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1. Systemic Inflammatory Response in Spontaneous Subarachnoid Hemorrhage from Aneurysmal Rupture versus Subarachnoid Hemorrhage of Unknown Origin

Author

Bacigaluppi S, Bragazzi NL, Ivaldi F, Benvenuto F, Uccelli A, and Zona G

Subjects
sah, aneurysmal sah, sine materia sah, sah of unknown origin, systemic inflammation, neutrophils, inflammatory indices, Pathology, RB1-214, Therapeutics. Pharmacology, RM1-950
Abstract

Susanna Bacigaluppi,1– 3 Nicola L Bragazzi,4 Federico Ivaldi,1 Federica Benvenuto,1 Antonio Uccelli,1,5,* Gianluigi Zona1,2,* 1DINOGMI, University of Genoa, Genoa, Italy; 2Department of Neurosurgery and Neurotraumatology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 3Department of Neurosurgery, E.O. Ospedali Galliera, Genoa, Italy; 4DISSAL-University of Genoa, Genoa, Italy; 5Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy*These authors contributed equally to this workCorrespondence: Susanna Bacigaluppi, Department of Neurosurgery and Neurotraumatology, DINOGMI, University of Genoa, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, 16132, Italy, Email susanna.bacigaluppi@unige.itObjective: It is well known that spontaneous non-aneurysmal subarachnoid hemorrhage (SAH), also known as sine materia SAH (smSAH), has usually a better course and prognosis than its aneurysmal counterpart (aSAH). This might depend on different inflammatory mechanisms initiated by bleeding events of different origins. The aim of the present study was to explore the systemic inflammatory response in spontaneous SAH, comparing aSAH and smSAH.Methods: We performed a prospective observational study over a consecutive series of patients with SAH. For these patients, we collected all clinical data and, furthermore, performed venous blood sampling over six time points to analyze blood cells. We further performed the analysis of lymphocytes and monocytes by means of flow cytometry to quantify common subtypes. Statistical analysis included a t-student test, Chi-square test, multivariate logistic regression, and ROC analysis.Results: 48 patients were included: six (12.5%) with a diagnosis of spontaneous smSAH, and forty-two patients (87.5%) with aSAH. Significant differences on Day 0 were found for neutrophils and a systemic neuro-inflammatory index, namely, systemic inflammatory response index (SIRI). At the ROC analysis, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and SIRI exhibited satisfactory predictive power on day 0. At the multivariable logistic regression analysis, the combined index (NLR, LMR, SIRI at day 0) yielded an OR of 0.59 (95% CI 0.29– 1.21]). LMR at day 0 yielded an OR of 1.25 ([95% CI 0.94– 1.68]), NLR at day 0 exhibited an OR of 0.68 ([95% CI 0.42– 1.09]), and SIRI at day 0 displayed an OR of 0.31 ([95% CI 0.06– 1.49]).Conclusion: This preliminary study indicated a possible role of some inflammatory indices that point out the importance of innate and adaptive immunity in the etiopathogenetic mechanisms. Drugs modulating these responses could eventually counteract or, at least, reduce secondary damage associated with SAH.Keywords: SAH, aneurysmal SAH, sine materia SAH, SAH of unknown origin, systemic inflammation, neutrophils, inflammatory indices

Published
2022

4. Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Author

Iaccarino, C., Kolias, A., Adelson, P. D., Rubiano, A. M., Viaroli, E., Buki, A., Cinalli, G., Fountas, K., Khan, T., Signoretti, S., Waran, V., Adeleye, A. O., Amorim, R., Bertuccio, A., Cama, A., Chesnut, R. M., De Bonis, P., Estraneo, A., Figaji, A., Florian, S. I., Formisano, R., Frassanito, P., Gatos, C., Germanò, A., Giussani, C., Hossain, I., Kasprzak, P., La Porta, F., Lindner, D., Maas, A. I. R., Paiva, W., Palma, P., Park, K. B., Peretta, P., Pompucci, A., Posti, J., Sengupta, S. K., Sinha, A., Sinha, V., Stefini, R., Talamonti, G., Tasiou, A., Zona, G., Zucchelli, M., Hutchinson, P. J., and Servadei, F.

Published
2021
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5. Octreotide-Resistant Acromegaly: Challenges and Solutions

Author

Corica G, Ceraudo M, Campana C, Nista F, Cocchiara F, Boschetti M, Zona G, Criminelli D, Ferone D, and Gatto F

Subjects
acromegaly, biochemical control, medical therapy, resistance, somatostatin receptor ligands, Therapeutics. Pharmacology, RM1-950
Abstract

Giuliana Corica,1,2 Marco Ceraudo,3 Claudia Campana,1,2 Federica Nista,1,2 Francesco Cocchiara,2 Mara Boschetti,1,2 Gianluigi Zona,3 Diego Criminelli,3 Diego Ferone,1,2 Federico Gatto1 1Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 2Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy; 3Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, ItalyCorrespondence: Diego FeroneEndocrinology Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa 16132, ItalyTel +39 010 3537946Fax +39 010 3537060Email ferone@unige.itAbstract: Acromegaly is a rare and severe disease caused by an increased and autonomous secretion of growth hormone (GH), thus resulting in high circulating levels of insulin-like growth factor 1 (IGF-1). Comorbidities and mortality rate are closely related to the disease duration. However, in most cases achieving biochemical control means reducing or even normalizing mortality and restoring normal life expectancy. Current treatment for acromegaly includes neurosurgery, radiotherapy and medical therapy. Transsphenoidal surgery often represents the recommended first-line treatment. First-generation somatostatin receptor ligands (SRLs) are the drug of choice in patients with persistent disease after surgery and are suggested as first-line treatment for those ineligible for surgery. However, only about half of patients treated with octreotide (or lanreotide) achieve biochemical control. Other available drugs approved for clinical use are the second-generation SRL pasireotide, the dopamine agonist cabergoline, and the GH-receptor antagonist pegvisomant. In the present paper, we revised the current literature about the management of acromegaly, aiming to highlight the most relevant and recent therapeutic strategies proposed for patients resistant to first-line medical therapy. Furthermore, we discussed the potential molecular mechanisms involved in the variable response to first-generation SRLs. Due to the availability of different medical therapies, the choice for the most appropriate drug can be currently based also on the peculiar clinical characteristics of each patient.Keywords: acromegaly, biochemical control, medical therapy, resistance, somatostatin receptor ligands

Published
2020

8. Management of intracranial hypertension following traumatic brain injury: A best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy: Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Author

