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Sop FYL, Benato A, Izoudine BK, Khouri K, Marangon A, Fraschetti F, Lonjon N, Ferraresi S. Spinal lymphangiomas: Case-based review of a chameleonic disease entity. J Craniovertebr Junction Spine 2024; 15:4-14. [PMID: 38644908 PMCID: PMC11029117 DOI: 10.4103/jcvjs.jcvjs_125_23] [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: 09/22/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024] Open
Abstract
Purpose Lymphangiomas are benign hamartomas in the spectrum of lymphatic malformations, exhibiting multifaceted clinical features. Spinal involvement is exceedingly rare, with only 35 cases reported to date. Both due to their rarity and chameleonic radiologic features, spinal lymphangiomas (SLs) are usually misdiagnosed; postoperatively, surgeons are thus confronted with an unexpected histopathological diagnosis with sparse pertinent literature and no treatment guidelines available. Methods Here, we report the case of a 67-year-old female who underwent surgery for a T6-T7 epidural SL with transforaminal extension, manifesting with spastic paraparesis. Then, we present the results of the first systematic review of the literature on this subject, delineating the clinical and imaging features and the therapeutic implications of this rare disease entity. Results Our patient was treated with T6-T7 hemilaminectomy and resection of the epidural mass, with complete recovery of her neurological picture. No recurrence was evident at 18 months. In the literature, 35 cases of SL were reported that can be classified as vertebral SL (n = 18), epidural SL (n = 10), intradural SL (n = 3), or intrathoracic lymphangiomas with secondary spinal involvement (n = 4). Specific treatment strategies (both surgical and nonsurgical) were adopted in relation to each of these categories. Conclusion Gathering knowledge about SL is fundamental to promote both correct preoperative identification and appropriate perioperative management of this rare disease entity. By reviewing the literature and discussing an exemplary case, we delineate a framework that can guide surgeons facing such an unfamiliar diagnosis.
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Affiliation(s)
- François Yves Legninda Sop
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
- Department of Neurosurgery, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | - Alberto Benato
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Kifah Khouri
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
| | - Anna Marangon
- Department of Anesthesiology and Critical Care Medicine, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
| | - Flavia Fraschetti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolas Lonjon
- Department of Neurosurgery, CHU Montpellier, Montpellier, France
| | - Stefano Ferraresi
- Department of Neurosurgery, Ospedale Santa Maria Della Misericordia, Rovigo, Italy
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Della Pepa GM, Fraschetti F, Domenico MD, Valz Gris A, Izzo A, Menna G, D'Alessandris QG, D'Ercole M, Stifano V, Ausili Cefaro C, Lauretti L, Tamburrini G, Olivi A, Montano N. Predictive value of intraoperative vagus nerve corticobulbar motor evoked potentials to assess the risk of dysphagia in fourth ventricle surgery. J Neurosurg 2023:1-9. [PMID: 38039532 DOI: 10.3171/2023.9.jns23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/21/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Dysphagia is a significant complication in fourth ventricle surgery. Corticobulbar motor evoked potentials (CB-MEPs) of the lower cranial nerves may provide real-time information possibly correlating with postoperative swallowing dysfunction, and the vagus nerves may prove ideal for this purpose. However, the literature is heterogeneous, non-systematic, and inconclusive on this topic. The object of this retrospective study was to evaluate the correlation between CB-MEPs of the vagus nerve and postoperative worsening or new-onset swallowing deficits in intraaxial fourth ventricle surgery. METHODS In 21 consecutive patients undergoing surgery for fourth ventricle intraaxial tumors between February 2018 and October 2022, endotracheal tubes with two applied electrodes contacting the vocal cords were used to record vagus nerve MEPs including values at baseline, the end of surgery, and the minimum value during the operation. From the mean value of right and left vagus nerve MEP amplitudes, the minimum-to-baseline amplitude ratio (MBR) and final-to-baseline amplitude ratio (FBR) were calculated. These indexes were correlated with postoperative swallowing function. RESULTS Given their clinical significance, receiver operating characteristic curves were obtained to evaluate the performance of these indexes in predicting postoperative swallowing function. The area under the curve (AUC) was 0.850 (p < 0.001) and the best cutoff for FBR was 67.55% for the worsening of swallowing in the postoperative period. The AUC was 0.750 (p = 0.026) and the best cutoff was 46.37% in MBR for the absence of a swallowing disorder at the late follow-up. CONCLUSIONS This study confirmed that vagus nerve MEPs are reliable predictors of postoperative swallowing function in fourth ventricle surgery and can be feasibly used as an intraoperative monitoring technique.
