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Pagano A, Iaquinandi A, Fraioli MF, Bossone G, Carra N, Salvati M. Cauda equina syndrome from intradural metastasis of a non-neural tumor: case report and review of literature. Br J Neurosurg 2023; 37:1487-1494. [PMID: 34330176 DOI: 10.1080/02688697.2021.1958155] [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: 03/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cauda equina syndrome (CES) is a challenging condition and it can be caused by variable entities. Leptomeningeal carcinomatosis (LC) is a multifocal seeding of the leptomeninges by malignant cells and it is observed in 1-8% of patients with solid tumors. Diagnosis of intradural metastases of the cauda equina is often delayed due to the non-specific characteristics of this condition but also to the delay of presentation of many patients. Cauda equina metastases usually occur in advanced cancers, but rarely can be the first presentation of disease. CASE DESCRIPTION A 63-year-old man presented with 6 months history of low back pain and 20 d history of bilateral sciatica, hypoesthesia of the legs and the saddle, flaccid paraparesis and bowel incontinence determine by multiple nodular small lesions on the entire cauda equina with contrast-enhancement. Total-body CT showed a millimetric lesion at the lung. The patient underwent L2-L5 laminectomy and subtotal removal and histological examination showed a small cell lung carcinoma metastasis. CONCLUSIONS In the literature, 54 cases of CES from non-CNS tumor metastasis are described. The diagnosis is challenging, back pain, with or without irradiation to the lower limbs, is the most frequently reported disturbance. In about 30% of patients there is no known malignancy and CES is the first clinical presentation. Treatment of choice is surgery, followed by radiotherapy and less frequently adjuvant chemotherapy. The surgical removal is almost always incomplete and functional outcome is often not satisfactory. Prognosis is poor.
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Affiliation(s)
- Andrea Pagano
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
| | - Andrea Iaquinandi
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
| | - Mario Francesco Fraioli
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
| | | | | | - Murizio Salvati
- Department of Neurosurgery, Policlinico 'Tor Vergata', University of Rome 'Tor Vergata', Rome, Italy
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Fraioli MF, Scalia G, Garaci FG, Fraioli C, Lunardi P, Umana GE. Letter to the Editor Regarding “Possible Prognostic Role of Magnetic Resonance Imaging Findings in Patients with Trigeminal Neuralgia and Multiple Sclerosis who Underwent Percutaneous Balloon Compression: Report of Our Series and Literature Review”. World Neurosurg 2020; 136:433-434. [DOI: 10.1016/j.wneu.2020.01.063] [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: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/24/2022]
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Novegno F, Pagano A, Fava F, Umana G, Lunardi P, Fraioli MF. Abrupt foramen magnum syndrome due to shunt malfunction in a previously asymptomatic chiari I malformation: the hidden predictable risk in long-lasting shunted patients. Br J Neurosurg 2019:1-5. [DOI: 10.1080/02688697.2019.1691977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Federica Novegno
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Andrea Pagano
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Filippo Fava
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Giuseppe Umana
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
| | - Pierpaolo Lunardi
- Department of Neurosurgery, Tor Vergata University Medical School, Rome, Italy
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Fraioli MF. Cranio-Spinal Junction Tumours: Role of Transoral Approach Followed by Stereotactic Radiotherapy. J Spine 2015; 04. [DOI: 10.4172/2165-7939.1000e117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Novegno F, Umana G, Di Muro L, Fraioli B, Fraioli MF. Spinal intramedullary arachnoid cyst: case report and literature review. Spine J 2014; 14:e9-15. [PMID: 24262859 DOI: 10.1016/j.spinee.2013.