117 results on '"Alessandro Pesce"'
Search Results
2. Resection of supratentorial high-grade gliomas availing of neuronavigation matched intraoperative ultrasound and Fluorescein: How far is it safe to push the resection?
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Alessandro Pesce, Mauro Palmieri, Andrea Pietrantonio, Silvia Ciarlo, Maurizio Salvati, and Angelo Pompucci
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Prognostic factor ,Long term survival ,Glioblastoma ,IDH ,EGFR ,Ki67 ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: High-Grade Gliomas are the most common primary brain malignancies and despite the multimodal treatment, and the increasing amount of adjuvant treatment options the overall prognosis remains dismal. The present investigation aims to analyze the safety profile of the use of intraoperative ultrasounds (Io-US) in a homogeneous and matched cohort of patients suffering from High-grade gliomas (HGG) operated on with or without the aid of Io-US and Fluorescein in specific relation to the incidence of neurological and functional status sequelae. Methods and materials: A retrospective analysis was performed on 74 patients affected by HGG. 22 patients were treated with Io-US matched with neuronavigational system (Group A); 15 patients were treated both with the use of Io-US and Fluorescein matched with neuronavigational system (Group B); 37 patients were treated with the use of the neuronavigational system only (Group C). Primary endpoints were the extent of resection and functional outcome (measured with Karnofski Performance Status) Results: Significative differences were observed in terms of a higher extent of resection in Group B. In a multivariate analysis, this data appears to be independent of the location (eloquent/non-eloquent) of the lesion and from its histology. Regarding functional outcomes, no differences were detected between the two groups. Conclusions: The present study is the first that analyzes the simultaneous use of Io-US and Fluorescein, and the results demonstrate that these two instruments together could improve the extent of resection in HGG while ensuring good outcomes in terms of functional status.
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- 2024
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3. Brain metastases: Comparing clinical radiological differences in patients with lung and breast cancers treated with surgery
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Daniele Armocida, Giuseppa Zancana, Andrea Bianconi, Fabio Cofano, Alessandro Pesce, Brandon Matteo Ascenzi, Paola Bini, Enrico Marchioni, Diego Garbossa, and Alessandro Frati
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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.
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- 2024
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4. Idiopathic Normal Pressure Hydrocephalus: The Real Social and Economic Burden of a Possibly Enormous Underdiagnosis Problem
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Gianpaolo Petrella, Silvia Ciarlo, Stefania Elia, Rita Dal Piaz, Paolo Nucera, Angelo Pompucci, Mauro Palmieri, and Alessandro Pesce
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idiopathic normal pressure hydrocephalus ,iNPH ,CT scan ,misdiagnosis ,underdiagnosis ,lumbar infusion test ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Normal Pressure Hydrocephalus (iNPH) typically affects the elderly and can cause cognitive decline, resulting in its differential diagnosis with other neurodegenerative conditions. Moreover, it is probably underdiagnosed; such under- and misdiagnosis prevents the patient from receiving the right treatment and significantly affects the quality of life and life expectancy. This investigation is an in-depth analysis of the actual incidence of iNPH in the population of the province served by our hospital (circa 580,000 individuals). The first phase of this study was conducted by visualizing a total of 1232 brain CT scans performed in the Emergency Departments of the four hospitals of our network on patients who were admitted for different complaints yet screened as suspicious for iNPH. Subsequently, corresponding Emergency Department medical records were investigated to understand the medical history of each patient in search of elements attributable to an alteration of CSF dynamics. The cohort of positive CT scans, according to the radiological and clinical inclusion criteria, included 192 patients. Among the reasons to require acute medical care, “Fall” was the most common. The cumulative incidence of CT scans suggestive of iNPH among the patients undergoing CT scans was as high as 15.58%, and the period prevalence calculated for the total amount of patients accessing the Emergency Departments was 1.084%. The real incidence of iNPH in the population may be underestimated, and the social burden linked to the assistance of patients suffering from such untreated conditions could be significantly relieved.
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- 2023
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5. 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
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Alessandro Pesce, Daniele Armocida, Gianpaolo Petrella, Alessandro Frati, and Angelo Pompucci
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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.
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- 2023
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6. Extradural Clinoidectomy in Clinoidal Meningiomas: Analysis of the Surgical Technique and Evaluation of the Clinical Outcome
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Luigi Sampirisi, Luca D’Angelo, Mauro Palmieri, Alessandro Pesce, and Antonio Santoro
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clinoidal ,clinoidectomy ,meningiomas ,visual function ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
The surgical treatment of clinoidal meningiomas is currently still discussed in the literature. Different surgical approaches have been proposed and evaluated, in multiple studies, in order to improve the surgical outcomes. The aim of this study is to evaluate the advantages of extradural clinoidectomy in the context of tumor removal radicality for visual function improvement. A retrospective analysis was performed on 74 patients—of which 26 patients with clinoidal meningiomas were in group III, according to Al Mefty classification—who underwent surgery at the Policlinico Umberto I Hospital between 2000 and 2019. Further, extradural clinoidectomy was performed on 15 patients (Group A), and 11 patients underwent the pterional approach only (Group B). Additionally, visual impairment was present in all 26 patients before surgery. Next, visual function assessment was performed on all patients, both in presurgery and postsurgery. Radiological follow up was performed at 3 and 6 months, and then every 12 months. Gross Total Resection (GTR) was achieved in 13/15 (86.7%) patients who underwent clinoidectomy, and in 4/11 (36.4%) patients who did not undergo clinoidectomy. Visual function improvement was achieved in 12/15 (80%) patients who underwent clinoidectomy and in 4 of 11 (36.4%) who did not undergo clinoidectomy. According to our study, extradural clinoidectomy is the most suitable method for facilitating the gross total resection of clinoidal meningiomas. Our experience and data suggest that a higher rate of total resection and, subsequently, the best visual outcomes are achieved. Extradural drilling via the anterior clinoid process reveals a wider surgical corridor for meticulous tumor resection.
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- 2022
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7. Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark
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Alessandro Pesce, Daniele Armocida, Francesco Fiorentino, Silvia Ciarlo, Biagia La Pira, Maurizio Salvati, Alessandro Frati, Angelo Pompucci, and Mauro Palmieri
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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.
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- 2022
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8. Peritumoral Brain Edema in Relation to Tumor Size Is a Variable That Influences the Risk of Recurrence in Intracranial Meningiomas
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Alessandro Frati, Daniele Armocida, Umberto Aldo Arcidiacono, Alessandro Pesce, Giancarlo D’Andrea, Fabio Cofano, Diego Garbossa, and Antonio Santoro
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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.
