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Article ; Online: Resection of Intracranial Tumors with a Robotic-Assisted Digital Microscope: A Preliminary Experience with Robotic Scope.

Piloni, Martina / Bailo, Michele / Gagliardi, Filippo / Mortini, Pietro

2021 Volume 152, Page(s) e205–e211

Abstract: Background: Magnified intraoperative visualization is of paramount importance during microsurgical procedures. Although the introduction of the operating microscope represented one of the most relevant innovations in modern neurosurgery, surgical vision ...

Abstract	Background: Magnified intraoperative visualization is of paramount importance during microsurgical procedures. Although the introduction of the operating microscope represented one of the most relevant innovations in modern neurosurgery, surgical vision and maneuverability can be limited in cases with unfavorable angles of attack. In such cases, the placement of the operating microscope can be difficult and result in significant discomfort to the surgeon. In previous decades, exoscopes were introduced as alternative tools to provide optimal ergonomics by decoupling the line of sight of the surgeon from the binocular lenses. However, exoscopic platforms entail interim manual adjustments of the camera position and setting. To overcome this limitation, robotic-assisted digital microscopy was developed. We have reported our preliminary experience with the RoboticScope to investigate the feasibility and safety of this novel digital system for intraoperative magnification. Methods: In September 2020, the RoboticScope was used to perform 3 cranial procedures for the resection of brain tumors. The surgeon's opinion was recorded to evaluate the quality of the intraoperative vision, the safety and efficacy of the surgical maneuverability, and the surgeon's personal comfort. Results: RoboticScope provided remarkable advantages in terms of enhanced workflow efficacy and increased comfort of the surgeon during the microsurgical phase of the cranial procedures. The overall quality of the intraoperative digital imaging was rated not inferior to that of traditional optical microscopes. Conclusions: The RoboticScope is a promising device that might represent a valuable alternative to conventional tools for intraoperative visualization in the resection of intracranial tumors.
MeSH term(s)	Adult ; Aged ; Astrocytoma/surgery ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Feasibility Studies ; Female ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Male ; Meningioma/surgery ; Microscopy/instrumentation ; Microsurgery/methods ; Middle Aged ; Neurosurgical Procedures/instrumentation ; Neurosurgical Procedures/methods ; Robotic Surgical Procedures/instrumentation ; Robotic Surgical Procedures/methods ; Robotics/methods ; Surgery, Computer-Assisted/methods
Language	English
Publishing date	2021-05-27
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.05.075
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Article: Brain Tumors Affecting the Orbit Globe and Orbit Tumors Affecting the Brain.

Spina, Alfio / Boari, Nicola / Calvanese, Francesco / Gagliardi, Filippo / Bailo, Michele / Piloni, Martina / Mortini, Pietro

Advances in experimental medicine and biology

2023 Volume 1405, Page(s) 507–526

Abstract: Brain tumors affecting the orbit and orbital tumors affecting the brain are a heterogeneous group of lesions, with histological features, behaviors, diagnostic criteria, and treatments varying from each other. Dermoid cyst and cavernous hemangiomas are ... ...

Abstract	Brain tumors affecting the orbit and orbital tumors affecting the brain are a heterogeneous group of lesions, with histological features, behaviors, diagnostic criteria, and treatments varying from each other. Dermoid cyst and cavernous hemangiomas are considered the most frequent benign lesions, while non-Hodgkin lymphoma is the most common malignant tumor in this region. Sharing the same anatomical region, clinical manifestations of orbital lesions may be often common to different types of lesions. Imaging studies are useful in the differential diagnosis of orbital lesions and the planning of their management. Lesions can be classified into ocular or extra-ocular ones: the latter can be further differentiated into extraconal or intraconal, based on the relationship with the extraocular muscles. Surgical therapy is the treatment of choice for most orbital lesions; however, based on the degree of removal, their histology and extension, other treatments, such as chemotherapy and radiotherapy, are indicated for the management of orbital lesions. In selected cases, chemotherapy and radiotherapy are the primary treatments. This chapter aimed to discuss the orbital anatomy, the clinical manifestations, the clinical testing and the imaging studies for orbital lesions, and the principal pathological entities affecting the orbit together with the principles of orbital surgery.
MeSH term(s)	Humans ; Orbital Neoplasms/diagnostic imaging ; Orbital Neoplasms/surgery ; Orbit/diagnostic imaging ; Orbit/surgery ; Orbit/pathology ; Diagnostic Imaging ; Brain/pathology ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	410187-X
ISSN	0065-2598
ISSN	0065-2598
DOI	10.1007/978-3-031-23705-8_19
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Zs.A 3192: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Craniopharyngioma in Pediatrics and Adults.

