Opening New Window in Upper Clival Region: Results from Anatomic Study.

Considering its position located anteriorly to the brainstem, the retrosellar area, in particular the upper clival region and the interpeduncular cistern, is one of the most difficult regions to surgically approach. To date, many different operative solutions have been described, given that this region is attainable by both lateral and median approaches. Lateral routes include the frontolateral, subtemporal, and frontotemporozygomatic approaches with relative variants that have been extensively reported. Among the lateral approaches, the frontotemporozygomatic one is considered particularly useful because it allows better visualization of the retrosellar and suprasellar areas minimizing the…

Treatment algorithm for spontaneous spinal infections: A review of the literature

Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the…

Changing paradigm in mild traumatic brain injury research

Isolated Pediatric Intramedullary Schwannoma: Case Report and Review of Literature

Background: Intramedullary (IM) schwannomas are rare entities representing 0.3%−1% of intramedullary tumors and 1.1% of spinal schwannomas. Beside many theories proposed, their rare occurrence might be related to the absence of Schwann cells in the spinal cord. Pediatric IM schwannomas are uncommon, and in the absence of neurofibromatosis they are extremely rare. To date, few cases have been reported in the literature. Case Description: We describe the case of an 8-year-old female affected by a progressive paraparesis. Neuroradiologic investigations showed an oval-shaped mass at the level of T10-T11. The patient underwent surgery, performed under neurophysiologic monitoring. The patient was…

Pathogenetic Mechanisms of Intratumoral Hemorrhage in Meningioma: The Role of Microvascular Differentiation

The transformation of normal cells into neoplastic cells is based on a series of gradual and progressive processes . One of the most important aspects underlying the tumorigenesis ist hat neoplastic proliferation needs mechanisms to ensure cancer development, bypass the body's protective strategies, and survive the apoptotic mechanisms. Subsequently, measures to promote replicative immortality and vascular support will be required. If cancer develops in an area offering excellent vascularization, pre-existing vascular circuits can supporti ts growth .Otherwise,tumor angiogenetic mechanisms will trigger new vascular networks, which will be necessary for tumor survival and expansion. The latt…

Long-term clinical and radiological outcomes following anterior cervical discectomy and fusion by zero-profile anchored cage

Objectives: The purpose of this study was to extend the results of our previous study providing a minimum of 4-year follow-up results of a prospective study following implantation of a cervical cage with an integrated fixation system. Summary of Background Data: The use of cervical intersomatic cages with an integrated fixation system for anterior cervical discectomy and fusion (ACDF) has increased rapidly in this last decade. In addition to immediate stabilization, these implants allow avoidance of anterior plating and iliac crest bone-grafting. Methods: Patients were studied prospectively, and data were collected and analyzed. Intersomatic cages with an integrated fixation system were use…

Prevention of lumbar reherniation by the intraoperative use of a radiofrequency bipolar device: A case-control study.

Objective: The most common complication after lumbar discectomy is reherniation. Although many studies have investigated factors that may increase the reherniation risk, few are agreed upon all. It has been suggested that limited nucleus removal is associated with higher reherniation risk, while more aggressive nucleus removal can result in increased disc degeneration. Here, we assessed the efficacy of a coblation-assisted microdiscectomy in adult patients undergoing single-level disc surgery. Methods: We prospectively compared the reherniation rate in 75 patients (Group 1) undergoing single-level lumbar disc surgery completed with the radiofrequency bipolar system Aquamantys® (Medtronic, M…

Spontaneous spinal discitis and spondylodiscitis: Clinicotherapeutic remarks

Spinal infections are rare (their incidence is estimated in about the 5% of all osteomyelitis) and severe pathologies. They are usually identified with different names, as disk space infection, spondylodiscitis, and vertebral osteomyelitis. Spondylodiscitis is the most frequent among spinal infections. The etiology might be due to bacteria, fungi, and parasites and might affect many anatomical structures. The reported incidence is increased in the last years.[1,2] The disease can be classified according to the involved anatomical structure: Vertebral osteomyelitis Discitis and spondylodiscitis Spinal canal infections Adjacent soft tissue infections. In adult patients, the terms osteomyeliti…

Preliminary experience with lumbar facet distraction and fixation as treatment for lumbar spinal stenosis

Objectives: To assess the properties of facet fixation with the Facet Wedge system in patients affected by lumbar spinal stenosis (LSS). Summary of Background Data: Implant of intra-articular spacers is an emerging technique for lumbar degenerative disease. Methods: This study included forty patients (Group 1) with symptomatic LSS in whom intra-articular spacers have been implanted along with microdecompression (MD) of the neural structures. Group 1 has been compared with a homogeneous group of patients with LSS treated with MD without intra-articular spacers implant (Group 2). Clinical findings have been observed preoperatively and 3, 6, 12 months postoperatively using dedicated questionna…

