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1. Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

Author

Fiorindi, A, Vezzoli, M, Doglietto, F, Zanin, L, Saraceno, G, Agosti, E, Barbieri, A, Bellocchi, S, Bernucci, C, Bongetta, D, Cardia, A, Costi, E, Egidi, M, Fioravanti, A, Gasparotti, R, Giussani, C, Grimod, G, Latronico, N, Locatelli, D, Mardighian, D, Nodari, G, Poli, J, Rasulo, F, Roca, E, Sicuri, G, Spena, G, Stefini, R, Vivaldi, O, Zoia, C, Calza, S, Fontanella, M, Cenzato, M, Fiorindi A., Vezzoli M., Doglietto F., Zanin L., Saraceno G., Agosti E., Barbieri A., Bellocchi S., Bernucci C., Bongetta D., Cardia A., Costi E., Egidi M., Fioravanti A., Gasparotti R., Giussani C., Grimod G., Latronico N., Locatelli D., Mardighian D., Nodari G., Poli J. C., Rasulo F., Roca E., Sicuri G. M., Spena G., Stefini R., Vivaldi O., Zoia C., Calza S., Fontanella M. M., Cenzato M., Fiorindi, A, Vezzoli, M, Doglietto, F, Zanin, L, Saraceno, G, Agosti, E, Barbieri, A, Bellocchi, S, Bernucci, C, Bongetta, D, Cardia, A, Costi, E, Egidi, M, Fioravanti, A, Gasparotti, R, Giussani, C, Grimod, G, Latronico, N, Locatelli, D, Mardighian, D, Nodari, G, Poli, J, Rasulo, F, Roca, E, Sicuri, G, Spena, G, Stefini, R, Vivaldi, O, Zoia, C, Calza, S, Fontanella, M, Cenzato, M, Fiorindi A., Vezzoli M., Doglietto F., Zanin L., Saraceno G., Agosti E., Barbieri A., Bellocchi S., Bernucci C., Bongetta D., Cardia A., Costi E., Egidi M., Fioravanti A., Gasparotti R., Giussani C., Grimod G., Latronico N., Locatelli D., Mardighian D., Nodari G., Poli J. C., Rasulo F., Roca E., Sicuri G. M., Spena G., Stefini R., Vivaldi O., Zoia C., Calza S., Fontanella M. M., and Cenzato M.

Abstract

Background: Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods: In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results: Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value = 0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p-values < 0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. Conclusions: We documented a significantly increased “diagnostic delay” for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was expe

Published
2022

2. Posterior fossa syndrome in a population of children and young adults with medulloblastoma: a retrospective, multicenter Italian study on incidence and pathophysiology in a histologically homogeneous and consecutive series of 136 patients

Author

de Laurentis, C, Cristaldi, P, Rebora, P, Valsecchi, M, Biassoni, V, Schiavello, E, Carrabba, G, Trezza, A, Dimeco, F, Ferroli, P, Cinalli, G, Locatelli, M, Cenzato, M, Talamonti, G, Fontanella, M, Spena, G, Stefini, R, Bernucci, C, Bellocchi, S, Locatelli, D, Massimino, M, Giussani, C, de Laurentis C., Cristaldi P. M. F., Rebora P., Valsecchi M. G., Biassoni V., Schiavello E., Carrabba G. G., Trezza A., DiMeco F., Ferroli P., Cinalli G., Locatelli M., Cenzato M., Talamonti G., Fontanella M. M., Spena G., Stefini R., Bernucci C., Bellocchi S., Locatelli D., Massimino M., Giussani C., de Laurentis, C, Cristaldi, P, Rebora, P, Valsecchi, M, Biassoni, V, Schiavello, E, Carrabba, G, Trezza, A, Dimeco, F, Ferroli, P, Cinalli, G, Locatelli, M, Cenzato, M, Talamonti, G, Fontanella, M, Spena, G, Stefini, R, Bernucci, C, Bellocchi, S, Locatelli, D, Massimino, M, Giussani, C, de Laurentis C., Cristaldi P. M. F., Rebora P., Valsecchi M. G., Biassoni V., Schiavello E., Carrabba G. G., Trezza A., DiMeco F., Ferroli P., Cinalli G., Locatelli M., Cenzato M., Talamonti G., Fontanella M. M., Spena G., Stefini R., Bernucci C., Bellocchi S., Locatelli D., Massimino M., and Giussani C.

Abstract

Introduction: Posterior fossa syndrome (PFS) is a set of debilitating complications that can occur after surgery for posterior fossa tumors. This study aimed to assess the preoperative radiological and surgical risk factors for the onset of PFS in a histologically homogeneous population of children with medulloblastoma and compare it to a similar population of young adults. Methods: Included patients underwent posterior fossa surgery for medulloblastoma at 11 Italian neurosurgical wards (2003–2019) and were referred to Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT) for postoperative treatments. We collected patients’ pre- and post-operative clinical, surgical and radiological data from the INT charts. To compare the distribution of variables, we used the Mann–Whitney and Fisher tests for continuous and categorical variables, respectively. Results: 136 patients (109 children and 27 young adults) were included in the study. Among children, 29 (27%) developed PFS, and all of them had tumors at midline site with invasion of the fourth ventricle. Radiological evidence of involvement of the right superior (39% versus 12%; p = 0.011) or middle cerebellar peduncles (52% versus 18%; p = 0.002) seemed more common in children who developed PFS. Young adults showed an expected lower incidence of PFS (4 out of 27; 15%), that may be due to anatomical, physiological and oncological elements. Conclusions: This study confirmed some factors known to be associated with PFS onset and shed light on other debated issues. Our findings enhance an already hypothesized role of cerebellar language lateralization. The analysis of a population of young adults may shed more light on the often-neglected existence of PFS in non-pediatric patients.