Piloni, Martina / Gagliardi, Filippo / Bailo, Michele / Losa, Marco / Boari, Nicola / Spina, Alfio / Mortini, Pietro

Advances in experimental medicine and biology

2023 Volume 1405, Page(s) 299–329

Abstract: Craniopharyngiomas are rare malignancies of dysembryogenic origin, involving the sellar and parasellar areas. These low-grade, epithelial tumors account for two main histological patterns (adamantinomatous craniopharyngioma and papillary ... ...

Abstract	Craniopharyngiomas are rare malignancies of dysembryogenic origin, involving the sellar and parasellar areas. These low-grade, epithelial tumors account for two main histological patterns (adamantinomatous craniopharyngioma and papillary craniopharyngioma), which differ in epidemiology, pathogenesis, and histomorphological appearance. Adamantinomatous craniopharyngiomas typically show a bimodal age distribution (5-15 years and 45-60 years), while papillary craniopharyngiomas are limited to adult patients, especially in the fifth and sixth decades of life. Recently, craniopharyngioma histological subtypes have been demonstrated to harbor distinct biomolecular signatures. Somatic mutations in CTNNB1 gene encoding β-catenin have been exclusively detected in adamantinomatous craniopharyngiomas, which predominantly manifest as cystic lesions, while papillary craniopharyngiomas are driven by BRAF V600E mutations in up to 95% of cases and are typically solid masses. Despite the benign histological nature (grade I according to the World Health Organization classification), craniopharyngiomas may heavily affect long-term survival and quality of life, due to their growth pattern in a critical region for the presence of eloquent neurovascular structures and possible neurological sequelae following their treatment. Clinical manifestations are mostly related to the involvement of hypothalamic-pituitary axis, optic pathways, ventricular system, and major blood vessels of the circle of Willis. Symptoms and signs referable to intracranial hypertension, visual disturbance, and endocrine deficiencies should promptly raise the clinical suspicion for sellar and suprasellar pathologies, advocating further neuroimaging investigations, especially brain MRI. The optimal therapeutic management of craniopharyngiomas is still a matter of debate. Over the last decades, the surgical strategy for craniopharyngiomas, especially in younger patients, has shifted from the aggressive attempt of radical resection to a more conservative and individualized approach via a planned subtotal resection followed by adjuvant radiotherapy, aimed at preserving functional outcomes and minimizing surgery-related morbidity. Whenever gross total removal is not safely feasible, adjuvant radiotherapy (RT) and stereotactic radiosurgery (SRS) have gained an increasingly important role to manage tumor residual or recurrence. The role of intracavitary therapies, including antineoplastic drugs or sealed radioactive sources, is predominantly limited to monocystic craniopharyngiomas as secondary therapeutic option. Novel findings in genetic profiling of craniopharyngiomas have unfold new scenarios in the development of targeted therapies based on brand-new biomolecular markers, advancing the hypothesis of introducing neoadjuvant chemotherapy regimens in order to reduce tumor burden prior to resection. Indeed, the rarity of these neoplasms requires a multispecialty approach involving an expert team of endocrinologists, neurosurgeons, neuro-ophthalmologists, neuroradiologists, radiotherapists, and neuro-oncologists, in order to pursue a significant impact on postoperative outcomes and long-term prognosis.
MeSH term(s)	Child ; Humans ; Adult ; Child, Preschool ; Adolescent ; Craniopharyngioma/genetics ; Craniopharyngioma/therapy ; Craniopharyngioma/diagnosis ; Quality of Life ; Radiosurgery ; Pituitary Neoplasms/genetics ; Pituitary Neoplasms/therapy ; Pituitary Neoplasms/diagnosis ; Pediatrics
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	410187-X
ISSN	0065-2598
ISSN	0065-2598
DOI	10.1007/978-3-031-23705-8_11
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Zs.A 3192: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Meningioma and Other Meningeal Tumors.

