0000000000089191
AUTHOR
Massimiliano Visocchi
showing 22 related works from this author
Reconstruction of vertebral body after radiofrequency ablation and augmentation in dorsolumbar metastatic vertebral fracture: Analysis of clinical an…
2017
Background: Painful spinal metastases usually occur in malignant neoplastic disease. Treatment for bone metastases has been largely conservative, and it includes the use of high doses of analgesics, radiotherapy, chemotherapy, hormone therapy, and bisphosphonates; however, results are sometimes transient and ineffective. In the presence of neurological involvement a surgical strategy should be considered. Recently, percutaneous procedures such as radiofrequency ablation, vertebroplasty, and kyphoplasty have been introduced as palliative techniques to treat painful vertebral metastases [3, 11, 25]. Methods: In our study we combined the use of radiofrequency ablation with vertebroplasty in th…
EMG-guided percutaneous placement of cement-augmented pedicle screws for osteoporotic thoracolumbar burst fractures
2017
Background: Percutaneous techniques have increasingly gained popularity in recent years. The application of technological innovation, including neuromonitoring techniques, has the potential to increase the safety and efficacy of these procedures. Methods: Thirty patients suffering from osteoporotic dorsolumbar burst fracture were prospectively enrolled in this study. The patients underwent percutaneous fenestrated pedicle screw fixation augmented with polymethylmethacrylate (PMMA) injection. A novel surgeon-dedicated neuromonitoring device was used in order to increase the safety and the accuracy of the screw insertion. A second group of 30 patients who did not undergo neuromonitoring durin…
Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement
2021
BackgroundExternal ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement.MethodsWe used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using pla…
Complications in Craniovertebral Junction Instrumentation: Hardware Removal Can Be Associated with Long-Lasting Stability. Personal Experience
2017
Background The causes of craniovertebral junction (CVJ) instabilities include trauma, rheumatological diseases, tumors, infections, congenital malformations, and degenerative disease processes; these complex pathologies often require CVJ instrumentation. Hardware complications were analyzed in a personal series of 48 treated patients. In light of the analysis of very unusual radiological and clinical findings, the authors tried to better investigate the related mechanisms and to reach possible useful conclusions. Methods In a series of 48 patients who underwent CVJ instrumentation and fusion procedures in our Institution, we describe three cases of hardware failure, due to: (1) infection; (…
Type II Odontoid Fracture: a case series highlighting the treatment strategies
2019
Background: A type II odontoid fracture, if unstable, can cause spinal cord damage. In this case, it is essential to choose the correct treatment—but the issues of what the correct treatment is and which of the different surgical options is best are quite controversial. In this paper we present strategies for treatment of type II odontoid fracture. Materials and Methods: Thirty consecutive cases of type II odontoid fracture were treated at the Division of Neurosurgery at Villa Sofia Hospital in Palermo (23 cases) and at the Neurosurgical Clinic, University Hospital of Palermo (seven cases), from January 2011 to August 2016. Four patients were treated with external immobilization. Twenty-six…
The craniovertebral junction in rheumatoid arthritis: State of the art
2019
Rheumatoid arthritis (RA) is a chronic inflammatory disorder, characterized by polyarticular inflammation causing progressive joint damage and disability. The mechanisms underlying its pathogenesis involve activation of innate and adaptive immunity, microvascular endothelial cell activation, and inflammatory infiltration of lymphocytes and monocytes into the synovium. Spinal involvement in RA is not typical; when it occurs, the main radiological features are (1) atlantoaxial subluxation (AAS), which is the most typical form of cervical spine involvement; (2) cranial settling—also known as basilar impression, atlantoaxial impaction or superior migration of the odontoid—which is the most seve…
Craniovertebral Junction Transanasal and Transoral Approaches: Reconstruct the Surgical Pathways with Soft or Hard Tissue Endocopic Lines? This Is th…
2017
A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ). These include congenital disorders, chronic inflammation, neoplasms, infections, and posttraumatic conditions that could all result in CVJ compression and myelopathy Endoscopic-assisted procedures have been further developed for CVJ decompression and they have now become conventional approaches. The aims of the present study were: (1) to compare “radiological” and “surgical” nasoaxial lines (NAxLs); (2) to introduce an analogous radiological line as a predictor of the superior extension of the transoral approach (palatine inferior dental arch line (PIA); (3) to compare the “radiological” nasop…
Minimally Invasive Management of Spontaneous Supratentorial Intracerebral Lobar Hemorrhages by a “Homemade” Endoscopic Strategy: The Evangelical Doct…
2019
Background Although the incidence of intracerebral hemorrhage (ICH) has appeared to be increasing over the years, its prognosis remains dismal. No consensus has yet been reached regarding the management of ICH; however, minimally invasive surgery should limit, if not avoid, intraoperative parenchymal damage. Therefore, we have presented a novel, modified “homemade” approach aimed to shorten the operative time and minimize the corticectomy and brain manipulation. Methods From 2008 to 2017, 53 patients (32 men and 21 women; mean age, 63.8 years) were admitted to our neurosurgery department and surgically treated for a lobar ICH. A modified suction tube, coupled with the endoscope light source…
Surgical Highways to the Craniovertebral Junction: Is It Time for a Reappraisal?