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- 2022
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9. Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience
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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
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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
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- 2023
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10. Editorial: Novel techniques and technologies in spine surgery: New approaches for the traumatic, oncologic, and aging spine
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Mauro Palmieri, Alessandro Frati, Giancarlo D’Andrea, Antonio Santoro, Maurizio Salvati, and Alessandro Pesce
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spine ,spine surgery ,spinal instrumentation ,trauma ,degenerative disease ,Surgery ,RD1-811 - Published
- 2023
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11. Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review
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Francesco Guerrini, Lucio Aniello Mazzeo, Giorgio Rossi, Mariarosaria Verlotta, Mattia Del Maestro, Angela Dele Rampini, Alessandro Pesce, Marco Viganò, Sabino Luzzi, Renato Juan Galzio, Andrea Salmaggi, and Giannantonio Spena
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glioblastoma ,MRI ,multifocal ,brain ,tumor ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Introduction. The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. By definition, if an anatomical connection through white matter bundles cannot be hypothesized, multiple lesions are defined as multicentric glioma (MC); on the other hand, when this connection exists, it is better defined as multifocal glioma (MF). Whether surgery can be advantageous for these patients has not been established yet. The aim of our study was to critically review our experience and to compare it to the existing literature. Materials and Methods. Retrospective analysis of patients operated on for MC HGG in two Italian institutions was performed. Distinction between MC and MF was achieved through revision of MR FLAIR images. Clinical and radiological preoperative and postoperative data were analyzed through chart revision and phone interviews. The same data were extracted from literature review. Univariate and multivariate analyses were conducted for the literature review only, and the null hypothesis was rejected for a p-value ≥ 0.05. Results. Sixteen patients met the inclusion criteria; male predominance and an average age of 66.5 years were detected. Sensory/motor deficit was the main onset symptom both in clinical study and literature review. A tendency to operate on the largest symptomatic lesion was reported and GTR was reached in the majority of cases. GBM was the histological diagnosis in most part of the patients. OS was 8.7 months in our series compared to 7.5 months from the literature review. Age ≤ 70 years, a postoperative KPS ≥ 70, a GTR/STR, a second surgery and adjuvant treatment were shown to be significantly associated with a better prognosis. Pathological examination revealed that MC HGG did not originate by LGG. Conclusions. MC gliomas are rare conditions with high malignancy and a poor prognosis. A maximal safe resection should be attempted whenever possible, especially in younger patients with life-threatening large mass.
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- 2021
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12. EGFR-Driven Mutation in Non-Small-Cell Lung Cancer (NSCLC) Influences the Features and Outcome of Brain Metastases
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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
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brain metastases ,lung cancer ,NSCLC ,EGFR ,ALK ,brain tumor ,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).
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- 2023
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13. Management of frontal sinus fractures: A comprehensive review and treatment algorithm from Sapienza university of Rome
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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
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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.
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- 2021
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14. Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review
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Umberto Aldo Arcidiacono, Daniele Armocida, Alessandro Pesce, Marco Maiotti, Luca Proietti, Giancarlo D’Andrea, Antonio Santoro, and Alessandro Frati
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spine surgery ,pain ,neurosurgery ,complex regional pain syndrome ,CRPS ,Medicine - 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.
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- 2022
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15. Periventricular zone involvement as a predictor of survival in glioblastoma patients: A single centre cohort-comparison investigation concerning a distinct clinical entity
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Daniele Armocida, Alessandro Pesce, Mauro Palmieri, Giancarlo D'Andrea, Maurizio Salvati, Antonio Santoro, and Alessandro Frati
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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.
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- 2021
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16. The beneficial effect of physiotherapy on the cervical spine mobility of ACDF patients and healthy individuals: An original observational cohort comparison research protocol
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Eszter Toth, Alessandro Pesce, Giorgio Tartaglia, Giacomo Maria Russo, Maurizio Inghilleri, and Riccardo Caruso
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ACDF ,Cervical Spine Mobility ,EMG ,Inclinometry ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Purpose: Population aging and certain behaviors associated with modern life are contributing factors for the increasing incidence of degenerative cervical spine conditions (DCSC), and the number of cervical spine surgeries every year is. Our aim was to determine, with an original research protocol, the impact of ACDF and physiotherapy on the range of motion and EMG parameters of patients suffering from DCSC. Patients and Methods: Two comparable subgroups of 29 patients each were recruited for the present investigation. The first cohort was composed of ACDF patients, whereas the second cohort was composed by healthy subjects. Inclinometry/Range of Motion (RoM) analyses of the neck, and cervical muscles electromyography (EMG) were used to evaluate the neck mobility. We investigated the effects of physiotherapy on ROM and EMG results in order to identify possible significant differences between healthy subjects and ACDF patients. Results: A total of 58 patients were included in the final cohort. Extensive statistical analysis disclosed that higher NDI values were associated with a reduction of the Extension and Rotation movements, NDI scores, were found to be negatively associated to EMG voltages for Rotation, independently of the physiotherapy performed either. Extension, Lateral Bending, and Rotation showed significant improvement after just one session of physiotherapy, whereas Flexion and Extension proved to be those that contributed most to the overall neck mobility. Conclusion: The cervical spine fusion contributes to an overall reduction of cervical mobility. This data is confirmed by inclinometer and EMG parameters. Physiotherapy increases neck mobility thus possibly improving the clinical status of patients.
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- 2021
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17. The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie
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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
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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.
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- 2022
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18. Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study
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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
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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.
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- 2020
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19. Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality
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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
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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 (
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- 2022
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20. Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up
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Riccardo Caruso, Alessandro Pesce, Valentina Martines, Venceslao Wierzbicki, Emanuele Piccione, Sergio Paolini, and Tiziana Lanciano
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Lumbar spine ,Lumbar spinal stenosis ,Laminectomy ,Iatrogenic instability ,Lumbar spinal fusion ,MRI ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Background The degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on. Methods Patients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016. Results Comparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort. Conclusions Although the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition. Level of Evidence 3.
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- 2018
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21. Diffuse Axonal Injury: Clinical Prognostic Factors, Molecular Experimental Models and the Impact of the Trauma Related Oxidative Stress. An Extensive Review Concerning Milestones and Advances
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Mauro Palmieri, Alessandro Frati, Antonio Santoro, Paola Frati, Vittorio Fineschi, and Alessandro Pesce
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traumatic brain injury ,diffuse axonal injury ,oxidative stress ,reactive oxygen species ,biomarkers ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Traumatic brain injury (TBI) is a condition burdened by an extremely high rate of morbidity and mortality and can result in an overall disability rate as high as 50% in affected individuals. Therefore, the importance of identifying clinical prognostic factors for diffuse axonal injury (DAI) in (TBI) is commonly recognized as critical. The aim of the present review paper is to evaluate the most recent contributions from the relevant literature in order to understand how each single prognostic factor determinates the severity of the clinical syndrome associated with DAI. The main clinical factors with an important impact on prognosis in case of DAI are glycemia, early GCS, the peripheral oxygen saturation, blood pressure, and time to recover consciousness. In addition, the severity of the lesion, classified on the ground of the cerebral anatomical structures involved after the trauma, has a strong correlation with survival after DAI. In conclusion, modern findings concerning the role of reactive oxygen species (ROS) and oxidative stress in DAI suggest that biomarkers such as GFAP, pNF-H, NF-L, microtubule associated protein tau, Aβ42, S-100β, NSE, AQP4, Drp-1, and NCX represent a possible critical target for future pharmaceutical treatments to prevent the damages caused by DAI.
