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Article ; Online: Acute deterioration of a Chiari I malformation: an uncommon neurosurgical emergency.

Pettorini, Benedetta Ludovica / Gao, Anna / Rodrigues, Desiderio

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2011 Volume 27, Issue 6, Page(s) 857–860

Abstract: Objectives: Report and discuss acute neurological deterioration of Chiari I malformation (CMI), surgical treatment and timing, clinical outcome and literature review.: Case report: We report a recent case of a 15-year-old girl admitted for an acute ... ...

Abstract	Objectives: Report and discuss acute neurological deterioration of Chiari I malformation (CMI), surgical treatment and timing, clinical outcome and literature review. Case report: We report a recent case of a 15-year-old girl admitted for an acute neurological deterioration caused by an undiagnosed hindbrain herniation that required an urgent foramen magnum decompression and external ventricular drainage insertion. Moreover, we report and discuss the literature. To the authors' knowledge, this is only the third paediatric patient identified in this setting to be treated for an acute neurological deterioration due to a previous asymptomatic hindbrain herniation. The patient made an uncomplicated recovery and was discharged home on the seventh postoperative day and has remained well at review. Discussion: Acute deterioration of CMI in completely asymptomatic patients in absence of concomitant pathological findings is rarely reported in the literature, and exceptional in children. Conclusions: CMI is typically treated electively, but as this case illustrates, it can present with rapidly deteriorating neurological signs. Symptoms usually respond well to surgical intervention with rapid improvement.
MeSH term(s)	Adolescent ; Arnold-Chiari Malformation/diagnostic imaging ; Arnold-Chiari Malformation/surgery ; Decompression, Surgical/methods ; Emergency Treatment/methods ; Encephalocele/diagnostic imaging ; Encephalocele/surgery ; Female ; Humans ; Radiography ; Rhombencephalon/diagnostic imaging ; Rhombencephalon/surgery
Language	English
Publishing date	2011-04-07
Publishing country	Germany
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-011-1442-9
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Article ; Online: Endoscopic third ventriculostomy for the treatment of osteopetrosis-related hydrocephalus: a case-based update.

Dhamija, Bhoresh / Pettorini, Benedetta Ludovica / Solanki, Guirish

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2011 Volume 27, Issue 11, Page(s) 1861–1865

Abstract: Background: Osteopetrosis is a heterogenous group of disorders characterised by a failure of normal bone maturation and abnormal bone sclerosis secondary to the failure of osteoclasts to resorb bone. The most serious consequences of this disorder affect ...

Abstract	Background: Osteopetrosis is a heterogenous group of disorders characterised by a failure of normal bone maturation and abnormal bone sclerosis secondary to the failure of osteoclasts to resorb bone. The most serious consequences of this disorder affect the nervous system. Patients with infantile osteopetrosis (also called malignant osteopetrosis) can develop a gradual occlusion of, or narrowing of the skull foramina at the skull base, resulting in the compression of vital nerves and vessels. Hydrocephalus has been identified in these patients, particularly those with the autosomal recessive variety of osteopetrosis. Although the exact aetiology is uncertain, it is possible that venous outflow obstruction at the cranial foramina along with a reduced intracranial space for cerebrospinal fluid (CSF) to flow around the hemispheres could be contributing factors. There are few reports in the literature on the management of this unusual association, hydrocephalus secondary to osteopetrosis. The authors report one such case where this association has been successfully surgically treated with endoscopic third ventriculostomy as a form of CSF diversion. Case report: We successfully treated a 9-month-old girl with osteopetrosis and symptomatic hydrocephalus with an endoscopic third ventriculostomy (ETV). She later went on to have stem cell transplantation to treat the osteopetrosis. Conclusions: Most reports in the literature have identified ventriculoperitoneal (or other distal site) shunting as the treatment of choice for hydrocephalus in this setting. We would like to highlight that ETV is another effective and often very suitable method of CSF diversion in these patients.
MeSH term(s)	Female ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Infant ; Neuroendoscopy/methods ; Osteopetrosis/complications ; Osteopetrosis/surgery ; Third Ventricle/surgery ; Ventriculostomy/methods
Language	English
Publishing date	2011-05-07
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-011-1474-1
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Article: New presenting symptoms of Chiari I malformation: report of two cases

Pettorini, Benedetta Ludovica / Oesman, Chenur / Magdum, Shailendra

Child's nervous system ChNS : official journal of the International Society for Pediatric Neurosurgery. 2010 Mar., v. 26, no. 3

2010

Abstract: Objective Chiari Malformation type I nowadays represents one of the most debated and treated entities of neurosurgery. Several different symptoms of cerebellar, brainstem and spinal cord pathology have been described and attributed to this malformation. ... ...