Published
2022

4. Defining activities in neurovascular microsurgery training: entrustable professional activities for vascular neurosurgery.

Author

Lieshout, J.H. van, Malzkorn, B., Steiger, H.J., Karadag, C., Kamp, Marcel A., Vajkoczy, P., Beck, J., Peschillo, S., Rohde, V., Walsh, D., Lukshin, V., Korja, M., Cenzato, M., Raabe, A., Gruber, A., Hänggi, D., Boogaarts, H.D., Lieshout, J.H. van, Malzkorn, B., Steiger, H.J., Karadag, C., Kamp, Marcel A., Vajkoczy, P., Beck, J., Peschillo, S., Rohde, V., Walsh, D., Lukshin, V., Korja, M., Cenzato, M., Raabe, A., Gruber, A., Hänggi, D., and Boogaarts, H.D.

Abstract

01 januari 2023, Item does not contain fulltext, BACKGROUND: Entrustable professional activities (EPAs) represent an assessment framework with an increased focus on competency-based assessment. Originally developed and adopted for undergraduate medical education, concerns over resident ability to practice effectively after graduation have led to its implementation in residency training but yet not in vascular neurosurgery. Subjective assessment of resident or fellow performance can be problematic, and thus, we aim to define core EPAs for neurosurgical vascular training. METHODS: We used a nominal group technique in a multistep interaction between a team of experienced neurovascular specialists and a medical educator to identify relevant EPAs. Panel members provided feedback on the EPAs until they reached consent. RESULTS: The process produced seven core procedural EPAs for vascular residency and fellowship training, non-complex aneurysm surgery, complex aneurysm surgery, bypass surgery, arteriovenous malformation resection, spinal dural fistula surgery, perioperative management, and clinical decision-making. CONCLUSION: These seven EPAs for vascular neurosurgical training may support and guide the neurosurgical society in the development and implementation of EPAs as an evaluation tool and incorporate entrustment decisions in their training programs.