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 07/04/2013] [Revised: 09/21/2013] [Accepted: 10/31/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary arachnoid cysts are extremely rare; only 14 cases have been reported in the literature so far. PURPOSE We report on the case of a 31-year-old woman who presented with back pain and progressive paraparesis secondary to a dorsal intramedullary arachnoid cyst detected on magnetic resonance imaging (MRI): the surgical planning and clinico-radiological outcome are discussed along with a review of the relevant literature. STUDY DESIGN Case report and literature review. PATIENT SAMPLE One patient affected by intramedullary arachnoid cyst. OUTCOME MEASURES Magnetic resonance imaging and pathological findings from operative specimens were used to confirm the diagnosis. METHODS A 31-year-old woman presented with a 7-year history of back pain that had worsened 3 months before admission to our department; for this reason, the patient had undergone a spinal MRI revealing the presence of a 1-cm cystic intramedullary lesion at the level T11-T12, with no contrast enhancement. After 2 months, the patient presented with a worsening of clinical symptoms complaining of severe back pain radiating to the lower extremities associated with a progressive paraparesis, urinary incontinence, and abdominal pain. Referred to our department, at the time of admission the patient was bedridden because of the impossibility of maintaining a standing position. The patient underwent a T11-T12 laminectomy with fenestration of the cyst. RESULTS She experienced an immediate relief of pain symptoms, and by the seventh postoperative day she was able to stand without help and walk a few meters with assistance. By the sixth postoperative month, the patient had significantly improved, having gained the ability to walk alone without assistance with complete resolution of the bladder dysfunctions, with no cyst recurrence after approximately 2 years of follow-up. CONCLUSIONS Intramedullary arachnoid cysts should be considered in the differential diagnosis for intramedullary cystic lesions. A particular consideration deserves their occurrence in asymptomatic patients, who should be adequately informed on the possible natural evolution: when symptomatic, surgical therapy should be promptly offered, considering that a postoperative complete recovery is usually observed, regardless of the surgical technique.
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Affiliation(s)
- Federica Novegno
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy.
| | - Giuseppe Umana
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Licia Di Muro
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Bernardo Fraioli
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Mario Francesco Fraioli
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
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Fraioli MF, Marciani MG, Umana GE, Fraioli B. Anterior Microsurgical Approach to Ventral Lower Cervical Spine Meningiomas: Indications, Surgical Technique and Long Term Outcome. Technol Cancer Res Treat 2014. [PMID: 24645744 DOI: 10.7785/tcrt.2012.500418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ventral lower cervical spinal meningiomas with posterior displacement of the spinal cord are rare and anterior approach has been rarely reported in the literature. The authors present their experience about eight patients operated through anterior microsurgical approach. Exposure of meningiomas was achieved through one or two corpectomies, according to meningioma extension. Tumour removal was performed thanks to the aid of a dedicated ultrasonic aspirator, and intraoperative evoked potentials were employed. Particular care was taken with the materials adopted for reconstruction of the anterior dural plane, to avoid postoperative cerebrospinal fluid leak. Vertebral fusion and stabilization were achieved by tantalum cage or titanium graft in case of one or two corpectomies respectively; anterior titanium plate fixed with screws was applied in all patients. Extent of tumour removal was related to the presence of a conserved arachnoidal plane between the tumour and the spinal cord: total removal was achieved in 2 patients, while gross total removal in the other six ones. Postoperative neurological outcome, which was favourable in all patients, was related mostly to preoperative neurologic status. No recurrence after total removal and no remnant growth after gross total removal occurred during an average follow-up period of 6, 7 years.
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Affiliation(s)
- M F Fraioli
- University of Rome Tor Vergata, Department of Neurosciences, Neurosurgery, Via Oxford 81, 00133 Roma, Italy.
