223 results on '"Alessandro Frati"'
Search Results
2. Editorial: Advances in neuroanatomy
- Author
-
Mauro Palmieri, Alexander I. Evins, Alessandro Pesce, Alessandro Frati, and Antonio Bernardo
- Subjects
anatomy ,skull base ,neurosurgery ,neurology ,neuroimaging studies ,neuromolecular anatomy ,Medicine (General) ,R5-920 - Published
- 2024
- Full Text
- View/download PDF
Catalog
3. Brain metastases: Comparing clinical radiological differences in patients with lung and breast cancers treated with surgery
- Author
-
Daniele Armocida, Giuseppa Zancana, Andrea Bianconi, Fabio Cofano, Alessandro Pesce, Brandon Matteo Ascenzi, Paola Bini, Enrico Marchioni, Diego Garbossa, and Alessandro Frati
- Subjects
Brain metastases ,Lung cancer ,NSCLC ,Breast cancer ,Brain tumor ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Purpose: Brain metastases (BMs) most frequently originate from the primary tumors of the lung and breast. Survival in patients with BM can improve if they are detected early. No studies attempt to consider all potential surgical predictive factors together by including clinical, radiological variables for their recognition. Methods: The study aims to simultaneously analyze all clinical, radiologic, and surgical variables on a cohort of 314 patients with surgically-treated BMs to recognize the main features and differences between the two histotypes. Results: The two groups consisted of 179 BM patients from lung cancer (Group A) and 135 patients from breast cancer (Group B). Analysis showed that BMs from breast carcinoma are more likely to appear in younger patients, tend to occur in the infratentorial site and are frequently found in patients who have other metastases outside of the brain (46 %, p = 0.05), particularly in bones. On the other hand, BMs from lung cancer often occur simultaneously with primitive diagnosis, are more commonly cystic, and have a larger edema volume. However, no differences were found in the extent of resection, postoperative complications or the presence of decreased postoperative performance status. Conclusion: The data presented in this study reveal that while the two most prevalent forms of BM exhibit distinctions with respect to clinical onset, age, tumor location, presence of extra-cranial metastases, and lesion morphology from a strictly surgical standpoint, they are indistinguishable with regard to outcome, demonstrating comparable resection rates and a low risk of complications. more...
- Published
- 2024
- Full Text
- View/download PDF
4. Post-traumatic meningoencephalocele as a complication after head trauma and surgery: literature review focusing on the relevance of patient’s history and radiological follow-up
- Author
-
Alessandro Pesce, Daniele Armocida, Gianpaolo Petrella, Alessandro Frati, and Angelo Pompucci
- Subjects
Meningoencephalocele ,Brain injury ,Head trauma ,Chronic subdural hematoma ,Neurosurgery ,Surgery ,RD1-811 ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Background Meningoencephalocele (ME) is an herniation of brain parenchyma covered by meninges through a bone defect and could be malformative or secondary. Except for rarer cases of spontaneous form, ME is usually due to endonasal or otologic infections and rarely after head trauma. In predisposed patients, even mild head trauma can lead to the formation of a ME. Methods We performed a systematic review of literature with the aims to identify the clinical characteristics of all reported forms of post-traumatic ME and the best diagnostic and treatment strategy. We illustrated a case of a patient treated for a post-traumatic subdural hematoma who developed cerebrospinal fluid leakage 3 months after the trauma. Results The search returned a total of 59 papers for the analysis, including radiological, clinical studies, technical note and the case reported from our experience. The total number of patients collected for this review was 61, with a mean age of 31.1 years. The diagnosis of ME could be heterogeneous in terms of timing and clinical onset after a head injury. Symptoms onset and subsequent radiological diagnosis of ME vary between 24 h to 43 years. The majority of traumas were reported in temporal site (52.45%). There were reported high variability of treatment strategies dependent on the location and extent of the defect: in the majority of cases (58%), duroplasty by the heterologous dural patch was the procedure of choice. There is a relative low rate of complications (6.5%) due to a delayed diagnosis of ME. Conclusions When ME is associated with violation of meninges, the clinical presentation may be that of cerebrospinal fluid otorrhoea or otorhinorrhoea, consequently, delay in diagnosis can lead to neurological complications. The clinical effectiveness of ME treatment depends much more on the correct and timely diagnosis than on the type of procedure selected. more...
- Published
- 2023
- Full Text
- View/download PDF
5. Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties
- Author
-
Pietro Familiari, Pierfrancesco Lapolla, Michela Relucenti, Ezio Battaglione, Loredana Cristiano, Veronica Sorrentino, Sara Aversa, Alessia D’Amico, Pierfabrizio Puntorieri, Lucia Bruzzaniti, Andrea Mingoli, Gioia Brachini, Giuseppe Barbaro, Anthony Kevin Scafa, Giancarlo D’Andrea, Alessandro Frati, Veronica Picotti, Luigi Valentino Berra, Vincenzo Petrozza, Stefania Nottola, Antonio Santoro, and Placido Bruzzaniti more...
- Subjects
Medicine ,Science - Abstract
Abstract Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation. more...
- Published
- 2023
- Full Text
- View/download PDF
6. Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark
- Author
-
Alessandro Pesce, Daniele Armocida, Francesco Fiorentino, Silvia Ciarlo, Biagia La Pira, Maurizio Salvati, Alessandro Frati, Angelo Pompucci, and Mauro Palmieri
- Subjects
calvarial metastasis ,salivary gland tumors ,craniotomy ,dural metastasis ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Calvarial metastases are a relatively rare entity, with an overall incidence of 3–4%. Among these cases, metastases arising from salivary gland cancers are even rarer; in fact, large studies regarding salivary gland tumors showed that brain metastases are observed in 0.8% of the cases. Generally, bone metastases have been described in proximity to primary tumors, while bloodstream-disseminated lesions are often located inside the brain parenchyma. During every surgical step, traction on lower-lying infiltrated tissues must be avoided in order to successfully remove the lesion. This case report presents the first ever case of a 67-year-old woman affected by submandibular gland undifferentiated adenocarcinoma metastasis with a full-thickness involvement of the calvarium, pachy- and leptomeninges. more...
- Published
- 2022
- Full Text
- View/download PDF
7. Peritumoral Brain Edema in Relation to Tumor Size Is a Variable That Influences the Risk of Recurrence in Intracranial Meningiomas
- Author
-
Alessandro Frati, Daniele Armocida, Umberto Aldo Arcidiacono, Alessandro Pesce, Giancarlo D’Andrea, Fabio Cofano, Diego Garbossa, and Antonio Santoro
- Subjects
meningioma ,neurosurgery ,peritumoral brain edema ,tumor recurrence ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and can increase their morbidity. It is not uncommon for a neurosurgeon to confront meningiomas with a large proportion of PBE independently from the site and size of the contrast-enhancing lesion with increased surgical risks. We performed a retrospective review of 216 surgically-treated patients suffering from IM. We recorded clinical, biological, and radiological data based on the rate of tumor and edema volume and divided the patients into a group with high Edema/Tumor ratio and a group with a low ratio. We investigated how the ratio of edema/lesion may affect the outcome. Multivariate analysis was performed for the two groups. Smokers were found to be more likely to belong to the high-rate group. The edema/tumor ratio did not affect the surgical radicality; however, independently of the biological sub-type, WHO grading, and EOR, a higher frequency of recurrence is shown in patients with a high edema/tumor ratio (70.5% vs. 8.4%. p < 0.01). There is evidence to suggest that the blood-brain barrier (BBB) damage from smoke could play a role in an increased volume of PBE. The present study demonstrates that IMs showing a high PBE ratio to tumor volume at diagnosis are associated with a smoking habit and a higher incidence of recurrence independently of their biological type and grading. more...
- Published
- 2022
- Full Text
- View/download PDF
8. Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience
- Author
-
Salvatore Petrone, Marco Ajello, Nicola Marengo, Marco Bozzaro, Alessandro Pesaresi, Mario Allevi, Alessandro Fiumefreddo, Federica Denegri, Maurizio Cogoni, Andrea Garnero, Fulvio Tartara, Giuseppe Di Perna, Daniele Armocida, Alessandro Pesce, Alessandro Frati, Francesco Zenga, Diego Garbossa, and Fabio Cofano more...
- Subjects
indirect decompression ,LLIF ,XLIF ,spondylolisthesis ,predictive factors ,Surgery ,RD1-811 - Abstract
IntroductionEvaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome.Materials and methodsFrom 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire).Results72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p more...