Abstract	Objective Chiari Malformation type I nowadays represents one of the most debated and treated entities of neurosurgery. Several different symptoms of cerebellar, brainstem and spinal cord pathology have been described and attributed to this malformation. In this paper, we reported a very uncommon association of Chiari I malformation with isolated hemihypertrophy in one case and clawing hands in the second case. Case reports We report the first case of a 14-year-old girl who presented with a 6-month history of left claw hand, with no evidence of radiculopathy and myopathy; MRI scan revealed a symmetrical herniation of cerebellar tonsils to the level of C1 (0.7 mm), downward displacement of the obex and holocord syrinx. We assisted to the complete resolution of the left clawing hand immediately after decompressive craniectomy, C1 laminectomy, opening of the dura and collagen matrix duraplasty. The second case is a 9-year-old boy who presented with hemihypertrophy affecting the left arm and chest wall, without involvement of the face. Conclusions These case reports can suggest the association of hemihypertrophy and claw hand with Chiari I malformation and syringomyelia. Further studies are necessary to assess the real incidence of focal motor deficits and mesodermic disorders in Chiari I malformation in order to clarify their pathogenetical mechanisms.
Language	English
Dates of publication	2010-03
Size	p. 399-402.
Publisher	Springer-Verlag
Publishing place	Berlin/Heidelberg
Document type	Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-009-1043-z
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: New presenting symptoms of Chiari I malformation: report of two cases.

Pettorini, Benedetta Ludovica / Oesman, Chenur / Magdum, Shailendra

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2009 Volume 26, Issue 3, Page(s) 399–402

Abstract: Objective: Chiari Malformation type I nowadays represents one of the most debated and treated entities of neurosurgery. Several different symptoms of cerebellar, brainstem and spinal cord pathology have been described and attributed to this malformation. ...

Abstract	Objective: Chiari Malformation type I nowadays represents one of the most debated and treated entities of neurosurgery. Several different symptoms of cerebellar, brainstem and spinal cord pathology have been described and attributed to this malformation. In this paper, we reported a very uncommon association of Chiari I malformation with isolated hemihypertrophy in one case and clawing hands in the second case. Case reports: We report the first case of a 14-year-old girl who presented with a 6-month history of left claw hand, with no evidence of radiculopathy and myopathy; MRI scan revealed a symmetrical herniation of cerebellar tonsils to the level of C1 (0.7 mm), downward displacement of the obex and holocord syrinx. We assisted to the complete resolution of the left clawing hand immediately after decompressive craniectomy, C1 laminectomy, opening of the dura and collagen matrix duraplasty. The second case is a 9-year-old boy who presented with hemihypertrophy affecting the left arm and chest wall, without involvement of the face. Conclusions: These case reports can suggest the association of hemihypertrophy and claw hand with Chiari I malformation and syringomyelia. Further studies are necessary to assess the real incidence of focal motor deficits and mesodermic disorders in Chiari I malformation in order to clarify their pathogenetical mechanisms.
MeSH term(s)	Adolescent ; Arm ; Arnold-Chiari Malformation/complications ; Arnold-Chiari Malformation/pathology ; Arnold-Chiari Malformation/surgery ; Brain/pathology ; Child ; Female ; Functional Laterality ; Hand ; Humans ; Hypertrophy/complications ; Hypertrophy/pathology ; Hypertrophy/surgery ; Magnetic Resonance Imaging ; Male ; Spinal Cord/pathology ; Treatment Outcome
Language	English
Publishing date	2009-11-18
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-009-1043-z
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Article ; Online: Mesencephalic enlarged Virchow-Robin spaces in a 6-year-old boy: a case-based update.

Fayeye, Oluwafikayo / Pettorini, Benedetta Ludovica / Foster, Katharine / Rodrigues, Desiderio

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2010 Volume 26, Issue 9, Page(s) 1155–1160

Abstract: Background: Perivascular spaces or Virchow-Robin spaces are normal anatomical structures within the brain, typically less than 5 mm in diameter. Rarely, they can reach much larger sizes and adopt bizarre single or multi-cystic configurations, as was the ...