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Fraioli MF, Catena E, Lecce M, Fraioli B. Transsphenoidal removal of huge pituitary adenomas with marked suprasellar extension: Results with modified surgical technique. Clin Neurol Neurosurg 2013; 115:450-3. [DOI: 10.1016/j.clineuro.2012.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 06/01/2012] [Accepted: 06/16/2012] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Patients affected by tuberous sclerosis (TS) have a greater incidence of tumors than the healthy population. Spinal tumours in TS are reported very rarely and consist mainly of sacrococcygeal and cervical chordomas. METHOD Case report. FINDINGS A 21-year-old man, affected by TS, presented a spinal dorsal T2 tumor that caused medullary compression. He underwent decompressive laminectomy and microsurgical excision of a giant cell tumor and an associated aneurysmal bone cyst. Postoperative hypofractionated radiotherapy was performed on the surgical field. At 2.4 years of follow-up the patient reported total recovery of neurological deficits and was free from tumor recurrence. CONCLUSION Considering this association, which is the first reported in the literature, spinal magnetic resonance imaging with gadolinium should be performed at the onset of spinal pain in patients affected by TS.
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Fraioli MF, Lecce M, Lisciani D, Fraioli B. Trigeminal Neuralgia: Role and Neurosurgical Indications of Peripheral Alcohol Injections, Controlled Radiofrequency Thermocoagulation, Gasserian Ganglion Compression with Balloon and Microvascular Decompression in Posterior Cranial Fossa. Experience in 437 Patients. J Neurol Neurophysiol 2011; 02. [DOI: 10.4172/2155-9562.1000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Fraioli MF, Moschettoni L, Fraioli C, Strigari L. Treatment of idiopathic hemifacial spasm with radiosurgery or hypofractionated stereotactic radiotherapy: preliminary results. ACTA ACUST UNITED AC 2010; 53:34-6. [PMID: 20376743 DOI: 10.1055/s-0030-1247584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Microvascular decompression in the posterior cranial fossa is the first treatment option for hemifacial spasm. For patients not suitable for surgery because of advanced age, poor general conditions or patients who refuse surgery, radiotherapeutic treatment could be an alternative. Only one case of resolution of hemifacial spasm in a patient undergoing radiosurgery for an intracanalicular vestibular schwannoma has been described in the literature. In this article we present three patients affected by idiopathic hemifacial spasm, refractory to medical therapy and botulinum toxin injections, who were treated by radiosurgery in one case and hypofractionated stereotactic radiotherapy in the other two. METHODS Radiosurgery, with a single dose of 8 Gy, was used in the first patient affected by idiopathic hemifacial spasm and autoimmune polyneuropathy with severe hypoacusia; hypofractionated stereotactic radiotherapy, with 15 Gy in 5 fractions of 3 Gy each, was preferred in the other 2 cases. In all patients, the target consisted of the vestibulocochlear-facial bundle immediately before its entry into the internal acoustic foramen. RESULTS A marked improvement of symptoms was observed in 2 patients, and almost complete disappearance in the other case, with no complications, particularly, auditory. CONCLUSION The mean follow-up time of 24 months reported here could be judged too short, and our series too small, but the good results observed so far lead us to underline that, as in trigeminal neuralgia, radiosurgery or hypofractionated stereotactic radiotherapy could represent a therapeutic alternative to microvascular decompression for idiopathic hemifacial spasm for patients not suitable for surgery.
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Affiliation(s)
- M F Fraioli
- Department of Neurosciences, University of Rome Tor Vergata, Rome, Italy.
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Fraioli MF, Moschettoni L, Fraioli C. Endoscopic pituitary surgery. J Neurosurg 2010; 112:471-2; author reply 472-3. [PMID: 20121378 DOI: 10.3171/2009.4.jns09493] [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: 11/06/2022]
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Fraioli MF, Moschettoni L, Fraioli C. Pituitary adenomas. J Neurosurg 2008; 109:362-3; author reply 363-4. [PMID: 18671656 DOI: 10.3171/jns/2008/109/8/0362a] [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: 11/06/2022]
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Fraioli MF, Contratti F, Fraioli C, Floris R. Lateral transmaxillosphenoidal approach to the lateral compartment of the cavernous sinus: technical case report. Skull Base 2008; 17:413-6. [PMID: 18449335 DOI: 10.1055/s-2007-991115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article outlines the surgical technique and the indications for the lateral transmaxillosphenoidal approach, which is illustrated by an index case. A 27-year-old woman presented with a trigeminal sensory deficit caused by a dermoid tumor occupying the lateral compartment of her right cavernous sinus. A lateral transmaxillosphenoidal approach was performed, and the tumor was removed lateral to the intracavernous carotid artery (ICA) and medial to intracavernous cranial nerves. The lateral transmaxillosphenoidal approach is similar to the transmaxillosphenoidal approach used for the removal of pituitary adenomas invading the medial compartment of the cavernous sinus. By opening the lateral wall of the sphenoid sinus just above and laterally to the carotid artery, tumor can be removed medial to the intracavernous cranial nerves and lateral to the ICA.
