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Molinari G, Calvaruso F, Presutti L, Marchioni D, Alicandri-Ciufelli M, Friso F, Fernandez IJ, Francoli P, Di Maro F. Vestibular schwannoma removal through expanded transcanal transpromontorial approach: a multicentric experience. Eur Arch Otorhinolaryngol 2022; 280:2165-2172. [PMID: 36208331 DOI: 10.1007/s00405-022-07682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Expanded Transcanal Transpromontorial Approach (ExpTTA) is an endomicroscopic technique that allow surgical excision of small and symptomatic neuromas limited to the internal auditory canal (IAC) or minimally invasive the cerebellopontine angle (CPA). ExpTTA is a safer alternative to the exclusive endoscopic technique as it allows a wider surgical field and better management of the auditory porus and CPA. METHODS We report a retrospective case series of 34 patients who underwent ExpTTA between 2017 and 2022 at the ENT Departments of the University Hospital of Modena, Bologna and Verona. Tumor size was defined according to the Koos staging and hearing function was classified according to the AAOHNS. A clinical evaluation of facial nerve (FN) function was performed using the House and Brackman scale (HBs). RESULTS Our cohort consists of 34 patients. At time of surgery all patients had a normal preoperative facial function. Gross total resection was achieved in all patients, without intraoperative complications, and FN continuity was preserved in all cases. No major complications were observed. Regarding post-operative FN function, at hospital discharge ten patients had impairment equal or greater than IV grade according to H&Bs. At 6 months after surgery only two patients presented with moderate/severe facial paralysis (grade IV H&Bs) and finally at 12-month follow-up all patients had a satisfactory recovery of nervous function (grade < III H&Bs). CONCLUSIONS ExpTTA is a safe and effectively technique for treatment of small VS (Koos I, II and selected cases of Koos III) with low postoperative morbidity.
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Affiliation(s)
- Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, via Giuseppe Massarenti 9, Bologna BO, 40138, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine, Alma Mater Studiorum University, via Giuseppe Massarenti 9, Bologna BO, 40138, Bologna, Italy
| | - Federico Calvaruso
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, via Giuseppe Massarenti 9, Bologna BO, 40138, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine, Alma Mater Studiorum University, via Giuseppe Massarenti 9, Bologna BO, 40138, Bologna, Italy
| | - Daniele Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Filippo Friso
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, via Altura 3, Bologna BO, 40139, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, IRCCS Istituto delle Scienze Neurologiche di Bologna, via Altura 3, Bologna BO, 40139, Bologna, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, via Giuseppe Massarenti 9, Bologna BO, 40138, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine, Alma Mater Studiorum University, via Giuseppe Massarenti 9, Bologna BO, 40138, Bologna, Italy
| | - Pietro Francoli
- Department of Otolaryngology, University Hospital of Verona, Piazzale Stefani 1, Verona VR, 37126, Verona, Italy
| | - Flavia Di Maro
- Department of Otolaryngology, University Hospital of Verona, Piazzale Stefani 1, Verona VR, 37126, Verona, Italy
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Fabbri VP, Friso F, Chiarucci F, Gramegna LL, Toni F, Foschini MP, Asioli S, Cremonini A, Acciarri N. Hemorrhagic Schwannoma of the Cauda Equina: Case Report and Review of the Literature. NMC Case Rep J 2022; 8:377-385. [PMID: 35079492 PMCID: PMC8769457 DOI: 10.2176/nmccrj.cr.2020-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
Spinal intradural hemorrhage is a rare event; the most common causes of spinal bleeding are traumas, medical therapy with anticoagulants and thrombolytics, vascular malformations, and congenital defects of coagulation. Rarely, spinal cord tumors may cause hemorrhage. Herein, we report the case of a patient with acute and quickly worsening lumbar pain: the neurological examination revealed a flaccid paraplegia caused by an intradural lesion extending on the right side of the spinal cord from T1 to L2 vertebral level. Pathological examination revealed an hemorrhagic schwannoma. Acute spinal subdural hemorrhage caused by spinal schwannomas is a very rare occurrence (29 cases only have been previously reported). Review of the literature with clinico-diagnostic features is presented, surgical treatment is explained, and pathological findings with possible etiopathogenesis of hemorrhage are described.