Iaccarino, C, Lippa, L, Munari, M, Castioni, C, Robba, C, Caricato, A, Pompucci, A, Signoretti, S, Zona, G, Rasulo, F, Aimar, E, Amato, S, Angileri, F, Anile, C, Assietti, R, Baratto, V, Barbanera, A, Basile, L, Battaglia, R, Bellocchi, S, Bertuccio, A, Blanco, S, Bolognini, A, Boniferro, B, Bordi, L, Bortolotti, C, Brandini, V, Broger, M, Brollo, M, Caffarella, D, Caggiano, C, Cantisani, P, Capone, C, Cappelletto, B, Capuano, C, Carangelo, B, Caruselli, G, Chessa, M, Chiara, M, Chibbaro, S, Cioffi, V, Ciprianocecchi, P, Colistra, D, Conti, C, Contratti, F, Costella, G, Cuoci, A, D'Avella, D, D'Ercole, M, Deangelis, M, Defalco, R, de Luca, G, de Marinis, P, Del Vecchio, C, Delfinis, C, Denaro, L, Deodato, F, Desogus, N, Disomma, A, Domenicucci, M, Dones, F, Fina, M, Fiori, L, Fricia, M, Gaetani, P, Gazzeri, R, Gentile, M, Germano, A, Ghadirpour, R, Gianfreda, C, Gigante, N, Gigli, R, Giorgetti, J, Giusa, M, Gravina, U, Grippi, L, Guida, F, Guizzardi, G, Iannuzzo, G, Kropp, M, Lattanzi, L, Lucantoni, D, Maffei, L, Magliulo, M, Marconi, F, Marruzzo, D, Martellotta, N, Marton, E, Maugeri, R, Mauro, G, Meli, F, Menniti, A, Merciadri, P, Milanese, L, Nardacci, B, Nasi, D, Orvieto, P, Pacca, P, Pansini, G, Panzarasa, G, Passanisi, M, Pavesi, G, Pizzoni, C, Pulera, F, Rapana, A, Ricci, A, Rispoli, R, Rotondo, M, Russo, N, Santilli, S, Scarano, E, Schwarz, A, Servadei, F, Simonetti, G, Stefini, R, Talamonti, G, Turrisi, A, Valente, V, Villa, A, Vindigni, M, Visocchi, M, Vitali, M, Wierzbicki, V, Zambon, G, Zanotti, B, Zenga, F, Alampi, D, Alessandri, F, Aloj, F, Amigoni, A, Aspide, R, Bertuetti, R, Betti, V, Bilotta, F, Bonato, V, Bosco, E, Brita, M, Buscema, G, Cafiero, T, Cappuccio, D, Caradonna, M, Caria, C, Casartelliliviero, M, Ciritella, P, Cirrincione, S, Citerio, G, Colelli, S, Coletta, F, Concordia, L, Congedo, E, Covotta, M, Crimella, F, Dall'Acqua, G, De Cassai, A, Defulviis, S, Deperi, E, Deana, C, Delgaudio, A, Denittis, N, Dicolandrea, S, Divezza, F, Ferri, F, Flocco, R, Fontana, C, Forastierimolinari, A, Frangiosa, A, Fumagalli, P, Fuselli, E, Garbarino, M, Gelormini, D, Geraci, C, Geraldini, F, Giacomucci, A, Giampaoli, V, Giorgetti, D, Gritti, P, Gualdani, S, Iacovazzo, C, Iermano, C, Latronico, N, Lugari, S, Lusenti, F, Maglione, C, Magnoni, S, Maiarota, F, Malla, M, Marchesi, M, Martino, C, Matteotti, I, Mazzeo, A, Morello, G, Nardiello, I, Paticchio, F, Pegoli, M, Perotti, V, Piazzolla, M, Picciafuochi, F, Rachedi, N, Radolovich, D, Recchia, A, Riccardi, S, Romagnoli, S, Sala, S, Scafuro, M, Sgarlata, P, Soragni, A, Stefani, F, Stival, E, Stofella, G, Terranova, F, Tinturini, R, Togni, T, Toto, R, Trapani, D, Tringali, E, Tullo, L, Valente, A, Valeo, T, Varelli, G, Villani, R, Zamacavicchi, F, Zanello, M, Zarrillo, N, Zugni, N, Iaccarino C., Lippa L., Munari M., Castioni C. A., Robba C., Caricato A., Pompucci A., Signoretti S., Zona G., Rasulo F. A., Aimar E., Amato S., Angileri F. F., Anile C., Assietti R., Baratto V., Barbanera A., Basile L., Battaglia R., Bellocchi S., Bertuccio A., Blanco S., Bolognini A., Boniferro B., Bordi L., Bortolotti C., Brandini V., Broger M., Brollo M., Caffarella D. D., Caggiano C., Cantisani P. L., Capone C., Cappelletto B., Capuano C., Carangelo B., Caruselli G., Chessa M. A., Chiara M., Chibbaro S., Cioffi V., Ciprianocecchi P., Colistra D., Conti C., Contratti F., Costella G. B., Cuoci A., D'Avella D., D'Ercole M., Deangelis M., Defalco R., de Luca G., de Marinis P., Del Vecchio C., Delfinis C., Denaro L., Deodato F., Desogus N., Disomma A., Domenicucci M., Dones F., Fina M., Fiori L., Fricia M., Gaetani P., Gazzeri R., Gentile M., Germano A., Ghadirpour R., Gianfreda C. D., Gigante N., Gigli R., Giorgetti J., Giusa M., Gravina U. G., Grippi L., Guida F., Guizzardi G., Iannuzzo G., Kropp M., Lattanzi L., Lucantoni D., Maffei L., Magliulo M., Marconi F., Marruzzo D., Martellotta N., Marton E., Maugeri R., Mauro G., Meli F., Menniti A., Merciadri P., Milanese L., Nardacci B., Nasi D., Orvieto P., Pacca P., Pansini G., Panzarasa G., Passanisi M., Pavesi G., Pizzoni C., Pulera F., Rapana A., Ricci A., Rispoli R., Rotondo M., Russo N., Santilli S., Scarano E., Schwarz A., Servadei F., Simonetti G., Stefini R., Talamonti G., Turrisi A., Valente V. M., Villa A., Vindigni M., Visocchi M., Vitali M., Wierzbicki V., Zambon G., Zanotti B., Zenga F., Alampi D., Alessandri F., Aloj F., Amigoni A., Aspide R., Bertuetti R., Betti V., Bilotta F., Bonato V., Bosco E., Brita M., Buscema G., Cafiero T., Cappuccio D., Caradonna M., Caria C. G., Casartelliliviero M., Ciritella P., Cirrincione S., Citerio G., Colelli S., Coletta F., Concordia L., Congedo E., Covotta M., Crimella F., Dall'Acqua G., De Cassai A., Defulviis S., Deperi E., Deana C., Delgaudio A., Denittis N., Dicolandrea S., Divezza F., Ferri F., Flocco R., Fontana C., Forastierimolinari A., Frangiosa A., Fumagalli P., Fuselli E., Garbarino M. M., Gelormini D., Geraci C., Geraldini F., Giacomucci A., Giampaoli V., Giorgetti D., Gritti P., Gualdani S., Iacovazzo C., Iermano C., Latronico N., Lugari S., Lusenti F., Maglione C., Magnoni S., Maiarota F., Malla M., Marchesi M., Martino C., Matteotti I., Mazzeo A. T., Morello G., Nardiello I., Paticchio F., Pegoli M., Perotti V., Piazzolla M., Picciafuochi F., Rachedi N., Radolovich D. K., Recchia A., Riccardi S., Romagnoli S., Sala S., Scafuro M. A., Sgarlata P., Soragni A., Stefani F., Stival E., Stofella G., Terranova F., Tinturini R., Togni T., Toto R., Trapani D., Tringali E., Tullo L., Valente A., Valeo T., Varelli G., Villani R., Zamacavicchi F., Zanello M., Zarrillo N., Zugni N., Iaccarino, C, Lippa, L, Munari, M, Castioni, C, Robba, C, Caricato, A, Pompucci, A, Signoretti, S, Zona, G, Rasulo, F, Aimar, E, Amato, S, Angileri, F, Anile, C, Assietti, R, Baratto, V, Barbanera, A, Basile, L, Battaglia, R, Bellocchi, S, Bertuccio, A, Blanco, S, Bolognini, A, Boniferro, B, Bordi, L, Bortolotti, C, Brandini, V, Broger, M, Brollo, M, Caffarella, D, Caggiano, C, Cantisani, P, Capone, C, Cappelletto, B, Capuano, C, Carangelo, B, Caruselli, G, Chessa, M, Chiara, M, Chibbaro, S, Cioffi, V, Ciprianocecchi, P, Colistra, D, Conti, C, Contratti, F, Costella, G, Cuoci, A, D'Avella, D, D'Ercole, M, Deangelis, M, Defalco, R, de Luca, G, de Marinis, P, Del Vecchio, C, Delfinis, C, Denaro, L, Deodato, F, Desogus, N, Disomma, A, Domenicucci, M, Dones, F, Fina, M, Fiori, L, Fricia, M, Gaetani, P, Gazzeri, R, Gentile, M, Germano, A, Ghadirpour, R, Gianfreda, C, Gigante, N, Gigli, R, Giorgetti, J, Giusa, M, Gravina, U, Grippi, L, Guida, F, Guizzardi, G, Iannuzzo, G, Kropp, M, Lattanzi, L, Lucantoni, D, Maffei, L, Magliulo, M, Marconi, F, Marruzzo, D, Martellotta, N, Marton, E, Maugeri, R, Mauro, G, Meli, F, Menniti, A, Merciadri, P, Milanese, L, Nardacci, B, Nasi, D, Orvieto, P, Pacca, P, Pansini, G, Panzarasa, G, Passanisi, M, Pavesi, G, Pizzoni, C, Pulera, F, Rapana, A, Ricci, A, Rispoli, R, Rotondo, M, Russo, N, Santilli, S, Scarano, E, Schwarz, A, Servadei, F, Simonetti, G, Stefini, R, Talamonti, G, Turrisi, A, Valente, V, Villa, A, Vindigni, M, Visocchi, M, Vitali, M, Wierzbicki, V, Zambon, G, Zanotti, B, Zenga, F, Alampi, D, Alessandri, F, Aloj, F, Amigoni, A, Aspide, R, Bertuetti, R, Betti, V, Bilotta, F, Bonato, V, Bosco, E, Brita, M, Buscema, G, Cafiero, T, Cappuccio, D, Caradonna, M, Caria, C, Casartelliliviero, M, Ciritella, P, Cirrincione, S, Citerio, G, Colelli, S, Coletta, F, Concordia, L, Congedo, E, Covotta, M, Crimella, F, Dall'Acqua, G, De Cassai, A, Defulviis, S, Deperi, E, Deana, C, Delgaudio, A, Denittis, N, Dicolandrea, S, Divezza, F, Ferri, F, Flocco, R, Fontana, C, Forastierimolinari, A, Frangiosa, A, Fumagalli, P, Fuselli, E, Garbarino, M, Gelormini, D, Geraci, C, Geraldini, F, Giacomucci, A, Giampaoli, V, Giorgetti, D, Gritti, P, Gualdani, S, Iacovazzo, C, Iermano, C, Latronico, N, Lugari, S, Lusenti, F, Maglione, C, Magnoni, S, Maiarota, F, Malla, M, Marchesi, M, Martino, C, Matteotti, I, Mazzeo, A, Morello, G, Nardiello, I, Paticchio, F, Pegoli, M, Perotti, V, Piazzolla, M, Picciafuochi, F, Rachedi, N, Radolovich, D, Recchia, A, Riccardi, S, Romagnoli, S, Sala, S, Scafuro, M, Sgarlata, P, Soragni, A, Stefani, F, Stival, E, Stofella, G, Terranova, F, Tinturini, R, Togni, T, Toto, R, Trapani, D, Tringali, E, Tullo, L, Valente, A, Valeo, T, Varelli, G, Villani, R, Zamacavicchi, F, Zanello, M, Zarrillo, N, Zugni, N, Iaccarino C., Lippa L., Munari M., Castioni C. A., Robba C., Caricato A., Pompucci A., Signoretti S., Zona G., Rasulo F. A., Aimar E., Amato S., Angileri F. F., Anile C., Assietti R., Baratto V., Barbanera A., Basile L., Battaglia R., Bellocchi S., Bertuccio A., Blanco S., Bolognini A., Boniferro B., Bordi L., Bortolotti C., Brandini V., Broger M., Brollo M., Caffarella D. D., Caggiano C., Cantisani P. L., Capone C., Cappelletto B., Capuano C., Carangelo B., Caruselli G., Chessa M. A., Chiara M., Chibbaro S., Cioffi V., Ciprianocecchi P., Colistra D., Conti C., Contratti F., Costella G. B., Cuoci A., D'Avella D., D'Ercole M., Deangelis M., Defalco R., de Luca G., de Marinis P., Del Vecchio C., Delfinis C., Denaro L., Deodato F., Desogus N., Disomma A., Domenicucci M., Dones F., Fina M., Fiori L., Fricia M., Gaetani P., Gazzeri R., Gentile M., Germano A., Ghadirpour R., Gianfreda C. D., Gigante N., Gigli R., Giorgetti J., Giusa M., Gravina U. G., Grippi L., Guida F., Guizzardi G., Iannuzzo G., Kropp M., Lattanzi L., Lucantoni D., Maffei L., Magliulo M., Marconi F., Marruzzo D., Martellotta N., Marton E., Maugeri R., Mauro G., Meli F., Menniti A., Merciadri P., Milanese L., Nardacci B., Nasi D., Orvieto P., Pacca P., Pansini G., Panzarasa G., Passanisi M., Pavesi G., Pizzoni C., Pulera F., Rapana A., Ricci A., Rispoli R., Rotondo M., Russo N., Santilli S., Scarano E., Schwarz A., Servadei F., Simonetti G., Stefini R., Talamonti G., Turrisi A., Valente V. M., Villa A., Vindigni M., Visocchi M., Vitali M., Wierzbicki V., Zambon G., Zanotti B., Zenga F., Alampi D., Alessandri F., Aloj F., Amigoni A., Aspide R., Bertuetti R., Betti V., Bilotta F., Bonato V., Bosco E., Brita M., Buscema G., Cafiero T., Cappuccio D., Caradonna M., Caria C. G., Casartelliliviero M., Ciritella P., Cirrincione S., Citerio G., Colelli S., Coletta F., Concordia L., Congedo E., Covotta M., Crimella F., Dall'Acqua G., De Cassai A., Defulviis S., Deperi E., Deana C., Delgaudio A., Denittis N., Dicolandrea S., Divezza F., Ferri F., Flocco R., Fontana C., Forastierimolinari A., Frangiosa A., Fumagalli P., Fuselli E., Garbarino M. M., Gelormini D., Geraci C., Geraldini F., Giacomucci A., Giampaoli V., Giorgetti D., Gritti P., Gualdani S., Iacovazzo C., Iermano C., Latronico N., Lugari S., Lusenti F., Maglione C., Magnoni S., Maiarota F., Malla M., Marchesi M., Martino C., Matteotti I., Mazzeo A. T., Morello G., Nardiello I., Paticchio F., Pegoli M., Perotti V., Piazzolla M., Picciafuochi F., Rachedi N., Radolovich D. K., Recchia A., Riccardi S., Romagnoli S., Sala S., Scafuro M. A., Sgarlata P., Soragni A., Stefani F., Stival E., Stofella G., Terranova F., Tinturini R., Togni T., Toto R., Trapani D., Tringali E., Tullo L., Valente A., Valeo T., Varelli G., Villani R., Zamacavicchi F., Zanello M., Zarrillo N., and Zugni N.