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Fraioli MF, Cristino B, Moschettoni L, Cacciotti G, Fraioli C. Validity of percutaneous controlled radiofrequency thermocoagulation in the treatment of isolated third division trigeminal neuralgia. ACTA ACUST UNITED AC 2008; 71:180-3. [PMID: 18291496 DOI: 10.1016/j.surneu.2007.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 09/02/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Of 756 percutaneous controlled radiofrequency thermocoagulations of gasserian ganglion and/or retrogasserian rootlets for idiopathic trigeminal neuralgia or for trigeminal neuralgia in multiple sclerosis, the results in 158 patients who had isolated third division trigeminal neuralgia were reviewed. METHODS In 129 patients, percutaneous thermocoagulation was fluoroscopic guided, whereas in the last 29 the procedure was performed under CT control. In all cases, the goal was to achieve selective anesthesia limited to the third trigeminal division. RESULTS Complete pain relief was obtained immediately after the procedure in all patients and selective anesthesia in the third division was achieved in all of them, except for 2 patients in whom unwanted first and second division anesthesia/hypoesthesia also occurred. Other significant complications were transient sixth cranial nerve palsy in 1 patient and masseter muscle dysfunction, which improved during follow-up, in another one. The selected sensory impairment was well tolerated in all patients. During an average follow-up period of 8.8 years, recurrences occurred in 12 patients, together with a partial regression of the anesthesia: in 10 patients the procedure was repeated successfully. In 2 patients with multiple sclerosis, the procedure was repeated twice and 3 times, respectively. CONCLUSIONS Percutaneous controlled radiofrequency thermocoagulation is quite easy to perform under fluoroscopic or CT control, and it involves no mortality and very low morbidity; it is an immediately effective procedure and the rate of recurrence is low. Last, but not least, if the anesthesia is limited to the third division, no anesthesia dolorosa occurs and patients are very grateful.
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Affiliation(s)
- Mario Francesco Fraioli
- Department of Neurosciences-Neurosurgery, University of Rome "Tor Vergata", 00133 Rome, Italy.
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Fraioli MF, Contratti F. Craniopharyngioma. J Neurosurg 2006; 105:159-60; author reply 160. [PMID: 16922083 DOI: 10.3171/ped.2006.105.2.159] [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: 11/06/2022]
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Contratti F, Fraioli MF, Cacciotti G. Poor prognosis/good outcome in patients with NPH. J Neurosurg 2006; 104:988-9; author reply 989-90. [PMID: 16776349 DOI: 10.3171/jns.2006.104.6.988] [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: 11/06/2022]
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Fraioli MF, Santoni R, Fraioli C, Contratti F. "Conservative" surgical approach and early postoperative radiotherapy in a patient with a huge cystic craniopharyngioma. Childs Nerv Syst 2006; 22:151-5; discussion 158-63. [PMID: 16320025 DOI: 10.1007/s00381-005-1191-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The treatment of huge craniopharyngiomas represents a therapeutic challenge for neurosurgeons. Some authors prefer to run the high risks of total removal at primary surgery, while others do not despise subtotal removal in accordance with a multidisciplinary treatment. METHODS We report the case of a 17-year-old girl who underwent subtotal removal (tumour remnant with maximum diameter of 2.5 cm) of a huge cystic craniopharyngioma by frontotemporal approach, followed by early external fractionated radiotherapy by linear accelerator. Serial magnetic resonance imaging during a follow-up period of 5 years showed a progressive marked reduction of the tumour remnant, accompanied by a complete recovery of visual deficits and an almost complete regression of diencephalic disturbances. CONCLUSIONS Subtotal removal followed by early fractionated radiotherapy can be an effective treatment for huge craniopharyngiomas. Such a multidisciplinary treatment may favour tumour control and assure a satisfactory quality of life as well.
