145 results on '"Giammattei, L"'
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2. Combined petrosal approach: a systematic review and meta-analysis of surgical complications
- Author
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Giammattei, L., Starnoni, D., Peters, D., George, M., Messerer, M., and Daniel, R. T.
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- 2023
- Full Text
- View/download PDF
3. Anterolateral (juxtacondylar) approach with limited mastoidectomy to resect a jugular foramen meningioma
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Giammattei, L., Passeri, T., di Russo, P., and Froelich, S.
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- 2023
- Full Text
- View/download PDF
4. Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section
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Starnoni, D., Tuleasca, C., Giammattei, L., Cossu, G., Bruneau, M., Berhouma, M., Cornelius, J. F., Cavallo, L., Froelich, S., Jouanneau, E., Meling, T. R., Paraskevopoulos, D., Schroeder, H., Tatagiba, M., Zazpe, I., Sufianov, A., Sughrue, M. E., Chacko, Ari G., Benes, V., González-Lopez, P., Roche, Pierre-Hugues, Levivier, Marc, Messerer, Mahmoud, and Daniel, Roy T.
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- 2021
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5. Vestibular schwannoma: care for soft tissues and subperineural dissection: how I do it
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Giammattei, L., Passeri, T., Padovan, S., and Froelich, S.
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- 2021
- Full Text
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6. Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma
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Giammattei, L., di Russo, P., Penet, N., and Froelich, S.
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- 2020
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7. Letter to the Editor regarding spontaneous regression of a clival chordoma. Case report
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Passeri, T., Giammattei, L., and Froelich, S.
- Published
- 2020
- Full Text
- View/download PDF
8. Extreme lateral supracerebellar infratentorial approach: how I do it
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Giammattei, L., Borsotti, F., and Daniel, R. T.
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- 2019
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9. Intramedullary cavernoma: A surgical resection technique
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Giammattei, L., Messerer, M., Prada, F., and DiMeco, F.
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- 2017
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10. Role of preoperative embolization of intramedullary hemangioblastoma
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Saliou, G., Giammattei, L., Ozanne, A., and Messerer, M.
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- 2017
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11. Intramedullary ependymoma: Microsurgical resection technique
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Giammattei, L., Penet, N., Parker, F., and Messerer, M.
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- 2017
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12. Transnasal endoscopic Skull Base and brain surgery: surgical anatomy and its applications by Aldo C Stamm (2019) 690 pp., 704 illustrations hardback ISBN: 9781626237100 Thieme publishers New York/Stuttgart
- Author
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di Russo, P., Giammattei, L., and Froelich, Sebastian
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- 2020
- Full Text
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13. Plasma levels of extracellular vesicles and the risk of post-operative pulmonary embolism in patients with primary brain tumors: a prospective study
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Passamonti, S, Artoni, A, Carrabba, G, Merati, G, Abbattista, M, Capecchi, M, Castellani, M, Marenghi, C, Trombetta, E, Giammattei, L, Caroli, M, Bucciarelli, P, Scalambrino, E, Peyvandi, F, Martinelli, I, Passamonti S. M., Artoni A., Carrabba G., Merati G., Abbattista M., Capecchi M., Castellani M., Marenghi C., Trombetta E., Giammattei L., Caroli M., Bucciarelli P., Scalambrino E., Peyvandi F., Martinelli I., Passamonti, S, Artoni, A, Carrabba, G, Merati, G, Abbattista, M, Capecchi, M, Castellani, M, Marenghi, C, Trombetta, E, Giammattei, L, Caroli, M, Bucciarelli, P, Scalambrino, E, Peyvandi, F, Martinelli, I, Passamonti S. M., Artoni A., Carrabba G., Merati G., Abbattista M., Capecchi M., Castellani M., Marenghi C., Trombetta E., Giammattei L., Caroli M., Bucciarelli P., Scalambrino E., Peyvandi F., and Martinelli I.
- Abstract
Primary brain tumors are associated with an increased risk of pulmonary embolism (PE), particularly in the early post-operative period. The pathophysiological mechanisms of PE are poorly understood. This study aims to describe prospectively extracellular vesicles (EVs) levels and investigate whether or not their variations allow to identify patients at increased risk of post-operative PE. Consecutive meningioma or glioma patients candidate to tumor resection were included in the study if a pulmonary perfusion scan (Q-scan) performed before surgery ruled out PE. EVs derived from platelets (CD41+) or endothelial cells (CD144+), tissue factor-bearing EVs (CD142+) and their procoagulant subtype (annexin V+) were analyzed by flow cytometry before surgery (T0), within 24 h (T1), two (T2) and seven days (T7) after surgery. Q-scan was repeated at T2. Ninety-three patients with meningioma, 59 with glioma and 76 healthy controls were included in the study. CD142+ and annexin V+/CD142+ EVs were increased at T0 in meningioma and glioma patients compared to healthy controls. Twenty-nine meningioma (32%) and 16 glioma patients (27%) developed PE at T2. EVs levels were similar in meningioma patients with or without PE, whereas annexin V+ and annexin V+/CD142+ EVs were significantly higher at T1 and T2 in glioma patients with PE than in those without. Procoagulant EVs, particularly annexin V+/CD142+, increase after surgery and are more prevalent in glioma patients who developed PE after surgery than in those who did not.
- Published
- 2021
14. Posterior reversible encephalopathy syndrome (PRES) due to neuroblastoma in a child presenting with acute hydrocephalus
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Aureli, V., Giammattei, L., Maduri, R., Daniel, R. T., and Messerer, M.
- Published
- 2017
- Full Text
- View/download PDF
15. Basal Cisternostomy for Severe TBI: Surgical Technique and Cadaveric Dissection
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Giammattei, L., Starnoni, D., Messerer, M., and Daniel, R.T.
- Subjects
cadaveric dissection ,cisternostomy ,decompressive craniectomy (DC) ,severe brain trauma ,skull base ,Surgery - Abstract
Cisternostomy is emerging as a novel surgical technique in the setting of severe brain trauma. Different surgical techniques have been proposed with a variable degree of epidural bone work. We present here the surgical technique as it is currently performed in our Institution. Anatomical dissection of one adult cadaveric head, injected and non-formalin fixed was perfomed. A large right fronto-temporo-parietal craniotomy was accomplished. Extradural sphenoidal drilling till opening of the superior orbital fissure was performed. The microsurgical anatomy of basal cisternostomy was then explored. A step by step description of the surgical technique, enriched with cadaveric and intraoperative images, was made. Basal cisternostomy is a promising surgical technique that does not necessarily include complex surgical maneuvers. Trained neurosurgeon can safely implement it in their clinical practice.