- Published
- 2023
- Full Text
- View/download PDF
9. Relationship between lumbar lordosis, pelvic parameters, PI-LL mismatch and outcome after short fusion surgery for lumbar degenerative disease. Literature review, rational and presentation of public study protocol: RELApSE study (registry for evaluation of lumbar arthrodesis sagittal alignEment)
- Author
-
Fulvio Tartara, Diego Garbossa, Daniele Armocida, Giuseppe Di Perna, Marco Ajello, Nicola Marengo, Marco Bozzaro, Salvatore Petrone, Pietro Domenico Giorgi, Giuseppe Rosario Schirò, Simona Legrenzi, Davide Boeris, Andrea Piazzolla, Anna Claudia Passarelli, Alessandro Longo, Alessandro Ducati, Federica Penner, Flavio Tancioni, Alberto Bona, Giovanni Paternò, Cristina Tassorelli, Roberto De Icco, Giovanni Andrea Lamaida, Enrico Gallazzi, Giulia Pilloni, Elena Virginia Colombo, Paolo Gaetani, Enrico Aimar, Cesare Zoia, Roberto Stefini, Angelo Rusconi, Amos M. Querenghi, Carlo Brembilla, Claudio Bernucci, Andrea Fanti, Alessandro Frati, Antonio Manelli, Vitaliano Muzii, Mattia Sedia, Alberto Romano, Ali Baram, Silvia Figini, Elena Ballante, Giuseppe Gioia, Marco Locatelli, Mauro Pluderi, Carlotta Morselli, Roberto Bassani, Francesco Costa, and Fabio Cofano more...
- Subjects
Spine ,Neurosurgery ,Fusion surgery ,Lumbar degenerative disease ,Lumbar lordosis ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Vertebral arthrodesis for degenerative pathology of the lumbar spine still remains burdened by clinical problems with significant negative results. The introduction of the sagittal balance assessment with the evaluation of the meaning of pelvic parameters and spinopelvic (PI-LL) mismatch offered new evaluation criteria for this widespread pathology, but there is a lack of consistent evidence on long-term outcome. Methods: The authors performed an extensive systematic review of literature, with the aim to identify all potentially relevant studies about the role and usefulness of the restoration or the assessment of Sagittal balance in lumbar degenerative disease. They present the study protocol RELApSE (NCT05448092 ID) and discuss the rationale through a comprehensive literature review. Results: From the 237 papers on this topic, a total of 176 articles were selected in this review. The analysis of these literature data shows sparse and variable evidence. There are no observations or guidelines about the value of lordosis restoration or PI-LL mismatch. Most of the works in the literature are retrospective, monocentric, based on small populations, and often address the topic evaluation partially. Conclusions: The RELApSE study is based on the possibility of comparing a heterogeneous population by pathology and different surgical technical options on some homogeneous clinical and anatomic-radiological measures aiming to understanding the value that global lumbar and segmental lordosis, distribution of lordosis, pelvic tilt, and PI-LL mismatch may have on clinical outcome in lumbar degenerative pathology and on the occurrence of adjacent segment disease. more...
- Published
- 2023
- Full Text
- View/download PDF
10. Editorial: Novel techniques and technologies in spine surgery: New approaches for the traumatic, oncologic, and aging spine
- Author
-
Mauro Palmieri, Alessandro Frati, Giancarlo D’Andrea, Antonio Santoro, Maurizio Salvati, and Alessandro Pesce
- Subjects
spine ,spine surgery ,spinal instrumentation ,trauma ,degenerative disease ,Surgery ,RD1-811 - Published
- 2023
- Full Text
- View/download PDF
11. Augmentative Craniotomy: A New Technique for the Treatment of Intracranial Hypertension
- Author
-
Pietro Familiari, Luigi Valentino Berra, Mauro Palmieri, Placido Bruzzaniti, Luca D'Angelo, Daniele Armocida, Alessandro Frati, and Antonio Santoro
- Subjects
Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2023
- Full Text
- View/download PDF
12. Brain Atrophy as 'Primum Movens' in the etiopathogenesis of Chronic Subdural Hematoma: Evidence for Neuroimaging, Immunohistochemical and Ultrastructural Analysis
- Author
-
Pietro Familiari, Placido Bruzzaniti, Pierfrancesco Lapolla, Mauro Palmieri, Luigi Valentino Berra, Valerio Di Norcia, Michela Relucenti, Alessandro Frati, and Antonio Santoro
- Subjects
Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2023
- Full Text
- View/download PDF
13. Adult IDH Wild-Type Glioblastoma Ultrastructural Investigation Suggests a Possible Correlation between Morphological Biomarkers and Ki-67 Index
- Author
-
Pietro Familiari, Michela Relucenti, Pierfrancesco Lapolla, Mauro Palmieri, Manila Antonelli, Loredana Cristiano, Claudio Barbaranelli, Myriam Catalano, Luca D’Angelo, Giuseppe Familiari, Antonio Santoro, Alessandro Frati, and Placido Bruzzaniti more...
- Subjects
microglia ,glioblastoma ,EVs ,biomarker ,Ki67 ,lipid vesicles ,Biology (General) ,QH301-705.5 - Abstract
Glioblastoma is an aggressive brain tumor with an average life expectancy between 14 and 16 months after diagnosis. The Ki-67 labeling index (LI), a measure of cellular proliferation, is emerging as a prognostic marker in GBM. In this study, we investigated the ultrastructure of glioblastoma tissue from 9 patients with the same molecular profile (adult IDH wild-type glioblastoma, wild-type ATRX, and positive for TP53 expression, GFAP expression, and EGFR overexpression) to find possible ultrastructural features to be used as biomarkers and correlated with the only parameter that differs among our samples, the Ki-67 LI. Our main results were the visualization of the anatomical basis of astrocyte-endothelial cells crosstalk; the ultrastructural in situ imaging of clusters of hyperactivated microglia cells (MsEVs); the ultrastructural in situ imaging of microglia cells storing lipid vesicles (MsLVs); the ultrastructural in situ imaging of neoplastic cells mitophagy (NCsM). The statistical analysis of our data indicated that MsEVs and MsLVs correlate with the Ki-67 LI value. We can thus assume they are good candidates to be considered morphological biomarkers correlating to Ki-67 LI. The role of NCsM instead must be further evaluated. Our study findings demonstrate that by combining ultrastructural characteristics with molecular information, we can discover biomarkers that have the potential to enhance diagnostic precision, aid in treatment decision-making, identify targets for therapy, and enable personalized treatment plans tailored to each patient. However, further research with larger sample sizes is needed to validate these findings and fully utilize the potential of ultrastructural analysis in managing glioblastoma. more...
- Published
- 2023
- Full Text
- View/download PDF
14. Autophagy Activation Promoted by Pulses of Light and Phytochemicals Counteracting Oxidative Stress during Age-Related Macular Degeneration
- Author
-
Roberto Pinelli, Michela Ferrucci, Francesca Biagioni, Caterina Berti, Violet Vakunseth Bumah, Carla Letizia Busceti, Stefano Puglisi-Allegra, Gloria Lazzeri, Alessandro Frati, and Francesco Fornai
- Subjects
autophagolysosomes ,drusen ,visual acuity ,curcumin ,lutein ,resveratrol ,Therapeutics. Pharmacology ,RM1-950 - Abstract
The seminal role of autophagy during age-related macular degeneration (AMD) lies in the clearance of a number of reactive oxidative species that generate dysfunctional mitochondria. In fact, reactive oxygen species (ROS) in the retina generate misfolded proteins, alter lipids and sugars composition, disrupt DNA integrity, damage cell organelles and produce retinal inclusions while causing AMD. This explains why autophagy in the retinal pigment epithelium (RPE), mostly at the macular level, is essential in AMD and even in baseline conditions to provide a powerful and fast replacement of oxidized molecules and ROS-damaged mitochondria. When autophagy is impaired within RPE, the deleterious effects of ROS, which are produced in excess also during baseline conditions, are no longer counteracted, and retinal degeneration may occur. Within RPE, autophagy can be induced by various stimuli, such as light and naturally occurring phytochemicals. Light and phytochemicals, in turn, may synergize to enhance autophagy. This may explain the beneficial effects of light pulses combined with phytochemicals both in improving retinal structure and visual acuity. The ability of light to activate some phytochemicals may further extend such a synergism during retinal degeneration. In this way, photosensitive natural compounds may produce light-dependent beneficial antioxidant effects in AMD. more...
- Published
- 2023
- Full Text
- View/download PDF
15. Can Post-Operative Posterior Reversible Encephalopathy Syndrome (PRES) Be Considered an Insidious Rare Surgical Complication?
