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  1. Article ; Online: Repeat Gamma Knife radiosurgery for recurrent trigeminal neuralgia in patients with multiple sclerosis: a single-center retrospective study.

    Franzini, Andrea / Picozzi, Piero / Baram, Ali / Navarria, Pierina / Scorsetti, Marta / Tomatis, Stefano / Pessina, Federico

    Acta neurochirurgica

    2024  Volume 166, Issue 1, Page(s) 15

    Abstract: Purpose: Gamma Knife radiosurgery (GKRS) has emerged as an effective treatment option for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). To date, the outcomes of repeat GKRS for patients with TN and MS with recurrent pain have been ... ...

    Abstract Purpose: Gamma Knife radiosurgery (GKRS) has emerged as an effective treatment option for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). To date, the outcomes of repeat GKRS for patients with TN and MS with recurrent pain have been investigated in a few patients. This study aims to report the outcomes and predictive factors of pain reduction for MS patients undergoing repeat GKRS for recurrent TN.
    Methods: Eighteen patients with MS underwent repeat GKRS for recurrent TN. A retrospective chart review and telephone interviews were conducted to determine background medical history, dosimetric data, and outcomes of the procedure. Facial pain and sensory function were evaluated using the Barrow Neurological Institute (BNI) scales.
    Results: Fifteen patients achieved a BNI pain score of IIIa or better, indicating pain reduction, within a median period of 21 days after repeat GKRS. The maximum dose for repeat GKRS ranged from 70 to 85 Gy. Pain recurred in 5 patients after a median period of 12 months after GKRS. Percentages of patients with pain reduction at 1, 2, 3, 5, and 7 years were 60%, 60%, 50%, 50%, and 50%, respectively. Older age at repeat GKRS predicted sustained pain reduction (P = 0.01). Seven patients developed facial sensory disturbances, which were bothersome in two patients.
    Conclusions: Repeat GKRS may be used as an effective treatment modality for prolonging the duration of pain reduction time in patients with MS and TN. After repeat GKRS, facial sensory disturbances are common; however, they are often not bothersome.
    MeSH term(s) Humans ; Trigeminal Neuralgia/radiotherapy ; Trigeminal Neuralgia/surgery ; Retrospective Studies ; Multiple Sclerosis/complications ; Radiosurgery ; Facial Pain
    Language English
    Publishing date 2024-01-16
    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/s00701-024-05913-6
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  2. Article ; Online: Staged Gamma Knife radiosurgery for a rosette-forming glioneuronal tumor of the fourth ventricle: a case report.

    Franzini, Andrea / Picozzi, Piero / Lasio, Giovanni Battista / Pessina, Federico

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

    2023  Volume 39, Issue 11, Page(s) 3323–3326

    Abstract: Background: Rosette-forming glioneuronal tumor (RGNT) is a rare slow-growing neoplasm with mixed glial and neurocytic components. Surgical resection is the mainstay of treatment, whereas the role of adjuvant radiation therapies for residual or recurrent ...

    Abstract Background: Rosette-forming glioneuronal tumor (RGNT) is a rare slow-growing neoplasm with mixed glial and neurocytic components. Surgical resection is the mainstay of treatment, whereas the role of adjuvant radiation therapies for residual or recurrent tumors has been poorly investigated.
    Case presentation: We describe the case of a patient with a recurrent fourth ventricular RGNT who was treated with two-staged Gamma Knife radiosurgery (GKRS). GKRS was effective in controlling tumor growth and safe up to seven years from treatment.
    Conclusions: This case suggests that GKRS may be a safe and effective treatment for patients with recurrent or residual RGNT.
    MeSH term(s) Humans ; Fourth Ventricle/diagnostic imaging ; Fourth Ventricle/surgery ; Fourth Ventricle/pathology ; Cerebral Ventricle Neoplasms/diagnostic imaging ; Cerebral Ventricle Neoplasms/radiotherapy ; Cerebral Ventricle Neoplasms/surgery ; Radiosurgery ; Neoplasm Recurrence, Local/pathology ; Neoplasms, Neuroepithelial/surgery ; Central Nervous System Neoplasms/pathology
    Language English
    Publishing date 2023-06-05
    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/s00381-023-06014-y
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    Zs.A 2036: Show issues Location:
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  3. Article ; Online: Gamma Knife radiosurgery for the treatment of cluster headache: a systematic review.