Abstract

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “T

Published
2021

9. Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Author

Iaccarino, C, Kolias, A, Adelson, P, Rubiano, A, Viaroli, E, Buki, A, Cinalli, G, Fountas, K, Khan, T, Signoretti, S, Waran, V, Adeleye, A, Amorim, R, Bertuccio, A, Cama, A, Chesnut, R, De Bonis, P, Estraneo, A, Figaji, A, Florian, S, Formisano, R, Frassanito, P, Gatos, C, Germano, A, Giussani, C, Hossain, I, Kasprzak, P, La Porta, F, Lindner, D, Maas, A, Paiva, W, Palma, P, Park, K, Peretta, P, Pompucci, A, Posti, J, Sengupta, S, Sinha, A, Sinha, V, Stefini, R, Talamonti, G, Tasiou, A, Zona, G, Zucchelli, M, Hutchinson, P, Servadei, F, Iaccarino C., Kolias A., Adelson P. D., Rubiano A. M., Viaroli E., Buki A., Cinalli G., Fountas K., Khan T., Signoretti S., Waran V., Adeleye A. O., Amorim R., Bertuccio A., Cama A., Chesnut R. M., De Bonis P., Estraneo A., Figaji A., Florian S. I., Formisano R., Frassanito P., Gatos C., Germano A., Giussani C., Hossain I., Kasprzak P., La Porta F., Lindner D., Maas A. I. R., Paiva W., Palma P., Park K. B., Peretta P., Pompucci A., Posti J., Sengupta S. K., Sinha A., Sinha V., Stefini R., Talamonti G., Tasiou A., Zona G., Zucchelli M., Hutchinson P. J., Servadei F., Iaccarino, C, Kolias, A, Adelson, P, Rubiano, A, Viaroli, E, Buki, A, Cinalli, G, Fountas, K, Khan, T, Signoretti, S, Waran, V, Adeleye, A, Amorim, R, Bertuccio, A, Cama, A, Chesnut, R, De Bonis, P, Estraneo, A, Figaji, A, Florian, S, Formisano, R, Frassanito, P, Gatos, C, Germano, A, Giussani, C, Hossain, I, Kasprzak, P, La Porta, F, Lindner, D, Maas, A, Paiva, W, Palma, P, Park, K, Peretta, P, Pompucci, A, Posti, J, Sengupta, S, Sinha, A, Sinha, V, Stefini, R, Talamonti, G, Tasiou, A, Zona, G, Zucchelli, M, Hutchinson, P, Servadei, F, Iaccarino C., Kolias A., Adelson P. D., Rubiano A. M., Viaroli E., Buki A., Cinalli G., Fountas K., Khan T., Signoretti S., Waran V., Adeleye A. O., Amorim R., Bertuccio A., Cama A., Chesnut R. M., De Bonis P., Estraneo A., Figaji A., Florian S. I., Formisano R., Frassanito P., Gatos C., Germano A., Giussani C., Hossain I., Kasprzak P., La Porta F., Lindner D., Maas A. I. R., Paiva W., Palma P., Park K. B., Peretta P., Pompucci A., Posti J., Sengupta S. K., Sinha A., Sinha V., Stefini R., Talamonti G., Tasiou A., Zona G., Zucchelli M., Hutchinson P. J., and Servadei F.

Abstract

Background: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Published
2021

10. Management of intracranial hypertension following traumatic brain injury: a best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy. Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Author