- Author
-
Alessandro Frati, Daniele Armocida, Fulvio Tartara, Fabio Cofano, Sergio Corvino, Sergio Paolini, Antonio Santoro, and Diego Garbossa
- Subjects
posterior reversible encephalopathy syndrome ,hydrocephalus ,surgical complication ,surgery ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms’ onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4–82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases. more...
- Published
- 2023
- Full Text
- View/download PDF
16. Autophagy Activation Associates with Suppression of Prion Protein and Improved Mitochondrial Status in Glioblastoma Cells
- Author
-
Paola Lenzi, Carla L. Busceti, Gloria Lazzeri, Rosangela Ferese, Francesca Biagioni, Alessandra Salvetti, Elena Pompili, Valerio De Franchis, Stefano Puglisi-Allegra, Alessandro Frati, Michela Ferrucci, and Francesco Fornai more...
- Subjects
mTOR ,cytofluorimetry ,mitochondrial fission ,Pink1 ,Parkin ,Fis1 ,Cytology ,QH573-671 - Abstract
Cells from glioblastoma multiforme (GBM) feature up-regulation of the mechanistic Target of Rapamycin (mTOR), which brings deleterious effects on malignancy and disease course. At the cellular level, up-regulation of mTOR affects a number of downstream pathways and suppresses autophagy, which is relevant for the neurobiology of GBM. In fact, autophagy acts on several targets, such as protein clearance and mitochondrial status, which are key in promoting the malignancy GBM. A defective protein clearance extends to cellular prion protein (PrPc). Recent evidence indicates that PrPc promotes stemness and alters mitochondrial turnover. Therefore, the present study measures whether in GBM cells abnormal amount of PrPc and mitochondrial alterations are concomitant in baseline conditions and whether they are reverted by mTOR inhibition. Proteins related to mitochondrial turnover were concomitantly assessed. High amounts of PrPc and altered mitochondria were both mitigated dose-dependently by the mTOR inhibitor rapamycin, which produced a persistent activation of the autophagy flux and shifted proliferating cells from S to G1 cell cycle phase. Similarly, mTOR suppression produces a long-lasting increase of proteins promoting mitochondrial turnover, including Pink1/Parkin. These findings provide novel evidence about the role of autophagy in the neurobiology of GBM. more...
- Published
- 2023
- Full Text
- View/download PDF
17. Management of frontal sinus fractures: A comprehensive review and treatment algorithm from Sapienza university of Rome
- Author
-
Roberto Becelli, Mauro Palmieri, Valerio Facchini, Daniele Armocida, Alessandro Pesce, Aleksandr Kapitonov, Marta Zappalà, Walter Colangeli, Fabrizio Bozza, Maurizio Salvati, Antonio Santoro, and Alessandro Frati more...
- Subjects
Head trauma ,Facial fractures ,Frontal sinus fractures ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Frontal sinus (FS) fractures are uncommon and depending on the impact’s force the fracture may involve the anterior table, the adjacent skull, the posterior table and the frontal sinus outflow tract (FSOT). The treatment is based on correcting anti-aesthetic alteration, avoiding the complications, protecting intracranial structures and treating cerebrospinal fluid (CSF) leak. However, the indication and type of treatment of FS fractures is still controversial.The purpose of this study is to evaluate and to propose a surgical algorithm for FS fractures treatment based on relevant data found in current literature.A comprehensive Literature review on FS fractures management was performed to define the most used treatment approaches. In this review, we sought in the Medical Literature for patterns that describe injuries of the FS and evaluated the quality of the classification schemes in terms of validity and reliability, severity assessment, treatment guidance and prognosis estimation. We identified 705 articles on the topic and after the screening process, we included 4 documents. In this 4 papers, the four most used classifications in the modern Literature were proposed. Therefore, we analyzed and discussed these main four classifications and, consequentially, we developed an algorithm that represents an attempt to provide a general guideline for the management of FS injuries.Here an intuitive multidisciplinary algorithm based on both radiological and clinical presentation of the fracture is proposed, trying to guide the surgeon in the correct treatment choice. We believe that a complete classification system must take into account not only the different involvement between anterior and posterior table fractures, but also the involvement of the FSOT and define for each type a therapeutic combined approach between neurosurgeons and maxillofacial surgeons. more...
- Published
- 2021
- Full Text
- View/download PDF
18. Periventricular zone involvement as a predictor of survival in glioblastoma patients: A single centre cohort-comparison investigation concerning a distinct clinical entity
- Author
-
Daniele Armocida, Alessandro Pesce, Mauro Palmieri, Giancarlo D'Andrea, Maurizio Salvati, Antonio Santoro, and Alessandro Frati
- Subjects
Ventricular-subventricular zone ,MRI ,Subventricular zone ,SVZ ,Glioblastoma ,Lateral ventricle ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Glioblastoma (GBM) contacting the Subventricular Zone (SVZ) may display a more aggressive pattern of invasiveness with higher potential to recruit migratory progenitor cells. We aims to determine the relationships between the location of the lesion and the clinical, molecular characteristics and outcome in patients affected by GBM. Methods: The surgical, radiological and clinical outcomes of patients have been retrospectively reviewed for the present study. All patients have been classified according their anatomical relationship with SVZ in SVZ + and SVZ-. A review of our surgical series was conducted to compare the results of SVZ tumors in regards to clinical and molecular characteristics, localization, and Extent of Resection (EOR). Uni- and Multivariate ANOVA and survival analyses were performed to investigate the cohort. Results: A total of 177 patients were included in the final cohort. A statistical analysis by means of multivariate analyses to demonstrate that SVZ + tumors were significantly associated to a greater volume at presentation, a lesser EOR, lesser functional postoperative outcome and a short overall survival. Conclusions: There are specific characteristics to consider the SVZ + GBMs a specific clinical entity how greater tumors at presentation, clinical associated with Headache and Sensory Disturbances, which are associated to a higher risk of partial resection and with a less satisfactory functional outcome in the early postoperative period. Our multivariate analysis demonstrated a clear and statistically significant survival advantage of cortical GBM over V-SVZ GBM. more...
- Published
- 2021
- Full Text
- View/download PDF
19. Bacopa Protects against Neurotoxicity Induced by MPP+ and Methamphetamine
- Author
-
Michela Ferrucci, Carla Letizia Busceti, Gloria Lazzeri, Francesca Biagioni, Stefano Puglisi-Allegra, Alessandro Frati, Paola Lenzi, and Francesco Fornai
- Subjects
oxidative stress ,ultrastructural morphometry ,mitochondrial alterations ,cell death ,cell degeneration ,Organic chemistry ,QD241-441 - Abstract
The neurotoxins methamphetamine (METH) and 1-methyl-4-phenylpyridinium (MPP+) damage catecholamine neurons. Although sharing the same mechanism to enter within these neurons, METH neurotoxicity mostly depends on oxidative species, while MPP+ toxicity depends on the inhibition of mitochondrial activity. This explains why only a few compounds protect against both neurotoxins. Identifying a final common pathway that is shared by these neurotoxins is key to prompting novel remedies for spontaneous neurodegeneration. In the present study we assessed whether natural extracts from Bacopa monnieri (BM) may provide a dual protection against METH- and MPP+-induced cell damage as measured by light and electron microscopy. The protection induced by BM against catecholamine cell death and degeneration was dose-dependently related to the suppression of reactive oxygen species (ROS) formation and mitochondrial alterations. These were measured by light and electron microscopy with MitoTracker Red and Green as well as by the ultrastructural morphometry of specific mitochondrial structures. In fact, BM suppresses the damage of mitochondrial crests and matrix dilution and increases the amount of healthy and total mitochondria. The present data provide evidence for a natural compound, which protects catecholamine cells independently by the type of experimental toxicity. This may be useful to counteract spontaneous degenerations of catecholamine cells. more...
- Published
- 2022
- Full Text
- View/download PDF
20. RET/PTC3 translocation in a rare hemorrhagic brain metastasis of papillary thyroid cancer post Chernobyl radiation affects vessels ultrastructure
- Author
-
Michela Relucenti, Pietro Familiari, Giorgia Iacopino, Placido Bruzzaniti, Selenia Miglietta, Maurizio Salvati, Xiaobo Li, Rui Chen, Giancarlo D'Andrea, Alessandro Frati, Cira Di Gioia, Angelina Pernazza, Carlo Della Rocca, Giuseppe Familiari, and Antonio Santoro more...