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- 2022
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16. Pituitary apoplexy: considerations on a single center experience and review of the literature
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Giammattei, L., Mantovani, G., Carrabba, G., Ferrero, S., Di Cristofori, A., Verrua, E., Guastella, C., Pignataro, L., Rampini, P., Minichiello, M., and Locatelli, M.
- Published
- 2016
- Full Text
- View/download PDF
17. Extreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature
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Giammattei L, Starnoni D, Benes V, Froelich S, Cossu G, Borsotti F, Majovsky M, Sufianov A, Fava A, di Russo P, Elbabaa S, Gonzalez-Lopez P, Messerer M, and Daniel R
- Subjects
Cavernoma ,Glioma ,Supracerebellar infratentorial approach ,Meningioma - Abstract
OBJECTIVE: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches. METHODS: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented. RESULTS: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intraaxial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches. CONCLUSIONS: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.
- Published
- 2021
18. Intracranial hemorrhage related to brain vascular disease and COVID-19 containment: Where are the patients?
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Bernat, A.-L., primary, Gaberel, T., additional, Giammattei, L., additional, Rault, F., additional, Gakuba, C., additional, Magro, E., additional, Peltier, C., additional, Graillon, T., additional, Baussart, B., additional, Premat, K., additional, Clarençon, F., additional, Nouet, A., additional, Civelli, V., additional, and Froelich, S., additional
- Published
- 2020
- Full Text
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19. Letter to the Editor regarding spontaneous regression of a clival chordoma. Case report
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Passeri, T., primary, Giammattei, L., additional, and Froelich, S., additional
- Published
- 2019
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20. Neuroendoscopic septostomy: Indications and surgical technique
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Giammattei, L., Aureli, V., Daniel, R.-T., and Messerer, M.
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- 2018
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21. ARE MENINGIOMAS AT HIGHER RISK OF THROMBOEMBOLISM THAN GLIOMAS? EARLY RESULT OF A PROSPECTIVE STUDY
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Carrabba, G, Giammattei, L, Draghi, R, Conte, V, Martinelli, I, Caroli, M, Bertani, G, Locatelli, M, Rampini, P, Artoni, A, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba, G, Giammattei, L, Draghi, R, Conte, V, Martinelli, I, Caroli, M, Bertani, G, Locatelli, M, Rampini, P, Artoni, A, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, and Artoni A
- Published
- 2013
22. Planned Subtotal Resection Followed by GKR for Complex Skull Base Meningiomas: Lausanne Experience
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Giammattei, L., additional, Tuleasca, C., additional, Schiappacasse, L., additional, Marguet, M., additional, Borruat, F., additional, Levivier, M., additional, and Daniel, R.T., additional
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- 2017
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23. Pituitary apoplexy : considerations on a single center experience and review of the literature
- Author
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Giammattei, L, Mantovani, G, Carrabba, G, Ferrero, S, Di Cristofori, A, Verrua, E, Guastella, C, Pignataro, L, Rampini, P, Minichiello, M, Locatelli, M, L. Giammattei, G. Mantovani, G. Carrabba, S. Ferrero, A. Di Cristofori, E. Verrua, C. Guastella, L. Pignataro, P. Rampini, M. Minichiello, M. Locatelli, Giammattei, L, Mantovani, G, Carrabba, G, Ferrero, S, Di Cristofori, A, Verrua, E, Guastella, C, Pignataro, L, Rampini, P, Minichiello, M, Locatelli, M, L. Giammattei, G. Mantovani, G. Carrabba, S. Ferrero, A. Di Cristofori, E. Verrua, C. Guastella, L. Pignataro, P. Rampini, M. Minichiello, and M. Locatelli
- Abstract
Purpose: To present a single-center experience on pituitary tumor apoplexy and a review of literature focusing on predisposing and precipitating factors. Methods: Clinical presentation of our series of cases. Contemporary published literature is also reviewed. Results: The definition of this syndrome has not been consistent although now the majority of authors agree to definite it as an acute condition caused by hemorrhage or infarction of a pre-existing pituitary adenoma. Different predisposing and precipitating factors have been described in literature; among these antithrombotic and anticoagulant drugs, seem to play relevant roles. The clinical cases observed in our clinic confirm these data and suggest a probable association between elderly patients taking anticoagulant therapy and pituitary apoplexy adenoma. Conclusion: Pituitary tumor apoplexy remains a challenging disease in relation to difficulties in correct diagnosis and thus in appropriate treatment. Antithrombotic/anticoagulant therapy may have an important role as precipitating factor. When a pituitary disorder is known, great care should be taken in the prescription of anticoagulant therapy.
- Published
- 2016
24. PP178-SUN SARCOPENIC OBESITY IS NOT ASSOCIATED WITH A LOSS OF AUTONOMY IN ACUTE CARE ELDERLY PATIENTS
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Michel-Giammattei, L., primary, Silicani-Amoros, P., additional, and Schneider, S.M., additional
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- 2013
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25. Posterior reversible encephalopathy syndrome (PRES) due to neuroblastoma in a child presenting with acute hydrocephalus.
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Aureli, V., Giammattei, L., Maduri, R., Daniel, R. T., and Messerer, M.
- Subjects
- *
HEADACHE , *EPILEPSY , *HYDROCEPHALUS in children , *CONSCIOUSNESS , *PATIENTS - Abstract
The article presents a case study of a two-year-boy presented with two days history of headache and vomiting followed by fever, decreased consciousness and focal motor seizures. Topics discussed include revealing a soft tissue mass in the peri-umblical region; obstructive hydrocephalus due to compression of the aqueduct secondary to posterior fossa edema; and diagnosis of posterior reversible encephalopathy syndrome.
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- 2018
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26. Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section
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Mahmoud Messerer, Vladimír Beneš, Diego Mazzatenta, Samer K. Elbabaa, Mustafa K. Baskaya, A. Samy Youssef, Karl Lothard Schaller, Emmanuel Jouanneau, Giulia Cossu, Mario Ammirati, Edward R. Laws, Michael Bruneau, Moncef Berhouma, Daniele Starnoni, Ari G Chacko, Torstein R. Meling, Paolo Cappabianca, Juan Barges-Coll, Roy Thomas Daniel, Luigi Maria Cavallo, Henry Dufour, Lorenzo Giammattei, Neurosurgery, Cossu G., Jouanneau E., Cavallo L.M., Elbabaa S.K., Giammattei L., Starnoni D., Barges-Coll J., Cappabianca P., Benes V., Baskaya M.K., Bruneau M., Meling T., Schaller K., Chacko A.G., Youssef A.S., Mazzatenta D., Ammirati M., Dufour H., Laws E., Berhouma M., Daniel R.T., and Messerer M.