    Franzini, Andrea / Clerici, Elena / Navarria, Pierina / Picozzi, Piero

    Neurosurgical review

    2022  Volume 45, Issue 3, Page(s) 1923–1931

    Abstract: Cluster headache (CH) is a severe trigeminal autonomic cephalalgia that, when refractory to medical treatment, can be treated with Gamma Knife radiosurgery (GKRS). The outcomes of studies investigating GKRS for CH in the literature are inconsistent, and ... ...

    Abstract Cluster headache (CH) is a severe trigeminal autonomic cephalalgia that, when refractory to medical treatment, can be treated with Gamma Knife radiosurgery (GKRS). The outcomes of studies investigating GKRS for CH in the literature are inconsistent, and the ideal target and treatment parameters remain unclear. The aim of this systematic review is to evaluate the safety and the efficacy, both short and long term, of GKRS for the treatment of drug-resistant CH. A systematic review of the literature was performed to identify all clinical articles discussing GKRS for the treatment of CH. The literature review revealed 5 studies describing outcomes of GKRS for the treatment of CH for a total of 52 patients (48 included in the outcome analysis). The trigeminal nerve, the sphenopalatine ganglion, and a combination of both were treated in 34, 1, and 13 patients. The individual studies demonstrated initial meaningful pain reduction in 60-100% of patients, with an aggregate initial meaningful pain reduction in 37 patients (77%). This effect persisted in 20 patients (42%) at last follow-up. Trigeminal sensory disturbances were observed in 28 patients (58%) and deafferentation pain in 3 patients (6%). Information related to GKRS for CH are limited to few small open-label studies using heterogeneous operative techniques. In this setting, short-term pain reduction rates are high, whereas the long-term results are controversial. GKRS targeted on the trigeminal nerve or sphenopalatine ganglion is associated to a frequent risk of trigeminal disturbances and possibly deafferentation pain.
    MeSH term(s) Causalgia/etiology ; Causalgia/surgery ; Cluster Headache/etiology ; Cluster Headache/surgery ; Humans ; Pain/etiology ; Radiosurgery/methods ; Retrospective Studies ; Treatment Outcome ; Trigeminal Neuralgia/surgery
    Language English
    Publishing date 2022-02-03
    Publishing country Germany
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 6907-3
    ISSN 1437-2320 ; 0344-5607
    ISSN (online) 1437-2320
    ISSN 0344-5607
    DOI 10.1007/s10143-021-01725-9
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    Zs.A 1445: Show issues Location:
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  4. Article ; Online: Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-year Single-Center Cohort Study and Review of the Literature.

    Tropeano, Maria Pia / Rossini, Zefferino / Franzini, Andrea / Baram, Ali / Creatura, Donato / Raspagliesi, Luca / Pessina, Federico / Fornari, Maurizio

    World neurosurgery

    2024  

    Abstract: Background: Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses, and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies ... ...

    Abstract Background: Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses, and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurologic outcome postsurgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcomes.
    Methods: We conducted a review of current literature on functional outcomes of IMSCTs, as well as a 10-years prospective analysis of a wide cohort of patients with diagnosis of IMSCTs who underwent surgical resection at our institution.
    Results: Our series encompasses 60 patients with IMSCTS, among which 36 ependymomas, 6 cavernous angiomas, 5 hemangioblastomas, 6 WHO Grade I-IV astrocytomas, 3 intramedullary spinal metastases and 4 miscellaneous tumors. GTR was achieved in 76,67% of patients, with high preoperative McCormick grade, syringomyelia and changes at neurophysiologic monitoring being the strongest predictors at multivariate analysis (P = 0.0027, P = 0.0017 and P = 0.001 respectively).
    Conclusions: Consistently with literature, preoperative neurologic function is the most important factor predicting long-term functional outcome (0.17, CI 0.069-0.57 with P = 0.0018), advocating for early surgery in the management of IMSCTs, whereas late complications such as myelopathy and neuropathic pain were present regardless of preoperative function.
    Language English
    Publishing date 2024-04-10
    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.2024.04.024
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    Zs.A 1159: Show issues Location:
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  5. Article ; Online: Radiosurgical thalamotomy for essential tremor: state of the art, current challenges and future directions.