Iaccarino C., Lippa L., Munari M., Castioni C. A., Robba C., Caricato A., Pompucci A., Signoretti S., Zona G., Rasulo F. A., Aimar E., Amato S., Angileri F. F., Anile C., Assietti R., Baratto V., Barbanera A., Basile L., Battaglia R., Bellocchi S., Bertuccio A., Blanco S., Bolognini A., Boniferro B., Bordi L., Bortolotti C., Brandini V., Broger M., Brollo M., Caffarella D. D., Caggiano C., Cantisani P. L., Capone C., Cappelletto B., Capuano C., Carangelo B., Caruselli G., Chessa M. A., Chiara M., Chibbaro S., Cioffi V., Ciprianocecchi P., Colistra D., Conti C., Contratti F., Costella G. B., Cuoci A., D'Avella D., D'Ercole M., Deangelis M., Defalco R., de Luca G., de Marinis P., Del Vecchio C., Delfinis C., Denaro L., Deodato F., Desogus N., Disomma A., Domenicucci M., Dones F., Fina M., Fiori L., Fricia M., Gaetani P., Gazzeri R., Gentile M., Germano A., Ghadirpour R., Gianfreda C. D., Gigante N., Gigli R., Giorgetti J., Giusa M., Gravina U. G., Grippi L., Guida F., Guizzardi G., Iannuzzo G., Kropp M., Lattanzi L., Lucantoni D., Maffei L., Magliulo M., Marconi F., Marruzzo D., Martellotta N., Marton E., Maugeri R., Mauro G., Meli F., Menniti A., Merciadri P., Milanese L., Nardacci B., Nasi D., Orvieto P., Pacca P., Pansini G., Panzarasa G., Passanisi M., Pavesi G., Pizzoni C., Pulera F., Rapana A., Ricci A., Rispoli R., Rotondo M., Russo N., Santilli S., Scarano E., Schwarz A., Servadei F., Simonetti G., Stefini R., Talamonti G., Turrisi A., Valente V. M., Villa A., Vindigni M., Visocchi M., Vitali M., Wierzbicki V., Zambon G., Zanotti B., Zenga F., Alampi D., Alessandri F., Aloj F., Amigoni A., Aspide R., Bertuetti R., Betti V., Bilotta F., Bonato V., Bosco E., Brita M., Buscema G., Cafiero T., Cappuccio D., Caradonna M., Caria C. G., Casartelliliviero M., Ciritella P., Cirrincione S., Citerio G., Colelli S., Coletta F., Concordia L., Congedo E., Covotta M., Crimella F., Dall'Acqua G., De Cassai A., Defulviis S., Deperi E., Deana C., Delgaudio A., Denittis N., Dicolandrea S., Divezza F., Ferri F., Flocco R., Fontana C., Forastierimolinari A., Frangiosa A., Fumagalli P., Fuselli E., Garbarino M. M., Gelormini D., Geraci C., Geraldini F., Giacomucci A., Giampaoli V., Giorgetti D., Gritti P., Gualdani S., Iacovazzo C., Iermano C., Latronico N., Lugari S., Lusenti F., Maglione C., Magnoni S., Maiarota F., Malla M., Marchesi M., Martino C., Matteotti I., Mazzeo A. T., Morello G., Nardiello I., Paticchio F., Pegoli M., Perotti V., Piazzolla M., Picciafuochi F., Rachedi N., Radolovich D. K., Recchia A., Riccardi S., Romagnoli S., Sala S., Scafuro M. A., Sgarlata P., Soragni A., Stefani F., Stival E., Stofella G., Terranova F., Tinturini R., Togni T., Toto R., Trapani D., Tringali E., Tullo L., Valente A., Valeo T., Varelli G., Villani R., Zamacavicchi F., Zanello M., Zarrillo N., Zugni N., Iaccarino, C, Lippa, L, Munari, M, Castioni, C, Robba, C, Caricato, A, Pompucci, A, Signoretti, S, Zona, G, Rasulo, F, Aimar, E, Amato, S, Angileri, F, Anile, C, Assietti, R, Baratto, V, Barbanera, A, Basile, L, Battaglia, R, Bellocchi, S, Bertuccio, A, Blanco, S, Bolognini, A, Boniferro, B, Bordi, L, Bortolotti, C, Brandini, V, Broger, M, Brollo, M, Caffarella, D, Caggiano, C, Cantisani, P, Capone, C, Cappelletto, B, Capuano, C, Carangelo, B, Caruselli, G, Chessa, M, Chiara, M, Chibbaro, S, Cioffi, V, Ciprianocecchi, P, Colistra, D, Conti, C, Contratti, F, Costella, G, Cuoci, A, D'Avella, D, D'Ercole, M, Deangelis, M, Defalco, R, de Luca, G, de Marinis, P, Del Vecchio, C, Delfinis, C, Denaro, L, Deodato, F, Desogus, N, Disomma, A, Domenicucci, M, Dones, F, Fina, M, Fiori, L, Fricia, M, Gaetani, P, Gazzeri, R, Gentile, M, Germano, A, Ghadirpour, R, Gianfreda, C, Gigante, N, Gigli, R, Giorgetti, J, Giusa, M, Gravina, U, Grippi, L, Guida, F, Guizzardi, G, Iannuzzo, G, Kropp, M, Lattanzi, L, Lucantoni, D, Maffei, L, Magliulo, M, Marconi, F, Marruzzo, D, Martellotta, N, Marton, E, Maugeri, R, Mauro, G, Meli, F, Menniti, A, Merciadri, P, Milanese, L, Nardacci, B, Nasi, D, Orvieto, P, Pacca, P, Pansini, G, Panzarasa, G, Passanisi, M, Pavesi, G, Pizzoni, C, Pulera, F, Rapana, A, Ricci, A, Rispoli, R, Rotondo, M, Russo, N, Santilli, S, Scarano, E, Schwarz, A, Servadei, F, Simonetti, G, Stefini, R, Talamonti, G, Turrisi, A, Valente, V, Villa, A, Vindigni, M, Visocchi, M, Vitali, M, Wierzbicki, V, Zambon, G, Zanotti, B, Zenga, F, Alampi, D, Alessandri, F, Aloj, F, Amigoni, A, Aspide, R, Bertuetti, R, Betti, V, Bilotta, F, Bonato, V, Bosco, E, Brita, M, Buscema, G, Cafiero, T, Cappuccio, D, Caradonna, M, Caria, C, Casartelliliviero, M, Ciritella, P, Cirrincione, S, Citerio, G, Colelli, S, Coletta, F, Concordia, L, Congedo, E, Covotta, M, Crimella, F, Dall'Acqua, G, De Cassai, A, Defulviis, S, Deperi, E, Deana, C, Delgaudio, A, Denittis, N, Dicolandrea, S, Divezza, F, Ferri, F, Flocco, R, Fontana, C, Forastierimolinari, A, Frangiosa, A, Fumagalli, P, Fuselli, E, Garbarino, M, Gelormini, D, Geraci, C, Geraldini, F, Giacomucci, A, Giampaoli, V, Giorgetti, D, Gritti, P, Gualdani, S, Iacovazzo, C, Iermano, C, Latronico, N, Lugari, S, Lusenti, F, Maglione, C, Magnoni, S, Maiarota, F, Malla, M, Marchesi, M, Martino, C, Matteotti, I, Mazzeo, A, Morello, G, Nardiello, I, Paticchio, F, Pegoli, M, Perotti, V, Piazzolla, M, Picciafuochi, F, Rachedi, N, Radolovich, D, Recchia, A, Riccardi, S, Romagnoli, S, Sala, S, Scafuro, M, Sgarlata, P, Soragni, A, Stefani, F, Stival, E, Stofella, G, Terranova, F, Tinturini, R, Togni, T, Toto, R, Trapani, D, Tringali, E, Tullo, L, Valente, A, Valeo, T, Varelli, G, Villani, R, Zamacavicchi, F, Zanello, M, Zarrillo, N, Zugni, N, Iaccarino, C., Lippa, L., Munari, M., Castioni, C. A., Robba, C., Caricato, A., Pompucci, A., Signoretti, S., Zona, G., Rasulo, F. A., Aimar, E., Amato, S., Angileri, F. F., Anile, C., Assietti, R., Baratto, V., Barbanera, A., Basile, L., Battaglia, R., Bellocchi, S., Bertuccio, A., Blanco, S., Bolognini, A., Boniferro, B., Bordi, L., Bortolotti, C., Brandini, V., Broger, M., Brollo, M., Caffarella, D. D., Caggiano, C., Cantisani, P. L., Capone, C., Cappelletto, B., Capuano, C., Carangelo, B., Caruselli, G., Chessa, M. A., Chiara, M., Chibbaro, S., Cioffi, V., Ciprianocecchi, P., Colistra, D., Conti, C., Contratti, F., Costella, G. B., Cuoci, A., D'Avella, D., D'Ercole, M., Deangelis, M., Defalco, R., de Luca, G., de Marinis, P., Del Vecchio, C., Delfinis, C., Denaro, L., Deodato, F., Desogus, N., Disomma, A., Domenicucci, M., Dones, F., Fina, M., Fiori, L., Fricia, M., Gaetani, P., Gazzeri, R., Gentile, M., Germano, A., Ghadirpour, R., Gianfreda, C. D., Gigante, N., Gigli, R., Giorgetti, J., Giusa, M., Gravina, U. G., Grippi, L., Guida, F., Guizzardi, G., Iannuzzo, G., Kropp, M., Lattanzi, L., Lucantoni, D., Maffei, L., Magliulo, M., Marconi, F., Marruzzo, D., Martellotta, N., Marton, E., Maugeri, R., Mauro, G., Meli, F., Menniti, A., Merciadri, P., Milanese, L., Nardacci, B., Nasi, D., Orvieto, P., Pacca, P., Pansini, G., Panzarasa, G., Passanisi, M., Pavesi, G., Pizzoni, C., Pulera, F., Rapana, A., Ricci, A., Rispoli, R., Rotondo, M., Russo, N., Santilli, S., Scarano, E., Schwarz, A., Servadei, F., Simonetti, G., Stefini, R., Talamonti, G., Turrisi, A., Valente, V. M., Villa, A., Vindigni, M., Visocchi, M., Vitali, M., Wierzbicki, V., Zambon, G., Zanotti, B., Zenga, F., Alampi, D., Alessandri, F., Aloj, F., Amigoni, A., Aspide, R., Bertuetti, R., Betti, V., Bilotta, F., Bonato, V., Bosco, E., Brita, M., Buscema, G., Cafiero, T., Cappuccio, D., Caradonna, M., Caria, C. G., Casartelliliviero, M., Ciritella, P., Cirrincione, S., Citerio, G., Colelli, S., Coletta, F., Concordia, L., Congedo, E., Covotta, M., Crimella, F., Dall'Acqua, G., De Cassai, A., Defulviis, S., Deperi, E., Deana, C., Delgaudio, A., Denittis, N., Dicolandrea, S., Divezza, F., Ferri, F., Flocco, R., Fontana, C., Forastierimolinari, A., Frangiosa, A., Fumagalli, P., Fuselli, E., Garbarino, M. M., Gelormini, D., Geraci, C., Geraldini, F., Giacomucci, A., Giampaoli, V., Giorgetti, D., Gritti, P., Gualdani, S., Iacovazzo, C., Iermano, C., Latronico, N., Lugari, S., Lusenti, F., Maglione, C., Magnoni, S., Maiarota, F., Malla, M., Marchesi, M., Martino, C., Matteotti, I., Mazzeo, A. T., Morello, G., Nardiello, I., Paticchio, F., Pegoli, M., Perotti, V., Piazzolla, M., Picciafuochi, F., Rachedi, N., Radolovich, D. K., Recchia, A., Riccardi, S., Romagnoli, S., Sala, S., Scafuro, M. A., Sgarlata, P., Soragni, A., Stefani, F., Stival, E., Stofella, G., Terranova, F., Tinturini, R., Togni, T., Toto, R., Trapani, D., Tringali, E., Tullo, L., Valente, A., Valeo, T., Varelli, G., Villani, R., Zamacavicchi, F., Zanello, M., Zarrillo, N., and Zugni, N.

Subjects
medicine.medical_specialty, Decompressive Craniectomy, Consensus development conference, Decompressive craniectomy, Guideline, Traumatic brain injuries, Critical Care, Intracranial Pressure, medicine.medical_treatment, MEDLINE, Neurosurgery, Traumatic brain injurie, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, Settore MED/41 - ANESTESIOLOGIA, Brain Injuries, Traumatic, medicine, Humans, Anesthesia, Intensive care medicine, Randomized Controlled Trials as Topic, business.industry, Neurointensive care, Evidence-based medicine, Italy, 030220 oncology & carcinogenesis, Intracranial pressure monitoring, Surgery, Neurology (clinical), Analgesia, Intracranial Hypertension, business, 030217 neurology & neurosurgery, Human
Abstract

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from "TBI Section" of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the "TBI Section" of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TBI management is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.

Published
2021

11. 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

12. 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

13. Preliminary Validation of FoRCaSco: A New Grading System for Cerebral and Cerebellar Cavernomas

Author

Fontanella, Marco Maria, Zanin, L., Panciani, P., Belotti, F., Doglietto, Francesco, Cremonesi, A., Migliorati, K., Roca, E., De Maria, L., Franzin, A., Vivaldi, O., Griva, F., Narducci, A., Draghi, R., Calbucci, F., Borghesi, I., Crobeddu, E., Cossandi, C., Fioravanti, A., Arias, J. A., Scerrati, A., De Bonis, P., Locatelli, D., Agosti, E., Veiceschi, P., Ceraudo, M., Zona, G., Gasparotti, R., Terzi di Bergamo, L., Rigamonti, D., Fontanella M. M., Doglietto F. (ORCID:0000-0002-7438-0734), Fontanella, Marco Maria, Zanin, L., Panciani, P., Belotti, F., Doglietto, Francesco, Cremonesi, A., Migliorati, K., Roca, E., De Maria, L., Franzin, A., Vivaldi, O., Griva, F., Narducci, A., Draghi, R., Calbucci, F., Borghesi, I., Crobeddu, E., Cossandi, C., Fioravanti, A., Arias, J. A., Scerrati, A., De Bonis, P., Locatelli, D., Agosti, E., Veiceschi, P., Ceraudo, M., Zona, G., Gasparotti, R., Terzi di Bergamo, L., Rigamonti, D., Fontanella M. M., and Doglietto F. (ORCID:0000-0002-7438-0734)

Abstract

Objective: Surgical indications for cerebral cavernous malformations (CCMs) remain significantly center- and surgeon-dependent; available grading systems are potentially limited, as they do not include epileptologic and radiologic data. Several experienced authors proposed a new grading system for CCM and the first group of patients capable of providing its statistical validation was analyzed. Methods: A retrospective series of 289 CCMs diagnosed between 2008 and 2021 was collected in a shared anonymous database among 9 centers. The new grading system ranges from –1 to 10. For each patient with cortical and cerebellar cavernous malformations the grading system was applied, and a retrospective outcome analysis was performed. We proposed a score of 4 as a cutoff for surgical indication. Results: Operated patients with a score ≥4 were grouped with non-operated patients with a score <4, as they constituted the group that received correct treatment according to the new grading system. Patients with a score ≥4, who underwent surgery and had an improved outcome, were compared to patients with a score ≥4 who were not operated (P = 0.04), and to patients with a score <4 who underwent surgery (P < 0.001). Conclusions: This preliminary statistical analysis demonstrated that this new grading would be applicable in surgical reality. The cutoff score of 4 correctly separated the patients who could benefit from surgical intervention from those who would not. The outcome analysis showed that the treated patients in whom the grading system has been correctly applied have a better outcome than those in whom the grading system has not been applied.