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- 2021
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22. Anterior-to-Posterior Migration of a Lumbar Disc Sequestration: Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy
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Alessandro Frati, Alessandro Pesce, Mauro Palmieri, Tommaso Vangelista, Riccardo Caruso, Maurizio Salvati, and Antonino Raco
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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.
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- 2017
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23. Acute Spinal Cord Injury: A Systematic Review Investigating miRNA Families Involved
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Enrica Pinchi, Alessandro Frati, Santina Cantatore, Stefano D’Errico, Raffaele La Russa, Aniello Maiese, Mauro Palmieri, Alessandro Pesce, Rocco Valerio Viola, Paola Frati, and Vittorio Fineschi
- Subjects
acute spinal cord injury ,pathophysiology ,clinical management ,postmortem techniques ,animal models ,miRNAs ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Acute traumatic spinal cord injury (SCI) involves primary and secondary injury mechanisms. The primary mechanism is related to the initial traumatic damage caused by the damaging impact and this damage is irreversible. Secondary mechanisms, which begin as early as a few minutes after the initial trauma, include processes such as spinal cord ischemia, cellular excitotoxicity, ionic dysregulation, and free radical-mediated peroxidation. SCI is featured by different forms of injury, investigating the pathology and degree of clinical diagnosis and treatment strategies, the animal models that have allowed us to better understand this entity and, finally, the role of new diagnostic and prognostic tools such as miRNA could improve our ability to manage this pathological entity. Autopsy could benefit from improvements in miRNA research: the specificity and sensitivity of miRNAs could help physicians in determining the cause of death, besides the time of death.
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- 2019
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24. Ancient Schwannoma of the Cauda Equina: Our Experience and Review of the Literature
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Venceslao Wierzbicki, Alessandro Pesce, Luigi Marrocco, Emanuele Piccione, Alessandro Frati, and Riccardo Caruso
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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.
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- 2016
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25. Surgical Approach to the Cavernous Sinus for a Trigeminal Schwannoma Resection: Technical Note and Case Report
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Riccardo Caruso, Alessandro Pesce, Venceslao Wierzbicki, Luigi Marrocco, and Emanuele Piccione
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Surgery ,RD1-811 - Abstract
We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.
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- 2016
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26. Diffuse Axonal Injury and Oxidative Stress: A Comprehensive Review
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Alessandro Frati, Daniela Cerretani, Anna Ida Fiaschi, Paola Frati, Vittorio Gatto, Raffaele La Russa, Alessandro Pesce, Enrica Pinchi, Alessandro Santurro, Flavia Fraschetti, and Vittorio Fineschi
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traumatic brain injury ,oxidative stress ,reactive oxygen species ,immunohistochemistry ,biomarkers ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Traumatic brain injury (TBI) is one of the world’s leading causes of morbidity and mortality among young individuals. TBI applies powerful rotational and translational forces to the brain parenchyma, which results in a traumatic diffuse axonal injury (DAI) responsible for brain swelling and neuronal death. Following TBI, axonal degeneration has been identified as a progressive process that starts with disrupted axonal transport causing axonal swelling, followed by secondary axonal disconnection and Wallerian degeneration. These modifications in the axonal cytoskeleton interrupt the axoplasmic transport mechanisms, causing the gradual gathering of transport products so as to generate axonal swellings and modifications in neuronal homeostasis. Oxidative stress with consequent impairment of endogenous antioxidant defense mechanisms plays a significant role in the secondary events leading to neuronal death. Studies support the role of an altered axonal calcium homeostasis as a mechanism in the secondary damage of axon, and suggest that calcium channel blocker can alleviate the secondary damage, as well as other mechanisms implied in the secondary injury, and could be targeted as a candidate for therapeutic approaches. Reactive oxygen species (ROS)-mediated axonal degeneration is mainly caused by extracellular Ca2+. Increases in the defense mechanisms through the use of exogenous antioxidants may be neuroprotective, particularly if they are given within the neuroprotective time window. A promising potential therapeutic target for DAI is to directly address mitochondria-related injury or to modulate energetic axonal energy failure.
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- 2017
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27. Brain Abscess after Percutaneous Therapy for Trigeminal Neuralgia
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Michele Acqui, Pietro Familiari, Alessandro Pesce, Giada Toccaceli, and Antonino Raco
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Infectious and parasitic diseases ,RC109-216 - Abstract
We report a case of brain abscess following the percutaneous treatment for trigeminal neuralgia. This procedure envisages the access with a needle into the middle cranial fossa through the oral cavity. Thus, in this case, the bacterial infection can be more likely ascribed to the possible contamination of the needle inside the oral cavity rather than to other frequent and more controllable causes of infection like an imperfect sterilization of surgical instruments or an inadequate antiseptic preparation of both operator’s hands and patient’s skin. The subsequent brain abscess was treated with antibiotic therapy (Vancomycin 2 gr a day and Meropenem 8 g a day for 22 days before the surgical procedure and 30 days after, until complete normalization of laboratory parameters, clinical parameters, and neurological symptoms) and surgical drainage, although the culture of the abscess capsule and the purulent material resulted sterile. In conclusion, the percutaneous therapy for trigeminal neuralgia can be objectively related to risks, even if performed by expert hands. Therefore, it is important that the patient should be advised regarding risks/benefits and/or septic complications of such procedures, even if they occur very seldom. An association of surgery and antibiotic therapy results as effective treatment for this pathologic condition.