Published
2023

5. Towards a common language in neurosurgical outcome evaluation: the NEON (NEurosurgical Outcome Network) proposal

Author

Ferroli, P, Schiavolin, S, Mariniello, A, Acerbi, F, Restelli, F, Schiariti, M, LA Corte, E, Falco, J, Levi, V, Dimeco, F, Assietti, R, Bongetta, D, Colombo, E, Bellocchi, S, Sangiorgi, S, Bistazzoni, S, Polosa, M, Orru, M, Spena, G, Bernucci, C, Sicignano, A, Fanti, A, Brembilla, C, Resmini, B, Costi, E, Cenzato, M, Talamonti, G, Bottini, G, Scarpa, P, Bollani, A, Querzola, M, Palmas, G, DE Gonda, F, Bosio, L, Egidi, M, Tardivo, V, Fioravanti, A, Subacchi, S, Fontanella, M, Biroli, A, Cereda, C, Panciani, P, Bergomi, R, Pertichetti, M, Tancioni, F, Bona, A, Tartara, F, Fornari, M, Pessina, F, Lasio, G, Cardia, A, Servadei, F, Riva, M, Casarotti, A, Giussani, C, Fiori, L, Mazzoleni, F, Vaiani, S, Carrabba, G, DI Cristofori, A, Sganzerla, E, Vimercati, A, Isella, V, Mauri, I, Incerti, M, Sicuri, G, Miramonti, V, Stefini, R, Spagnoli, D, Piparo, M, Grimod, G, Regazzoni, R, Vismara, D, Mazzeo, L, Monti, E, Franzin, A, Vivaldi, O, Maietti, A, Pini, E, Servello, D, Zekaj, E, DE Michele, S, Locatelli, M, Borsa, S, Grimoldi, N, Caroli, M, Tariciotti, L, Abete-Fornara, G, Vitale, M, Leonardi, M, Broggi, M, Ferroli, Paolo, Schiavolin, Silvia, Mariniello, Arianna, Acerbi, Francesco, Restelli, Francesco, Schiariti, Marco, LA Corte, Emanuele, Falco, Jacopo, Levi, Vincenzo, Dimeco, Francesco, Assietti, Roberto, Bongetta, Daniele, Colombo, Elena V, Bellocchi, Silvio, Sangiorgi, Simone, Bistazzoni, Simona, Polosa, Maria, Orru, Maria I, Spena, Giannantonio, Bernucci, Claudio, Sicignano, Angelo M, Fanti, Andrea, Brembilla, Carlo, Resmini, Bruno, Costi, Emanuele, Cenzato, Marco, Talamonti, Giuseppe, Bottini, Gabriella, Scarpa, Pina, Bollani, Alessandra, Querzola, Matteo, Palmas, Giulio, DE Gonda, Federico, Bosio, Lorenzo, Egidi, Marcello, Tardivo, Valentina, Fioravanti, Antonio, Subacchi, Sara, Fontanella, Marco, Biroli, Antonio, Cereda, Claudio, Panciani, Pier Paolo, Bergomi, Riccardo, Pertichetti, Marta, Tancioni, Flavio, Bona, Alberto, Tartara, Fulvio A, Fornari, Maurizio, Pessina, Federico, Lasio, Giovanni, Cardia, Andrea, Servadei, Franco, Riva, Marco, Casarotti, Alessandra, Giussani, Carlo, Fiori, Leonardo, Mazzoleni, Fabio, Vaiani, Simona, Carrabba, Giorgio, DI Cristofori, Andrea, Sganzerla, Erik P, Vimercati, Alberto, Isella, Valeria, Mauri, Ilaria, Incerti, Michele, Sicuri, Giovanni, Miramonti, Valentina, Stefini, Roberto, Spagnoli, Diego, Piparo, Maurizio, Grimod, Gianluca, Regazzoni, Rossana, Vismara, Daniela, Mazzeo, Lucio, Monti, Emanuele, Franzin, Alberto, Vivaldi, Oscar, Maietti, Alessandra, Pini, Elisa, Servello, Domenico, Zekaj, Edvin, DE Michele, Sara, Locatelli, Marco, Borsa, Stefano, Grimoldi, Nadia, Caroli, Manuela, Tariciotti, Leonardo, Abete-Fornara, Giorgia, Vitale, Mario, Leonardi, Matilde, Broggi, Morgan, Ferroli, P, Schiavolin, S, Mariniello, A, Acerbi, F, Restelli, F, Schiariti, M, LA Corte, E, Falco, J, Levi, V, Dimeco, F, Assietti, R, Bongetta, D, Colombo, E, Bellocchi, S, Sangiorgi, S, Bistazzoni, S, Polosa, M, Orru, M, Spena, G, Bernucci, C, Sicignano, A, Fanti, A, Brembilla, C, Resmini, B, Costi, E, Cenzato, M, Talamonti, G, Bottini, G, Scarpa, P, Bollani, A, Querzola, M, Palmas, G, DE Gonda, F, Bosio, L, Egidi, M, Tardivo, V, Fioravanti, A, Subacchi, S, Fontanella, M, Biroli, A, Cereda, C, Panciani, P, Bergomi, R, Pertichetti, M, Tancioni, F, Bona, A, Tartara, F, Fornari, M, Pessina, F, Lasio, G, Cardia, A, Servadei, F, Riva, M, Casarotti, A, Giussani, C, Fiori, L, Mazzoleni, F, Vaiani, S, Carrabba, G, DI Cristofori, A, Sganzerla, E, Vimercati, A, Isella, V, Mauri, I, Incerti, M, Sicuri, G, Miramonti, V, Stefini, R, Spagnoli, D, Piparo, M, Grimod, G, Regazzoni, R, Vismara, D, Mazzeo, L, Monti, E, Franzin, A, Vivaldi, O, Maietti, A, Pini, E, Servello, D, Zekaj, E, DE Michele, S, Locatelli, M, Borsa, S, Grimoldi, N, Caroli, M, Tariciotti, L, Abete-Fornara, G, Vitale, M, Leonardi, M, Broggi, M, Ferroli, Paolo, Schiavolin, Silvia, Mariniello, Arianna, Acerbi, Francesco, Restelli, Francesco, Schiariti, Marco, LA Corte, Emanuele, Falco, Jacopo, Levi, Vincenzo, Dimeco, Francesco, Assietti, Roberto, Bongetta, Daniele, Colombo, Elena V, Bellocchi, Silvio, Sangiorgi, Simone, Bistazzoni, Simona, Polosa, Maria, Orru, Maria I, Spena, Giannantonio, Bernucci, Claudio, Sicignano, Angelo M, Fanti, Andrea, Brembilla, Carlo, Resmini, Bruno, Costi, Emanuele, Cenzato, Marco, Talamonti, Giuseppe, Bottini, Gabriella, Scarpa, Pina, Bollani, Alessandra, Querzola, Matteo, Palmas, Giulio, DE Gonda, Federico, Bosio, Lorenzo, Egidi, Marcello, Tardivo, Valentina, Fioravanti, Antonio, Subacchi, Sara, Fontanella, Marco, Biroli, Antonio, Cereda, Claudio, Panciani, Pier Paolo, Bergomi, Riccardo, Pertichetti, Marta, Tancioni, Flavio, Bona, Alberto, Tartara, Fulvio A, Fornari, Maurizio, Pessina, Federico, Lasio, Giovanni, Cardia, Andrea, Servadei, Franco, Riva, Marco, Casarotti, Alessandra, Giussani, Carlo, Fiori, Leonardo, Mazzoleni, Fabio, Vaiani, Simona, Carrabba, Giorgio, DI Cristofori, Andrea, Sganzerla, Erik P, Vimercati, Alberto, Isella, Valeria, Mauri, Ilaria, Incerti, Michele, Sicuri, Giovanni, Miramonti, Valentina, Stefini, Roberto, Spagnoli, Diego, Piparo, Maurizio, Grimod, Gianluca, Regazzoni, Rossana, Vismara, Daniela, Mazzeo, Lucio, Monti, Emanuele, Franzin, Alberto, Vivaldi, Oscar, Maietti, Alessandra, Pini, Elisa, Servello, Domenico, Zekaj, Edvin, DE Michele, Sara, Locatelli, Marco, Borsa, Stefano, Grimoldi, Nadia, Caroli, Manuela, Tariciotti, Leonardo, Abete-Fornara, Giorgia, Vitale, Mario, Leonardi, Matilde, and Broggi, Morgan

Abstract

Background: The aim of this study was to achieve a consensus on the minimum set of outcome measures and predictors to be used in the neurosurgical practice and on the timing of outcome assessment. Methods: A consensus building approach was employed. All neurosurgical departments in Lombardy (Italy) were invited to participate by the Carlo Besta Neurologic Institute IRCCS Foundation. Three workshops were organized during which a multidisciplinary group called Neurosurgical Outcome Network (NEON) was created and the methodology to select outcome measures, predictors, and timing of outcome assessment was established. Eight working groups were created for the different neurosurgical diseases (neuro-oncological, skull base, vascular, traumatic, spinal, peripheral nervous system, malformation, functional) and 8 workshops were organized to identify the outcome measures and predictors specific for each of the neurosurgical diseases based on the experts' clinical practice and the existing literature. Results: A total of 20 neurosurgical departments participated in this study. Specific outcome measures, predictors and the timing of outcome assessment were identified for each of the 8 neurosurgical diseases. Moreover, a list of variables common to all pathologies were identified by the NEON group as further data to be collected. Conclusions: A consensus on the minimum set of outcome measures and predictors and the timing of outcome assessments for 8 neurosurgical diseases was achieved by a group of neurosurgeons of the Lombardy region, called NEON. These sets could be used in future studies for a more homogeneous data collection and as a starting point to reach further agreement also at national and international level.