    Iorio-Morin, Christian / Mathieu, David / Franzini, Andrea / Hodaie, Mojgan / Villeneuve, Samuelle-Arianne / Hamel, Andréanne / Lozano, Andres M

    Expert review of neurotherapeutics

    2024  , Page(s) 1–9

    Abstract: Introduction: Essential tremor (ET) is the most frequent movement disorder, affecting up to 5% of adults > 65 years old. In 30-50% of cases, optimal medical management provides insufficient tremor relief and surgical options are considered. Thalamotomy ... ...

    Abstract Introduction: Essential tremor (ET) is the most frequent movement disorder, affecting up to 5% of adults > 65 years old. In 30-50% of cases, optimal medical management provides insufficient tremor relief and surgical options are considered. Thalamotomy is a time-honored intervention, which can be performed using radiofrequency (RF), stereotactic radiosurgery (SRS), or magnetic resonance-guided focused ultrasounds (MRgFUS). While the latter has received considerable attention in the last decade, SRS has consistently been demonstrated as an effective and well-tolerated option.
    Areas covered: This review discusses the evidence on SRS thalamotomy for ET. Modern workflows and emerging techniques are detailed. Current outcomes are analyzed, with a specific focus on tremor reduction, complications and radiological evolution of the lesions. Challenges for the field are highlighted.
    Expert opinion: SRS thalamotomy improves tremor in > 80% patients. The efficacy appears comparable to other modalities, including DBS, RF and MRgFUS. Side effects result mostly from idiosyncratic hyper-responses to radiation, which occur in up to 10% of treatments, are usually self-resolving, and are symptomatic in < 4% of patients. Future research should focus on accumulating more data on bilateral treatments, collecting long-term outcomes, refining targeting, and improving lesion consistency.
    Language English
    Publishing date 2024-05-07
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2112534-X
    ISSN 1744-8360 ; 1473-7175
    ISSN (online) 1744-8360
    ISSN 1473-7175
    DOI 10.1080/14737175.2024.2351512
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  6. Article ; Online: Gamma Knife Radiosurgery Targeting the Trigeminal Nerve for Tumor-Related Trigeminal Neuralgia: A Case Series.

    Franzini, Andrea / Picozzi, Piero / Farinaro, Generoso / Bono, Beatrice / Navarria, Pierina / Pessina, Federico

    World neurosurgery

    2023  Volume 175, Page(s) e413–e420

    Abstract: Background: Tumor-related trigeminal neuralgia (TN) is a challenging condition to manage that is commonly treated by surgical resection of the tumor. Stereotactic radiosurgery targeting the tumor is used to control pain and tumor growth in patients ... ...

    Abstract Background: Tumor-related trigeminal neuralgia (TN) is a challenging condition to manage that is commonly treated by surgical resection of the tumor. Stereotactic radiosurgery targeting the tumor is used to control pain and tumor growth in patients unsuitable for surgery. Stereotactic radiosurgery targeting the trigeminal nerve has been explored as a viable treatment for patients with tumor-related TN who are unsuitable for surgical removal of the tumor or whose pain is refractory to radiation therapy targeting the tumor. Information regarding the efficacy of this procedure is limited to only a few studies. We report the outcomes of Leskell Gamma Knife radiosurgery (GKRS) targeting the trigeminal nerve for tumor-related TN from a case series.
    Methods: A retrospective review of our GKRS database identified 6 patients with unilateral tumor-related TN treated with GKRS targeting the trigeminal nerve between 2014 and 2020. Five patients had undergone previous radiation therapy targeting the tumor. Facial pain and sensory function were evaluated using the Barrow Neurological Institute scales.
    Results: Three patients achieved a Barrow Neurological Institute score of IIIb or better, indicating pain reduction, within a mean period of 4.3 months after GKRS. The maximum dose for GKRS ranged from 80 to 88 Gy. Pain recurred in 1 patient at 64 months after GKRS. No patient developed permanent facial sensory disturbances. No adverse event was recorded.
    Conclusions: GKRS targeting the trigeminal nerve could be a safe and effective treatment for a subset of patients with tumor-related TN who are unsuitable for surgical removal of the tumor or whose pain is refractory to radiation therapy targeting the tumor.
    MeSH term(s) Humans ; Trigeminal Neuralgia/etiology ; Trigeminal Neuralgia/radiotherapy ; Trigeminal Neuralgia/surgery ; Radiosurgery/methods ; Trigeminal Nerve/surgery ; Treatment Outcome ; Retrospective Studies ; Facial Pain/surgery ; Neoplasms/surgery
    Language English
    Publishing date 2023-04-03
    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.2023.03.113
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  7. Article ; Online: Gamma Knife Radiosurgery for SUNCT: A Case Series.

