1,720,992 research outputs found
Fluorescein-aided neurosurgery
Full text linkNeurosurgery made enormous advances over the last century. Moving from a meticulous anatomical knowledge of the cerebral structures and passing through the “microscope revolution” we arrived in the modern neuronavigation era in which we can render and correlate real-time the preoperative imaging to the patient. Real life, though, is way different from simulation and technological promises. In fact, some tumours are still almost undistinguishable from the brain in normal vision and our individual estimate of vessel patency may be proved way wrong at the ischemic post operative imaging. Sometimes, even with all the best resources, we are blindly performing life-saving procedures. The development of fluorescent intra-operative tracers tried to address these issues. This PhD thesis is, basically, the synthesis of three years of personal clinical experience on the experimental use of intra-operative Fluorescein in Neurosurgery.
Briefly, I will describe the optical and pharmaceutical properties of Fluorescein and explain how I assembled a low-cost fluorescence detection system. Then I will go through all the fields of Neurosurgery in which I applied this technology.
Firstly, I will report the preliminary results of an ongoing Clinical Trial on the use of Fluorescein as an intra-operative contrast enhancer of the borders of high grade glioma tumours.
Then, the potential advantages of fluorescein use in vascular neurosurgery will be discussed. In particular the use of fluorescein for the evaluation of the exclusion of intra-cerebral aneurysms will be illustrated by means of an explicative case. Similarly, I will report the usefulness of intra-operative fluorescence detection in a case of intra-cerebral cavernoma. Lastly, I will describe the experience of fluorescein staining in the field of Hereditary hemorrhagic telangiectasia and explain the potential advantages of this technique in arteriovenous malformations.
Eventually, I will describe the usefulness of dedicated endoscopic filters for fluorescein detection in trans-nasal skull base procedures. The rationale and preliminary results of the use of fluorescein as an intra-operative contrast medium in pituitary adenoma surgery will be presented. CSF leak detection and pedicled flaps' perfusion evaluation techniques will be also described in detail.Neurosurgery made enormous advances over the last century. Moving from a meticulous anatomical knowledge of the cerebral structures and passing through the “microscope revolution” we arrived in the modern neuronavigation era in which we can render and correlate real-time the preoperative imaging to the patient. Real life, though, is way different from simulation and technological promises. In fact, some tumours are still almost undistinguishable from the brain in normal vision and our individual estimate of vessel patency may be proved way wrong at the ischemic post operative imaging. Sometimes, even with all the best resources, we are blindly performing life-saving procedures. The development of fluorescent intra-operative tracers tried to address these issues. This PhD thesis is, basically, the synthesis of three years of personal clinical experience on the experimental use of intra-operative Fluorescein in Neurosurgery.
Briefly, I will describe the optical and pharmaceutical properties of Fluorescein and explain how I assembled a low-cost fluorescence detection system. Then I will go through all the fields of Neurosurgery in which I applied this technology.
Firstly, I will report the preliminary results of an ongoing Clinical Trial on the use of Fluorescein as an intra-operative contrast enhancer of the borders of high grade glioma tumours.
Then, the potential advantages of fluorescein use in vascular neurosurgery will be discussed. In particular the use of fluorescein for the evaluation of the exclusion of intra-cerebral aneurysms will be illustrated by means of an explicative case. Similarly, I will report the usefulness of intra-operative fluorescence detection in a case of intra-cerebral cavernoma. Lastly, I will describe the experience of fluorescein staining in the field of Hereditary hemorrhagic telangiectasia and explain the potential advantages of this technique in arteriovenous malformations.
Eventually, I will describe the usefulness of dedicated endoscopic filters for fluorescein detection in trans-nasal skull base procedures. The rationale and preliminary results of the use of fluorescein as an intra-operative contrast medium in pituitary adenoma surgery will be presented. CSF leak detection and pedicled flaps' perfusion evaluation techniques will be also described in detail
Chordoid glioma: A rare radiologically, histologically, and clinically mystifying lesion
Full text linkProtesi + Cage nella patologia disco-artrosi cervicale; nostra esperienza e razionale degli impianti misti; R. Pugliese, D. Bongetta, D. Adinolfi, GL. Brambilla, C. Arienta
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Neuroembolization may expose patients to radiation doses previously linked to tumor induction.
No full textOBJECTIVE: Epidemiological studies indicate a link between low-dose irradiation
(<10,000 mGy) to the head and the local occurrence of tumors after decades of
delay. Comparable radiation doses can be reached during neuro-endovascular
procedures (NEP), but the incidence of similar exposures has not been completely
delineated. We compared the levels of radiation to the head measured during NEP
to those reported for patients developing radiation-induced cancers.
METHODS: In our prospective study we determined the cumulative maximum entrance
skin doses (MESD) and the incidence of epilation in 107 consecutive patients
submitted to NEP between 2003 and 2007. We also extensively searched the
literature and compared our results with the data we found.
RESULTS: The cumulative MESD due to NEP was above 3,000 mGy (range 3,101-5,421
mGy) in 18 patients. In 22 we observed partial epilation within 10 weeks from the
initial NEP. Sixty cases of epilation after NEP have been previously reported in
the literature. The average of the reported MESD was 4,241 mGy (range 2,000-6,640
mGy).
CONCLUSION: Physical dosimetry and the incidence of partial epilation indicate
that about one fifth of the patients submitted to NEP received radiation doses
comparable to those linked to the occurrence of tumors. The potential risks of
developing tumors after a long delay, when compared to the immediate benefits of
endovascular treatment of aneurysm and arteriovenous malformations (AVM) of the
brain, do not counterindicate NEP, but increased awareness of the risk should
help physicians and patients to make a fully informed decision when other
treatments are available
Chirurgia dei meningiomi negli anziani: “si può fare!”, Zoia C, Cattalani A, Bongetta D, Minelli M, Adinolfi D, Gaetani P,
No full textLetter: Safety and efficacy issues of tirofiban use in endovascular procedures: What are the actual indications?
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Erratum to: Neuroembolization may expose patients to radiation doses previously linked to tumor induction.
No full textErratum to: Neuroembolization may expose patients to radiation doses previously linked to tumor induction
Adjuvant radiotherapy in grossly total resected grade II atypical meningiomas: a protective effect on recurrence?
No full textIntroduction: Management of grade II atypical meningiomas (AM) remains controversial. Conflicting evidence exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival. Evidence acquisition: Literature review was performed by the study investigators who handily queried the MEDLINE database using keywords and MeSH terms in different combinations using the Boolean operators "AND" or "OR," and database-related filters to maximize the chance to identify articles focusing on role of radiotherapy in atypical (WHO grade II) meningiomas. Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery + ART. Only grossly total resected AMs (Simpson grades 1-3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery + ART. Evidence synthesis: Eleven studies were considered eligible. 8 were included for the outcome "crude recurrence;" 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery + ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery + ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach. Conclusions: Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone
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