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- 2015
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28. An understimated maneuver for oculomotor nerve palsy due to posterior communicating artery aneurysm: the opening of the anterior petroclinoid ligament. A technical note
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Biagia LA PIRA, Veronica PICOTTI, Alessandro FRATI, Alessandro PESCE, and Giancarlo D’ANDREA
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Surgery ,Neurology (clinical) - Published
- 2023
29. Role of 1p/19q Codeletion in Diffuse Low-grade Glioma Tumour Prognosis
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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
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Cancer Research ,Oncology ,molecular markers ,Diffuse low-grade glioma ,overall survival ,intraoperative magnetic resonance imaging ,extent of resection ,General Medicine - Published
- 2023
30. Microsurgical clipping versus newer endovascular techniques in treatment of unruptured anterior communicating artery-complex aneurysms: a meta-analysis and systematic review
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Alessandro Pesce, Antonino Raco, V. Muralidharan, Giada Toccaceli, Simone Peschillo, Paolo Missori, Massimo Miscusi, Francesco Diana, and E. Raz
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medicine.medical_specialty ,Unruptured brain aneurysms ,ACoCA ,Anterior cerebral artery ,Clipping ,Endovascular treatment ,medicine.artery ,Occlusion ,Humans ,Medicine ,Retrospective Studies ,Clipping (audio) ,business.industry ,Endovascular Procedures ,Intracranial Aneurysm ,Arteries ,General Medicine ,Embolization, Therapeutic ,Surgery ,Anterior communicating artery ,Treatment Outcome ,Microsurgical clipping ,Meta-analysis ,Stents ,Neurology (clinical) ,Neurosurgery ,business ,Complication - Abstract
The aim of this study is to compare occlusion rate, complication rate, and clinical outcome of microsurgical clipping (MC) and advanced endovascular techniques (EVT) in unruptured anterior communicating artery-complex aneurysms (ACoCAs). We reviewed the scientific literature reporting occlusion rate, time of occlusion assessment, and clinical outcome of MC and EVT in patients with unruptured ACoCAs, from January 2009 to December 2019. We included in our analysis 25 studies and 872 patients with unruptured ACoCAs (434 treated with endovascular techniques and 438 with MC). Ninety-three (10.7%), 320 (36.7%), 21 (2.4%), and 438 (50.2%) were treated with flow diverter (FD), stent-assisted coiling (SAC), endosaccular devices (ES), and microsurgical clipping (MC) respectively. FD, SAC, ES, and MC subgroups presented minor complications in 11.8%, 3.8%, 14.3%, and 7.1% of cases (p=.016), and major complications in 3.2%, 4.4%, 0%, and 7.1% (p=.136) of patients. A total occlusion rate post-treatment has been achieved in 4.3%, 87.1%, 47.6%, and 98.2% of cases (p=.000), while at 12 months' follow-up in 50%, 66%, 83.3%, and 80% of patients (p=.001). FD, SAC, ES, and MC subgroups had a good clinical outcome at 12 months in 93.5%, 90.5%, 100%, and 67.8% of cases. MC is associated with higher post-treatment total occlusion rate, but higher complication and lower good clinical outcome rates. EVT are promising in treating unruptured anterior cerebral artery aneurysms with high margin of safety and good clinical outcome, despite the lower total occlusion rate.
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- 2021
31. Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review
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Alessandro Pesce, Giorgio Rossi, Renato Galzio, Francesco Guerrini, Andrea Salmaggi, Mattia Del Maestro, Marco Viganò, Mariarosaria Verlotta, Angela Dele Rampini, Sabino Luzzi, Giannantonio Spena, and Lucio Aniello Mazzeo
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Male ,medicine.medical_specialty ,tumor ,Multivariate analysis ,multifocal ,brain ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Disease ,Fluid-attenuated inversion recovery ,Malignancy ,Article ,Lesion ,Glioma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pathological ,neoplasms ,Aged ,Retrospective Studies ,business.industry ,Brain Neoplasms ,glioblastoma ,medicine.disease ,Prognosis ,Magnetic Resonance Imaging ,nervous system diseases ,Radiological weapon ,Radiology ,medicine.symptom ,business ,MRI - Abstract
Introduction. The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. By definition, if an anatomical connection through white matter bundles cannot be hypothesized, multiple lesions are defined as multicentric glioma (MC), on the other hand, when this connection exists, it is better defined as multifocal glioma (MF). Whether surgery can be advantageous for these patients has not been established yet. The aim of our study was to critically review our experience and to compare it to the existing literature. Materials and Methods. Retrospective analysis of patients operated on for MC HGG in two Italian institutions was performed. Distinction between MC and MF was achieved through revision of MR FLAIR images. Clinical and radiological preoperative and postoperative data were analyzed through chart revision and phone interviews. The same data were extracted from literature review. Univariate and multivariate analyses were conducted for the literature review only, and the null hypothesis was rejected for a p-value ≥ 0.05. Results. Sixteen patients met the inclusion criteria, male predominance and an average age of 66.5 years were detected. Sensory/motor deficit was the main onset symptom both in clinical study and literature review. A tendency to operate on the largest symptomatic lesion was reported and GTR was reached in the majority of cases. GBM was the histological diagnosis in most part of the patients. OS was 8.7 months in our series compared to 7.5 months from the literature review. Age ≤ 70 years, a postoperative KPS ≥ 70, a GTR/STR, a second surgery and adjuvant treatment were shown to be significantly associated with a better prognosis. Pathological examination revealed that MC HGG did not originate by LGG. Conclusions. MC gliomas are rare conditions with high malignancy and a poor prognosis. A maximal safe resection should be attempted whenever possible, especially in younger patients with life-threatening large mass.
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- 2021
32. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience
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Andrea Zini, Maria Ruggiero, Vittorio Semeraro, Giulia Frauenfelder, Agostino Tessitore, Alessandro Pesce, Sandra Bracco, Daniele Giuseppe Romano, Nicola Burdi, Sergio Vinci, Luigi Simonetti, Mariano Velo, Maria Porzia Ganimede, Luigi Cirillo, Renato Saponiero, Beatrice Modello, Christian Commodaro, Samuele Cioni, Matteo Zanoni, Aldo Paolucci, Francesco Diana, Diana F., Vinci S.L., Ruggiero M., Semeraro V., Bracco S., Frauenfelder G., Paolucci A., Cirillo L., Pesce A., Tessitore A., Commodaro C., Ganimede M.P., Zanoni M., Saponiero R., Zini A., Velo M., Modello B., Burdi N., Cioni S., Simonetti L., and Romano D.G.
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Carotid Artery Diseases ,thrombolysis ,medicine.medical_specialty ,medicine.medical_treatment ,Arterial Occlusive Diseases ,Brain Ischemia ,Modified Rankin Scale ,Occlusion ,Post-hoc analysis ,medicine ,Humans ,Stroke ,intervention ,Ischemic Stroke ,Retrospective Studies ,Thrombectomy ,stent ,stroke ,thrombectomy ,Cerebral infarction ,business.industry ,Endovascular Procedures ,Stent ,General Medicine ,Thrombolysis ,medicine.disease ,Treatment Outcome ,Stents ,Surgery ,Neurology (clinical) ,Radiology ,business ,Carotid Artery, Internal ,Cohort study - Abstract
BackgroundThere is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions.MethodsWe performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson’s bivariate correlation for the statistical analyses.ResultsBetween January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0–2 of 47.8% vs 34.0%) and at 3 months’ follow-up (mRs 0–2 of 56.5% vs 38.9%) compared with AT.ConclusionThrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.
- Published
- 2021
33. EGFR driving mutation in non-small-cell lung cancer influences the incidence and characteristics of related brain metastases
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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
- 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.
