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  1. Article ; Online: Prediction of diabetes insipidus occurrence after endoscopic endonasal removal of sellar lesions using MRI-based radiomics and machine learning.

    Mastantuoni, Ciro / Ugga, Lorenzo / Solari, Domenico / D'Aniello, Serena / Spadarella, Gaia / Cuocolo, Renato / Angileri, Filippo F / Cavallo, Luigi M

    Journal of neurosurgical sciences

    2024  

    Abstract: Background: Pituitary adenomas and craniopharyngiomas are the most common lesions of the sellar region. These tumors are responsible for invasion or compression of crucial neurovascular structures. The involvement of the pituitary stalk warrants high ... ...

    Abstract Background: Pituitary adenomas and craniopharyngiomas are the most common lesions of the sellar region. These tumors are responsible for invasion or compression of crucial neurovascular structures. The involvement of the pituitary stalk warrants high rates of both pre- and post- operative diabetes insipidus. The aim of our study was to assess the accuracy of machine learning analysis from preoperative MRI of pituitary adenomas and craniopharyngiomas for the prediction of DI occurrence.
    Methods: All patients underwent MRI exams either on a 1.5- or 3-T MR scanner from two Institutions, including coronal T2-weighted (T2-w) and contrast-enhanced T1-weighted (CE T1-w) Turbo Spin Echo sequences. Feature selection was carried out as a multi-step process, with a threshold of 0.75 to identify robust features. Further feature selection steps included filtering based on feature variance (threshold >0.01) and pairwise correlation (threshold <0.80). A Bayesian Network model was trained with 10-fold cross validation employing SMOTE to balance classes exclusively within the training folds.
    Results: Thirty patients were included in this study. In total 2394 features were extracted and 1791 (75%) resulted stable after ICC analysis. The number of variant features was 1351 and of non-colinear features was 125. Finally, 10 features were selected by oneR ranking. The Bayesian Network model showed an accuracy of 63% with a precision of 77% for DI prediction (0.68 area under the precision-recall curve).
    Conclusions: We assessed the accuracy of machine learning analysis of texture-derived parameters from preoperative MRI of pituitary adenomas and craniopharyngiomas for the prediction of DI occurrence.
    Language English
    Publishing date 2024-01-29
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 193139-8
    ISSN 1827-1855 ; 0390-5616 ; 0026-4881
    ISSN (online) 1827-1855
    ISSN 0390-5616 ; 0026-4881
    DOI 10.23736/S0390-5616.23.06162-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Endoscopic endonasal treatment of craniopharyngiomas: current management strategies and future perspectives.

    Solari, Domenico / Mastantuoni, Ciro / Cavallo, Luigi M / Esposito, Felice / Cappabianca, Paolo

    Journal of neurosurgical sciences

    2022  Volume 67, Issue 1, Page(s) 26–35

    Abstract: Introduction: Craniopharyngiomas are locally aggressive disembryogenetic tumors presenting mostly in childhood and late adulthood. They are often burdened by an unfavorable clinical course due to close relationships with nearby critical neurovascular ... ...

    Abstract Introduction: Craniopharyngiomas are locally aggressive disembryogenetic tumors presenting mostly in childhood and late adulthood. They are often burdened by an unfavorable clinical course due to close relationships with nearby critical neurovascular structures and high risk of recurrences. The aim of our paper is to provide a systematic review of the literature regarding current strategies and future perspectives for the treatment of craniopharyngiomas, focusing on the role of endoscopic endonasal surgery.
    Evidence acquisition: A comprehensive literature search of three databases (PubMed, Ovid Medline, and Ovid Embase) has been conducted to identify papers addressing the management strategies in adult and pediatric craniopharyngioma patients.
    Evidence synthesis: Twenty-two articles have been included, providing data for 560 adult and 215 pediatric patients. Mean follow-up was 40.29 months for the adult and 58.05 months for pediatric population. GTR rate was 60.97% and 82.52% in adult and pediatric patients, respectively. Adjuvant radiotherapy was delivered in 20.99% of adult and 8.25% of pediatric cases; 89% of adult patients and 94.11% of pediatric patients receiving radiotherapy had previously undergone NTR, STR or partial resection. The recurrence rate was 19.32% and 18.61% for adult and pediatric population, respectively. Recurrences occurred mostly in patients receiving incomplete resection without adjuvant radiotherapy (72.87% in adults and 51.28% in children); 86.69% and 87.12% of adult and pediatric patients reported improvement of their previous ophthalmologic deficit; 40% of the adult population and 41.86%% of pediatric patients worsened or developed endocrinological disturbances. CSF leak rate was 16.4% in adults and 13.95%% in children.
    Conclusions: Modern policy of craniopharyngioma management is represented by the combination of a "maximum safe" allowed surgical removal plus radiotherapy. In this scenario, the endoscopic endonasal technique proved to be a valid approach for removing these lesions, providing satisfactory outcomes with lower morbidity.
    MeSH term(s) Adult ; Humans ; Child ; Craniopharyngioma/surgery ; Neuroendoscopy/methods ; Treatment Outcome ; Pituitary Neoplasms/surgery ; Pituitary Neoplasms/pathology ; Retrospective Studies ; Postoperative Complications/etiology ; Recurrence
    Language English
    Publishing date 2022-03-17
    Publishing country Italy
    Document type Review ; Journal Article
    ZDB-ID 193139-8
    ISSN 1827-1855 ; 0390-5616 ; 0026-4881
    ISSN (online) 1827-1855
    ISSN 0390-5616 ; 0026-4881
    DOI 10.23736/S0390-5616.21.05507-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Guanti bianchi

