1,721,022 research outputs found
Endovascular Neurosurgery in Europe and in Italy: What Is in the Future?
No full textBACKGROUND: The cerebrovascular discipline has undergone dramatic changes in recent years. This has been made possible by the work of pioneers in the fields of neurosurgery and neuroradiology. METHODS: In this article we review the evolution and fundamental stages that led to the birth of endovascular treatment and discuss why, also in Europe, this treatment must be included in neurosurgery, encouraging the training of endovascular neurosurgeons who can collaborate with their interventional neuroradiology colleagues in order to form unbiased surgeons who understand the disease from both the endovascular as well as the surgical prospective. We examine how the new generation of European cerebrovascular specialists, including neurosurgeons, neuroradiologists, and some neurologists, will attain their requisite endovascular training. Finally, we briefly review the current state of endovascular neurosurgery in Europe and in Italy and speculate about what its role will be in the near and distant future. CONCLUSIONS: To remain at the forefront of evaluating, caring for, and treating patients with cerebrovascular disease, vascular neurosurgery must evolve toward a specialty, mastering the knife as well as the catheter. We think it is time for European neurosurgeons to start training residents in endovascular neurosurgery in the same way we train neurosurgeons in every other neurosurgical discipline
Endovascular superselective treatment of brain tumors: a new endovascular era? A quick review
No full textBackground Intra-arterial therapy for malignant brain tumors, especially high-grade gliomas, has been administered since the 1950s and 1960s when the structure of the blood-brain barrier was first described. However, only with the advent of modern techniques used by endovascular neurosurgeons has it been possible to proceed with the release of chemotherapeutic agents in an ultraselective mode by superselective intraarterial cerebral infusion (SIACI). Methods A brief review was performed of all the published works from January 2000 to December 2013 in which the main issue was the superselective endovascular treatment of brain tumors with chemotherapy drugs. Results Intra-arterial non-selective therapy has been reported to be effective in chemosensitive tumors whereas the results in glioblastoma, at least in the prebevacizumab era, have been disappointing. Conclusions If the SIACI method for delivering bevacizumab after disruption of the blood-brain barrier is proved to be safe and effective in larger phase II and III trials, this paradigm may significantly alter the way chemotherapies are delivered to patients with both diffusely infiltrating low-grade and those with high-grade malignant brainstem gliomas and open a new endovascular era
A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms
Full text linkBACKGROUND AND PURPOSE: Blister-like aneurysms are uncommon but challenging lesions. Their small size and atypical location often make the diagnosis difficult. Microsurgery and endovascular procedures have been used for their treatment, but there is no consensus on the best treatment technique. We conducted a systematic review and meta-analysis of treatments and outcomes of these vascular lesions. MATERIALS AND METHODS: We reviewed English-language articles on "blood blister-like aneurysms" published between January 1997 and November 2014. All studies reporting patients with these aneurysms treated with surgery, endovascular procedures, or combined therapy with data on treatment modalities and clinical and/or angiographic outcomes were selected, including case reports and series. We performed a meta-analysis on the 2 largest treatment groups (surgery and endovascular management). RESULTS: Sixty studies with 334 patients met our inclusion criteria. Surgery was performed in 114 patients (34.2%), and endovascular treatment, in 199 patients (59.5%). A combined treatment was used in 19 patients (5.7%). A favorable outcome (mRS 0-2) was reported in 67.4% and 78.9% of patients treated with surgery and with endovascular therapy, respectively (P = .034). CONCLUSIONS: Blister-like aneurysms are challenging vascular lesions. The choice of treatment method must be based on the initial clinical presentation and an analysis of the radiologic features of the lesion to select the best technique. Endovascular treatment seems to have lower morbidity and mortality and provides a better outcome compared with surgical approaches. Further prospective studies must be performed to confirm such interesting result
Historical Landmarks in the Management of Aneurysms and Arteriovenous Malformations of the Central Nervous System
No full textIschaemic stroke with partial haemorrhagic transformation related to a small-sized tuberculum sellae meningioma.
No full textIntracranial tumours compress and dislocate surrounding blood vessels, which leads to reduced cerebral blood flow. These compressions of the vasculature can become symptomatic through an ischaemic stroke. In patients with benign meningioma, an ischaemic lesion can also occur suddenly To our knowledge, no previous reports have described an acute ischaemic stroke and partial reperfusion haemorrhage in a single region, both related to a small-sized tuberculum sellae meningioma
Clinical remarks on acute post-traumatic atlanto-axial rotatory subluxation in pediatric-aged patients.
No full textObjective. This study aimed to identify specific findings related to acute posttraumatic atlanto-axial rotatory
subluxation in pediatric patients.
Methods. We studied 14 children with acute atlanto-axial rotatory subluxations admitted to a hospital over a
5-year period after craniocervical injury. Clinical and radiological findings were reviewed to identify new
findings related to atlanto-axial rotatory subluxation.
