli P, Acerbi F. Fluorescein sodium in the surgical treatment of pleomorphic xanthoastrocytomas: Results from a retrospective study. Front Oncol 2022; 12:1009796. [PMID: 36452506 PMCID: PMC9702556 DOI: 10.3389/fonc.2022.1009796] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/19/2022] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Pleomorphic xanthoastrocytoma (PXA) is a rare brain tumor, most commonly affecting children and young adults. Surgical resection represents the mainstay of treatment, and extent of resection is associated with improved survival. In this study, we analyzed the role of sodium fluorescein (SF) in improving intraoperative visualization easing resection. METHODS Surgical database of FLUOCERTUM study (Besta Institute, Milan, Italy) was retrospectively reviewed to find pleomorphic xanthoastrocytomas and anaplastic xanthoastrocytomas, according to WHO-2016/2021 classification, surgically removed by a fluorescein-guided technique from March 2016 to February 2022. SF was intravenously injected (5mg/kg) immediately after induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW 560 filter (Carl Zeiss Meditec, Oberkochen, Germany). RESULTS Twelve patients (7 males and 5 females; 3 pediatric patients, mean age 10 years, range 5 to 13 years and 9 adult patients, mean age 50.6 years, range 35 to 63 years) underwent fluorescein-guided surgery. No side effects related to SF occurred. In all tumors, contrast enhancement on preoperative MRI correlated with intense, heterogeneous yellow fluorescence with bright fluorescent cystic fluid. Fluorescein was considered helpful in distinguishing tumors from viable tissue in all cases. Gross total resection was achieved in 8 cases (66.7%); in 4 cases, otherwise, the resection was subtotal with fluorescent residual spots to avoid neurological worsening (33.3%). CONCLUSIONS The use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data documented a positive effect of fluorescein-guided surgery on intraoperative visualization, suggesting a probable role in improving the extent of resection during yellow surgery of PXA.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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17
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Mazzapicchi E, Restelli F, Falco J, Broggi M, Gatti L, Alongi P, Valentini L, Ferroli P, Vetrano IG, DiMeco F, Acerbi F. Sporadic and von Hippel-Lindau Related Hemangioblastomas of Brain and Spinal Cord: Multimodal Imaging for Intraoperative Strategy. Cancers (Basel) 2022; 14:cancers14225492. [PMID: 36428588 PMCID: PMC9688688 DOI: 10.3390/cancers14225492] [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: 09/17/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Hemangioblastomas (HBs) are rare, benign tumors often related to von Hippel-Lindau disease. They represent the most frequent primary cerebellar tumors in adults. Neurosurgical procedures aim to obtain a gross-total resection of tumor nodules, avoiding intra-postoperative hemorrhage. The introduction of new intraoperative imaging techniques has considerably changed surgical strategies in neuro-oncology. We present an overview of clinical and radiological data of a mono-institutional retrospective cohort, focusing on the role of intraoperative multimodal imaging in surgical strategy. From 2015 to 2021, we identified 64 (81%) cranial (42 cerebellar, 8 supratentorial, and 14 of the brainstem) HBs and 15 (19%) spinal (4 cervical and 11 dorsal) HBs in 79 patients. Intraoperatively, indocyanine green videoangiography with FLOW800 was used in 62 cases (52 cranial and 10 spinal), intraoperative ultrasound and contrast-enhanced ultrasounds in 22 cases (18 cranial and 4 spinal HBs), and fluorescein in 10 cases (in 6 cranial and 2 spinal cases used as SF-VA). Gross total resection was achieved in 100% of the cases (53 mural nodule removal and 26 complete resections of the solid tumor). No side effects were reported following the combination of these tools. Multimodal intraoperative techniques provide valuable and reliable information to identify the tumor and its vasculature, guiding a more precise and safer resection and reducing the risk of recurrence.
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Affiliation(s)
- Elio Mazzapicchi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Laura Gatti
- Neurobiology Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy
| | - Laura Valentini
- Neurosurgical Unit 1, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ignazio G. Vetrano
- Neurosurgical Unit 1, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, Università di Milano, 20122 Milan, Italy
- Correspondence:
| | - Francesco DiMeco
- Neurosurgical Unit 1, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università di Milano, 20122 Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD 21205, USA
| | - Francesco Acerbi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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18
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Falco J, Zattra CM, Broggi M. Commentary: Combined Orbitozygomatic Pretemporal Transcavernous and Endonasal Transmaxillary Approach for Resection of a Giant Trigeminal Schwannoma. Oper Neurosurg (Hagerstown) 2022; 23:e409-e410. [DOI: 10.1227/ons.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
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19
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Acerbi F, Mazzapicchi E, Falco J, Vetrano IG, Restelli F, Faragò G, La Corte E, Bonomo G, Bersano A, Canavero I, Gemma M, Broggi M, Schiariti M, Ziliani V, Raccuia G, Mangiafico S, Ganci G, Ciceri E, Ferroli P. The Role of Bypass Surgery for the Management of Complex Intracranial Aneurysms in the Anterior Circulation in the Flow-Diverter Era: A Single-Center Series. Brain Sci 2022; 12:brainsci12101339. [PMID: 36291273 PMCID: PMC9599372 DOI: 10.3390/brainsci12101339] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the increasing popularity of flow diverters (FDs) as an endovascular option for intracranial aneurysms, the treatment of complex aneurysms still represents a challenge. Combined strategies using a flow-preservation bypass could be considered in selected cases. In this study, we retrospectively reviewed our series of patients with complex intracranial aneurysms submitted to bypass. From January 2015 to May 2022, 23 patients were selected. We identified 11 cases (47.8%) of MCA, 6 cases (26.1%) of ACA and 6 cases (26.1%) of ICA aneurysms. The mean maximal diameter was 22.73 ± 12.16 mm, 8 were considered as giant, 9 were fusiform, 8 presented intraluminal thrombosis, 10 presented wall calcification, and 18 involved major branches or perforating arteries. Twenty-five bypass procedures were performed in 23 patients (two EC–IC bypasses with radial artery graft, seventeen single- or double-barrel STA–MCA bypasses and six IC–IC bypasses in anterior cerebral arteries). The long-term bypass patency rate was 94.5%, and the total aneurysm exclusion was 95.6%, with a mean follow-up of 28 months. Median KPS values at last follow-up was 90, and a favorable outcome (KPS ≥ 70 and mRS ≤ 2) was obtained in 87% of the cases. The use of bypass techniques represents, in selected cases, a valid therapeutic option in the management of complex anterior circulation aneurysms when a simpler direct approach, including the use of FD, is considered not feasible.
