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Background: At global level, the vulnerability of aquifers is deteriorating at an alarming rate due to environmental pollution and intensive human activities. In this context, Local Health Authority ASL Lecce has launched the M.I.N.O.Re. (Not Compulsory Water Monitoring Activities at Regional level) project, in order to assess the vulnerability of the aquifer in Salento area (Puglia Region) by performing several non-compulsory analyses on groundwater samples. This first paper describes the quali-quantitative approach adopted under the M.I.N.O.Re. project for the assessment of environmental pressures suffered by groundwater and determines the number of wells to be monitored in specific sampling areas on the basis of the local potential contamination and vulnerability of the aquifer. Methods: We created a map of the entire Lecce province, interpolating it with a grid that led to the subdivision of the study area in 32 quadrangular blocks measuring 10 km × 10 km. Based on current hydrogeological knowledge and institutional data, we used GIS techniques to represent on these 32 blocks the 12 different layers corresponding to the main anthropic or environmental type of pressures potentially impacting on the aquifer. To each kind of pressure, a score from 0 to 1 was attributed on the basis of the potential impact on groundwater. A total score was assigned to each of the 32 blocks. A higher number of wells was selected to be monitored in those blocks presenting higher risk scores for possible groundwater contamination due to anthropic/environmental pressures. Results: The range of total scores varied from 2.4 to 42.5. On the basis of total scores, the 10 km × 10 km blocks were divided into four classes of environmental pressure (1st class: from 0,1 to 10,00; 2nd class: from 10,01 to 20,00; 3rd class: from 20,1 to 30,00; 4th class: from 30,01 to 42,50). There were 11 areas in the 1st class, 9 areas in the 2nd class, 8 areas in the 3rd class and 4 areas in the 4th class. We assigned 1 monitoring well in 1st class areas, 2 monitoring wells in 2nd class areas, 3 monitoring wells in 3rd class areas and 4 monitoring wells in 4th class areas. Conclusion: The methodology developed under the M.I.N.O.Re. project could represent a useful model to be used in other areas to assess the environmental pressures suffered by aquifers and the quality of the groundwater.

Objective: To assess usefulness and limitations of flexible fiber carbon dioxide (CO 2 ) laser in the microsurgical treatment of intraventricular tumors., Methods: We reviewed a series of 9 patients treated with microsurgical resection of intraventricular tumors using a flexible fiber CO 2 laser. The lesions involved the third ventricle (8) and the frontal horn of the right lateral ventricle (1). Histology revealed 6 craniopharyngiomas, 1 pituitary macroadenoma, 1 subependymoma, and 1 neurocytoma. In all cases, an interhemispheric transcallosal approach was performed. The laser was used during callosotomy, fornix column sectioning, tumor debulking, and to facilitate tumor dissection. We used a 5-tiered score system to assess laser's efficacy in each surgical step (approach, dissection, debulking): grade 1: laser was not at all helpful, grade 5: laser was extremely helpful. Limits of the instrument also are discussed., Results: Gross total resection was achieved in 6 cases and subtotal resection in the remaining 3. Three patients had pulmonary complications treated without clinical sequelae. No laser-related complication was described. Mean utility score observed was 4.2 (range 3-5) during approach, 2.8 (range 2-4) during tumor dissection; and 3.3 (range 2-5) during tumor debulking. Main limits were low hemostatic effect and inefficiency versus calcified and highly vascularized tumors., Conclusions: The CO 2 laser proved to be a useful and safe tool that could be used for intraventricular pathology; its design is suitable for narrow surgical corridors like interhemispheric fissure and foramen of Monro; its main utility is the ability to create precise and relatively bloodless cut (callosotomy, tumor debulking); low hemostatic effect is its main limit., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The use of intraoperative ultrasound (iUS) has increased in the last 15 years becoming a standard tool in many neurosurgical centers. Our aim was to assess the utility of routine use of iUS during various types of intracranial surgery. We reviewed our series to assess ultrasound visibility of different pathologies and iUS applications during the course of surgery., Materials and Methods: This is a retrospective review of 162 patients who underwent intracranial surgery with assistance of the iUS guidance system (SonoWand). Pathologic categories were neoplastic (135), vascular (20), infectious (2), and CSF related (5). Ultrasound visibility was assessed using the Mair classification, a four-tiered grading system that considers the echogenicity of the lesion and its border visibility (from 0 to 3; grade 0, pathology not visible; grade 3, visible with clear border with normal tissue). iUS applications included lesion localization, approach planning to deep-seated lesions, and lesion removal., Results: All pathologies were visible on iUS except one aneurysm. On average, extra-axial tumors were identified more easily and had clearer limits compared to intra-axial tumors (extra-axial 17% grade 2, 83% grade 3; intra-axial 5.5% grade 1, 46.5% grade 2, 48% grade 3). iUS provided precise and safe transcortical trajectories to deep-seated lesions (71 patients; tumors, hemangiomas, ICHs); iUS was judged to be less useful to approach skull base tumors and aneurysms. iUS was used to judge extent of resection in 152 cases; surgical artifacts reduced sonographic visibility in 25 cases: extent of resection was correctly checked in 127 patients (53 gliomas, 15 metastases, 39 meningiomas, 4 schwannomas, 4 sellar region tumors, 6 hemangiomas, 3 AVMs, 2 abscesses)., Conclusions: iUS was highly sensitive in detecting all types of pathology, was safe and precise in planning trajectories to intraparenchymal lesions (including minimally mini-invasive approaches), and was accurate in checking extent of resection in more than 80% of cases. iUS is a versatile and feasible tool; it could improve safety and its use may be considered in routine intracranial surgery.