2019
Background: The craniovertebral junction (CVJ) can be affected by a variety of congenital or acquired anomalies. Because of its complexity, a careful evaluation of bones and ligamentous structures in all three planes is required. This can be achieved by studying the CVJ in terms of several anatomical and radiological lines that have been visualized to facilitate understanding of its surgical anatomy. In this study we aimed to review the state-of-the art craniometric CVJ lines and approaches. Methods: In December 2016 a PubMed search was performed, including the search terms ‘CVJ surgical approach/line’, ‘cervical approach’, ‘craniometric measurement’, ‘CVJ anatomy’ and ‘ventral/dorsal/far-l…
Familial Replicating Arachnoidal Cysts: Case Series and Review of Literature
2015
Background: Arachnoid cysts are intra-arachnoid fluid collections covered by a thin membrane that may develop throughout the cerebrospinal axis. Although the precise causative mechanism is unknown, arachnoid cyst (AC) are now generally accepted to be developmental anomalies of arachnoid. These lesions have commonly been described in the literature; however the presence of familial arachnoid cysts is quite rare. Most genetically related AC have been documented in patients with a known genetic syndrome. The current case report describes a family with four members affected by an arachnoid cyst in the same region. Methods: In addition to reviewing the current case, a literature search was condu…
Spinal cord stimulation: An alternative concept of rehabilitation?
2017
Background: Chronic low back and leg pain is a disabling condition, affecting, in most cases, older patients with congenital or acquired spinal stenosis or patients with failed back surgery syndrome. Spinal cord stimulation has been introduced as an effective therapeutic option for those patients who have previously been operated without significant clinical benefits, or for all those patients who are ineligible for traditional surgery. Methods: We report our experience with ten patients treated with spinal cord stimulation plus medication and physical therapy between November 2014 and September 2015. Inclusion criteria were: previous surgical treatments for lumbar stenosis and metameric in…
Direct and oblique approaches to the craniovertebral junction: Nuances of microsurgical and endoscope-assisted techniques along with a review of the …
2017
Purpose: The aim of this review is to provide an update of the technical nuances of microsurgical and endoscopic-assisted approaches to the craniovertebral junction (transnasal, transoral, and transcervical), and to report on the available clinical results in order to identify the best strategy. Methods: A nonsystematic update of the reviews and reporting on the anatomical and clinical results of endoscopic-assisted and microsurgical approaches to the craniovertebral junction (CVJ) was performed. Results: Pure endonasal and cervical endoscopic approaches still have some disadvantages, including their steep learning curves and their deeper surgical fields. Endoscopically assisted transoral s…
Walk the Line. The Surgical Highways to the Craniovertebral Junction in Endoscopic Approaches: A Historical Perspective
2018
Background We compiled a comprehensive literature review on the anatomic and clinical results of endoscopic approaches to the craniocervical junction (CVJ) to better contribute to identify the best strategy. Methods An updated literature review was performed in the PubMed, OVID, and Google Scholar medical databases, using the terms “Craniovertebral junction,” “Transoral approach,” “Transnasal approach,” “Transcervical approach,” “Endoscopic endonasal approach,” “Endoscopic transoral approach,” “Endoscopic transcervical approach.” Clinical series, anatomic studies, and comparative studies were reviewed. Results Pure endonasal and cervical endoscopic approaches still have some disadvantages, …
Update on mechanism and therapeutic implications of spinal cord stimulation and cerebral hemodynamics: A narrative review
2017
Spinal cord stimulation (SCS) is well known for its early role in the management of chronic pain, mainly failed back surgery syndrome (FBSS), spasticity, and bowel and bladder dysfunction. In more recent years, SCS has been proposed for patients suffering from refractory angina or peripheral vasculopathies in order to gain symptom relief, thus indicating some hemodynamic effect on the peripheral circulation. Taking into account this scientific observation, since the late1980s, researchers have started to investigate the potential effect of SCS on cerebral blood flow (CBF) regulation and its possible application in certain pathological settings dealing with vascular pattern dysfunction, such…
Complex reconstructive surgery following removal of extra-intracranial meningiomas, including the use of autologous fibrin glue and a pedicled muscle…
2014
Abstract Background Skull reconstructive surgery is critical to prevent cerebrospinal fluid (CSF) fistulas and infections, and to ensure good aesthetic results in meningiomas surgery. Methods A 65-year-old woman was surgically treated for a bilateral parasagittal meningioma with complete superior sagittal sinus (SSS) involvement, and an intra-extracranial extension, determining a significant cranial defect at the vertex. A Simpson I resection was achieved. Postoperatively a considerable and not conservatively repairable CSF leak was detected. Surgical revision of the wound with repair of the fistula and complex reconstructive operation was performed including a combination of techniques and…
Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported ca…
2015
Purpose: Transoral odontoidectomy followed by occipito-cervical fixation is a widely used approach to relieve ventral compressions at the craniovertebral junction (CVJ). Despite the large amount of literature on this approach and its complications, no previous reports of odontoid process and clival regeneration following transoral odontoidectomy are present in the English literature. Methods: We report the case of odontoid process and clival regeneration following transoral odontoidectomy. Results: A 7-year-old boy presented with symptoms of brainstem and upper cervical spinal cord compression due to a complex malformation at the CVJ including a basilar invagination with Chiari malformation…
Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center…
2022
Spine is a frequent site of bone metastases, with a 8.5 months median survival time after diagnosis. In most cases treatment is only palliative. Several advanced techniques can ensure a better Quality of Life (QoL) and increase life expectancy. Radiofrequency ablation (RFA) uses alternating current to produce local heating and necrosis of the spinal lesion, preserving the healthy bone. RFA is supported by vertebral reinforcement through kyphoplasty and vertebroplasty in order to stabilize the fracture with polymethylmethacrylate (PMMA) injection, restoring vertebral body height and reducing the weakness of healthy bone. The aim of this study is to demonstrate the efficacy and advantages of …
Focus on functional delayed central sleep apnea following cervical laminectomy. An example of respiratory dysfunction in restorative neurosurgical pr…
2017
In sleep-related breathing disorders, sleep apnea is a clinical symptom that can be categorized as obstructive sleep apnea (OSA) or mixed apnea by analysis using poly-somnography. The occurrence of delayed central sleep apnea (CSA) is an extremely rare complication of cervical laminectomy for spondylotic myelopathy. So far only three studies concerning such an event have been reported in the literature. Naim-ur-Rahman, in 1994, reported a case of postoperative CSA following C3-C6 laminectomy, and Visocchi and colleagues, in 2014, in two studies, stressed the lack of association with any other neurological sign of spinal cord damage. No definitive mechanism has been recognized so far for del…
Recovery from chronic diseases of consciousness: State of the art in neuromodulation for persistent vegetative state and minimally conscious state
2017
Chronic diseases of consciousness (CDC) can still be considered a challenging frontier for modern medicine, probably because of their not completely understood physiopathological mechanisms. Following encouraging evidence on cerebral hemodynamics, some authors have hypothesized a role for neuromodulation in the treatment of CDC patients. In the past 40 years, spinal cord stimulation (SCS) and deep brain stimulation (DBS) have been used experimentally for the treatment of patients in a severe altered state of consciousness, with some interesting but not conclusive results. The present review summarizes the data currently available in the literature on this particular and debated topic. On th…
Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25 Adult Patients Treated with Cerebellar Tonsil Shrinkage
2019
Background: The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year experience, describing our technique and critically evaluating the clinical results. Methods: Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39.2 years) underwent posterior fossa decompression for Chiari malformation type I. Their clinical complaints included headache, nuchalgia, upper limb weakness or numbness, instability, dizziness and diplopia. Syringomyelia was present in 12 patients (48%). Suboccipital craniectomy was completed in all cases with C1 laminectomy …
Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma
2015
Background To demonstrate that the diagnosis of an intracranial subdural hematoma should be considered for patients presenting with acute or delayed symptoms of intracranial pathology following resection of a spinal tumor. Case description We present a case of a 57-year-old woman found to have a chronic subdural hematoma 1 month following resection of a thoracic extramedullary ependymoma. Evacuation of the hematoma through a burr hole relieved the presenting symptoms and signs. Resolution of the hematoma was confirmed with a computed tomography (CT) scan. Conclusion Headache and other symptoms not referable to spinal pathology should be regarded as a warning sign of an intracranial subdural…
Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature
2015
Patient: Male, 30 Final Diagnosis: Acute epidural hematoma Symptoms: — Medication: — Clinical Procedure: Observation Specialty: Neurosurgery Objective: Unusual clinical course Background: Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1% of all patients with head injuries and fewer than 10% of those who are comatose), they should always be considered in evaluation of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited unde…