Bailo, Michele / Gagliardi, Filippo / Boari, Nicola / Spina, Alfio / Piloni, Martina / Castellano, Antonella / Mortini, Pietro

Advances in experimental medicine and biology

2023 Volume 1405, Page(s) 73–97

Abstract: Meningiomas develop from meningothelial cells and approximately account for more than 30 percent of central nervous system (CNS) tumors. They can occur anywhere in the dura, most often intracranially and at dural reflection sites. Half of the cases are ... ...

Abstract	Meningiomas develop from meningothelial cells and approximately account for more than 30 percent of central nervous system (CNS) tumors. They can occur anywhere in the dura, most often intracranially and at dural reflection sites. Half of the cases are usually at parasagittal/falcine and convexity locations; other common sites are sphenoid ridge, suprasellar, posterior fossa, and olfactory groove. The female-to-male ratio is approximately 2 or 3-1, and the median age at diagnosis is 65 years. Meningiomas are generally extremely slow-growing tumors; many are asymptomatic or paucisymptomatic at diagnosis and are discovered incidentally. Clinical manifestations, when present, are influenced by the tumor site and by the time course over which it develops. Meningiomas are divided into three grades. Grade I represents the vast majority of cases; they are considered typical or benign, although their CNS location can still lead to severe morbidity or mortality, resulting in a reported ten-year net survival of over 80%. Atypical (WHO grade II) meningiomas are considered "intermediate grade" malignancies and represent 5-7% of cases. They show a tendency for recurrence and malignant degeneration with a relevant increase in tumor cell migration and surrounding tissue infiltration; ten-year net survival is reported over 60%. The anaplastic subtype (WHO III) represents only 1-3% of cases, and it is characterized by a poor prognosis (ten-year net survival of 15%). The treatment of choice for these tumors stands on complete microsurgical resection in case the subsequent morbidities are assumed minimal. On the other hand, and in case the tumor is located in critical regions such as the skull base, or the patient may have accompanied comorbidities, or it is aimed to avoid intensive treatment, some other approaches, including stereotactic radiosurgery and radiotherapy, were recommended as safe and effective choices to be considered as a primary treatment option or complementary to surgery. Adjuvant radiosurgery/radiotherapy should be considered in the case of atypical and anaplastic histology, especially when a residual tumor is identifiable in postoperative imaging. A "watchful waiting" strategy appears reasonable for extremely old individuals and those with substantial comorbidities or low-performance status, while there is a reduced threshold for therapeutic intervention for relatively healthy younger individuals due to the expectation that tumor progression will inevitably necessitate proactive treatment. To treat and manage meningioma efficiently, the assessments of both neurosurgeons and radiation oncologists are essential. The possibility of other rarer tumors, including hemangiopericytomas, solitary fibrous tumors, lymphomas, metastases, melanocytic tumors, and fibrous histiocytoma, must be considered when a meningeal lesion is diagnosed, especially because the ideal diagnostic and therapeutic approaches might differ significantly in every tumor type.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Meningioma/surgery ; Meningioma/diagnosis ; Meningeal Neoplasms/surgery ; Diagnostic Imaging ; Radiosurgery ; Head ; Treatment Outcome
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	410187-X
ISSN	0065-2598
ISSN	0065-2598
DOI	10.1007/978-3-031-23705-8_3
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Zs.A 3192: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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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: Endoscope-Assisted Neuroportal Transcerebellar Approach to the Fourth Ventricle: An Anatomical Study.