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Affiliation(s)
- Viscardo P Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Filippo Friso
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS/Institute of Neurological Science of Bologna, Department of Neurologic Surgery, Bellaria Hospital, Bologna, Italy
| | - Federico Chiarucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS/Institute of Neurological Science of Bologna, Unit of Functional and Molecular Neuroimaging, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS/Institute of Neurological Science of Bologna, Unit of Neuradiology, Bellaria Hospital, Bologna, Italy
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Anna Cremonini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Nicola Acciarri
- IRCCS/Institute of Neurological Science of Bologna, Department of Neurologic Surgery, Bellaria Hospital, Bologna, Italy
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Friso F, Rucci P, Rosetti V, Carretta A, Bortolotti C, Ramponi V, Martinoni M, Palandri G, Zoli M, Badaloni F, Franceschi E, Asioli S, Fabbri VP, Rustici A, Foschini MP, Brandes AA, Mazzatenta D, Sturiale C, Conti A. Is There a Role for Surgical Resection of Multifocal Glioblastoma? A Retrospective Analysis of 100 Patients. Neurosurgery 2021; 89:1042-1051. [PMID: 34662898 DOI: 10.1093/neuros/nyab345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glioblastoma with multiple localizations (mGBMs) can be defined as multifocal, where enhancing lesions present a connection visible on magnetic resonance imaging fluid-attenuated inversion recovery imaging, or multicentric, in the absence of a clear dissemination pathway. OBJECTIVE To evaluate the role of the extent of resection (EOR) in the treatment of mGBMs and its correlation with overall survival (OS) and progression free survival (PFS). METHODS One hundred patients with mGBMs were treated at our Institution between 2009 and 2019. Clinical, radiological, and follow-up data were collected. EOR of the contrast-enhancing part of lesions was classified as gross total resection (GTR, absence of tumor remnant), subtotal resection (STR, residual tumor < 30% of the initial mass), partial resection (PR, residual tumor > 30% of the initial mass), and needle or open biopsy (residual tumor > 75% of the initial mass). RESULTS Approximately 15% of patients underwent GTR, 14% STR, 32% PR, and 39% biopsy. Median OS was 17 mo for GTR, 11 mo for STR, 7 mo for PR, and 5 mo for biopsy. Greater EOR was associated with a significantly longer OS than biopsy. GTR and STR were associated with a longer PFS in Kaplan-Meier survival analyses. After adjusting for age, Karnofsky performance status (KPS), number of lesions, and adjunctive therapy in multivariable Cox regression analyses, GTR, STR, and PR were still associated with OS, but only GTR remained associated with PFS. CONCLUSION Our study suggests that EOR may positively influence survival of patients with mGBM. Surgical resection can be a reasonable option when performance and access to adjuvant treatment can be preserved.
