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Article: The carotid sheath route: An option to approach retrocarotid prespinal tumors with paravertebral extension.

Gagliardi, Filippo / Giordano, Leone / Medone, Marzia / Snider, Silvia / Roncelli, Francesca / Pompeo, Edoardo / Mortini, Pietro

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 1, Page(s) 11–15

Abstract: Background: The elective route to approach paravertebral lesions growing into the anterolateral lodge of the neck is widely recognized as the prespinal route with its two major variants. Recently, attention has been focused on the possibility of opening ...

Abstract	Background: The elective route to approach paravertebral lesions growing into the anterolateral lodge of the neck is widely recognized as the prespinal route with its two major variants. Recently, attention has been focused on the possibility of opening the inter-carotid-jugular window in case of reparative surgery for traumatic brachial plexus injury. Aims: For the first time, the authors validate the clinical application of the carotid sheath route in the surgical treatment of paravertebral lesions expanding into the anterolateral lodge of the neck. Methods: A microanatomic study was conducted to collect anthropometric measurements. The technique was illustrated in a clinical setting. Results: The opening of the inter-carotid-jugular surgical window allows additional access to the prevertebral and periforaminal space. It optimizes the operability on the prevertebral compartment, compared to the retro-sternocleidomastoid (SCM) approach, and on the periforaminal compartment, compared to the standard pre-SCM approach. The surgical control of the vertebral artery is comparable to that obtained with the retro-SCM approach, while the control of the esophagotracheal complex and the retroesophageal space is comparable to the pre-SCM approach. The risk profile on the inferior thyroid vessels, recurrent nerve, and sympathetic chain is superimposable to the pre-SCM approach. Conclusions: The carotid sheath route is a safe and effective option to approach prespinal lesions with retrocarotid monolateral paravertebral extension.
Language	English
Publishing date	2023-03-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_148_22
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Article: Posttraumatic extraskeletal chondroma of the posterior neck: A systematic literature review on a rare finding and report of a case.

Pompeo, Edoardo / Gagliardi, Filippo / Medone, Marzia / Roncelli, Francesca / De Domenico, Pierfrancesco / Snider, Silvia / Terreni, Mariarosa / Mortini, Pietro

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 3, Page(s) 306–310

Abstract: Extraskeletal chondromas (EC) are uncommon, benign cartilaginous tumours. Most common locations are upper and lower extremities. Location in the neck is extremely rare and reported only within the anterior compartment. Data are limited to just four case ... ...

Abstract	Extraskeletal chondromas (EC) are uncommon, benign cartilaginous tumours. Most common locations are upper and lower extremities. Location in the neck is extremely rare and reported only within the anterior compartment. Data are limited to just four case reports in the paediatric population. The first case of EC in neck's posterior compartment is described herein. EC present peculiar features on imaging. Aetiology is unclear; however, trauma has been suggested as possible causative mechanism. Treatment of choice is surgical excision; recurrence is not uncommon, but additional removal seems to be resolutive. All cases in literature were asymptomatic, except for one presenting respiratory stridor. The present patient suffered from neck functional limitation and upper limb hypoesthesia. Symptoms improved after surgery in both cases. Imaging follow-up at 6 months in the present case showed no sign of recurrence. ECs are rare, benign lesions. However, they may be preoperatively misinterpreted as more malignant counterparts (both radiologically or histologically), so accurate diagnostic work-up and planning of the surgical procedure are essential.
Language	English
Publishing date	2023-09-18
Publishing country	India
Document type	Case Reports
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_65_23
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Article: Anterior selective scalenectomy for periforaminal exposure in the ventral supraclavicular approach.

Gagliardi, Filippo / Medone, Marzia / Giordano, Leone / Snider, Silvia / Piloni, Martina / Pompeo, Edoardo / Roncelli, Francesca / Ruffino, Luca / Mortini, Pietro

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 2, Page(s) 144–148

Abstract: Aims and objectives: Route of choice to access cervical paravertebral lesions with foraminal involvement is the anterolateral corridor with its variants. Main limitation of these techniques is represented by the limited surgical access to periforaminal ... ...