- Subjects
Blood vessel ,Metastasis ,Papillary thyroid carcinoma ,RET/PTC3 translocation ,Transmission electron microscopy ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Slow progression and good prognosis are the usual characteristics of papillary thyroid carcinoma (PTC). The presence of brain metastases (0.4–1.2%) is suggestive of a worse prognosis. RET/PTC rearrangements were particularly prevalent in PTCs developed after Chernobyl nuclear accident. Case description: A 50-year-old woman born in Slovakia, exposed to radiation resulting from the accident at the Chernobyl nuclear power plant, affected since 2017 by papillary thyroid cancer and in therapy at our hospital, experimented cerebral hemorrhagic metastasis. Biopsy analyses revealed a RET/PTC3 rearrangement, so our aim was to find possible morphological relation between hemorrhagic metastasis and RET/PTC3 translocation. Results: Immunohistochemical analysis showed diffuse and intense positivity for VEGF in endothelial cells of the neoplasm’ vascular network. Transmission electron microscopy images showed vessels with unorganized pattern and uneven diameters. In particular, metastasis endothelial cells (MECs) showed irregular shape and size, thickened cytoplasm and swelling of endoplasmic reticulum. MECs organized in irregular monolayers or multiple layers, surrounded by a thickened but unstructured extracellular matrix. Absence of strong junctional complexes among MECs resulted in a further weakened vessels wall. Conclusion: RET/PTC3 translocation causes VEGF overexpression via STAT3 signaling cascade and the increased amount of VEGF adds to the greater amount of VEGFRs expressed by MECs. Our ultrastructural investigation show that this condition creates a massive growth of altered vessels prone to bleeding. The clinical significance of our study consists in alert oncologist and surgeons on possible arising of hemorrhagic brain metastases in patients with PTC and RET/PTC3 translocation exposed to ionizing radiation as people living in areas caught up in Chernobyl or Fukushima disasters. more...
- Published
- 2021
- Full Text
- View/download PDF
21. The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie
- Author
-
Daniele Armocida, Antonia Catapano, Mauro Palmieri, Umberto Aldo Arcidiacono, Alessandro Pesce, Fabio Cofano, Veronica Picotti, Maurizio Salvati, Diego Garbossa, Giancarlo D’Andrea, Antonio Santoro, and Alessandro Frati more...
- Subjects
meningioma ,brain tumor ,peritumoral brain edema ,giant meningiomas ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence. more...
- Published
- 2022
- Full Text
- View/download PDF
22. Within the Ischemic Penumbra, Sub-Cellular Compartmentalization of Heat Shock Protein 70 Overlaps with Autophagy Proteins and Fails to Merge with Lysosomes
- Author
-
Federica Mastroiacovo, Francesca Biagioni, Paola Lenzi, Gloria Lazzeri, Michela Ferrucci, Stefano Puglisi-Allegra, Alessandro Frati, Ferdinando Nicoletti, and Francesco Fornai
- Subjects
autophagy vacuoles ,lysosomes ,cell clearing systems ,ultrastructural stoichiometry ,Organic chemistry ,QD241-441 - Abstract
The brain area which surrounds the frankly ischemic region is named the area penumbra. In this area, most cells are spared although their oxidative metabolism is impaired. area penumbra is routinely detected by immunostaining of a molecule named Heat Shock Protein 70 (HSP70). Within the area penumbra, autophagy-related proteins also increase. Therefore, in the present study, the autophagy-related microtubule-associated protein I/II-Light Chain 3 (LC3) was investigated within the area penumbra along with HSP70. In C57 black mice, ischemia was induced by permanent occlusion of the distal part of the middle cerebral artery. Immunofluorescence and electron microscopy show that LC3 and HSP70 are overexpressed and co-localize within the area penumbra in the same cells and within similar subcellular compartments. In the area penumbra, marked loss of co-localization of HSP70 and LC3-positive autophagy vacuoles, with lysosomal-associated membrane protein 1 (LAMP1) or cathepsin-D-positive lysosome vacuoles occurs. This study indicates that, within the area penumbra, a failure of autophagolysosomes depends on defective compartmentalization of LC3, LAMP1 and cathepsin-D and a defect in merging between autophagosomes and lysosomes. Such a deleterious effect is likely to induce a depletion of autophagolysosomes and cell clearing systems, which needs to be rescued in the process of improving neuronal survival. more...
- Published
- 2022
- Full Text
- View/download PDF
23. Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study
- Author
-
Fabio Cofano, Alessandro Pesce, Giovanni Vercelli, Marco Mammi, Armando Massara, Massimiliano Minardi, Mauro Palmieri, Giancarlo D'Andrea, Chiara Fronda, Michele Maria Lanotte, Fulvio Tartara, Francesco Zenga, Alessandro Frati, and Diego Garbossa more...
- Subjects
craniostomy ,chronic subdural hematoma ,corticosteroids ,drain ,recurrence ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.Objective: To identify factors associated with increased risk of recurrence.Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes.Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013).Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs. more...
- Published
- 2020
- Full Text
- View/download PDF
24. Glioblastoma: Molecular profile and immunophenotypic analysis as prognostic tools for tailored therapy and decision making in a recent surgical series
- Author
-
Maurizio Salvati, Leonardo Tariciotti, Giacoma M.F. Brunetto, Gaetano Gallo, Francesca Santoro, Alessandro Frati, and Antonio Santoro
- Subjects
Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: Despite combined approaches the prognosis of Glioblastoma remains poor. However, different variants of this tumor might show different prognostic characteristics. Aim of the study is to investigate the role of molecular prognostic factors in predicting clinical outcomes in patients treated for glioblastoma. The study focuses on therapeutic and prognostic value of IDH1 gene mutations and MGMT promoter methylation status. Methods: 115 patients diagnosed and treated for glioblastoma at our institution within a period of five years (2013–2018) were included. All patients received pre-operative MRI, gross-total surgical resection and adjuvant treatments (chemotherapy and radiotherapy). Immunohistochemical analysis of histological samples was performed for IDH1 gene R132H mutations and MGMT promoter methylation status. Follow-up was conducted through clinical examination and MRI scans for a period of 60 months. Results: Mean population age was 59.21 ± 13.9 [19–85]. Overall median survival was 14 months, range 12–16. IDH1 gene mutation was identified in 30 patients (26%) and positively correlated with survival (IDH1 mutated: 32 months 95%C.I. [12–16] vs IDH1 wild type: 12 months, 95%C.I. [11–14]; p more...
- Published
- 2020
- Full Text
- View/download PDF
25. Visual Aura Secondary to Supratentorial Lipomatous Meningioma: A Rare Case Report
- Author
-
Pierfrancesco Lapolla, Placido Bruzzaniti, Giuseppa Zancana, Antonella Stoppacciaro, Michela Relucenti, Rui Chen, Xiaobo Li, Andrea Mingoli, Alessandro Frati, and Pietro Familiari
- Subjects
migraine ,meningioma ,imaging ,seizure ,headache ,lipomatous meningiomas ,Medicine (General) ,R5-920 - Abstract
Background/Aim: Lipomatous meningioma is a rare type of meningioma that is formed as the result of an accumulation of lipids inside the cell due to metabolic activity dysregulation. It differs from other types of meningiomas in its radiological and immunohistochemical characteristics. We report a rare case of a patient treated in our department for this particular type of meningioma who developed a type of migraine with the aura component as the first clinical symptom. Case Report: A 55-year-old woman presented with a migraine and reported having phosphenes in recent years. Head Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans were performed; these showed an extensive hypodense and hypointense formation located in the left parieto-occipital region. This formation was implanted in the tentorium region, with a prevailingly adipose-type signal intensity. The patient underwent an occipital craniotomy with the total removal of the lesion. The histological examination indicated a lipomatous metaplastic meningioma. Conclusion: We reported the first case of a lipomatous meningioma presenting with a migraine with a visual aura. Seizures and headaches can be included as possible symptoms. According to the current literature, lipomatous meningiomas affect women more commonly than men. The patient of our reported case presented visual disturbances in the form of a visual aura, which occurred 10 years before finding the meningioma, and surgery dramatically improved the symptoms and quality of life. more...
- Published
- 2022
- Full Text
- View/download PDF
26. Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality
- Author
-
Daniele Armocida, Umberto Aldo Arcidiacono, Mauro Palmieri, Alessandro Pesce, Fabio Cofano, Veronica Picotti, Maurizio Salvati, Giancarlo D’Andrea, Diego Garbossa, Antonio Santoro, and Alessandro Frati more...
- Subjects
meningioma ,elderly patient ,neurosurgery ,brain tumor ,risk factors ,Medicine (General) ,R5-920 - Abstract
With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group ( more...
