Publications by authors named "Alessandro Pesce"

61 Publications

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study.

Front Neurol 2020 24;11:560269. Epub 2020 Nov 24.

Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.

Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear. To identify factors associated with increased risk of recurrence. Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes. A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs ( = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded ( = 0.013). No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.
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http://dx.doi.org/10.3389/fneur.2020.560269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732444PMC
November 2020

No prognostic differences between GBM-patients presenting with postoperative SMA-syndrome and GBM-patients involving cortico-spinal tract and primary motor cortex.

J Neurol Sci 2020 Dec 15;419:117188. Epub 2020 Oct 15.

Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.

Background: The supplementary motor area (SMA) is involved in several aspects of motor control and its can be associated to a contralateral motor deficit and speech disorders. After the resection of low-grade gliomas, this syndrome is diffusely reported but it is rarely investigated in high-grade gliomas. SMA deficits may resolve completely or with minor sequelae within weeks. Whether this condition of transient deficit affects survival, was not previously investigated, and is not currently understood.

Objective: The study aimed to perform an accurate investigation concerning the real clinical and prognostic impact of the postoperative SMA syndrome in order to shed light over its relationship to survival parameters and postoperative functional status of the patients.

Methods: We performed a retrospective review of a series of 176 surgically treated patients suffering from Glioblastomas. Tumors classified as Group A: Involving the SMA and Group B: Lesion located outside and distal to the SMA but in anatomical relationship to primary motor cortices (PM1) or corticospinal tract (CST), in order to investigate differences concerning immunohistochemical and molecular profiles in regard to the survival parameters.

Results: Although lesions involving SMA demonstrated a significantly higher volume in respect to their general counterparts they did not significantly differ in concerns to the molecular patterns, pre and postoperative KPS scores and in PFS and OS findings.

Conclusions: In our cohort SMA-syndrome is reversible and therefore guarantees a satisfactory functional status at follow-up, apparently not compromising survival when compared to other lesions affecting the primary or cortical motor area -spinal tract.
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http://dx.doi.org/10.1016/j.jns.2020.117188DOI Listing
December 2020

How SARS-Cov-2 can involve the central nervous system. A systematic analysis of literature of the department of human neurosciences of Sapienza University, Italy.

J Clin Neurosci 2020 Sep 7;79:231-236. Epub 2020 Jul 7.

IRCCS - "Neuromed", Pozzilli, (IS), Italy; A.U.O. "Policlinico Umberto I", Neurosurgery Division, Sapienza University, Rome Human Neurosciences Department, Via del Policlinico, 155 - 00161 Rome, Italy.

Italy is currently one of the countries most affected by the global emergency of COVID-19, a lethal disease of a novel coronavirus renamed as SARS-CoV-2. SARS-CoV-2 shares highly homological sequence with the most studied SARS-CoV, and causes acute, highly deadly pneumonia (COVID-19) with clinical symptoms similar to those reported for SARS-CoV and MERS-CoV. Increasing evidence shows that these coronaviruses are not always confined to the respiratory tract and that they may also neuroinvasive and neurotropic, with potential neuropathological consequences in vulnerable populations. The aim of this study is to predict a likely CNS involvement by SARS-CoV-2 by studying the pathogenic mechanisms in common with other better known and studied coronaviruses with which it shares the same characteristics. Understanding the mechanisms of neuroinvasion and interaction of HCoV (including SARS-Cov-2) with the CNS is essential to evaluate potentially pathological short- and long-term consequences. Autopsies of the COVID-19 patients, detailed neurological investigation, and attempts to isolate SARS-CoV-2 from the endothelium of cerebral microcirculation, cerebrospinal fluid, glial cells, and neuronal tissue can clarify the role played by COVID-19 in CNS-involvement and in the ongoing mortalities as has been in the recent outbreak.
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http://dx.doi.org/10.1016/j.jocn.2020.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340069PMC
September 2020

Is Ki-67 index overexpression in IDH wild type glioblastoma a predictor of shorter Progression Free survival? A clinical and Molecular analytic investigation.

Clin Neurol Neurosurg 2020 11 3;198:106126. Epub 2020 Aug 3.

IRCCS "Neuromed" Pozzilli (IS), Italy.

Background: Ki-67 proliferation index is widely used for differentiating between high and low-grade gliomas, but differentiating between the same grade IV appears to be more problematic, and the point about its prognostic value for GBM patients remains unclear. To reduce the possibility to find a marked histological heterogeneity, and may contain areas that could be diagnosed as lower grade, in this study we considered a large group of patients with IDH wild-type Glioblastoma (IDH-WT GBM) and we have analyzed previously reported prognostic factors, in regards to their relationship with the Ki-67 expression index.

