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Article: Editorial: Novel techniques and technologies in spine surgery: New approaches for the traumatic, oncologic, and aging spine.

Palmieri, Mauro / Frati, Alessandro / D'Andrea, Giancarlo / Santoro, Antonio / Salvati, Maurizio / Pesce, Alessandro

2023 Volume 10, Page(s) 1155636

Language	English
Publishing date	2023-02-20
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1155636
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Article ; Online: An understimated maneuver for oculomotor nerve palsy due to posterior communicating artery aneurysm: the opening of the anterior petroclinoid ligament. A technical note.

LA Pira, Biagia / Picotti, Veronica / Frati, Alessandro / Pesce, Alessandro / D'Andrea, Giancarlo

Journal of neurosurgical sciences

2023

Abstract: Posterior communicating artery aneurysms (PcomAs) present with oculomotor nerve (OMN) palsy in 20-30% of cases, and the sudden onset of OMN palsy has to raise the suspicion of rupture, until proven otherwise. The surgical technique is described in a ... ...

Abstract	Posterior communicating artery aneurysms (PcomAs) present with oculomotor nerve (OMN) palsy in 20-30% of cases, and the sudden onset of OMN palsy has to raise the suspicion of rupture, until proven otherwise. The surgical technique is described in a stepwise fashion. An illustrative case is reported: a 57-year-old female was admitted to our department with the diagnosis of a right sided-PcomA. Three months before the admission, when she harbored with the acute onset of complete ptosis, diplopia, orbital pain, impairment of the medial, upward, and downward gaze, with no pupil dysfunction. The origin of the Pcom and the neck of the aneurysm were easily identified and the aneurysm was clipped. Then, we followed the OMN and cut for less than 4 mm the above-lying anterior petroclinoid ligament (APL) to obtain nerve release. Although few cases are described in the literature, and ours represents a single case, we support that this maneuver should be introduced in the clinical practice of expert neurosurgeons dealing with vascular pathologies, such as the opening of the falciform ligament occurs for the decompression of the optical nerve.
Language	English
Publishing date	2023-05-15
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/S0390-5616.23.06020-4
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Article ; Online: Ultrasound Lancet-aided Translaminar Posterior Lumbar Approach to the Recesso-Foraminal Area: Technical Note.

Rustia, Alessandro / Pesce, Alessandro / Palmieri, Mauro / D'Andrea, Giancarlo / Frati, Alessandro

Clinical spine surgery

2021 Volume 35, Issue 3, Page(s) 107–110

Abstract: Extrusion and sequestration of the nucleus pulposus involving the spinal canal or the foramina/recesses complicates up to 28% of the lumbar disc herniations. The transpars/translaminar anatomical approach is well described and its advantages when ... ...

Abstract	Extrusion and sequestration of the nucleus pulposus involving the spinal canal or the foramina/recesses complicates up to 28% of the lumbar disc herniations. The transpars/translaminar anatomical approach is well described and its advantages when handling with a lateral, foraminal extruded disc herniation are appreciated and recognized. Nevertheless, this approach presents several pitfalls such as the risk of disconnecting the pars interarticularis, which may cause segmental instability. This particular eventuality is because of the particular anatomical conformation of the pars interarticularis. Although already part of the modern surgical armamentarium for general, orthopedic, cranial and spinal surgeons, the use of the ultrasonic scalpel technique for such approach has never been discussed to date, to the best of our knowledge. The purpose of the present paper is therefore to introduce and describe the stepwise technique along with an extensive discussion of the facilitating role of the ultrasonic scalpel in the translaminar/transpars approach in the management of extruded disc herniation of the lumbar spine.
MeSH term(s)	Humans ; Intervertebral Disc Displacement/surgery ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Lumbosacral Region/diagnostic imaging ; Lumbosacral Region/surgery ; Spinal Canal ; Treatment Outcome
Language	English
Publishing date	2021-10-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2849646-2
ISSN	2380-0194 ; 2380-0186
ISSN (online)	2380-0194
ISSN	2380-0186
DOI	10.1097/BSD.0000000000001263
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Article ; Online: Peritumoral Brain Edema in Relation to Tumor Size Is a Variable That Influences the Risk of Recurrence in Intracranial Meningiomas.