Published
2022

14. Anatomical meningo-orbital band evaluation and clinical implications: a cadaveric dissection study

Author

Anania, P, Lucas, RM, Todaro, G, Zona, G, Cortes, CA, and Hernandez, FM

Subjects
Skull base, Neurosurgery, K EY wo?ns, Cavernous sinus
Abstract

BACKGROUND: The meningo-orbital band (MOB) is a dural structure which runs around the superior orbital fissure (SOF) tethering the frontotemporal basal dura to the periorbita, through the SOF. MOB division is important to expose and remove the anterior clinoid process, to access to proximal carotid artery and cavernous sinus area. The aim of this study was to measure how the MOB could be safely incised without cranial nerves and cavernous sinus injuries. METHODS: Anatomical dissections and extradural exposure of the anterior clinoid process was performed on 20 cadavers (40 sides). Measurement of the MOB thickness was performed before its incision, after dura propria dissection, and retraction off the inner cavernous membrane, RESULTS: We analyzed 20 cadaveric formalin-fixed heads injected with colored silicone, 11 man and 9 women of Caucasian race. The average length of a safe incision of the MOB was 10.6??1.1 mm on the right side, and 10.65??1.09 mm on the left side. CONCLUSIONS: In our study the average length of a safe incision of the MOB was 10.6??1.1 mm. Thus, the incision length of the MOB should not exceed 9 mm; the peeling of the anterior cavernous sinus and of the SOF, dissecting the two layers of the dura throughout the incision of the MOB, is a useful technique to avoid cranial nerves and cavernous sinus lesions. (Cite this article as: Anania P, Mirapeix Lucas R, Todaro G, Zona G, Asencio Cortes C, Muiloz Hernandez F. Anatomical meningo-orbital band evaluation and clinical implications: a cadaveric dissection study. J Neurosurg Sci 2022;66:215-9. DOI: 10.23736/S0390-5616.19.04794-5)

Published
2022

18. Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Author

Robba, C., Ball, L., Battaglini, D., Cardim, D., Moncalvo, E., Brunetti, I., Bassetti, M., Giacobbe, D. R., Vena, A., Patroniti, N., Rocco, P. R. M., Matta, B. F., Pelosi, P., Anania, P., Berri, C., Ciaravolo, E., Dentone, C., Fiaschi, P., Frisoni, P., Gratarola, A., Magnasco, L., Marramao, F., Sottano, M., Taramasso, L., Tarantino, F., and Zona, G.

Subjects
Male, ARDS, Population, Hemodynamics, Critical Care and Intensive Care Medicine, Recruitment maneuvers, Rescue therapies, 03 medical and health sciences, Prone position, 0302 clinical medicine, Interquartile range, medicine, Humans, Prospective Studies, education, Prospective cohort study, Oxygen saturation (medicine), Aged, Carbon dioxide removal, Cerebral oxygenation, Coronavirus, COVID-19, Female, Italy, Middle Aged, Oxygen, Respiratory Distress Syndrome, Treatment Outcome, Cerebrovascular Circulation, Respiration, Artificial, education.field_of_study, business.industry, Research, Respiration, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Oxygenation, medicine.disease, Anesthesia, Artificial, Arterial blood, business, 030217 neurology & neurosurgery
Abstract

BackgroundIn COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics.MethodsThis is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients.ResultsForty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2and PaCO2values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%,p 2(from 62 [56–71] to 82 [76–87] mmHg,p = 0.005) and rSO2(from 53 [52–54]% to 60 [59–64]%,p = 0.005). The use of iNO increased PaO2(from 65 [67–73] to 72 [67–73] mmHg,p = 0.015) and rSO2(from 53 [51–56]% to 57 [55–59]%,p = 0.007). The use of ECCO2R decreased PaO2(from 75 [75–79] to 64 [60–70] mmHg,p = 0.009), with reduction of rSO2values (59 [56–65]% vs. 56 [53–62]%,p = 0.002). In the whole population, a significant relationship was found between SpO2and rSO2(R = 0.62,p 2and rSO2(R0 0.54,p ConclusionsRescue therapies exert specific pathophysiological mechanisms, resulting in different effects on systemic and cerebral oxygenation in critically ill COVID-19 patients with ARDS. Cerebral and systemic oxygenation are correlated. The choice of rescue strategy to be adopted should take into account both lung and brain needs.RegistrationThe study protocol was approved by the ethics review board (Comitato Etico Regione Liguria, protocol n. CER Liguria: 23/2020).

Published
2021

19. Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience

Author

Lofrese, G., Scerrati, A., Balsano, M., Bassani, R., Cappuccio, M., Cavallo, M. A., Cofano, F., Cultrera, F., De Iure, F., Biase, F. D., Donati, R., Garbossa, D., Menegatti, M., Olivi, Alessandro, Palandri, G., Raco, A., Ricciardi, L., Spena, G., Tosatto, L., Visani, J., Visocchi, Massimiliano, Zona, G., De Bonis, P., Olivi A. (ORCID:0000-0002-4489-7564), Visocchi M. (ORCID:0000-0003-1087-0491), Lofrese, G., Scerrati, A., Balsano, M., Bassani, R., Cappuccio, M., Cavallo, M. A., Cofano, F., Cultrera, F., De Iure, F., Biase, F. D., Donati, R., Garbossa, D., Menegatti, M., Olivi, Alessandro, Palandri, G., Raco, A., Ricciardi, L., Spena, G., Tosatto, L., Visani, J., Visocchi, Massimiliano, Zona, G., De Bonis, P., Olivi A. (ORCID:0000-0002-4489-7564), and Visocchi M. (ORCID:0000-0003-1087-0491)

Abstract

Study Design: Retrospective multicenter. Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel (P = 0.12) to the burr (P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level (P = 0.15). Use of curved chisel reduced the surgical times (P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more (P = 0.04) and shorter waiting times for surgery (P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. Conclusion: The “age of DISH” counts more than patients’ age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.

Published
2021

20. Hemodynamic Monitoring in Patients With Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Author

Simonassi, F, Ball, L, Badenes, R, Millone, M, Citerio, G, Zona, G, Pelosi, P, Robba, C, Simonassi, Francesca, Ball, Lorenzo, Badenes, Rafael, Millone, Marco, Citerio, Giuseppe, Zona, Gianluigi, Pelosi, Paolo, Robba, Chiara, Simonassi, F, Ball, L, Badenes, R, Millone, M, Citerio, G, Zona, G, Pelosi, P, Robba, C, Simonassi, Francesca, Ball, Lorenzo, Badenes, Rafael, Millone, Marco, Citerio, Giuseppe, Zona, Gianluigi, Pelosi, Paolo, and Robba, Chiara

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous pressure measurements, fluid balance assessment), and/or advanced (pulse index continuous cardiac output, pulse dye densitometry, pulmonary artery catheterization) hemodynamic monitoring. We conducted a systematic review and meta-analysis of the literature to determine whether standard compared with advanced hemodynamic monitoring can improve patient management and clinical outcomes after aSAH. A literature search was performed for articles published between January 1, 2000 and January 1, 2019. Studies involving aSAH patients admitted to the intensive care unit and subjected to any type of hemodynamic monitoring were included. A total of 14 studies were selected for the qualitative synthesis and 3 randomized controlled trials, comparing standard versus advanced hemodynamic monitoring, for meta-analysis. The incidence of delayed cerebral ischemia was lower in the advanced compared with standard hemodynamic monitoring group (relative risk [RR]=0.71, 95% confidence interval [CI]=0.52-0.99; P=0.044), but there were no differences in neurological outcome (RR=0.83, 95% CI=0.64-1.06; P=0.14), pulmonary edema onset (RR=0.44, 95% CI=0.05-3.92; P=0.46), or fluid intake (mean difference=-169 mL; 95% CI=-1463 to 1126 mL; P=0.8) between the 2 groups. In summary, this systematic review and meta-analysis found only low-quality evidence to support the use of advanced hemodynamic monitoring in selected aSAH patients. Because of the small number and low quality of studies available for inclusion in the review, further studies are required to investigate the impact of standard and advanced hemodynamic monitoring-guided management on aSAH outcomes

Published
2021

21. Management of intracranial hypertension following traumatic brain injury: A best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy: Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Author

