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Article ; Online: Syringopleural shunt for refractory syringomyelia: how I do it.

Perrini, Paolo / Benedetto, Nicola / Vercelli, Alberto / Di Carlo, Davide Tiziano

2023 Volume 165, Issue 10, Page(s) 3039–3043

Abstract: Background: Surgical treatment of syringomyelia is directed at the reconstruction of the subarachnoid space and restoration normal cerebrospinal fluid flow. Direct intervention on the syrinx is a rescue procedure and should be offered to patients with ... ...

Abstract	Background: Surgical treatment of syringomyelia is directed at the reconstruction of the subarachnoid space and restoration normal cerebrospinal fluid flow. Direct intervention on the syrinx is a rescue procedure and should be offered to patients with refractory syringomyelia. Methods: We provide an overview on indications and technique of syringopleural shunt (SPS). The procedure involves the connection of syrinx with the pleural space using a lumboperitoneal shunt. The occurrence of a negative pressure inside the pleural compartment offers an appropriate gradient for drainage from the syrinx. Conclusions: The SPS allows for a safe and effective treatment of persistent syringomyelia when management of the underlying cause does not yield substantial improvement.
MeSH term(s)	Humans ; Syringomyelia/diagnostic imaging ; Syringomyelia/surgery ; Syringomyelia/etiology ; Magnetic Resonance Imaging/methods ; Subarachnoid Space/diagnostic imaging ; Subarachnoid Space/surgery ; Treatment Outcome ; Drainage/adverse effects ; Cerebrospinal Fluid Shunts/adverse effects ; Arnold-Chiari Malformation/surgery
Language	English
Publishing date	2023-06-19
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-023-05654-y
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Article ; Online: Clinical outcome after microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis.

Di Carlo, Davide Tiziano / Benedetto, Nicola / Perrini, Paolo

Neurosurgical review

2022 Volume 46, Issue 1, Page(s) 8

Abstract: Microvascular decompression (MVD) is considered an effective treatment for trigeminal neuralgia (TN). However, the anatomical and clinical variables associated with a better outcome are not fully examined. The authors performed a systematic review and ... ...

Abstract	Microvascular decompression (MVD) is considered an effective treatment for trigeminal neuralgia (TN). However, the anatomical and clinical variables associated with a better outcome are not fully examined. The authors performed a systematic review and meta-analysis of the literature investigating the immediate and long-term clinical results of MVD for TN, and the impact of the anatomical features of the neurovascular conflict on the outcome. The systematic search of three databases was performed for studies published between January 1990 and November 2021. PRISMA guidelines were followed. Random-effects meta-analysis was used to pool the analyzed outcomes, and random-effect meta-regression was used to examine the association between the effect size and potential confounders. A funnel plot followed by Egger's linear regression was used to test publication bias. A total of 9 studies were included in this analysis, including 2102 patients with trigeminal neuralgia. The immediate post-operative rate of BNI I was 82.9%, whereas surgical failure (BNI IV-V) was reported in approximately 2.6% of patients. CSF leak was the most common postoperative complication (2.4%). The rate of BNI I at last follow up was 64.7% (p < 0.01), showing a significant negative correlation after multiple meta-regression with the rate of patients with isolated venous conflict (p < 0.01). On the other hand, the evidence of an arterial conflict proved is positive association with a favorable outcome (p < 0.01). At the last follow-up, BNI IV-V was reported in 19.2% (95% CI 8.9-29.5%, p < 0.01, I
MeSH term(s)	Humans ; Trigeminal Neuralgia/surgery
Language	English
Publishing date	2022-12-08
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-022-01922-0
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Article: Post-Operative Complications after Foramen Magnum Decompression with Duraplasty Using Different Graft Materials in Adults Patients with Chiari I Malformation: A Systematic Review and Meta-Analysis.

Perrini, Paolo / Lorenzini, Daniele / Vercelli, Alberto / Perrone, Alessandra / Di Carlo, Davide Tiziano

Journal of clinical medicine

2023 Volume 12, Issue 10

Abstract: Despite extensive investigations, the choice of graft material for reconstructive duraplasty after foramen magnum decompression for Chiari type I malformation (CMI) is still a topic of discussion. The authors performed a systematic review and meta- ... ...

Abstract	Despite extensive investigations, the choice of graft material for reconstructive duraplasty after foramen magnum decompression for Chiari type I malformation (CMI) is still a topic of discussion. The authors performed a systematic review and meta-analysis of the literature examining the post-operative complications in adult patients with CMI after foramen magnum decompression and duraplasty (FMDD) using different graft materials. Our systematic review included 23 studies with a total of 1563 patients with CMI who underwent FMDD with different dural substitutes. The most common complications were pseudomeningocele (2.7%, 95% CI 1.5-3.9%,
Language	English
Publishing date	2023-05-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12103382
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Article ; Online: Lateral-PLIF for spinal arthrodesis: concept, technique, results, complications, and outcomes.