Methods: We explore the prognostic impact of ki-67 index status in 127 patients affected by IDH-WT GBM. We therefore analyzed clinical characteristics, tumor genetics, dimension and clinical outcomes. We selected a total of 127 patients affected by newly diagnosed IDH-WT GBM who underwent surgery, radiation, and chemotherapy in our Institution in the period ranging between January 2014 and December 2016 RESULTS: The volume of the lesion had a strong association with the Ki67 overexpression. In particular lesions whose volume was greater than 45  cm, presented a higher percentage of Ki67 expression demonstrating that greater tumors are more likely associated to higher values of Ki67 percentages. On a multivariate analysis, it was possible to outline that Ki67 was significant a predictor of shorter PFS independently from the age of the patients, the volume of the lesion and preoperative KPS.

Conclusions: There is a correlation between percentage staining of Ki-67 and OS in our cohort of patients with IDH-WT GBM. This is only the third observational study documenting a positive correlation between Ki-67 and overall survival in GBM and the first one demonstrates that percentage Ki-67 staining >20 % predicts poorer progression free survival in IDH-WT GBM.
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http://dx.doi.org/10.1016/j.clineuro.2020.106126DOI Listing
November 2020

Histological, molecular, clinical and outcomes characteristics of Multiple Lesion Glioblastoma. A retrospective monocentric study and review of literature.

Neurocirugia (Astur : Engl Ed) 2021 May-Jun;32(3):114-123. Epub 2020 Jun 18.

Human Neurosciences Department Neurosurgery Division "Sapienza" University, Italy.

Background: Multiple lesion glioblastoma (M-GBM) represent a group of GBM patients in which there exist multiple foci of tumor enhancement. The prognosis is poorer than that of single-lesion GBM patients, but this actually is a controversial data. Is unknown whether multifocality has a genetic and molecular basis. Our specific aim is to identify the molecular characteristics of M-GBM by performing a comprehensive multidimensional analysis.

Methods: The surgical, radiological and clinical outcomes of patients that underwent surgery for GBM at our institution for 2 years have been retrospectively reviewed. We compared the overall survival (OS), progression free survival and extent of resection (EOR) between M-GBM tumors (type I) and S-GBM (single contrast-enhancing lesion, type II).

Results: A total of 177 patients were included in the final cohort, 12 patients had M-GBM and 165 patients had S-GBM. Although patients with M-GBM had higher tumor volumes and midline location, the EOR was not different between both type of lesions. Higher percentage of tumors with EGFR overexpression was detected in M-GBM. PFS and OS was significantly shorter in M-GBM.

Conclusions: Considering no differences in EOR, patients with M-GBM showed shorter PFS and OS in comparison with S-GBM. Evidences about the M-GBM origin as a multifocal lesion because its molecular profile are suggested.
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http://dx.doi.org/10.1016/j.neucir.2020.04.003DOI Listing
May 2021

Transoral Endoscopic Approach to Repair Early Pharyngeal Perforations After Anterior Cervical Spine Surgery without Failure of Instrumentation: Our Experience and Review of Literature.

World Neurosurg 2020 09 17;141:219-225. Epub 2020 Jun 17.

IRCCS Neuromed, Pozzilli, Italy.

Background: Pharyngoesophageal injury during anterior cervical spine surgery is a rare and potentially life-threatening complication; generally it is the result of intraoperative manipulation or hardware erosion and sometimes may be due to weakness of the pharyngoesophageal wall from pre-existing pathologic conditions, such as diabetes, gastritis, or obesity.

Case Description: We describe the management strategies in patients with an early postoperative hypopharyngeal perforation that occurred after anterior cervical spine surgery without failure of instrumentation, and we present a case treated endoscopically at our institution.

Conclusions: Appropriate treatment for pharyngoesophageal perforations is controversial and not investigated in detail. There is a lack of prospective studies comparing initial conservative versus surgical approaches to treatment. In addition, endoscopic management is growing as a therapeutic option, but no consensus concerning the indications for an endoscopic approach in the treatment of pharyngoesophageal injury in anterior cervical spine surgery is currently reached. A common theme proposed in the literature is that early recognition and aggressive investigation and treatment are essential to ensure a good outcome. A customized interdisciplinary surgical approach is essential for successful treatment. Use of the transoral endoscopic approach is a useful noninvasive method to treat this rare but potentially devastating complication.
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http://dx.doi.org/10.1016/j.wneu.2020.06.080DOI Listing
September 2020

A Forgotten Tale from the Great War: General Lorenzo Bonomo and the Birth of Italian War Neurosurgery.

World Neurosurg 2020 08 12;140:338-346. Epub 2020 Jun 12.

Rome Army Hospital Celio, Neurosurgery Division, Roma, Italy.