Iaccarino, C., Lippa, L., Munari, M., Castioni, C. A., Robba, C., Caricato, Anselmo, Pompucci, Angelo, Signoretti, S., Zona, G., Rasulo, F. A., Aimar, E., Amato, S., Angileri, F. F., Anile, Carmelo, Assietti, R., Baratto, V., Barbanera, A., Basile, L., Battaglia, R., Bellocchi, S., Bertuccio, A., Blanco, S., Bolognini, A., Boniferro, B., Bordi, L., Bortolotti, C., Brandini, V., Broger, Maximilian, Brollo, M., Caffarella, D. D., Caggiano, Cinzia, Cantisani, P. L., Capone, C., Cappelletto, B., Capuano, C., Carangelo, B., Caruselli, G., Chessa, M. A., Chiara, M., Chibbaro, S., Cioffi, V., Ciprianocecchi, P., Colistra, D., Conti, C., Contratti, F., Costella, G. B., Cuoci, A., D'Avella, D., D'Ercole, Manuela, Deangelis, M., Defalco, R., de Luca, G., de Marinis, P., Del Vecchio, C., Delfinis, C., Denaro, Luca, Deodato, F., Desogus, N., Disomma, A., Domenicucci, M., Dones, F., Fina, M., Fiori, L., Fricia, M., Gaetani, P., Gazzeri, R., Gentile, M., Germano, A., Ghadirpour, R., Gianfreda, C. D., Gigante, N., Gigli, R., Giorgetti, J., Giusa, M., Gravina, U. G., Grippi, L., Guida, F., Guizzardi, G., Iannuzzo, G., Kropp, M., Lattanzi, L., Lucantoni, D., Maffei, L., Magliulo, M., Marconi, F., Marruzzo, D., Martellotta, N., Marton, E., Maugeri, R., Mauro, G., Meli, F., Menniti, A., Merciadri, P., Milanese, L., Nardacci, B., Nasi, D., Orvieto, P., Pacca, P., Pansini, G., Panzarasa, G., Passanisi, M., Pavesi, G., Pizzoni, C., Pulera, F., Rapana, A., Ricci, A., Rispoli, R., Rotondo, M., Russo, N., Santilli, S., Scarano, E., Schwarz, A., Servadei, Franco, Simonetti, G., Stefini, R., Talamonti, G., Turrisi, A., Valente, V. M., Villa, A., Vindigni, M., Visocchi, Massimiliano, Vitali, M., Wierzbicki, V., Zambon, G., Zanotti, B., Zenga, F., Alampi, D., Alessandri, F., Aloj, F., Amigoni, A., Aspide, R., Bertuetti, R., Betti, V., Bilotta, F., Bonato, V., Bosco, E., Brita, M., Buscema, G., Cafiero, T., Cappuccio, D., Caradonna, M., Caria, C. G., Casartelliliviero, M., Ciritella, P., Cirrincione, S., Citerio, G., Colelli, S., Coletta, F., Concordia, L., Congedo, E., Covotta, M., Crimella, F., Dall'Acqua, G., De Cassai, A., Defulviis, S., Deperi, E., Deana, C., Delgaudio, A., Denittis, N., Dicolandrea, S., Divezza, F., Ferri, F., Flocco, R., Fontana, C., Forastierimolinari, A., Frangiosa, A., Fumagalli, P., Fuselli, E., Garbarino, M. M., Gelormini, D., Geraci, C., Geraldini, F., Giacomucci, A., Giampaoli, V., Giorgetti, D., Gritti, P., Gualdani, S., Iacovazzo, C., Iermano, C., Latronico, N., Lugari, S., Lusenti, F., Maglione, C., Magnoni, S., Maiarota, F., Malla, M., Marchesi, M., Martino, C., Matteotti, I., Mazzeo, A. T., Morello, G., Nardiello, I., Paticchio, F., Pegoli, M., Perotti, Valerio, Piazzolla, M., Picciafuochi, F., Rachedi, N., Radolovich, D. K., Recchia, A., Riccardi, S., Romagnoli, S., Sala, S., Scafuro, M. A., Sgarlata, P., Soragni, A., Stefani, F., Stival, Eleonora, Stofella, G., Terranova, F., Tinturini, R., Togni, T., Toto, R., Trapani, D., Tringali, E., Tullo, L., Valente, A., Valeo, T., Varelli, G., Villani, R., Zamacavicchi, F., Zanello, M., Zarrillo, N., Zugni, N., Caricato A. (ORCID:0000-0001-5929-120X), Pompucci A. (ORCID:0000-0002-5427-9719), Anile C. (ORCID:0000-0002-0481-9713), Broger M., Caggiano C., D'Ercole M., Denaro L., Servadei F., Visocchi M. (ORCID:0000-0003-1087-0491), Perotti V. (ORCID:0000-0001-9461-2101), Stival E., Iaccarino, C., Lippa, L., Munari, M., Castioni, C. A., Robba, C., Caricato, Anselmo, Pompucci, Angelo, Signoretti, S., Zona, G., Rasulo, F. A., Aimar, E., Amato, S., Angileri, F. F., Anile, Carmelo, Assietti, R., Baratto, V., Barbanera, A., Basile, L., Battaglia, R., Bellocchi, S., Bertuccio, A., Blanco, S., Bolognini, A., Boniferro, B., Bordi, L., Bortolotti, C., Brandini, V., Broger, Maximilian, Brollo, M., Caffarella, D. D., Caggiano, Cinzia, Cantisani, P. L., Capone, C., Cappelletto, B., Capuano, C., Carangelo, B., Caruselli, G., Chessa, M. A., Chiara, M., Chibbaro, S., Cioffi, V., Ciprianocecchi, P., Colistra, D., Conti, C., Contratti, F., Costella, G. B., Cuoci, A., D'Avella, D., D'Ercole, Manuela, Deangelis, M., Defalco, R., de Luca, G., de Marinis, P., Del Vecchio, C., Delfinis, C., Denaro, Luca, Deodato, F., Desogus, N., Disomma, A., Domenicucci, M., Dones, F., Fina, M., Fiori, L., Fricia, M., Gaetani, P., Gazzeri, R., Gentile, M., Germano, A., Ghadirpour, R., Gianfreda, C. D., Gigante, N., Gigli, R., Giorgetti, J., Giusa, M., Gravina, U. G., Grippi, L., Guida, F., Guizzardi, G., Iannuzzo, G., Kropp, M., Lattanzi, L., Lucantoni, D., Maffei, L., Magliulo, M., Marconi, F., Marruzzo, D., Martellotta, N., Marton, E., Maugeri, R., Mauro, G., Meli, F., Menniti, A., Merciadri, P., Milanese, L., Nardacci, B., Nasi, D., Orvieto, P., Pacca, P., Pansini, G., Panzarasa, G., Passanisi, M., Pavesi, G., Pizzoni, C., Pulera, F., Rapana, A., Ricci, A., Rispoli, R., Rotondo, M., Russo, N., Santilli, S., Scarano, E., Schwarz, A., Servadei, Franco, Simonetti, G., Stefini, R., Talamonti, G., Turrisi, A., Valente, V. M., Villa, A., Vindigni, M., Visocchi, Massimiliano, Vitali, M., Wierzbicki, V., Zambon, G., Zanotti, B., Zenga, F., Alampi, D., Alessandri, F., Aloj, F., Amigoni, A., Aspide, R., Bertuetti, R., Betti, V., Bilotta, F., Bonato, V., Bosco, E., Brita, M., Buscema, G., Cafiero, T., Cappuccio, D., Caradonna, M., Caria, C. G., Casartelliliviero, M., Ciritella, P., Cirrincione, S., Citerio, G., Colelli, S., Coletta, F., Concordia, L., Congedo, E., Covotta, M., Crimella, F., Dall'Acqua, G., De Cassai, A., Defulviis, S., Deperi, E., Deana, C., Delgaudio, A., Denittis, N., Dicolandrea, S., Divezza, F., Ferri, F., Flocco, R., Fontana, C., Forastierimolinari, A., Frangiosa, A., Fumagalli, P., Fuselli, E., Garbarino, M. M., Gelormini, D., Geraci, C., Geraldini, F., Giacomucci, A., Giampaoli, V., Giorgetti, D., Gritti, P., Gualdani, S., Iacovazzo, C., Iermano, C., Latronico, N., Lugari, S., Lusenti, F., Maglione, C., Magnoni, S., Maiarota, F., Malla, M., Marchesi, M., Martino, C., Matteotti, I., Mazzeo, A. T., Morello, G., Nardiello, I., Paticchio, F., Pegoli, M., Perotti, Valerio, Piazzolla, M., Picciafuochi, F., Rachedi, N., Radolovich, D. K., Recchia, A., Riccardi, S., Romagnoli, S., Sala, S., Scafuro, M. A., Sgarlata, P., Soragni, A., Stefani, F., Stival, Eleonora, Stofella, G., Terranova, F., Tinturini, R., Togni, T., Toto, R., Trapani, D., Tringali, E., Tullo, L., Valente, A., Valeo, T., Varelli, G., Villani, R., Zamacavicchi, F., Zanello, M., Zarrillo, N., Zugni, N., Caricato A. (ORCID:0000-0001-5929-120X), Pompucci A. (ORCID:0000-0002-5427-9719), Anile C. (ORCID:0000-0002-0481-9713), Broger M., Caggiano C., D'Ercole M., Denaro L., Servadei F., Visocchi M. (ORCID:0000-0003-1087-0491), Perotti V. (ORCID:0000-0001-9461-2101), and Stival E.

Abstract

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “T

Published
2021

23. Hemodynamic Monitoring in Patients With Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

Author

Simonassi F, Ball L, Badenes R, Millone M, Citerio G, Zona G, Pelosi P, and Robba C

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) often causes cardiopulmonary dysfunction. Therapeutic strategies can be guided by standard (invasive arterial/central venous pressure measurements, fluid balance assessment), and/or advanced (pulse index continuous cardiac output, pulse dye densitometry, pulmonary artery catheterization) hemodynamic monitoring. We conducted a systematic review and meta-analysis of the literature to determine whether standard compared with advanced hemodynamic monitoring can improve patient management and clinical outcomes after aSAH. A literature search was performed for articles published between January 1, 2000 and January 1, 2019. Studies involving aSAH patients admitted to the intensive care unit and subjected to any type of hemodynamic monitoring were included. A total of 14 studies were selected for the qualitative synthesis and 3 randomized controlled trials, comparing standard versus advanced hemodynamic monitoring, for meta-analysis. The incidence of delayed cerebral ischemia was lower in the advanced compared with standard hemodynamic monitoring group (relative risk [RR]=0.71, 95% confidence interval [CI]=0.52-0.99; P=0.044), but there were no differences in neurological outcome (RR=0.83, 95% CI=0.64-1.06; P=0.14), pulmonary edema onset (RR=0.44, 95% CI=0.05-3.92; P=0.46), or fluid intake (mean difference=-169mL; 95% CI=-1463 to 1126mL; P=0.8) between the 2 groups. In summary, this systematic review and meta-analysis found only low-quality evidence to support the use of advanced hemodynamic monitoring in selected aSAH patients. Because of the small number and low quality of studies available for inclusion in the review, further studies are required to investigate the impact of standard and advanced hemodynamic monitoring-guided management on aSAH outcomes.