- Subjects
Adult ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Consensus ,medicine.medical_treatment ,Consensu ,Nose ,Neurosurgical Procedure ,pituitary ,Neurosurgical Procedures ,030218 nuclear medicine & medical imaging ,surgery ,03 medical and health sciences ,Craniopharyngioma ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Pituitary Neoplasms ,Pituitary Neoplasm ,endoscopy ,Societies, Medical ,Neuroradiology ,Medicine(all) ,medicine.diagnostic_test ,business.industry ,General surgery ,Interventional radiology ,Endoscopy ,Neurovascular bundle ,medicine.disease ,ddc:616.8 ,Radiation therapy ,Skull base ,Systematic review ,Pituitary ,Practice Guidelines as Topic ,Surgery ,Postoperative Complication ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery ,Human - Abstract
Background and objective: Craniopharyngiomas are locally aggressive neuroepithelial tumors infiltrating nearby critical neurovascular structures. The majority of published surgical series deal with childhood-onset craniopharyngiomas, while the optimal surgical management for adult-onset tumors remains unclear. The aim of this paper is to summarize the main principles defining the surgical strategy for the management of craniopharyngiomas in adult patients through an extensive systematic literature review in order to formulate a series of recommendations. Material and methods: The MEDLINE database was systematically reviewed (January 1970–February 2019) to identify pertinent articles dealing with the surgical management of adult-onset craniopharyngiomas. A summary of literature evidence was proposed after discussion within the EANS skull base section. Results: The EANS task force formulated 13 recommendations and 4 suggestions. Treatment of these patients should be performed in tertiary referral centers. The endonasal approach is presently recommended for midline craniopharyngiomas because of the improved GTR and superior endocrinological and visual outcomes. The rate of CSF leak has strongly diminished with the use of the multilayer reconstruction technique. Transcranial approaches are recommended for tumors presenting lateral extensions or purely intraventricular. Independent of the technique, a maximal but hypothalamic-sparing resection should be performed to limit the occurrence of postoperative hypothalamic syndromes and metabolic complications. Similar principles should also be applied for tumor recurrences. Radiotherapy or intracystic agents are alternative treatments when no further surgery is possible. A multidisciplinary long-term follow-up is necessary.
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- 2020
27. Pituitary apoplexy: considerations on a single center experience and review of the literature
- Author
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A. Di Cristofori, Paolo Rampini, Stefano Ferrero, Elisa Verrua, M. Minichiello, Lorenzo Pignataro, Giovanna Mantovani, Lorenzo Giammattei, Giorgio Carrabba, Claudio Guastella, Marco Locatelli, Giammattei, L, Mantovani, G, Carrabba, G, Ferrero, S, Di Cristofori, A, Verrua, E, Guastella, C, Pignataro, L, Rampini, P, Minichiello, M, and Locatelli, M
- Subjects
medicine.medical_specialty ,Pediatrics ,Pituitary disorder ,Adenoma ,Endocrinology, Diabetes and Metabolism ,review ,Infarction ,030209 endocrinology & metabolism ,Disease ,pituitary ,apoplexy ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Pituitary adenoma ,Antithrombotic ,medicine ,Humans ,diabetes and metabolism ,Clinical Trials as Topic ,anticoagulant therapy ,business.industry ,Pituitary tumors ,Pituitary apoplexy ,medicine.disease ,Surgery ,business ,Pituitary Apoplexy ,030217 neurology & neurosurgery - Abstract
Purpose: To present a single-center experience on pituitary tumor apoplexy and a review of literature focusing on predisposing and precipitating factors. Methods: Clinical presentation of our series of cases. Contemporary published literature is also reviewed. Results: The definition of this syndrome has not been consistent although now the majority of authors agree to definite it as an acute condition caused by hemorrhage or infarction of a pre-existing pituitary adenoma. Different predisposing and precipitating factors have been described in literature; among these antithrombotic and anticoagulant drugs, seem to play relevant roles. The clinical cases observed in our clinic confirm these data and suggest a probable association between elderly patients taking anticoagulant therapy and pituitary apoplexy adenoma. Conclusion: Pituitary tumor apoplexy remains a challenging disease in relation to difficulties in correct diagnosis and thus in appropriate treatment. Antithrombotic/anticoagulant therapy may have an important role as precipitating factor. When a pituitary disorder is known, great care should be taken in the prescription of anticoagulant therapy.
- Published
- 2016
28. Combined Petrosal Intertentorial Approach: A Cadaveric Study of Comparison With the Standard Combined Petrosectomy.
- Author
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Giammattei L, Peters D, Cadas H, Fava A, Schranz S, George M, Sabatasso S, Messerer M, Starnoni D, and Daniel RT
- Abstract
Background and Objectives: The combined petrosal intertentorial approach (CPIA) has been proposed as an alternative to standard combined petrosal approach (SCPA). CPIA has been designed to maintain integrity of the temporal dura with a view to reduce temporal lobe morbidity and venous complications. This study has been designed to perform a quantitative comparison between these approaches., Methods: Five human specimens were used for this study. CPIA was performed on one side and SCPA on the opposite side. The area of exposure (petroclival and brainstem), surgical freedom, and angles of attack to a predefined target were measured and compared., Results: SCPA provided a significantly larger petroclival area of exposure (6.81 ± 0.60 cm2) over the CPIA (5.59 ± 0.59 cm2), P = .012. The area of brainstem exposed with SCPA was greater than with CPIA (7.17 ± 0.84 vs 5.63 ± 0.72, P = .014). The area of surgical freedom was greater in SCPA rather than in CPIA (8.59 ± 0.55 and 7.13 ± 0.96 cm2, respectively, P = .019). There was no significative difference between CPIA and SCPA in the vertical angles of attack for the Meckel cave, Dorello canal, and root entry zone of cranial nerve VII. Conversely, the horizontal angles of attack permitted by the CPIA were significantly smaller for the Meckel cave (52.36° ± 5.01° vs 64.4° ± 5.3°, P = .006) and root entry zone of cranial nerve VII (30.7° ± 4.4° vs 40.1° ± 6.2°, P = .025)., Conclusion: CPIA is associated with a reduction in terms of the area of surgical freedom (22%), skull base (18%), brainstem exposure (17%), and horizontal angles of attack (18%-23%) when compared with SCPA. This loss in terms of exposure is counterbalanced by the advantage of keeping the temporal lobe covered by an extra layer of meningeal tissue, thus possibly reducing the risk of temporal lobe injury and venous infarction. These results need to be validated with adequate clinical experience., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Congress of Neurological Surgeons.)
- Published
- 2024
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29. Cisternal nicardipine for prevention of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a comparative retrospective cohort study.