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Affiliation(s)
- Filippo Friso
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Vittoria Rosetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Alessandro Carretta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy
| | - Carlo Bortolotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Vania Ramponi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Matteo Martinoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy
| | - Filippo Badaloni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Bellaria Hospital, Azienda USL di Bologna, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy.,Unit of Pathology, Department of Biomedical and Neuromotor Sciences (DIBINEM), Azienda USL di Bologna, Alma Mater Studiorum University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Viscardo Paolo Fabbri
- Unit of Pathology, Department of Biomedical and Neuromotor Sciences (DIBINEM), Azienda USL di Bologna, Alma Mater Studiorum University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Arianna Rustici
- Department of Experimental, Diagnostic and Speciality Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria P Foschini
- Unit of Pathology, Department of Biomedical and Neuromotor Sciences (DIBINEM), Azienda USL di Bologna, Alma Mater Studiorum University of Bologna, Bellaria Hospital, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Bellaria Hospital, Azienda USL di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi- Pituitary Unit, Bologna, Italy
| | - Carmelo Sturiale
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Capelli I, Zoli M, Righini M, Faccioli L, Aiello V, Spinardi L, Gori D, Friso F, Rustici A, Bortolotti C, Graziano C, Mantovani V, Sciascia N, Mazzatenta D, Seri M, Pastore Trossello M, La Manna G. MR Brain Screening in ADPKD Patients : To Screen or not to Screen? Clin Neuroradiol 2021; 32:69-78. [PMID: 34586427 PMCID: PMC8894296 DOI: 10.1007/s00062-021-01050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/31/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adult polycystic kidney disease (ADPKD) still represents a major cause of renal failure and intracranial aneurisms (IA) have a higher prevalence in ADPKD than in the general population. Current guidelines suggest performing brain MRI only in the subjects with a positive familiar history of IAs or subarachnoid hemorrhage (SAH). This is a retrospective case-control analysis to evaluate the usefulness of a MR screening program in ADPKD patients. METHODS We retrospectively analyzed all ADPKD patients followed in our outpatient clinic between 2016 and 2019 who underwent a brain MRI screening. We evaluated the presence of IAs and others brain abnormalities and compared our results with a non-ADPKD population (n = 300). We performed univariate and multivariate regression analysis to evaluate if general and demographic features, laboratory findings, clinical parameters and genetic test results correlated with IAs or other brain abnormalities presence. RESULTS Among the patients evaluated 17 out of 156 (13.6%) ADPKD patients had IAs, compared to 16 out of 300 (5.3%) non-ADPKD controls (p < 0.005). Considering ADPKD patients presenting IAs, 12 (70.6%) had no family history for IAs or SAH. Genetic analysis was available for 97 patients: in the sub-population with IAs, 13 (76.5%) presented a PKD1 mutation and none a PKD2 mutation. We found that arachnoid cysts (AC) (p < 0.001) and arterial anatomical variants (p < 0.04) were significantly more frequent in ADPKD patients. CONCLUSION In our population ADPKD patients showed a higher prevalence of IAs, AC and arterial variants compared to non-ADPKD. Most of the IAs were found in patients presenting a PKD1 mutation. We found a significant number of alterations even in those patients without a family history of IAs or SAH. The practice of submitting only patients with familial IAs or kidney transplantation candidates to MRI scan should be re-evaluated.
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Affiliation(s)
- I Capelli
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Zoli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - M Righini
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - L Faccioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - V Aiello
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - L Spinardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - D Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - F Friso
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - A Rustici
- Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - C Bortolotti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - C Graziano
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - V Mantovani
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - N Sciascia
- Radiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - D Mazzatenta
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - M Seri
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Pastore Trossello
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - G La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Zoli M, Staartjes VE, Guaraldi F, Friso F, Rustici A, Asioli S, Sollini G, Pasquini E, Regli L, Serra C, Mazzatenta D. Machine learning-based prediction of outcomes of the endoscopic endonasal approach in Cushing disease: is the future coming? Neurosurg Focus 2021; 48:E5. [PMID: 32480364 DOI: 10.3171/2020.3.focus2060] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/31/2020] [Accepted: 03/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Machine learning (ML) is an innovative method to analyze large and complex data sets. The aim of this study was to evaluate the use of ML to identify predictors of early postsurgical and long-term outcomes in patients treated for Cushing disease (CD). METHODS All consecutive patients in our center who underwent surgery for CD through the endoscopic endonasal approach were retrospectively reviewed. Study endpoints were gross-tumor removal (GTR), postsurgical remission, and long-term control of disease. Several demographic, radiological, and histological factors were assessed as potential predictors. For ML-based modeling, data were randomly divided into 2 sets with an 80% to 20% ratio for bootstrapped training and testing, respectively. Several algorithms were tested and tuned for the area under the curve (AUC). RESULTS The study included 151 patients. GTR was achieved in 137 patients (91%), and postsurgical hypersecretion remission was achieved in 133 patients (88%). At last follow-up, 116 patients (77%) were still in remission after surgery and in 21 patients (14%), CD was controlled with complementary treatment (overall, of 131 cases, 87% were under control at follow-up). At internal validation, the endpoints were predicted with AUCs of 0.81-1.00, accuracy of 81%-100%, and Brier scores of 0.035-0.151. Tumor size and invasiveness and histological confirmation of adrenocorticotropic hormone (ACTH)-secreting cells were the main predictors for the 3 endpoints of interest. CONCLUSIONS ML algorithms were used to train and internally validate robust models for all the endpoints, giving accurate outcome predictions in CD cases. This analytical method seems promising for potentially improving future patient care and counseling; however, careful clinical interpretation of the results remains necessary before any clinical adoption of ML. Moreover, further studies and increased sample sizes are definitely required before the widespread adoption of ML to the study of CD.
