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Background: The COVID-19 pandemic and its impact on hospitals' activity and organization has imposed a vast change in standard neurosurgical oncology practice to accommodate for shifting resources. Aims: This investigation aims to analyse the nationwide capability in reorganizing the surgical neuro-oncological activity during the COVID-19 pandemic to evaluate whether COVID-19-pandemic influenced the surgical management in these patients. Method: A web-based dataset model organized by the Italian Neurosurgical Society (SINCh) was sent to all the Italian neurosurgical departments in May 2021, requesting to report the types and numbers of surgical procedures performed in the pre-pandemic period (from March 9th 2019 to March 9th 2020) compared to the pandemic period (from March 10th 2020 to March 10th 2021). Results: This multicentre investigation included the surgical activity of 35 Italian Neurosurgical Departments in a pre-pandemic year versus a pandemic year. During the COVID period, 699 fewer neuro-oncological patients were operated on than in the pre-COVID period. We noted a slight increase in urgency and a more severe decrease in elective and benign pathology. None of these differences was statistically significant. Surgically treated patients who tested positive for SARS-CoV-2 were 36, of which 11 died. Death was found to be COVID-related only in 2 cases. Conclusion: The reorganization of the Italian Neurosurgical Departments was able to guarantee a redistribution of the CNS tumors during the inter-pandemic periods, demonstrating that patients even in the pandemic era could be treated without compromising the efficacy and safety of the surgical procedure.

Eagle Syndrome (ES) is an often misdiagnosed syndrome due to its wide spectrum of signs and symptoms. Recent works have pointed out the relation between ES and some types of craniofacial pain often misdiagnosed with migraine or temporomandibular disorders. Moreover, the presence of Vascular ES as a cause of Carotid Artery Dissection in same cases of stroke as well as cause of intracranial venous hypertension resulting in migraine and other pains has been recently discussed. A multidisciplinary approach is mandatory to allow clinicians to better understand the pathophysiology and clinical main patterns of ES. The aim of the work is to perform a comprehensive review all the clinical patterns and available diagnostic tools to guide clinicians through lights and shadows of such an underestimated syndrome. Finally, a novel flow-chart for comprehensive diagnosis of ES is proposed, including “dynamic” imaging investigating the relationship between stiloyd processes and the neurovascular structures of the neck during head movements.

Background: Stereotactic irradiation is proposed for treatment of pituitary adenomas (PAs) in patients with tumor progression/recurrence after surgery and in cases not eligible for other therapies. In the literature several papers have been published on the role of the Gamma-Knife stereotactic irradiation for management of PAs, but data on the role of stereotactic Cyberknife (CK) are still limited. We describe a single-center experience using CK stereotactic radiosurgery (CK-SRS) and hypofractionated radiotherapy (CK-SRT) for PAs treatment, analyzing its efficacy/safety in the light of current literature. Methods: We retrospectively collected clinical data from PAs patients treated using CK system at the University Hospital of Messina, Italy, between 2008 and 2018. The efficacy was evaluated by analyzing the tumor growth/biochemical disease control rates, and the safety by evaluating post-treatment pituitary and/or visual deficits. Results: Twenty-four PAs patients were included in the study. The mean follow-up was 42.21 ± 32.67 months. The overall tumor growth control rate was 91.6%, but it was higher using the single-session scheme (100%) than using hypofractionated sessions (80%). The biochemical disease control rate was 60%, but increased to 80% in GH-secreting PAs. Post-treatment hypopituitarism occurred in 41.66% of cases, being 35.71% using a hypofractionated scheme, and 50% using a single-session treatment. No cases of post-treatment visual deterioration were observed. Overall and progression-free survival were respectively 84.6% and 83.6% at three years. Conclusions: Cyberknife irradiation is an effective and safe option for PAs treatment, being associated to an excellent tumor growth/biochemical control of the disease, and to a low rate of post-treatment complications. The efficacy seems to be higher when using a single-session scheme even if this could be associated to a higher incidence of post-treatment hypopituitarism. Keywords: Cyberknife, Pituitary adenomas, Radiosurgery

Background: Standard open techniques for pedicle screws placement require extensive tissue dissection for optimal screw trajectory. Furthermore, they have been associated with extensive blood loss, long hospital stays and, consequently, significant costs. Objective: To describe a percutaneous pedicle screw fixation performed with a novel navigated “one-step” system, underlining the safety and effectiveness of such technique. Methods: During a 43-month period, 43 patients with 230 pedicle screws were evaluated. Percutaneous pedicle screw fixation was performed in the lumbosacral region in 5 patients (12%), lumbar region in 13 (30%), thoraco-lumbar region in 21 (49%) and thoracic region in 4 (9%). We have compared the accuracy rates of screw placement achieved with percutaneous pedicle screw fixation using fluoroscopy, and neuronavigated percutaneous pedicle screw fixation using an innovative “one-step” technique. Results: Statistical differences in screws placement accuracy between the group A and B were evaluated by Fisher exact test. The accuracy rate of pedicle screws placement in group with the intraoperative navigation system was higher than that of the group with fluoroscopy (P = 0.04). There was no hardware failure except 3 screws of Group A (1.3%) that pulled out few weeks after surgery, There were a total of 6 SAR (2.61%) and only 1 of them belonged to group B, without the need of revision surgery (0.61% out of the total neuronavigated stabilizations), while the other 5 represent 7.35% of the total screws placed with fluoroscopy. In our patient series the risk of mispositioning has been reduced by 14.95% with the use of the neuronavigation system, considering as malposition the set of IMP and SAR. Conclusions: Percutaneous pedicle screw fixation with neuronavigated “one-step” technique represents a safe and effective tool in minimally invasive spine surgery that deserves a further investigation and widespread diffusion.