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Affiliation(s)
- Francesco Acerbi
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-022-394-2309
| | - Elio Mazzapicchi
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ignazio Gaspare Vetrano
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giuseppe Faragò
- Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Bonomo
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Anna Bersano
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Isabella Canavero
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Gemma
- Intensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Marco Schiariti
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Vanessa Ziliani
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Gabriella Raccuia
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | | | - Giuseppe Ganci
- Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elisa Ciceri
- Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Chiapparini L, Opancina V, Erbetta A, Pollo B, Broggi M, Ciceri E. Case 310. Radiology 2022; 305:239-241. [PMID: 36154283 DOI: 10.1148/radiol.212606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HISTORY A 49-year-old man presented with right foot drop, bilateral cruralgia mainly on the left side, and genital and perianal hypoesthesia, which started suddenly 12 days before. After onset of symptoms, the patient also experienced an accidental fall at home, resulting in a left fibular fracture, which was treated with reduction and with seven-hole plate Synthes Locking Compression Plate at the orthopedic clinic. The neurologic examination showed paresthesias on the posterior aspect of both thighs and crural regions that was worse on the left side, hypoesthesia in the L5 root region on the right side, and right foot drop. There was no urinary retention or fecal incontinence. The patient denied past surgery, back trauma, heavy manual labor, hypermobility, or any other remarkable medical history. The patient was afebrile. Laboratory results on the 1st day of hospitalization showed increased C-reactive protein level (0.62 mg/dL; reference range, 0.0-0.5 mg/dL), elevated erythrocyte sedimentation rate (60 mm/h; reference range, 0-20 mm/h), and increased aspartate transaminase (38 U/L [0.63 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), alanine transaminase (70 U/L [1.17 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), and high lymphocyte (4.55 × 103/μL; reference range, [1.0-3.0] × 103/μL), and neutrophil (8.79 × 103/μL; reference range, [2.0-7.0] × 103/μL) levels. Absence of coagulopathy was demonstrated by normal coagulation values (international normalized ratio, 1.19; reference value, 0.80-1.25; activated partial thromboplastin time ratio, 0.88 second; reference range, 0.79-1.27 seconds). Electroneurography showed marked hypoevocable F response in the right tibia. Electromyography indicated severe reduction of muscle recruitment pertaining to right L4, L5, and S1 nerve territory and, to a lesser extent, of muscles pertaining to L3 territory bilaterally in the absence of spontaneous denervation. Unenhanced CT (Fig 1) and contrast-enhanced MRI of the lumbosacral spine were performed (Figs 2, 3).
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Affiliation(s)
- Luisa Chiapparini
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Valentina Opancina
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Alessandra Erbetta
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Bianca Pollo
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Morgan Broggi
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
| | - Elisa Ciceri
- From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.)