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Affiliation(s)
- Giuseppe Maria Della Pepa
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Flavia Fraschetti
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Michele Di Domenico
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Angelica Valz Gris
- 2Department of Health Science and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome; and
| | - Alessandro Izzo
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Grazia Menna
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Quintino Giorgio D'Alessandris
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Manuela D'Ercole
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Vito Stifano
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Carolina Ausili Cefaro
- 3Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, Division of Phoniatrics, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Liverana Lauretti
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Gianpiero Tamburrini
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Alessandro Olivi
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
| | - Nicola Montano
- 1Department of Neurosurgery, A. Gemelli University Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome
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Signorelli F, Fraschetti F, Benato A, Visocchi M. Repeated surgery for hemorrhagic brain metastases from hepatocellular carcinoma: palliation or effective part of a multimodal treatment? A case-based approach. Br J Neurosurg 2023; 37:1770-1773. [PMID: 33759662 DOI: 10.1080/02688697.2021.1903394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Brain metastases from hepatocellular carcinoma (HCCBM) are encountered very rarely in clinical practice, especially in western countries. Only a minority of patients undergoes resective surgery, as clinical picture is usually complex and presentation is often catastrophic with intra-cerebral hemorrhage (ICH). Neurosurgical intervention can be not only life-saving but may also alleviate significantly the burden of symptoms. We present the case of a patient with six metachronous hemorrhagic HCCBM in which emergent surgery extended survival by 9 months, of which seven spent in near-normal life quality, stressing the role of neurosurgery in the evaluation of HCCBM patients.
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Affiliation(s)
- Francesco Signorelli
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Flavia Fraschetti
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Alberto Benato
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Massimiliano Visocchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Marrone S, Sanz JAA, Cacciotti G, Campione A, Boccacci F, Fraschetti F, Iacopino DG, Mastronardi L. Utility of sodium fluorescein in recurrent cervical vagus schwannoma surgery. Surg Neurol Int 2023; 14:376. [PMID: 37941611 PMCID: PMC10629342 DOI: 10.25259/sni_451_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023] Open
Abstract
Background Cervical schwannoma is a rare neoplasm that usually occurs like a nondolent lateral neck mass but when growing and symptomatic requires radical excision. Sodium fluorescein (SF) is a dye that is uptake by schwannomas, which makes it amenable for its use in the resection of difficult or recurrent cases. Methods We describe the case of a patient presenting with a recurrence of a vagus nerve schwannoma in the cervical region and the step-by-step technique for its complete microsurgical exeresis helped by the use of SF dye. Results We achieved a complete microsurgical exeresis, despite the presence of exuberant perilesional fibrosis, by exploiting the ability of SF to stain the schwannoma and nearby tissues. That happens due to altered vascular permeability, allowing us to better differentiate the lesion boundaries and reactive scar tissue under microscope visualization (YELLOW 560 nm filter). Conclusion Recurrent cervical schwannoma might represent a surgical challenge due to its relation to the nerve, main cervical vessels, and the scar tissue encompassing the lesion. Although SF can cross both blood-brain and blood-tumor barriers, the impregnation of neoplastic tissue is still greater than that of nonneoplastic peripheric tissues. Such behavior may facilitate a safer removal of this kind of lesion while respecting contiguous anatomical structures.
