1,721,111 research outputs found
Metodo di realizzazione di un dispositivo di rigenerazione di tessuti biologici, particolarmente per la rigenerazione di tessuti appartenenti al sistema nervoso centrale
No full textTreatment of empty sella associated with visual impairment: a systematic review of chiasmapexy techniques
No full textPurpose: Chiasmapexy is a poorly described surgical procedure adopted to correct the downward displacement of suprasellar visual system (SVS) into an empty sella (ES) causing visual worsening. The aim of our study is to define the indications for extradural and intradural chiasmapexy. Methods: A systematic literature review has been performed on MEDLINE database (US National Library of Medicine), including only articles that depicted cases of surgically treated patients affected by ES and progressive delayed visual worsening. Moreover, we have reported three cases of secondary ES syndrome (SESS) with visual worsening treated in our Department with transsphenoidal (TS) microsurgical intradural approach. Finally, we have compared the results of extradural and intradural chiasmapexy described in literature. Results: The etiology of visual impairment is different in primary and secondary ESS. In primary ESS (PESS) the only predisposing factor is a dehiscence of diaphragma sellae, and the anatomical distortion caused by displacement of optic chiasm or traction of pituitary stalk and infundibulum may determine a direct injury of neural fibers and ischemic damage of SVS. In PESS the mechanical elevation of SVS performed through extradural approach is sufficient to resolve the main pathologic mechanism. In SESS, arachnoidal adhesions play an important role in addition to downward herniation of SVS. Consequently, the surgical technique should provide elevation of SVS combined to intradural release of scar tissue and arachnoidal adhesions. In treatment of SESS, the intradural approaches result to be more effective, guaranteeing the best visual outcomes with the lowest complications rates. Conclusions: The intradural chiasmapexy is indicated in treatment of SESS, instead the extradural approaches are suggested for surgical management of PESS
Coexistence of TSH-secreting pituitary adenoma and autoimmune hypothyroidim
No full textOBJECTIVE:
TSH-secreting pituitary adenomas account for about 1-2% of all pituitary adenomas. Their diagnosis may be very difficult when coexistence of other diseases masquerades the clinical and biochemical manifestations of TSH-hypersecretion.
CLINICAL PRESENTATION:
A 41-yr-old female patient, weighing 56 kg, was referred for evaluation of an intra- and suprasellar mass causing menstrual irregularities. Eight yr before, the patient had been given a diagnosis of subclinical autoimmune hypothyroidism because of slightly elevated TSH levels and low-normal free T4 (FT4). Menses were normal. Despite increasing doses of levo-T4 (L-T4; up to 125 microg/day), TSH levels remained elevated and the patient developed mild symptoms of hyperthyroidism. After 7 yr, the menstrual cycle ceased. Gonadotropins were normal, whereas PRL level was elevated at 70 microg/l and magnetic resonance imaging (MRI) of the hypothalamic- pituitary region revealed a pituitary lesion with slight suprasellar extension. The tumor was surgically removed and histological examinations revealed a pituitary adenoma strongly positive for TSH. Three months after surgery the patient was well while receiving L-T4 75 microg/day and normal menses had resumed. MRI of the hypothalamic-pituitary region showed no evidence of residual tumor. At the last follow-up, 16 months after surgery, serum TSH, free T3 (FT3), and FT4 levels were normal.
CONCLUSIONS:
Coexistence of autoimmune hypothyroidism and TSH-secreting pituitary adenoma may cause further delays in the diagnosis of the latter. In patients with autoimmune hypothyroidism, one should be aware of the possible presence of a TSH-secreting pituitary adenoma when TSH levels do not adequately suppress in the face of high doses of L-T4 replacement therapy and elevated serum thyroid hormone levels
Hemispheric Intra-Axial Tumors
No full textGliomas are the most common primary tumors in the brain hemispheres, with glioblastomas being the most frequent and aggressive. The treatment strategy for gliomas typically involves maximum safe resection to provide histopathological diagnosis and cytoreduction, followed by radiotherapy and chemotherapy, especially for high-grade tumors. Advanced intraoperative imaging and direct electrical stimulation are essential for achieving maximal tumor removal while preserving neurological function. Other intra-axial tumors, such as brain metastases and primary CNS lymphomas, also require specific management approaches. Brain metastases, common in adults with systemic malignancies, can require surgical resection followed by adjuvant RT in case of large lesions with symptomatic mass effects. Primary stereotactic radiosurgery and whole-brain RT are reasonable options for all the other patients, according to their performance status and expected survival, as well as the number of lesions and their cumulative intracranial volume. The general approach to central nervous system lymphomas is represented by stereotactic biopsy followed by systemic chemotherapy. Surgery represents the cornerstone of the treatment of brain cavernomas. A multidisciplinary approach is crucial for optimizing patient outcomes and ensuring effective treatment
METHOD FOR MANUFACTURING A DEVICE FOR REGENERATING BIOLOGICAL TISSUES, PARTICULARLY FOR REGENERATING TISSUES OF THE CENTRAL NERVOUS SYSTEM
No full textImage-Guided Neurosurgery