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Broggi M, Zattra CM, Falco J. Commentary: Transsulcal, Transchoroidal Approach for Resection of Posterior Clinoid Meningioma With Virtual Reality Demonstration: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e287-e288. [PMID: 36103322 DOI: 10.1227/ons.0000000000000379] [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: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Falco J, Höhne J, Broggi M, Rubiu E, Restelli F, Vetrano IG, Schiariti M, Mazzapicchi E, Bonomo G, Ferroli P, Schebesch KM, Acerbi F. Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study. Front Oncol 2022; 12:943085. [PMID: 36016608 PMCID: PMC9395669 DOI: 10.3389/fonc.2022.943085] [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: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePilocytic astrocytomas (PAs) are relatively benign tumors, usually enhancing on post-contrast MRI and often characterized by a mural nodule within a cystic component. Surgical resection represents the mainstay of treatment, and extent of resection (EOR) is associated with improved survival. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of these circumscribed astrocytic gliomas.MethodsSurgical databases at two neurosurgical departments (Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy and Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany) were retrospectively reviewed to identify the cohort of patients with pilocytic astrocytoma who had undergone fluorescein-guided tumor resection at any of the centers between March 2016 and February 2022. SF was intravenously injected (5 mg/kg) immediately after the induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW 560 filter (Carl Zeiss Meditec, Oberkochen, Germany).ResultsForty-four patients (25 males and 19 females; 26 pediatric patients, mean age of 9.77 years, range 2 to 17 years; and 18 adult patients, mean age of 34.39 years, range 18 to 58 years) underwent fluorescein-guided surgery. No side effects related to SF occurred. In all tumors, contrast enhancement on preoperative MRI was correlated with intense, heterogeneous yellow fluorescence with bright fluorescent cystic fluid. Fluorescein was considered helpful in distinguishing tumors from viable tissue in all cases except three patients due to faint fluorescein enhancement. Biopsy was intended in two operations, and partial resection was intended in three operations. Gross total resection was achieved in 24 cases out of 39 patients scheduled for tumor removal (61.54%), in five cases a minimal residual volume was highlighted by postoperative MRI despite the intraoperative subjective evaluation of complete tumor removal (12.82%); in the other 10 cases, the resection was subtotal with fluorescent residual spots to avoid neurological worsening (25.64%).ConclusionsThe use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of Pas, suggesting a possible role in improving the extent of resection of these lesions.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Julius Höhne
- Department of Neurosurgery, Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Karl-Michael Schebesch
- Department of Neurosurgery, Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- *Correspondence: Francesco Acerbi,
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Schiavolin S, Mariniello A, Broggi M, Abete-Fornara G, Bollani A, G GP, Bottini G, Querzola M, Scarpa P, Casarotti A, De Michele S, Isella V, Mauri I, Maietti A, Miramonti V, Orru MI, Pertichetti M, Pini E, Regazzoni R, Subacchi S, Ferroli P, Leonardi M. Patient-reported outcome and cognitive measures to be used in vascular and brain tumor surgery: proposal for a minimum set. Neurol Sci 2022; 43:5143-5151. [DOI: 10.1007/s10072-022-06162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
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Acerbi F, Broggi M, Hadjipanayis CG, Kiris T, Schebesch KM. Editorial: Intraoperative Fluorescence Imaging and Diagnosis in Central and Peripheral Nervous System Tumors: Established Applications and Future Perspectives. Front Oncol 2022; 12:845333. [PMID: 35198454 PMCID: PMC8858970 DOI: 10.3389/fonc.2022.845333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Acerbi
- Department of Neurosurgery, Foundation IRCCS Neurological Institute Carlo Besta, Milano, Italy
- *Correspondence: Francesco Acerbi,
| | - Morgan Broggi
- Department of Neurosurgery, Foundation IRCCS Neurological Institute Carlo Besta, Milano, Italy
| | - Constantinos G. Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, United States
| | - Talat Kiris
- Department of Neurosurgery, School of Medicine, Koc University, Istanbul, Turkey
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Schiavolin S, Mariniello A, Broggi M, DiMeco F, Ferroli P, Leonardi M. Preoperative nonmedical predictors of functional impairment after brain tumor surgery. Support Care Cancer 2022; 30:3441-3450. [PMID: 34999949 DOI: 10.1007/s00520-021-06732-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the preoperative nonmedical predictors of functional impairment after brain tumor surgery. METHODS Patients were evaluated before brain tumor surgery and after 3 months. The cognitive evaluation included MOCA for the general cognitive status, TMT for attention and executive functions, ROWL-IR and ROWL-DR for memory, and the F-A-S for verbal fluency. Anxiety, depression, social support, resilience, personality, disability, and quality of life were evaluated with the following patient-reported outcome measures (PROMs): HADS, OSS-3, RS-14, TIPI, WHODAS-12, and EORTC-QLQ C30. Functional status was measured with KPS. Regression analyses were performed to identify preoperative nonmedical predictors of functional impairment; PROMs and cognitive tests were compared with the normative values. RESULTS A total of 149 patients were enrolled (64 glioma; 85 meningioma). Increasing age, lower education, higher disability, and lower ROWL-DR scores were predictors of functional impairment in glioma patients while higher TMT scores and disability were predictors in meningioma patients. In multiple regression, only a worse performance in TMT remains a predictor in meningioma patients. Cognitive tests were not significantly worse than normative values, while psychosocial functioning was impaired. CONCLUSION TMT could be used in the preoperative evaluation and as a potential predictor in the research field on outcome predictors. Psychosocial functioning should be studied further and considered in a clinical context to identify who need major support and to plan tailored interventions.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Arianna Mariniello