Frati, Alessandro / Armocida, Daniele / Arcidiacono, Umberto Aldo / Pesce, Alessandro / D'Andrea, Giancarlo / Cofano, Fabio / Garbossa, Diego / Santoro, Antonio

Tomography (Ann Arbor, Mich.)

2022 Volume 8, Issue 4, Page(s) 1987–1996

Abstract: Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and can increase their morbidity. It is not uncommon for a neurosurgeon to confront meningiomas with a large proportion of PBE independently from the site and size of the contrast- ... ...

Abstract	Peritumoral brain edema (PBE) is common in intracranial meningiomas (IM) and can increase their morbidity. It is not uncommon for a neurosurgeon to confront meningiomas with a large proportion of PBE independently from the site and size of the contrast-enhancing lesion with increased surgical risks. We performed a retrospective review of 216 surgically-treated patients suffering from IM. We recorded clinical, biological, and radiological data based on the rate of tumor and edema volume and divided the patients into a group with high Edema/Tumor ratio and a group with a low ratio. We investigated how the ratio of edema/lesion may affect the outcome. Multivariate analysis was performed for the two groups. Smokers were found to be more likely to belong to the high-rate group. The edema/tumor ratio did not affect the surgical radicality; however, independently of the biological sub-type, WHO grading, and EOR, a higher frequency of recurrence is shown in patients with a high edema/tumor ratio (70.5% vs. 8.4%. p < 0.01). There is evidence to suggest that the blood-brain barrier (BBB) damage from smoke could play a role in an increased volume of PBE. The present study demonstrates that IMs showing a high PBE ratio to tumor volume at diagnosis are associated with a smoking habit and a higher incidence of recurrence independently of their biological type and grading.
MeSH term(s)	Brain Edema/diagnostic imaging ; Brain Edema/etiology ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms/complications ; Meningeal Neoplasms/diagnostic imaging ; Meningeal Neoplasms/surgery ; Meningioma/diagnostic imaging ; Meningioma/pathology ; Tumor Burden
Language	English
Publishing date	2022-08-08
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2379-139X
ISSN (online)	2379-139X
DOI	10.3390/tomography8040166
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Article: Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review.

Arcidiacono, Umberto Aldo / Armocida, Daniele / Pesce, Alessandro / Maiotti, Marco / Proietti, Luca / D'Andrea, Giancarlo / Santoro, Antonio / Frati, Alessandro

Journal of clinical medicine

2022 Volume 11, Issue 24

Abstract: Background: Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only ... ...

Abstract	Background: Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon's inappropriate decision to resort to a second surgical treatment. Methods: We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. Results: We retrieve 20 articles. Most of the papers are clinical cases showing the disorder's rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. Conclusion: CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately.
Language	English
Publishing date	2022-12-14
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11247409
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Article ; Online: Impact of early surgery of ruptured cerebral aneurysms on vasospasm and hydrocephalus after SAH: Our preliminary results.

D'Andrea, Giancarlo / Picotti, Veronica / Familiari, Pietro / Barbaranelli, Claudio / Frati, Alessandro / Raco, Antonino

Clinical neurology and neurosurgery

2020 Volume 192, Page(s) 105714

Abstract: Objective: Timing of surgical treatment of ruptured intracranial aneurysms has undergone a drastic change in the last few decades with preference for early surgery Our paper focuses specifically on the prognostic importance of timing of surgery, since ... ...