Little is known of the advances in battlefield medicine achieved in Italy before and during the Great War. Some deserve wider recognition; this is especially true for the field of neurosurgery. There are a limited number of historical records currently available, fewer still in English, and most of the systematic investigations on field surgery have been in the form of monographs within science history reviews, which obviously lack a strictly clinical perspective. Together with shell shock, the gunshot-related traumatic brain injury (GrTBI) is considered one of the typical, or signature, lesions of the Great War. It was intrinsically linked to trench and mountain warfare: to view the battlefield from a trench/hiding area, soldiers' heads and necks were repeatedly exposed, therefore making them the most likely target for snipers. Military physicians therefore focused their efforts in the clinical and experimental treatment of GrTBI. Among notable contributions of the military surgeons of the time, there is a volume of selected war-surgery lectures conserved in the archives of the Library of the Italian National Academy of Military Medicine. These lectures shed light over the work of General Dr. Lorenzo Bonomo. His incredibly advanced and modern ideas had unfortunately been forgotten. He pioneered research in the ballistic and forensic medical fields, building on first-hand experience, as he performed surgeries himself before the conflict and even while on the frontline, actively working to improve the chances of survival for the Italian troops fighting in the Great War.
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http://dx.doi.org/10.1016/j.wneu.2020.05.113DOI Listing
August 2020

Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial.

J Clin Neurosci 2020 Jul 11;77:41-48. Epub 2020 May 11.

IRCCS "Neuromed" - Pozzilli (IS), Italy.

Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.
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http://dx.doi.org/10.1016/j.jocn.2020.05.047DOI Listing
July 2020

Letter: Neurosurgery and Coronavirus (COVID-19) Epidemic: Doing our Part.

Neurosurgery 2020 07;87(1):E48-E49

A.U.O. "Policlinico Umberto I" Neurosurgery Division Sapienza University, Rome Human Neurosciences Department Roma, Italy.

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http://dx.doi.org/10.1093/neuros/nyaa115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184435PMC
July 2020

EGFR amplification is a real independent prognostic impact factor between young adults and adults over 45yo with wild-type glioblastoma?

J Neurooncol 2020 Jan 30;146(2):275-284. Epub 2019 Dec 30.

IRCCS "Neuromed", Pozzilli, IS, Italy.

Background: In 2019 a group of University of Pennsylvania (Hoffman et al., J Neurooncol 145: 321-328, 2019) aimed to explore the prognostic impact of expression of epidermal growth factor receptor (EGFR), one of the most common genetic alterations in WT-GBM, in young adults with IDH-WT GBM, suggesting an inferior outcomes in young adults (< 45yo) with newly diagnosed, IDH-WT GBM. At the same time, our group were considering the dimension of this subpopulation treated in our centre, and we performed the same analysis, comparing datas with affected elderly adults.

Methods: We explore the prognostic impact of EGFR expression status in young adults with IDH-WT GBM, and compare this impact with the affected elderly adults. We therefore analyzed clinical characteristics, tumor genetics, and clinical outcomes in a cohort of adults aged 18-45 years with newly diagnosed WT GBM. We selected a total of 146 patients affected by newly diagnosed IDH-WT GBM who underwent surgery, radiation, and chemotherapy in our Institution in the period ranging between January 2014 and December 2016. We focused primarily on the prognostic impact of EGFR expression.

Results: We confirmed through a Bivariate Analysis that the Age of the Patients, the Volume of the lesions, were statistically strongly associated with the survival parameters; The general OS of the cohort presented a breakthrough point between the patients who were respectively younger and older than 45 years, EGFR mutation was per se not associated to a survival reduction in all the cohort patients. When analyzing exclusively the Survival parameters of the patients whose age was under 40, it was possible to outline a non statistically significant trend towards a lesser OS in younger patients harboring an EGFR expression.

Conclusions: Once again the main difference in terms of OS in GBM is shown in a EOR and in Age. To our knowledge, ours is the second study (Hoffman et al., J Neurooncol 145: 321-328, 2019) to evaluate the prognostic impact of EGFR CN gain specifically in young adults with IDH-WT GBM and in the era of modern radiation and Temozolomide, but is the first one to compares this impact with a population of adults over 45, and correlates this date with clinical onset, dimension and localization of disease between this groups. We suggest other centers to evaluate this important finding with a larger number of patients and we are inclined to accept collaborations to increase the power of this study.
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http://dx.doi.org/10.1007/s11060-019-03364-zDOI Listing
January 2020

Long Term Survival in Patients Suffering from Glio-blastoma Multiforme: A Single-Center Observational Cohort Study.

Diagnostics (Basel) 2019 Nov 30;9(4). Epub 2019 Nov 30.

IRCCS "Neuromed" Pozzilli (IS), Università Sapienza of Rome, 00135 Roma, Italy.

