Utilizzo di un nuovo sistema di coagulazione bipolare nella chirurgia dei meningiomi. Nota tecnica

TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY ITALIAN (AND WORLD-FIRST) EXPERIENCE AT 1,5 TESLA (first 3 cases treated)

PURPOSE: We present our preliminary results achieved with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. Moreover, to our knowledge, this is the world-first tcMRgFUS system ever installed on a 1.5T MRI unit. TcMRgFUS is a promising new technology for the non-invasive treatment of neurologic disorders such as Essential Tremor (ET), tremor dominant idiopathic Parkinson's Disease (PD) and Neuropathic Pain (NP). This is a new method for focal targeting and lesioning of specific regions in the brain through intact skull by using high intensity focused ultrasound beam to achieve thermal ablation and …

A rare case of a giant cervical osteochondroma

Background: Osteochondroma or osteocartolaginous exostosis is the most common benign tumor of bone. They account for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumors. Usually these tumors are found in the appendicular skeleton, especially in the metadiaphyseal region of long bones. Spinal osteochondromas, however, are uncommon especially at cervical level. Clinical presentation: We report the case of a 16 year old boy presenting a hard, gradually progressing, large swelling mass, over the posterior part of the neck causing pain. Radiological images revealed a giant solitary osteochondroma arising from C3 to C6 laminae. The patient underwent complete surgical exc…

Aneurysms of Vertebro-basilar Junction: a single center experience and meta-analysis of endovascular treatments

Vascular lesions of the vertebrobasilar junction (VBJ) are a challenging task in neurosurgical practice, and their gold-standard therapy is still under debate. The authors describe the operative strategies currently in use for the management of those complex vascular lesions and discuss their rationale throughout a literature metaanalysis and a single center blinded retrospective study. The single center study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated with endosaccular coils embolization; whereas a strategy including flow-d…

Customized approach for otogenic brain abscess: the neurosurgical prospective.

A new concept to treat lumbar spine stenosis in a mini invasive way

Advanced Hemostatics in the Management of Cerebral Dural Sinus Lacerations

The authors reported their experience with 57 consecutive patients who were treated with this hemostatic technique to control bleeding from iatrogenic tears of the superior sagittal sinus or transverse/ sigmoid sinuses whenever standard maneuvers (eg, compression, oxidized cellulose, gelatin sponge) failed or were considered too time-consuming, inadequate, or risky.

Is there still a role for lesioning in functional neurosurgery: the Italian experience of delivering focused ultrasound high energy through a 1,5 tesla MR apparatus.

Basilar Invagination, Bone Regrowth, Chiari malformation, Clivus, Odontoid Process, Transoral Odontoidectomy

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…

Neuronavigated-biopsy in the diagniosis of demyelinating pseudotumoral brain lesions. Case report.

Introduction: Pseudotumoral-demyelinating lesions are typically characterized by severe difficulties in differential diagnosis from gliomas, metastatic tumors and abscesses. Marburg’s disease (MD) is an extremely rare and aggressive form of Mutiple Sclerosis (MS) with acute onset, rapid neurological deterioration, and poor prognosis. MRI images often show pseudotumoral lesions characterized by mild and focal or, sometimes, ring enhancement. Perhaps, radiological aspect can vary, making necessary hystopathological confirmation. Objectives: There is increasing interest in the role of surgical biopsy for a correct and early diagnosis of pseudotumoral demyelinating lesions. We report an histopa…

Effetto neuroprotettivo dell'asialo-eritropoietina: evidenze sperimentali e future applicazioni cliniche.

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida RM: esperienza preliminare a 1,5T

Da qualche anno la chirurgia mediante ultrasuoni focalizzati ad alta intensità guidati da Risonanza Magnetica (Magnetic Resonance guided Focused Ultrasound Surgery, MRgFUS) si sta diffondendo anche in Italia per la palliazione del dolore da metastasi ossee, per il trattamento di tumori ossei primitivi (benigni e non), dei fibromi e dell’adenomiosi uterina; sono già stati inoltre pubblicati i risultati preliminari del trattamento di alcuni tumori epatici, pancreatici, prostatici e della mammella mediante MRgFUS. Questa innovativa tecnica prevede l’utilizzo di un’apparecchiatura di Risonanza Magnetica per il monitoraggio della procedura e sfrutta le caratteristiche fisico- meccaniche degli …

The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective

Spine represents the most common site for metastatic disease involvement. Due to the close relationship between the spinal cord and critical structures, therapeutic management of spinal metastases remains challenging. Spinal localization can lead to neurological sequelae, which can significantly affect the quality of life in patients with a limited life expectancy. The authors conducted a systematic literature review according to PRISMA guidelines in order to determine the impact of the most updated palliative care on spinal metastases. The initial literature search retrieved 2526 articles, manually screened based on detailed exclusion criteria. Finally, 65 studies met the inclusion criteri…