Abstract	Background: Perivascular spaces or Virchow-Robin spaces are normal anatomical structures within the brain, typically less than 5 mm in diameter. Rarely, they can reach much larger sizes and adopt bizarre single or multi-cystic configurations, as was the case in the patient that we report on. When there is such markedly gross dilatation, the phenomenon is known as Giant or tumefactive perivascular space enlargement. Case report: We report a 6-year-old boy with a multi-cystic mesencephalic lesions presenting with obstructive hydrocephalus secondary to obstruction of the aqueduct of Sylvius due to tumefactive dilatation of Virchow-Robin spaces. The patient underwent an endoscopic fenestration and biopsy of the cystic portion abutting into the ventricular system. Conclusion: In this paper, we discuss the phenomenon of perivascular (Virchow-Robin) spaces and their treatment options and review the relevant literature. To our knowledge, this is the first pediatric case of tumefactive dilatation of the Virchow-Robin spaces causing obstructive hydrocephalus that were directly fenestrated using neuroendoscopy.
MeSH term(s)	Brain Diseases/pathology ; Brain Diseases/therapy ; Child ; Cysts/complications ; Cysts/pathology ; Cysts/therapy ; Dilatation, Pathologic/complications ; Dilatation, Pathologic/pathology ; Dilatation, Pathologic/therapy ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/pathology ; Hydrocephalus/therapy ; Magnetic Resonance Imaging ; Male ; Mesencephalon/blood supply ; Mesencephalon/pathology ; Neuroendoscopy ; Subarachnoid Space/pathology ; Treatment Outcome
Language	English
Publishing date	2010-05-02
Publishing country	Germany
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-010-1164-4
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Article ; Online: Aperius PercLID stand alone interspinous system for the treatment of degenerative lumbar stenosis: experience on 152 cases.

Nardi, PierVittorio / Cabezas, Daniel / Rea, Giancarla / Pettorini, Benedetta Ludovica

Journal of spinal disorders & techniques

2010 Volume 23, Issue 3, Page(s) 203–207

Abstract: Study design: This study is a retrospective clinical investigation of a new interspinous device implanted via a totally percutaneous technique involving 152 consecutive patients.: Objective: Evaluation of the efficacy of the percutaneous Aperius ... ...

Abstract	Study design: This study is a retrospective clinical investigation of a new interspinous device implanted via a totally percutaneous technique involving 152 consecutive patients. Objective: Evaluation of the efficacy of the percutaneous Aperius stand alone implant in patients with degenerative lumbar stenosis and neurogenic intermittent claudication that did not respond to conservative treatment. Summary of background data: The use of interspinous implants grew markedly during the last years. Nowadays, many extension controller devices are positioned through minimally invasive procedures. Methods: From January 2007 to February 2008, 152 consecutive patients with neurogenic intermittent claudication were treated with Aperius PercLID system. Under a local anesthesia, a 1.5 cm skin incision was performed. Trocars for interspinous space distraction were positioned using fluoroscopy guidance. A suitable size Aperius was positioned and released in the interspinous space with a totally percutaneous technique. In 145 patients 1 level was treated, whereas 6 patients received 2 level treatments, and 1 patient received 3 level treatments. The levels treated were L4-L5 in 125 patients (78.2%), L3-L4 level in 26 patients (16.3%), L2-L3 level in 5 patients (3.1%), L5-S1 level in 3 patients (1.8%), and L1-L2 level in 1 patient (0.6%). Results: The surgical time ranged from 8 to 14 minutes for 1 single level. No adverse events were noted. In 1 case (0.6%), Aperius was not implanted because of hypertrophic facet joints that have hindered the correct insertion of the device; we observed only 2 cases of therapeutic failure (1.3%). There was a significant improvement in the Visual Analog Scale and Zurich Claudication Questionnaire scores for low-back and leg pain and for neurogenic claudication. Conclusions: These results indicate that Aperius PercLID system offers an easy, safe, and effective treatment for patients with lumbar degenerative stenosis. Thus, this device system treatment represents a valid alternative to the traditional surgical techniques.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intermittent Claudication/etiology ; Lumbar Vertebrae/surgery ; Male ; Middle Aged ; Patient Satisfaction ; Patient Selection ; Prostheses and Implants/adverse effects ; Prosthesis Implantation/adverse effects ; Prosthesis Implantation/methods ; Spinal Stenosis/surgery ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2010-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2075910-1
ISSN	1539-2465 ; 1536-0652
ISSN (online)	1539-2465
ISSN	1536-0652
DOI	10.1097/BSD.0b013e31819b08da
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Article ; Online: Surgical pathway and management of pineal region tumours in children.