- Published
- 2022
34. Global Neurocognitive and Frontal Functions analysis and Precision Intrathecal Pressure Measurement to Settle the Diagnostic Dilemma of the Normal Pressure Hydrocephalus: a preliminary experience
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Alessandro Pesce, Mauro Palmieri, Angela Scattolin, Francesco Guerrini, Marek Czosnyka, Zofia Czosnyka, Massimo Marano, Vincenzo di Lazzaro, Angelo Pompucci, Luigi Iuliano, and Gianpaolo Petrella
- Subjects
Tap Test ,Neuropsychology ,Surgery ,Neurology (clinical) ,Lumbar Infusion ,MRI ,Normal Pressure Hydrocephalus - Abstract
Normal-pressure hydrocephalus (NPH) is a common condition associated with a cognitive deterioration and possibly involving up to 9%-14% of all nursing home residents older than 65 years old. The purpose of the present paper is to introduce an inclusive study protocol aimed at increasing the diagnostic precision and follow-up accuracy.A total of 28 patients were operated on for NPH in our institution in the period ranging between January 2015 and December 2019. All the patients underwent magnetic resonance imaging of the brain with standard sequences, calculation of the Evans index and corpus callosum angle, and evaluations by means of Montreal Cognitive Assessment (MOCA), Mini-Mental State Examination, and Frontal Assessment Battery (FAB) neuropsychological tests preoperatively and at 1 and 6 months. A preoperative lumbar test infusion (LIT) with fine measurement of the intrathecal pressures at the beginning and at the end of the procedures was performed.MOCA and FAB proved an overall improvement of the neurocognitive conditions at 1 month postoperatively. The mean pressure at the beginning of the LIT, was negatively associated with the neuropsychological outcome variables (Mini-Mental State Examination, FAB, and MOCA) in the 3 different evaluations, with FAB and MOCA at 6 months. We found a strong positive correlation between the Evans index as measured on the first magnetic resonance imaging scan both with the diastolic and systolic pressure at the beginning of the test.Neuropsychological assessment, combined with LIT with intrathecal pressure managements aids the diagnostic process in patients affected by NPH. It allows standardizing in a rigorous fashion the follow-up evaluation of patients undergoing surgery for a ventriculoperitoneal shunt.
- Published
- 2022
35. Transoral Endoscopic Approach to Repair Early Pharyngeal Perforations After Anterior Cervical Spine Surgery without Failure of Instrumentation: Our Experience and Review of Literature
- Author
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Giovanni Di Nardo, Antonio Santoro, Giorgio Balsamo, Alessandro Pesce, Daniele Armocida, Luca Proietti, Mauro Palmieri, Giacoma Maria Floriana Brunetto, and Alessandro Frati
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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.
- Published
- 2020
36. Management of frontal sinus fractures: A comprehensive review and treatment algorithm from Sapienza university of Rome
- Author
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Alessandro Pesce, A. Kapitonov, Daniele Armocida, F. Bozza, Maurizio Salvati, Walter Colangeli, Alessandro Frati, Marta Zappalà, Valerio Facchini, Antonio Santoro, Mauro Palmieri, and Roberto Becelli
- Subjects
Frontal sinus ,Facial fractures ,RD1-811 ,business.industry ,Guideline ,Frontal sinus fractures ,Combined approach ,Head trauma ,Severity assessment ,medicine.anatomical_structure ,Multidisciplinary approach ,Radiological weapon ,Medicine ,Surgery ,Neurology (clinical) ,Neurology. Diseases of the nervous system ,Presentation (obstetrics) ,business ,RC346-429 ,Algorithm ,Medical literature - 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.
- Published
- 2021
37. IDH Wild-type Glioblastoma Presenting with Seizure: Clinical Specificity, and Oncologic and Surgical Outcomes
- Author
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Alessandro Pesce, Giancarlo D'Andrea, Francesco Paglia, Antonio Santoro, Maurizio Salvati, Mauro Palmieri, Daniele Armocida, and Alessandro Frati
- Subjects
p53 ,Oncology ,Male ,medicine.medical_specialty ,EGFR ,seizure ,brain tumor ,epilepsy ,glioblastoma ,survival ,Lesion ,Epilepsy ,Seizures ,Internal medicine ,medicine ,Overall survival ,Humans ,Retrospective Studies ,business.industry ,Brain Neoplasms ,Wild type ,Parietal lobe ,medicine.disease ,Prognosis ,Isocitrate Dehydrogenase ,Isocitrate dehydrogenase ,Treatment Outcome ,Cohort ,Mutation ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,Glioblastoma - Abstract
Background Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients. Methods We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs. Results A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival. Conclusions The typical patient with IDH-WT GBM with SaO is a young (
- Published
- 2021
38. The Most Significant Surgical Risk Factors of Giant Intracranial Meningiomas: Localization Matters Much More than Grading and Volume of Peritumoral Brain Edema. A Retrospective Clinical Neuroradiological and Immunohistochemical Study
- Author
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Giuseppina Bevacqua, Alessandro Pesce, Mauro Palmieri, Veronica Picotti, Fabio Cofano, Antonia Catapano, Diego Garbossa, Umberto Aldo Arcidiacono, Giancarlo D'Andrea, Daniele Armocida, Antonio Santoro, Maurizio Salvati, and Alessandro Frati
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Immunohistochemistry ,Radiology ,business ,Peritumoral Brain Edema ,Grading (tumors) ,Surgical risk - Abstract
Background: Giant intracranial meningiomas (GIMs) are extremely rare and are usually considered arduous to resect totally with poorer prognosis. The real mechanisms by which a meningioma can grow to be defined as "giant" are unknown, as well as the real biological , radiological profile and the different outcomes.Methods: We performed a retrospective review of a consecutive series of surgically-treated patients suffering from intracranial Meningioma. All the patients were assigned on the ground of the preoperative imaging to the Giant and Medium/Large Meningiomas. We investigated whether the presence large diameter on radiological diagnosis is indicative for different mortality rate, grading, characteristic and clinical/neurological outcome.Results: The study shows that surgically treated giant meningiomas have a higher risk of developing complications in the postoperative phase (Chi square= 11.121, dF=1, p=0.001). The direct proportional relationship between peritumoral brain edema (PBE) volume and tumor volume was present only in the medium/large group and was not present in the giant meningioma group. When comparing the degree of performance there is a statistically significant difference between localization and KPS immediately postoperatively (p=0.04) particularly for sphenopetroclival meningiomas (p=0.071), and partially with GIM of the olfactory groove with arterial encasement. The most frequently encountered complications include the occurrence of ischemia (p=0.049), infection (p=0.03), and the occurrence of postoperative seizures.Conclusions: We identified that the major surgical risk factor for GIMs is location, where the petro-clival region and, to a lesser extent the anterior basicranium offer a greater risk of neurovascular involvement and arterial encasement. On other hand, the risk correlated with PBE is poorer in GIM although there is a well-noted correlation between the Edema volume and outcome in meningiomas.