Piloni, Martina / Gagliardi, Filippo / Bailo, Michele / Barzaghi, Lina R / Caputy, Anthony J / Mortini, Pietro

Journal of neurological surgery. Part A, Central European neurosurgery

2021 Volume 82, Issue 3, Page(s) 248–256

Abstract: Background and study aims: Minimally invasive approaches to deep-seated lesions still represent a fundamental issue in modern neurosurgery. Tubular retractors allow to enhance the operability of intraventricular lesions, minimizing the risk of damages ... ...

Abstract	Background and study aims: Minimally invasive approaches to deep-seated lesions still represent a fundamental issue in modern neurosurgery. Tubular retractors allow to enhance the operability of intraventricular lesions, minimizing the risk of damages to brain parenchyma. Increasing interest for portal devices has been mainly focused on supratentorial pathologies, while transportal approaches in the posterior cranial fossa have been rarely described. In the present study, the authors aimed to investigate the surgical exposure and operability obtained with a microsurgical neuroportal transcerebellar approach targeting the fourth ventricle, assisted by endoscopic exploration. Material and methods: Six cadaveric specimens were provided for anatomical microsurgical dissection and Vycor ViewSite Brain Access System was used as tubular retractor. Surgical feasibility of the neuroportal transcerebellar approach was demonstrated through a definable and measurable parameter, the operability score. Results: The neuroport provided a surgical corridor away from eloquent structures to target the whole fourth ventricle cavity, preventing injury to cerebellar nuclei and white matter pathways and, potentially, minimizing the risk of surgical morbidity. Maximal operability was reached in the pontomedullary junction and medullary area of the ventricular floor. Transportal endoscopic assistance contributed to a further extension of surgical exposure in blind spots, corresponding to the ipsilateral lateral recess, the uppermost part of the fourth ventricle, and the obex. Conclusion: The neuroportal transcerebellar approach represents a viable alternative route to the fourth ventricle, avoiding vermian splitting or subarachnoid dissection of the cerebellomedullary cistern. Endoscopic assistance enhances the exposure of the surgical field and accomplishes a valid instrument for intraventricular orientation to ease microsurgical procedures.
MeSH term(s)	Cerebellum/surgery ; Cranial Fossa, Posterior/surgery ; Fourth Ventricle/surgery ; Humans ; Microsurgery/methods ; Neuroendoscopy ; Neurosurgical Procedures/methods
Language	English
Publishing date	2021-03-09
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-0040-1719107
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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: Hemorrhagic Suprasellar Central Nervous System Embryonal Tumor in an Adult: Uncommon Features of an Extremely Rare Neoplasm.

Piloni, Martina / Gagliardi, Filippo / Bailo, Michele / Barzaghi, Lina Raffaella / Callea, Marcella / Terreni, Mariarosa / Falini, Andrea / Castellano, Antonella / Mortini, Pietro

Journal of neurological surgery. Part A, Central European neurosurgery

2021 Volume 83, Issue 1, Page(s) 89–98

Abstract: Background: Occurrences of suprasellar central nervous system (CNS) embryonal tumors in adults are extremely rare. Hemorrhagic onset is further uncommon, with only anecdotic cases reported in the literature. The authors describe the case of a 57-year- ... ...