Capo, Gabriele / Calvanese, Francesco / Vandenbulcke, Alberto / Zaed, Ismail / Di Carlo, Davide Tiziano / Cao, Roberta / Barrey, Cédric Y

Acta neurochirurgica

2024 Volume 166, Issue 1, Page(s) 123

Abstract: Background: Posterior lumbar interbody fusion (PLIF) surgery represents an effective option to treat degenerative conditions in the lumbar spine. To reduce the drawbacks of the classical technique, we developed a variant, so-called Lateral-PLIF, which ... ...

Abstract	Background: Posterior lumbar interbody fusion (PLIF) surgery represents an effective option to treat degenerative conditions in the lumbar spine. To reduce the drawbacks of the classical technique, we developed a variant, so-called Lateral-PLIF, which we then evaluated through a prospective consecutive series of patients. Methods: All adult patients treated at our institute with single or double level Lateral-PLIF for lumbar degenerative disease from January to December 2017 were prospectively collected. Exclusion criteria were patients < 18 years of age, traumatic patients, active infection, or malignancy, as well as unavailability of clinical and/or radiological follow-up data. The technique consists of insert the cages bilaterally through the transition zone between the central canal and the intervertebral foramen, just above the lateral recess. Pre- and postoperative (2 years) questionnaires and phone interviews (4 years) assessed pain and functional outcomes. Data related to the surgical procedure, postoperative complications, and radiological findings (1 year) were collected. Results: One hundred four patients were selected for the final analysis. The median age was 58 years and primary symptoms were mechanical back pain (100, 96.1%) and/or radicular pain (73, 70.2%). We found a high fusion rate (95%). A statistically significant improvement in functional outcome was also noted (ODI p < 0.001, Roland-Morris score p < 0.001). Walking distance increased from 812 m ± 543 m to 3443 m ± 712 m (p < 0.001). Complications included dural tear (6.7%), infection/wound dehiscence (4.8%), and instrument failure (1.9%) but no neurological deterioration. Conclusions: Lateral-PLIF is a safe and effective technique for lumbar interbody fusion and may be considered for further comparative study validation with other techniques before extensive use to treat lumbar degenerative disease.
MeSH term(s)	Adult ; Humans ; Middle Aged ; Prospective Studies ; Spinal Fusion/adverse effects ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Lumbosacral Region ; Pain ; Postoperative Complications
Language	English
Publishing date	2024-03-07
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-024-06024-y
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Article ; Online: Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV).

Montemurro, Nicola / Indaimo, Antonino / Di Carlo, Davide Tiziano / Benedetto, Nicola / Perrini, Paolo

International journal of environmental research and public health

2022 Volume 19, Issue 4

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adult ; Child ; Child, Preschool ; Humans ; Hydrocephalus/surgery ; Retrospective Studies ; Third Ventricle/surgery ; Treatment Outcome ; Ventriculoperitoneal Shunt ; Ventriculostomy/methods
Language	English
Publishing date	2022-02-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19041926
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Article ; Online: Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA)

Nicola Montemurro / Antonino Indaimo / Davide Tiziano Di Carlo / Nicola Benedetto / Paolo Perrini

International Journal of Environmental Research and Public Health, Vol 19, Iss 1926, p

A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV)

2022 Volume 1926

Abstract: Background: Long-standing overt ventriculomegaly in adults (LOVA) is an uncommon type of adult chronic hydrocephalus. In recent years, conflicting case series described different outcomes after treatment of LOVA with endoscopic third ventriculostomy (ETV) ...

Abstract	Background: Long-standing overt ventriculomegaly in adults (LOVA) is an uncommon type of adult chronic hydrocephalus. In recent years, conflicting case series described different outcomes after treatment of LOVA with endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS). The aim of this study is to report a single institutional surgical experience of patients with LOVA in order to evaluate the clinical outcome of those patients treated with one or, sometimes, both surgical procedures, analyzing the main clinical features of these patients, before and after surgery. Methods: We conducted a retrospective study on 31 patients with diagnosis of LOVA, who were treated in our University Hospital between December 2010 and October 2020. We reported gender, age, clinical presentation, surgical treatment, and clinical outcome according to the Kiefer index (KI). Evans’ index, head circumference, aqueductal stenosis and expanded/destroyed sella turcica were assessed on preoperative MRI. Results: The most common clinical manifestation was gait disturbances (100%) followed by urinary incontinence in 23 (74.2%) patients and cognitive deficits in 22 (71%) patients. On preoperative MRI, the overall mean Evans’s Index was 0.49, whereas the overall mean head circumference was 57.3 cm. Twenty-three patients (74.2%) had obliterated cortical sulci, 20 (64.5%) patients had aqueductal stenosis, and 22 (71%) patients had an expanded/destroyed sella turcica on preoperative MRI. Fifteen (48.4%) patients underwent ETV and sixteen (51.6%) were treated with VPS as first surgical procedure. Four (26.6%) out of fifteen patients treated with ETV required a subsequent VPS. The overall median age of patients was 64 (IQR: 54.5–74) and the overall median follow-up was 57 months (IQR 21.5–81.5). Overall morbidity was 22.5%. Mean recovery index (RI), according to KI, was 3.8 ± 4.3 and 2.2 ± 5.6 ( p = 0.05) at last follow-up in patients treated with ETV and VPS, respectively. Conclusions: The choice of surgical treatment of LOVA ...
Keywords	long-standing overt ventriculomegaly ; LOVA ; ventriculoperitoneal shunt ; endoscopic third ventriculostomy ; clinical outcome ; traumatic brain injury ; Medicine ; R
Subject code	616 ; 610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Microvascular decompression for trigeminal neuralgia due to vertebrobasilar artery compression: a systematic review and meta-analysis.