- Published
- 2021
39. Diffuse Axonal Injury: Clinical Prognostic Factors, Molecular Experimental Models and the Impact of the Trauma Related Oxidative Stress. An Extensive Review Concerning Milestones and Advances
- Author
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Alessandro Pesce, Paola Frati, Mauro Palmieri, Antonio Santoro, Alessandro Frati, and Vittorio Fineschi
- Subjects
Traumatic ,Prognostic factor ,Traumatic brain injury ,QH301-705.5 ,Diffuse Axonal Injury ,Review ,medicine.disease_cause ,Bioinformatics ,Catalysis ,Inorganic Chemistry ,Lesion ,Microtubule associated protein tau ,Brain Injuries, Traumatic ,medicine ,Humans ,Physical and Theoretical Chemistry ,Biology (General) ,Molecular Biology ,Clinical syndrome ,QD1-999 ,Spectroscopy ,reactive oxygen species ,business.industry ,traumatic brain injury ,Organic Chemistry ,Diffuse axonal injury ,biomarkers ,General Medicine ,Biomarkers ,Oxidative stress ,Reactive oxygen species ,Prognosis ,Reactive Oxygen Species ,Oxidative Stress ,medicine.disease ,Computer Science Applications ,Chemistry ,Blood pressure ,Brain Injuries ,medicine.symptom ,business - Abstract
Traumatic brain injury (TBI) is a condition burdened by an extremely high rate of morbidity and mortality and can result in an overall disability rate as high as 50% in affected individuals. Therefore, the importance of identifying clinical prognostic factors for diffuse axonal injury (DAI) in (TBI) is commonly recognized as critical. The aim of the present review paper is to evaluate the most recent contributions from the relevant literature in order to understand how each single prognostic factor determinates the severity of the clinical syndrome associated with DAI. The main clinical factors with an important impact on prognosis in case of DAI are glycemia, early GCS, the peripheral oxygen saturation, blood pressure, and time to recover consciousness. In addition, the severity of the lesion, classified on the ground of the cerebral anatomical structures involved after the trauma, has a strong correlation with survival after DAI. In conclusion, modern findings concerning the role of reactive oxygen species (ROS) and oxidative stress in DAI suggest that biomarkers such as GFAP, pNF-H, NF-L, microtubule associated protein tau, Aβ42, S-100β, NSE, AQP4, Drp-1, and NCX represent a possible critical target for future pharmaceutical treatments to prevent the damages caused by DAI.
- Published
- 2021
40. Microsurgical clipping of Unruptured Intracranial Aneurysms (UIA) by a single surgeon's experience: why we should definitely preserve the neurosurgical skills in our health areas
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Veronica Picotti, Alessandro Frati, Alessandro Pesce, Giancarlo D'Andrea, Biagia La Pira, Vincenza Maiola, Antonio Santoro, and Marta Zappalà
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medicine.medical_specialty ,Preoperative planning ,business.industry ,medicine.disease ,Neurovascular bundle ,Single surgeon ,Surgery ,Microsurgical clipping ,Aneurysm ,Radiological weapon ,medicine ,cardiovascular diseases ,Neurology (clinical) ,Endovascular treatment ,Surgical treatment ,business - Abstract
BACKGROUND The long standing comparison between the endovascular and microsurgical treatment is still ongoing. While not any center avails of a neuroendovascular service, and not every aneurysm is suitable for endovascular treatment, the neurovascular technique is slowly disappearing from our territories, whereas in the current Literature, the role of the neurosurgical treatment is being re-appreciated. The objective of this paper is to discuss a single surgeon's clinical and radiological results with the microsurgical management of UIA. METHODS We retrospectively reviewed the clinical and radiological records of patients treated for UIA, by a single surgeon,in the period ranging between 2015 and 2019. We recorded all the relevant anatomic features of the aneurysm, saliencies of the surgical treatment, such as the need for temporary clipping, intraoperative rupture or postoperative complications. The results of the clinical and radiological follow-up examinations were recorded either. RESULTS Fifty-eight patient undergoing microsurgical clipping were included, harboring a total of 65 UIAs. CTA with 3D reconstructions was sufficient to reach a reliable preoperative planning in 46 patients (76%). A total of 94% of the cases were unchanged or neurologically unremarkable at follow-up. The presence of postoperative complications was associated to the neck size and predictor of a longer hospitalizations, as well as longer hospitalizations are associated to the patients' age, size of the aneurysms and surgical times. CONCLUSIONS According to our experience, we believe that microsurgical clipping plays a critical role in the management of UIA, also on the ground of the encouraging results of the relevant Literature.
- Published
- 2021
41. Letter to the Editor: 'The Neurosurgical Perspective for the 2021 WHO Classification of Tumors of the Central Nervous System: A Missed Opportunity?'
- Author
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Antonio Santoro, Maurizio Salvati, Daniele Armocida, Alessandro Frati, and Alessandro Pesce
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Letter to the editor ,business.industry ,Perspective (graphical) ,MEDLINE ,Neurosurgery ,medicine.disease ,World Health Organization ,Central Nervous System Neoplasms ,Humans ,Medicine ,Surgery ,Neurology (clinical) ,Medical emergency ,Who classification ,business ,Missed opportunity - Published
- 2021
42. Awake Surgery for Arteriovenous Malformations (AVM) in Eloquent Area: Risk and Outcome Analysis in the Most Complete Case-Collection
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Daniele Armocida, Luca D'Angelo, Alessandro Pesce, Veronica Di Palma, Gaspare Galati, Alessandro Frati, and Antonio Santoro
- Abstract
Background: Artero-venous malformations (AVMs) located in eloquent area are associated with significant risk of neurological deterioration, especially in patients presenting with unruptured AVMs and minimal or no neurological deficits. Awake-surgery allows a better identification of eloquent gyrus, but its feasibility and application in resection of eloquent AVMs is controversial and mostly limited to small case series.Methods: A total of 31 patients suffering from intracranial AVMs have been operated on in our Department. Patients were stratified into two groups: patients submitted to Asleep Surgery and patients submitted to Awake surgery. We implemented the Awake Group with results from the most complete case series reported in the literature to obtain a complete uni and multivariate analysis of surgical risks and outcome.Results: Awake craniotomy was performed in 19,35% of the AVMs treated in our centre. Considering the reported cases from all other series published in the literature, we obtained a comparison between the asleep group of 25 patients derived from our series and the awake group of 34 patients. No statistically significant differences were identified regarding the risk of postoperative complications, surgical radicality, presence of residual, and need for adjuvant treatment. Interestingly, however, improvement in performance status was more rapid and effective during follow-up in patients treated with awake surgery compared with asleep surgery.Conclusions: In contrast to what is commonly believed, applying awake surgery in this type of lesions does not involve increased intra-operative risks, but rather it seems to determine a greater improvement in the outcome of patients from the thirtieth postoperative day. Awake patients allow for more precise brain mapping and superior clinical neurologic monitoring, which facilitates resection by defining the safe margins without an increased risk.