- Published
- 2022
- Full Text
- View/download PDF
27. Inhibition of Autophagy In Vivo Extends Methamphetamine Toxicity to Mesencephalic Cell Bodies
- Author
-
Michela Ferrucci, Francesca Biagioni, Carla L. Busceti, Chiara Vidoni, Roberta Castino, Ciro Isidoro, Larisa Ryskalin, Alessandro Frati, Stefano Puglisi-Allegra, and Francesco Fornai
- Subjects
psychostimulants ,stress ,asparagine ,glutamine ,midbrain dopamine neurons ,ventral tegmental area ,Medicine ,Pharmacy and materia medica ,RS1-441 - Abstract
Methamphetamine (METH) is a widely abused psychostimulant and a stress-inducing compound, which leads to neurotoxicity for nigrostriatal dopamine (DA) terminals in rodents and primates including humans. In vitro studies indicate that autophagy is a strong modulator of METH toxicity. In detail, suppressing autophagy increases METH toxicity, while stimulating autophagy prevents METH-induced toxicity in cell cultures. In the present study, the role of autophagy was investigated in vivo. In the whole brain, METH alone destroys meso-striatal DA axon terminals, while fairly sparing DA cell bodies within substantia nigra pars compacta (SNpc). No damage to either cell bodies or axons from ventral tegmental area (VTA) is currently documented. According to the hypothesis that ongoing autophagy prevents METH-induced DA toxicity, we tested whether systemic injection of autophagy inhibitors such as asparagine (ASN, 1000 mg/Kg) or glutamine (GLN, 1000 mg/Kg), may extend METH toxicity to DA cell bodies, both within SNpc and VTA, where autophagy was found to be inhibited. When METH (5 mg/Kg × 4, 2 h apart) was administered to C57Bl/6 mice following ASN or GLN, a frank loss of cell bodies takes place within SNpc and a loss of both axons and cell bodies of VTA neurons is documented. These data indicate that, ongoing autophagy protects DA neurons and determines the refractoriness of cell bodies to METH-induced toxicity. more...
- Published
- 2021
- Full Text
- View/download PDF
28. Intramedullary Spinal Cord Metastasis Mimicking Astrocytoma: A Rare Case Report
- Author
-
Pierfrancesco Lapolla, Placido Bruzzaniti, Leopoldo Costarelli, Alessandro Frati, Rui Chen, Xiaobo Li, Selenia Miglietta, Giuseppe Familiari, and Pietro Familiari
- Subjects
intramedullary metastasis ,carcinoid tumour ,neuroendocrine lung tumour ,spinal cord metastasis ,small-cell neuroendocrine carcinoma ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Intramedullary spinal cord metastases (ISCMs) are infrequent lesions. Their incidence is estimated to range from 0.9 to 2.1%, found in autopsies of cancer patients. However, as the life expectancy of malignant tumour patients constantly increases, the reported incidences of ISCMs are consequently rising. This report presents a case of the misdiagnosis of an anaplastic astrocytoma type of tumour due to its similarities to small-cell neuroendocrine carcinoma. Therefore, we would like to underline the importance of further investigation that could assist and support the surgeon in the making of the differential diagnosis. We present the clinical case of a 73-year-old woman with a solitary intramedullary spinal cord metastasis as the initial manifestation of a carcinoid type of tumour. The patient was admitted to our department while presenting a rapid onset of paraparesis. Magnetic resonance imaging was performed, which showed an intramedullary mass at the C2–C6 vertebral level with a heterogeneous contrast enhancement. In light of these findings, the patient underwent surgery for a partial tumour resection. The lesion resulted in being a small-cell neuroendocrine type of carcinoma. This peculiar type of tumour presents similar radiological characteristics to the anaplastic astrocytoma type, which is why our diagnostical mismatch occurred. This is the report of a rare case of solitary intramedullary spinal cord metastasis, which is the result of an initial presentation of a lung small-cell neuroendocrine type of carcinoma. We conclude that ISCMs should be regularly considered as a part of the differential diagnosis of intramedullary lesions, especially in the case of a rapid onset and deterioration of neurological symptoms. more...
- Published
- 2021
- Full Text
- View/download PDF
29. The Baseline Structure of the Enteric Nervous System and Its Role in Parkinson’s Disease
- Author
-
Gianfranco Natale, Larisa Ryskalin, Gabriele Morucci, Gloria Lazzeri, Alessandro Frati, and Francesco Fornai
- Subjects
gastrointestinal tract ,enteric nervous system ,microbiota–gut–brain axis ,Parkinson’s disease ,neurodegeneration ,α-synuclein ,Science - Abstract
The gastrointestinal (GI) tract is provided with a peculiar nervous network, known as the enteric nervous system (ENS), which is dedicated to the fine control of digestive functions. This forms a complex network, which includes several types of neurons, as well as glial cells. Despite extensive studies, a comprehensive classification of these neurons is still lacking. The complexity of ENS is magnified by a multiple control of the central nervous system, and bidirectional communication between various central nervous areas and the gut occurs. This lends substance to the complexity of the microbiota–gut–brain axis, which represents the network governing homeostasis through nervous, endocrine, immune, and metabolic pathways. The present manuscript is dedicated to identifying various neuronal cytotypes belonging to ENS in baseline conditions. The second part of the study provides evidence on how these very same neurons are altered during Parkinson’s disease. In fact, although being defined as a movement disorder, Parkinson’s disease features a number of degenerative alterations, which often anticipate motor symptoms. Among these, the GI tract is often involved, and for this reason, it is important to assess its normal and pathological structure. A deeper knowledge of the ENS is expected to improve the understanding of diagnosis and treatment of Parkinson’s disease. more...
- Published
- 2021
- Full Text
- View/download PDF
30. Stoichiometric Analysis of Shifting in Subcellular Compartmentalization of HSP70 within Ischemic Penumbra
- Author
-
Federica Mastroiacovo, Francesca Biagioni, Paola Lenzi, Larisa Ryskalin, Stefano Puglisi-Allegra, Ferdinando Nicoletti, Alessandro Frati, and Francesco Fornai
- Subjects
mitochondria ,autophagy-related vacuoles ,chaperones ,area penumbra ,brain ischemia ,transmission electron microscopy ,Organic chemistry ,QD241-441 - Abstract
The heat shock protein (HSP) 70 is considered the main hallmark in preclinical studies to stain the peri-infarct region defined area penumbra in preclinical models of brain ischemia. This protein is also considered as a potential disease modifier, which may improve the outcome of ischemic damage. In fact, the molecule HSP70 acts as a chaperonine being able to impact at several level the homeostasis of neurons. Despite being used routinely to stain area penumbra in light microscopy, the subcellular placement of this protein within area penumbra neurons, to our knowledge, remains undefined. This is key mostly when considering studies aimed at deciphering the functional role of this protein as a determinant of neuronal survival. The general subcellular placement of HSP70 was grossly reported in studies using confocal microscopy, although no direct visualization of this molecule at electron microscopy was carried out. The present study aims to provide a direct evidence of HSP70 within various subcellular compartments. In detail, by using ultrastructural morphometry to quantify HSP70 stoichiometrically detected by immuno-gold within specific organelles we could compare the compartmentalization of the molecule within area penumbra compared with control brain areas. The study indicates that two cell compartments in control conditions own a high density of HSP70, cytosolic vacuoles and mitochondria. In these organelles, HSP70 is present in amount exceeding several-fold the presence in the cytosol. Remarkably, within area penumbra a loss of such a specific polarization is documented. This leads to the depletion of HSP70 from mitochondria and mostly cell vacuoles. Such an effect is expected to lead to significant variations in the ability of HSP70 to exert its physiological roles. The present findings, beyond defining the neuronal compartmentalization of HSP70 within area penumbra may lead to a better comprehension of its beneficial/detrimental role in promoting neuronal survival. more...
- Published
- 2021
- Full Text
- View/download PDF
31. The Multi-Faceted Effect of Curcumin in Glioblastoma from Rescuing Cell Clearance to Autophagy-Independent Effects
- Author
-
Larisa Ryskalin, Francesca Biagioni, Carla L. Busceti, Gloria Lazzeri, Alessandro Frati, and Francesco Fornai
- Subjects
curcuma longa ,natural polyphenols ,neuroprotection ,anti-cancer effects ,glioblastoma stem-like cells ,autophagy ,Organic chemistry ,QD241-441 - Abstract
The present review focuses on the multi-faceted effects of curcumin on the neurobiology glioblastoma multiforme (GBM), with a special emphasis on autophagy (ATG)-dependent molecular pathways activated by such a natural polyphenol. This is consistent with the effects of curcumin in a variety of experimental models of neurodegeneration, where the molecular events partially overlap with GBM. In fact, curcumin broadly affects various signaling pathways, which are similarly affected in cell degeneration and cell differentiation. The antitumoral effects of curcumin include growth inhibition, cell cycle arrest, anti-migration and anti-invasion, as well as chemo- and radio-sensitizing activity. Remarkably, most of these effects rely on mammalian target of rapamycin (mTOR)-dependent ATG induction. In addition, curcumin targets undifferentiated and highly tumorigenic GBM cancer stem cells (GSCs). When rescuing ATG with curcumin, the tumorigenic feature of GSCs is suppressed, thus counteracting GBM establishment and growth. It is noteworthy that targeting GSCs may also help overcome therapeutic resistance and reduce tumor relapse, which may lead to a significant improvement of GBM prognosis. The present review focuses on the multi-faceted effects of curcumin on GBM neurobiology, which represents an extension to its neuroprotective efficacy. more...
