1,720,974 research outputs found
3D Model-Guided Robot-Assisted Giant Presacral Ganglioneuroma Exeresis by a Uro-Neurosurgeons Team: A Case Report
Full text linkBackground and Clinical Significance: Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. Case Presentation: An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Conclusions: Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm x 9 cm x 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury
In Reply to the "Letter to the Editor Regarding Intraneural Ewing Sarcoma of the Fibular Nerve-Case Report, Radiologic Findings and Review of Literature"
No full textThe Role of Exoscope in the Peripheral Nerve Surgery: Proof of Concept: 2-Dimensional Operative Video
No full textIntraneural Ewing Sarcoma of Fibular Nerve: Case Report, Radiologic Findings and Review of Literature
No full textBackground: Intraneural Ewing sarcoma (ES) was first described in 1918 by Stout in a tumor of the ulnar nerve. These tumors are in the category of ES family of tumors, together with ES of bone, extraosseous ES, and primitive neuroectodermal tumor. ES typically occurs in the second decade of life; only 20% of cases affect elder people. The most frequently involved sites are the craniospinal vault and cauda equina, while the peripheral nerve location is extremely rare (only 11 cases mentioned in the literature to date). Case Description: This case report documents a rare case of a 46-year-old woman with an intraneural extraosseous ES and offers a complete radiologic documentation including contrast magnetic resonance imaging and microbubble contrast-enhanced ultrasonographic data. A review of the literature about diagnostic and treatment management is presented. Conclusions: The challenge of intraneural extraosseous ES consists of the right balance between the necessity to consider a potential malignant nature of the lesion and perform adequate surgical excision in a relatively brief time from the first clinical examination and the fact that these are extremely rare pathologic entities among most frequent cases of completely benign tumors, which could even have the same clinical and radiologic presentation. For this reason, a multidisciplinary setting with a team of neurosurgeons, orthopedic specialists, radiologists, pathologists, and oncologists should manage these cases as soon as a pathologic diagnosis is available. More attention should be focused on other therapies that effectively manage microscopic pathologic involvement, without increasing the risk of postoperative morbidity
Transfer of the peroneal component of the sciatic nerve in total brachial plexus lesion: An anatomical feasibility study
No full textClosed brachial plexus lesions (BPLs) are generally associated with a traumatic mechanism of forced traction between the neck and the shoulder-arm complex. For brachial plexus reconstruction different techniques have been proposed with donor motor nerves like intercostal nerves, or the ipsilateral cervical plexus, the phrenic nerve, the contralateral C7 root, and many others. Despite all these surgical possibilities, the overall recovery is generally poor and not satisfactory. The principal drawback is linked to the loss of upper limb proprioception, in a way that dramatically influences even a good motor recovery, so in complete BPLs the sensory loss still represents a debilitating problem. In this anatomical feasibility study, the possibility to transfer the peroneal component of the sciatic nerve as a donor for complete BPLs has been evaluated. This technique would conceptually bring an important motor and sensory contribution to the upper limb using pure motor and sensory branches of the sciatic nerve. Performing immediate tendon transfer for foot drop palsy could significantly decrease the morbidity of the surgical procedure
Double cystic brain metastasis in a patient with stable pancreatic intraductal papillary mucinous neoplasm
Full text linkBackground: Brain metastases in pancreatic cancer are a rare condition and are usually seen in case of pancreatic adenocarcinoma. Only few cases of brain metastasis in patients affected by Intraductal papillary mucinous neoplasm (IPMN) are actually reported. Case description: We report a patient diagnosed with double cystic brain lesions that the histological examination reveal to be consistent, with pancreatic metastasis. Our patient had an history shown of stable pancreatic IPMN which has never made the oncologist suspicious about neoplastic progression or degeneration into pancreatic carcinoma. Considering the rarity of these metastasis we did a literature review on the topic Conclusions: Despite rare, pancreatic origin of a cystic brain metastasis should considered in differential diagnosis in both patient with IPMN or patient with unknown primitive tumor
Surgery and COVID-19 pandemic's effects on the fragile psychosocial background in tetraplegic patients: psychological considerations
No full textLetter to the Editor Regarding "Opinion Piece: Microsurgery in COVID-19-Positive Patients"
Full text linkIntraoperative ultrasound and 5-ALA: the two faces of the same medal?
No full textBACKGROUND: High grade gliomas (HGG) still remain the most demanding neuro-oncological challenge. Several studies have confirmed that the extent of resection (EOR) correlates with increased survival in patients with HGGs. The gross total resection of HGGs can be difficult and challenging. For this reason, technologies to improve EORhave been of interest. The aim of this paper was to analyze advantages and limitations of both intraoperative fluorescence and intraoperative ultrasound (IOUS) resection techniques. METHODS: Our work deals with the comparison of one group of 15 patients treated with both tools (study group) with a control group of 15 patients in where only fluorescence was used. Postoperative outcome are valued using Karnofsky Performance Status scale (KPS) while EOR are valued with MRIwithin 24 hours after surgery. RESULTS: The difference between the postoperative KPS and between EOR in the 2 groups resulted not statistically significant considering P<0.05. In our experience 5-ALAhas a limited sensitivity before starting resection while shows its central role in identifying the tumor remnants after its removal. Conversely, IOUSis very useful in identifying the tumor before starting resection. After the tumor removal, the sensitivity of the ultrasound in identifying tumor remnants in the margins of the cavity decreases significantly. However, in one case, at the end of resection, we have not visualized any fluorescent tissue but we detect a residual of tumor using the IOUS. CONCLUSIONS: In our preliminary experience we observed that there are no significant advantages using IOUS+5-ALA. However, we feel that IOUS is useful in the first step of resection and fluorescence in the last steps of operation. Therefore these two technologies could be considered the two faces of the same medal as they can help the surgeon to detect the tumor in every step of tumor resection
Principles of Cortical Plasticity in Peripheral Nerve Surgery
No full text: Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to change in response to internal and external stimuli. While these modifications occur throughout normal brain development, interestingly, they are also elicited after peripheral nerve injury and surgery. This article provides an overview of the principle mechanisms of synaptic, neuronal, cortical and subcortical neuroplasticity, with special attention to cortical and subcortical modifications-as suggested by modern neuroimaging techniques-after peripheral nerve surgery. The main nerve transfer techniques for the superior extremities and their effect on cortical plasticity are also described
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