Abstract	Objective: Timing of surgical treatment of ruptured intracranial aneurysms has undergone a drastic change in the last few decades with preference for early surgery Our paper focuses specifically on the prognostic importance of timing of surgery, since early surgery of ruptured aneurysms provides immediately good clinical results. We present a series of cases operated in early and ultra early surgery, evaluating the technical aspects, the efficacy, the safety and the clinical results. Patients and methods: We retrospectively reviewed the clinical records and radiological imaging of patients treated for ruptured intracranial aneurysms who underwent early and ultra early clipping between January 2011 and April 2017 at our Institution. We included patients treated within the first 12 h and subsequently we divided our series in two subgroups based on the timing of surgery comparing the "early surgery" group (within 12 h) with the "ultra early surgery" group (within 6 h). Results: Seventy-six (76) patients undergoing either early or ultra-early surgery for ruptured intracranial aneurysms have been reported Either early or ultra-early surgery showed a statistically favorable impact on reducing the incidence of both postoperative vasospasm and hydrocephalus. Ultra-early surgery group had the best outcome at the statistical analyses. (good postoperative 1Y GOSE.) CONCLUSIONS: We strongly believe that patients affected by ruptured intracranial aneurysms excluding Hunt and Hess grade V patients) should be treated as soon as possible and hence it should be considered as an emergency surgery. This approach prevents immediately a second bleeding of the aneurysm, allows to treat any associated condition of intracranial hypertension including hematomas and hydrocephalus and to use safely aggressive medical therapy such as hypertension.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Aneurysm, Ruptured/complications ; Aneurysm, Ruptured/diagnostic imaging ; Aneurysm, Ruptured/physiopathology ; Aneurysm, Ruptured/surgery ; Computed Tomography Angiography ; Early Medical Intervention ; Female ; Functional Status ; Humans ; Hydrocephalus/diagnostic imaging ; Hydrocephalus/etiology ; Hydrocephalus/physiopathology ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/physiopathology ; Intracranial Aneurysm/surgery ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Prognosis ; Retrospective Studies ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/physiopathology ; Subarachnoid Hemorrhage/surgery ; Time-to-Treatment/statistics & numerical data ; Treatment Outcome ; Ultrasonography, Doppler, Transcranial ; Vasospasm, Intracranial/diagnostic imaging ; Vasospasm, Intracranial/etiology ; Vasospasm, Intracranial/physiopathology
Language	English
Publishing date	2020-02-03
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2020.105714
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Article ; Online: 1.5-T Field Intraoperative Magnetic Resonance Imaging Improves Extent of Resection and Survival in Glioblastoma Removal.

Marongiu, Alessandra / D'Andrea, Giancarlo / Raco, Antonino

World neurosurgery

2017 Volume 98, Page(s) 578–586

Abstract: Objective: Gross total resection (GTR) of glioblastoma may be achieved with the aid of intraoperative magnetic resonance imaging (Io-MRI), which detects residual tumor during surgery, with the aim of maximizing resection, therefore reducing the risk of ... ...

Abstract	Objective: Gross total resection (GTR) of glioblastoma may be achieved with the aid of intraoperative magnetic resonance imaging (Io-MRI), which detects residual tumor during surgery, with the aim of maximizing resection, therefore reducing the risk of recurrence. Moreover, intraoperative fiber tracking and neuronavigated electrophysiologic cortical and subcortical mapping may help prevent postoperative deficits. Methods: There were 114 patients who underwent surgical removal of newly diagnosed supratentorial glioblastoma between January 2009 and January 2013: 78 (group A) were operated on with the aid of Io-MRI, and 36 were operated on without Io-MRI (group B). The protocol included preoperative magnetic resonance imaging and Io-MRI with diffusion tensor imaging in all the cases that presented eloquent areas of involvement. The extent of resection (EOR) was compared in the 2 groups 24-72 hours after surgery. Results: The first Io-MRI detected a GTR in 31 patients (39.7%) and a residual tumor in 47 patients (60.3%) in group A. Twenty-one patients had residual tumor within eloquent areas: Io-MRI with fiber tracking permitted further resection, achieving GTR in 12 patients. GTR was radiologically detected in the remaining 26 patients (33.3% of group A) who had residual tumor in noneloquent areas after 1 or 2 further resection extensions. Io-MRI enhanced both EOR and 6-month progression-free survival (6-PFS): the overall GTR for group A amounted to 88.5% (n = 69), whereas for group B it was 44% (n = 16). 6-PFS accounted for 73% (n = 57) for group A and 38.9% (n = 14) for group B. Conclusions: Our experience suggests that Io-MRI may lead to EOR optimization and associated 6-PFS improvement.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Glioblastoma/mortality ; Glioblastoma/pathology ; Glioblastoma/surgery ; Humans ; Intraoperative Complications/etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Quality of Life ; Supratentorial Neoplasms/mortality ; Supratentorial Neoplasms/pathology ; Supratentorial Neoplasms/surgery
Language	English
Publishing date	2017-02
Publishing country	United States
Document type	Comparative Study ; Evaluation Studies ; Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2016.11.013
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Article ; Online: IDH Wild-type Glioblastoma Presenting with Seizure: Clinical Specificity, and Oncologic and Surgical Outcomes.