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Vandenbulcke A, Messerer M, Garvayo Navarro M, Peters DR, Starnoni D, Giammattei L, Ben-Hamouda N, Puccinelli F, Saliou G, Cossu G, and Daniel RT
- Subjects
- Adult, Humans, Nicardipine, Retrospective Studies, Prospective Studies, Cerebral Infarction, Subarachnoid Hemorrhage complications, Brain Ischemia drug therapy, Vasospasm, Intracranial etiology
- Abstract
Purpose: Intrathecal vasoactive drugs have been proposed in patients with aneurysmal subarachnoid hemorrhage (aSAH) to manage cerebral vasospasm (CV). We analyzed the efficacy of intracisternal nicardipine compared to intraventricular administration to a control group (CG) to determine its impact on delayed cerebral ischemia (DCI) and functional outcomes. Secondary outcomes included the need for intra-arterial angioplasties and the safety profile., Methods: We performed a retrospective analysis of prospectively collected data of all adult patients admitted for a high modified Fisher grade aSAH between January 2015 and April 2022. All patients with significant radiological CV were included. Three groups of patients were defined based on the CV management: cisternal nicardipine (CN), ventricular nicardipine (VN), and no intrathecal nicardipine (control group)., Results: Seventy patients met the inclusion criteria. Eleven patients received intracisternal nicardipine, 18 intraventricular nicardipine, and 41 belonged to the control group. No cases of DCI were observed in the CN group (p = 0.02). Patients with intracisternal nicardipine had a reduced number of intra-arterial angioplasties when compared to the control group (p = 0.03). The safety profile analysis showed no difference in complications across the three groups. Intrathecal (ventricular or cisternal) nicardipine therapy improved functional outcomes at 6 months (p = 0.04) when compared to the control group., Conclusion: Administration of intrathecal nicardipine for moderate to severe CV reduces the rate of DCI and improved long-term functional outcomes in patients with high modified Fisher grade aSAH. This study also showed a relative benefit of cisternal over intraventricular nicardipine, thereby reducing the number of angioplasties performed in the post-treatment phase. However, these preliminary results should be confirmed with future prospective studies., (© 2024. The Author(s).)
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- 2024
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30. Anterior Petrosectomy With Intertentorial Approach.
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Starnoni D, Peters D, Giammattei L, Fava A, Cadas H, Schranz S, Sabatasso S, Messerer M, and Daniel RT
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- Adult, Humans, Craniotomy, Skull Base surgery, Cadaver, Neurosurgical Procedures, Skull Base Neoplasms surgery
- Abstract
Background and Objectives: The extradural anterior petrosal approach (EAPA) can present a challenge because it deals with critical structures in a narrow, confined corridor. It is associated with several potential approach-related risks including temporal lobe and venous injuries. Tentorial peeling has the potential to largely eliminate these risks during the approach and may offer more options for tailoring the dural opening to the anatomic region that one wants to expose., Methods: Anatomic dissections of five adult injected non-formalin-fixed cadaveric heads were performed. Anterior petrosectomy with intertentorial approach (APIA) through a tentorial peeling was completed. Step-by-step documentation of the cadaveric dissections and diagrammatic representations are presented along with an illustrative case., Results: Tentorial peeling separates the tentorium into a temporal tentorial leaf and posterior fossa tentorial leaf, adding a fourth dural layer to the three classic ones described during a standard EAPA. This opens out the intertentorial space and offers more options for tailoring the dural incisions specific to the pathology being treated. This represents a unique possibility to address brainstem or skull base pathology along the mid- and upper clivus with the ability to keep the entire temporal lobe and basal temporal veins covered by the temporal tentorial leaf. The APIA was successfully used for the resection of a large clival chordoma in the illustrative case., Conclusion: APIA is an interesting modification to the classic EAPA to reduce the approach-related morbidity. The risk reduction achieved is by eliminating the exposure of the temporal lobe while maintaining the excellent access to the petroclival region. It also provides several options to tailor the durotomies based on the localization of the lesion., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Congress of Neurological Surgeons.)
- Published
- 2024
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31. Letter to the Editor. CSF after decompressive craniectomy: lumbar or cisternal drainage?
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Peters DR, Tuleasca C, Giammattei L, Starnoni D, and Daniel RT
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- Humans, Postoperative Complications etiology, Decompressive Craniectomy adverse effects, Drainage
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- 2024
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32. Cisternostomy for Severe Traumatic Brain Injury: Illustrative Case and Cadaveric Study of the Neurovascular Anatomy of the Basal Cisterns: 2-Dimensional Operative Video.
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Peters DR, Tuleasca C, Giammattei L, Starnoni D, Diaz S, Cossu G, Messerer M, and Daniel RT
- Subjects
- Humans, Subarachnoid Space surgery, Cadaver, Brain Injuries, Traumatic surgery
- Published
- 2023
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33. Endovascular treatment of pediatric basilar artery aneurysms: case series and literature review.
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Peters DR, Parish JM, Starnoni D, Giammattei L, Stetler WR, Wait SD, and Bernard JD
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- Humans, Child, Treatment Outcome, Retrospective Studies, Stents, Basilar Artery pathology, Intracranial Aneurysm surgery, Embolization, Therapeutic methods, Endovascular Procedures methods
- Abstract
Purpose: Pediatric basilar artery aneurysms are rare and challenging to treat. Microsurgical options and standard endovascular coiling are often undesirable choices for treatment of this pathology. Additional endovascular strategies are needed., Methods: Presentation, diagnosis, and management of pediatric basilar aneurysms were reviewed, with an emphasis on endovascular treatment strategies. Our case series of 2 patients was presented in detail, one treated with flow diversion and vessel sacrifice and one treated with stent-assisted coiling. An extensive review of the literation was performed to find other examples of pediatric basilar artery aneurysms treated with endovascular techniques., Results: Twenty-nine studies met inclusion criteria. Fifty-nine aneurysms in 58 patients were treated using endovascular techniques. Mortality rate was 10.3% (6/58) and a poor outcome (GOS 1-3) occurred in 15.5% (9/58). There were 4 reported recurrences requiring retreatment; however, only 46.5% of patients had reported follow-up of at least 1 year. 71.1% (42/59) were dissecting aneurysms., Conclusion: Basilar artery aneurysms in the pediatric population are rare, commonly giant and fusiform, and often not amenable to microsurgical or coiling techniques. The surrounding vasculature, location, size, and morphology of the aneurysm along with the durability of treatment must be considered in treatment decisions. With proper patient selection, stent-assisted coiling and flow diversion may increase the durability and safety of endovascular treatment in this population., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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34. External Validation of the HATCH (Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus) Score for Prediction of Functional Outcome After Subarachnoid Hemorrhage.