No full textImaging is critical in guiding neurosurgery since the target is often hidden, difficult to reach, and surrounded by anatomically and functionally critical tissue. Image-guided neurosurgery integrates various imaging techniques during preplanning, execution, and postoperative assessment of neurosurgical procedures, each offering substantial advantages while facing specific limitations. Neuronavigation facilitates intra-operative orientation but is limited by the “brain-shift” phenomenon. Intraoperative MRI provides the most accurate imaging for verifying and enhancing the extent of resection (EOR), though it is extremely costly and time-consuming. Intraoperative CT is faster, less expensive, and beneficial for spine surgery and interventional procedures, although it is less detailed for soft tissues. Intraoperative ultrasound is cost-effective and rapid but requires significant expertise to interpret images. Intraoperative fluorescence enables direct visualization of tumors, though it may produce false positives and negatives. 3D virtual reality aids in detailed preplanning, potentially reducing operative time and disorientation while enhancing effectiveness and safety at a lower cost. Combining multiple imaging modalities and integrating advanced physiological and functional imaging into surgical planning and execution compensates for individual limitations, providing optimal safety and EOR outcomes
Radiotherapy of Parasellar Tumours
No full textParasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogenous histology. It often requires a multimodal approach, including surgery, radiation therapy (RT), and medical therapy. Due to the proximity of critical structures and the risks of side effects related to the procedure, a successful surgical resection is often not achievable. Thus, RT plays a crucial role in the treatment of several parasellar tumours. Conventional fractionated RT and modern radiation techniques, like stereotactic radiosurgery and proton beam RT, have become a standard management option, in particular for cases with residual or recurrent tumours after surgery and for those cases where surgery is contraindicated. This review examines the role of RT in parasellar tumours analysing several techniques, outcomes and side effects
Microsurgical treatment of frontal mucocele sequelae
No full textSkull base surgery has undergone a revolution in recent decades with the introduction and development of new surgical approaches correlated with many modifications in this anatomically and functionally complex area. The most important progress has been possible with the advent of microsurgical flaps, which allow for the movement of large masses and different tissue components, providing effective separation and coverage of the endocranial content, replacement of the composite craniofacial defects, and reconstruction of poorly vascularized areas. To reduce the incidence of complications in the treatment of frontal recurrent mucoceles, accurate planning of reconstruction is mandatory.
We introduce 2 cases involving anterior cranial base repair after radical resection of chronically infected tissues in patients affected by frontal recurrent mucoceles. Reconstruction was accomplished through a forearm flap and a frontal bone reconstruction with custommade prosthesis
Local Pterional advancement flap: a minimally-invasive option to reconstruct spheno-temporal extracranial soft tissues dehiscences in fragile patients
No full textBackground:Late-onset, extracranial soft tissues dehiscence in the spheno-temporal region after major neurosurgical procedures might represent a potentially life-threatening complication.Due to surgery-related galeal/pericranial and myofascial temporal atrophy, classical regional flaps are often unavailable, enforcing potential indication for free vascularized flaps.Nevertheless, in elderly multioperated patients, who are not eligible for major surgery, it becomes mandatory to consider less invasive options for reconstruction.Authors describe the application of a reconstructive option for late-onset, pterional soft tissues dehiscence in fragile patients, using a local pterional advancement flap.Methods:Technique is stepwise described and illustrated in its clinical application.Results:Local pterional advancement flap provides an excellent coverage, being extremely pliable, and flexible in contents and design. Vascular pedicle is independent from distal branches of the superficial temporal artery and provides adequate blood flow. Pedicle length enables a good arc of rotation, which facilitates its transposition. Flap preparation is very easy and minimally time consuming, due to its immediate regional availability and the easy harvesting technique.Conclusions:Local pterional advancement flap represents an effective option as regional flap for the reconstruction of late-onset, pterional soft tissues dehiscence in fragile patients
Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: Evidence for a better outcome independently of other patients' characteristics
No full textObjective: Few data are available on the surgical results in patients with incidentally discovered nonfunctioning pituitary adenoma (NFPA). We investigated the efficacy and safety of surgery in patients with incidentally discovered NFPA. Design: Retrospective analysis of prospectively recorded outcomes. Methods: From 1990 to 2011, of 804 consecutive patients undergoing surgery for NFPA, 212 cases had an incidentally discovered tumor (26.4%). Among them, 117 patients were asymptomatic, while 95 had some visual and/or hormonal deficit. The main outcome of the study was to evaluate the frequency of radical resection as judged on the first postoperative neuroimaging study and detection of recurring disease during long-term follow-up. Results: Postoperative residual tumor was detected in 8.9% of patients with asymptomatic incidentalomas as compared with 31.2% of patients with symptomatic incidentalomas (P<0.001) and 41.2% of patients in the control group (P<0.001). Multivariate analysis confirmed that having an asymptomatic incidentaloma was independently associated with a better outcome. The 5-year recurrence-free survival in patients with incidentalomawas 86.8% (95% CI 80.2-92.4%) as compared with 77.9% (95% CI 73.6-82.2%; P<0.01) in the control group. This difference was almost completely due to a lower frequency of relapse in asymptomatic patients. Multivariate analysis confirmed the independent lower risk of tumor recurrence in asymptomatic NFPA. Conclusion: Our study shows for the first time that surgically treated patients with asymptomatic NFPA have a better early and long-term outcome that is independent from all the other demographic, clinical, and morphologic characteristics of the patients. © 2013 European Society of Endocrinology
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