- Published
- 2020
- Full Text
- View/download PDF
32. Retrospective and Randomized Analysis of Influence and Correlation of Clinical and Molecular Prognostic Factors in a Mono-Operative Series of 122 Patients with Glioblastoma Treated with STR or GTR
- Author
-
Maurizio Salvati, Placido Bruzzaniti, Michela Relucenti, Mariagrazia Nizzola, Pietro Familiari, Marco Giugliano, Anthony Kevin Scafa, Santi Galletta, Xiaobo Li, Rui Chen, Claudio Barbaranelli, Alessandro Frati, and Antonio Santoro more...
- Subjects
glioblastoma multiforme ,gtr ,str ,kps ,idh1 ,mgmt ,atrx ,egfr ,tp53 ,ki67 ,neurosurgery ,oncology ,epilepsy ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Glioblastoma is a solid, infiltrating, and the most frequent highly malignant primary brain tumor. Our aim was to find the correlation between sex, age, preoperative Karnofsky performance status (KPS), presenting with seizures, and extent of resection (EOR) with overall survival (OS), progression-free survival (PFS), and postoperative KPS, along with the prognostic value of IDH1, MGMT, ATRX, EGFR, and TP53 genes mutations and of Ki67 through the analysis of a single-operator series in order to avoid the biases of a multi-operator series, such as the lack of homogeneity in surgical and adjuvant nonsurgical treatments. A randomized retrospective analysis of 122 patients treated by a single first operator at Sapienza University of Rome was carried out. After surgery, patients followed standard Stupp protocol treatment. Exclusion criteria were: (1) patients with primary brainstem and spinal cord gliomas and (2) patients who underwent partial resections (resection < 90%) or a biopsy exclusively for diagnostic purposes. Statistical analysis with a simultaneous regression model was carried out through the use of SPSS 25® (IBM). Results showed statistically significant survival increase in four groups: (1) patients treated with gross total resection (GTR) (p < 0.030); (2) patients with mutation of IDH1 (p < 0.0161); (3) patients with methylated MGMT promoter (p < 0.005); (4) patients without EGFR amplification or EGFRvIII mutation (p < 0.035). Higher but not statistically significant survival rates were also observed in: patients more...
- Published
- 2020
- Full Text
- View/download PDF
33. Egas Moniz: 90 Years (1927–2017) from Cerebral Angiography
- Author
-
Marco Artico, Marialuisa Spoletini, Lorenzo Fumagalli, Francesca Biagioni, Larisa Ryskalin, Francesco Fornai, Maurizio Salvati, Alessandro Frati, Francesco Saverio Pastore, and Samanta Taurone
- Subjects
angiography ,history of anatomy ,imaging methodology ,neuroimaging ,neurosurgery ,neuroanatomy ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Human anatomy ,QM1-695 - Abstract
In June 2017 we celebrate the 90th anniversary of the pioneer discovery of cerebral angiography, the seminal imaging technique used for visualizing cerebral blood vessels and vascular alterations as well as other intracranial disorders. Egas Moniz (1874–1955) was the first to describe the use of this revolutionary technique which, until 1975 (when computed tomography, CT, scan was introduced in the clinical practice), was the sole diagnostic tool to provide an imaging of cerebral vessels and therefore alterations due to intracranial pathology. Moniz introduced in the clinical practice this fundamental and important diagnostic tool. The present contribution wishes to pay a tribute to the Portuguese neurosurgeon, who was also a distinguished neurologist and statesman. Despite his tremendous contribution in modern brain imaging, Egas Moniz was awarded the Nobel Prize in Physiology or Medicine in 1949 for prefrontal leucotomy, the neurosurgical intervention nowadays unacceptable, but should rather be remembered for his key contribution to modern brain imaging. more...
- Published
- 2017
- Full Text
- View/download PDF
34. Loud Noise Exposure Produces DNA, Neurotransmitter and Morphological Damage within Specific Brain Areas
- Author
-
Giada Frenzilli, Larisa Ryskalin, Michela Ferrucci, Emanuela Cantafora, Silvia Chelazzi, Filippo S. Giorgi, Paola Lenzi, Vittoria Scarcelli, Alessandro Frati, Francesca Biagioni, Stefano Gambardella, Alessandra Falleni, and Francesco Fornai more...
- Subjects
hippocampus ,striatum ,cerebellum ,cell damage ,loud noise ,rat ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Human anatomy ,QM1-695 - Abstract
Exposure to loud noise is a major environmental threat to public health. Loud noise exposure, apart from affecting the inner ear, is deleterious for cardiovascular, endocrine and nervous systems and it is associated with neuropsychiatric disorders. In this study we investigated DNA, neurotransmitters and immune-histochemical alterations induced by exposure to loud noise in three major brain areas (cerebellum, hippocampus, striatum) of Wistar rats. Rats were exposed to loud noise (100 dBA) for 12 h. The effects of noise on DNA integrity in all three brain areas were evaluated by using Comet assay. In parallel studies, brain monoamine levels and morphology of nigrostriatal pathways, hippocampus and cerebellum were analyzed at different time intervals (24 h and 7 days) after noise exposure. Loud noise produced a sudden increase in DNA damage in all the brain areas under investigation. Monoamine levels detected at 7 days following exposure were differently affected depending on the specific brain area. Namely, striatal but not hippocampal dopamine (DA) significantly decreased, whereas hippocampal and cerebellar noradrenaline (NA) was significantly reduced. This is in line with pathological findings within striatum and hippocampus consisting of a decrease in striatal tyrosine hydroxylase (TH) combined with increased Bax and glial fibrillary acidic protein (GFAP). Loud noise exposure lasting 12 h causes immediate DNA, and long-lasting neurotransmitter and immune-histochemical alterations within specific brain areas of the rat. These alterations may suggest an anatomical and functional link to explain the neurobiology of diseases which prevail in human subjects exposed to environmental noise. more...
- Published
- 2017
- Full Text
- View/download PDF
35. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy
- Author
-
Alessandro Frati, Alessandro Pesce, Mauro Palmieri, Tommaso Vangelista, Riccardo Caruso, Maurizio Salvati, and Antonino Raco
- Subjects
Surgery ,RD1-811 - Abstract
Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical “corridors” created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots. more...
- Published
- 2017
- Full Text
- View/download PDF
36. Vacuolar Protein Sorting genes in Parkinson’s Disease: a re-appraisal of mutations detection rate and neurobiology of disease
- Author
-
Stefano Gambardella, Francesca Biagioni, Rosangela Ferese, Carla Letizia Busceti, Alessandro Frati, Giuseppe Novelli, Stefano Ruggieri, and Francesco Fornai
- Subjects
Neurogenetics ,Protein Clearance ,VPS ,Autophagoproteasome ,Genetic Parkinsonism ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Mammalian retromers play a critical role in protein trans-membrane sorting from endosome to the trans-Golgi network (TGN). Recently, retromers have been linked to Parkinson's Disease (PD) since the identification of the variant p.Asp620Asn in VPS35 (Vacuolar Protein Sorting 35) as a cause of late onset PD. This variant causes a primary defect in endosomal trafficking and retromers formation, which represent critical steps in the molecular mechanisms of disease. Other slightly penetrant and mildly deleterious mutations in VPS genes have been reported in both sporadic and familial PD. Therefore, understanding the actual prevalence of the whole range of VPS gene mutations is key to understand the relevance of retromers impairment in PD. This scenario indicates a plethora of mutations occurring in different pathways (autophagy, mitophagy, proteasome, endosomes, protein misfolding) all converging to cell clearing systems. This may explain how genetic predispositions to PD may derive from slightly deleterious mutations when combining with heterogeneous environmental factors. This manuscript is a re-appraisal of genetic data produced in the last five years redefining the prevalence of VPS mutations in PD. The prevalence of p.Asp620Asn in VPS35 is 0.286 of familial PD. This data increases up to 0.548 considering mutations affecting all VPS genes, thus representing the second most frequent autosomal dominant PD genotype. This high prevalence, joined with increased awareness of the key role of retromers alterations in PD, strongly candidate environmentally-induced VPS alterations as key molecular mechanisms in the genesis of PD. rations as key molecular mechanisms in the genesis of PD. more...