Background: Glioblastomas (GBM) are generally burdened, to date, by a dismal prognosis, although long term survivors have a relatively significant incidence. Our specific aim was to determine the exact impact of many surgery-, patient- and tumor-related variables on survival parameters.

Methods: The surgical, radiological and clinical outcomes of patients have been retrospectively reviewed for the present study. All the patients have been operated on in our institution and classified according their overall survival in long term survivors (LTS) and short term survivors (STS). A thorough review of our surgical series was conducted to compare the oncologic results of the patients in regard to: (1) surgical-(2) molecular and (3) treatment-related features.

Results: A total of 177 patients were included in the final cohort. Extensive statistical analysis by means of univariate, multivariate and survival analyses disclosed a survival advantage for patients presenting a younger age, a smaller lesion and a better functional status at presentation. From the histochemical point of view, Ki67 (%) was the strongest predictor of better oncologic outcomes. A stepwise analysis of variance outlines the existence of eight prognostic subgroups according to the molecular patterns of Ki67 overexpression and epidermal growth factor receptor (EGFR), p53 and isocitrate dehydrogenase (IDH) mutations.

Conclusions: On the grounds of our statistical analyses we can affirm that the following factors were significant predictors of survival advantage: Karnofsky performance status (KPS), age, volume of the lesion, motor disorder at presentation and/or a Ki67 overexpression. In our experience, LTS is associated with a gross total resection (GTR) of tumor correlated with EGFR and p53 mutations with regardless of localization, and poorly correlated to dimension. We suppose that performing a standard molecular analysis (IDH, EGFR, p53 and Ki67) is not sufficient to predict the behavior of a GBM in regards to overall survival (OS), nor to provide a deeper understanding of the meaning of the different genetic alterations in the DNA of cancer cells. A fine molecular profiling is feasible to precisely stratify the prognosis of GBM patients.
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http://dx.doi.org/10.3390/diagnostics9040209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963741PMC
November 2019

Purely Meningeal Intracranial Relapse of Melanoma Brain Metastases After Surgical Resection and Immunotherapy as a Unique Disease Progression Pattern: Our Experience and Review of the Literature.

World Neurosurg 2020 Feb 18;134:150-154. Epub 2019 Nov 18.

Azienda Ospedaliero-Universitaria "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy.

Background: We present a case of 72-year-old man with a history of metastatic melanoma diagnosed in 2015 presenting a stable disease in treatment with dabrafenib.

Case Description: The patient had been surgically treated for a presumed intracranial parietooccipital metastasis. He presented 1 month later with a meningeal lesion associated with a subdural hematoma. A second surgical treatment confirmed the diagnosis of meningeal recurrence of metastatic melanoma.

Conclusions: The most recent literature lacks studies defining the clinical phenomena of an early recurrence of intracranial melanoma with de novo involvement of dural compartment in patients in treatment with a target immunotherapy. The aim of this present study is to report a case of early recurrence of intracranial melanoma metastases with evidence of fast immunohistochemical and macroscopical mutation of pathologic elements, with an analysis of literature that shows the lack of well-described occurrences.
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http://dx.doi.org/10.1016/j.wneu.2019.10.101DOI Listing
February 2020

Radiation-Induced Brain Aneurysms: Institutional Experience and State of the Art in the Contemporary Literature.

World Neurosurg 2020 Mar 9;135:339-351. Epub 2019 Oct 9.

IRCCS "Neuromed", Pozzilli, Isernia, Italy. Electronic address:

Background: Brain aneurysms (BAs) are the most common intracranial vascular condition, with an overall incidence of 1%-2%. Among the common causes of their initial formation and growth, the role of radiation therapy (RT) has been reported in some studies. The aim of the present study is to report the most relevant features of BA related to a previous cranial RT.

Methods: Data deriving from 1 patient treated for RT-induced BA in our institution were added to reports of another 66 BAs retrieved from the literature. The following parameters were evaluated: age, sex, location, primary lesion, clinical presentation, dosage/amount of radiation delivered, type of treatment for the BA, dimension, morphology, chemotherapy, comorbidities, risk factors, and number of BAs.

Results: The most commonly involved vessel was the internal carotid artery (34%). In general, the anterior circulation showed higher vulnerability compared with the posterior circulation and middle cerebral artery (56.7%). The average latency between RT and the first imaging showing the BA was 9.01 ± 6.85 years. Vessels coursing in the posterior cranial fossa showed a significant univariate association with lower X-ray dosages (P = 0.014) compared with the other locations. No statistically significant correlation between the continuous variables age, latency of BA appearance, RT delivered dose, and dimension of the BA was shown.

Conclusions: The apparent higher fragility of the vascular structures of the posterior cranial fossa was statistically outlined, and the X-ray dosage, the primary condition target of the RT, the age of the patients, and no statistically significant correlation were outlined. Biological factors could play a significant role.
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http://dx.doi.org/10.1016/j.wneu.2019.09.157DOI Listing
March 2020

Corrigendum to "Spinal dural tenting sutures in intradural tumor surgery: A technical insight" [J Clin Neurosci 61 (2019) 322-323].