Abstract	Aims and objectives: Route of choice to access cervical paravertebral lesions with foraminal involvement is the anterolateral corridor with its variants. Main limitation of these techniques is represented by the limited surgical access to periforaminal area due to the bulk generated by the anterior scalene muscle (ASM). Over the years, alternative techniques for ASM surgical management have been developed, which are still today a matter of debate. Most popular include ASM scalene complete section (SCS) and ASM medial detachment (SMD). Authors describe an innovative, minimally invasive muscle section technique, the anterior selective scalenectomy (ASS), which reduces the risk of iatrogenic morbidity and optimizes exposure of periforaminal area in anterolateral cervical routes. Materials and methods: A laboratory investigation was conducted. Technique was applied in a surgical setting, and an illustrative case was reported. Results: ASS is a quick and easy technique to perform. It allows optimization of surgical visibility and control on the periforaminal area in the cervical anterolateral corridor. It respects muscle anatomy and vascularization, favoring functional recovery and management of peri-operative pain; it reduces the risk of morbidity on phrenic nerve and pleura. Considering the minimally invasive nature of the technique, it allows for a slightly more limited exposure compared to traditional techniques while ensuring optimal surgical maneuverability on the target area. Conclusions: ASS represents an effective and safe alternative to traditional ASM section techniques for the exposure of periforaminal area in anterolateral cervical routes. It is indicated in case of lesions with paravertebral development and minimal intraforaminal component in the C3-C6 segment.
Language	English
Publishing date	2023-06-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_153_22
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Article ; Online: Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations.

Gagliardi, Filippo / Pompeo, Edoardo / Snider, Silvia / Roncelli, Francesca / Medone, Marzia / De Domenico, Pierfrancesco / Piloni, Martina / Mortini, Pietro

Journal of neurological surgery. Part A, Central European neurosurgery

2022 Volume 85, Issue 3, Page(s) 307–315

Abstract: Background: Intraforaminal lumbar disk herniations (IFDHs) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomical relationships with nerve roots and vertebral joints. Over time, several ...

Abstract	Background: Intraforaminal lumbar disk herniations (IFDHs) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomical relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy. Materials and methods: Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to IFDHs, defining the impact of each approach on surgical maneuverability and exposure on specific targets.A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Results: Transarticular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered the main drawback. Conclusions: Approach selection has to consider disease location, the possible migration of disk fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach and on surgical maneuverability on specific targets.
MeSH term(s)	Humans ; Intervertebral Disc Displacement/surgery ; Lumbar Vertebrae/surgery ; Iatrogenic Disease
Language	English
Publishing date	2022-12-08
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/a-1994-8142
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Article ; Online: Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques.

Gagliardi, Filippo / Snider, Silvia / Pompeo, Edoardo / Medone, Marzia / Piloni, Martina / Giordano, Leone / De Domenico, Pierfrancesco / Roncelli, Francesca / Mortini, Pietro

Journal of neurological surgery. Part A, Central European neurosurgery

2021 Volume 83, Issue 2, Page(s) 173–182

Abstract: The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of ... ...

Abstract	The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.
MeSH term(s)	Head and Neck Neoplasms/surgery ; Humans ; Reconstructive Surgical Procedures/methods ; Retrospective Studies ; Surgical Flaps
Language	English
Publishing date	2021-12-12
Publishing country	Germany
Document type	Journal Article ; Systematic Review
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/s-0041-1739213
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Article ; Online: Comparison between extended transsphenoidal and transcranial surgery for craniopharyngioma: focus on hypothalamic function and obesity.

Gallotti, Alberto Luigi / Barzaghi, Lina Raffaella / Albano, Luigi / Medone, Marzia / Gagliardi, Filippo / Losa, Marco / Mortini, Pietro

Pituitary

2021 Volume 25, Issue 1, Page(s) 74–84

Abstract: Purpose: Patients suffering from craniopharyngiomas currently have good survival rates, but long-term sequelae, such as development of obesity, worsen their quality of life. Optimal treatment is still controversial and changed during the decades, ... ...