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Maldaner N, Visser V, Hostettler IC, Bijlenga P, Haemmerli J, Roethlisberger M, Guzman R, Daniel RT, Giammattei L, Stienen MN, Regli L, Verbaan D, Post R, and Germans MR
- Subjects
- Humans, Cohort Studies, Prospective Studies, Prognosis, Treatment Outcome, Subarachnoid Hemorrhage therapy, Subarachnoid Hemorrhage surgery, Hydrocephalus etiology, Hydrocephalus surgery
- Abstract
Background: The Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus (HATCH) Score has previously shown to predict functional outcome in aneurysmal subarachnoid hemorrhage (aSAH)., Objective: To validate the HATCH score., Methods: This is a pooled cohort study including prospective collected data on 761 patients with aSAH from 4 different hospitals. The HATCH score for prediction of functional outcome was validated using calibration and discrimination analysis (area under the curve). HATCH score model performance was compared with the World Federation of Neurosurgical Societies and Barrow Neurological Institute score., Results: At the follow-up of at least 6 months, favorable (Glasgow Outcome Score 4-5) and unfavorable functional outcomes (Glasgow Outcome Score 1-3) were observed in 512 (73%) and 189 (27%) patients, respectively. A higher HATCH score was associated with an increased risk of unfavorable outcome with a score of 1 showing a risk of 1.3% and a score of 12 yielding a risk of 67%. External validation showed a calibration intercept of -0.07 and slope of 0.60 with a Brier score of 0.157 indicating good model calibration and accuracy. With an area under the curve of 0.81 (95% CI 0.77-0.84), the HATCH score demonstrated superior discriminative ability to detect favorable outcome at follow-up compared with the World Federation of Neurosurgical Societies and Barrow Neurological Institute score with 0.72 (95% CI 0.67-0.75) and 0.63 (95% CI 0.59-0.68), respectively., Conclusion: This multicenter external validation analysis confirms the HATCH score to be a strong independent predictor for functional outcome. Its incorporation into daily practice may be of benefit for goal-directed patient care in aSAH., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)
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- 2022
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35. Letter: Review of Cerebrospinal Fluid Physiology and Dynamics: A Call for Medical Education Reform.
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Giammattei L, Starnoni D, Messerer M, and Daniel RT
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- Humans, Education, Medical
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- 2022
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36. Tentorial peeling during combined petrosal approach: a cadaveric dissection.
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Giammattei L, Starnoni D, Ronconi D, Camara B, George M, Cossu G, Messerer M, Peters D, and Daniel RT
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- Adult, Humans, Dissection, Temporal Lobe, Cadaver, Dura Mater surgery, Cerebral Veins
- Abstract
Background: The combined petrosal approach is an excellent method to access the petroclival region but has the inherent risk of injury to the temporal lobe and Vein of Labbé. Tentorial peeling has the potential to largely eliminate these risks during the classic combined transpetrosal approach., Methods: Anatomical dissection of three adult injected non-formalin fixed cadaveric heads was performed. Combined petrosal approach with tentorial peeling was completed. A tentorial incision just superior and parallel to the superior petrosal sinus was made to enable peeling of the tentorium into two layers, the posterior fossa tentorial leaf (PFTL), and the temporal tentorial leaf (TTL)., Results: Tentorial peeling clearly exposed the continuity between the temporal dura and the TTL as well as the continuity between the presigmoid dura and the PFTL. This enabled the creation of a large dural flap extending to the tentorial incisura, providing wide access to the petroclival region without any exposure of the temporal lobe and/or basal temporal veins. Techniques to create the dural flap without trochlear nerve injury were also explored., Conclusion: The technique of tentorial peeling into two distinct layers has the potential to reduce the morbidity associated with temporal lobe retraction and venous injury. Further cadaveric studies and surgical case series are needed to validate this important surgical nuance in transpetrosal approaches., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
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- 2022
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37. Lariboisiere Hospital pre-operative surgical checklist to improve safety during transpetrosal approaches.
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di Russo P, Giammattei L, Passeri T, Fava A, Voormolen E, Bernat AL, Guichard JP, Watanabe K, and Froelich S
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- Humans, Cranial Fossa, Posterior diagnostic imaging, Cranial Fossa, Posterior surgery, Cranial Sinuses, Hospitals, Checklist, Petrous Bone diagnostic imaging, Petrous Bone surgery, Petrous Bone anatomy & histology
- Abstract
Background: Transpetrosal approaches are technically complex and require a complete understanding of surgical and radiological anatomy. A careful evaluation of pre-operative magnetic resonance imaging and computed tomography scan is mandatory, because anatomical or pathological variations are common and may increase the risk of complications related with the approach., Methods: Pre-operative characteristics of venous and petrous bone anatomy were analysed and correlated with intraoperative findings, using injected magnetic resonance imaging and thin-slices computed tomography scan. These data regularly checked before each transpetrosal approach were progressively included in the presented checklist., Results: Transpetrosal approaches have been used in 101 patients. Items included in the checklist were petrous bone pneumatization, angle between petrous apex and clivus, dehiscence of petrous carotid artery, dehiscence of geniculate ganglion, distance between superior semicircular canal and middle fossa floor, distance between cochlea and middle fossa floor, sigmoid sinus dominance, transverse sigmoid sinus junction depth to the outer cortical bone, jugular bulb height (high or low), location of the vein of Labbé, characteristics of superior petrosal vein complex., Conclusion: The presented checklist provides a systematic scheme of consultation of characteristic of venous and petrous bone anatomy for transpetrosal approaches. In our experience, the use of this checklist reduces the risk of complications related with approach, by minimizing the neglect of crucial information., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
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- 2022
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38. Management strategies in clival and craniovertebral junction chordomas: a 29-year experience.
