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  1. Article: Structural networking of the developing brain: from maturation to neurosurgical implications.

    De Benedictis, Alessandro / Rossi-Espagnet, Maria Camilla / de Palma, Luca / Sarubbo, Silvio / Marras, Carlo Efisio

    Frontiers in neuroanatomy

    2023  Volume 17, Page(s) 1242757

    Abstract: Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, ...

    Abstract Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
    Language English
    Publishing date 2023-11-30
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2452969-2
    ISSN 1662-5129
    ISSN 1662-5129
    DOI 10.3389/fnana.2023.1242757
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives.

    De Benedictis, Alessandro / de Palma, Luca / Rossi-Espagnet, Maria Camilla / Marras, Carlo Efisio

    Epilepsy & behavior : E&B

    2023  Volume 149, Page(s) 109523

    Abstract: Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option ... ...

    Abstract Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
    MeSH term(s) Adult ; Child ; Humans ; Connectome ; Treatment Outcome ; Epilepsy/diagnostic imaging ; Epilepsy/surgery ; Brain/diagnostic imaging ; Brain/surgery ; Brain Diseases
    Language English
    Publishing date 2023-11-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2010587-3
    ISSN 1525-5069 ; 1525-5050
    ISSN (online) 1525-5069
    ISSN 1525-5050
    DOI 10.1016/j.yebeh.2023.109523
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Posterior hypothalamus as a target in the treatment of aggression: From lesioning to deep brain stimulation.

    Rizzi, Michele / Gambini, Orsola / Marras, Carlo Efisio

    Handbook of clinical neurology

    2021  Volume 182, Page(s) 95–106

    Abstract: Intermittent explosive disorder can be described as a severe "affective aggression" condition, for which drugs and other supportive therapies are not fully effective. In the first half of the 19th century, experimental studies progressively increased ... ...

    Abstract Intermittent explosive disorder can be described as a severe "affective aggression" condition, for which drugs and other supportive therapies are not fully effective. In the first half of the 19th century, experimental studies progressively increased knowledge of aggressive disorders. A neurobiologic approach revealed the posterior hypothalamic region as a key structure for the modulation of aggression. In the 1960s, patients with severe aggressive disorder, frequently associated with intellectual disability, were treated by bilateral stereotactic lesioning of the posterior hypothalamic area, with efficacy. This therapy was later abandoned because of issues related to the misuse of psychosurgery. In the last 2 decades, however, the same diencephalic target has been selected for the reversible treatment by deep brain stimulation, with success. This chapter presents a comprehensive approach to posterior hypothalamic surgery for the treatment of severely aggressive patients and discusses the experimental steps that allowed this surgical target to be selected. Surgical experiences are reported, together with considerations on target features and related encephalic circuits.
    MeSH term(s) Aggression ; Brain ; Deep Brain Stimulation ; Humans ; Hypothalamus ; Hypothalamus, Posterior ; Intellectual Disability
    Language English
    Publishing date 2021-07-15
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-12-819973-2.00007-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Networking of the Human Cerebellum: From Anatomo-Functional Development to Neurosurgical Implications.

    De Benedictis, Alessandro / Rossi-Espagnet, Maria Camilla / de Palma, Luca / Carai, Andrea / Marras, Carlo Efisio

    Frontiers in neurology

    2022  Volume 13, Page(s) 806298

    Abstract: In the past, the cerebellum was considered to be substantially involved in sensory-motor coordination. However, a growing number of neuroanatomical, neuroimaging, clinical and lesion studies have now provided converging evidence on the implication of the ...