Published
2020

24. Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Author

Iaccarino, C., primary, Kolias, A., additional, Adelson, P. D., additional, Rubiano, A. M., additional, Viaroli, E., additional, Buki, A., additional, Cinalli, G., additional, Fountas, K., additional, Khan, T., additional, Signoretti, S., additional, Waran, V., additional, Adeleye, A. O., additional, Amorim, R., additional, Bertuccio, A., additional, Cama, A., additional, Chesnut, R. M., additional, De Bonis, P., additional, Estraneo, A., additional, Figaji, A., additional, Florian, S. I., additional, Formisano, R., additional, Frassanito, P., additional, Gatos, C., additional, Germanò, A., additional, Giussani, C., additional, Hossain, I., additional, Kasprzak, P., additional, La Porta, F., additional, Lindner, D., additional, Maas, A. I. R., additional, Paiva, W., additional, Palma, P., additional, Park, K. B., additional, Peretta, P., additional, Pompucci, A., additional, Posti, J., additional, Sengupta, S. K., additional, Sinha, A., additional, Sinha, V., additional, Stefini, R., additional, Talamonti, G., additional, Tasiou, A., additional, Zona, G., additional, Zucchelli, M., additional, Hutchinson, P. J., additional, and Servadei, F., additional

Published
2020
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26. A Survey on Pituitary Surgery in Italy

Author

Solari, D, Zenga, F, Angileri, Ff, Barbanera, A, Berlucchi, S, Bernucci, C, Carapella, C, Catapano, D, Catapano, G, Cavallo, Lm1, D'Arrigo, C, de Angelis, M, Denaro, L, Desogus, N, Ferroli, P, Fontanella, Mm, Galzio, Rj, Gianfreda, Cd, Iacoangeli, M, Lauretti, Liverana, Locatelli, D, Locatelli, M, Luglietto, D, Mazzatenta, D, Menniti, A, Milani, D, Nasi, Mt, Romano, A, Ruggeri, Ag, Saladino, A, Santonocito, O, Schwarz, A, Skrap, M, Stefini, R, Volpin, L, Wembagher, Gc, Zoia, C, Zona, G, Cappabianca, P, Lauretti L (ORCID:0000-0002-6463-055X), Solari, D, Zenga, F, Angileri, Ff, Barbanera, A, Berlucchi, S, Bernucci, C, Carapella, C, Catapano, D, Catapano, G, Cavallo, Lm1, D'Arrigo, C, de Angelis, M, Denaro, L, Desogus, N, Ferroli, P, Fontanella, Mm, Galzio, Rj, Gianfreda, Cd, Iacoangeli, M, Lauretti, Liverana, Locatelli, D, Locatelli, M, Luglietto, D, Mazzatenta, D, Menniti, A, Milani, D, Nasi, Mt, Romano, A, Ruggeri, Ag, Saladino, A, Santonocito, O, Schwarz, A, Skrap, M, Stefini, R, Volpin, L, Wembagher, Gc, Zoia, C, Zona, G, Cappabianca, P, and Lauretti L (ORCID:0000-0002-6463-055X)

Abstract

BACKGROUND: Pituitary tumors are a heterogeneous group of lesions that are usually benign. Therefore, a proper understanding of the anatomy, physiology, and pathology is mandatory to achieve favorable outcomes. Accordingly, diagnostic tests and treatment guidelines should be determined and implemented. Thus, we decided to perform a multicenter study among Italian neurosurgical centers performing pituitary surgery to provide an actual depiction from the neurosurgical standpoint. METHODS: On behalf of the SINch (Società Italiana di Neurochirurgia), a survey was undertaken with the participants to explore the activities in the field of pituitary surgery within 41 public institutions. RESULTS: Of the 41 centers, 37 participated in the present study. The total number of neurosurgical procedures performed in 2016 was 1479. Most of the procedures were performed using the transsphenoidal approach (1320 transsphenoidal [1204 endoscopic, 53 microscopic, 53 endoscope-assisted microscopic] vs. 159 transcranial). A multidisciplinary tumor board is convened regularly in 32 of 37 centers, and a research laboratory is present in 18 centers. CONCLUSIONS: Diagnosing pituitary/hypothalamus disorders and treating them is the result of teamwork, composed of several diverse experts. Regarding neurosurgery, our findings have confirmed the central role of the transsphenoidal approach, with preference toward the endoscopic technique. Better outcomes can be expected at centers with a multidisciplinary team and a full, or part of a, residency program, with a greater surgical caseload.

Published
2019

29. Adiponectin as novel regulator of cell proliferation in human glioblastoma

Author

Porcile C, Di Zazzo E, Monaco ML, D'Angelo G, Passarella D, Russo C, Di Costanzo A, Pattarozzi A, Gatti M, Bajetto A, Zona G, Barbieri F, Oriani G, Moncharmont B, Florio T, DANIELE, Aurora, Porcile, C, Di Zazzo, E, Monaco, Ml, D'Angelo, G, Passarella, D, Russo, C, Di Costanzo, A, Pattarozzi, A, Gatti, M, Bajetto, A, Zona, G, Barbieri, F, Oriani, G, Moncharmont, B, Florio, T, and Daniele, Aurora

Subjects
Adult, Aged, 80 and over, DNA Replication, Male, Mitogen-Activated Protein Kinase 1, Mitogen-Activated Protein Kinase 3, Time Factors, Dose-Response Relationship, Drug, adiponectin, Brain Neoplasms, glioblastoma, Antineoplastic Agents, adiponectin receptor 1, Middle Aged, G1 Phase Cell Cycle Checkpoints, Cell Line, Tumor, Humans, Female, Receptors, Adiponectin, Proto-Oncogene Proteins c-akt, Aged, Cell Proliferation, Signal Transduction
Abstract

Adiponectin (Acrp30) is an adipocyte-secreted hormone with pleiotropic metabolic effects, whose reduced levels were related to development and progression of several malignancies. We looked at the presence of Acrp30 receptors in human glioblastomas (GBM), hypothesizing a role for Acrp30 also in this untreatable cancer. Here we demonstrate that human GBM express Acrp30 receptors (AdipoR1 and AdipoR2), which are often co-expressed in GBM samples (70% of the analyzed tumors). To investigate the effects of Acrp30 on GBM growth, we used human GBM cell lines U87-MG and U251, expressing both AdipoR1 and AdipoR2 receptors. In these cells, Acrp30 treatment inhibits DNA synthesis and cell proliferation rate, inducing arrest in G1 phase of the cell cycle. These effects were correlated to a sustained activation of ERK1/2 and Akt kinases, upon Acrp30 treatment. Our results suggest that Acrp30 may represent a novel endogenous negative regulator of GBM cell proliferation, to be evaluated for the possible development of novel pharmacological approaches. © 2014 Wiley Periodicals, Inc.

Published
2014

30. Unruptured Aneurysms Italian Study (UAIS) background and method

Author

Versari, P. b, Tartara, F. b, Scerrati, M. c, Caroselli, G. c, Pasquini, U. c, Ciappetta, P. d, Vailati, G. d, Occhiogrosso, M. d, Biroli, F. e, Bonaldi, G. e, Calbucci, F. f, Andreoli, A. f, Leopardi, M. f, Raff, L. f, Bollati, A. g, Gasparotti, R. g, Martellotto, N. h, Distefano, G. h, Pinna, G. i, Francaviglia, N. j, Ventura, F. k, Orazio, G. k, Cristaudo, C. k, Consoli, V. l, Nicoletti, G. l, Albanese, V. m, Ceccotti, C. n, Frattarelli, M. o, Servadei, F. o, Cremonini, A. M. o, Taborelli, A. p, Corriero, G. q, Galli, G. r, Morandini, A. r, Medina, M. s, Padovani, R. t, Farneti, M. t, Ghadirpour, R. t, DiLorenzo, N. u, Mennonna, P. v, Ammannati, F. v, Mangiafico, S. v, Celerini, M. v, Paoli, L. v, Andrioli, G. w, Zerbi, D. w, Spaziante, R. x, Pau, A. x, Stefani, F. x, Zona, G. L. x, Castellan, L. x, Cantore, G. y, Innocenzi, G. y, Galzio, R. z, Ricci, A. z, Montinaro, A. aa, Cantisani, P. aa, Arena, O. ab, Tonnarelli, G. P. ac, Gagliardi, R. ad, Benvenuti, L. ad, Tomasello, F. ae, Paterniti, S. ae, Trincia, G. af, Conti, C. af, Broggi, G. ag, Giombini, S. ag, Solero, C. L. ag, Marras, C. ag, Todaro, Ciceri, E. ag, Fornari, M. ah, DeSantis, A. ah, Cardia, Ortolina, Rodriguez, R. ai, Gaetani, P. ai, Collice, M. aj, D'Aliberti, G. aj, Talamonti, G. aaj, LaCamera, A. aj, Boccardi, E. aj, Villani, R. ak, Gaini, S. ak, Miserocchi, G. ak, Branca, V. ak, Giovanelli, M. al, Cenzato, Scotti, G. al, Merli, A. am, Piazza, P. am, Sganzerla, E. an, Profeta, G. ao, Daniele, B. ao, Monsignore, R. ao, Cioffi, F. ap, Rotondo, M. ap, Natale, DeDivitiis, E. aq, F. aq, Franco, A. ar, Apolito, R. ar, Delehaye, L. ar, Sossio, C. as, Bellotti, C. at, Car, P. G. at, Benvenuto, F. at, Scienza, R. au, Berlucchi, S. au, Pavesi, G. au, Fiore, D. au, LaSeta, F. av, Filizzolo, F. aw, Fiumara, E. aw, Tumbiolo, S. aw, Benericetti, E. ax, Sacchelli, A. ax, Arienta, C. ay, Zappoli, F. ay, Buoncristiani, P. az, Buonaguidi, R. ba, Bianchini, E. ba, Boccardo, M. bb, Valsania, V. bb, Bruzzone, L. bb, Cantini, L. R. bc, Marconi, F. bc, Parenti, G. F. bd, Liberti, G. bd, Severino, P. be, Delitala, A. bf, Cotroneo, E. bf, Gazzeri, G. bg, Fiume, D. bg, Esposito, S. bh, Agrillo, U. bi, Sidoti, C. bi, Maira, G. bj, Vignati, A. bj, Marchese, E. bj, Delfini, R. bk, Guidetti, G. bk, Bufatti, P. bl, Strabella, G. bm, D'Angelo, V. bn, Monte, Florio, F. bn, Olivieri, G. bo, Palma, L. bp, Serchi, E. bp, Fontana, R. bq, Resta, M. br, Faccani, G. bs, Musso, C. bs, Ducati, A. bt, Bradac, G. B. bt, Longatti, P. bu, Tacconi, L. bv, Skrap, M. bw, Nicassio, N. bw, Graziussi, G. bx, Migliaccio, N. bx, Puglisi, A. bx, Tomei, G. by, Bonfanti, N. by, Tabano, A. by, Bricolo, A. bz, Pasqualin, Beltramello, Colombo, F. ca, Causin, Perini, S. ca, MAIURI, FRANCESCO, BRIGANTI, FRANCESCO, Versari, P. b, Tartara, F. b, Scerrati, M. c, Caroselli, G. c, Pasquini, U. c, Ciappetta, P. d, Vailati, G. d, Occhiogrosso, M. d, Biroli, F. e, Bonaldi, G. e, Calbucci, F. f, Andreoli, A. f, Leopardi, M. f, Raff, L. f, Bollati, A. g, Gasparotti, R. g, Martellotto, N. h, Distefano, G. h, Pinna, G. i, Francaviglia, N. j, Ventura, F. k, Orazio, G. k, Cristaudo, C. k, Consoli, V. l, Nicoletti, G. l, Albanese, V. m, Ceccotti, C. n, Frattarelli, M. o, Servadei, F. o, Cremonini, A. M. o, Taborelli, A. p, Corriero, G. q, Galli, G. r, Morandini, A. r, Medina, M., Padovani, R. t, Farneti, M. t, Ghadirpour, R. t, Dilorenzo, N. u, Mennonna, P. v, Ammannati, F. v, Mangiafico, S. v, Celerini, M. v, Paoli, L. v, Andrioli, G. w, Zerbi, D. w, Spaziante, R. x, Pau, A. x, Stefani, F. x, Zona, G. L. x, Castellan, L. x, Cantore, G. y, Innocenzi, G. y, Galzio, R. z, Ricci, A. z, Montinaro, A., Aa, Cantisani, P., Aa, Arena, O., Ab, Tonnarelli, G. P., Ac, Gagliardi, R., Ad, Benvenuti, L., Ad, Tomasello, F., Ae, Paterniti, S., Ae, Trincia, G., Af, Conti, C., Af, Broggi, G., Ag, Giombini, S., Ag, Solero, C. L., Ag, Marras, C., Ag, Todaro, Ciceri, E., Ag, Fornari, M., Ah, Desantis, A., Ah, Cardia, Ortolina, Rodriguez, R., Ai, Gaetani, P., Ai, Collice, M., Aj, D'Aliberti, G., Aj, Talamonti, G., Aaj, Lacamera, A., Aj, Boccardi, E., Aj, Villani, R., Ak, Gaini, S., Ak, Miserocchi, G., Ak, Branca, V., Ak, Giovanelli, M., Al, Cenzato, Scotti, G., Al, Merli, A., Am, Piazza, P., Am, Sganzerla, E., An, Profeta, G., Ao, Daniele, B., Ao, Monsignore, R., Ao, Cioffi, F., Ap, Rotondo, M., Ap, Natale, Dedivitiis, E., Aq, Maiuri, Francesco, F., Aq, Briganti, Francesco, Franco, A., Ar, Apolito, R., Ar, Delehaye, L., Ar, Sossio, C., A, Bellotti, C., At, Car, P. G., At, Benvenuto, F., At, Scienza, R., Au, Berlucchi, S., Au, Pavesi, G., Au, Fiore, D., Au, Laseta, F., Av, Filizzolo, F., Aw, Fiumara, E., Aw, Tumbiolo, S., Aw, Benericetti, E., Ax, Sacchelli, A., Ax, Arienta, C., Ay, Zappoli, F., Ay, Buoncristiani, P., Az, Buonaguidi, R., Ba, Bianchini, E., Ba, Boccardo, M., Bb, Valsania, V., Bb, Bruzzone, L., Bb, Cantini, L. R., Bc, Marconi, F., Bc, Parenti, G. F., Bd, Liberti, G., Bd, Severino, P., Be, Delitala, A., Bf, Cotroneo, E., Bf, Gazzeri, G., Bg, Fiume, D., Bg, Esposito, S., Bh, Agrillo, U., Bi, Sidoti, C., Bi, Maira, G., Bj, Vignati, A., Bj, Marchese, E., Bj, Delfini, R., Bk, Guidetti, G., Bk, Bufatti, P., Bl, Strabella, G., Bm, D'Angelo, V., Bn, Monte, Florio, F., Bn, Olivieri, G., Bo, Palma, L., Bp, Serchi, E., Bp, Fontana, R., Bq, Resta, M., Br, Faccani, G., B, Musso, C., B, Ducati, A., Bt, Bradac, G. B., Bt, Longatti, P., Bu, Tacconi, L., Bv, Skrap, M., Bw, Nicassio, N., Bw, Graziussi, G., Bx, Migliaccio, N., Bx, Puglisi, A., Bx, Tomei, G., By, Bonfanti, N., By, Tabano, A., By, Bricolo, A., Bz, Pasqualin, Beltramello, Colombo, F., Ca, Causin, Perini, and S., Ca