    Franzini, Andrea / Milani, Davide / Attuati, Luca / Navarria, Pierina / Pessina, Federico / Picozzi, Piero

    Stereotactic and functional neurosurgery

    2023  Volume 101, Issue 2, Page(s) 86–92

    Abstract: Background: The treatment of medically refractory patients with chronic short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is challenging. Stereotactic radiosurgery targeting the trigeminal nerve and ... ...

    Abstract Background: The treatment of medically refractory patients with chronic short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is challenging. Stereotactic radiosurgery targeting the trigeminal nerve and sphenopalatine ganglion (SPG) has been used as a less-invasive treatment. The outcomes of this procedure have been described in a few case reports.
    Objectives: The objective of the study was to report on the effect of Gamma Knife radiosurgery (GKRS) in 5 patients with chronic SUNCT.
    Methods: Retrospective review of our GKRS database identified 5 patients with chronic SUNCT who underwent GKRS targeted to the trigeminal nerve and SPG. A maximum dose of 80-85 Gy and 80 Gy was, respectively, delivered to the trigeminal nerve and SPG. Pain intensity and facial numbness were evaluated using the Barrow Neurological Institute (BNI) scores.
    Results: These 5 patients were clinically followed for a mean period of 26.2 months. Within a period ranging from 2 days to 9 months, GKRS was successful in reducing pain attacks and autonomic symptoms in all 5 patients. At the last assessments, BNI pain scores of I, II, and IIIa were achieved in 1, 1, and 3 patients, respectively. Two patients developed nonbothersome facial numbness (BNI facial numbness score II).
    Conclusions: These 5 cases show that GKRS targeted to both the trigeminal nerve and the SPG is effective in reducing pain and autonomic symptoms of patients with SUNCT, although nonbothersome trigeminal sensory disturbances may occur.
    MeSH term(s) Humans ; Radiosurgery/methods ; Hypesthesia/surgery ; SUNCT Syndrome/radiotherapy ; SUNCT Syndrome/surgery ; Headache ; Trigeminal Nerve/surgery ; Trigeminal Neuralgia/radiotherapy ; Trigeminal Neuralgia/surgery ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2023-02-02
    Publishing country Switzerland
    Document type News
    ZDB-ID 645069-6
    ISSN 1423-0372 ; 1011-6125
    ISSN (online) 1423-0372
    ISSN 1011-6125
    DOI 10.1159/000528632
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  8. Article ; Online: Gamma Knife radiosurgery for the treatment of a mature teratoma of the pineal region.

    Franzini, Andrea / Clerici, Elena / Navarria, Pierina / Pessina, Federico / Picozzi, Piero

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

    2021  Volume 37, Issue 8, Page(s) 2427–2429

    MeSH term(s) Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Humans ; Pineal Gland/diagnostic imaging ; Pineal Gland/surgery ; Pinealoma/diagnostic imaging ; Pinealoma/surgery ; Radiosurgery ; Teratoma/diagnostic imaging ; Teratoma/surgery
    Language English
    Publishing date 2021-06-09
    Publishing country Germany
    Document type Letter
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-021-05234-4
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    Zs.A 2036: Show issues Location:
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  9. Article ; Online: Neurosurgery during the Greco-Italian War (World War II): the management of war-related head injuries at the Italian field hospital of Sinanaj in Albania.

    Franzini, Andrea / Rossini, Zefferino / Tropeano, Maria Pia / Picozzi, Piero / Servadei, Franco / Pessina, Federico

    Neurosurgical focus

    2022  Volume 53, Issue 3, Page(s) E10

    Abstract: During the Greco-Italian War (World War II [WWII], 1940-1941), an Italian field hospital was set up in Sinanaj, Albania. The hospital's military surgeons carefully collected information about the characteristics and management of patients with war- ... ...