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Zattra CM, Mazzapicchi E, Broggi M. Commentary: Endoscope-Assisted Resection of Extra-Axial Premedullary Neurenteric Cyst via Far Lateral-Supracondylar Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 22:e140-e141. [DOI: 10.1227/ons.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
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Ferroli P, Iess G, Bonomo G, Raccuia G, Broggi M. Neuronavigation Applied to Piezosurgery: Toward Robotic Image-Aided Craniotomy? A Technical Note. World Neurosurg 2021; 158:148-151. [PMID: 34800729 DOI: 10.1016/j.wneu.2021.11.059] [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: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although simple in its concept, craniotomy can still cause serious consequences to the patient. A recent alternative to standard techniques (i.e., perforator and craniotome) is represented by piezosurgery (PS), which exploits a microvibration-emitting blade that cuts the bone directly from the outer surface of the skull. Although PS has been demonstrated to decrease complications, dural lacerations and neurovascular injuries are still possible from inadvertent penetration of the inner tabula. Modern neuronavigation systems can provide the surgeon with the possibility to track the instrument while carving the skull, thus potentially lowering the complication rates. METHODS Two cases of miniretromastoid craniotomy for trigeminal neuralgia were performed using neuronavigated PS. Before surgery, the patients underwent volumetric brain magnetic resonance imaging and computed tomography. The piezosurgical cutter was registered on the S8 StealthStation neuronavigation system (Medtronic, Dublin, Ireland) using the step-by-step cranial standard instrument calibration protocol. RESULTS The craniotomy was performed with the surgeon using the neuronavigation monitor to visualize both the position and the trajectory of the instrument's blade while penetrating the bone. No dural lacerations or neurovascular injuries were reported. At the end of the procedure, the bone flaps were perfectly repositioned within their craniotomy margins without the use of cranial fixation devices. CONCLUSIONS Neuronavigated PS has the potential to decrease craniotomy-related complication rates. By allowing for real-time visualization of the blade's level of penetration, it provides the surgeon with the ability to halt progression when needed, avoiding dural lacerations and neurovascular injuries. The principles behind this technique could anticipate the advent of robotic-image aided craniotomy.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; University of Milan, Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; University of Milan, Milan, Italy
| | - Gabriella Raccuia
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; University of Milan, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
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Ferroli P, Restelli F, Broggi M. Olfactory nerve sparing technique for anterior skull base meningiomas: how I do it. Acta Neurochir (Wien) 2021; 163:2453-2457. [PMID: 34291382 DOI: 10.1007/s00701-021-04929-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Olfactory function preservation is a desirable objective in anterior skull base (ASB) surgery. The "infracerebral-supraolfactory nerve" corridor is presented. METHOD The technique for preserving the olfactory nerves (OlfNs) in anterior ASB meningioma removal involves the following points: deep knowledge of the ASB vascular and meningeal anatomy, precise preoperative planning, wide and sharp dissection of the OlfNs away from the frontal lobes, gravity-aided frontal lobe retraction, Gelfoam-assisted hemostasis on nervous structures, and access to the lesion through an infracerebral-supraolfactory nerve corridor. CONCLUSIONS This technique may be a valid option for patients affected by anterior skull base meningiomas with intact preoperative olfactory function.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Zattra CM, Restelli F, Broggi M. Commentary: Endoscopic Endonasal Excision of an Optic Pathway Cavernous Malformation: Technical Case Report. Oper Neurosurg (Hagerstown) 2021; 21:E163-E164. [PMID: 34015827 DOI: 10.1093/ons/opab166] [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: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Broggi M, Zattra CM, Schiariti M. Commentary: Microsurgical Resection of a Pontine Cavernoma Using an Expanded Retrosigmoid Corridor: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E155-E156. [PMID: 34018002 DOI: 10.1093/ons/opab159] [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: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Acerbi F, Vetrano IG, Falco J, Gioppo A, Ciuffi A, Ziliani V, Schiariti M, Broggi M, Faragò G, Ferroli P. In Situ Side-to-Side Pericallosal-Pericallosal Artery and Callosomarginal-Callosomarginal Artery Bypasses for Complex Distal Anterior Cerebral Artery Aneurysms: A Technical Note. Oper Neurosurg (Hagerstown) 2021; 19:E487-E495. [PMID: 32726426 DOI: 10.1093/ons/opaa236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite surgical and endovascular technical improvements over the last decades, the treatment of complex aneurysms of the distal anterior cerebral artery (ACA) is very challenging for both vascular neurosurgeons and interventional neuroradiologists. Furthermore, the interpersonal anatomic variability requires, most of the time, a tailored planning. OBJECTIVE To describe a novel technique of bypasses in the territory of ACA to protect the brain territory distal to the aneurysm. METHODS A 53-yr-old male with a large complex fusiform aneurysm of the left distal A2 segment of the ACA, involving the origin of the callosomarginal and pericallosal arteries, was judged not suitable for a single procedure (endovascular or neurosurgical). Two side-to-side bypasses were performed in a single surgery to connect the pericallosal and callosomarginal arteries of both sides, distally to the aneurysm. Subsequently, an endovascular embolization of the aneurysm was achieved with coils. RESULTS The patency of the microanastomoses, performed in the anterior interhemispheric fissure, was positively evaluated intraoperatively with indocyanine green and fluorescein videoangiography. The aneurysm sac, together with proximal A2 segment, was completely occluded with platinum coils. At the last follow-up, computed tomography angiography confirmed the patency of both bypasses, without any sign of aneurysm recanalization. The patients never complained of any focal neurological deficits or worsening of clinical status. CONCLUSION We present an elegant and innovative solution to completely protect the distal ACA territory in cases of complex aneurysm involving the origin of both callosomarginal and pericallosal arteries.