Subjects
Aneurysm
Published
2006

31. Sellar repair in transsphenoidal surgery

Author

SPAZIANTE R., ZONA G., DE DIVITIIS, ENRICO, CAPPABIANCA, PAOLO, SCHMIDEK H.H., ROBERTS D., Spaziante, R., DE DIVITIIS, Enrico, Cappabianca, Paolo, and Zona, G.

Published
2005

32. Balance between somatostatin and D2 receptor expression drives TSH-secreting adenoma response to somatostatin analogues and dopastatins

Author

Gatto, Federico, Barbieri, F, Gatti, M, Wurth, R, Schulz, S, Ravetti, JL, Zona, G, Culler, MD, Saveanu, A, Giusti, M, Minuto, F, Hofland, Leo, Ferone, D, Florio, T, and Internal Medicine

Abstract

Context First-line therapy for thyrotropin-secreting pituitary adenomas (TSHomas) is neurosurgery, while medical treatment rests mainly on somatostatin analogues. Clinically available sst2-preferring analogues, octreotide and lanreotide, induce normalization of hormone levels in approximately 90% of patients and tumour shrinkage in 45%. Objective We evaluated somatostatin 1, 2, 3 and 5 and dopamine D2 receptor expression in tumour samples from three TSHomas, and the relationships between receptor expression, in vitro antiproliferative response and clinical data, including octreotide test and three months of therapy with octreotide long-acting repeatable (LAR). TSHoma cell proliferation was tested in vitro using octreotide, cabergoline and two chimeric compounds, BIM-23A760 and BIM-23A387. Results All patients showed significant TSH lowering to acute octreotide test, but a hormonal response to long-term treatment was observed in only two patients, showing a high sst5/sst2 ratio. Patient 2, characterized by high expression of sst2 and sst1 and a relative lower expression of sst5, experienced tachyphylaxis after prolonged octreotide treatment. In vitro, the somatostatin/dopamine receptor agonist BIM-23A760 caused the highest antiproliferative effect among those tested. Combined trea Conclusions A high sst5/sst2 ratio might be predictive of a positive outcome to long-term treatment with somatostatin analogues in TSHomas. Moreover, combined somatostatin and D2 receptor targeting might be considered as a potential tool to improve the response rate in octreotide-resistant tumours.

Published
2012

33. Binding of paroxetine to the serotonin transporter in membranes from different dells, subcellular fractions and species

Author

Cupello A. 1, 2, Albano C. 3, Gatta E. 2, Scarrone S. 1, Villa E. 1, and Zona G. 4

Subjects
Serotonin transporter, Platelet membranes, Different species, Synaptosomal membranes, Paroxetine binding
Abstract

The binding of [(3)H]-paroxetine to membrane serotonin transporter (SERT) has been studied in membranes from different sources and subcellular fractions. From rat were membranes from venous blood platelets, brain total cortex, brain microsomes, brain crude and purified synaptosomes. Membranes were obtained from venous blood platelets from human volunteers and from brain cortex tissue from neurosurgery (cerebral lobectomies following craniocerebral injuries). The main finding was that the K (D) of paroxetine binding to the SERT was the same for platelet and nerve ending (synaptosomal) membranes. That parameter was significantly lower in membranes from brain microsomes and cortex total tissue. No species related difference was found, where comparison was possible, between human and rat tissue. The equality of K (D) of paroxetine binding to blood platelet membranes and to membranes from nerve endings appears to encourage the use of such membranes as a model for brain SERT. Binding at two different temperatures for several of the fractions suggests that paroxetine-SERT interaction is entropy-driven.

Published
2009

34. MRI findings in patients with a GH deficit

Author

D'AMICO A, CARANCI F, SIMONETTI L, ZONA G, SALERNO M, DI MAIO S, ELEFANTE R., CIRILLO, Sossio, D'Amico, A, Caranci, F, Simonetti, L, Zona, G, Salerno, M, DI MAIO, S, Cirillo, Sossio, and Elefante, R.

Published
1997

36. Biological air filter for air quality control

Author

van Ras, N., Krooneman, J., Ogink, N.W.M., Willers, H.C., D'Amico, A., Di Natale, C., Godia, F., Albiol, J., Perez, J., Martinez, N., Dixon, M., Llewellyn, D., Eckhard, F., Zona, G., Fachecci, L., Kraakman, B., Demey, D., Michel, N., and Darlington, A.

Subjects
AFSG Agrisystems & Environment, Life Science, Agrotechnology and Food Sciences, Agrotechnologie en Levensmiddelentechnologie
Published
2005

43. Factors affecting formation and rupture of intracranial saccular aneurysms

Author

Bacigaluppi, S., primary, Piccinelli, M., additional, Antiga, L., additional, Veneziani, A., additional, Passerini, T., additional, Rampini, P., additional, Zavanone, M., additional, Severi, P., additional, Tredici, G., additional, Zona, G., additional, Krings, T., additional, Boccardi, E., additional, Penco, S., additional, and Fontanella, M., additional

Published
2013
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45. Epilessia ed amartomi del tuber cinereum

Author

Caranci, Ferdinando, Castellano, E., Esposito, G., Zona, G., Cirillo, S., Striano, S., Elefante, R., Caranci, Ferdinando, E., Castellano, G., Esposito, G., Zona, S., Cirillo, Striano, Salvatore, and R., Elefante

Published
1997

49. Efficacy of a dopamine-somatostatin chimeric molecule, BIM-23A760, in the control of cell growth from primary cultures of human non-functioning pituitary adenomas: a multi-center study

Author

Florio, T., primary, Barbieri, F., additional, Spaziante, R., additional, Zona, G., additional, Hofland, L. J, additional, van Koetsveld, P. M, additional, Feelders, R. A, additional, Stalla, G. K, additional, Theodoropoulou, M., additional, Culler, M. D, additional, Dong, J., additional, Taylor, J. E, additional, Moreau, J.-P., additional, Saveanu, A., additional, Gunz, G., additional, Dufour, H., additional, and Jaquet, P., additional

Published
2008
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