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Passeri T, Champagne PO, Giammattei L, Abbritti R, Cartailler J, Calugaru V, Feuvret L, Guichard JP, Polivka M, Adle-Biassette H, Mammar H, Bresson D, Herman P, Mandonnet E, George B, and Froelich S
- Abstract
Objective: Chordomas represent one of the most challenging subsets of skull base and craniovertebral junction (CVJ) tumors to treat. Despite extensive resection followed by proton-beam radiation therapy, the recurrence rate remains high, highlighting the importance of developing efficient treatment strategies. In this study, the authors present their experience in treating clival and CVJ chordomas over a 29-year period., Methods: The authors conducted a retrospective study of clival and CVJ chordomas that were surgically treated at their institution from 1991 to 2020. This study focuses on three aspects of the management of these tumors: the factors influencing the extent of resection (EOR), the predictors of survival, and the outcomes of the endoscopic endonasal approaches (EEAs) compared with open approaches (OAs)., Results: A total of 265 surgical procedures were performed in 210 patients, including 123 OAs (46.4%) and 142 EEAs (53.6%). Tumors that had an intradural extension (p = 0.03), brainstem contact (p = 0.005), cavernous sinus extension (p = 0.004), major artery encasement (p = 0.01), petrous apex extension (p = 0.003), or high volume (p = 0.0003) were significantly associated with a lower EOR. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 52.1% and 75.1%, respectively. Gross-total resection and Ki-67 labeling index < 6% were considered to be independent prognostic factors of longer PFS (p = 0.0005 and p = 0.003, respectively) and OS (p = 0.02 and p = 0.03, respectively). Postoperative radiation therapy correlated independently with a longer PFS (p = 0.006). Previous surgical treatment was associated with a lower EOR (p = 0.01) and a higher rate of CSF leakage after EEAs (p = 0.02) but did not have significantly lower PFS and OS compared with primary surgery. Previously radiation therapy correlated with a worse outcome, with lower PFS and OS (p = 0.001 and p = 0.007, respectively). EEAs were more frequently used in patients with upper and middle clival tumors (p = 0.002 and p < 0.0001, respectively), had a better rate of EOR (p = 0.003), and had a lower risk of de novo neurological deficit (p < 0.0001) compared with OAs. The overall rate of postoperative CSF leakage after EEAs was 14.8%., Conclusions: This large study showed that gross-total resection should be attempted in a multidisciplinary skull base center before providing radiation therapy. EEAs should be considered as the gold-standard approach for upper/middle clival lesions based on the satisfactory surgical outcome, but OAs remain important tools for large complex chordomas.
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- 2022
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39. A new simple and free tubular device for microscopic transcortical approach to deep-seated lesions: technical note and case example.
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Passeri T, Giammattei L, Abbritti R, di Russo P, Bernat AL, Penet N, Mandonnet E, and Froelich S
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- Brain surgery, Humans, Microsurgery methods, Neurosurgical Procedures, Brain Injuries surgery, Brain Neoplasms surgery
- Abstract
Background: Surgery for deep-seated brain tumors remains challenging. Transcortical approaches often require brain retraction to ensure an adequate surgical corridor, thus possibly leading to brain damage. Various techniques have been developed to minimize brain retraction such as self-retaining retractors, endoscopic approaches, or tubular retractor systems. Even if they evenly distribute the mechanical pressure over the parenchyma, rigid retractors can also cause some degree of brain damage and have significant disadvantages. We propose here a soft cottonoid retractor for microscopic resection of deep-seated and ventricular lesions., Methods: Through a small corticectomy, a channel route with a blunt cannula is developed until the lesion is reached. Then, a "balloon-like system" made with a surgical glove is progressively inflated, dilatating the surgical corridor. A mini-tubular device, handmade by suturing a surgical cottonoid, is positioned into the corridor, unfolded, and sutured to the edge of the dura, to prevent it from being progressively expelled from the working channel. This allows a good visualization of the lesion and surrounding structures under the microscope., Results: Advantages of this technique are the softness of the tube walls, the absence of rigid arm to hold the tube, and the possibility for the tube to follow the movements of the instruments and to modify its orientation according to the working area., Conclusion: This simple and inexpensive tubular working channel for microscopic transcortical approach is a valuable alternative technique to traditional self-retaining retractor and rigid tube for the microsurgical resection of deep-seated brain tumors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
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- 2022
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40. Surgical morbidity of the extradural anterior petrosal approach: the Lariboisière experience.
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Giammattei L, Passeri T, Abbritti R, Lieber S, Matano F, Van TL, Okano A, Fava A, Russo PD, and Froelich S
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- Humans, Neurosurgical Procedures adverse effects, Neurosurgical Procedures methods, Petrous Bone diagnostic imaging, Petrous Bone surgery, Petrous Bone pathology, Meningeal Neoplasms surgery, Meningioma surgery, Facial Paralysis surgery
- Abstract
Objective: Concerns about the approach-related morbidity of the extradural anterior petrosal approach (EAPA) have been raised, especially regarding temporal lobe and venous injuries, hearing impairment, facial nerve palsy, cerebrospinal fluid fistula, and seizures. There is lack in the literature of studies with detailed analysis of surgical complications. The authors have presented a large series of patients who were treated with EAPA, focusing on complications and their avoidance., Methods: The authors carried out a retrospective review of patients who underwent EAPA at their institution between 2012 and 2021. They collected preoperative clinical characteristics, operative reports, operative videos, findings on neuroimaging, histological diagnosis, postoperative course, and clinical status at last follow-up. For pathologies without petrous bone invasion, the amount of petrous apex drilling was calculated and classified as low (< 70% of the volume) or high (≥ 70%). Complications were dichotomized as approach related and resection related., Results: This study included 49 patients: 26 with meningiomas, 10 brainstem cavernomas, 4 chondrosarcomas, 4 chordomas, 2 schwannomas, 1 epidermoid cyst, 1 cholesterol granuloma, and 1 osteoblastoma. The most common approach-related complications were temporal lobe injury (6.1% of patients), seizures (6.1%), pseudomeningocele (6.1%), hearing impairment (4.1%), and dry eye (4.1%). Approach-related complications occurred most commonly in patients with a meningioma (p = 0.02) and Meckel's cave invasion (p = 0.02). Gross-total or near-total resection was correlated with a higher rate of tumor resection-related complications (p = 0.02) but not approach-related complications (p = 0.76). Inferior, lateral, and superior tumoral extension were not correlated with a higher rate of tumor resection-related complications. No correlation was found between high amount of petrous bone drilling and approach- or resection-related complications., Conclusions: EAPA is a challenging approach that deals with critical neurovascular structures and demands specific skills to be safely performed. Contrary to general belief, its approach-related morbidity seems to be acceptable at dedicated skull base centers. Morbidity can be lowered with careful examination of the preoperative neuroradiological workup, appropriate patient selection, and attention to technical details.
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- 2022
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41. Eyebrow incision with a crescent-shaped orbital rim craniotomy for microscopic and endoscopic transorbital approach to the anterior and middle cranial fossa: A cadaveric study and case presentation.
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Matano F, Passeri T, Abbritti R, Camara B, Mastantuoni C, Noya C, Giammattei L, Devaux B, Mandonnet E, and Froelich S
- Abstract
•The transorbital approach combining eyebrow incision and crescent-shaped craniotomy increases the surgical freedom to access the anterior and middle skull-base.•The technic allows the use of both endoscope and microscope.•The concept is at the crossroad between the supraorbital keyhole and endoscopic trans-orbital approach., (© 2022 Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies.)
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- 2022
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42. Combined petrosal approach for resection of a large left petroclival meningioma.