Endoscopic third ventriculostomy (ETV) is considered a safe technique for the treatment of obstructive hydrocephalus. We describe a case of chronic subdural haematoma (CSDH) after ETV, revealed by MRI four weeks after the procedure, and requiring surgical evacuation, in a 69 y.o. asymptomatic male patient. In our opinion, overdrainage may evolve also in endoscopic treatment of obstructive hydrocephalus. This complication could be the starting point of the subdural collection. We review the literature and discuss the causes that may lead to CSDH after ETV procedure., (Copyright 2004 Springer-Verlag)

Endoscopic third ventriculostomy is considered a safe technique for the treatment of obstructive hydrocephalus. However, the literature contains several reports of complications related to this procedure. We describe a case of chronic subdural hematoma (CSDH) after ETV, which required surgical evacuation, in a 69-year-old male patient completely asymptomatic up to the control MRI four weeks after the operation. We believe this unusual complication could result from the ICP changes caused by ETV. In our opinion, successful ETV gives a boost to CSF absorption, and overdrainage may evolve also in endoscopic treatment of obstructive hydrocephalus. This situation could be the starting point of the subdural collection. We review the literature and discuss the causes that may lead to CSDH after ETV procedure.

After reading reports of successful neuroendoscopic treatment of hydrocephalus, colloid cysts and arachnoid cysts as well as tumor biopsy, we started using endoscopic procedures in our Department, one year ago. One surgeon (E.S.) skilled in the Decq Endoscope, performed a series of sixteen procedures, from January 2001 to March 2002 (in patients aged 28 to 69 years). The most common pathology was obstructive hydrocephalus (14 cases), one was colloid cyst, and the last case was tumor biopsy. The surgical treatment consisted of third ventriculostomy, cyst opening and shrinking and tumor biopsy. In fourteen patients treated for hydrocephalus with third ventriculostomy (ETV), one required a definitive shunt. Complication occurred in one case with chronic subdural collection. We further report one case of aqueductal restoration after third ventriculostomy. Our results, with no neurological deficits or deaths, confirmed our opinion that neuroendoscopy is a safe surgical technique in well-selected patients and we believe it is the ideal treatment in obstructive hydrocephalus.

We report an asymptomatic case of a large calcified chronic subdural hematoma (CCSH). Skull X-ray examination, computer tomography (CT) and magnetic resonance imaging (MRI), showed an adhering calcification extending to the whole cerebral cortex, as if the skull had another concentric skull inside it. These radiological findings recall the famous Russian doll named "Matrioska"; for this reason we defined this case "Matrioska head". The patient was absolutely asymptomatic and we discuss the causes that may give the calcification of chronic subdural hematoma (CSH).

Chlamydia pneumoniae infection is a common event in neurological patients and recovery of C. pneumoniae DNA in the cerebrospinal fluids (CSF) of multiple sclerosis (MS) patients could represent an epiphenomenon. We assessed the relevance of C. pneumoniae infection in 62 CSF samples from 32 MS patients and 30 neurological controls by means of PCR, immunofluorescence microscopy, enzyme-linked fluorescence and antibody detection. Multiple sclerosis (9.3%) and neurological controls (13.3) had similar percentage of anti-C. pneumoniae antibodies. However, C. pneumoniae DNA was only detectable in MS patients' CSF (9.3%). Our data support the hypothesis that C. pneumoniae persistence in some MS patients may be the result of an impaired clearance within the central nervous system.

The case is reported of a 49-year-old man with a giant infratentorial extradural epidermoid tumour, with cervical syringomyelia and hydrocephalus, and partial protrusion of the cerebellar tonsils through the foramen magnum. The patient complained of symptoms of raised intracranial pressure and was admitted to our Department, where ventriculoperitoneal shunting and total removal of the epidermoid tumour were performed. One year later, MR imaging demonstrated collapse of the cervical syringomyelia.

The indications and the results of different surgical procedures for the management of intracranial abscesses are dealt in a cooperative study. Two series, amounting 68 patients altogether, collected in epidemiologically homogeneous areas with high percentage of rural population without adequate medical control, are appraised. Due to the high rate of chronic lesions, particularly in the pre-CT scan era (1968-1975), radical excision was required in 70.6% of cases. Overall postoperative mortality was 14.7%: 7.3% during the hospital stay, mostly due to pyrogenic ventriculitis in patients with large deep located abscesses, and 7.4% for different complications, both intra- and extracerebral, at home or other institutions several months after surgery. 29% of patients recovered completely and 45.6% have only minor disability, only 10.3% remained severely crippled and dependent. The results of the surgery, both in terms of operative mortality and functional recovery seem to depend on the neuropathological background rather than on the kind of therapeutic procedure implemented. Even though it must be acknowledged that at present conservative and minor surgical procedures are more often successfully used, radical excision still appears to keep far from negligible indications.