Pesce, Alessandro / Armocida, Daniele / Paglia, Francesco / Palmieri, Mauro / Frati, Alessandro / D'Andrea, Giancarlo / Salvati, Maurizio / Santoro, Antonio

Journal of neurological surgery. Part A, Central European neurosurgery

2021 Volume 83, Issue 4, Page(s) 351–360

Abstract: Background: Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, ... ...

Abstract	Background: Glioblastoma (GBM) is the most common and aggressive primary brain neoplasia in adults. Seizure is a common manifestation in GBM. Up to 25 to 60% of patients with GBM have seizures. We aim to summarize all the relevant clinical, surgical, radiologic, and molecular features of a cohort of patients suffering from GBM-related epilepsy and measure the outcome, to understand the possible existence of a clinical/phenotypical specificity of this subgroup of patients. Methods: We retrospectively analyzed a cohort of 177 patients affected by isocitrate dehydrogenase wild-type (IDH-WT) GBM; 49 patients presented seizure at onset (SaO) and 128 were seizure free (SF). We investigated the relationship between seizures and other prognostic factors of GBMs. Results: A statistically significant association between the location of the lesions in the parietal lobe and seizures was observed. The left side was more commonly affected. Interestingly, there was a statistical relationship between tumors involving the subventricular zone (SVZ) and SaO patients. The tumors were also smaller on average at diagnosis, and generalized SaOs were associated with longer overall survival. Conclusions: The typical patient with IDH-WT GBM with SaO is a young (<55 year) male without a history of headache. The lesion is typically small to medium in size and located in the temporoparietal dominant lobe, with a high tendency to involve the SVZ.
MeSH term(s)	Brain Neoplasms/complications ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/genetics ; Glioblastoma/complications ; Glioblastoma/diagnostic imaging ; Glioblastoma/genetics ; Humans ; Isocitrate Dehydrogenase/genetics ; Male ; Mutation ; Prognosis ; Retrospective Studies ; Seizures/etiology ; Seizures/surgery ; Treatment Outcome
Chemical Substances	Isocitrate Dehydrogenase (EC 1.1.1.41)
Language	English
Publishing date	2021-11-18
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/s-0041-1735515
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Article ; Online: Microsurgical clipping of unruptured intracranial aneurysms by a single surgeon's experience: why should we preserve the neurosurgical skills in our health areas?

LA Pira, Biagia / Picotti, Veronica / Zappalà, Marta / Maiola, Vincenza / Pesce, Alessandro / Frati, Alessandro / Santoro, Antonio / D'Andrea, Giancarlo

Journal of neurosurgical sciences

2021 Volume 68, Issue 2, Page(s) 157–163

Abstract: Background: The long-standing comparison between the endovascular and microsurgical treatment is still ongoing. While not any center avails of a neuroendovascular service, and not every aneurysm is suitable for endovascular treatment, the neurovascular ... ...

Abstract	Background: The long-standing comparison between the endovascular and microsurgical treatment is still ongoing. While not any center avails of a neuroendovascular service, and not every aneurysm is suitable for endovascular treatment, the neurovascular technique is slowly disappearing from our territories, whereas in the current literature, the role of the neurosurgical treatment is being re-appreciated. The aim of this paper was to discuss a single surgeon's clinical and radiological results with the microsurgical management of unruptured intracranial aneurysms (UIA). Methods: We retrospectively reviewed the clinical and radiological records of patients treated for UIA, by a single surgeon, in the period ranging between 2015 and 2019. We recorded all the relevant anatomic features of the aneurysm, saliencies of the surgical treatment, such as the need for temporary clipping, intraoperative rupture, or postoperative complications. The results of the clinical and radiological follow-up examinations were recorded either. Results: Fifty-eight patient undergoing microsurgical clipping were included, harboring a total of 65 UIAs. CTA with 3D reconstructions was sufficient to reach a reliable preoperative planning in 46 patients (76%). A total of 94% of the cases were unchanged or neurologically unremarkable at follow-up. The presence of postoperative complications was associated to the neck size and predictor of a longer hospitalizations, as well as longer hospitalizations are associated to the patients' age, size of the aneurysms and surgical times. Conclusions: According to our experience, we believe that microsurgical clipping plays a critical role in the management of UIA, also on the ground of the encouraging results of the relevant literature.
MeSH term(s)	Humans ; Intracranial Aneurysm/therapy ; Retrospective Studies ; Treatment Outcome ; Neurosurgical Procedures/methods ; Microsurgery/methods ; Postoperative Complications/etiology ; Surgeons
Language	English
Publishing date	2021-08-03
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/S0390-5616.21.05366-2
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Article ; Online: Role of 1p/19q Codeletion in Diffuse Low-grade Glioma Tumour Prognosis.

