Publications by authors named "Angelo Luca"

162 Publications

An automatic method for feature segmentation of human thoracic and lumbar vertebrae.

Comput Methods Programs Biomed 2021 Oct 19;210:106360. Epub 2021 Aug 19.

Department of Industrial and Information Engineering and Economics, L'Aquila, Italy.

Background And Objective: Because of the three-dimensional distribution of morphological features of human vertebrae and the whole spine, in recent years, to make more precise diagnoses and to design optimized surgical procedures, new protocols have been proposed based on analysing their three-dimensional (3D) models. In the related literature, processes of segmentation and morphological features recognition are essentially performed by a skilled operator that selects the interesting areas. So, being affected by the preparation and experience of the operator, this produces an evaluation that is poorly reproducible and repeatable for the uncertainties of a typical manual measurement process.

Methods: To overcome this limitation, in this paper a new automatic method is proposed for feature segmentation and recognition of human vertebrae. The proposed computer-based method, starting from 3D high density discretized models of thoracic and lumbar vertebrae, automatically performs both the semantic and geometric segmentation of their morphological features. The segmentation and recognition rules codify some important definitions used in the traditional manual method, considering all the vertebra morphology information that is invariant inter-subject.

Results: The automatic method proposed here is verified by analysing many real vertebrae, both acquired using a 3D scanner and coming from Computerized Tomography (CT) scans. The obtained results are critically discussed and compared with the traditional manual methods for vertebra analysis. The method has proven to be robust and reliable in the segmentation and recognition of morphological features of vertebrae. Furthermore, the proposed automatic method avoids the blurring of quantitative parameters get from vertebrae, resulting from poor repeatability and reproducibility of manual methods used in the state-of-the-art.

Conclusions: Starting from the automatic segmentation and recognition here proposed, it is possible to automatically calculate the parameters of thoracic or lumbar vertebrae used in archaeology, medicine, or biomechanics or define their new ones.
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http://dx.doi.org/10.1016/j.cmpb.2021.106360DOI Listing
October 2021

Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?

Am J Transplant 2021 Sep 1. Epub 2021 Sep 1.

Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy.

COVID-19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS-CoV-2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS-CoV-2-RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS-CoV-2 infection were allowed to be considered for urgent-need transplant candidates with active/resolved COVID-19. We present the results of the first 10 LTs with active COVID-19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post-LT. None of the other eight recipients was found to be SARS-CoV-2 positive during follow-up. IgG against SARS-CoV-2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID-19. In addition, testing for SARS-CoV-2 RNA on donors' liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID-19 in informed candidates with SARS-CoV-2 immunity, might contribute to safely increase the donor pool.
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http://dx.doi.org/10.1111/ajt.16823DOI Listing
September 2021

Rapidly progressive dementia and Parkinsonism as the first symptoms of dural arteriovenous fistula. The Sapienza University experience and comprehensive literature review concerning the clinical course of 102 patients.

Clin Neurol Neurosurg 2021 Sep 22;208:106835. Epub 2021 Jul 22.

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

Background: Dementia is a chronic loss of neurocognitive function that is progressive and irreversible. Dural arteriovenous fistulas (DAVFs) are acquired lesions that account for 10-15% of intracranial vascular malformations that could present with a rapid decline in neurocognitive function with or without Parkinson-like symptoms and evolve in a rapidly progressive dementia (RPD). Often the DAVFs are not even included in the differential hypotheses of this type of dementia and are not present in any type of diagnostic algorithm for evaluating RPD.

Methods: We performed a systematic review of the international literature and adding the cases coming from our institutional experience and we have collected all the reported cases of DAVFs that debut with ROD identifying the most frequent forms in terms of location and type, reporting the neurological characteristics and the outcome of each patient.

Results: The exact pathogenesis for developing dementia in patients with DAVFs remains largely unknown. The imaging changes and pathologic findings support the hypothesis that the clinical course results from the delivery of excessive volumes of blood flow into a venous system with outflow obstruction and venous congestion. The large variety of clinical manifestations of DAVFs depends on its location but this is not exactly valid for the onset of dementia. It supposed that the highly variable clinical manifestation of DAVFs has been convincingly related to the pattern of venous drainage more than location.

Conclusions: Neurologists and clinicians generally are familiar with the differential diagnoses of slowly progressive neurodegenerative dementias, but the diagnosis of RPD entails a different diagnostic approach. Due to their curable nature, the diagnosis of DAVFs must be suspected when facing a RPD picture, even more so if it is associated with characteristic abnormalities of the hemispheric white matter.
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http://dx.doi.org/10.1016/j.clineuro.2021.106835DOI Listing
September 2021

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology.

J Hepatol 2021 Jul 30. Epub 2021 Jul 30.

Gastroenterology Unit, ASL Latina, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Italy.

Background & Aims: Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model.

Methods: In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses.

Results: In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD.

Conclusions: In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed.

Lay Summary: While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
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http://dx.doi.org/10.1016/j.jhep.2021.07.018DOI Listing
July 2021

Combination of aztreonam, ceftazidime-avibactam and amikacin in the treatment of VIM-1 Pseudomonas aeruginosa ST235 osteomyelitis.

Int J Infect Dis 2021 Jul 4;108:510-512. Epub 2021 Jun 4.

Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese, Italy.