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Affiliation(s)
- Matteo Zoli
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy
| | - Victor E Staartjes
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Switzerland.,4Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Federica Guaraldi
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy
| | - Filippo Friso
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna
| | - Arianna Rustici
- 5Department of Neuroradiology, IRCCS Istitute of Neurological Sciences of Bologna.,6Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna
| | - Sofia Asioli
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy.,7Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, Bologna; and
| | - Giacomo Sollini
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,8ENT Department, Bellaria Hospital, Bologna, Italy
| | - Ernesto Pasquini
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,8ENT Department, Bellaria Hospital, Bologna, Italy
| | - Luca Regli
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Switzerland
| | - Carlo Serra
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Switzerland
| | - Diego Mazzatenta
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy
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6
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Conti A, Friso F, Tomasello F. Commentary: Improved Cerebral Arteriovenous Malformation Obliteration With 3-Dimensional Rotational Digital Subtraction Angiography for Radiosurgical Planning: A Retrospective Cohort Study. Neurosurgery 2020; 88:E33-E34. [PMID: 32970150 DOI: 10.1093/neuros/nyaa409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alfredo Conti
- Department of Neurosurgery, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Filippo Friso
- Department of Neurosurgery, Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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7
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Guaraldi F, Zoli M, Asioli S, Corona G, Gori D, Friso F, Pasquini E, Bacci A, Sforza A, Mazzatenta D. Results and predictors of outcome of endoscopic endonasal surgery in Cushing's disease: 20-year experience of an Italian referral Pituitary Center. J Endocrinol Invest 2020; 43:1463-1471. [PMID: 32215861 DOI: 10.1007/s40618-020-01225-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess outcomes and predictors of early and long-term remission in patients with Cushing's disease (CD) due to ACTH-secreting adenomas treated via endoscopic endonasal approach (EEA). METHODS This is a retrospective study. Consecutive patients operated for CD from 1998 to 2017 in an Italian referral Pituitary Center were enrolled. Clinical, radiological, and histological data at enrollment and follow-up were collected. RESULTS 151 patients (107 F) were included; 88.7% were naïve for treatment, 11.3% had been treated surgically and 11.2% medically. At pre-operative magnetic resonance imaging (MRI), 35 had a macroadenoma and 80 a microadenoma, while tumor was undetectable in 36 patients. Mean age at surgery was 41.1 ± 16.6 years. Diagnosis was confirmed histologically in 82.4% of the cases. Patients with disease persistence underwent second surgery and/or medical and/or radiation therapy. Mean follow-up was 92.3 ± 12.0 (range 12-237.4) and median 88.2 months. Remission rate was 88.1% after the first surgery and 90.7% at last follow-up. One patient died of pituitary carcinoma. Post-surgical cortisol drop (p = 0.004), tumor detection at MRI (p = 0.03) and size < 1 cm (p = 0.045) increased the chance of disease remission; cavernous sinus invasion was a negative predictor of outcome (p = 0.002). Twenty-seven patients developed diabetes insipidus and 18 hypopituitarism. Surgery repetition increased the risk of hypopituitarism (p = 0.03), but not of other complications, which included epistaxis (N = 2), cerebrospinal fluid leakage (1), pneumonia (3), myocardial infarction (1), and pulmonary embolisms (2). CONCLUSIONS Selective adenomectomy via EEA performed by experienced surgeons, supported by a multidisciplinary dedicated team, allows long-term remission in the vast majority of CD patients with low complication rate.