Pettorini, Benedetta Ludovica / Al-Mahfoud, Rafid / Jenkinson, Michael D / Avula, Shivaram / Pizer, Barry / Mallucci, Conor

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2012 Volume 29, Issue 3, Page(s) 433–439

Abstract: Background: Pineal region tumours are rare. Surgery is associated with high morbidity, and consensus on ideal management pathways remains variable.: Method: Patients with pineal region tumours were identified from the neuro-oncology database, and ... ...

Abstract	Background: Pineal region tumours are rare. Surgery is associated with high morbidity, and consensus on ideal management pathways remains variable. Method: Patients with pineal region tumours were identified from the neuro-oncology database, and their data were retrospectively reviewed. Data collection included presentation, germ cell markers, tumour size and location, imaging, histology, treatment and control/relapse rates. Results: Twenty-four patients were treated at Alder Hey Children's Hospital between 1998 and 2010. Median age at diagnosis was 12.7 years. Sixteen patients presented with hydrocephalus. Twelve were successfully treated with endoscopic third ventriculostomy (EVT), and four required shunt insertion during follow-up. Fifteen patients had endoscopic biopsies. Eleven biopsies were performed at the same time as third ventriculostomy, and four patients without significant hydrocephalus had endoscopic image-guided biopsies. Eight patients had stereotactic biopsies (either because of slit ventricles at diagnosis or because of a ventriculoperitoneal shunt already in place), and only one patient had an open biopsy. No morbidity or mortality was associated with the biopsies. Histology showed four pineal parenchymal tumours, nine gliomas and eleven germ cell tumours. Thirteen patients underwent surgical resection. Significant tumour debulking was achieved in all of these patients, with gross total resection in 70 % of cases. There was one intraventricular haemorrhage (full recovery) and one mild hemiparesis. There was no surgical mortality. Conclusion: The mainstay of hydrocephalus management is EVT which provides a safe and reliable route for biopsy. In our experience, craniotomy and tumour resection are effective and safe.
MeSH term(s)	Adolescent ; Biopsy/methods ; Brain Neoplasms/complications ; Brain Neoplasms/diagnosis ; Brain Neoplasms/surgery ; Child ; Child, Preschool ; Craniotomy ; Decision Trees ; Endoscopy ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Infant ; Neurosurgical Procedures/methods ; Pineal Gland/pathology ; Pineal Gland/surgery ; Pinealoma/complications ; Pinealoma/diagnosis ; Pinealoma/surgery ; Retrospective Studies ; Treatment Outcome ; Ventriculostomy/instrumentation
Language	English
Publishing date	2012-11-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-012-1954-y
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Article ; Online: Spontaneous regression of a midbrain lesion in a patient with chronic transtentorial herniation: is it a pre-syrinx?

Cianfoni, Alessandro / da Graca Morais Martin, Maria / Luigetti, Marco / Pettorini, Benedetta Ludovica / Hesselink, John R

Journal of neurology

2010 Volume 257, Issue 5, Page(s) 848–850

MeSH term(s)	Brain/pathology ; Brain/physiopathology ; Brain Diseases/pathology ; Brain Diseases/physiopathology ; Chronic Disease ; Diencephalon/pathology ; Diencephalon/physiopathology ; Encephalocele/pathology ; Encephalocele/physiopathology ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Mesencephalon/pathology ; Mesencephalon/physiopathology ; Remission, Spontaneous ; Young Adult
Language	English
Publishing date	2010-02-06
Publishing country	Germany
Document type	Case Reports ; Letter
ZDB-ID	187050-6
ISSN	1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
ISSN (online)	1432-1459
ISSN	0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
DOI	10.1007/s00415-010-5460-4
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Article ; Online: Molecular pathogenesis of craniopharyngioma: switching from a surgical approach to a biological one.

Pettorini, Benedetta Ludovica / Frassanito, Paolo / Caldarelli, Massimo / Tamburrini, Gianpiero / Massimi, Luca / Di Rocco, Concezio

Neurosurgical focus

2010 Volume 28, Issue 4, Page(s) E1

Abstract: Craniopharyngioma has long been considered a benign tumor because of its pathological aspect. This primordial view of craniopharyngioma fit with the primitive treatment attempts based on blind resection of the tumor each time it recurred. The limits of ... ...