- Published
- 2021
43. Trigonal and Peritrigonal Lesions of the Lateral Ventricle: Presurgical Tractographic Planning and Clinic Outcome Evaluation
- Author
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Andrea Romano, Alessandro Bozzao, Giancarlo D'Andrea, Alessandro Pesce, Maria Camilla Rossi-Espagnet, Giorgia Olivieri, Antonino Raco, and Veronica Picotti
- Subjects
medicine.medical_specialty ,business.industry ,Middle temporal gyrus ,White matter ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Ventricle ,030220 oncology & carcinogenesis ,Corticospinal tract ,medicine ,Surgery ,Neurology (clinical) ,Neurosurgery ,Radiology ,mri ,presurgical planning ,tractography ,trigonal lesions ,business ,030217 neurology & neurosurgery ,Tractography ,Optic radiation ,Diffusion MRI - Abstract
Background Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and peritrigonal lesions. Methods Diffusion tensor imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using the Karnofsky Performance Status Scale. The corticospinal tract, optic radiation, and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography. Results According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) and the posterior parietal gyrus in 7 patients (37%), leading to an a priori change in the surgical approach in 14 patients (73%). Six patients (31%) showed new postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status Scale evaluation showed an improvement or a substantial stability of symptoms in 90% of cases. In 2 patients, a worsening of 30% of clinical performance was appreciable. Conclusions The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.
- Published
- 2019
44. Impact of 1p/19q Codeletion Status in The Outcome of Patients Affected By Oligodendroglioma and Diffuse Astrocytoma: A Retrospective Single Surgeon Series With 1.5 Io-MRI Guided Surgery
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Alessandra Marongiu, Placido Bruzzaniti, Alessandro Pesce, Giancarlo D'Andrea, Giulia Carosi, Antonio Santoro, Maurizio Salvati, Alessandro Frati, and Veronica Picotti
- Subjects
medicine.medical_specialty ,Series (stratigraphy) ,Diffuse Astrocytoma ,business.industry ,medicine ,Radiology ,Oligodendroglioma ,1p/19q Codeletion ,medicine.disease ,business ,Mri guided ,Single surgeon - Abstract
Purpose: The real impact of the Extent of Resection in respect to the 1p/19q codeletion status in determining the outcomes of Low Grade Glioma (LGG) patients is extensively debated. The aim of this paper is to retrospectively analyze the oncologic outcomes of a homogeneous cohort of LGG patients who underwent surgery by a single operator, first author of the present paper (GDA).Methods: A total of 66 patients suffering LGG who underwent craniotomy for tumor resection were operated on and retrospectively evaluated between 2008 and 2016 in a single center in which the operative theater was equipped with an Io-MRI system. We compared a subgroup of 37 patients suffering from Diffuse Astrocytoma to a second subgroup of 29 patients affected by Oligodendroglioma. Volumetric analyses of the Extent of Resection (EOR) were performed, PFS and OS were accurately recorded and used as endpoint variable, as well as the 1p/19q codeletion status of every patient included in the final cohort.Results: GTR produced a statistically significant survival advantage in respect to those associated with STR. This finding is confirmed even in patients suffering from Oligodendrogliomas (in the 1p/19q codeletion group 73.27 versus 101.73 months p=.0001). Similar findings were confimed for patients affected by Diffuse Astrocytomas(81.63 versus 60.44 months p < 0.012), despite the globally shorter survival.Conclusions: We can affirm that the EOR is an independent predictor of survival advantage. The 1p/19q codeletion is an independent prognostic factor significantly associated to a globally longer survival and a longer time to malignant transformation.
- Published
- 2021
45. Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity
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Antonio Santoro, Mauro Palmieri, Vittorio Fineschi, Giuseppa Zancana, Paola Frati, Alessandro Frati, Carlo Cirelli, Armocida Daniele, Aniello Maiese, and Alessandro Pesce
- Subjects
Brain aneurysm ,medicine.medical_specialty ,Complications ,medicine.diagnostic_test ,business.industry ,Traumatic brain injury ,Mortality rate ,General Medicine ,medicine.disease ,Dissection ,Aneurysm ,Brain trauma ,Intracranial aneurysms ,Post-traumatic brain aneurysms ,Vascular lesions ,Angiography ,Medicine ,Surgery ,Neurology (clinical) ,Radiology ,Pica (disorder) ,Neurosurgery ,medicine.symptom ,business - Abstract
Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.
- Published
- 2021
46. Minimally invasive transforaminal lumbar interbody fusion using expandable cages: increased risk of late postoperative subsidence without a real improvement of perioperative outcomes: a clinical monocentric study
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Alessandro Pesce, Antonio Santoro, Alessandro Frati, Marco Cimatti, Daniele Armocida, and Luca Proietti
- Subjects
Expandable cage ,medicine.medical_specialty ,Lordosis ,Radiography ,degenerative discopathy ,expandable cage ,minimally invasive ,MS-TLIF ,sagittal alignment ,spine ,aged ,cohort studies ,female ,follow-up studies ,humans ,intervertebral disc degeneration ,lordosis ,lumbar vertebrae ,male ,middle aged ,minimally invasive surgical procedures ,postoperative complications ,retrospective studies ,risk factors ,spinal fusion ,treatment outcome ,internal fixators ,Lumbar ,Lumbar interbody fusion ,medicine ,Sagittal alignment ,business.industry ,Perioperative ,medicine.disease ,Surgery ,Increased risk ,Neurology (clinical) ,business - Abstract
Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is one of several approaches to lumbar interbody fusion that has proven to be a safe and effective treatment for symptomatic lumbar degenerative disease The clinical outcomes of MIS-TLIF are generally favorable, but there is still controversy regarding its ability to restore sagittal alignment. For this reason, expandable transforaminal lumbar interbody fusion cages have been developed and designed to improve ability to restore disc height and segmental lordosis. The use of expandable cages in transforaminal lumbar interbody fusion has increased drastically; however, it is not clear how effective cage expansion is in regard to disc space lordosis, distraction, and long-term outcome. Methods We reviewed a cohort of patients with symptomatic lumbar degenerative disc pathology who underwent MIS-TLIF at our institution. We compared clinical and radiographic outcomes of expandable versus nonexpandable cage use in MIS-TLIF focusing on mean changes in segmental lordosis, disc height, and postoperative complications. The results were compared with other studies reported in the international literature. Results Mean change in segmental lordosis was not significantly different between the 2 groups. A significantly higher rate of postoperative subsidence was demonstrated in the expandable cage group. Conclusion This study established that expandable cage use in single-level transforaminal lumbar interbody fusion did not reduce the rate of postoperative complications, but rather significantly increased a patient’s risk of postoperative subsidence. Expandable cages do not presently demonstrate improved clinical outcomes or improved sagittal alignment compared with static cages.