Abstract	Purpose: Patients suffering from craniopharyngiomas currently have good survival rates, but long-term sequelae, such as development of obesity, worsen their quality of life. Optimal treatment is still controversial and changed during the decades, becoming less aggressive. Transcranial (TC) surgery was the first approach to be used, followed by extended transsphenoidal (eTNS) access. This study aims to compare the two approaches in terms of risk of hypothalamic damage leading to obesity. Methods: This is a monocentric retrospective analysis of post-puberal patients treated for primary craniopharyngioma. Postoperative obesity and percentual postsurgical BMI variation were considered proxy for hypothalamic function and used to fit regression models with basal BMI, type of surgery, tumor volume and hypothalamic involvement (anterior vs. anteroposterior). Results: No difference in radicality was observed between the two approaches; eTNS was more effective in ameliorating visual function but was significantly associated with CSF leaks. The TC approach was associated with a higher incidence of diabetes insipidus. Regression analysis showed only tumor volume and basal BMI resulted as independent predictors for both postoperative obesity (respectively, OR 1.15, P = 0.041, and OR 1.57, P < 0.001) and percentual BMI variation (respectively, + 0.92%, P = 0.005, and - 1.49%, P = 0.001). Conclusions: Larger lesions portend a higher risk to develop postoperative obesity, independently of hypothalamic involvement. Interestingly, basal BMI is independent of lesional volume and is associated with postoperative obesity, but lesser postoperative BMI variation. The surgical approach does not influence the obesity risk. However, eTNS proves valid in managing large tumors with important hypothalamic invasion.
MeSH term(s)	Craniopharyngioma/surgery ; Humans ; Obesity ; Pituitary Neoplasms/surgery ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-021-01171-2
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Article: Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations

Gagliardi, Filippo / Pompeo, Edoardo / Snider, Silvia / Roncelli, Francesca / Medone, Marzia / De Domenico, Pierfrancesco / Piloni, Martina / Mortini, Pietro

Journal of Neurological Surgery Part A: Central European Neurosurgery

2022 Volume 85, Issue 03, Page(s) 307–315

Abstract	Background: Intraforaminal lumbar disk herniations (IFDHs) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomical relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy. Materials and methods: Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to IFDHs, defining the impact of each approach on surgical maneuverability and exposure on specific targets. A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Results: Transarticular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered the main drawback. Conclusions: Approach selection has to consider disease location, the possible migration of disk fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach and on surgical maneuverability on specific targets.
Keywords	intraforaminal ; disk herniation ; approaches ; surgical operability ; operative algorithm
Language	English
Publishing date	2022-12-08
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/a-1994-8142
Database	Thieme publisher's database

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Article: Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques

Gagliardi, Filippo / Snider, Silvia / Pompeo, Edoardo / Medone, Marzia / Piloni, Martina / Giordano, Leone / De Domenico, Pierfrancesco / Roncelli, Francesca / Mortini, Pietro

Journal of Neurological Surgery Part A: Central European Neurosurgery

2021 Volume 83, Issue 02, Page(s) 173–182

Abstract	The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.
Keywords	temporal flap ; skull base reconstruction ; myofascial flap ; galeopericranial flap ; chimeric flap ; reverse flap ; head and neck reconstruction
Language	English
Publishing date	2021-12-12
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/s-0041-1739213
Database	Thieme publisher's database

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Article ; Online: Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method.

Barzaghi, Lina Raffaella / Medone, Marzia / Losa, Marco / Bianchi, Stefania / Giovanelli, Massimo / Mortini, Pietro

Neurosurgical review

2011 Volume 35, Issue 3, Page(s) 369–78; discussion 378–9

Abstract: The objective of the study was to evaluate the preoperative visual field defect, the postoperative outcome and the possible prognostic factors in patients with pituitary macroadenoma, using a quantitative method (the mean deviation = MD), and to review ... ...