Abstract	Background: Occurrences of suprasellar central nervous system (CNS) embryonal tumors in adults are extremely rare. Hemorrhagic onset is further uncommon, with only anecdotic cases reported in the literature. The authors describe the case of a 57-year-old man affected by a suprasellar CNS embryonal tumor, with hemorrhagic onset and a unique diffusion pattern along the optic pathways. Material and methods: A 57-year-old man presenting with acute visual acuity worsening and left homonymous hemianopia was referred to our hospital. Neuroradiologic studies demonstrated an infiltrating, high-grade lesion involving the optic chiasm and right retrochiasmatic pathways with a hemorrhagic area in the ipsilateral pulvinar. Results: The patient underwent microsurgical biopsy. Pathologic assessment confirmed the diagnosis of CNS embryonal tumor, not otherwise specified (NOS) according to the 2016 World Health Organization (WHO) classification of CNS tumors. The patient was referred to a multimodal adjuvant treatment; he eventually died 4 months after surgery. Competent literature has been systematically reviewed in the light of the relevant changes made in the last version of the WHO classification. Conclusion: Embryonal tumors should be considered in the differential diagnosis for sellar and suprasellar space-occupying lesions, despite the rarity of the disease and the uncommon features at time of presentation. As per our knowledge, this is the first case ever described of hemorrhagic suprasellar embryonal tumor with a diffusion pattern along white matter fibers. Histogenesis, biomolecular and neuroradiologic features, and classification of embryonal tumors are an open field of research, with considerable implications for the definition of better diagnostic pitfalls and therapeutic regimens.
MeSH term(s)	Adult ; Biopsy ; Central Nervous System ; Diagnosis, Differential ; Hemorrhage ; Humans ; Male ; Middle Aged ; Neoplasms, Germ Cell and Embryonal/complications ; Neoplasms, Germ Cell and Embryonal/diagnostic imaging ; Neoplasms, Germ Cell and Embryonal/surgery
Language	English
Publishing date	2021-01-21
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/s-0040-1721022
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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: Impact of C-shaped skin incision on surgical operability in the retrosigmoid approach: when a good start is half of the job.

Gagliardi, Filippo / Piloni, Martina / Snider, Silvia / Roncelli, Francesca / Pompeo, Edoardo / Caputy, Anthony J / Mortini, Pietro

Acta neurochirurgica

2021 Volume 163, Issue 8, Page(s) 2155–2163

Abstract: Background: The retrosigmoid approach (RSA) is one of the routes of choice to approach tumors and vascular lesions of the cerebellopontine angle. Among different types of skin incisions and soft tissue dissection techniques, the most widely used ... ...

Abstract	Background: The retrosigmoid approach (RSA) is one of the routes of choice to approach tumors and vascular lesions of the cerebellopontine angle. Among different types of skin incisions and soft tissue dissection techniques, the most widely used variants comprise the straight/lazy S-shaped and the C-shaped incisions. Several reports discuss advantages in terms of functional and clinical outcomes of the C-shaped incision, but scientific considerations about the critical impact of this kind of incision on surgical operability are still extremely limited. Object: Authors comparatively analyze the advantage provided by C-shaped incision in RSA in terms of anatomic exposure and surgical operability, compared with straight/lazy S-shaped one. Methods: A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Results: C-shaped incision, providing a significant reduction of the overall working distance (-13%) together with an overall increase of the maneuverability area (+ 204.9%), did improve the conizing effect on the surgical corridor. It optimized overall maneuverability of surgical instruments, in terms of angle of attack (+ 27.7%), as well as maneuverability arc (+ 122%), on the entire surgical field. C-shaped incision ensured good operability on all surgical targets (OS ranging from 2 to 3), most significantly improving surgical maneuverability at the porus trigeminus and internal acoustic meatus. Conclusion: C-shaped incision in the RSA significantly improves anatomic exposure and surgical operability as compared with straight/lazy S-shaped incision.
MeSH term(s)	Cerebellopontine Angle/surgery ; Craniotomy ; Dermatologic Surgical Procedures ; Dissection ; Humans ; Microsurgery ; Skin
Language	English
Publishing date	2021-06-07
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/s00701-021-04889-x
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