    Villalonga, Juan F / Burroni, Matias / Fabozzi, Gianluca L / Solari, Domenico / Campero, Alvaro / Cappabianca, Paolo / Cavallo, Luigi M

    Brain & spine

    2023  Volume 3, Page(s) 101724

    Abstract: Introduction: Since the introduction of the endoscopic endonasal approach (EEA) to skull base, the nasal phase has been a true challenge as it represents the moment of definition of the corridor, thus defining the instruments maneuverability at tumor ... ...

    Abstract Introduction: Since the introduction of the endoscopic endonasal approach (EEA) to skull base, the nasal phase has been a true challenge as it represents the moment of definition of the corridor, thus defining the instruments maneuverability at tumor removal phase. The longstanding cooperation between ENT and neurosurgeons have provided the possibility of creating adequate corridor with maximal respect toward nasal structures and mucosa. This sparked the idea of entering the sella as thieves, so we named "Guanti Bianchi" technique a lesser invasive variation of the approach for the removal of selected pituitary adenoma.
    Research question: The purpose of this study is to present the preliminary results of "Guanti Bianchi" technique.
    Material and methods: Data from 17 patients undergoing "Guanti Bianchi" technique (out of 235 standard EEA) at our center, were retrospectively analysed. ASK Nasal-12, a quality-of-life instrument developed specifically to assess patient perception of nasal morbidity, was administered pre- and postoperatively.
    Results: 10 (59%) patients were men and 7 (41%) women. The mean age was 67.7 (range 35-88). The average duration of the surgical procedure was 71.17 minutes (range 45-100). GTR was achieved in all patients, no postoperative complications were observed. Baseline ASK Nasal-12 was near normal in all patients, 3/17 (17,6%) experienced transitory very mild symptoms without any worsening at 3 and 6 months.
    Discussion and conclusions: This minimally invasive technique does not require turbinectomy or carving of the nasoseptal flap, it alters the nasal mucosa as little as necessary, and it is quick and easy to perform.
    Language English
    Publishing date 2023-02-25
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2023.101724
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  4. Article ; Online: Commentary: Endoscopic Endonasal Removal of Primary/Recurrent Meningiomas in the Medial Optic Canal: Surgical Technique and Long-Term Visual Outcome.

    Solari, Domenico / Cavallo, Luigi M / Cappabianca, Paolo

    Operative neurosurgery (Hagerstown, Md.)

    2019  Volume 17, Issue 5, Page(s) E192–E194

    MeSH term(s) Endoscopy ; Humans ; Meningeal Neoplasms ; Meningioma ; Neoplasm Recurrence, Local ; Sphenoid Bone
    Language English
    Publishing date 2019-04-30
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1093/ons/opz080
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  5. Article ; Online: The 3F (Fat, Flap, and Flash) Technique For Skull Base Reconstruction After Endoscopic Endonasal Suprasellar Approach.

    Cavallo, Luigi M / Solari, Domenico / Somma, Teresa / Cappabianca, Paolo

    World neurosurgery

    2019  Volume 126, Page(s) 439–446

    Abstract: Background: Endoscopic endonasal surgery is a rapidly evolving field that offers the possibility of treating a wide variety of skull base lesions. Reconstruction of the osteodural defect is of utmost importance, as an effective and watertight closure is ...