Abstract	The objective of the study was to evaluate the preoperative visual field defect, the postoperative outcome and the possible prognostic factors in patients with pituitary macroadenoma, using a quantitative method (the mean deviation = MD), and to review the literature. A total of 73 patients, operated trough trans-sphenoidal approach, were selected, and data in single eyes were analysed by calculating the frequency and the degree of postoperative improvement (relative improvement). The visual field defect improved in 95.7% of eyes: The recovery was complete in 48.9% and partial in 46.8%. Multivariate logistic regression showed that factors, independently predictive for complete recovery, were as follows: low preoperative MD absolute value (p = 0.008), low cranio-caudal diameter of tumour (p = 0.02) and young age (p = 0.0001). The mean relative improvement in visual field defect (dMD%) was correlated with the preoperative visual acuity (p = 0.0001) and inversely related with the preoperative MD (p = 0.007) and the age (p = 0.017). The relative improvement was higher in tumours with a smaller cranio-caudal diameter (p = 0.0185). In conclusion, using a quantitative method, we can measure the degree of the postoperative visual field defect improvement. Predictive factors for a complete recovery were good preoperative visual function, young age and low cranio-caudal tumour.
MeSH term(s)	Adenoma/complications ; Adenoma/pathology ; Adenoma/surgery ; Humans ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/pathology ; Pituitary Neoplasms/surgery ; Treatment Outcome ; Vision Disorders/etiology ; Vision Disorders/physiopathology ; Vision Disorders/surgery ; Visual Fields
Language	English
Publishing date	2011-11-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-011-0365-y
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Article ; Online: Evaluation of hearing function after Gamma Knife surgery of vestibular schwannomas.

Franzin, Alberto / Spatola, Giorgio / Serra, Carlo / Picozzi, Piero / Medone, Marzia / Milani, Davide / Castellazzi, Paola / Mortini, Pietro

Neurosurgical focus

2009 Volume 27, Issue 6, Page(s) E3

Abstract: Object: Due to technological advances in neuroradiology in recent years, incidental diagnoses of vestibular schwannomas (VSs) have increased. The aim of this study was to evaluate the hearing function after treatment with Gamma Knife surgery (GKS) for ... ...

Abstract	Object: Due to technological advances in neuroradiology in recent years, incidental diagnoses of vestibular schwannomas (VSs) have increased. The aim of this study was to evaluate the hearing function after treatment with Gamma Knife surgery (GKS) for VSs in patients adequately selected with "good" or "useful" hearing before treatment and to assess the possible predictive factors for hearing function preservation. Methods: Of all patients treated in the authors' hospital between 2001 and 2007, they retrospectively studied 50 patients with a unilateral VS in whom there was serviceable hearing (Gardner-Robertson [GR] Class I or II). Additional inclusion criteria were: no Type 2 neurofibromatosis, no previous treatment, and at least 6 months' follow-up of neuroradiological and audiological data. The median patient age was 54 years (range 24-78 years). The median tumor volume was 0.73 ml (range 0.03-6.6 ml), and the median radiation dose to the tumor margin was 13 Gy (range 12-16 Gy) with an isodose of 50%. Results: Patient age, tumor volume, and presenting symptoms were found to correlate with hearing function. At a median of 36 months after radiosurgery, tumor growth control was 96% and no patient required any other additional treatment. Serviceable hearing was preserved in 34 patients (68%): 21 (62%) with GR Class I hearing and 13 (38%) with GR Class II hearing. The remaining 16 patients had poor hearing function:15 with GR Class III and 1 with GR Class IV hearing function. In 19 (58%) of 33 patients with GR Class I function before GKS the same class was maintained posttreatment; 29 (88%) maintained functional hearing (GR Class I or II). In all patients with an intracanalicular lesion, functional hearing was maintained. Significant prognostic factors for maintaining serviceable hearing were GR Class I function before treatment, symptoms at presentation, patient age younger than 54 years, and Koos Stage T1 disease. Conclusions: The results of the study show that the probability of preserving functional hearing in patients undergoing GKS treatment for unilateral VSs is very high. Patients with GR Class I, age younger than 54 years, with presenting symptoms other than hearing loss, and a Koos Stage T1 tumor have better prognosis. The prescribed dose of 13 Gy appears to represent an excellent compromise between controlling the disease and preserving auditory function.
MeSH term(s)	Adult ; Age Factors ; Aged ; Audiometry, Pure-Tone/statistics & numerical data ; Auditory Threshold/physiology ; Auditory Threshold/radiation effects ; Female ; Follow-Up Studies ; Hearing Loss/prevention & control ; Hearing Tests/statistics & numerical data ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Neuroma, Acoustic/diagnosis ; Neuroma, Acoustic/pathology ; Neuroma, Acoustic/surgery ; Postoperative Complications/prevention & control ; Prognosis ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Survival Rate ; Treatment Outcome ; Tumor Burden
Language	English
Publishing date	2009-12
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2009.9.FOCUS09196
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