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Affiliation(s)
- Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Diagnostic Radiology and Interventional Neuroradiology Unit, Fondazione IRCCS "Istituto Neurologico Carlo Besta", Milan, Italy
| | - Andrea Ciuffi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vanessa Ziliani
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Diagnostic Radiology and Interventional Neuroradiology Unit, Fondazione IRCCS "Istituto Neurologico Carlo Besta", Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Broggi M, Zattra CM, Ferroli P. Commentary: Outcome of Endoscope-Assisted Microvascular Decompression in Patients With Hemifacial Spasm Caused by Severe Indentation of the Brain Stem at the Pontomedullary Sulcus by the Posterior Inferior Cerebellar Artery. Oper Neurosurg (Hagerstown) 2021; 20:E408-E409. [PMID: 33733274 DOI: 10.1093/ons/opab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/12/2022] Open
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Broggi M, Zattra CM, Ferroli P. Commentary: Risk of Brain Herniation After Craniotomy With Preoperative Lumbar Spinal Drainage: A Single-Surgeon Experience of 365 Patients Among 3000 Major Cranial Cases. Oper Neurosurg (Hagerstown) 2021; 20:E83-E84. [PMID: 33305791 DOI: 10.1093/ons/opaa348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 11/14/2022] Open
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Zattra CM, Broggi M, Schiavolin S, Schiariti M, Acerbi F, Esposito S, de Laurentis C, Broggi G, Ferroli P. Surgical outcome and indicators of postoperative worsening in intra-axial thalamic and posterior fossa pediatric tumors: Preliminary results from a single tertiary referral center cohort. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Falco J, Agosti A, Vetrano IG, Bizzi A, Restelli F, Broggi M, Schiariti M, DiMeco F, Ferroli P, Ciarletta P, Acerbi F. In Silico Mathematical Modelling for Glioblastoma: A Critical Review and a Patient-Specific Case. J Clin Med 2021; 10:2169. [PMID: 34067871 PMCID: PMC8156762 DOI: 10.3390/jcm10102169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/24/2021] [Accepted: 05/14/2021] [Indexed: 01/28/2023] Open
Abstract
Glioblastoma extensively infiltrates the brain; despite surgery and aggressive therapies, the prognosis is poor. A multidisciplinary approach combining mathematical, clinical and radiological data has the potential to foster our understanding of glioblastoma evolution in every single patient, with the aim of tailoring therapeutic weapons. In particular, the ultimate goal of biomathematics for cancer is the identification of the most suitable theoretical models and simulation tools, both to describe the biological complexity of carcinogenesis and to predict tumor evolution. In this report, we describe the results of a critical review about different mathematical models in neuro-oncology with their clinical implications. A comprehensive literature search and review for English-language articles concerning mathematical modelling in glioblastoma has been conducted. The review explored the different proposed models, classifying them and indicating the significative advances of each one. Furthermore, we present a specific case of a glioblastoma patient in which our recently proposed innovative mechanical model has been applied. The results of the mathematical models have the potential to provide a relevant benefit for clinicians and, more importantly, they might drive progress towards improving tumor control and patient's prognosis. Further prospective comparative trials, however, are still necessary to prove the impact of mathematical neuro-oncology in clinical practice.
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Affiliation(s)
- Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
| | - Abramo Agosti
- MOX, Department of Mathematics, Politecnico di Milano, 20133 Milan, Italy; (A.A.); (P.C.)
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
| | - Alberto Bizzi
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimora, MD 21205, USA
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
| | - Pasquale Ciarletta
- MOX, Department of Mathematics, Politecnico di Milano, 20133 Milan, Italy; (A.A.); (P.C.)
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (J.F.); (I.G.V.); (F.R.); (M.B.); (M.S.); (F.D.); (P.F.)
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Ferroli P, Vetrano IG, Schiavolin S, Acerbi F, Zattra CM, Schiariti M, Leonardi M, Broggi M. Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model. Cancers (Basel) 2021; 13:cancers13102320. [PMID: 34065990 PMCID: PMC8151018 DOI: 10.3390/cancers13102320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Brain tumor surgery in older patients is becoming more relevant, considering that the proportion of older adults being treated for cancer is rising, whereas some pivotal studies in neuro-oncology comprised young patients only. The knowledge of possible predictors of outcome should be included in the preoperative assessment to make the best possible decision in terms of management. We present a case series of 143 patients older than 65 years, intending to identify the possible factors predicting the risk of clinical worsening after elective surgical resection of intracranial tumors in elderly patients. We found that postoperative complications occurrence and preoperative surgical complexity significantly influence the outcome in this subgroup of patients, whereas postoperative complications were the only factor with an impact also at long-term follow-up. Abstract The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (P.F.); (F.A.); (C.M.Z.); (M.S.); (M.B.)
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (P.F.); (F.A.); (C.M.Z.); (M.S.); (M.B.)
- Correspondence:
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (S.S.); (M.L.)
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (P.F.); (F.A.); (C.M.Z.); (M.S.); (M.B.)
| | - Costanza Maria Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (P.F.); (F.A.); (C.M.Z.); (M.S.); (M.B.)
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (P.F.); (F.A.); (C.M.Z.); (M.S.); (M.B.)
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (S.S.); (M.L.)
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (P.F.); (F.A.); (C.M.Z.); (M.S.); (M.B.)