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Affiliation(s)
- Mario Francesco Fraioli
- Department of Neurosciences, Neurosurgery, Tor Vergata University of Rome, Via Oxford 81, 00133, Rome, Italy.
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Contratti F, Contratt F, Menniti A, Fraioli MF, Fraioli B. Fibrous dysplasia of the clivus with a second T8 bone lesion: case report. ACTA ACUST UNITED AC 2006; 65:202-5; discussion 205-6. [PMID: 16427429 DOI: 10.1016/j.surneu.2005.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 05/23/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND We present a rare case of a probably poliostotic fibrous dysplasia of the clivus in a young woman with a clival and vertebral involvement. We also compare our case with data reported in tables that include all cases of clival fibrous dysplasia present in literature. CASE DESCRIPTION Thirty-year-old women presented with headache. We reviewed radiological and clinical literature before surgery. It was possible to perform a preoperative diagnosis of fibrous dysplasia of the clivus so it was possible to adopt a minimally invasive surgical approach on the clivus. The diagnosis of fibrous dysplasia of the clivus was confirmed after the operation. As the patient was asymptomatic, we did not operate on the vertebral lesion which was stable after 1 year. CONCLUSION We draw the conclusion that it is possible to obtain a correct preoperative diagnosis of fibrous dysplasia based on magnetic resonance imaging and computed tomographic scans; this makes it possible to avoid major surgical operations. The reported case is particularly interesting because apart from the clival fibrous dysplasia, a vertebral involvement of the same type can be assumed; this association has never been reported in literature.
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Fraioli MF, Contratti F, Fraioli C, Floris R. Percutaneous computer tomography-guided technique to close postsurgical cerebrospinal fluid fistulas of the frontal sinus. ACTA ACUST UNITED AC 2005; 64:351-3; discussion 353-4. [PMID: 16231426 DOI: 10.1016/j.surneu.2004.12.018] [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: 11/20/2022]
Abstract
BACKGROUND The occurrence of cerebrospinal fluid fistulas of the frontal sinus after anterior skull base surgery is not rare. The extracerebral techniques to repair cerebrospinal fluid fistulas are often used, especially because they avoid open-air surgical operations. METHODS A percutaneous CT-guided technique to close postsurgical cerebrospinal fluid fistulas of the frontal sinus in three patients after anterior skull base surgery is presented in this report. Ten millimeters of human fibrin glue was injected into the frontal sinus through one of the burr holes of the bone flap by an 18-gauge spinal needle. RESULTS After an average follow-up period of 2.8 years, all three patients are in excellent general and neurological conditions and have not shown any further signs of rhinoliquorrhea. CONCLUSIONS The presented percutaneous CT-guided technique can be considered a valid and harmless solution to closer small or moderate cerebrospinal fluid fistula that occurred after anterior skull base surgery.
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Affiliation(s)
- Mario Francesco Fraioli
- Department of Neurosciences and Neurosurgery, Policlinic of Tor Vergata, University of Rome Tor Vergata, 00133 Rome, Italy.
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Fraioli B, Conti C, Lunardi P, Liccardo G, Fraioli MF, Pastore FS. Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case report. Neurosurgery 2003; 52:1487-90; discussion 1490. [PMID: 12762897 DOI: 10.1227/01.neu.0000065183.05896.9c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2002] [Accepted: 02/12/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.
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Affiliation(s)
- Bernardo Fraioli
- Department of Neuroscience, Neurosurgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
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