Compressione midollare dorsale in paziente con Sindrome da immunodeficienza accquisita (AIDS)

Studio preliminare di parcellizzazione talamica per l’identificazione del target di trattamento applicato alle talamotomie trans-craniche mediante ultrasuoni focalizzati guidati da Risonanza Magnetica (tcMRgFUS) [Thalamic parcelization for target identification in trans-cranial MR-guided Focused UltraSound (tcMRgFUS) thalamotomies: a preliminary study]

Introduzione La tcMRgFUS consente di effettuare una vera e propria esplorazione neurofunzionale per confermare ed ottimizzare il target lesionale prima di indurre una lesione cerebrale permanete. La scelta del target di trattamento si basa tuttavia su coordinate stereotassiche che non tengono conto delle diversità anatomiche di ciascun individuo. L'ottimizzazione del target di trattamento viene effettuata sulla base del feedback del paziente durante la procedura stessa. Materiali e metodi È’ stato utilizzato uno scanner RM da 1.5T per acquisire sequenze morfologiche 3D e ultrastrutturali (DTI) in pazienti successivamente sottoposti a tcMRgFUS. È stata effettuata una segmentazione delle aree…

Chirurgia trans-cranica mediante ultrasuoni focalizzati ad alta intensità su guida rm: esperienza preliminare a 1,5T (primi 2 casi trattati)

Scopo del Lavoro Presentiamo i risultati preliminari ottenuti con la prima istallazione italiana di un’apparecchiatura per la neurochirurgia funzionale mediante ultrasuoni focalizzati ad alta intensità su guida RM (trans-cranial MRI-guided Focused Ultrasound Surgery, tcMRgFUS); si tratta tra l’altro della prima apparecchiatura tcMRgFUS al mondo mai installata su uno scanner RM da 1,5T. Tale apparecchiatura è attualmente certificata (CE ed FDA) per trattamenti di neurochirurgia funzionale in pazienti con tremore essenziale (Essential Tremor, ET), Parkinson idiopatico (Parkinson Disease, PD) unilaterale prevalentemente tremorigeno e dolore neuropatico (Neuropathic Pain, NP). Materiali e Metod…

Neuroprotection by erythropoetin and darbopoetin-alfa - Following experimental intracerebral hemorrhage

Intramedullary spinal cord tumor presenting as the initial manifestation of metastatic colon cancer: case report and review of the literature

Study design: Case reports and review of the literature. Objective: Intramedullary spinal cord metastases (ISCMs) are rare type of central nervous system (CNS) involvement of systemic malignant tumors. Since the advent of new neuroradiological techniques, their detection have become increasingly diagnosed in recent years and, although somewhat controversial, surgical treatment has been considered a valid option. Setting: Neurosurgical Clinic, Department of Clinic Neuroscience, University of Palermo, Italy. Method: The authors describe the case of a 61-year-old woman who was admitted presenting withprogres sive tetraplegia. Investigations revealed an intramedullary spinal cord lesion at the …

Chronic inflammation causing spinal cord compression in human immunodeficiency virus infection

BACKGROUND: The incidence of central nervous system involvement has increased in the setting of acquired immune deficiency syndrome (AIDS). Although rarely reported, spinal cord compression, in the setting of AIDS, has been associated with primary lymphoma or opportunistic infections. CASE REPORT: The authors describe the case of a young man who was admitted to our institution with rapid and progressive paraplegia. Imaging studies revealed an extramedullary lesion compressing the spinal cord spanning 3 thoracic levels. Surgical treatment was performed, and the compressing process completely excised. Histologic examination of the lesion showed a chronic inflammatory tissue with many necrotic…

Regressione di stato vegetativo dopo derivazione ventricolo-peritoneale e cranioplasstica in paziente con idrocefalo post-traumatico: case report e review della letteratura.

Experimental investigations on a model of cryogenic edema.

The role of mechanisms underlying formation and progression of vasogenic brain edema is investigated. On this purpose, cerebral edema was produced by cortical freezing in two different brain situations in rabbits (with or without replacement of bone flap). BBB (Blood-Brain Barrier) breakdown was evaluated by observation of Evans blue extravation, while a histopathological evaluation was carried out by light and transmission electron microscopy. Water content of brain tissue was determined by the wet/dry weight ratio method. Comparison of extension and intensity of cerebral edema between these two groups of animals shows a statistically significant difference: there was evidence of higher wa…

y

Trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS): preliminary Italian (and world-first) experience at 1,5 Tesla (first 5 patient treated)

Spinal cord compression in HIV infection

Incidenza del vasospasmo e correlazione tra la neuroradiologia per immagini e l’emodinamica cerebrale

Is trans-cranial MR-guided Focused UltraSound a repeatable treatment option? Report of a successfully re-treated patient