J Clin Neurosci 2020 04 6;74:274. Epub 2019 Aug 6.

A.O.U. "Sant'Andrea", Neurosurgery Division, Sapienza University, Rome, NESMOS Department, Via di Grottarossa, 1035-1039, 00189 Roma, Italy.

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http://dx.doi.org/10.1016/j.jocn.2019.06.002DOI Listing
April 2020

Spinal cordectomy for the management of thoracic malignant intraspinal tumors in paraplegic or irreversibly, severely paraparetic patients: A technical remark.

J Clin Neurosci 2019 Oct 18;68:308-311. Epub 2019 Jul 18.

IRCCS, "Neuromed", Via Atinense 18, 86077 Pozzilli, IS, Italy.

Background: Malignant Intramedullary Spinal Cord Tumor are a relatively uncommon entity affecting patients whose prognosis is quickly and relentlessly dismal. Since the '50s Spinal Cordectomy' has been advocated for the surgical management of these conditions, but to date, no standard operative protocol has been reported yet.

Objective: Although apparently "easy", burdened by virtually no further risk for the neurological function in paraplegic or severely paraparetic patients, SCt conceals notable pitfalls and surgical problems that are to date not yet completely discussed. The objective of the present paper is therefore to report a detailed stepwise description of the surgical technique.

Methods And Results: SCt addresses the problem of reaching a surgical radicality in patients whom neurological preoperative conditions have already irreversibly declined to a deep nonfunctional motor impairment and whose preoperative Brain MRI scan rules out intracranial seeding. The dural sac along with the radicular pouches must be considered as possible seeding and recurrence locations therefore such structure should be "en-bloc" removed. The cranial medullary end of the resection should be identified on the ground of the preoperative MRI and intraoperatively confirmed with fresh histological examinations ruling out the presence of tumor cells above the cordectomy. Due to the topographic and functional medullary arterial anatomy, no SCt should be performed above T3. The risk of postoperative sagittal imbalance is high and therefore a concurrent posterior vertebral stabilization is required.

Conclusion: Spinal Cordectomy is a safe and feasible "last chance" treatment to prolong survival in paraplegic or severely paraparetic patients.
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http://dx.doi.org/10.1016/j.jocn.2019.07.041DOI Listing
October 2019

Spinal Myxopapillary Ependymoma: The Sapienza University Experience and Comprehensive Literature Review Concerning the Clinical Course of 1602 Patients.

World Neurosurg 2019 Sep 29;129:245-253. Epub 2019 May 29.

Neurosurgery Division, NESMOS Department, A.O.U. "Sant'Andrea", Sapienza University - Rome, Rome, Italy.

Background: Spinal myxopapillary ependymoma (sMPE) is an uncommon primary spinal neoplasm infiltrating the spinal cord, conus medullaris (CM), and nerve roots. It is associated with low resection and high recurrence rates. The purpose of this literature review is to evaluate the exact impact of the involvement of the CM and the role played by gross total resection (GTR) on overall survival (OS).

Methods: The English literature was systematically investigated using MEDLINE, the NIH Library, PubMed, and Google Scholar search engines with relevant queries. Case series reporting details concerning OS, GTR, and CM involvement rate were included, with a differential statistical weight given by the number of patients enrolled. A final cohort of 1602 clinical records was analyzed according to the 3 selected end point variables.

Results: The average age was 36.44 ± 3.41 years, and the CM was involved in 28.4% ± 28.2% of cases. The average GTR rate was 53.94% ± 22.20%. Five- and 10-year OS rates were respectively available in 1170 and 1167 cases, with an average 5- and 10-year OS rate of 94.99% ± 3.87% and 92.31% ± 5.73%. By means of analyses performed both on aggregated and disaggregated data a strong positive statistical connection between GTR and increased OS was demonstrated despite the real clinical advantage could range as low as around 1% of increased OS rate.

Conclusions: Given the indolent sMPE behavior, it is difficult to evaluate the exact impact of GTR and CM involvement on OS; however, GTR could be associated with a limited survival advantage, whereas CM involvement could be associated with a survival disadvantage.
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http://dx.doi.org/10.1016/j.wneu.2019.05.206DOI Listing
September 2019

Acute Spinal Cord Injury: A Systematic Review Investigating miRNA Families Involved.

Int J Mol Sci 2019 Apr 13;20(8). Epub 2019 Apr 13.

Department SAIMLAL, "Sapienza" University of Roma, 00161 Rome, Italy.