    Abstract Background: Endoscopic endonasal surgery is a rapidly evolving field that offers the possibility of treating a wide variety of skull base lesions. Reconstruction of the osteodural defect is of utmost importance, as an effective and watertight closure is mandatory. Over the years, various techniques and materials have been adopted in an effort of providing a resilient and reliable method of closure.
    Materials and methods: We retrospectively analyzed data from a series of 25 patients who underwent skull base reconstruction according to a novel paradigm following endoscopic endonasal transtuberculum-transplanum approaches for tumor removal between June 2017 and June 2018. The 3F strategy involves autologous fat grafting, nasoseptal flap coverage, and flash mobilization out of the bed following the operation.
    Results: The 3F technique achieved successful watertight closure in 24 of 25 cases (96%). One case of postoperative cerebrospinal fluid rhinorrhea developed on postoperative day 10, which did not require reoperation. No perioperative complications related to the 3F strategy (e.g., overpacking, infections, or hematomas) occurred. No donor graft site infections or hematomas developed.
    Conclusions: The 3F skull base reconstruction is a safe and effective method in achieving watertight closure after extended endoscopic endonasal approaches. Despite this study reporting a preliminary experience in a small series of patients, it seems that the 3F technique can be considered as a viable solution among the wide kaleidoscope of available skull base reconstruction methods.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Endoscopy/methods ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity/surgery ; Neurosurgical Procedures/methods ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skull Base Neoplasms/surgery ; Surgical Flaps/surgery ; Treatment Outcome
    Language English
    Publishing date 2019-03-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2019.03.125
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  6. Article ; Online: Extended endonasal approaches for pituitary adenomas.

    Solari, Domenico / D'Avella, Elena / Bove, Ilaria / Cappabianca, Paolo / Cavallo, Luigi M

    Journal of neurosurgical sciences

    2020  Volume 65, Issue 2, Page(s) 160–168

    Abstract: Pituitary adenomas with significant extension beyond the sellar boundary, large size, asymmetrical shape and subarachnoid space invasion, although rare, represent a therapeutic challenge. The invasiveness of the tumor itself often limits the potential ... ...

    Abstract Pituitary adenomas with significant extension beyond the sellar boundary, large size, asymmetrical shape and subarachnoid space invasion, although rare, represent a therapeutic challenge. The invasiveness of the tumor itself often limits the potential for complete tumor resection and increases the likelihood of intraoperative or postoperative complications, regardless of the approach. The extended endoscopic endonasal approach has been proposed as a valid alternative to the transcranial route for the treatment of certain pituitary adenomas not suitable to the standard transsphenoidal approach. Thanks to the wide and close up view provided by the endoscope via the appropriate expanded bone removal at the skull base, this technique offers, in an adequate working space, a safe exposure of the tumor and surrounding anatomical structures, at the supra-, para-, and retro-sellar areas. It stands clear that the primary goal of this approach remains the maximum allowed resection with preservation of neurological and endocrine functions. Herein, we debate the extended endoscopic endonasal technique for the treatment of pituitary adenomas, with the aim of underlying its indications, pitfalls, advantages, and limitations.
    MeSH term(s) Adenoma/surgery ; Endoscopy ; Humans ; Pituitary Neoplasms/surgery ; Skull Base/surgery ; Treatment Outcome
    Language English
    Publishing date 2020-11-27
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 193139-8
    ISSN 1827-1855 ; 0390-5616 ; 0026-4881
    ISSN (online) 1827-1855
    ISSN 0390-5616 ; 0026-4881
    DOI 10.23736/S0390-5616.20.05120-6
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  7. Article ; Online: The nose lid for the endoscopic endonasal procedures during COVID-19 era: technical note.

    Solari, Domenico / Bove, Ilaria / Esposito, Felice / Cappabianca, Paolo / Cavallo, Luigi M

    Acta neurochirurgica

    2020  Volume 162, Issue 10, Page(s) 2335–2339

    Abstract: Background: COVID-19 pandemic has disrupted the global health systems worldwide. According to the tremendous rate of interhuman transmission via aerosols and respiratory droplets, severe measures have been required to contain contagion spread. ... ...

    Abstract Background: COVID-19 pandemic has disrupted the global health systems worldwide. According to the tremendous rate of interhuman transmission via aerosols and respiratory droplets, severe measures have been required to contain contagion spread. Accordingly, medical and surgical maneuvers involving the respiratory mucosa and, among them, transnasal transsphenoidal surgery have been charged of maximum risk of spread and contagion, above all for healthcare professionals.
    Method: Our department, according to the actual COVID-19 protocol national guidelines, has suspended elective procedures and, in the last month, only three patients underwent to endoscopic endonasal procedures, due to urgent conditions (a pituitary apoplexy, a chondrosarcoma causing cavernous sinus syndrome, and a pituitary macroadenoma determining chiasm compression). We describe peculiar surgical technique modifications and the use of an endonasal face mask, i.e., the nose lid, to be applied to the patient during transnasal procedures for skull base pathologies as a further possible COVID-19 mitigation strategy.
    Results: The nose lid is cheap, promptly available, and can be easily assembled with the use of few tools available in the OR; this mask allows to both operating surgeon and his assistant to perform wider surgical maneuvers throughout the slits, without ripping it, while limiting the nostril airflow.
    Conclusions: Transnasal surgery, transgressing respiratory mucosa, can definitely increase the risk of virus transmission: we find that adopting further precautions, above all limiting high-speed drill can help preventing or at least reducing aerosol/droplets. The creation of a non-rigid face mask, i.e., the nose lid, allows the comfortable introduction of instruments through one or both nostrils and, at the same time, minimizes the release of droplets from the patient's nasal cavity.
    MeSH term(s) COVID-19 ; Chondrosarcoma/surgery ; Coronavirus Infections/prevention & control ; Coronavirus Infections/surgery ; Coronavirus Infections/transmission ; Endoscopes ; Equipment Design ; Female ; Guideline Adherence ; Humans ; Male ; Masks ; Pandemics/prevention & control ; Pituitary Apoplexy/surgery ; Pituitary Neoplasms/surgery ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/surgery ; Pneumonia, Viral/transmission
    Keywords covid19
    Language English
    Publishing date 2020-08-11
    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/s00701-020-04518-z
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  8. Article ; Online: Multimodality attitude for the treatment of a pituitary metastasis.