Familiari, Pietro / Lapolla, Pierfrancesco / Picotti, Veronica / Palmieri, Mauro / Pesce, Alessandro / Carosi, Giulia / Relucenti, Michela / Nottola, Stefania / Gianno, Francesca / Minasi, Simone / Antonelli, Manila / Frati, Alessandro / Santoro, Antonio / D'Andrea, Giancarlo / Bruzzaniti, Placido / LA Pira, Biagia

Anticancer research

2023 Volume 43, Issue 6, Page(s) 2659–2670

Abstract: Background/aim: In the latest 2021 WHO classification of central nervous system tumours (CNS), gliomas that present isocitrate dehydrogenase (IDH) mutations are defined as diffuse low-grade gliomas (DLGGs). IDH mutations are commonly observed in this ... ...

Abstract	Background/aim: In the latest 2021 WHO classification of central nervous system tumours (CNS), gliomas that present isocitrate dehydrogenase (IDH) mutations are defined as diffuse low-grade gliomas (DLGGs). IDH mutations are commonly observed in this tumour type. The Extent of Resection (EOR) positively influence survival; however, it is still debated whether the predictive value of EOR is independent of the 1p/19q co-deletion. We carried out a retrospective analysis on patients operated on for DLGG at the Sant'Andrea University Hospital Sapienza University of Rome, correlating the outcome with the presence of 1p/19q co-deletion and EOR. Patients and methods: The study examined 66 patients with DLGG who had undergone surgery for tumour resection between 2008 and 2018. Patients with DLGG were divided into two groups; diffuse astrocytoma (DA) in which 1p/19q codeletion is absent and oligodendroglioma (OG) in which 1p/19q codeletion is present. According to EOR, both groups were divided into two subgroups: subtotal resection (STR) and gross total resection (GTR). Three end-point variables were considered: overall survival (OS), progression-free survival (PFS) and time to malignant transformation (TMT). Results: In the DA group, the GTR subgroup had an average OS of 81.6 months, an average PFS of 45.9 months and an average TMT of 63.6 months. After surgery, these patients had an average Karnofsky Performance Score (KPS) of 83.4. The STR subgroup had an average OS of 60.4 months, PFS was 38.7 months, and TMT was 46.4 months, post-operative KPS was 83.4. In contrast, in the OG group, the GTR averagely had 101.7 months of OS, 64.9 months of PFS, 80.3 months of TMT and an average post-operative KPS of 84.2, and the STR subgroup had an average of OS of 73.3 months, PFS of 48.2 months, TMT of 57.3 and an average postoperative KPS of 96.2. Conclusion: In patients affected by DLGGs, 1p/19q codeletion is significantly associated with prolonged survival and longer time-to-malignant transformation (TMT) compared to the absence of 1p/19q codeletion. Also, the extent of surgical resection (EOR) in DLGG patients has been confirmed as one of the main prognostic factors. However, its predictive value is substantially influenced by the presence of the 1p/19q codeletion.
MeSH term(s)	Humans ; Brain Neoplasms/genetics ; Brain Neoplasms/surgery ; Brain Neoplasms/pathology ; Retrospective Studies ; Glioma/genetics ; Glioma/surgery ; Glioma/pathology ; Chromosome Aberrations ; Prognosis ; Mutation ; Oligodendroglioma ; Astrocytoma ; Isocitrate Dehydrogenase/genetics ; Chromosomes, Human, Pair 1/genetics ; Chromosomes, Human, Pair 19/genetics
Chemical Substances	Isocitrate Dehydrogenase (EC 1.1.1.41)
Language	English
Publishing date	2023-05-27
Publishing country	Greece
Document type	Journal Article
ZDB-ID	604549-2
ISSN	1791-7530 ; 0250-7005
ISSN (online)	1791-7530
ISSN	0250-7005
DOI	10.21873/anticanres.16432
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