Acute traumatic spinal cord injury (SCI) involves primary and secondary injury mechanisms. The primary mechanism is related to the initial traumatic damage caused by the damaging impact and this damage is irreversible. Secondary mechanisms, which begin as early as a few minutes after the initial trauma, include processes such as spinal cord ischemia, cellular excitotoxicity, ionic dysregulation, and free radical-mediated peroxidation. SCI is featured by different forms of injury, investigating the pathology and degree of clinical diagnosis and treatment strategies, the animal models that have allowed us to better understand this entity and, finally, the role of new diagnostic and prognostic tools such as miRNA could improve our ability to manage this pathological entity. Autopsy could benefit from improvements in miRNA research: the specificity and sensitivity of miRNAs could help physicians in determining the cause of death, besides the time of death.
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http://dx.doi.org/10.3390/ijms20081841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515063PMC
April 2019

Herpes Simplex Reactivation After Surgical Treatment of Trigeminal Neuralgia: A Retrospective Cohort Study.

World Neurosurg 2019 Jul 13;127:e16-e21. Epub 2019 Feb 13.

Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy.

Background: Herpes simplex virus (HSV) reactivation after surgery for trigeminal neuralgia has long been recognized. Only a few studies to date have focused on this complication, and its actual incidence remains unknown. The aim of this study was to investigate the incidence of postoperative herpes labialis (HL) in a cohort of patients treated with either percutaneous balloon compression or microvascular decompression to identify potentially significant differences between different treatments.

Methods: A total of 92 patients who were operated on for TN with microvascular decompression (group A) or percutaneous balloon compression (group B) in the period 2010-2017 were retrospectively evaluated. The 2 subgroups of patients were compared according to history of previous HL and incidence of postoperative HL.

Results: The final cohort comprised 56 male and 36 female patients. Average age was 58.50 years; 30 male patients belonged to group A and 26 male patients belonged to group B. Lifetime incidence of episodes of HL before surgery in 18/58 patients in group A (31.0%) and 12/34 patients in group B (35.3%), with no statistically significant difference among subgroups. Postoperatively, 1/56 patients in group A (1.7%) experienced HL compared 5/34 patients in group B (14.7%), with a strongly statistically significant difference between the 2 subgroups.

Conclusions: In our clinical experience, herpes simplex virus reactivation after surgery for trigeminal neuralgia is not so rare and is still not completely understood. Postoperative herpes simplex virus reactivation could be due to a direct mechanical injury on gasserian ganglion neurons, which is more common after percutaneous balloon compression.
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http://dx.doi.org/10.1016/j.wneu.2019.01.226DOI Listing
July 2019

Spinal dural tenting sutures in intradural tumor surgery: A technical insight.

J Clin Neurosci 2019 Mar 28;61:322-323. Epub 2018 Oct 28.

A.O.U. "Sant'Andrea", Neurosurgery Division, Sapienza University, Rome, NESMOS Department, Via di Grottarossa, 1035-1039, 00189 Roma, Italy.

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http://dx.doi.org/10.1016/j.jocn.2018.10.085DOI Listing
March 2019

The Role and Real Effect of an Iterative Surgical Approach for the Management of Recurrent High-Grade Glioma: An Observational Analytic Cohort Study.

World Neurosurg 2019 Jan 3. Epub 2019 Jan 3.

Department of Neurosurgery, Neuromed, IRCCS, Sapienza University of Rome, Pozzilli, Italy.

Background: The benefits of multiple interventions on the recurrence of high-grade gliomas are renowned. However, the real effect of repeated operations on the survival parameters does not seem to have been assessed. The aim of the present study was to determine whether reoperation for selected patients is safe and feasible.

Methods: A total of 78 patients with high-grade glioma had undergone surgery from 2004 to 2014. All the patients had met the following inclusion criteria: American Society of Anesthesiologists score 1-3, Karnofsky performance scale score >60, and reintervention ≥4 months after the first surgery. The following parameters were evaluated: overall survival (OS) after diagnosis and reintervention, progression-free survival (PFS) after reintervention, number of surgical procedures, and OS of patients who had undergone surgery >2 times. The results were compared with those of 78 patients with high-grade glioma who had undergone adjuvant chemotherapy.

Results: OS at 1 year was 100%. At 2 years, OS was 39.4% for those with glioblastoma and 58.3% for those with anaplastic astrocytoma. PFS after 6 months was 53.03% for glioblastoma and 75.0% for anaplastic astrocytoma. Of the 78 patients, 55 had undergone reoperation, with 15 requiring a third intervention and 8 requiring 4. Major complications developed in only 2 patients. Statistical analysis revealed no significant differences in complications or worsening neurological status.