    Abstract In the past, the cerebellum was considered to be substantially involved in sensory-motor coordination. However, a growing number of neuroanatomical, neuroimaging, clinical and lesion studies have now provided converging evidence on the implication of the cerebellum in a variety of cognitive, affective, social, and behavioral processes as well. These findings suggest a complex anatomo-functional organization of the cerebellum, involving a dense network of cortical territories and reciprocal connections with many supra-tentorial association areas. The final architecture of cerebellar networks results from a complex, highly protracted, and continuous development from childhood to adulthood, leading to integration between short-distance connections and long-range extra-cerebellar circuits. In this review, we summarize the current evidence on the anatomo-functional organization of the cerebellar connectome. We will focus on the maturation process of afferent and efferent neuronal circuitry, and the involvement of these networks in different aspects of neurocognitive processing. The final section will be devoted to identifying possible implications of this knowledge in neurosurgical practice, especially in the case of posterior fossa tumor resection, and to discuss reliable strategies to improve the quality of approaches while reducing postsurgical morbidity.
    Language English
    Publishing date 2022-02-04
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2022.806298
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Deep Brain Stimulation for the Treatment of Aggressive Behaviour: Considerations on Pathophysiology and Target Choice.

    Rizzi, Michele / Marras, Carlo Efisio

    Stereotactic and functional neurosurgery

    2017  Volume 95, Issue 2, Page(s) 114–116

    Language English
    Publishing date 2017
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 645069-6
    ISSN 1423-0372 ; 1011-6125
    ISSN (online) 1423-0372
    ISSN 1011-6125
    DOI 10.1159/000460260
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The value of linear and non-linear quantitative EEG analysis in paediatric epilepsy surgery: a machine learning approach.

    Mercier, Mattia / Pepi, Chiara / Carfi-Pavia, Giusy / De Benedictis, Alessandro / Espagnet, Maria Camilla Rossi / Pirani, Greta / Vigevano, Federico / Marras, Carlo Efisio / Specchio, Nicola / De Palma, Luca

    Scientific reports

    2024  Volume 14, Issue 1, Page(s) 10887

    Abstract: Epilepsy surgery is effective for patients with medication-resistant seizures, however 20-40% of them are not seizure free after surgery. Aim of this study is to evaluate the role of linear and non-linear EEG features to predict post-surgical outcome. We ...

    Abstract Epilepsy surgery is effective for patients with medication-resistant seizures, however 20-40% of them are not seizure free after surgery. Aim of this study is to evaluate the role of linear and non-linear EEG features to predict post-surgical outcome. We included 123 paediatric patients who underwent epilepsy surgery at Bambino Gesù Children Hospital (January 2009-April 2020). All patients had long term video-EEG monitoring. We analysed 1-min scalp interictal EEG (wakefulness and sleep) and extracted 13 linear and non-linear EEG features (power spectral density (PSD), Hjorth, approximate entropy, permutation entropy, Lyapunov and Hurst value). We used a logistic regression (LR) as feature selection process. To quantify the correlation between EEG features and surgical outcome we used an artificial neural network (ANN) model with 18 architectures. LR revealed a significant correlation between PSD of alpha band (sleep), Mobility index (sleep) and the Hurst value (sleep and awake) with outcome. The fifty-four ANN models gave a range of accuracy (46-65%) in predicting outcome. Within the fifty-four ANN models, we found a higher accuracy (64.8% ± 7.6%) in seizure outcome prediction, using features selected by LR. The combination of PSD of alpha band, mobility and the Hurst value positively correlate with good surgical outcome.
    MeSH term(s) Humans ; Electroencephalography/methods ; Child ; Machine Learning ; Female ; Male ; Child, Preschool ; Adolescent ; Epilepsy/surgery ; Epilepsy/physiopathology ; Epilepsy/diagnosis ; Neural Networks, Computer ; Treatment Outcome ; Infant ; Sleep/physiology
    Language English
    Publishing date 2024-05-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-024-60622-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Intraoperative Neuromonitoring for Pediatric Pelvic Tumors.

