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Objective To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia. Methods Adult patients admitted to 20 Neurological Units between 1/3–30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). Results Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. Conclusions We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures.

At the time of writing, the number of confirmed COVID‐19 cases in Italy has dropped off to less than 150 cases per day. Now we can finally take a breath and think back on what we have experienced during the last months in our hospital Papa Giovanni XXIII in Bergamo, Lombardy, the epicentre of the Italian pandemic.

Background: Prognostic factors affecting outcome of traumatic brain injury (TBI), despite their importance, are still under discussion. The purpose of this study was to describe risk factors of in-hospital mortality and outcome at 1 year in a homogeneously treated population of patients with moderate/severe TBI. Methods: A total of 193 consecutive patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score 13–3, including patients with initial GCS score of 13 at high risk for subsequent neurologic deterioration), admitted to the intensive care unit, were retrospectively analyzed. In-hospital mortality and unfavorable outcome at 1 year, based on a Glasgow Outcome Scale–Extended score ≤4, were considered as primary and secondary outcomes. Results: At 1 year, unfavorable outcome occurred in 47.2%, including an in-hospital mortality of 19.7%. Increasing age, GCS motor score

This report describes two elderly patients with large disc fragments extruded into lumbar radicular recesses not treatable by any conventional conservative, minimally invasive or surgical approach. Direct access to the disc fragments was obtained crossing the articular zygapophyseal cavity instead of the interlaminar space and spinal canal, using a small needle through which a laser fibre was inserted to deliver energy for tissue ablation. The procedures obtained regression of both symptoms and the bulk of the fragments at early and late clinical and MR follow-ups.

Introduction In the last 15 years, the surgery of the posterior cranial fossa, within the methods of neurosurgery and microneurosurgery, has improved and grown enormously. However, it is still a challenge for the surgeon, because of the importance of functional neural structures at risk. The recording of auditory pathways, to the peculiar characteristics of their course and the relationships with the brainstem structures that undertake this long, gives an effective system of neurophysiological monitoring for the protection of the central structures brainstem and for the preservation of hearing itself. The attempt to preserve hearing in the final of the small acoustic neuroma surgery, it is to be considered almost infeasible without the proper support of a neurophysiological monitoring. Materials and methods In the report it will be discussed and explained how to record Electrocochleography, C-NAP (Compound Acoustic Nerve Potential), and near field ABR (auditory brainstem response), which we record always simultaneously. The report shall also place the accent on how effective is the monitoring of the different methods, with an attempt to correlate anatomical and functional at risk structure. Results We will show several neurophysiological pictures, trying to correlate the findings to the etiology of suffering, laying the foundations for the solution of the problem as possible. Conclusion From our experience in the last 15 years, we were able to finalize selection of patients, a method of surgical approach and the neurophysiological monitoring system to enable us to preserve the hearing level “socially useful” in 52.6% of patients (case studies of recent 7 years of 113 patients). Particular attention is placed on the indication for intervention and the selection of patients with an adequate preoperative study.

Background Neurosurgery aims to achieve maximal tumor resection while preserving neurological function. Tools such as neuronavigation, high-field intraoperative magnetic resonance imaging (iMRI), and intraoperative neurophysiological monitoring (IOM) have consistently helped to achieve this goal, but integration has often been difficult. Surgery of eloquent areas requires IOM, which in an operating theater equipped with high-field (1.5-T) iMRI could present several issues. Objective To identify the electrodes types more suitable for IOM in a high-field iMRI operating theater by performing an experimental study on phantoms, to report our experience with platinum-iridium (Pt/Ir) electrodes during surgery, and to prove that integration between IOM with Pt/Ir electrodes and high-field iMRI is safe and reliable. Methods Electrodes of different materials (gold, Pt/Ir, and stainless steel) were tested on jelly phantom and apples to evaluate their safety and compatibility. Subsequently, electrodes were tested on 5 healthy volunteers before being used on patients. Results None of the different electrodes presented thermal instability, and no damage to the volunteers' skin occurred. Stainless steel electrodes caused severe imaging distortion. Gold electrodes had no distortion, but their high cost makes their use in routine surgery unaffordable. Pt/Ir electrodes are significantly less expensive than gold electrodes and were completely safe, compatible, and suitable for use in an operating theater with high-field iMRI, providing excellent IOM and mild interference that did not affect the quality of intraoperative imaging. Conclusion We suggest the use of Pt/Ir electrodes for IOM in 1.5-T iMRI suites. Abbreviations DTI, diffusion tensor imagingiMRI, intraoperative magnetic resonance imagingIOM, intraoperative neurophysiological monitoring.