- Published
- 2016
- Full Text
- View/download PDF
37. Ancient Schwannoma of the Cauda Equina: Our Experience and Review of the Literature
- Author
-
Venceslao Wierzbicki, Alessandro Pesce, Luigi Marrocco, Emanuele Piccione, Alessandro Frati, and Riccardo Caruso
- Subjects
Surgery ,RD1-811 - Abstract
Ancient schwannomas (AS) are exceedingly rare variant of common schwannomas (CS). Only two cases involving the cauda equina region have been previously reported in literature. AS are typically associated with a higher histological degree of degenerative changes (Antoni B areas). It is of peculiar importance, according to our opinion, to outline that, because of their extremely slow growth (which explains the increase of the degenerative changes in respect to the CS) and their typical soft consistency in respect to their standard counterparts, AS usually imply an even better prognosis. more...
- Published
- 2016
- Full Text
- View/download PDF
38. Radiological and surgical aspects of polymorphous low-grade neuroepithelial tumor of the young (PLNTY)
- Author
-
Daniele Armocida, Luigi Valentino Berra, Alessandro Frati, and Antonio Santoro
- Subjects
PLNTY ,brain tumor ,neurosurgery ,neuro-oncology ,Neurology (clinical) ,General Medicine - Abstract
Background Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a low-grade epilepsy-associated tumor recently introduced in WHO 2021 classification. Since it has been recognized as an independent nosological entity, PLNTY has been mainly studied from a genetic and molecular perspective, not recognizing unique characteristic clinical and radiological features. Methods A systematic literature research has been conducted aiming to identify all relevant studies about the radiological, clinical and surgical features of PLNTY. We described a representative case of a 45-year-old man treated with awake-surgery with confirmed diagnosis of PLNTY, reporting the radiological and surgical characteristics through imaging and intra-operative video. We performed a statistical meta-analysis attempting to assess the presence of relationships between surgical and radiologic tumor characteristics and clinical outcome and type of surgery. Results A total of 16 studies were included in the systematic review. The final cohort was composed of 51 patients. Extent of resection (EOR) and outcome are not significantly associated with the different genetic profiling (p = 1), the presence of cystic intralesional component, calcification (p = 0.85), contrast-enhancing and lesion boundaries (p = 0.82). No significant correlation there is between EOR and remission or better control of epilepsy-related symptoms (p = 0.38). The contrast enhancement in the tumor is significantly associated with recurrence or poor control of epileptic symptoms (p = 0.07). Conclusions In PLNTYs, contrast enhancement seems to impact prognosis, recurrence, and seizure control much more than radiological features, genetic features and type of resection of the tumor. more...
- Published
- 2023
- Full Text
- View/download PDF
39. EGFR-Driven Mutation in Non-Small-Cell Lung Cancer (NSCLC) Influences the Features and Outcome of Brain Metastases
- Author
-
Daniele Armocida, Alessandro Pesce, Mauro Palmieri, Fabio Cofano, Giuseppe Palmieri, Paola Cassoni, Carla Letizia Busceti, Francesca Biagioni, Diego Garbossa, Francesco Fornai, Antonio Santoro, and Alessandro Frati more...
- Subjects
brain metastases ,lung cancer ,NSCLC ,EGFR ,ALK ,brain tumor ,General Medicine - Abstract
Background: Brain metastases (BMs) is one of the most frequent metastatic sites for non-small-cell lung cancer (NSCLC). It is a matter of debate whether EGFR mutation in the primary tumor may be a marker for the disease course, prognosis, and diagnostic imaging of BMs, comparable to that described for primary brain tumors, such as glioblastoma (GB). This issue was investigated in the present research manuscript. Methods: We performed a retrospective study to identify the relevance of EGFR mutations and prognostic factors for diagnostic imaging, survival, and disease course within a cohort of patients affected by NSCLC-BMs. Imaging was carried out using MRI at various time intervals. The disease course was assessed using a neurological exam carried out at three-month intervals. The survival was expressed from surgical intervention. Results: The patient cohort consisted of 81 patients. The overall survival of the cohort was 15 ± 1.7 months. EGFR mutation and ALK expression did not differ significantly for age, gender, and gross morphology of the BM. Contrariwise, the EGFR mutation was significantly associated with MRI concerning the occurrence of greater tumor (22.38 ± 21.35 cm3 versus 7.68 ± 6.44 cm3, p = 0.046) and edema volume (72.44 ± 60.71 cm3 versus 31.92 cm3, p = 0.028). In turn, the occurrence of MRI abnormalities was related to neurological symptoms assessed using the Karnofsky performance status and mostly depended on tumor-related edema (p = 0.048). However, the highest significant correlation was observed between EGFR mutation and the occurrence of seizures as the clinical onset of the neoplasm (p = 0.004). Conclusions: The presence of EGFR mutations significantly correlates with greater edema and mostly a higher seizure incidence of BMs from NSCLC. In contrast, EGFR mutations do not affect the patient’s survival, the disease course, and focal neurological symptoms but seizures. This contrasts with the significance of EGFR in the course and prognosis of the primary tumor (NSCLC). more...
- Published
- 2023
- Full Text
- View/download PDF
40. An understimated maneuver for oculomotor nerve palsy due to posterior communicating artery aneurysm: the opening of the anterior petroclinoid ligament. A technical note
- Author
-
Biagia LA PIRA, Veronica PICOTTI, Alessandro FRATI, Alessandro PESCE, and Giancarlo D’ANDREA
- Subjects
Surgery ,Neurology (clinical) - Published
- 2023
- Full Text
- View/download PDF
41. Letter to editor regarding: 'Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion.'
- Author
-
Daniele Armocida, Luca Proietti, and Alessandro Frati
- Subjects
spine ,subsidence ,minimally invasive spine surgery ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) - Published
- 2023
- Full Text
- View/download PDF
42. Clinical Efficacy of Adjuvant Radiotherapy for World Health Organization Grade II Intracranial Meningioma
- Author
-
Mauro Palmieri, Daniele Armocida, Raffaella De Pietro, Giuseppina Chiarello, Francesca Rizzo, Diego Garbossa, Francesco Marampon, Antonio Santoro, and Alessandro Frati
- Subjects
Surgery ,Neurology (clinical) - Published
- 2023
- Full Text
- View/download PDF
43. En Bloc Resection of Solitary Brain Metastasis: The Role of Perilesional Edema
- Author
-
PLACIDO BRUZZANITI, PIERFRANCESCO LAPOLLA, ALESSIA D’AMICO, GIUSEPPA ZANCANA, MICHAEL KATSEV, MICHELA RELUCENTI, GIUSEPPE FAMILIARI, ANDREA MINGOLI, GIANCARLO D’ANDREA, ALESSANDRO FRATI, MAURIZIO SALVATI, ANTONIO SANTORO, and PIETRO FAMILIARI more...
- Subjects
brain edema ,Pharmacology ,brain neoplasms ,Cancer Research ,sexually transmitted diseases ,perilesional edema ,General Biochemistry, Genetics and Molecular Biology ,overall mass effect ,retrospective studies ,brain metastasis ,en bloc resection ,size of lesion ,edema ,humans ,Research Article - Abstract
Background/Aim: The treatment of solitary brain metastasis is a challenging intervention since the incidence increases and prognosis is poor. This study investigated the role of perilesional edema in the overall mass effect of solitary brain metastasis. Patients and Methods: We conducted a retrospective analysis on 88 patients with single supratentorial brain metastasis and concomitant perilesional edema undergoing en bloc resection. Each patient was evaluated for perilesional brain edema grading. We stratified patients into three groups based on the size of the metastatic lesion and the extent of perilesional edema. Results: The grade of perilesional edema at 30 days after surgical removal did not correlate with the maximum diameter of the metastasis (Pearson’s correlation 0.098, p=0.494). In patients with a maximal metastatic diameter ≤2 cm, the grade of perilesional edema before surgical treatment was 1.63 (STD 0.43), while 30 days after removal it was significantly reduced; 0.47 (STD 0.26), p more...