    Crocoli, Alessandro / Martucci, Cristina / Randi, Franco / Ponzo, Viviana / Trucchi, Alessandro / De Pasquale, Maria Debora / Marras, Carlo Efisio / Inserra, Alessandro

    Frontiers in pediatrics

    2022  Volume 10, Page(s) 949037

    Abstract: Background: Tumors of the pre-sacral and sacral spaces are a rare occurrence in children. Total tumor excision is required due to the significant risk of relapse in the event of partial surgery, but the surgical procedure may lead to postoperative ... ...

    Abstract Background: Tumors of the pre-sacral and sacral spaces are a rare occurrence in children. Total tumor excision is required due to the significant risk of relapse in the event of partial surgery, but the surgical procedure may lead to postoperative problems such as urinary, sexual, and anorectal dysfunctions. Intraoperative neuromonitoring (IONM) has gained popularity in recent years as a strategy for preventing the onset of neurologic impairments by combining several neurophysiological techniques. The aim of our study is to describe the experience of Bambino Gesù Children's Hospital in the use of IONM in pediatric pelvic surgery.
    Materials and methods: The data of patients treated for pelvic malignancies at Bambino Gesù Children's Hospital from 2015 to 2019 were retrospectively collected. All patients were assessed from a neurologic and neuro-urologic point of view at different time-points (before and immediately after surgery, after 6 months, and 1-year follow-up). They were all monitored during a surgical procedure using multimodal IONM including transcranial motor evoked potentials (TcMEP), triggered-EMG (t-EMG), pudendal somatosensory evoked potentials (PSSEP), and bulbocavernosus reflex (BCR).
    Results: During the study period, ten children underwent pelvic tumor removal at our Institution. In all cases, intraoperative neurophysiological recordings were stable and feasible. The preservation of neurophysiological response at the same intensity during surgical procedures correlated with no new deficits for all neurophysiological techniques.
    Discussion: Although the impact of the IONM on surgical strategies and clinical follow-up is unknown, this preliminary experience suggests that the appropriate use of several neurophysiological techniques can influence both the radicality of pelvic tumor removal and the neurological and urological outcome at clinical follow-up. Finally, because of the highly complex anatomy and inter-individual variances, this is especially useful in this type of surgery.
    Language English
    Publishing date 2022-08-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2022.949037
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Deep Brain Stimulation for the Treatment of Aggressive Behaviour: Considerations on Pathophysiology and Target Choice

    Rizzi, Michele / Marras, Carlo Efisio

    Stereotactic and Functional Neurosurgery

    2017  Volume 95, Issue 2, Page(s) 114–116

    Institution Functional Neurosurgery Unit, Department of Neurosurgery, Foundazione IRCCS Istituto Neurologico Carlo Besta, and Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Milan Department of Neuroscience, University of Parma, Parma, and Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
    Language English
    Publishing date 2017-03-24
    Publisher S. Karger AG
    Publishing place Basel, Switzerland
    Document type Article
    Note Letter to the Editor
    ZDB-ID 645069-6
    ISSN 1423-0372 ; 1011-6125
    ISSN (online) 1423-0372
    ISSN 1011-6125
    DOI 10.1159/000460260
    Database Karger publisher's database

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  9. Article ; Online: Primary cerebral cystic echinococcosis in a child from Roman countryside: Source attribution and scoping review of cases from the literature.

    Casulli, Adriano / Pane, Stefania / Randi, Franco / Scaramozzino, Paola / Carvelli, Andrea / Marras, Carlo Efisio / Carai, Andrea / Santoro, Azzurra / Santolamazza, Federica / Tamarozzi, Francesca / Putignani, Lorenza

    PLoS neglected tropical diseases

    2023  Volume 17, Issue 9, Page(s) e0011612

    Abstract: Background: Human cystic echinococcosis (CE) is a zoonotic parasitic infection caused by the larval stage of the species belonging to the Echinococcus granulosus sensu lato (s.l.) complex. Parasitic cysts causing human CE are mainly localized in the ... ...

