1,720,984 research outputs found
Validazione esterna di una scala di grading delle malformazioni artero-venose rotte (RAGS) in una coorte multicentrica di adulti
Full text linkIntroduzione.
La scala di valutazione del gradind delle MAV rotte (RAGS) è stata recentemente validata nella popolazione pediatrica. Il nostro studio è finalizzato a valutarne la sua efficacia in una coorte multicentrica di adulti comparandola con altre scale comunemente utilizzate.
Materiali e metodi.
Abbiamo effettuato un'analisi retrospettiva sui pazienti ricoverati per MAV rotte in 5 dipartimenti di neurochirurgia dal 2012 al 2019. Nei pazienti inclusi è stata effettuata un'analisi di regressione standard e dell'area sottesa alla curva AUROC delle seguenti scale: emorragia intracerebrale (ICH), ICH associata a MAV (AVICH), Spetzler-Martin (SM), SM Supplementare (Supp-SM), Hunt e Hess (HH), Glasgow Coma Scale (GCS), World Federation of Neurological Surgeons (WFNS) e RAGS al fine di valutare il valore predittivo nella variazioni cliniche stimate con la scala di Rankin modificata (mRS) categoriale e dicotomizzata in tre periodi di follow-up: entro i 6 mesi, da 6 mesi a 1 anno e oltre 1 anno.Risultati.
Sono stati inclusi 61 pazienti con un'età media di 43,6 anni. Nella nostra analisi RAGS è risultata superiore alle altre scale prese in esame in tutti e tre i periodi follow-up. RAGS ha presentato un AUROC rispettivo nei tre periodi di follow-up di 0,78 (entro 6 mesi), 0,74 (tra 6 e 12 mesi) e 0,71(oltre 12 mesi) quando è stata applicata la mRS categoriale ed ha presentato un AUROC rispettivo di 0,79, 0,76 e 0,73 quando è stata applicata la mRS dicotomizzata.
Conclusioni.
RAGS costituisce una scala affidabile che predice i risultati clinici nelle MAV rotte negli adulti. Inoltre, RAGS ha dimostrato di mantenere il suo valore predittivo anche se applicata a dipartimenti di neurochirurgia con preferenze di trattamento diverse
Completely Thrombosed Distal Middle Cerebral Artery Aneurysm Mimicking a Cavernous Angioma. Case Report and Review of the Literature
No full textBackground Distal middle cerebral artery (MCA) aneurysms originate from branches of MCA distal to its main bifurcation or the peripheral branches. Distal MCA aneurysms are uncommon compared with saccular aneurysms, which develop along the proximal trunks of MCA. However, thrombotic aneurysms, characterized by organized intraluminal thrombus and solid mass, are frequently in the large and giant size range, whereas complete thrombosis of non-giant MCA aneurysms is very rare. Case Presentation We present the clinical case of a 53 years-old woman with a completely thrombosed medium distal MCA aneurysm mimicking a cavernous angioma. She came to our emergency department after the onset of tinnitus and persistent headache. Magnetic resonance imaging performed subsequently showed a nodular mass surrounded by edema located in the temporal lobe with a homogeneous peripheral contrast enhancement. Furthermore, angiography showed regular flow in the MCA and confirmed the diagnosis of cavernous angioma. The patient underwent surgery, and the lesion was found to be a thrombosed aneurysm originating from the distal temporal branch of the left MCA (M2 segment). Conclusions To our knowledge, this is the first report of a thrombosed distal medium MCA aneurysm that mimicked a cavernous angioma. The completely thrombosed aneurysm can be confused with intracranial lesions or cavernous malformations, which can have similar radiographic features without angiographic anomalies, so it is mandatory to consider the possibility of a thrombosed aneurysm for a correct differential diagnosis
Lipomatous meningioma: clinical-pathological findings, imaging characterisation and correlations of a rare type of meningioma
Full text linkLipomatous meningioma (LM) is a form of metaplasia, originating from intracellular lipid bodies accumulation due to metabolic alterations. A comprehensive literature review was performed introducing further elements of evaluation. The parameters utilized were age, sex, location, clinical presentation, imaging features, treatment, and recurrences. Seizure and headache are the primary onsets of symptoms. Further LM clinical features, such as visual disturbances and visual epileptic seizures were examined. Symptoms may occur ten years prior to LM finding and it can resolve completely with the indicated surgery. LM computed tomography imaging analysis reveals hypodense regions due to the presence of fat content. On magnetic resonance imaging, the lesion displays hyperintense signal in T1-T2 with signal loss in the fat-suppression sequences. Immunohistochemically, lipidized meningioma cells are positive for Epithelial-Membrane Antigen, Vimentin, CD99, S-100 protein, and progesterone receptor. The recurrence risk rate of LM is estimated to be around 17%. Precise immune-histological findings have been correlated with imaging features to help with early diagnosis. A defined diagnosis of LM is a crucial factor in the choice of treatment
The prognostic value of emergency microsurgical clipping of ruptured anterior circulation aneurysms