Conclusions: These data showed excellent outcomes in terms of OS and PFS and clinical conditions after multiple surgical procedures. Therefore, reintervention appears to be a feasible and safe solution for selected patients.
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http://dx.doi.org/10.1016/j.wneu.2018.12.118DOI Listing
January 2019

Trigonal and Peritrigonal Lesions of the Lateral Ventricle: Presurgical Tractographic Planning and Clinic Outcome Evaluation.

World Neurosurg 2018 Dec 30. Epub 2018 Dec 30.

NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy.

Background: Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and peritrigonal lesions.

Methods: Diffusion tensor imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using the Karnofsky Performance Status Scale. The corticospinal tract, optic radiation, and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography.

Results: According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) and the posterior parietal gyrus in 7 patients (37%), leading to an a priori change in the surgical approach in 14 patients (73%). Six patients (31%) showed new postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status Scale evaluation showed an improvement or a substantial stability of symptoms in 90% of cases. In 2 patients, a worsening of 30% of clinical performance was appreciable.

Conclusions: The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.
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http://dx.doi.org/10.1016/j.wneu.2018.12.086DOI Listing
December 2018

Intradural extramidullary dorsal melanocytoma in the adult: Case report and review of the literature.

J Clin Neurosci 2019 Apr 20;62:248-253. Epub 2018 Dec 20.

A.U.O. "Policlinico Umberto I", Neurosurgery Division, Sapienza University, Rome, Human Neurosciences Department, Via del Policlinico, 155, 00161 Roma, Italy.

Intradural Extramedullary Spinal Melanocytoma (IESM) is an extremely uncommon tumour arising from the spinal leptomeninges; both from a gross pathology and microscopic point of view it can mimick its malignant counterpart, the Melanoma. Such tumours are usually solitary, with a lower proliferating rate and without obvious SC invasion. Their common differential diagnoses include Spinal Schwannoma and Spinal Meningiomas since they share a significant amount of radiological similarities. It is a relatively benign condition which is, to date, with no more than 24 previously reported cases, yet widely unexplored and poorly understood. We report the detailed clinical history of a 60 years old individual suffering from IESM and, by means of a thorough Literature review, the most relevant features concerning the epidemiological issues, the clinical course, the radiological appearance, the surgical results and the typical gross and microscopic pathology of a cohort of previously reported cases of IESM are extensively discussed and systematically investigated through statistical analyses in order to add to the relevant Literature a dedicated work concerning this rare and enigmatic condition.
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http://dx.doi.org/10.1016/j.jocn.2018.12.004DOI Listing
April 2019

Pneumoventricle of Unknown Origin: A Personal Experience and Literature Review of a Clinical Enigma.

World Neurosurg 2019 Feb 15;122:661-664. Epub 2018 Nov 15.

A.U.O. "Sant'Andrea", Neurosurgery Division, NESMOS Department, Sapienza University, Rome, Italy.

Background: Pneumocephalus is an uncommon and life-threatening neurologic condition. Air within the ventricular system of the brain is also known as pneumoventricle (PV). It requires emergency treatments to prevent catastrophic neurologic outcomes. Head injury is the most common cause of PV, but there are other well-recognized etiologies in case there is no clear radiological evidence of skull discontinuity.

Case Description: Although this clinical entity has been well described in the literature, our report presents the unique feature of describing a purely ventricular pneumocephalus without evidence of skull base or cranial vault fracture. Therefore, this case presentation explores mysterious causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault.

Conclusions: The aim of the present paper is to report a case of post-traumatic PV without radiological signs of skull base or convexity fracture in a 72-year-old man, underlining the diagnostic and clinical features, and review the relevant literature.
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http://dx.doi.org/10.1016/j.wneu.2018.11.050DOI Listing
February 2019

Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience.

World Neurosurg 2019 Jan 10;121:e882-e891. Epub 2018 Oct 10.

NESMOS Department Neurosurgery Department, "Sapienza" University, Roma, Italy; Azienda Universitario-Ospedaliera Sant'Andrea, Roma, Italy.

Background: Hypnosis is a technique that could aid awake surgery protocols. The aim of the present study is to describe the results of a preliminary experience of a cohort of patients operated on with an original protocol of hypnosis-aided awake surgery (HAS).

Methods: All patients were operated on with the aid of HAS and their data were retrospectively reviewed. A thorough literature review was conducted to compare the results of HAS with the standard awake surgery protocol regarding 1) the incidence of intraoperative pain; 2) the overall incidence of complications; 3) the length of time in which the patients were suitable for intraoperative neuropsychological testing; and 4) the incidence of gross total resection. The comparison presented a notably high statistical impact (1-β = 0.90-0.93 for α = 0.05; effect size, 0.5).

Results: The final cohort comprised 6 patients from our institution and 43 records retrieved in the relevant literature underwent HAS for intrinsic brain tumor treatment. This cohort was compared with cohorts of patients who were considered eligible through a literature review. HAS showed a statistically significant superiority in the first 3 outcome variables, whereas the incidence of gross total resection favored the standard awake approaches.