    Cavallo, Luigi M / Solari, Domenico

    World neurosurgery

    2013  Volume 79, Issue 5-6, Page(s) 673–674

    MeSH term(s) Carcinoma, Renal Cell/secondary ; Carcinoma, Renal Cell/therapy ; Cerebral Hemorrhage/therapy ; Humans ; Kidney Neoplasms/therapy ; Male ; Pituitary Neoplasms/secondary ; Pituitary Neoplasms/therapy
    Language English
    Publishing date 2013-05
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2013.01.073
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  9. Article ; Online: Predicting endoscopic third ventriculostomy success in adult hydrocephalus: preliminary assessment of a modified ETV success score for adults (ETVSS-A) in a series of 47 patients.

    Bruscella, Sara / Solari, Domenico / Somma, Teresa / Barbato, Marcello / Gangemi, Michelangelo / Cavallo, Luigi M

    Journal of neurosurgical sciences

    2019  Volume 66, Issue 1, Page(s) 33–39

    Abstract: Background: Endoscopic third ventriculostomy is an established treatment for non-communicating hydrocephalus. In carefully selected patients, it can be adopted for the management of communicating variant; however controversy exists in regards to the ... ...

    Abstract Background: Endoscopic third ventriculostomy is an established treatment for non-communicating hydrocephalus. In carefully selected patients, it can be adopted for the management of communicating variant; however controversy exists in regards to the definition of the appropriate candidates. Predictive score of Endoscopic Third Ventriculostomy Success (ETVSS) has been reported for pediatric and mixed populations only. Our purpose was to define an ETV success score for adult population (ETVSS-A), measuring the strength of correlation between preoperative score retrospectively evaluated and the success rates achieved in a class of adult patients.
    Methods: A retrospective analysis of 47 cases which received ETV procedure at our Institution between 2015 and 2018 was run. Demographic data,clinical history,preoperative and postoperative signs were reviewed and ETVSS-A was calculated.Thereafter ETVSS-A results were compared with the actual success rates.
    Results: Twenty-nine patients (61.7%) presented unchanged or improved clinical status with a mean ETVSS-A of 54.5%; 18 patients (38.3%) worsened with mean ETVSS-A of 37.7%. We found that age, type of hydrocephalus and symptoms of admission are each apart important factors in predicting ETV success: older patients and those with non-obstructive hydrocephalus had the lowest predicted ETV success. In patients in whom ETV was actually successful, the preoperative ETVSS-A was significantly higher as compared to those patients in whom we observed a poor surgical outcome.
    Conclusions: From the results of this series, though small and retrospectively analyzed, it seems that ETVSS-A can be considered as a useful instrument to help neurosurgeon in predicting the ETV success and though define a more accurate surgical strategy in cases of hydrocephalus. Wider series and prospective studies are attended to validate these preliminary results.
    MeSH term(s) Adult ; Child ; Humans ; Hydrocephalus/surgery ; Infant ; Neuroendoscopy/methods ; Prospective Studies ; Retrospective Studies ; Third Ventricle/surgery ; Treatment Outcome ; Ventriculostomy/methods
    Language English
    Publishing date 2019-09-23
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 193139-8
    ISSN 1827-1855 ; 0390-5616 ; 0026-4881
    ISSN (online) 1827-1855
    ISSN 0390-5616 ; 0026-4881
    DOI 10.23736/S0390-5616.19.04712-X
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  10. Article ; Online: Skull base cholesterol granulomas: the endoscopic endonasal perspective.

    Cavallo, Luigi M / Solari, Domenico

    World neurosurgery

    2012  Volume 78, Issue 6, Page(s) 597

    MeSH term(s) Cholesteatoma/surgery ; Female ; Granuloma/surgery ; Humans ; Male ; Minimally Invasive Surgical Procedures/methods ; Neuroendoscopy/methods ; Skull Base/surgery
    Language English
    Publishing date 2012-12
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2011.12.069
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