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Paglia F, Giammattei L, di Russo P, and Froelich S
- Abstract
Petroclival meningiomas represent the most complex lesions in skull base surgery, being closely related to critical neurovascular structures. The combined petrosal approach allows a wide exposure of the petroclival region and provides multiple angles of attack, limiting brain retraction. The authors present the case of a 54-year-old man with a large left petroclival meningioma responsible for headaches, dysphagia, and trigeminal neuralgia. The lesion was resected using a combined petrosal approach. A progressive improvement of the preoperative symptoms was observed. Postoperative MRI showed a near-total resection of the tumor, along with reexpansion of the brainstem. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21226., Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication., (© 2022, The Authors.)
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- 2022
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43. The mini-combined transpetrosal approach: an anatomical study and comparison with the combined transpetrosal approach.
- Author
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Fava A, di Russo P, Passeri T, Camara B, Paglia F, Matano F, Okano A, Giammattei L, and Froelich S
- Subjects
- Craniotomy methods, Humans, Neurosurgical Procedures methods, Skull Base surgery, Petrous Bone diagnostic imaging, Petrous Bone surgery, Skull Base Neoplasms surgery
- Abstract
Background: The combined transpetrosal approach (CTPA) is a versatile technique suitable for challenging skull base pathologies. Despite the advantages provided by a wide surgical exposure, the soft tissue trauma, complex and time-consuming bony work, and cosmetic issues make it far from patient expectations. In this study, the authors describe a less invasive modification of the CTPA, the mini-combined transpetrosal approach (mini-CTPA), and perform a quantitative comparison between these two approaches., Methods: Five human specimens were used for this study. CTPA was performed on one side and mini-CTPA on the opposite side. The surgical freedom, petroclival and brainstem area of exposure, and maneuverability for 6 anatomical targets, provided by the CTPA and mini-CTPA, were calculated and statistically compared. The bony volumes corresponding to each anterior petrosectomy were also measured and compared. Three clinical cases with an operative video are also reported to illustrate the effectiveness of the approach., Results: The question-mark skin incision done along the muscle attachments permits an optimal cosmetic result. Even though the limited incision, the smaller craniotomy, and the less extensive bone drilling of mini-CTPA provide a smaller area of surgical freedom, the areas of exposure of petroclival region and brainstem were not statistically different between the two approaches. The antero-posterior maneuverability for the oculomotor foramen (OF), Meckel's cave (MC) and the REZ of trigeminal nerve, and the supero-inferior maneuverability for OF, MC, Dorello's canal, and REZ of CN VII are significantly reduced by the smaller opening. The bony volume of anterior petrosectomy resulted similar among the approaches., Conclusions: The mini-CTPA is an interesting alternative to the CTPA, providing comparable surgical exposure both for petroclival region and for brainstem. Although the lesser soft tissue dissection and bony opening decrease the surgical maneuverability, the mini-CTPA may reduce surgical time, potential approach-related morbidities, and improve cosmetic and functional outcomes for the patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
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- 2022
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44. Surgical management of giant pituitary neuroendocrine tumors: Meta-analysis and consensus statement on behalf of the EANS skull base section.
- Author
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Cossu G, Jouanneau E, Cavallo LM, Froelich S, Starnoni D, Giammattei L, Harel E, Mazzatenta D, Bruneau M, Meling TR, Berhouma M, Chacko AG, Cornelius JF, Paraskevopoulos D, Schroeder HWS, Zazpe I, Manet R, Gardner PA, Dufour H, Cappabianca P, Daniel RT, and Messerer M
- Abstract
Introduction: The optimal surgical treatment for giant pituitary neuroendocrine tumors(GPitNETs) is debated., Research Question: The aim of this paper is to optimize the surgical management of these patients and to provide a consensus statement on behalf of the EANS Skull Base Section., Material and Methods: We constituted a task force belonging to the EANS skull base committee to define some principles for the management of GPitNETs. A systematic review was performed according to PRISMA guidelines to perform a meta-analysis on surgical series of GPitNETs. Weighted summary rates were obtained for the pooled extent of resection and according to the surgical technique. These data were discussed to obtain recommendations after evaluation of the selected articles and discussion among the experts., Results: 20articles were included in our meta-analysis, for a total of 1263 patients. The endoscopic endonasal technique was used in 40.3% of cases, the microscopic endonasal approach in 34% of cases, transcranial approaches in 18.7% and combined approaches in 7% of cases. No difference in terms of gross total resection (GTR) rate was observed among the different techniques. Pooled GTR rate was 36.6%, while a near total resection (NTR) was possible in 45.2% of cases. Cavernous sinus invasion was associated with a lower GTR rate (OR: 0.061). After surgery, 35% of patients had endocrinological improvement and 75.6% had visual improvement. Recurrent tumors were reported in 10% of cases., Discussion and Conclusion: After formal discussion in the working group, we recommend the treatment of G-PitNETs tumors with a more complex and multilobular structure in tertiary care centers. The endoscopic endonasal approach is the first option of treatment and extended approaches should be planned according to extension, morphology and consistency of the lesion. Transcranial approaches play a role in selected cases, with a multicompartmental morphology, subarachnoid invasion and extension lateral to the internal carotid artery and in the management of residual tumor apoplexy., (Crown Copyright © 2022 Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies.)
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- 2022
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45. Correction to: Atypical evolution of meningiomatosis after discontinuation of cyproterone acetate: clinical cases and histomolecular characterization.
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Passeri T, Giammattei L, Le Van T, Abbritti R, Perrier A, Wong J, Bourneix C, Polivka M, Adle-Biassette H, Bernat AL, Masliah-Planchon J, Mandonnet E, and Froelich S
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- 2022
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46. Atypical evolution of meningiomatosis after discontinuation of cyproterone acetate: clinical cases and histomolecular characterization.
