78 research outputs found
Considerazioni sulla neurostimoalzione spinale nella failed back surgery syndrome. [Spinal stimulation in failed back surgery syndrome].
No full text[no abstract available
Seizure suppression after left anterior temporal lobectomy in a patient with an ipsilateral parietal lesion
No full textEpilepsy surgery can provide a solution
for drug-resistant patients (Revlyn, 2003).
Non-lesional epilepsies account for
20–30% of patients in major epilepsy
surgery centres (Cascino, 2001)
Factors affecting functional outcome in patients with intramedullary spinal cord tumors: results from a literature analysis
No full textRecently, great advances have been made in the surgical treatment of intramedullary spinal cord tumors (IMSCTs). Many articles have been published; but looking at the literature of the last 5 years, there are only descriptive reviews and no works in which a literature statistical analysis was performed. Here, we analyzed the literature to identify potential prognosticators of good functional outcome in IMSCT patients. To level out the selected studies, we stratified patients’ neurological status as independent (ambulation possible without caregiver assistance) or disabled (cannot ambulate or can only ambulate with caregiver assistance). 18 out of 125 articles were included in the analysis (691 patients). A significant higher percentage of gross total resection (GTR) in ependymomas, hemangioblastomas and cavernomas compared to the astrocytomas (particularly high-grade gliomas) was observed. We found a strong correlation between a good pre-operative neurological function and a good post-operative and at follow-up (FU) neurological status and between GTR and a good post-operative and at FU neurological status. A significant better outcome was found in ependymomas, hemangioblastomas and cavernomas compared to astrocytomas. Our analysis suggests that an early surgery could be reasonable in IMSCTs, because a good pre-operative neurological function is a strong predictor of good neurological outcome. In patients with high-grade gliomas, there is no indication to attempt a GTR due to the infiltrative growth pattern of this tumor that leads to a higher surgical morbidity. Although not innovative, the evidences of our literature statistical analysis strengthen the results from previous surgical series and descriptive reviews
Hemopatch® with fibrin glue as a dural sealant in cranial and spinal surgery. A technical note with a review of the literature
No full textA major complication in cranial and spinal surgery is the post-operative occurrence of a cerebrospinal fluid (CSF) leak. Here we reported a technical note firstly describing the use of Hemopatch® with fibrin glue as a dural sealant in cranial and spinal neurosurgical procedures. Moreover we carried out a review of the literature. Further to the best of our knowledge this was the first series including patients submitted to different spinal surgeries in whom Hemopatch® was used as dural sealant. We prospectively collected the data of 22 patients. In all procedures, fibrin glue was applied after Hemopatch®. The mean age was 59.68 ± 10.79 years and the mean follow-up (FU) was 3.63 ± 1.46 months, respectively. Overall, Hemopatch® with fibrin glue was used in 8 cranial procedures (36.36%; all were retrosigmoid craniotomies) and 14 spinal procedures (63.64%). 9/14 spinal cases (64.28%) were incidental durotomies during a spinal decompression procedure. No CSF leak, no postoperative infection, no adverse reaction were observed during the FU in all cases. The literature search revealed only two retrospective series, reporting only patients submitted to cranial surgery for a total of 56 patients and a CSF leak occurring in 3 patients (5.35%). In conclusion, we firstly reported the feasibility and the safety of using Hemopatch® with fibrin glue as dural sealant in cranial surgery and different spinal procedures. Further larger comparative studies are needed to confirm our initial encouraging results
Callosotomy versus vagus nerve stimulation in drug-resistant epilepsies
No full text[no abstract available
Diagnostic yield and predictive value of provoked ictal SPECT in drug-resistant epilepsies
No full textBrain single photon emission computed tomography (SPECT) can be a useful tool to identify the epileptogenic zone in selected patients. However, ictal SPECT during spontaneous seizures is difficult to obtain and can be expensive, due to extra hospitalization time and personnel resource utilization. The efficacy of ictal SPECT depends on the ability to inject as early as possible after the beginning of the ictal discharge and/or the occurrence of the first symptom and is challenged by the short duration and rapid propagation of seizures, especially extratemporal seizures. We studied 52 patients with drug-resistant epilepsy who underwent ictal SPECT during provoked seizures in order to demonstrate the efficacy of this technique to define the epileptogenic zone and its predictive value on surgical outcome 2 and 5 years after surgery. In our study, SPECT hyperperfusion areas and electroclinical findings co-localized within the same lobe in 40 patients. Thirty-one patients were operated; at the 2-year follow-up 25 of these patients were in Engel's class I. Eighteen of the seizure-free patients showed a co-localization between the provoked SPECT hyperperfusion areas and the epileptogenic zones. Eighteen of the 31 operated patients were followed 5 years after surgery. The surgical outcome was stable in all but one subject. All the patients who were seizure-free at the 5-year follow-up showed a co-localization between the provoked SPECT hyperperfusion areas and the epileptogenic zones. Ictal SPECT demonstrated additional diagnostic value in the identification of the epileptogenic zone in 20 patients: 11 extratemporal (4 probably symptomatic and 7 lesional), 1 temporal plus (probably symptomatic), and 8 temporal (1 probably symptomatic and 7 lesional). Statistical analysis showed a significant association between the concordance of SPECT hyperperfusion areas to epileptogenic zones and freedom from seizures as assessed 5 years after surgery
The role of preoperative angiography in the management of giant meningiomas associated to vascular malformation
No full textBackground: The role of preoperative digital subtraction angiography (DSA) in meningiomas is currently under discussion because of the introduction of noninvasive magnetic resonance imaging (MRI) angiography to study vascular anatomy associated to the tumor. Preoperative DSA is mainly performed to obtain embolization of the lesion, although a number of complications have been reported after this procedure. Nonetheless, the coexistence of meningiomas with vascular malformations has previously been reported and it has been evidenced that this event could be underestimated because of neglect of preoperative DSA. Here, we report on two challenging cases of giant meningiomas associated to vascular malformations and we discuss the pertinent literature. Case Descriptions: In the first case: A large right temporal meningioma with erosion of the sphenoid greater wing and extension toward infratemporal fossa and right orbit - a large pseudoaneurysm of right middle cerebral artery branch was found end embolized during DSA. In the second case: A giant parieto-temporal meningioma - DSA permitted the full visualization of an abnormal drainage of superior sagittal sinus like a "sinus pericranii" that was respected during the following surgery. Conclusion: We think that MRI angiography is the exam of choice to study vascular anatomy in meningiomas. Nonetheless, DSA remains a useful tool in giant meningiomas not only to embolizate the lesion but also to treat tumor associated vascular malformation and to achieve the full knowledge of vascular anatomy. We think that a wide communication between interventionalist and surgeon is essential for the optimal management of these patients
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