- Published
- 2022
- Full Text
- View/download PDF
44. Role of 1p/19q Codeletion in Diffuse Low-grade Glioma Tumour Prognosis
- Author
-
PIETRO FAMILIARI, PIERFRANCESCO LAPOLLA, VERONICA PICOTTI, MAURO PALMIERI, ALESSANDRO PESCE, GIULIA CAROSI, MICHELA RELUCENTI, STEFANIA NOTTOLA, FRANCESCA GIANNO, SIMONE MINASI, MANILA ANTONELLI, ALESSANDRO FRATI, ANTONIO SANTORO, GIANCARLO D’ANDREA, PLACIDO BRUZZANITI, and BIAGIA LA PIRA more...
- Subjects
Cancer Research ,Oncology ,molecular markers ,Diffuse low-grade glioma ,overall survival ,intraoperative magnetic resonance imaging ,extent of resection ,General Medicine - Published
- 2023
45. Letter to the Editor Regarding 'Case Series and Systematic Review of Electronic Scooter Crashes and Severe Traumatic Brain Injury'
- Author
-
Daniele Armocida, Antonio Santoro, and Alessandro Frati
- Subjects
Surgery ,Neurology (clinical) - Published
- 2023
- Full Text
- View/download PDF
46. Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review
- Author
-
Umberto Aldo Arcidiacono, Daniele Armocida, Alessandro Pesce, Marco Maiotti, Luca Proietti, Giancarlo D’Andrea, Antonio Santoro, and Alessandro Frati
- Subjects
spine surgery ,complex regional pain syndrome ,pain ,General Medicine ,neurosurgery ,CRPS - Abstract
Background: Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon’s inappropriate decision to resort to a second surgical treatment. Methods: We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. Results: We retrieve 20 articles. Most of the papers are clinical cases showing the disorder’s rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. Conclusion: CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately. more...
- Published
- 2022
47. L'espressione «Ecclesia Christi subsistit in Ecclesia Catholica»
- Author
-
Alessandro Frati
- Published
- 2014
48. EGFR driving mutation in non-small-cell lung cancer influences the incidence and characteristics of related brain metastases
- Author
-
Alessandro Pesce, Daniele Armocida, Mauro Palmieri, Fabio Cofano, Sara Mantovani, Giuseppe Perna, Giuseppe Palmieri, Paola Cassoni, Maurizio Salvati, Manila Antonelli, Giancarlo D’Andrea, Marco Anile, Antonio Santoro, and Alessandro Frati more...
- Abstract
Background: Brain metastases (BMs) are the most common intracranial tumors in adults and the brain is one of the most frequent metastatic sites for non-small-cell lung cancer (NSCLC). Some studies have hypothesized that EGFR expression in the primary tumor may result in clinically radiological and prognostic changes in related brain metastases, comparable to EGFR's correlation with prognosis in primary brain tumors. There are no current studies that clinically and radiologically demonstrate a difference between BMs from EGFR-mutated and wild-type NSCLC.Methods: We performed a retrospective study to identify prognostic factors for the survival of patients with NSCLC-BMs by exploring the role of driving mutations in NSCLC, focusing on EGFR mutated status, and comparing all morphological, radiological, and clinical features of NSCLC-BMs with their outcome parameters in a cohort of surgically treated patients. Results: The final cohort consisted of 81 patients. The overall survival of the cohort was 15±17 months. The tumor-related edema was associated with neurological symptoms at the clinical onset of the disease (p=.048). We found that EGFR and ALK mutation status did not reach significant associations with age, sex, and the morphology of the lesions. EGFR mutation in the primary tumor is positively associated with higher edema and tumor volume (respectively 22.38±21.35cm3 versus 7.68±8.44cm3 and 72.44±60.71cm3 versus 31.92cm3 p=.046 and p=.028). Moreover, EGFR mutation is associated with a clinical debut of seizures (p=.004).Conclusions: The role of EGFR and ALK mutations of NSCLC on prognostic characteristics of BMs is still to be fully clarified; however the results retrieved from the present study suggest that the presence of EGFR mutations significantly correlates with bigger edema volume and higher incidence of seizures. In recent studies, while EGFR mutation status did not affect the immune pathway scores of primary lung tumors, the overall immune pathway scores in related BMs indicate a peculiar immunogenic phenotype that could explain a large amount of edema volume. This study could be considered the first clinical and radiological demonstration of this immunological phenotype. more...
- Published
- 2022
- Full Text
- View/download PDF
49. Transoral Endoscopic Approach to Repair Early Pharyngeal Perforations After Anterior Cervical Spine Surgery without Failure of Instrumentation: Our Experience and Review of Literature
- Author
-
Giovanni Di Nardo, Antonio Santoro, Giorgio Balsamo, Alessandro Pesce, Daniele Armocida, Luca Proietti, Mauro Palmieri, Giacoma Maria Floriana Brunetto, and Alessandro Frati
- Subjects
Male ,Cervical spine surgery ,Weakness ,medicine.medical_specialty ,Laryngoscopy ,Perforation (oil well) ,Endoscopic management ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,In patient ,Prospective cohort study ,Esophageal Perforation ,medicine.diagnostic_test ,business.industry ,Endoscopy ,Middle Aged ,Surgery ,anterior cervical spine surgery ,laryngoscopy ,neurosurgery complication ,pharyngoesophageal perforation ,transoral endoscopic ,Spinal Fusion ,030220 oncology & carcinogenesis ,Cervical Vertebrae ,Pharynx ,Neurology (clinical) ,medicine.symptom ,Complication ,business ,Intervertebral Disc Displacement ,030217 neurology & neurosurgery ,Diskectomy - Abstract
Pharyngoesophageal injury during anterior cervical spine surgery is a rare and potentially life-threatening complication; generally it is the result of intraoperative manipulation or hardware erosion and sometimes may be due to weakness of the pharyngoesophageal wall from pre-existing pathologic conditions, such as diabetes, gastritis, or obesity.We describe the management strategies in patients with an early postoperative hypopharyngeal perforation that occurred after anterior cervical spine surgery without failure of instrumentation, and we present a case treated endoscopically at our institution.Appropriate treatment for pharyngoesophageal perforations is controversial and not investigated in detail. There is a lack of prospective studies comparing initial conservative versus surgical approaches to treatment. In addition, endoscopic management is growing as a therapeutic option, but no consensus concerning the indications for an endoscopic approach in the treatment of pharyngoesophageal injury in anterior cervical spine surgery is currently reached. A common theme proposed in the literature is that early recognition and aggressive investigation and treatment are essential to ensure a good outcome. A customized interdisciplinary surgical approach is essential for successful treatment. Use of the transoral endoscopic approach is a useful noninvasive method to treat this rare but potentially devastating complication. more...
- Published
- 2020
- Full Text
- View/download PDF
50. Surgical management of giant calcified thoracic disc herniation and the role of neuromonitoring. The outcome of large mono centric series
- Author
-
Daniele Armocida, Luca D'Angelo, Francesco Paglia, Francesca Pedace, Tiziano De Giacomo, Luigi Valentino Berra, Alessandro Frati, and Antonio Santoro
- Subjects
Neurosurgery ,Neurophysiology ,Calcinosis ,General Medicine ,Spine ,Thoracic Vertebrae ,Treatment Outcome ,Neurology ,Physiology (medical) ,Thoracic disc herniation ,Diskectomy ,Humans ,Retrospective Studies ,Intervertebral Disc Displacement ,Surgery ,Neurology (clinical) - Abstract
Giant thoracic disc herniations (GTDH) are considered a subgroup of TDHs with worse functional outcomes, a high calcification rate, and a considerable risk of complications. We aimed to determine whether there is a relationship between the extent of calcification of GTDH and outcomes concerning the risk of complications, the surgical technique, and changes in neuromonitoring signals.We present a retrospective analysis of 76 patients undergoing surgery for calcific GTDH. We introduced and defined a radiological definition of the calcified disc into"fully calcified" and "partially calcified." We performed a statistical analysis between clinical and radiological variables, type of surgical procedure, the extent of excision, neuro-monitoring signals, and outcome, comparing a group of 58 "fully-calcified TDH" patients and 18 "partially-calcified TDH" patients.Fully calcified TDHs, compared with partially calcified TDHs, do not have significant differences in outcome (worse outcome 4/58-6.9% versus 0/18, p = 0.25) and complications (10/58-17.24% versus 4/18-22.2%, p = 0.63); Fully calcified TDH is associated with a higher risk of alterations in neurophysiological potentials (14/58-24.1% versus 0/18, p = 0.02) and subtotal excision (18/58-31% versus 2/18-11%, p = 0.15), without significant differences between the approaches used.Fully calcified TDH group has a similar outcome and complication rate as the partially calcified TDH group, but they are associated with higher intraoperative neuromonitoring signal changes. We introduced a new classificationsystem that guides the approach and helps tocounsel the patients. more...
- Published
- 2022
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.