- Author
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Passeri T, Giammattei L, Le Van T, Abbritti R, Perrier A, Wong J, Bourneix C, Polivka M, Adle-Biassette H, Bernat AL, Masliah-Planchon J, Mandonnet E, and Froelich S
- Subjects
- Cyproterone Acetate adverse effects, Female, Humans, Retrospective Studies, Meningeal Neoplasms chemically induced, Meningeal Neoplasms genetics, Meningioma chemically induced, Meningioma genetics, Skull Base Neoplasms
- Abstract
Purpose: The long-term use of cyproterone acetate (CPA) is associated with an increased risk of developing intracranial meningiomas. CPA discontinuation most often induces a stabilization or regression of the tumor. The underlying biological mechanisms as well as the reasons why some meningiomas still grow after CPA discontinuation remain unknown. We reported a series of patients presenting CPA-induced meningiomatosis with opposed tumor evolutions following CPA discontinuation, highlighting the underlying histological and genetic features., Methods: Patients presenting several meningiomas with opposite tumor evolution (coexistence of growing and shrinking tumors) following CPA discontinuation were identified. Clinical and radiological data were reviewed. A retrospective volumetric analysis of the meningiomas was performed. All the growing meningiomas were operated. Each operated tumor was characterized by histological and genetic analyses., Results: Four women with multiple meningiomas and opposite tumor volume evolutions after CPA discontinuation were identified. Histopathological analysis characterized the convexity and tentorial tumors which continued to grow after CPA discontinuation as fibroblastic meningiomas. The decreasing skull base tumor was characterized as a fibroblastic meningioma with increased fibrosis and a widespread collagen formation. The two growing skull base meningiomas were identified as meningothelial and transitional meningiomas. The molecular characterization found two NF2 mutations among the growing meningiomas and a PIK3CA mutation in the skull base tumor which decreased., Conclusion: To our knowledge, this is the first report describing an atypical tumor evolution of CPA-associated meningiomas after CPA discontinuation. The underlying biological mechanisms explaining this observation and especially the close relationship between mutational landscapes and embryologic origins of the meninges in CPA-related meningiomas as well as their clonal origin require further research., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
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- 2022
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47. In Reply: Tumor Growth Rate as a New Predictor of Progression-Free Survival After Chordoma Surgery.
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Passeri T, di Russo P, Giammattei L, and Froelich S
- Subjects
- Humans, Progression-Free Survival, Chordoma mortality, Skull Base Neoplasms surgery
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- 2022
- Full Text
- View/download PDF
48. The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus.
- Author
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di Russo P, Fava A, Giammattei L, Passeri T, Okano A, Abbritti R, Penet N, Bernat AL, Labidi M, and Froelich S
- Subjects
- Cranial Fossa, Posterior surgery, Humans, Mucous Membrane, Skull Base surgery, Chordoma diagnostic imaging, Chordoma surgery, Skull Base Neoplasms diagnostic imaging, Skull Base Neoplasms surgery
- Abstract
Background: Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach., Objective: To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas., Methods: Three cases of clival chordomas illustrating this technique are provided, together with an operative video., Results: The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed., Conclusion: We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions., (© Congress of Neurological Surgeons 2021.)
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- 2021
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49. Extradural anterior temporal fossa approach to the paranasal sinuses, nasal cavities through the anterolateral and anteromedial triangles: Combined microscopic and endoscopic strategy.
- Author
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Watanabe K, Passeri T, Hanakita S, Giammattei L, Zomorodi AR, Fava A, Abbritti R, Labidi M, Champagne PO, Fukushima T, and Froelich S
- Subjects
- Cadaver, Humans, Neuroendoscopy, Pterygopalatine Fossa anatomy & histology, Pterygopalatine Fossa surgery, Sphenoid Bone anatomy & histology, Nasal Cavity, Paranasal Sinuses surgery
- Abstract
Objective: To demonstrate the utility and limitations of the extradural endoscopic-assisted anterior temporal fossa approach to the pterygopalatine fossa (PPF), infratemporal fossa (ITF), paranasal sinuses (PS), parapharyngeal region (PPR), nasal cavities (NC), epipharynx (EP), and clivus., Methods: A frontotemporal orbitozygomatic craniotomy is performed. The dura is elevated from the cavernous sinus (CS). The anterior temporal fossa floor is drilled. Foramen rotundum and ovale are opened. The PPF is exposed and the lateral margin of inferior orbital fissure (IOF) is removed. The anterolateral triangle (ALT) is drilled and the vidian nerve (VN) is exposed. Drilling between the maxillary nerve (V2) and the VN provides access to the sphenoid sinus (SphS). The medial pterygoid plate is drilled exposing the EP. The maxillary sinus (MaxS) is opened anterior to the PPF. V2 is transposed laterally to enlarge the anteriomedial triangle (AMT). The orbital muscle of Muller is removed as well as the medial margin of the IOF, which opens the SphS. Anteriorly, the posterior ethmoid air cells are opened. Morphometric measurements evaluating the size of the ALT were done and the PS, NC, EP were explored with the endoscope., Results: The ALT and AMT triangle provides a wide exposure of the PPF, ITF, PPR. In addition, those triangles represent a deep entry point to explore the PS, NC, and EP., Conclusion: The ALT and AMT are useful corridors to access to the SphS, MaxS, PS, NC, and EP via a transcranial approach. The use of the endoscope through this corridor widely extend the extradural anterior temporal fossa approach which may be considered as a valuable alternative to the extended endoscopic endonasal approach for selected skull base lesions extending both intracranial and into the PS, NC and EP., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
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- 2021
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50. Tumor Growth Rate as a New Predictor of Progression-Free Survival After Chordoma Surgery.
- Author
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Passeri T, di Russo P, Champagne PO, Bernat AL, Cartailler J, Guichard JP, Mammar H, Giammattei L, Adle-Biassette H, George B, Mandonnet E, and Froelich S
- Subjects
- Follow-Up Studies, Humans, Neoplasm Recurrence, Local diagnostic imaging, Neoplasm Recurrence, Local epidemiology, Progression-Free Survival, Retrospective Studies, Survival Rate, Chordoma diagnostic imaging, Chordoma surgery, Skull Base Neoplasms
- Abstract
Background: Currently, different postoperative predictors of chordoma recurrence have been identified. Tumor growth rate (TGR) is an image-based calculation that provides quantitative information of tumor's volume changing over time and has been shown to predict progression-free survival (PFS) in other tumor types., Objective: To explore the usefulness of TGR as a new preoperative radiological marker for chordoma recurrence., Methods: A retrospective single-institution study was carried out including patients reflecting these criteria: confirmed diagnosis of chordoma on pathological analysis, no history of previous radiation, and at least 2 preoperative thin-slice magnetic resonance images available to measure TGR. TGR was calculated for all patients, showing the percentage change in tumor size over 1 mo., Results: A total of 32 patients were retained for analysis. Patients with a TGR ≥ 10.12%/m had a statistically significantly lower mean PFS (P < .0001). TGR ≥ 10.12%/m (odds ratio = 26, P = .001) was observed more frequently in recurrent chordoma. In a subgroup analysis, we found that the association of Ki-67 labeling index ≥ 6% and TGR ≥ 10.12%/m was correlated with recurrence (P = .0008)., Conclusion: TGR may be considered as a preoperative radiological indicator of tumor proliferation and seems to preoperatively identify more aggressive tumors with a higher tendency to recur. Our findings suggest that the therapeutic strategy and clinical-radiological follow-up of patients with chordoma can be adapted also according to this new parameter., (© Congress of Neurological Surgeons 2021.)
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- 2021
- Full Text
- View/download PDF
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