No full textBackground: The treatment of aneurysmal subarachnoid hemorrhage poses a formidable challenge, given the high mortality rate and associated mortality. Current recommendations are for treatment to be initiated within 24 hours of diagnosis. Methods: In our study, we compared a cohort of 66 patients who received prompt microsurgical treatment within 6 hours of diagnosis with a cohort of 51 patients who received prompt microsurgical treatment within 12 hours of diagnosis. Results: The modified Rankin Scale was utilized to evaluate the follow-up of patients at 30 days, 12 months, and 18 months following surgery. We performed a parametric comparison of the distributions of the means of groups, and our results indicate that treatment within 6 hours of diagnosis results in a lower incidence of obstructive hydrocephalus and a more favorable outcome. Conclusions: A favorable outcome was observed in patients who were treated within 6 hours. The availability of a specialized vascular team ensures the highest levels of care
Minimally invasive surgery for the treatment of traumatic monosegmental thoracolumbar burst fractures. clinical and radiologic outcomes of 144 patients with a 6-year follow-up comparing two groups with or without intermediate screw
No full textStudy Design: This was a retrospective study of the clinical and radiologic outcomes of traumatic thoracolumbar (TL) burst fractures. Objectives: We aimed to evaluate the clinical and radiologic outcomes after 6 years of follow-up of 144 patients with monosegmental TL burst fractures treated with percutaneous short-segment pedicle screw fixation, comparing two groups with versus without placement of an intermediate screw at the fractured vertebra. Summary of Background Data: Traumatic TL fractures are the most common vertebral fractures, especially at the TL junction (T10-L2). Minimally invasive surgery (MIS) is a valuable treatment option for traumatic TL burst fractures. Materials and Methods: The clinical outcomes and radiologic parameters (Cobb angle, midsagittal index, and sagittal index) of 144 patients with traumatic monosegmental TL fractures treated with MIS were evaluated preoperatively, postoperatively, and after 3 and 6 years of follow-up. Patients were categorized into a nonintermediate screw group (nISG) and an intermediate screw group (ISG), and the groups were compared. Results: There were 71 patients (49.3%) in the nISG and 73 patients (50.7%) in the ISG. The radiologic parameters improved significantly more from the preoperative evaluation to the 6-year follow-up in the ISG than in the nISG (P<0.025). There were no significant differences in the mean Oswestry Disability Index (ODI) and Visual Analog Scale scores at the 6-year follow-up between the ISG and the nISG: 15.6% (ISG) versus 16.8% (nISG) for ODI (P<0.1) and 2.2 (ISG) versus 2.4 (nISG) for Visual Analog Scale score (P<0.85) (P<0.73). Conclusions: MIS showed good clinical outcomes 6 years after surgery in both the ISG and the nISG. The additional intermediate screw significantly improved radiologic parameters but not clinical outcomes
Cerebellopontine angle pilocytic astrocytoma in adults: a systematic review
Full text linkBackground: In adults, the cerebellopontine angle (CPA) pilocytic astrocytoma (PA) is very rare. This tumor has radiological features similar to those of a vestibular schwannoma in the few cases reported in the literature. Methods: In this study, we conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and scrutinized all original studies pertaining to pontocerebellar angle PA in adult patients. We conducted an analysis of the clinical, radiological, and molecular components of all eligible articles. We have also reported a case involving a 67-year-old male individual in whom the PA exhibited radiological characteristics similar to an epidermoid cyst. Results: After the screening phase, we found four cases of PA of the pontocerebellar angle. Three cases were identified that resembled vestibular schwannoma; however, in our case, the tumor resembled an epidermoid cyst. These uncommon tumors exhibit distinctive histological patterns and molecular characteristics (adenosine triphosphate dependent helicase (ATP- dependent helicase)+, Isocitrate dehydrogenase 1-), rendering them a potential differential diagnosis for glioblastoma (GBM). Conclusion: The CPA PA has rarely been found in adult patients and should be considered in the differential diagnosis of vestibular schwannoma and epidermoid cysts. In these rare cases, the histological characteristics of PA are significant for the differential diagnosis of GBM. © 2024 Published by Scientific Scholar on behalf of Surgical Neurology International
First-in-Man Craniectomy and Asportation of Solitary Cerebellar Metastasis in COVID-19 Patient. - Researchregistry6241
No full textThis is the first case reported of solitary cerebellar metastasis of oesophagus carcinoma operated on a COVID-19 positive patient. It shows that cases of asymptomatic COVID-19 positive patients can undergo major emergency surgeries without the risk of infecting the operating team if adequate Personal Protection Equipment (PPE) and specific safety protocols are used. In the current crisis, a prophylactic routine COVID-19 screening test can identify asymptomatic patients undergoing major surgery and adequate resource planning and Personal Protective Equipment (PPE) for healthcare workers can minimise the effect of the COVID-19 pandemic
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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