Conclusions: According to the results, hypnosis-aided resection of intrinsic brain tumor located in eloquent areas is safe and effective, although dissociation phenomena deserve further investigation to be completely understood.
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http://dx.doi.org/10.1016/j.wneu.2018.10.004DOI Listing
January 2019

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up.

J Orthop Traumatol 2018 Jul 27;19(1). Epub 2018 Jul 27.

IRCCS "Neuromed", Neurosurgery Division, Sapienza University, Via Atinense, 18, 86077, Pozzilli, IS, Italy.

Background: The degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on.

Methods: Patients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016.

Results: Comparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort.

Conclusions: Although the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition.

Level Of Evidence: 3.
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http://dx.doi.org/10.1186/s10195-018-0497-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119163PMC
July 2018

The Real Impact of an Intraoperative Magnetic Resonance Imaging-Equipped Operative Theatre in Neurovascular Surgery: The Sapienza University Experience.

World Neurosurg 2018 Dec 27;120:190-199. Epub 2018 Aug 27.

A.O.U. "Sant'Andrea", Neurosurgery Division, NESMOS Department, Sapienza University, Rome, Italy. Electronic address:

The fundamental role of technological instruments in contemporary Neurosurgery is undisputed, and intraoperative magnetic resonance imaging (MRI) represents one of the best examples. The use of a modern high-field magnet and the possibility to match the MRI with an operative microscope and an integrated neuronavigation system has led to successful results in the surgical treatment of different diseases. At our institute, we have performed surgery routinely with the aid of intraoperative MRI over the last 15 years. The aim of this article is to report our experience in the management of neurovascular lesions with the use of this device. We experienced that intraoperative MRI enhanced the surgical experience, leading to an improved postoperative outcome in the treatment of different lesions, such as arteriovenous malformations, dural arteriovenous fistulas, intracranial cavernous angiomas, and intracranial aneurysms. There are several advantages provided by the use of intraoperative MRI. The use of intraoperative MRI coupled with the planning station and the neuronavigation system allows one to obtain preoperative 3-dimensional reconstructions of the vessels, which aids the definition of the anatomy of each neurovascular lesion. Furthermore, the possibility performing an intraoperative scan allows a comparison with preoperative images and, subsequently, the updating of the surgical strategy. Intraoperative diffusion-weighted imaging can detect possible territorial ischemia that would be amenable to intensive treatment. Although increased costs, increased surgical times, increased anesthesiology times, and the possible increased risk of surgical infection may represent some major limitation, the use of intraoperative MRI-equipped operative theaters with integrated neuronavigation systems can prove extremely helpful in the management of neurovascular conditions.
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http://dx.doi.org/10.1016/j.wneu.2018.08.124DOI Listing
December 2018

Comparison of pure lateral and oblique lateral inter-body fusion for treatment of lumbar degenerative disk disease: a multicentric cohort study.

Eur Spine J 2018 06 18;27(Suppl 2):222-228. Epub 2018 Apr 18.

Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza", University of Rome, Rome, Italy.

Purpose: The most effective interbody fusion technique for degenerative disk disease (DDD) is still controversial. The purpose of our study is to compare pure lateral (LLIF) and oblique lateral (OLIF) approaches for the treatment of lumbar DDD from L1-L2 to L4-L5, in terms of clinical and radiological outcomes.

Materials And Methods: 45 patients underwent lumbar interbody fusion for pure lumbar DDD from  L1-L2 to L4-L5 through LLIF (n = 31, mean age 62.1 years, range 45-78 years) or OLIF (n = 14, mean age 57.4 years, range 47-77 years). Clinical evaluations were performed with ODI and SF-36 tests. Radiological assessment was based on the modification of coronal segmental Cobb angles and segmental lumbar lordosis (L1-S1).

Results: On ODI and SF-36, all patients presented good results at follow-up, with 26% the difference between the LIF and OLIF groups on ODI scale in the post-operative period, and 3.9 and 8.8 points difference on physical and mental SF-36 in favor of OLIF. Radiological parameters improved significantly in both groups. The mean correction was 6.25° for cCobb (11.3° in LIF and 1.9° in OLIF), 2.5° for sLL (2° in LLIF and 4° in OLIF).

Conclusions: LLIF and OLIF represent safe and effective MIS procedures for the treatment of lumbar DDD. LLIF had some risks of motor deficit and monitoring is mandatory, though it addressed more the coronal deformities. OLIF did not imply risks for motor deficits, but attention should be paid to vascular anatomy. It was more effective in kyphotic segmental deformities. These slides can be retrieved under Electronic Supplementary material.
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http://dx.doi.org/10.1007/s00586-018-5596-yDOI Listing
June 2018
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