Abstract	Craniopharyngioma has long been considered a benign tumor because of its pathological aspect. This primordial view of craniopharyngioma fit with the primitive treatment attempts based on blind resection of the tumor each time it recurred. The limits of this management strategy were proven early by the high morbidity related to the resection and recurrence risk despite radical lesion removal. Nowadays, craniopharyngioma must be considered a complex molecular disease, and a detailed explanation of the mechanisms underlying its aggressive biological and clinical behavior, despite some benign pathological features, would be the first step toward defining the best management of craniopharyngioma. Indeed, advances in the knowledge of the molecular mechanisms at the base of craniopharyngioma oncogenesis will lead to comprehension of the critical checkpoints involved in neoplastic transformation. The final research target will be the definition of new biological agents able to reverse the neoplastic process by acting on these critical checkpoints. This biological approach will lead to a refined therapy combining higher efficacy and safety with lower morbidity. In this paper the authors reveal state-of-the-art comprehension of the molecular biology of craniopharyngioma and the consequent therapeutic implications.
MeSH term(s)	Adult ; Child ; Craniopharyngioma/pathology ; Craniopharyngioma/surgery ; Craniopharyngioma/therapy ; Humans ; Molecular Biology/methods ; Neoplastic Processes ; Pituitary Neoplasms/pathology ; Pituitary Neoplasms/surgery ; Pituitary Neoplasms/therapy
Language	English
Publishing date	2010-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2010.1.FOCUS09300
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Article ; Online: The use of a reconstituted collagen foil dura mater substitute in paediatric neurosurgical procedures--experience in 47 patients.

Pettorini, Benedetta Ludovica / Tamburrini, Gianpiero / Massimi, Luca / Paternoster, Giovanna / Caldarelli, Massimo / Di Rocco, Concezio

British journal of neurosurgery

2010 Volume 24, Issue 1, Page(s) 51–54

Abstract: Background: CSF leakage is a common complication of neurosurgical procedures, with defective dural suture thought to be the most frequent cause. We report our experience with a new collagen foil (TissuDura, Baxter Healthcare SA, Switzerland) utilized as ...

Abstract	Background: CSF leakage is a common complication of neurosurgical procedures, with defective dural suture thought to be the most frequent cause. We report our experience with a new collagen foil (TissuDura, Baxter Healthcare SA, Switzerland) utilized as dural substitute in paediatric neurosurgical procedures. Methods: TissuDura was used in children consecutively operated on at the department of paediatric neurosurgery, Catholic University, Rome, from March 2004 to August 2007. Children underwent surgical procedures in supratentorial, infratentorial and spinal compartments. In supratentorial and spinal procedures, the dural graft was used according to the overlay technique. In the posterior fossa procedures, the underlay technique was used. Results: Forty-seven patients received TissuDura during surgery. Thirty-one patients underwent surgery for the removal of posterior fossa tumours, nine for supratentorial tumours and seven for spinal dysraphisms. No CSF leakage was observed following the use of TissuDura in supratentorial procedures. Two post-operative CSF leaks occurred in patients who had undergone spinal surgery. No post-operative hydrocephalus was noted in these two surgery groups. Three cases of CSF leakage occurred in patients who had undergone posterior cranial fossa surgery. All 3 cases had an associated supratentorial ventricular dilation present prior to the removal of the tumour (one case) or occurring after the tumour excision (two cases). No clinically evident adverse reactions directly related to TissuDura were observed. Conclusions: The main advantages of TissuDura were its apparent ability to prevent CSF leakage when utilized in a specific subset of patients, and the absence of reactions or postoperative infections.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Collagen/therapeutic use ; Contraindications ; Cranial Fossa, Posterior/surgery ; Dura Mater/surgery ; Female ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Infant ; Male ; Membranes, Artificial ; Neurosurgical Procedures/methods ; Postoperative Complications/prevention & control ; Prospective Studies ; Skull Base Neoplasms/surgery ; Spinal Dysraphism/surgery ; Spine/surgery ; Subdural Effusion/prevention & control ; Supratentorial Neoplasms/surgery ; Surgical Wound Infection/prevention & control ; Treatment Outcome
Chemical Substances	Membranes, Artificial ; Collagen (9007-34-5)
Language	English
Publishing date	2010-02
Publishing country	England
Document type	Evaluation Studies ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688690903386991
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