    Abstract Background: Human cystic echinococcosis (CE) is a zoonotic parasitic infection caused by the larval stage of the species belonging to the Echinococcus granulosus sensu lato (s.l.) complex. Parasitic cysts causing human CE are mainly localized in the liver and in the lungs. In a smaller number of cases, larvae may establish in any organ or tissue, including the central nervous system (CNS). Cerebral CE (CCE) is rare but poses serious clinical challenges.
    Methods: This study presents a case of CCE in a child living in the countryside near Rome (Italy), along with a comparative molecular analysis of the isolated cyst specimens from the patient and sheep of local farms. We also systematically searched the literature to summarize the most relevant epidemiological and clinical aspects of this uncommon localization.
    Findings: The comparative molecular analysis confirmed that the infection was caused by E. granulosus sensu stricto (s.s.) (G3 genotype), and most likely acquired in the family farm. The literature search identified 2,238 cases of CCE. In 80.51% of cases, brain was the only localization and single CCE cysts were present in 84.07% of cases. Mean patients' age was 20 years and 70.46% were children. Cyst rupture was reported in 12.96% and recurrence of CCE after treatment in 9.61% of cases. Permanent disability was reported in 7.86% of cases, while death occurred in 6.21%. In case series reporting all CE localization, CCE represented 1.5% of all CE cases. In the few reports that identified at molecular level the CCE cyst, E. granulosus s.s. was found in 40% and E. canadensis in 60% of cases.
    Conclusions: We report a rare case of CCE and evidenced the probable local origin of infection. The proportions of CE cases with uncommon localizations and with high impact on patients' lives have been globally neglected and should be included in the computation of the global burden of CE.
    MeSH term(s) Humans ; Child ; Animals ; Sheep ; Young Adult ; Adult ; Echinococcosis ; Cysticercosis ; Central Nervous System Parasitic Infections ; Zoonoses ; Cysts ; Larva
    Language English
    Publishing date 2023-09-05
    Publishing country United States
    Document type Systematic Review ; Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2429704-5
    ISSN 1935-2735 ; 1935-2735
    ISSN (online) 1935-2735
    ISSN 1935-2735
    DOI 10.1371/journal.pntd.0011612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Craniopagus: a proposed nursing care protocol.

    Pannacci, Ilaria / de Laurentis, Camilla / Cristaldi, Paola / Renzetti, Tommaso / Armani, Riccarda / Pianura, Luca / Recchiuti, Veronica / Carlesi, Adelina / Santato, Francesca / Franci, Marina / Serafini, Laura / Latini, Barbara / Marras, Carlo Efisio

    Nursing children and young people

    2023  Volume 36, Issue 3, Page(s) 25–33

    Abstract: Craniopagus is a rare condition in which the skulls of conjoined twins, and the neurovascular structures in their skulls, are incompletely separated. Separation surgery is complex and requires a range of skills and expertise, including from all the ... ...

    Abstract Craniopagus is a rare condition in which the skulls of conjoined twins, and the neurovascular structures in their skulls, are incompletely separated. Separation surgery is complex and requires a range of skills and expertise, including from all the nursing teams involved. A multidisciplinary group of professionals in a tertiary paediatric care setting in Italy developed a comprehensive protocol for the nursing care of craniopagus twins in hospital, informed by the findings of a literature review and the expertise of its members. The protocol was applied to the management of a pair of craniopagus twins who successfully underwent separation surgery at the authors' hospital. The protocol describes the crucial role of nurses in the care of craniopagus twins and their families before, during and after separation surgery.
    MeSH term(s) Humans ; Twins, Conjoined ; Italy ; Skull/abnormalities ; Infant ; Male
    Language English
    Publishing date 2023-10-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 2603456-6
    ISSN 2046-2344 ; 2046-2336
    ISSN (online) 2046-2344
    ISSN 2046-2336
    DOI 10.7748/ncyp.2023.e1485
    Database MEDical Literature Analysis and Retrieval System OnLINE

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