Published
2023

6. May we deliver neuro-oncology in difficult times (e.g. COVID-19)?

Author

Perin, A, Servadei, F, Dimeco, F, Locatelli, M, Benazzo, M, Spena, G, Bernucci, C, Sganzerla, E, Egidi, M, Spagnoli, D, Giussani, C, Incerti, M, Lorusso, G, Stefini, R, Assietti, R, Bellocchi, S, Fornari, M, Skrap, M, Tartara, F, Vitale, M, Ferroli, P, Franzini, A, Silvani, A, Fontanella, M, Cenzato, M, Perin A., Servadei F., DiMeco F., Locatelli M., Benazzo M., Spena G., Bernucci C., Sganzerla E., Egidi M., Spagnoli D., Giussani C., Incerti M., Lorusso G., Stefini R., Assietti R., Bellocchi S., Fornari M., Skrap M., Tartara F., Vitale M., Ferroli P., Franzini A., Silvani A., Fontanella M., Cenzato M., Perin, A, Servadei, F, Dimeco, F, Locatelli, M, Benazzo, M, Spena, G, Bernucci, C, Sganzerla, E, Egidi, M, Spagnoli, D, Giussani, C, Incerti, M, Lorusso, G, Stefini, R, Assietti, R, Bellocchi, S, Fornari, M, Skrap, M, Tartara, F, Vitale, M, Ferroli, P, Franzini, A, Silvani, A, Fontanella, M, Cenzato, M, Perin A., Servadei F., DiMeco F., Locatelli M., Benazzo M., Spena G., Bernucci C., Sganzerla E., Egidi M., Spagnoli D., Giussani C., Incerti M., Lorusso G., Stefini R., Assietti R., Bellocchi S., Fornari M., Skrap M., Tartara F., Vitale M., Ferroli P., Franzini A., Silvani A., Fontanella M., and Cenzato M.

Published
2020

7. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)—part 2

Author

Picetti, E, Barbanera, A, Bernucci, C, Bertuccio, A, Bilotta, F, Boccardi, E, Cafiero, T, Caricato, A, Castioni, C, Cenzato, M, Chieregato, A, Citerio, G, Gritti, P, Lanterna, L, Menozzi, R, Munari, M, Panni, P, Rossi, S, Stocchetti, N, Sturiale, C, Zoerle, T, Zona, G, Rasulo, F, Robba, C, Picetti, Edoardo, Barbanera, Andrea, Bernucci, Claudio, Bertuccio, Alessandro, Bilotta, Federico, Boccardi, Edoardo Pietro, Cafiero, Tullio, Caricato, Anselmo, Castioni, Carlo Alberto, Cenzato, Marco, Chieregato, Arturo, Citerio, Giuseppe, Gritti, Paolo, Lanterna, Luigi, Menozzi, Roberto, Munari, Marina, Panni, Pietro, Rossi, Sandra, Stocchetti, Nino, Sturiale, Carmelo, Zoerle, Tommaso, Zona, Gianluigi, Rasulo, Frank, Robba, Chiara, Picetti, E, Barbanera, A, Bernucci, C, Bertuccio, A, Bilotta, F, Boccardi, E, Cafiero, T, Caricato, A, Castioni, C, Cenzato, M, Chieregato, A, Citerio, G, Gritti, P, Lanterna, L, Menozzi, R, Munari, M, Panni, P, Rossi, S, Stocchetti, N, Sturiale, C, Zoerle, T, Zona, G, Rasulo, F, Robba, C, Picetti, Edoardo, Barbanera, Andrea, Bernucci, Claudio, Bertuccio, Alessandro, Bilotta, Federico, Boccardi, Edoardo Pietro, Cafiero, Tullio, Caricato, Anselmo, Castioni, Carlo Alberto, Cenzato, Marco, Chieregato, Arturo, Citerio, Giuseppe, Gritti, Paolo, Lanterna, Luigi, Menozzi, Roberto, Munari, Marina, Panni, Pietro, Rossi, Sandra, Stocchetti, Nino, Sturiale, Carmelo, Zoerle, Tommaso, Zona, Gianluigi, Rasulo, Frank, and Robba, Chiara

Abstract

Background Questions remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance regarding this topic. Specifically, in this manuscript (part 2), we aim to provide a list of experts’ recommendations regarding the management of SAH patients in a center with neurosurgical/neuroendovascular facilities after aneurysm treatment. Methods A multidisciplinary consensus panel composed by 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted. Results A total of 33 statements were discussed, voted, and approved. Consensus was reached on 30 recommendations (28 strong and 2 weak). In 3 cases, where consensus could not be agreed upon, no recommendation was provided. Conclusions This consensus provides practical recommendations (and not mandatory standard of practice) to support clinician’s decision-making in the management of SAH patients in centers with neurosurgical/neuroendovascular facilities after aneurysm securing.