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Restelli F, Pollo B, Vetrano IG, Cabras S, Broggi M, Schiariti M, Falco J, de Laurentis C, Raccuia G, Ferroli P, Acerbi F. Confocal Laser Microscopy in Neurosurgery: State of the Art of Actual Clinical Applications. J Clin Med 2021; 10:jcm10092035. [PMID: 34068592 PMCID: PMC8126060 DOI: 10.3390/jcm10092035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Achievement of complete resections is of utmost importance in brain tumor surgery, due to the established correlation among extent of resection and postoperative survival. Various tools have recently been included in current clinical practice aiming to more complete resections, such as neuronavigation and fluorescent-aided techniques, histopathological analysis still remains the gold-standard for diagnosis, with frozen section as the most used, rapid and precise intraoperative histopathological method that permits an intraoperative differential diagnosis. Unfortunately, due to the various limitations linked to this technique, it is still unsatisfactorily for obtaining real-time intraoperative diagnosis. Confocal laser technology has been recently suggested as a promising method to obtain near real-time intraoperative histological data in neurosurgery, due to its established use in other non-neurosurgical fields. Still far to be widely implemented in current neurosurgical clinical practice, this technology was initially studied in preclinical experiences confirming its utility in identifying brain tumors, microvasculature and tumor margins. Hence, ex vivo and in vivo clinical studies evaluated the possibility with this technology of identifying and classifying brain neoplasms, discerning between normal and pathologic tissue, showing very promising results. This systematic review has the main objective of presenting a state-of-the-art summary on actual clinical applications of confocal laser imaging in neurosurgical practice.
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Affiliation(s)
- Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Samuele Cabras
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Camilla de Laurentis
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Gabriella Raccuia
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.); (I.G.V.); (S.C.); (M.B.); (M.S.); (J.F.); (C.d.L.); (G.R.); (P.F.)
- Correspondence: ; Tel.: +39-022-3932-309
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Terrapon APR, Zattra CM, Voglis S, Velz J, Vasella F, Akeret K, Held U, Schiavolin S, Bozinov O, Ferroli P, Broggi M, Sarnthein J, Regli L, Neidert MC. Adverse Events in Neurosurgery: The Novel Therapy-Disability-Neurology Grade. Neurosurgery 2021; 89:236-245. [PMID: 33887774 DOI: 10.1093/neuros/nyab121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/14/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The most widely used classifications of adverse events (AEs) in neurosurgery define their severity according to the therapy used to treat them. This concept has substantial shortcomings because it does not reflect the severity of AEs that are not treated, such as new neurological deficits. OBJECTIVE To present a novel multidimensional and patient-centered classification of the severity of AE in neurosurgery and evaluate its applicability. METHODS The Therapy-Disability-Neurology (TDN) grading system classifies AEs depending on the associated therapy, disability, and neurological deficits. We conducted a 2-center retrospective observational study on 6071 interventions covering the whole neurosurgical spectrum with data prospectively recorded between 2013 and 2019 at 2 institutions from 2 countries. RESULTS Using the first patient cohort (4680 interventions), a positive correlation was found between severity of AE and LOS as well as treatment cost. Each grade was associated with a greater deterioration of the Karnofsky Performance Status Scale (KPS) at discharge and at follow-up. When using the same methods on the external validation cohort (1391 interventions), correlations between the grades of AE, LOS, and KPS at discharge were even more pronounced. CONCLUSION Our results suggest that the TDN grade is consistent with clinical and economic repercussions of AE and thus reflects AE severity. It is easily interpreted and enables comparison between different medical centers. The standardized report of the severity of AE in the scientific literature could constitute an important step forward toward a more critical, patient-centered, and evidence-based decision-making in neurosurgery.
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Affiliation(s)
- Alexis Paul Romain Terrapon
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen and Medical School St. Gallen, St. Gallen, Switzerland
| | - Costanza Maria Zattra
- Department of Neurosurge, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefanos Voglis
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Julia Velz
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kevin Akeret
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Oliver Bozinov
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen and Medical School St. Gallen, St. Gallen, Switzerland
| | - Paolo Ferroli
- Department of Neurosurge, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurge, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Johannes Sarnthein
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian Christoph Neidert
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Kantonsspital St. Gallen and Medical School St. Gallen, St. Gallen, Switzerland
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La Corte E, Broggi M, Raggi A, Schiavolin S, Acerbi F, Danesi G, Farinotti M, Felisati G, Maccari A, Pollo B, Saini M, Toppo C, Valvo F, Ghidoni R, Bruzzone MG, DiMeco F, Ferroli P. Peri-operative prognostic factors for primary skull base chordomas: results from a single-center cohort. Acta Neurochir (Wien) 2021; 163:689-697. [PMID: 31950268 DOI: 10.1007/s00701-020-04219-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients. METHODS A retrospective review of all the patients diagnosed and treated for SBC at the Fondazione IRCCS Istituto Neurologico "Carlo Besta" between January 1992 and December 2017 has been performed. Survival analysis was performed and a logistic regression model was used. Statistically significant predictors were rated based on their log odds in order to preliminarily build a personalized grading scale-the Peri-Operative Chordoma Scale (POCS). RESULTS Fifty-nine primary chordoma patients were included. The average follow-up from the first treatment was 82.6 months (95% CI, 65.5-99.7). POCS was built over PFS and MR contrast enhancement (intense vs mild/no, value 4), preoperative motor deficit (yes vs no, value 3), and the development of any postoperative complications (yes vs no, value 2). POCS ranges between 0 and 9, with higher scores being associated with reduced likelihood of survival and progression-free state. CONCLUSIONS Our results show that preoperative clinical symptoms (motor deficits), surgical features (extent of tumor resection and surgeon's experience), development of postoperative complications, and KPS decline represent significant prognostic factors. The degree of MR contrast enhancement significantly correlated to both OS and PFS. We also preliminarily developed the POCS as a prognostic grading scale which may help neurosurgeons in the personalized management of patients undergoing potential adjuvant therapies.