    Abstract During the Greco-Italian War (World War II [WWII], 1940-1941), an Italian field hospital was set up in Sinanaj, Albania. The hospital's military surgeons carefully collected information about the characteristics and management of patients with war-related injuries. In 1942, they published a detailed report, with a section dedicated to the management of war-related head injuries. The aim of this report is to analyze that section, to describe the characteristics and neurosurgical management of war-related head injuries, and to depict the status of war neurosurgery in the Royal Italian Army during WWII. The analysis revealed that, during the Greco-Italian War (November 1940-April 1941), 149 patients with war-related head injuries were admitted to the Sinanaj hospital, and 48 patients underwent surgery. Head injuries were caused by bomb fragments in 126 patients, bullets in 5 patients, and other causes (falls from height, vehicle accidents, or rock fragments) in 18 patients. Six patients (12.5%) died after surgery. Before surgery, patients underwent resuscitation with blood transfusions and fluid. Preoperatively, a plain head radiograph was usually acquired to locate metallic and bone fragments. The surgical technique consisted of craniotomy or craniectomy, aggressive debridement of metallic and bone fragments, and watertight dural closure. Surgical drainage, overall aseptic technique, serial spinal taps, and perioperative antibiotics were used to prevent infections. The surgical aims and technique used by the Italian surgeons for the management of head injuries were similar to those of the Allied surgeons during WWII. Operative mortality was also comparable. Although the surgical technique for war-related head injuries has evolved since WWII, many aspects of the technique used by the Italian and Allied surgeons during WWII are still in the standard of care today.
    MeSH term(s) Albania ; Craniocerebral Trauma/etiology ; Craniocerebral Trauma/surgery ; Humans ; Italy ; Military Medicine ; Mobile Health Units ; Neurosurgery/history ; War-Related Injuries/complications ; World War II
    Language English
    Publishing date 2022-09-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2026589-X
    ISSN 1092-0684 ; 1092-0684
    ISSN (online) 1092-0684
    ISSN 1092-0684
    DOI 10.3171/2022.6.FOCUS2228
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  10. Article: Multimodal Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumors: A 10-Year Single Center Experience.

    Tropeano, Maria Pia / Rossini, Zefferino / Franzini, Andrea / Capo, Gabriele / Olei, Simone / De Robertis, Mario / Milani, Daniela / Fornari, Maurizio / Pessina, Federico

    Cancers

    2023  Volume 16, Issue 1

    Abstract: Objective: The study aimed at evaluating the efficacy and the ability of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to predict functional outcomes in intramedullary spinal cord tumor (IMSCT) ...

    Abstract Objective: The study aimed at evaluating the efficacy and the ability of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to predict functional outcomes in intramedullary spinal cord tumor (IMSCT) surgery.
    Methods: Between December 2011 and December 2020, all patients harboring IMSCT who underwent surgery at our institution were prospectively collected in a surgical spinal registry and retrospectively analyzed. Patient charts and surgical and histological reports were analyzed. The multimodal IONM included SSEPs, MEPs, and-whenever possible-D-waves. All patients were evaluated using the modified McCormick and Frankel grade at admission and 3, 6, and 12 months of follow-up.
    Results: Sixty-four patients were enrolled in the study. SSEP and MEP monitoring was performed in all patients. The D-wave was not recordable in seven patients (11%). Significant IONM changes (at least one evoked potential modality) were registered in 26 (41%) of the 64 patients. In five cases (8%) where the SSEPs and MEPs lost and the D-wave permanently dropped by about 50%, patients experienced a permanent deterioration of their neurological status. Multimodal IONM (SSEP, MEP, and D-wave neuromonitoring) significantly predicted postoperative deficits (
    Conclusion: The use of multimodal IONM showed a statistically significant greater ability to predict postoperative deficits compared with SSEP, MEP, and D-wave monitoring alone. D-wave recording significantly increased the accuracy and clinical value of neurophysiological monitoring in IMSCT tumor resection.
    Language English
    Publishing date 2023-12-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers16010111
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