Published
2022

8. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)–Part 1

Author

Picetti, E, Barbanera, A, Bernucci, C, Bertuccio, A, Bilotta, F, Boccardi, E, Cafiero, T, Caricato, A, Castioni, C, Cenzato, M, Chieregato, A, Citerio, G, Gritti, P, Lanterna, L, Menozzi, R, Munari, M, Panni, P, Rossi, S, Stocchetti, N, Sturiale, C, Zoerle, T, Zona, G, Rasulo, F, Robba, C, Picetti, Edoardo, Barbanera, Andrea, Bernucci, Claudio, Bertuccio, Alessandro, Bilotta, Federico, Boccardi, Edoardo Pietro, Cafiero, Tullio, Caricato, Anselmo, Castioni, Carlo Alberto, Cenzato, Marco, Chieregato, Arturo, Citerio, Giuseppe, Gritti, Paolo, Lanterna, Luigi, Menozzi, Roberto, Munari, Marina, Panni, Pietro, Rossi, Sandra, Stocchetti, Nino, Sturiale, Carmelo, Zoerle, Tommaso, Zona, Gianluigi, Rasulo, Frank, Robba, Chiara, Picetti, E, Barbanera, A, Bernucci, C, Bertuccio, A, Bilotta, F, Boccardi, E, Cafiero, T, Caricato, A, Castioni, C, Cenzato, M, Chieregato, A, Citerio, G, Gritti, P, Lanterna, L, Menozzi, R, Munari, M, Panni, P, Rossi, S, Stocchetti, N, Sturiale, C, Zoerle, T, Zona, G, Rasulo, F, Robba, C, Picetti, Edoardo, Barbanera, Andrea, Bernucci, Claudio, Bertuccio, Alessandro, Bilotta, Federico, Boccardi, Edoardo Pietro, Cafiero, Tullio, Caricato, Anselmo, Castioni, Carlo Alberto, Cenzato, Marco, Chieregato, Arturo, Citerio, Giuseppe, Gritti, Paolo, Lanterna, Luigi, Menozzi, Roberto, Munari, Marina, Panni, Pietro, Rossi, Sandra, Stocchetti, Nino, Sturiale, Carmelo, Zoerle, Tommaso, Zona, Gianluigi, Rasulo, Frank, and Robba, Chiara

Abstract

Background: Issues remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI). In this manuscript, we aim to provide a list of experts’ recommendations regarding the early management of SAH patients from hospital admission, in a center with neurosurgical/neuro-endovascular facilities, until securing of the bleeding aneurysm. Methods: A multidisciplinary consensus panel composed of 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different background (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted. Results: Among 19 statements discussed. The consensus was reached on 18 strong recommendations. In one case, consensus could not be agreed upon and no recommendation was provided. Conclusions: This consensus provides practical recommendations for the management of SAH patients in hospitals with neurosurgical/neuroendovascular facilities until aneurysm securing. It is intended to support clinician’s decision-making and not to mandate a standard of practice.

Published
2022

9. Resection of the internal carotid artery in selected patients affected by cancer of the skull base

Author

Ferrari, M., Zanoletti, E., Taboni, S., Cazzador, D., Tealdo, G., Schreiber, A., Mattavelli, D., Rampinelli, V., Doglietto, Francesco, Fontanella, M. M., Buffoli, B., Vural, A., Verzeletti, V., Carobbio, A. L. C., Mardighian, D., Causin, F., Orlandi, E., Cenzato, M., Rezzani, R., Nicolai, P., Doglietto F. (ORCID:0000-0002-7438-0734), Ferrari, M., Zanoletti, E., Taboni, S., Cazzador, D., Tealdo, G., Schreiber, A., Mattavelli, D., Rampinelli, V., Doglietto, Francesco, Fontanella, M. M., Buffoli, B., Vural, A., Verzeletti, V., Carobbio, A. L. C., Mardighian, D., Causin, F., Orlandi, E., Cenzato, M., Rezzani, R., Nicolai, P., and Doglietto F. (ORCID:0000-0002-7438-0734)

Abstract

Invasion of the internal carotid artery (ICA) has been historically considered a criterion of non-resectability of skull base cancer (SBC). Patients affected by SBC who underwent surgery including resection of ICA at two tertiary institutions were included. Demographics, oncologic, and surgical information, complications, and survival outcomes were retrospectively reviewed. Survival outcomes were calculated. Ten patients were included. Three surgical approaches (transnasal endoscopic, transorbital, and transpetrosal) were employed to resect the invaded/abutted tract(s) of the ICA. All patients underwent ICA temporary balloon occlusion test. In two patients, an extracranial-to-intracranial arterial bypass was harvested. Major neuromorbidity was observed in two patients. Perioperative mortality of the series was 10.0%. Mean overall survival was 27.2 months, with 2-year overall and progression-free survival rate of 88.9%. ICA resection is feasible as part of the ablation performed for very advanced SBCs. Survival outcomes are acceptable in adequately selected patients.

Published
2022

10. Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

Author

Fiorindi, A., Vezzoli, M., Doglietto, Francesco, Zanin, L., Saraceno, G., Agosti, E., Barbieri, A., Bellocchi, S., Bernucci, C., Bongetta, D., Cardia, A., Costi, E., Egidi, M., Fioravanti, A., Gasparotti, R., Giussani, C., Grimod, G., Latronico, N., Locatelli, D., Mardighian, D., Nodari, G., Poli, J. C., Rasulo, F., Roca, E., Sicuri, G. M., Spena, G., Stefini, R., Vivaldi, O., Zoia, C., Calza, S., Fontanella, Marco Maria, Cenzato, M., Doglietto F. (ORCID:0000-0002-7438-0734), Fontanella M. M., Fiorindi, A., Vezzoli, M., Doglietto, Francesco, Zanin, L., Saraceno, G., Agosti, E., Barbieri, A., Bellocchi, S., Bernucci, C., Bongetta, D., Cardia, A., Costi, E., Egidi, M., Fioravanti, A., Gasparotti, R., Giussani, C., Grimod, G., Latronico, N., Locatelli, D., Mardighian, D., Nodari, G., Poli, J. C., Rasulo, F., Roca, E., Sicuri, G. M., Spena, G., Stefini, R., Vivaldi, O., Zoia, C., Calza, S., Fontanella, Marco Maria, Cenzato, M., Doglietto F. (ORCID:0000-0002-7438-0734), and Fontanella M. M.