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Affiliation(s)
- F Guaraldi
- IRCCS Istituto delle Science Neurologiche di Bologna, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.
| | - M Zoli
- IRCCS Istituto delle Science Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - S Asioli
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna, Bologna, Italy
| | - G Corona
- Division of Endocrinology, Ospedale Maggiore, Bologna, Italy
| | - D Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - F Friso
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - E Pasquini
- ENT Division, Bellaria Hospital, Bologna, Italy
| | - A Bacci
- Division of Neuroradiology, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - A Sforza
- Division of Endocrinology, Ospedale Maggiore, Bologna, Italy
| | - D Mazzatenta
- IRCCS Istituto delle Science Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
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Zoli M, Rossi N, Friso F, Sturiale C, Frank G, Pasquini E, Mazzatenta D. Limits of endoscopic endonasal approach for cranio-vertebral junction tumors. J Neurosurg Sci 2018; 62:356-368. [PMID: 29327864 DOI: 10.23736/s0390-5616.18.04303-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The endoscopic endonasal approach has been recently proposed for cranio-vertebral junction lesions. The more common indication for this sagittal extension of the endonasal route is represented by odontoidectomy for irreducible ventral brainstem compression due to congenital or degenerative conditions. However, in an increasing number of studies its adoption for tumors involving the cranio-cervical junction has been reported. The aim of this study is to consider retrospectively our surgical series, focusing on the advantages and limits of this approach. METHODS Each consecutive case of tumor involving the cranio-vertebral junction since 2007 to 2017 treated through an endoscopic endonasal approach has been included. All patients undergone preoperative neurological examination and neuroimaging (magnetic resonance imaging [MRI] and computed tomography angiography). These examinations were repeated after 3 months and then annually. Complementary treatments, recurrence rate and clinical status at mean follow-up of 18±7.3 months were considered. RESULTS Seven patients have been included in this study, mean age was of 47±17 years; male-to-female ratio was of 3:4. Series is composed by 6 chordomas and one foramen magnum meningioma. One patient had been already posteriorly stabilized for cranio-vertebral instability. Gross tumor removal was achieved in two cases, in the others a subtotal removal was demonstrated at postoperative MRI. One patient presented a transitory worsening of CN XII palsy, resolved within 3 months. For preoperative dysphagia and inhalation pneumonia, one case undergone tracheostomy and was fed with oro-gastric tube for 10 days. Three patients died for chordoma progression and at follow-up one presented a local recurrence. CONCLUSIONS Despite our experience is preliminary, the endoscopic endonasal approach has resulted safe for cranio-cervical junction tumor with a reduced number of complications. It can give a straight and direct trajectory to this deep region. We suggest that lateral extension of the tumor beyond the plane of cranial nerves is a limit for this approach, as well as an inferior expansion caudal to C1. Larger series and longer follow-up are required to assess the proper indications of this approach.
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Affiliation(s)
- Matteo Zoli
- Department of Biomedical and Neuromotor Sciences, Center for the Diagnosis and Cure of Pituitary and Skull Base Tumors, Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy -
| | - Nicolò Rossi
- Department of Biomedical and Neuromotor Sciences, Center for the Diagnosis and Cure of Pituitary and Skull Base Tumors, Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Filippo Friso
- Department of Biomedical and Neuromotor Sciences, Center for the Diagnosis and Cure of Pituitary and Skull Base Tumors, Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Carmelo Sturiale
- Department of Biomedical and Neuromotor Sciences, Center for the Diagnosis and Cure of Pituitary and Skull Base Tumors, Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Giorgio Frank
- Department of Biomedical and Neuromotor Sciences, Center for the Diagnosis and Cure of Pituitary and Skull Base Tumors, Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
| | - Ernesto Pasquini
- Department of Ear Nose and Throat, Bellaria Hospital, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences, Center for the Diagnosis and Cure of Pituitary and Skull Base Tumors, Institute of Neurological Sciences of Bologna, University of Bologna, Bologna, Italy
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