Background: In recent years, transcranial Magnetic Resonance-guided Focused UltraSounds (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. This technique has been proven safe and effective in selected patients. Here we present the case of a patient affected by tremor combined with parkinsonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremor after a few months from the first tcMRgFUS treatment. Materials and Methods: A 72-year-old, right-handed man, who came to our observation because of a disabling tremor affecting mainly his upper right limb and refusing any invasive surgical procedure. Hi…

Aneurysm clipping following endovascular coil embolization: A report of two cases

Abstract BACKGROUND: Treatment of intracranial aneurysms by Guglielmi detachable coil (GDC) embolization is a useful therapeutic alternative to surgery. This procedure is attractive as a minimally invasive approach to treat cerebral aneurysms; however, is not devoid of complications or failure and retreatment, with either a surgical or endovascular technique, may often be required. CASE REPORTS: Two cases are presented in which surgery was required after coil embolization. In one case, surgical treatment was performed one month later because of regrowth and subsequent bleeding of the aneurysm. In the second case, surgical treatment was carried out six months later because of recanalization …

Surgery of Parkinson's disease. Experience in Messina

No abstract

Eosinophilic granuloma of the skull vault: A case report

Background: Eosinophilic granuloma is the benign form of Langerhans cell histiocytosis, a rare proliferative disorder. Skull osteolytic lesions are quite frequently encountered. Case report: We report the case of a 16 year old boy who was admitted to our Department with a painful swelling left frontal mass. A diagnosis of eosinophilic granuloma was presumed on the basis of the neuroradiological findings. Surgical removal of the lesion was achieved and the bone defect reconstructed by autologous fibrin glue and a titanium mesh. Histopathology confirmed the diagnosis. Conclusion: Although uncommon, eosinophilic granuloma should be considered in the differential diagnosis in case of an osteoly…

Ruolo del complesso EPO/EPO-R nella oncogenesi cerebrale.

Lesione secondaria intramidollare del tratto cervicale come prima manifestazione di adenocarcinoma del colon: case report e review della letteratura

Emergency Surgery ina a patient with large spontaneous epidurl hematoma determinig exellent neurological recovery: review of the literature

Study Design: Case report Objectives: we report a case of a 75-year-old woman suffering voluminous idiopathic spontaneous spinal epidural hematomas (SSEH) that was rapidly diagnosed and successfully treated Methods: Clinical presentation was characterized by sudden and intense back pain that rapidly evolved into plegia of the right leg and severe paresis of the left leg. Hypoesthesia below T6 and urinary retention were also present. The MRI showed a significant posterior spinal compression from T6 through L3 caused by an epidural hematoma that involved 10 metameric levels, extending for approximately 20 cm, with a maximum thickness of 1.6 cm from T12 to L1. Results: Within 12 hours, emergen…

PECULIARE EVOLUZIONE DELLA SEMEIOTICA NEURORADIOLOGICA DI UN CASO DI MALATTIA DEMIELINIZZANTE CON LESIONI PSEUDOTUMORALI

SCOPO DEL LAVORO Presentiamo un caso di una paziente di 24 anni che giunge alla nostra attenzione per la comparsa di disartria come quadro clinico d’esordio di una forma aggressiva di malattia demielinizzante di cui si valuta l’atipica evoluzione neuroradiologica delle lesioni pseudotumorali che la caratterizzano e le possibili diagnosi differenziali. MATERIALI E METODI La paziente dopo una prima valutazione in PS è stata sottoposta a TC encefalo, ricoverata presso l’U.O. di Neurologia, sottoposta a controlli RM seriati (anche con tecniche avanzate); durante la degenza è stata inoltre effettuata una biopsia stereotassica. RISULTATI La TC ha rilevato almeno tre lesioni ipodense: a sinistra…

Utilizzo di eritropoietina umana ricombinante nell’emorragia subaracnoidea sperimentale

Book review: New trends in cerebral homodynamics and neurosonology

No abstract available

Neuroprotection by erythropoietin and darbopoietin-alfa following experimental intracerebral hemorrhage

Erythropoietin and erythropoietin receptor expression in low and high-grade glioma

Pallidotomy improves quality of life in selected parkinsonian patients: an Italian report.

Pallidotomy has recently been reconfirmed as effective for otherwise intractable symptoms of Parkinson's disease. Nonetheless almost every aspect of its performance requires choices which are not fully established and may vary between centers. These include: 1) patient selection; 2) choice of imaging modality, 3) choice of anatomic landmarks for targeting the lesion, 4) choice of method for physiologic confirmation of location, 5) choice of lesion size and shape. We present two cases of pallidotomy procedures in Parkinsonian patients that in our knowledge are the first reported in Italy. Our experience and a careful review of the literature led to the following choices: 1) selection of Park…

Impianto di dispositivo interspinoso (X Stop) per il trattamento della stenosi del canale lombare; analisi della nostra esperienza.