Di Carlo, Davide Tiziano / Benedetto, Nicola / Marani, Walter / Montemurro, Nicola / Perrini, Paolo

Neurosurgical review

2021 Volume 45, Issue 1, Page(s) 285–294

Abstract: Trigeminal neuralgia (TN) caused by vertebrobasilar artery (VBA) compression is a rare event, reported between 2 and 6% (Linskey et al. J Neurosurg 81:1-9,1992, Vanaclocha et al.World Neurosurg 96:516-529,2016) of the time. Microvascular decompression ( ... ...

Abstract	Trigeminal neuralgia (TN) caused by vertebrobasilar artery (VBA) compression is a rare event, reported between 2 and 6% (Linskey et al. J Neurosurg 81:1-9,1992, Vanaclocha et al.World Neurosurg 96:516-529,2016) of the time. Microvascular decompression (MVD) is advised for drug-resistant pain and, although technically challenging, is associated with an excellent outcome in current literature (Apra et al.Neurosurg Rev 40:577-582,2017, Cruccuet al. EurJ Neurol 15:1013-1028,2008, Linskey et al. J Neurosurg 81:1-9,1992). The authors performed a systematic review and meta-analysis of the literature examining the rate of MVD for trigeminal neuralgia caused by VBA compression and the post-operative outcome. The systematic search of three databases was performed for studies published between January 1990 and October 2020. Random-effects meta-analysis was used to pool the analyzed outcomes, and random-effects meta-regression was used to examine the association between the effect size and potential confounders. Funnel plot followed by Egger's linear regression was used to test publication bias. We included 9 studies, and the overall rate of TN due to VBA compression was 3.4% (95% CI 2.5-4.3%, p < 0.01, I
MeSH term(s)	Arteries ; Humans ; Microvascular Decompression Surgery ; Pain ; Postoperative Complications ; Trigeminal Neuralgia/etiology ; Trigeminal Neuralgia/surgery
Language	English
Publishing date	2021-07-26
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-021-01606-1
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Article ; Online: Development of associational fiber tracts in fetal human brain: a cadaveric laboratory investigation.

Di Carlo, Davide Tiziano / Filice, Maria Elena / Fava, Arianna / Quilici, Francesca / Fuochi, Beatrice / Cecchi, Paolo / Donatelli, Graziella / Restani, Laura / Nardini, Vincenzo / Turillazzi, Emanuela / Cosottini, Mirco / Perrini, Paolo

Brain structure & function

2023 Volume 228, Issue 8, Page(s) 2007–2015

Abstract: The advent of diffusion tensor imaging (DTI) in addition to cadaveric brain dissection allowed a comprehensive description of an adult human brain. Nonetheless, the knowledge of the development of the internal architecture of the brain is mostly ... ...