Results. Most patients exhibited a typical picture of atlanto-axial rotatory subluxation, but one child also
experienced transient blindness that was related to peculiar anatomical findings on neuroradiological images.
A characteristic C2-C3 anterior pseudo-subluxation was detected among the radiographic signs. Magnetic
resonance imaging showed no clear break in the alar ligaments, which were oriented horizontally. However,
unlike the case in adult anatomy, in these children, the alar ligaments were laterally attached at the occipital
condyle-axis condylar joints. In all children, atlanto-axial rotatory subluxation spontaneously reduced within
a few hours after short bed rest without halter traction but with a cervical collar. No recurrence was observed
during follow-up.
Conclusions. Acute posttraumatic atlanto-axial rotatory subluxation in pediatric-aged patients is a rapidly
resolving disease of the cranio-cervical junction. The disease appears to be related to an elasticity of the
contralateral alar ligament, which is attached to the occipital condyle-axis condylar joint. Neurological
symptoms (blindness) occurred in one patient when the vertebrobasilar blood flow was impaired and no
compensation was provided from the anterior circulation. Use of a cervical collar and short bed rest without
halter traction is recommended, based on our observations of complete recovery and no recurrence following
the use of this treatment strategy
Pros and cons of a minimally invasive percutaneous subdural drainage system for evacuation of chronic subdural hematoma under local anesthesia
No full textObjective: Chronic subdural hematoma (CSH) is a common neurosurgical disease among elderly population with concomitant degenerative neurological disorders. This is a retrospective series-control analysis of prospectively collected data, aiming to show advantages and indications of a minimally invasive, percutaneous drainage system for CSH. Patients and methods: We retrospectively analyse the clinical and radiological data of a minimally invasive, percutaneous draining system (Integra TM) used in fifteen patients (Group A; mean age: 75.7) with CSH, and compare them with those obtained from two retrospective series of patients: the first one (Group B 15 patients, mean age 77.1) treated with standard, single-burr hole technique for subdural drainage under general anaesthesia; the second one (Group C 15 patients, mean age 76.4) treated with standard, single-burr hole technique for subdural drainage under local anaesthesia and mild sedation. All The percutaneous procedures (Group A) were performed under local anaesthesia. Results: Mean follow-up was 10.9 (range 3–14), 18.2 (range 10–29) and 15.2 (range 8–28) months in Group A, B and C respectively. Three of 15 and in Group B experienced a worsening of pre-existing neurodegenerative disorders after general anaesthesia. One patient in group C suffering from Parkinson's disease experienced a worsening of gait disturbances. Post-operative CT scans were performed at 48 h and 21 days after the operation. An early post-operative CT-scan, obtained immediately after surgical procedure, was performed in all Group A patients. No differences in CSH evacuation were observed comparing the three groups. Two recurrent hematomas, one in group A and one in group B, required revision. Post-operative hospitalization was similar (5.1 vs 5.7 vs 5.6 days, respectively, in group A, B and C) but analgesics use was lower in Group A. Conclusion: Pre-operative evaluation of radiological features of CSDHs is crucial in determining the right indication for a minimally invasive drainage. Minimally invasive treatments of CSH may reduce the use of anaesthetic drugs and worsening of pre-existing neurodegenerative disorders
Surgical Treatment of Single Pontomedullary Junction Metastasis from Lung Cancer
Full text linkBACKGROUND: When lung cancer develops a solitary metastasis at the pontomedullary junction, due to surgical risk, the current oncologic treatment is radiosurgery and chemotherapy. Case Description. We describe a patient with a single intrinsic metastasis at the pons and medulla. Removal was successful, without complication. CONCLUSION: Surgery can provide excellent results, and in selected patients, it should be considered a first-line treatment in experienced hands
Intraoperative Computed Tomography, navigated ultrasound, 5-Amino-Levulinic Acid fluorescence and neuromonitoring in brain tumor surgery: overtreatment or useful tool combination?
No full textBrain tumor surgery is routinely supported by several intraoperative techniques, such as fluorescence, brain mapping and neuronavigation, which are often used independently. Efficacy of navigation is limited by the brain-shift phenomenon, particularly in cases of large or deep-sited lesions. Intraoperative imaging was introduced also to update neuronavigation data, to try and solve the brain-shift phenomenon-related pitfalls and increase overall safety. Nevertheless, each intraoperative imaging modality has some intrinsic limitations and technical shortcomings, making its clinical use challenging. We used a multimodal intraoperative imaging protocol to update neuronavigation, based on the combination of intraoperative Ultrasound (i-US) and intraoperative Computed Tomography (i-CT) integrated with 5-ALA fluorescence and neuromonitoring-guided resection
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