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Affiliation(s)
- Salvatore Marrone
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo Scuola di Medicina e Chirurgia, Palermo, Italy
| | | | | | - Alberto Campione
- Department of Neurosurgery, Ospedale di Circolo e Fondazione Macchi di Varese, Varese
| | - Fabio Boccacci
- Department of Neurosurgery, San Filippo Neri Hospital, Rome
| | | | - Domenico Gerardo Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo Scuola di Medicina e Chirurgia, Palermo, Italy
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Ferrara PE, Del Vecchio A, DI Polito A, Bastoni I, Fraschetti F, Cori MS, Massimi L, Ronconi G. The relevance of an integrated neuro-evolutive approach in the plagiocephaly infant treatment. Minerva Pediatr (Torino) 2022; 74:612-613. [PMID: 32914609 DOI: 10.23736/s2724-5276.20.05847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Paola E Ferrara
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | | | | | - Ilaria Bastoni
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | - Maria S Cori
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luca Massimi
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Corrivetti F, Fraschetti F, Cacciotti G, Bernardi C, Sufianov A, Mastronardi L. Inflammatory pseudotumor simulating a jugular foramen meningioma: case report, technical video and literature review. World Neurosurg 2022; 161:106-109. [PMID: 35092811 DOI: 10.1016/j.wneu.2022.01.069] [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: 11/12/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Inflammatory pseudotumor (IP) is a non-neoplastic, reactive inflammatory process, of unknown etiology, characterized by a proliferation of connective tissue with an inflammatory infiltrate, most commonly involving the lungs and orbits. Primary intracranial inflammatory pseudotumor is an extremely rare entity often arising from the meningeal structures of the skull base. We reported an extremely rare case of a primary intracranial IP located in the cerebello-pontine angle, mimicking a jugular foramen meningioma. We further illustrated our microsurgical technique through a surgical video and performed a review of the pertinent scientific literature. The patient underwent gross total microsurgical resection of the tumor mass through a left retrosigmoid approach. Intraoperative neuro-monitoring of VII-VIII cranial nerve complex and lower cranial nerve was performed, and thulium laser fibers were used as a tool for tumor debulking. Post-operatively, patient neurological symptoms recovered. Histopathological studies showed dense infiltrate of T and B cells lymphocytes and epithelioid granulomas, compatible with the diagnosis of inflammatory pseudotumor. Post-operative, MRI scans showed complete tumor resection. Patient underwent a 3-month oral corticosteroid therapy showing no signs of recurrence at the radiological follow-up. Primary intracranial inflammatory pseudotumors are very rare pathological entities that can mimic extra-axial tumors, and should take into consideration as a potential differential diagnosis. Complete microsurgical resection in combination with other treatments (steroids therapy, radiotherapy) is the most common treatment of choice and in associated to good outcome and low rate of recurrence.
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Affiliation(s)
- Francesco Corrivetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy; Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Asl Salerno, Salerno, Italy
| | - Flavia Fraschetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy
| | - Guglielmo Cacciotti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy
| | - Cinzia Bernardi
- Division of Pathological Anatomy, San Filippo Neri Hospital/ASL Roma1, Roma, Italy
| | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russian Federation; Department of Neurosurgery, The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health, Russian Federation
| | - Luciano Mastronardi
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma1, Roma, Italy; Department of Neurosurgery, The State Education Institution of Higher Professional Training The First Sechenov Moscow State Medical University under Ministry of Health, Russian Federation.
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7
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Ferrara PE, Del Vecchio A, Di Polito A, Bastoni I, Fraschetti F, Cori MS, Massimi L, Ronconi G. The relevance of an integrated neuro-evolutive approach in the plagiocephaly infant treatment. Minerva Pediatr (Torino) 2020. [DOI: 10.23736/s0026-4946.20.05847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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D'alessandris QG, Rigante M, Mattogno PP, La Rocca G, Romanello M, Auricchio AM, Bevacqua G, Fraschetti F, Giordano M, Di Bonaventura R, Pallini R, Anile C, Olivi A, Lauretti L. Impact of 4K ultra-high definition endoscope in pituitary surgery: analysis of a comparative institutional case series. J Neurosurg Sci 2020; 66:425-433. [PMID: 32043848 DOI: 10.23736/s0390-5616.20.04875-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Trans-sphenoidal endoscopic surgery has drawn huge benefits from advances in surgical visualization. The Ultra-HD "4K" endoscope has improved 4-fold image resolution compared with HD, but its actual advantages are unclear. Aim of the present study was to assess its usefulness in the early outcome of trans-sphenoidal surgery. METHODS We analyzed a series of 199 trans-sphenoidal pituitary adenoma procedures performed by an experienced team using alternatively HD (n=102) or 4K (n=97) endoscopes. We evaluated extent of resection both subjectively, based on intraoperative surgeon's impression, and objectively based on post-operative MR scan. RESULTS Baseline patients' characteristics were balanced. Objective near-total and total resection rates were comparable between 4K and HD groups (91.5% vs 86.3% and 64.9% vs 56.9%, respectively). 4K endoscope slightly improved resection rate in recurrent adenoma. At multivariate analysis, the only independent prognosticator of total resection was cavernous sinus invasion. Importantly, 4K endoscope enhanced the reliability of intraoperative judgement on extent of resection, significantly reducing unexpected residuals (12.8% vs 33.3% for HD). Operative features and clinical outcomes were similar. CONCLUSIONS The HD endoscope remains the standard-of-care for pituitary surgery. The 4K enhanced, "immersive" visualization significantly improved the reliability of surgeon's judgment on resection and might be useful in surgically difficult cases.