- Published
- 2021
47. Periventricular zone involvement as a predictor of survival in glioblastoma patients: A single centre cohort-comparison investigation concerning a distinct clinical entity
- Author
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Giancarlo D'Andrea, Mauro Palmieri, Alessandro Pesce, Maurizio Salvati, Alessandro Frati, Antonio Santoro, and Daniele Armocida
- Subjects
Oncology ,medicine.medical_specialty ,Multivariate statistics ,Multivariate analysis ,RD1-811 ,animal diseases ,Subventricular zone ,ventricular-subventricular zone ,SVZ ,survival ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Progenitor cell ,RC346-429 ,Lateral ventricle ,business.industry ,subventricular zone ,medicine.disease ,glioblastoma lateral ventricle ,MRI ,medicine.anatomical_structure ,nervous system ,Cohort ,Surgery ,Neurology. Diseases of the nervous system ,Neurology (clinical) ,Analysis of variance ,medicine.symptom ,Glioblastoma ,business ,030217 neurology & neurosurgery - 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 s tatistical 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.
- Published
- 2021
48. Vertebral Body Erosion by a Chronic Contained Rupture of Thoracoabdominal Aortic Aneurysm: Systematic Review and Spine Surgical Recommendations
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Francesco Guerrini, Alessandro Pesce, Gianpaolo Petrella, Daniele Armocida, and Angelo Pompucci
- Subjects
medicine.medical_specialty ,Aortic aneurysm ,Spine stabilization ,Spine surgery ,Vertebral erosion ,Back Pain ,Humans ,Spine ,Treatment Outcome ,Vertebral Body ,Aortic Aneurysm, Abdominal ,Aortic Aneurysm, Thoracic ,Aortic Rupture ,Spinal Diseases ,Thoracic ,medicine ,Back pain ,Abdominal ,business.industry ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Vertebral body ,medicine.anatomical_structure ,Radiological weapon ,Etiology ,Neurology (clinical) ,Differential diagnosis ,medicine.symptom ,business ,Vertebral column - Abstract
Background Vertebral body erosion (VBE) is commonly caused by neoplastic, inflammatory or infectious diseases: it can be rarely associated with aortic wall disorders, such as contained rupture of aortic aneurysm (CCR-AA). CCR-AA is a rare event consisting of less than 5% of all reported cases. This condition is easily undiagnosed, differential diagnosis may be challenging, and there is no consensus or recommendation that dictates guidance on management of spinal surgical treatment. Material And Methods We performed a systematic review of literature of all cases of VBE secondary to CCR-AA to identify clinical, radiological, and surgical outcome characteristics with the aim of providing a basis for future research studies. Results The search returned a total of 80 patients. All reported cases have a history of hypertension. In almost all cases the AA size reported was very high (mean diameter of 7.056 cm). The treatment of this condition involves various reported treatment strategies: a totally conservative approach, treatment of the aortic aneurysm through a minimally invasive endovascular procedure, or through open surgery and combined approach. Despite the wide variability in therapeutic strategy, the rate of good outcomes was 80%, relatively high. Conclusions ‘‘Back pain’’ and pain along the vertebral column are such frequent complaints that unusual etiologies or serious and life threatening complications may be overlooked. In addition to the common traumatic and degenerative causes of back pain, AA must also be considered. A combined approach between vascular and spine surgery could be achieved without any increased risk.
- Published
- 2021
49. The beneficial effect of physiotherapy on the cervical spine mobility of ACDF patients and healthy individuals: An original observational cohort comparison research protocol
- Author
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Maurizio Inghilleri, Alessandro Pesce, Eszter Toth, G. Tartaglia, Riccardo Caruso, and Giacomo Maria Russo
- Subjects
medicine.medical_specialty ,lcsh:Surgery ,Electromyography ,lcsh:RC346-429 ,ACDF ,Cervical Spine Mobility ,EMG ,Inclinometry ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,lcsh:Neurology. Diseases of the nervous system ,Cohort comparison ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,lcsh:RD1-811 ,Cervical spine ,Healthy individuals ,Cohort ,Physical therapy ,Surgery ,Observational study ,Neurology (clinical) ,business ,Range of motion ,030217 neurology & neurosurgery - Abstract
Purpose Population aging and certain behaviors associated with modern life are contributing factors for the increasing incidence of degenerative cervical spine conditions (DCSC), and the number of cervical spine surgeries every year is. Our aim was to determine, with an original research protocol, the impact of ACDF and physiotherapy on the range of motion and EMG parameters of patients suffering from DCSC. Patients and Methods Two comparable subgroups of 29 patients each were recruited for the present investigation. The first cohort was composed of ACDF patients, whereas the second cohort was composed by healthy subjects. Inclinometry/Range of Motion (RoM) analyses of the neck, and cervical muscles electromyography (EMG) were used to evaluate the neck mobility. We investigated the effects of physiotherapy on ROM and EMG results in order to identify possible significant differences between healthy subjects and ACDF patients. Results A total of 58 patients were included in the final cohort. Extensive statistical analysis disclosed that higher NDI values were associated with a reduction of the Extension and Rotation movements, NDI scores, were found to be negatively associated to EMG voltages for Rotation, independently of the physiotherapy performed either. Extension, Lateral Bending, and Rotation showed significant improvement after just one session of physiotherapy, whereas Flexion and Extension proved to be those that contributed most to the overall neck mobility. Conclusion The cervical spine fusion contributes to an overall reduction of cervical mobility. This data is confirmed by inclinometer and EMG parameters. Physiotherapy increases neck mobility thus possibly improving the clinical status of patients.
- Published
- 2021
50. Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study
- Author
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Giovanni Vercelli, Fabio Cofano, Giancarlo D'Andrea, Francesco Zenga, Fulvio Tartara, Mauro Palmieri, Michele Lanotte, Diego Garbossa, Massimiliano Minardi, Armando Massara, Marco Mammi, Chiara Fronda, Alessandro Frati, and Alessandro Pesce
- Subjects
craniostomy ,medicine.medical_specialty ,recurrence ,medicine.medical_treatment ,lcsh:RC346-429 ,corticosteroids ,Chronic subdural hematoma ,Antithrombotic ,medicine ,In patient ,chronic subdural hematoma ,drain ,lcsh:Neurology. Diseases of the nervous system ,Craniotomy ,Dexamethasone ,Original Research ,business.industry ,Surgery ,Increased risk ,Neurology ,Neurology (clinical) ,Neurosurgery ,business ,Cohort study ,medicine.drug - 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.
- Published
- 2020
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