Abstract

Background: Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods: In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results: Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value = 0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p-values < 0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. Conclusions: We documented a significantly increased “diagnostic delay” for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was expe

Published
2022

15. May we deliver neuro-oncology in difficult times (e.g. COVID-19)?

Author

Perin, A., Servadei, F., Dimeco, F., Locatelli, M., Benazzo, M., Spena, G., Bernucci, C., Sganzerla, E., Egidi, M., Spagnoli, D., Giussani, C., Incerti, M., Lorusso, G., Stefini, R., Assietti, R., Bellocchi, S., Fornari, M., Skrap, M., Tartara, F., Vitale, M., Ferroli, P., Franzini, A., Silvani, A., Fontanella, M., Cenzato, M., Perin, A, Servadei, F, Dimeco, F, Locatelli, M, Benazzo, M, Spena, G, Bernucci, C, Sganzerla, E, Egidi, M, Spagnoli, D, Giussani, C, Incerti, M, Lorusso, G, Stefini, R, Assietti, R, Bellocchi, S, Fornari, M, Skrap, M, Tartara, F, Vitale, M, Ferroli, P, Franzini, A, Silvani, A, Fontanella, M, and Cenzato, M

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Cancer Research, Coronavirus disease 2019 (COVID-19), Neuro oncology, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Viral transmission, Clinical Neurology, Medical Oncology, Brain Neoplasm, Betacoronavirus, medicine, Disease Transmission, Infectious, Humans, Medical physics, Pandemics, Betacoronaviru, Pandemic, business.industry, Brain Neoplasms, Coronavirus Infection, SARS-CoV-2, COVID-19, Oncology, Disease Transmission, Infectiou, Neurology, Neurology (clinical), business, Coronavirus Infections, Disease transmission, Delivery of Health Care, Human
Published
2020

19. Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital without neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)

Author

Picetti, E, Berardino, M, Bertuccio, A, Bertuetti, R, Boccardi, E, Caricato, A, Castioni, C, Cenzato, M, Chieregato, A, Citerio, G, Gritti, P, Longhi, L, Martino, C, Munari, M, Rossi, S, Stocchetti, N, Zoerle, T, Rasulo, F, Robba, C, Picetti, Edoardo, Berardino, Maurizio, Bertuccio, Alessandro, Bertuetti, Rita, Boccardi, Edoardo Pietro, Caricato, Anselmo, Castioni, Carlo Alberto, Cenzato, Marco, Chieregato, Arturo, Citerio, Giuseppe, Gritti, Paolo, Longhi, Luca, Martino, Costanza, Munari, Marina, Rossi, Sandra, Stocchetti, Nino, Zoerle, Tommaso, Rasulo, Frank, Robba, Chiara, Picetti, E, Berardino, M, Bertuccio, A, Bertuetti, R, Boccardi, E, Caricato, A, Castioni, C, Cenzato, M, Chieregato, A, Citerio, G, Gritti, P, Longhi, L, Martino, C, Munari, M, Rossi, S, Stocchetti, N, Zoerle, T, Rasulo, F, Robba, C, Picetti, Edoardo, Berardino, Maurizio, Bertuccio, Alessandro, Bertuetti, Rita, Boccardi, Edoardo Pietro, Caricato, Anselmo, Castioni, Carlo Alberto, Cenzato, Marco, Chieregato, Arturo, Citerio, Giuseppe, Gritti, Paolo, Longhi, Luca, Martino, Costanza, Munari, Marina, Rossi, Sandra, Stocchetti, Nino, Zoerle, Tommaso, Rasulo, Frank, and Robba, Chiara

Abstract

Background: The immediate management of subarachnoid hemorrhage (SAH) patients in hospitals without neurosurgical/neurointerventional facilities and their transfer to a specialized center is challenging and not well covered in existing guidelines. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance. Methods: A multidisciplinary consensus panel composed by 19 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery and interventional neuroradiology) was created. A modified Delphi approach was adopted. Results: A total of 14 statements have been discussed. Consensus was reached on 11 strong recommendations and 2 weak recommendations. In one case, where consensus could not be agreed upon, no recommendation could be provided. Conclusions: Management of SAH in a non-specialized setting and early transfer are difficult and may have a critical impact on outcome. Clinical advice, based on multidisciplinary consensus, might be helpful. Our recommendations cover most, but not all, topics of clinical relevance

Published
2021

20. When Is Diagnostic Subtraction Angiography Indicated Before Clipping of Unruptured and Ruptured Intracranial Aneurysms? An International Survey of Current Practice

Author

Esposito, Giuseppe, Regli, Luca, Cenzato, Marco, Kaku, Yasuhiko, Tanaka, Michihiro, Tsukahara, Tetsuya, Esposito, G ( Giuseppe ), Regli, L ( Luca ), Cenzato, M ( Marco ), Kaku, Y ( Yasuhiko ), Tanaka, M ( Michihiro ), Tsukahara, T ( Tetsuya ), Sebök, Martina; https://orcid.org/0000-0002-7246-3421, Dufour, Jean-Philippe, Esposito, Giuseppe, Regli, Luca, Cenzato, Marco, Kaku, Yasuhiko, Tanaka, Michihiro, Tsukahara, Tetsuya, Esposito, G ( Giuseppe ), Regli, L ( Luca ), Cenzato, M ( Marco ), Kaku, Y ( Yasuhiko ), Tanaka, M ( Michihiro ), Tsukahara, T ( Tetsuya ), Sebök, Martina; https://orcid.org/0000-0002-7246-3421, and Dufour, Jean-Philippe

