1,721,006 research outputs found
Fistole rinoliquorali spontanee: verso un moderno algoritmo diagnostico-terapeutico.
Full text linkIntroduzione: Le fistole rinoliquorali spontanee sono un eterogeneo gruppo di fistole a cui afferiscono tutti i casi di fistola rinoliquorale per le quali non è stata possibile identificare un meccanismo eziopatogenetico. Permane tuttavia il dubbio da parte di molti autori che in tale gruppo confluiscano fistole rinoliquorali causate da patologie non correttamente diagnosticate. Sebbene siano state effettuate numerose ricerche per meglio identificare l’eziologia e la patogenesi delle fistole rinoliquorali spontanee non si è ancora giunti a formulare un algoritmo diagnostico-terapeutico condiviso. Tale tipologia di fistole, dai dati ricavati dalla analisi della letteratura, è gravata da un maggiore tasso di recidiva rispetto alle fistole a eziologia nota probabilmente proprio poiche' il fattore eziopatogenetico rimane spesso misconosciuto e conseguentemente non trattato.
Materiali e Metodi: Il presente studio, attraverso una valutazione retrospettiva della casistica (2002-2013) delle Cliniche Otorinolaringoiatrica e Neurochirurgica dell’Ospedale del Circolo e Fondazione Macchi-Università degli Studi dell’Insubria di Varese, analizza una popolazione di 103 pazienti sottoposti a intervento chirurgico di riparazione di fistola rinoliquorale spontanea. Scopo di questa tesi è arrivare alla stesura di un algoritmo diagnostico-terapeutico per le fistole rinoliquorali spontanee e in particolare identificare le indagini diagnostiche opportune per una diagnosi precoce delle fistole rinoliquorali spontanee e validare l’approccio endoscopico endonasale come tecnica chirurgica di scelta nel trattamento delle fistole rinoliquorali spontanee.
Discussione: L' algoritmo diagnostico da noi utilizzato ha permesso una rapida diagnosi ed una precisa localizzazione della fistola, e di conseguenza la pianificazione dell’intervento chirurgico più adeguato per il paziente. L’approccio endoscopico endonasale ha inoltre soppiantato nella maggior parte dei casi gli approcci intracranici ed extracranici non endoscopici, relegando quest’ultima tecnica al solo intervento combinato endoscopico-lembo osteoplastico frontale per il trattamento delle fistole rinoliquorali spontanee della parete posteriore del seno frontale. I vantaggi della chirurgia endoscopica consistono soprattutto in una minore invasività, che consente di evitare le principali complicanze dell’approccio intracranico come la lesione del bulbo olfattorio con conseguentemente anosmia, l’edema cerebrale.
Conclusioni: L’utilizzo di un valido algoritmo diagnostico-terapeutico ha infatti permesso una corretta e tempestiva diagnosi, una precisa localizzazione del difetto e un trattamento chirurgico ottimale. La possibilità di scegliere fra le varie tecniche d’approccio e di effettuare il tipo di chiusura ottimale, a seconda delle caratteristiche anatomopatologiche della fistola, risulta determinate per ottenere una bassa percentuale di recidive. Una maggiore comprensione della fisiopatologia delle fistole rinoliquorali spontanee potrebbe portare a un corretto inquadramento e a una adeguata classificazione di tale patologia poiché riconoscerne i meccanismi causali consentirebbe un miglioramento della loro gestione e permetterebbe di intraprendere, quando necessario, il trattamento più adeguato
Commentary: "Sagittal Crest": Definition, Stepwise Dissection, and Clinical Implication From a Transorbital Perspective
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Epidural haematoma by Mayfield head-holder®. Case report and review of literature.
No full textA lot of neurosurgical interventions require the use of a pin-type head-holder to immobilize the patients' head. We report the case of an epidural haematoma caused by penetration of head holders’ pin in a 7-year-old boy. The haematoma was showed by a head CT-scan at the end of surgery performed to treat a cerebellar astrocytoma that was managed surgically. Mmany factors seem to contribute to elevate the risk of complications due to the use of the Mayfield head-holder. Prevention and management measures are discussed also through a review of literature.