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Affiliation(s)
- Quintino G D'alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
| | - Mario Rigante
- Department of Otorhinolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe La Rocca
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Matteo Romanello
- Department of Otorhinolaryngology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppina Bevacqua
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Fraschetti
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Giordano
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Pallini
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Anile
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Frassanito P, Bianchi F, Stifano V, Fraschetti F, Massimi L, Tamburrini G, Caldarelli M. Craniocerebral disproportion after decompressive craniectomy in infants: The hidden enemy of cranial repair? Childs Nerv Syst 2019; 35:1467-1471. [PMID: 31134339 DOI: 10.1007/s00381-019-04166-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cranioplasty aims at restoring the physiological integrity and volume of the skull. Any disproportion between the intracranial content and the volume of the container may favor the occurrence of complications. A classification of volume mismatches is proposed. A negative mismatch, consisting of intracranial content minor to skull volume, is well represented by the sinking flap. On the other side, a positive mismatch, consisting of intracranial content higher than skull volume, usually depends on CSF collection or hydrocephalus once the brain edema is regressed. Though, in children, this condition may result from physiological brain growth after decompressive craniectomy. Treatment algorithm based on this classification is presented. ILLUSTRATIVE CASE A 1-year-old boy with a severe traumatic brain injury underwent right decompressive craniectomy, evacuation of subdural hematoma, and dural expansion at another institution. After failure of autologous bone-assisted cranioplasty for infection, a helmet was recommended in order to postpone the cranial repair. Patient was admitted to our institution 3 years later. CT scan showed brain herniation through the cranial defect, associated to a condition of acquired craniocerebral disproportion, due to the condition of "open skull". Augmented hydroxyapatite cranioplasty (CustomBone, Finceramica, Faenza, Italy) was performed in order to manage this rare condition of positive volume mismatch. Subsequent course was uneventful and no complication was recorded at 30-month follow-up. CONCLUSIONS This illustrative case highlights the possible occurrence of a positive structural mismatch between the skull and the intracranial content after decompressive craniectomy, thus configuring a condition of acquired craniocerebral disproportion, aside of other brain or CSF complications. We firstly recognize this condition in the literature and propose it as a possible factor affecting the outcome of cranioplasty in infants and young children.
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Affiliation(s)
- Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Vito Stifano
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Fraschetti
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Caldarelli
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Trungu S, Forcato S, Bruzzaniti P, Fraschetti F, Miscusi M, Cimatti M, Raco A. Minimally Invasive Surgery for the Treatment of Traumatic Monosegmental Thoracolumbar Burst Fractures: Clinical and Radiologic Outcomes of 144 Patients With a 6-year Follow-Up Comparing Two Groups With or Without Intermediate Screw. Clin Spine Surg 2019; 32:E171-E176. [PMID: 31048604 DOI: 10.1097/bsd.0000000000000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study of the clinical and radiologic outcomes of traumatic thoracolumbar (TL) burst fractures. OBJECTIVES We aimed to evaluate the clinical and radiologic outcomes after 6 years of follow-up of 144 patients with monosegmental TL burst fractures treated with percutaneous short-segment pedicle screw fixation, comparing two groups with versus without placement of an intermediate screw at the fractured vertebra. SUMMARY OF BACKGROUND DATA Traumatic TL fractures are the most common vertebral fractures, especially at the TL junction (T10-L2). Minimally invasive surgery (MIS) is a valuable treatment option for traumatic TL burst fractures. MATERIALS AND METHODS The clinical outcomes and radiologic parameters (Cobb angle, midsagittal index, and sagittal index) of 144 patients with traumatic monosegmental TL fractures treated with MIS were evaluated preoperatively, postoperatively, and after 3 and 6 years of follow-up. Patients were categorized into a nonintermediate screw group (nISG) and an intermediate screw group (ISG), and the groups were compared. RESULTS There were 71 patients (49.3%) in the nISG and 73 patients (50.7%) in the ISG. The radiologic parameters improved significantly more from the preoperative evaluation to the 6-year follow-up in the ISG than in the nISG (P<0.025). There were no significant differences in the mean Oswestry Disability Index (ODI) and Visual Analog Scale scores at the 6-year follow-up between the ISG and the nISG: 15.6% (ISG) versus 16.8% (nISG) for ODI (P<0.1) and 2.2 (ISG) versus 2.4 (nISG) for Visual Analog Scale score (P<0.85) (P<0.73). CONCLUSIONS MIS showed good clinical outcomes 6 years after surgery in both the ISG and the nISG. The additional intermediate screw significantly improved radiologic parameters but not clinical outcomes.