Abstract

Introduction: The goal of this survey is to investigate the indications for preoperative digital subtraction angiography (DSA) before clipping of ruptured and unruptured intracranial aneurysms in an international panel of neurovascular specialists. Methods: An anonymous survey of 23 multiple-choice questions relating to indications for DSA before clipping of an intracranial aneurysm was distributed to the international panel of attendees of the European-Japanese Cerebrovascular Congress (EJCVC), which took place in Milan, Italy on 7–9 June 2018. The survey was collected during the same conference. Descriptive statistics were used to analyze the data. Results: A total of 93 surveys were distributed, and 67 (72%) completed surveys were returned by responders from 13 different countries. Eighty-five percent of all responders were neurosurgeons. For unruptured and ruptured middle cerebral artery (MCA) aneurysms without life-threatening hematoma, approximately 60% of responders perform surgery without preoperative DSA. For aneurysms in other locations than MCA, microsurgery is done without preoperative DSA in 68% of unruptured and in 73% of ruptured cases. In cases of ruptured MCA or ruptured non-MCA aneurysms with life-threatening hematoma, surgery is performed without DSA in 97% and 96% of patients, respectively. Factors which lead to preoperative DSA being performed were: aneurysmal shape (fusiform, dissecting), etiology (infectious), size (>25 mm), possible presence of perforators or efferent vessels arising from the aneurysm, intra-aneurysmal thrombus, previous treatment, location (posterior circulation and paraclinoid aneurysm) and flow-replacement bypass contemplated for final aneurysm treatment. These are all factors that qualify an aneurysm as a complex aneurysm. Conclusion: There is still a high variability in the surgeons’ preoperative workup regarding the indication for DSA before clipping of ruptured and unruptured intracranial aneurysms, except for ruptured

Published
2021

21. Intraoperative BOLD-fMRI Cerebrovascular Reactivity Assessment

Author

Esposito, Guiseppe, Regli, Luca, Cenzato, Marco, Kaku, Yasuhiko, Tanaka, Michihiro, Tsukahara, Tetsuya, Esposito, G ( Guiseppe ), Regli, L ( Luca ), Cenzato, M ( Marco ), Kaku, Y ( Yasuhiko ), Tanaka, M ( Michihiro ), Tsukahara, T ( Tetsuya ), Muscas, Giovanni; https://orcid.org/0000-0002-6155-2891, van Niftrik, Christiaan Hendrik Bas, Sebök, Martina; https://orcid.org/0000-0002-7246-3421, Esposito, Giuseppe, Fierstra, Jorn, Esposito, Guiseppe, Regli, Luca, Cenzato, Marco, Kaku, Yasuhiko, Tanaka, Michihiro, Tsukahara, Tetsuya, Esposito, G ( Guiseppe ), Regli, L ( Luca ), Cenzato, M ( Marco ), Kaku, Y ( Yasuhiko ), Tanaka, M ( Michihiro ), Tsukahara, T ( Tetsuya ), Muscas, Giovanni; https://orcid.org/0000-0002-6155-2891, van Niftrik, Christiaan Hendrik Bas, Sebök, Martina; https://orcid.org/0000-0002-7246-3421, Esposito, Giuseppe, and Fierstra, Jorn

Abstract

Blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) has gained attention in recent years as an effective way to investigate CVR, a measure of the hemodynamic state of the brain, with high spatial and temporal resolution. An association between impaired CVR and diverse pathologies has been observed, especially in ischemic cerebrovascular diseases and brain gliomas. The ability to obtain this information intraoperatively is novel and has not been widely tested. We report our first experience with this intraoperative technique in vascular and oncologic neurosurgical patients, discuss the results of its feasibility, and the possible developments of the intraoperative employment of BOLD-CVR.

Published
2021

22. Trends in Cerebrovascular Surgery and Interventions

Author

Esposito, Giuseppe, Regli, Luca, Cenzato, Marco, Kaku, Yasuhiko, Tanaka, Michihiro, Tsukahara, Tetsuya, Esposito, G ( Giuseppe ), Regli, L ( Luca ), Cenzato, M ( Marco ), Kaku, Y ( Yasuhiko ), Tanaka, M ( Michihiro ), Tsukahara, T ( Tetsuya ), Esposito, Giuseppe, Regli, Luca, Cenzato, Marco, Kaku, Yasuhiko, Tanaka, Michihiro, Tsukahara, Tetsuya, Esposito, G ( Giuseppe ), Regli, L ( Luca ), Cenzato, M ( Marco ), Kaku, Y ( Yasuhiko ), Tanaka, M ( Michihiro ), and Tsukahara, T ( Tetsuya )

Abstract

This is an open access proceeding book of 9th European-Japanese Cerebrovascular Congress at Milan 2018. Since many experts from Europe and Japan had very important and fruitful discussion on the management of Cerebrovascular diseases, the proceeding book is very attractive for the physician and scientists of the area.

Published
2021

26. Trauma

Author

Ruiz-Lopez M. J., Serrano-Gonzalez A., Ruíz-Beltran A., Garcia-Perez J., Casado-Flores J., da Costa, R. B. Carrington, Pimentel, J., Rebelo, A., Costa, J. J., Sousa, J. P. A., Femandes, V., Simões, A., Robalo-Cordeiro, C., Mesqulta, L., Berrarda, R. Azevedo, Beretta L., Citerio G., Dell’Acqua A., Napolitano L., Frascoli C., Cenzato M., Anzalone N., Charpentier, C., Audibert, G., Garric, J., Welfringer, P., Laxenaire, M. C., Mata, G. Vazquez, Aragon, A. Perez, Fernandez, R. Rivera, Navarro, P. Navarrete, Mondejar, E. Fernandez, Ferrón, F. Ruiz, Barth, J., Hochhaus, G., Möllmann, H. W., Schumann, F., Bötel, U., Winden, E. v., Derendorf, H., Velasco, P., Domingo, C., Rincón, R., Tomás, R., Esquirol, J., Armengol, S., Gener, J., Djordjević Ž., Antunović V., Nestorović B., Djurović B., Jovanović I., Talvik, R., O’Konnel-Bronina, N., Huping, Zhou, Zhongmin, Hou, Quesada, A., Teja, J. L., Serrano, J., Rabanal, J. M., Espadas, F. L., Herrera, S. G., Regañon, G. D., Garrido, C., Kremžar, B., Špec-Marn, A., Burja, H., Toš, L., Ciaglia, P., Barron, J., Graniero, K., Marx, W., Tran, D. D., Cuesta, M. A., van Leeuwen, P. A. M., Wesdorp, R. I. C., Mavrocordatos, P., Chiolero, R., Revelly, J. -P., Cayeux, C., Livio, J. -J., Bui-Xuan, B., Godard, Guillaume, C., Vedrinne, J. M., Bachmann, P., Allaouchiche, B., and Reverdy, M. E.