A lot of neurosurgical interventions require the use of a pin-type head-holder to immobilize the patients' head. We report the case of an epidural haematoma caused by penetration of head holders’ pin in a 7-year-old boy. The haematoma was showed by a head CT-scan at the end of surgery performed to treat a cerebellar astrocytoma that was managed surgically. Mmany factors seem to contribute to elevate the risk of complications due to the use of the Mayfield head-holder. Prevention and management measures are discussed also through a review of literature
Tension pneumocephalus secondary to osteoradionecrosis of the clivus
No full textWe report the case of a 36 year-old man with relapsing undifferentiated nasopharyngeal carcinoma treated with a re-irradiation Cyberknife, who subsequently developed tension pneumocephalus due to a cerebrospinal fluid leakage located at the clivus. The fistula was caused by osteonecrosis of the skull base secondary to the tumor invasion and to the sequelae of the radiotherapy. An endoscopic endonasal technique was used in order to repair the defect, with a peduncolated nasoseptal flap harvested to perform the skull base reconstruction. In this paper, we discuss the importance of identifying this possible complication related to radiotherapy in the management of neoplasm along the skull base; moreover, the role of endoscopy in the diagnosis and treatment of skull base fistulas is also described and commented
Idatidosi cistica vertebrale primitiva ad estensione intratoracica ed intrarachidea: un caso clinico.
No full textAdjuvant radiotherapy in grossly total resected grade II atypical meningiomas: a protective effect on recurrence?
No full textIntroduction: Management of grade II atypical meningiomas (AM) remains controversial. Conflicting evidence exist on the possible protective effect of adjuvant radiotherapy (ART) on recurrence in grossly resected AMs. The aim of this meta-analysis is to evaluate the role of ART in grossly resected (Simpson grades 1-3) AMs on the recurrence and survival. Evidence acquisition: Literature review was performed by the study investigators who handily queried the MEDLINE database using keywords and MeSH terms in different combinations using the Boolean operators "AND" or "OR," and database-related filters to maximize the chance to identify articles focusing on role of radiotherapy in atypical (WHO grade II) meningiomas. Data were retrieved from comparative studies of AMs undergone surgical resection alone vs. surgery + ART. Only grossly total resected AMs (Simpson grades 1-3) were included. The individual and pooled odds ratio (OR) for the crude recurrence, progression free survival (PFS) at 1, 3 and 5-years, as well as for the overall survival (OS) at 5-years were calculated by using the Mantel-Haenszel model in surgery alone vs. surgery + ART. Evidence synthesis: Eleven studies were considered eligible. 8 were included for the outcome "crude recurrence;" 6 for PFS at 1-3 years, 7 for PFS at 5-years; 6 for the OS at 5-years. Results suggest that surgery + ART might have a protective role on recurrence in gross-totally resected AMs (OR:1.66). Specifically, surgery + ART slightly improved PFS at 1-year (OR:0.92) and more consistently at 3- and 5-years (OR:0.31 and 0.35 respectively) hence favoring a combined approach. Conclusions: Current literature on the impact of ART after gross total resection of AM are still heterogeneous and not systematically reported. The present meta-analysis suggests a possible protective role of postoperative RT against long-term recurrence as compared to surgical resection alone
Letter: Safety and efficacy issues of tirofiban use in endovascular procedures: What are the actual indications?
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Young Neurosurgeons and Technology: Survey of Young Neurosurgeons Section of Italian Society of Neurosurgery (Società Italiana di Neurochirurgia, SINch)
No full textBackground: Technological advancement in neurosurgery is a continuous process aimed at improving existing devices and implementing innovative ones. Recently, artificial intelligence (AI)-derived technologies (i.e., machine learning and virtual or augmented reality) have been entering this field, promising to significantly change its future. The acquisition of technological skills should be a goal of training for young neurosurgeons. The aim of this study is the analysis of competence and attitude toward intraoperative devices of young neurosurgeons. Methods: An online electronic survey was sent to 256 members of the Young Neurosurgeons Section of the Italian Society of Neurosurgery (Società Italiana di Neurochirurgia, SINch), inquiring about their competences and attitude toward surgical technologies and AI-derived devices. Results: A total of 152 neurosurgeons participated in the survey. Most participants reported sufficient skills in autonomously setting up and using the optic neuronavigator (93.4% and 92.1%, respectively), advanced microscope (80.3% and 76.3%), magnetic neuronavigator (75% and 72.4%), ultrasonography (63.2% and 60.5%) and high-definition endoscope (55.3% and 46%). Most (92.1%) considered operative devices useful and 89.5% reported a high motivation to acquire technological skills. AI-derived devices have already been used by 56.6% of participants but only 31.6% received proper dedicated training. Conclusions: Italian young neurosurgeons have acquired technical skills sufficient for the autonomous use of the most common operative devices, reporting a positive attitude toward technology with high motivation to learn and awareness of their potential harmfulness. A promising number of participants had already used AI-derived technologies, although only a few had received focused training for these devices
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