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Affiliation(s)
- Sokol Trungu
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome.,Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy
| | - Stefano Forcato
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome.,Neurosurgery Unit, Card. G. Panico Hospital, Tricase, Italy
| | - Placido Bruzzaniti
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Flavia Fraschetti
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Massimo Miscusi
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Marco Cimatti
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
| | - Antonino Raco
- N.E.S.M.O.S Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome
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11
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Mattogno PP, D'Alessandris QG, Fraschetti F, Lauretti L. Going beyond scoring systems for cavernous sinus involvement in trans-sphenoidal pituitary surgery. Acta Neurochir (Wien) 2019; 161:1033-1034. [PMID: 30944989 DOI: 10.1007/s00701-019-03890-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Flavia Fraschetti
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Fraschetti F, Katsuda S, Sato T, Jokipii JR, Giacalone J. Vortical Amplification of the Magnetic Field at an Inward Shock of Supernova Remnant Cassiopeia A. Phys Rev Lett 2018; 120:251101. [PMID: 29979069 DOI: 10.1103/physrevlett.120.251101] [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] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/30/2018] [Indexed: 06/08/2023]
Abstract
We present an interpretation of the time variability of the x-ray flux recently reported from a multiepoch campaign of 15 years of observations of the supernova remnant Cassiopeia A by Chandra. We show for the first time quantitatively that the [4.2-6] keV nonthermal flux increase up to 50% traces the growth of the magnetic field due to a vortical amplification mechanism at a reflection inward shock colliding with inner overdensities. The fast synchrotron cooling as compared with shock-acceleration time scale qualitatively supports the flux decrease.
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Affiliation(s)
- F Fraschetti
- Department of Planetary Sciences, University of Arizona, Tucson, Arizona 85721, USA; Harvard/Smithsonian Center for Astrophysics, Cambridge, Massachusetts 02138, USA
| | - S Katsuda
- Graduate School of Science and Engineering, Saitama University, 255 Shimo-Ohkubo, Sakura, Saitama 338-8570, Japan
| | - T Sato
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - J R Jokipii
- Departments of Planetary Sciences and Astronomy, University of Arizona, Tucson, Arizona 85721, USA
| | - J Giacalone
- Departments of Planetary Sciences and Astronomy, University of Arizona, Tucson, Arizona 85721, USA
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Pesce A, Fraschetti F, D'Andrea G, Polli F, Acqui M, Frati A, Raco A. Risk of Postoperative Performance Status Worsening after Resection of Lesions Involving the Motor Pathway: A Multinomial Logistic Regression Model. J Neurol Surg A Cent Eur Neurosurg 2018. [DOI: 10.1055/s-0037-1617756] [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: 10/28/2022]
Abstract
Background and Study Objective In surgery for gliomas and brain metastases, preservation of neurologic functions is essential to ensure a good quality of life and the eligibility for adjuvant therapies. This article assesses which factors could influence the functional outcome in patients with lesions located in the motor pathways.
Materials and Methods A total of 92 patients with gliomas and metastases involving the motor pathways were studied for concerns regarding quality of life (Karnofsky performance status [KPS] and modified Rankin scale [mRS]) before and after surgical treatment supported by intraoperative neuromonitoring. Patient-related, surgery-related, and lesion-related data were recorded to identify the relationships with postoperative performance status. The relationship between lesions and the corticospinal tract were investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions.