Published
1992
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36. Position statement from the Italian Society of Neurosurgery on the ARUBA Study

Author

Cenzato, M., Delitala, A., Delfini, R., Pasqualin, A., Maira, G., Vincenzo Esposito, Tomasello, F., and Boccardi, E.

Subjects
Intracranial Arteriovenous Malformations, Clinical Trials as Topic, Italy, Neurosurgery, Humans
Abstract

As the conclusions of the ARUBA Study are strongly oriented towards therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study might have on the health of patients, if not properly evaluated. The vast majority of patients (76-81%) included in the study was treated with endovascular or radiotherapy treatments, alone or in combination. Only 18 patients (19%) had surgery. It is well known that a partial treatment of arteriovenous malformations (AVMs), as is often the case with endovascular therapy, may increase the risk of bleeding. The primary endpoint (death or symptomatic stroke) in the treated group was reached in 30.7%, i.e. almost one-third of the subjects. This has no comparison in the current surgical literature. Considering permanent and transient neurological deficits along with headaches and seizures all together in the same outcome evaluation parameter may be inappropriate and misleading. The graph with all results from the ARUBA Study, which claims to be the demonstration that natural history is better that treatment, clearly shows that what is assumed to be treated has not actually been treated. If death or stroke occur a few years from treatment, it only means that the disease was not cured and patients received a partial - therefore ineffective, if not dangerous - treatment. An effective treatment, as surgery is, must have a flat follow-up curve. The ARUBA Study shows that incomplete treatment leads to negative outcome, confirming that an integrated multidisciplinary strategy has to be plotted out before starting any treatment and that a complete exclusion of the AVM must be achieved.

Published
2015

37. Unruptured vs ruptured cerebral AVMs: a critical analysis

Author

Cenzato, M, Debernardi, A, Piparo, M, Tartara, F, Stefini, R, Ducati, A, and Lanterna, LA

Subjects
ddc: 610, 610 Medical sciences, Medicine
Abstract

Objective: We analyzed multicenter data of surgical treatment for cerebral unruptured and ruptured AVMs with particular attention for patients' functional outcome in relation to the recent ARUBA Study. Method: We retrospectively reviewed a database of cerebral unruptured and ruptured AVMs surgically[for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Published
2015
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38. Pre-surgical endovascular embolization of cerebral AVMs as a targeted treatment

Author

Cenzato, M, Debernardi, A, Piparo, M, Boccardi, E, Valvassori, L, and Piano, M

Subjects
surgical procedures, operative, ddc: 610, cardiovascular system, cardiovascular diseases, 610 Medical sciences, Medicine
Abstract

Objective: Nidal penetration and obliteration was the aim of endovascular pre-operative treatment for severals years, otherwise we presented here a different treatment "strategy" where endovascular embolization is directed at specific angiographic target areas. The aim of pre-surgical endovascular[for full text, please go to the a.m. URL], 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Published
2015
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41. Chemokine detection in the cerebral tissue of patients with posttraumatic brain contusions RID C-1447-2009 RID B-3413-2009 RID F-1557-2010

Author

Stefini R, Catenacci E, Piva S, Sozzani S, Valerio A, Bergomi R, Cenzato M, Latronico N., MORTINI , PIETRO, Stefini, R, Catenacci, E, Piva, S, Sozzani, S, Valerio, A, Bergomi, R, Cenzato, M, Mortini, Pietro, and Latronico, N.

Abstract

Object. The clinical outcome of patients with severe head injuries is still critically dependent on their secondary injuries. Although hypoxia and hypotension appear to mediate a substantial proportion of secondary injuries, many studies associate secondary brain injury with neuroinflammatory responses. Chemokines have been detected in the cerebrospinal fluid but not in the brain tissue of patients with head trauma. This study was performed to determine if chemokines were expressed in pericontusional brain tissue in patients with moderate or severe head trauma who underwent surgical evacuation of their brain contusions. Methods. Twelve patients with posttraumatic cerebral contusion requiring a surgical evacuation were studied. A 20- to 40-mg sample of white matter was removed from the surgical cavity in the pericontusional area. Two patients undergoing elective surgery for clip ligation of an unruptured aneurysm were used as controls. The median interval from trauma to biopsy procedure was 44 hours (range 3-360 hours). Total RNA was isolated from these samples and a ribonuclease protection assay was performed to measure the mRNA levels of several chemokines: CCL2, CCL3, CCL4, CCL5, CXCL8, CXCL10, and XCL1. Results. The CCL2, a monocyte chemoattractant produced by activated astrocytes, was the most strongly expressed chemokine, followed by CXCL8, CCL3, and CCL4. The chemokines CXCL10 and CCL5 were expressed at very low levels, and XCL1 was not detected. Conclusions. Chemokine activation occurs early after moderate or severe head trauma and is maintained for several days after trauma. This event may contribute to neuroinflammatory exacerbation of posttraumatic brain damage in the pericontusional brain tissue.

Published
2008

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