Abstract	The advent of diffusion tensor imaging (DTI) in addition to cadaveric brain dissection allowed a comprehensive description of an adult human brain. Nonetheless, the knowledge of the development of the internal architecture of the brain is mostly incomplete. Our study aimed to provide a description of the anatomical variations of the major associational bundles, among fetal and early post-natal periods. Seventeen formalin-fixed fetal human brains were enrolled for sulci analysis, and 13 specimens were dissected under the operating microscope, using Klingler's technique. Although fronto-temporal connections could be observed in all stages of development, a distinction between the uncinate fascicle, and the inferior fronto-occipital fascicle was clear starting from the early preterm period (25-35 post-conceptional week). Similarly, we were consistently able to isolate the periatrial white matter that forms the sagittal stratum (SS), with no clear distinction among SS layers. Arcuate fascicle and superior longitudinal fascicle were isolated only at the late stage of development without a reliable description of their entire course. The results of our study demonstrated that, although white matter is mostly unmyelinated among fetal human brains, cadaveric dissection can be performed with consistent results. Furthermore, the stepwise development of the associational fiber tracts strengthens the hypothesis that anatomy and function run in parallel, and higher is the cognitive functions subserved by an anatomical structure, later the development of the fascicle. Further histological-anatomical-DWI investigations are required to appraise and explore this topic.
MeSH term(s)	Adult ; Infant, Newborn ; Humans ; Diffusion Tensor Imaging ; Brain/diagnostic imaging ; White Matter/diagnostic imaging ; Nerve Tissue ; Cadaver
Language	English
Publishing date	2023-09-02
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2273162-3
ISSN	1863-2661 ; 1863-2653
ISSN (online)	1863-2661
ISSN	1863-2653
DOI	10.1007/s00429-023-02701-3
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Article ; Online: Radiological outcome after surgical treatment of syringomyelia-Chiari I complex in adults: a systematic review and meta-analysis.

Perrini, Paolo / Anania, Yury / Cagnazzo, Federico / Benedetto, Nicola / Morganti, Riccardo / Di Carlo, Davide Tiziano

Neurosurgical review

2020 Volume 44, Issue 1, Page(s) 177–187

Abstract: Foramen magnum decompression (FMD) is widely accepted as the standard treatment for syringomyelia associated with Chiari type I malformation (CMI). Despite extensive clinical investigations, relevant surgical details are still matter of debate. The ... ...

Abstract	Foramen magnum decompression (FMD) is widely accepted as the standard treatment for syringomyelia associated with Chiari type I malformation (CMI). Despite extensive clinical investigations, relevant surgical details are still matter of debate. The authors performed a systematic review and meta-analysis of the literature examining the radiological outcome of syringomyelia in adult patients with CMI after different surgical strategies. PRISMA guidelines were followed. A systematic search of three databases was performed for studies published between 1990 and 2018. Our systematic review included 13 studies with a total of 276 patients with CMI associated with syringomyelia. Overall, the rate of post-operative radiological improvement at last follow-up was 81.1% (95% CI 73.3-88.9%; p < 0.001; I
MeSH term(s)	Arnold-Chiari Malformation/diagnostic imaging ; Arnold-Chiari Malformation/surgery ; Decompression, Surgical/methods ; Foramen Magnum/surgery ; Humans ; Neurosurgical Procedures/methods ; Syringomyelia/diagnostic imaging ; Syringomyelia/surgery ; Treatment Outcome
Language	English
Publishing date	2020-01-17
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-020-01239-w
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Article ; Online: Microsurgical Resection of Cervical Intradural Juxtamedullary Solitary Fibrous Tumor: 2-Dimensional Operative Video.

Perrini, Paolo / Di Carlo, Davide Tiziano / Montemurro, Nicola / Benedetto, Nicola / Ortenzi, Valerio / Naccarato, Antonio Giuseppe

Operative neurosurgery (Hagerstown, Md.)

2020 Volume 19, Issue 5, Page(s) E532

Abstract: Solitary fibrous tumors (SFTs) are uncommon mesenchymal lesions originally described as pleura-based neoplasms. Intradural juxtamedullary SFTs are rare, hard, and scarcely vascularized and generally present a conspicuous extramedullary exophytic ... ...

Abstract	Solitary fibrous tumors (SFTs) are uncommon mesenchymal lesions originally described as pleura-based neoplasms. Intradural juxtamedullary SFTs are rare, hard, and scarcely vascularized and generally present a conspicuous extramedullary exophytic component without dural attachment and nerve root involvement. Gross-total resection is the mainstay of treatment, although the absence of an arachnoidal plane and the firm adherence to the spinal cord make resection challenging. We describe the case of a 74-yr-old female patient presenting with a history of progressive spastic tetraparesis due to a cervical juxtamedullary SFT. The patient was not able to walk and magnetic resonance imaging (MRI) of the cervical spine demonstrated a possible intramedullary lesion at C2-C3 with homogeneous enhancement after gadolinium injection. Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. The patient underwent C2-C3 laminoplasty and tumor resection under neurophysiologic monitoring. The tumor presented extremely hard without dural attachment or nerve root involvement and was progressively debulked using microsurgical techniques and ultrasonic aspirator. The identification of a plane between the mass and the spinal cord white matter allowed for a gross total resection. Permanent pathological analysis eventually demonstrated SFT. The patient's neurological condition was unchanged postoperatively. MRI performed 2 mo after the operation demonstrated gross total resection of the lesion. At the 6-mo follow-up visit, the patient was able to walk with assistance. The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.
MeSH term(s)	Aged ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Solitary Fibrous Tumors ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/surgery
Language	English
Publishing date	2020-06-30
Publishing country	United States
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1093/ons/opaa232
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