Results Means of preoperative mRS and KPS were 1.91 ± 1.34 and 80.8 ± 20, and at 30 days postoperatively they were 1.93 ± 1.63 and 79.8 ± 24.4, respectively. The better preoperative performance status was a predictor of better outcome in terms of quality of life. Gender showed a statistical association with ∆KPS (p = 0.033) and ∆mRS (p = 0.031). A recurrent lesion was a predictor of poor functional outcome (p= 0.045 for KPS at 30 days).A left-sided lesion showed a statistical association with a lesser improvement with respect to right sided. Complications were associated with a lesser functional improvement (∆mRS, ∆KPS, and clinical improvement: p = 0.001, p = 0.006, and p = 0.003, respectively). Hemorrhagic complications were associated with the worst functional prognosis.
Conclusions In our experience, factors associated with worse functional prognosis and quality of life were a poor preoperative performance status, female gender, operating on a recurrent lesion, involvement of the left corticospinal tract, and surgical or medical postoperative complications.
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Affiliation(s)
- Alessandro Pesce
- Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
- Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
| | - Flavia Fraschetti
- Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
- Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
| | | | - Filippo Polli
- Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
- Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
| | - Michele Acqui
- Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
- Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
| | - Alessandro Frati
- Department of Neurosurgery, IRCCS “Neuromed” – Pozzilli (IS), Italy
| | - Antonino Raco
- Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
- Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
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Frati A, Pesce A, Toccaceli G, Fraschetti F, Caruso R, Raco A. Spinal Meningiomas Prognostic Evaluation Score (SPES): predicting the neurological outcomes in spinal meningioma surgery. Neurosurg Rev 2018. [PMID: 29516306 DOI: 10.1007/s10143-018-0961-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Among many factors leading to a worse functional prognosis in spinal meningioma (SM) surgery, in a previous study, we recognized anterior/anterolateral axial topography, sphincter involvement at first evaluation, surgery performed on a recurrence, and worse preoperative functional status. The purpose of this paper is to evaluate the cumulative weight of these factors on prognosis through a multinomial logistic regression model performed on an original evaluation scale designed by the authors on the ground of the experience of the neurosurgical departments of our University. The original SM database composed of 173 cases was classified in regard to sex, age, symptoms, axial and sagittal location, Simpson grade resection, and functional pre/postoperative status. Fine presurgical and follow-up reevaluations were available. The authors propose a scale (Spinal Meningiomas Prognostic Evaluation Score (SPES)) of preoperative evaluation to assess the surgery-related risk of neurological worsening experienced by the patients included in the present cohort. The authors describe a strong statistical association between the SPES and the follow-up Frankel and McCormick scores (r = - 460 and .441, p .001, both). Through a univariate ANOVA analysis, we disclosed that patients presenting scores 2 and 3 had a significantly higher association to lesser Frankel and McCormick postoperative scores, in respect to patients presenting SPES scores 0-1 (univariate ANOVA, p .008 and .011). Anterior or anterolateral axial location, operating on a recurrence of SM, sphincter involvement, and worse functional grade at onset present, along with the SPES scores are fairly predictive and reliable in respect to the long-term results of patients suffering from SM.
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Affiliation(s)
- Alessandro Frati
- IRCCS "Neuromed" Neurosurgery Department, Sapienza University, Rome, Italy
| | - Alessandro Pesce
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy. .,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Giada Toccaceli
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy.,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Flavia Fraschetti
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy.,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Riccardo Caruso
- Neurosurgery Division of "Neurology and Psychiatry" Department, Sapienza University, Rome, Italy
| | - Antonino Raco
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy.,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Frati A, Pesce A, D'Andrea G, Fraschetti F, Salvati M, Cimatti M, Esposito V, Raco A. A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies. J Clin Neurosci 2018; 50:252-261. [PMID: 29429789 DOI: 10.1016/j.jocn.2018.01.045] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY OBJECT The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard "anatomical" approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. MATERIALS AND METHODS 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. RESULTS The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. CONCLUSIONS A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and "tailored" cortico-leucotomy for an optimal exposure of the lesion.