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La Corte E, Eldahaby D, Greco E, Aquino D, Bertolini G, Levi V, Ottenhausen M, Demichelis G, Romito LM, Acerbi F, Broggi M, Schiariti MP, Ferroli P, Bruzzone MG, Serrao G. The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications. Front Neurol 2021; 12:641586. [PMID: 33732210 PMCID: PMC7959833 DOI: 10.3389/fneur.2021.641586] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual–motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix–Chavany–Marie syndrome, social communication deficit in autism spectrum disorders, and attention–deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.
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Affiliation(s)
- Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Daniela Eldahaby
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Greco
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Domenico Aquino
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giacomo Bertolini
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Malte Ottenhausen
- Department of Neurological Surgery, University Medical Center Mainz, Mainz, Germany
| | - Greta Demichelis
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luigi Michele Romito
- Parkinson's Disease and Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Graziano Serrao
- San Paolo Medical School, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Zattra CM, La Corte E, Broggi M. Commentary: Microsurgical and Tractographic Anatomical Study of Transtemporal-Transchoroidal Fissure Approaches to the Ambient Cistern. Oper Neurosurg (Hagerstown) 2021; 20:E241-E242. [PMID: 33372983 DOI: 10.1093/ons/opaa386] [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: 09/04/2020] [Accepted: 09/13/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Schiavolin S, Mariniello A, Broggi M, Acerbi F, Schiariti M, Franzini A, Di Meco F, Ferroli P, Leonardi M. Characteristics of Patients Returning to Work After Brain Tumor Surgery. Front Hum Neurosci 2021; 14:609080. [PMID: 33613204 PMCID: PMC7886680 DOI: 10.3389/fnhum.2020.609080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the differences between patients returning to work and those who did not after brain tumor surgery. Methods: Patients were evaluated before surgery and after 3 months. The Montreal Cognitive Assessment test, Trail-Making Test (parts A and B), 15-word Rey–Osterrieth Word List (immediate and delayed recall), F-A-S tests, and Karnosfky Performance Status were used to assess cognitive status, attention, executive functions, memory, word fluency, and functional status. Patient-reported outcome measures (PROMs) used to evaluate emotional distress and disability were the Hospital Anxiety and Depression Scale and World Health Organization Disability Assessment Schedule. Clinical and work-related variables, PROMs, and cognitive tests were compared using chi-squared, t-test or Mann–Whitney U test. Results: Sixty patients were included. Patients returning to work were 61.3 and 31.0% among people with meningioma and glioma, respectively. They reported lower postoperative disability and lesser home-to-work travel time. Patients with meningioma also showed better preoperative and postoperative attention and executive functions, better postoperative functional and cognitive status, and lower frequency of treatments. Conclusions: These variables should be considered in a clinical context to plan interventions for people who need support during return to work and in future research to investigate preoperative and postoperative predictive factors of going back to work.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arianna Mariniello
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angelo Franzini
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy
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Yang Y, Zeitlberger AM, Neidert MC, Staartjes VE, Broggi M, Zattra CM, Vasella F, Velz J, Bartek J, Fletcher-Sandersjöö A, Förander P, Kalasauskas D, Renovanz M, Ringel F, Brawanski KR, Kerschbaumer J, Freyschlag CF, Jakola AS, Sjåvik K, Solheim O, Schatlo B, Sachkova A, Bock HC, Hussein A, Rohde V, Broekman ML, Nogarede CO, Lemmens CM, Kernbach JM, Neuloh G, Krayenbühl N, Ferroli P, Regli L, Bozinov O, Stienen MN. The association of patient age with postoperative morbidity and mortality following resection of intracranial tumors. Brain and Spine 2021; 1:100304. [PMID: 36247402 PMCID: PMC9560674 DOI: 10.1016/j.bas.2021.100304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
Introduction The postoperative functional status of patients with intracranial tumors is influenced by patient-specific factors, including age. Research question This study aimed to elucidate the association between age and postoperative morbidity or mortality following the resection of brain tumors. Material and methods A multicenter database was retrospectively reviewed. Functional status was assessed before and 3–6 months after tumor resection by the Karnofsky Performance Scale (KPS). Uni- and multivariable linear regression were used to estimate the association of age with postoperative change in KPS. Logistic regression models for a ≥10-point decline in KPS or mortality were built for patients ≥75 years. Results The total sample of 4864 patients had a mean age of 56.4 ± 14.4 years. The mean change in pre-to postoperative KPS was −1.43. For each 1-year increase in patient age, the adjusted change in postoperative KPS was −0.11 (95% CI -0.14 - - 0.07). In multivariable analysis, patients ≥75 years had an odds ratio of 1.51 to experience postoperative functional decline (95%CI 1.21–1.88) and an odds ratio of 2.04 to die (95%CI 1.33–3.13), compared to younger patients. Discussion Patients with intracranial tumors treated surgically showed a minor decline in their postoperative functional status. Age was associated with this decline in function, but only to a small extent. Conclusion Patients ≥75 years were more likely to experience a clinically meaningful decline in function and about two times as likely to die within the first 6 months after surgery, compared to younger patients. A multicenter database of patients with intracranial tumors is analyzed in this study. Age is associated with a minor decline in the postoperative functional status & mortality. Patients ≥75 years are more likely to experience a clinically meaningful decline in function and to die.