A Novel Pathophysiological Mechanism Contributing to Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a form of neuropathic pain that affects the fifth cranial nerve, the most widely distributed nerve in the head. Although TN has been associated with a variety of pathological conditions, neurovascular compression on the trigeminal nerve, as it exits the brain stem, is the most frequent reported cause. This compression provides a progressive demyelination of the nerve and a subsequent aberrant neural transmission. Although several studies have clarified some physiopathological mechanisms underlying TN, the molecular basis remains vague. Very recently the substitution of methionine 136 by valine (MET126Val) in sodium channel Nav1.6 in a case study of typical TN ha…

Revision Surgery for Primary Spinal Tumor: Too Little Too Late

Primary tumors of the spine are rare and represent less than 8% of all bone tumors.1 Because of their low prevalence, they are often misdiagnosed and consequently managed improperly. Unlike metastatic spine tumors, some primary tumors can be cured. Spine tumors are classified according to their histology. How- ever, patient age and anatomic location add relevant information on the biological behavior of the tumor. In children, the most frequent spinal tumors are malignant and are represented by neuroblastoma and sarcoma. In adults, the most common spinal tumors are multiple myeloma, osteosarcoma, histiocytosis, chordoma, and hemangioma. These tumors often develop in the anterior vertebral b…

Recurrent lumbar disc herniation: Is there a correlation with the surgical technique? A multivariate analysis

Purpose: The recurrence of a lumbar disc herniation (LDH) is a common cause of poor outcome following lumbar discectomy. The aim of this study was to assess a potential relationship between the incidence of recurrent LDH and the surgical technique used. Furthermore, we tried to define the best surgical technique for the treatment of recurrent LDH to limit subsequent recurrences. Materials and Methods: A retrospective study was conducted on 979 consecutive patients treated for LDH. A multivariate analysis tried to identify a possible correlation between (1) the surgical technique used to treat the primary LDH and its recurrence; (2) technique used to treat the recurrence of LDH and the secon…

Multimodal Intraoperative Neuromonitoring in Aneurysm Surgery

Following aneurysmal subarachnoid hemorrhage, the primary goal of treatment is to exclude the vascular malformation from the intracranial circulation, while preserving the parent artery. In unruptured aneurysms, the decision whether to treat or observe the malformation is made on a case-by-case basis. In this regard, the ISUIA (International Study of Unruptured Intracranial Aneurysms) investigators suggested that aneurysm size and location were independent predictors for aneurysm rupture.1 ISUIA examined 1692 patients with cerebral aneurysms with a mean follow-up time of 4.1 years. Rupture rates differed depending on size and location, ranging from 0% in aneurysms <7 mm located in the in…

Comment on “Controversies about Interspinous Process Devices in the Treatment of Degenerative Lumbar Spine Diseases: Past, Present, and Future”

Diagnostic potential of the diffusion tensor tractography with fractional anisotropy in the diagnosis and treatment of cervical spondylotic and posttraumatic myelopathy

Background: Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI)-based methodology widely used for the evaluation of microstructural integrity of the central nervous system (CNS), particularly of brain white matter fibers and bundles. Methods: The most common parameters evaluated in a DTI study are the fractional anisotropy (FA) and mean diffusivity (MD). Combining FA and MD analyses is commonly used in the evaluation of various types of brain pathologies, such as brain tumors, where a combined analysis allows an accurate tumor characterization. Results: Recent studies have shown that FA and MD could be of value in non-oncologic spinal pathology. In this regard, it has been …

Introducing the concept of “CSF-shift edema” in traumatic brain injury

Brain edema after severe traumatic brain injury (TBI) plays an important role in the outcome and survival of injured patients. It is also one of the main targets in the therapeutic approach in the current clinical practice. To date, the pathophysiology of traumatic brain swelling is complex and, being that it is thought to be mainly cytotoxic and vasogenic in origin, not yet entirely understood. However, based on new understandings of the hydrodynamic aspects of cerebrospinal fluid (CSF), an additional mechanism of brain swelling can be considered. An increase in pressure into the subarachnoid space, secondary to traumatic subarachnoid hemorrhage, would result in a rapid shift of CSF from t…

Long-Term Efficacy of Shunt Therapy in Idiopathic Normal Pressure Hydrocephalus.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is one of the very few treatable types of dementia. Shunt therapy has been shown to be effective in improving symptoms. However, the long-term results of cerebrospinal fluid diversion are variable. The aim of this retrospective study was to investigate long-term outcomes of patients with idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt by using programmable valves. Methods: Symptoms before treatment were recorded. Clinical symptoms and outcome after ventriculoperitoneal shunt were assessed based on changes in gait, urinary incontinence, and cognitive dysfunction at yearly follow-up spanning at least …