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Affiliation(s)
- Alessandro Frati
- IRCCS "Neuromed" - Neurosurgery - "Sapienza" Univesity, Pozzilli (IS), Italy
| | - Alessandro Pesce
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | | | - Flavia Fraschetti
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy.
| | - Maurizio Salvati
- IRCCS "Neuromed" - Neurosurgery - "Sapienza" Univesity, Pozzilli (IS), Italy
| | - Marco Cimatti
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | - Vincenzo Esposito
- IRCCS "Neuromed" - Neurosurgery - "Sapienza" Univesity, Pozzilli (IS), Italy
| | - Antonino Raco
- NESMOS Department Neurosurgery Department "Sapienza" University, Roma, Italy; Azienda Ospedaliera Sant'Andrea, Roma, Italy
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Pinchi E, Frati A, Cipolloni L, Aromatario M, Gatto V, La Russa R, Pesce A, Santurro A, Fraschetti F, Frati P, Fineschi V. Clinical-pathological study on β-APP, IL-1β, GFAP, NFL, Spectrin II, 8OHdG, TUNEL, miR-21, miR-16, miR-92 expressions to verify DAI-diagnosis, grade and prognosis. Sci Rep 2018; 8:2387. [PMID: 29402984 PMCID: PMC5799407 DOI: 10.1038/s41598-018-20699-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/05/2017] [Accepted: 01/23/2018] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the most important death and disability cause, involving substantial costs, also in economic terms, when considering the young age of the involved subject. Aim of this paper is to report a series of patients treated at our institutions, to verify neurological results at six months or survival; in fatal cases we searched for βAPP, GFAP, IL-1β, NFL, Spectrin II, TUNEL and miR-21, miR-16, and miR-92 expressions in brain samples, to verify DAI diagnosis and grade as strong predictor of survival and inflammatory response. Concentrations of 8OHdG as measurement of oxidative stress was performed. Immunoreaction of β-APP, IL-1β, GFAP, NFL, Spectrin II and 8OHdG were significantly increased in the TBI group with respect to control group subjects. Cell apoptosis, measured by TUNEL assay, were significantly higher in the study group than control cases. Results indicated that miR-21, miR-92 and miR-16 have a high predictive power in discriminating trauma brain cases from controls and could represent promising biomarkers as strong predictor of survival, and for the diagnosis of postmortem traumatic brain injury.
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Affiliation(s)
- Enrica Pinchi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Alessandro Frati
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Alessandro Pesce
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy
| | - Flavia Fraschetti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy.,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Viale Regina Elena 336, 00185, Rome, Italy. .,IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, Italy.
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Raco A, Pesce A, Fraschetti F, Frati A, D’Andrea G, Cimatti M, Acqui M. Motor Outcomes After Surgical Resection of Lesions Involving the Motor Pathway: A Prognostic Evaluation Scale. World Neurosurg 2017; 103:748-756. [DOI: 10.1016/j.wneu.2017.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
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Abstract
I derive analytically the temporal dependence of the perpendicular transport coefficient of a charged particle in the three-dimensional anisotropic turbulence conjectured by Goldreich-Sridhar by implementing multispacecraft constraints on the turbulence power spectrum. The particle motion away from the turbulent local field line is assessed as gradient-curvature drift of the guiding center and compared with the magnetic field line random walk. At inertial scales much smaller than the turbulence outer scale, particles decorrelate from field lines in a free-streaming motion, with no diffusion. In the solar wind at 1 AU, for energy sufficiently small (<1 keV protons), the perpendicular average displacement due to field line tangling generally dominates over two decades of turbulent scales. However, for higher energies (≃25 MeV protons) within the range of multispacecraft measurements, the longitudinal spread originating from transport due to gradient-curvature drift reaches up to ≃10^{∘}-20^{∘}. This result highlights the role of perpendicular transport in the interpretation of interplanetary and interstellar data.
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Affiliation(s)
- F Fraschetti
- Departments of Planetary Sciences and Astronomy, University of Arizona, Tucson, Arizona 85721, USA
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Di Simone L, Fraschetti F. Gas chromatographic determination of succinodinitrile in pharmaceuticals. J Chromatogr A 1968; 37:213-5. [PMID: 5724058 DOI: 10.1016/s0021-9673(01)99097-1] [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] [Indexed: 01/16/2023]
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