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Acerbi F, Pollo B, De Laurentis C, Restelli F, Falco J, Vetrano IG, Broggi M, Schiariti M, Tramacere I, Ferroli P, DiMeco F. Ex Vivo Fluorescein-Assisted Confocal Laser Endomicroscopy (CONVIVO® System) in Patients With Glioblastoma: Results From a Prospective Study. Front Oncol 2020; 10:606574. [PMID: 33425764 PMCID: PMC7787149 DOI: 10.3389/fonc.2020.606574] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/19/2020] [Indexed: 01/02/2023] Open
Abstract
Background Confocal laser endomicroscopy (CLE) allowing intraoperative near real-time high-resolution cellular visualization is a promising method in neurosurgery. We prospectively tested the accuracy of a new-designed miniatured CLE (CONVIVO® system) in giving an intraoperative first-diagnosis during glioblastoma removal. Methods Between January and May 2018, 15 patients with newly diagnosed glioblastoma underwent fluorescein-guided surgery. Two biopsies from both tumor central core and margins were harvested, dividing each sample into two specimens. Biopsies were firstly intraoperatively ex vivo analyzed by CLE, subsequently processed for frozen and permanent fixation, respectively. Then, a blind comparison was conducted between CLE and standard permanent section analyses, checking for CLE ability to provide diagnosis and categorize morphological patterns intraoperatively. Results Blindly comparing CONVIVO® and frozen sections images we obtained a high rate of concordance in both providing a correct diagnosis and categorizing patterns at tumor central core (80 and 93.3%, respectively) and at tumor margins (80% for both objectives). Comparing CONVIVO® and permanent sections, concordance resulted similar at central core (total/partial concordance in 80 and 86.7% for diagnosis and morphological categorization, respectively) and lower at tumor margins (66.6% for both categories). Time from fluorescein injection and time from biopsy sampling to CONVIVO® scanning was 134 ± 31 min (122–214 min) and 9.23 min (1–17min), respectively. Mean time needed for CONVIVO® images interpretation was 5.74 min (1–7 min). Conclusions The high rate of diagnostic/morphological consistency found between CONVIVO® and frozen section analyses suggests the possibility to use CLE as a complementary tool for intraoperative diagnosis of ex vivo tissue specimens during glioblastoma surgery.
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Affiliation(s)
- Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Camilla De Laurentis
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
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Broggi M, Restelli F, Zattra CM, Schiariti M. Commentary: Endoscopic Endonasal Resection-Olfactory Groove Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E528-E529. [PMID: 32735651 DOI: 10.1093/ons/opaa241] [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: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Ferroli P, Vetrano IG, Acerbi F, Raccuia G, Schiariti M, Confalonieri P, Chiapparini L, Broggi M. Trigeminal interfascicular neurolysis (nerve combing) for refractory recurrent neuralgia in multiple sclerosis. Neurosurgical Focus: Video 2020; 3:V3. [PMID: 36285264 PMCID: PMC9542691 DOI: 10.3171/2020.5.focvid203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/27/2020] [Indexed: 11/06/2022]
Abstract
In multiple sclerosis (MS) patients, trigeminal neuralgia (TN) represents a challenging syndrome to treat, often refractory to medical therapy and percutaneous techniques. Despite the frequent lack of a neurovascular conflict, the trigeminal nerve’s axons are often damaged, with the myelin sheath permanently degenerated, thus explaining the difficulty in treating TN in MS. The authors illustrate trigeminal interfascicular neurolysis (the combing technique) to control refractory recurrent TN in MS: the nerve is longitudinally divided along its fibers from the root entry zone, determining good pain relief. The video can be found here: https://youtu.be/o1XksPW5fMY
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Affiliation(s)
| | | | | | | | | | | | - Luisa Chiapparini
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Vetrano IG, Broggi M, Acerbi F. Commentary: Symptomatic Primary Tethered Optic Chiasm: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E446-E447. [PMID: 32442271 DOI: 10.1093/ons/opaa146] [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: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Broggi M, Zattra CM, Tringali G, Acerbi F. Commentary: Novel Use of Stimulating Fence-Post Technique for Functional Mapping of Subcortical White Matter During Tumor Resection: A Technical Case Series. Oper Neurosurg (Hagerstown) 2020; 19:E222-E223. [PMID: 32348480 DOI: 10.1093/ons/opaa111] [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: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Broggi M, Tringali G. In Reply to the Letter to the Editor Regarding "Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment". World Neurosurg 2020; 140:436. [PMID: 32797961 DOI: 10.1016/j.wneu.2020.05.074] [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: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Schiariti M, Restelli F, Broggi M, Acerbi F, Ferroli P. In Reply: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm. Neurosurgery 2020; 87:E216-E217. [PMID: 32382731 PMCID: PMC7239129 DOI: 10.1093/neuros/nyaa178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marco Schiariti
- Department of Neurosurgery Fondazione IRCCS Istituto Neurologico Carlo Besta Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery Fondazione IRCCS Istituto Neurologico Carlo Besta Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery Fondazione IRCCS Istituto Neurologico Carlo Besta Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery Fondazione IRCCS Istituto Neurologico Carlo Besta Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery Fondazione IRCCS Istituto Neurologico Carlo Besta Milan, Italy
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