We describe a challenging case of patient with metallo-beta-lactamase-producing Pseudomonas aeruginosa sternal osteomyelitis following aortic valve replacement with biological prosthesis. The strain exhibited a multidrug-resistance phenotype carrying the bla gene and belonged to the high-risk clone sequence type ST235. The patient was successfully treated with surgical debridement plus antibiotic therapy with ceftazidime/avibactam, aztreonam, and amikacin. Time-kill curves showed that this triple antibiotic combination at 1 × MIC was strongly synergic after 8 h, achieving 99.9% killing and maintaining this until 48 h.
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http://dx.doi.org/10.1016/j.ijid.2021.05.085DOI Listing
July 2021

Dorsal epidural "Spindle Cell Lipoma" in a pregnant female.

Surg Neurol Int 2021 14;12:162. Epub 2021 Apr 14.

Department of Neurosurgery, Sapienza University, Rome, Italy.

Background: Spindle cell lipoma (SCL) constitutes just 1.5% of all lipomatous tumors. They typically occur in the upper back and shoulders. Here, we report a 37-year-old female presenting with a SCL in the dorsal epidural thoracic spine, during her 9 month of pregnancy.

Case Description: A 37-year-old female presented with a subacute (2 months) progressive paraparesis during her month of pregnancy. The MR showed a dorsal epidural mass at the D8 level. Following a cesarean section, the patient underwent a laminectomy for tumor excision. Microscopically, the lesion proved to be a SCL. At 5-year follow-up, there was no tumor recurrence.

Conclusion: SCL represents a variant of benign lipomas that may occur in the dorsal thoracic spine. Gross total excision may be followed by a benign clinical course without recurrence or malignant degeneration. Very atypical SCLs need closer follow-up to avoid the misdiagnosis of liposarcoma.
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http://dx.doi.org/10.25259/SNI_128_2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088489PMC
April 2021

Good habits from the pandemic age to bring home: Effective communication and briefing tools.

Intensive Crit Care Nurs 2021 08 17;65:103056. Epub 2021 Apr 17.

IRCCS ISMETT Direttore, Servizi Diagnostici e Terapeutici, IRCCS ISMETT, Italy.

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http://dx.doi.org/10.1016/j.iccn.2021.103056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052518PMC
August 2021

Microbiological Surveillance of Endoscopes in a Southern Italian Transplantation Hospital: A Retrospective Study from 2016 to 2019.

Int J Environ Res Public Health 2021 03 16;18(6). Epub 2021 Mar 16.

Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), 90127 Palermo, Italy.

Endoscopes are medical instruments that are used routinely in health structures. Due to their invasive nature and contact with many patients, they may cause hospital-acquired infections if not disinfected correctly. To ensure a high-level disinfection procedure or reprocessing, since the methods currently adopted in our institute are adequate, we evaluated retrospectively the presence of microorganisms in our endoscopes after reprocessing. Microbiological surveillance was performed from January 2016 to December 2019 in the instruments in use in our endoscopic room after reprocessing. In total, 35 endoscopes (3 duodenoscopes, 3 echoendoscopes, 12 bronchoscopes, 5 colonoscopes, and 12 gastroscopes) were evaluated for the presence of microorganisms, including multidrug-resistant pathogens and indicator microorganisms (IMOs). Our procedures were in agreement with an internal protocol based on Italian, international, and the Center for Disease Control and Prevention (CDC) recommendations. Of a total of 811 samples, 799 (98.5%) complied with the regulatory guidelines, while 9 (1.1%) were positive for IMOs, and 3 (0.4%) displayed more than 10 colony-forming units (CFU) of environmental and commensal pathogens. Our results show that the internal reprocessing protocol is very efficient, leading to a very low number of observed contaminations, and it could be easily implemented by other health facilities that face a huge number of hospital-acquired infections due to incorrectly disinfected endoscopes.
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http://dx.doi.org/10.3390/ijerph18063057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002344PMC
March 2021

Transjugular Intrahepatic Portosystemic Shunt: A Single-Centre Mid-term Experience Using the Viatorr Controlled-Expansion Stent.

Dig Dis Sci 2021 Feb 27. Epub 2021 Feb 27.

Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via E. Tricomi 5, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s10620-021-06867-wDOI Listing
February 2021

Moon landing in the operating room: neurosurgery in the covid-19 era.

Br J Neurosurg 2021 Feb 10. Epub 2021 Feb 10.

Department of Neurosurgery Policlinico Umberto I, University of Rome, Roma, Italia.

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http://dx.doi.org/10.1080/02688697.2021.1879014DOI Listing
February 2021

A 3D Informational Database for Automatic Archiving of Archaeological Pottery Finds.

Sensors (Basel) 2021 Feb 2;21(3). Epub 2021 Feb 2.

Department of Engineering for Innovation, University of Salento, via per Monteroni, 73100 Lecce, Italy.

From archaeological excavations, huge quantities of material are recovered, usually in the form of fragments. Their correct interpretation and classification are laborious and time-consuming and requires measurement, analysis and comparison of several items. Basing these activities on quantitative methods that process 3D digital data from experimental measurements allows optimizing the entire restoration process, making it faster, more accurate and cheaper. The 3D point clouds, captured by the scanning process, are raw data that must be properly processed to be used in automatic systems for the analysis of archeological finds. This paper focuses on the integration of a shape feature recognizer, able to support the semantic decomposition of the ancient artifact into archaeological features, with a structured database, able to query the large amount of information extracted. Through the automatic measurement of the dimensional attributes of the various features, it is possible to facilitate the comparative analyses between archaeological artifacts and the inferences of the archaeologist and to reduce the routine work. Here, a dedicated database has been proposed, able to store the information extracted from huge quantities of archaeological material using a specific shape feature recognizer. This information is useful for making comparisons but also to improve the archaeological knowledge. The database has been implemented and used for the identification of pottery fragments and the reconstruction of archaeological vessels. Reconstruction, in particular, often requires the solution of complex problems, especially when it involves types of potsherds that cannot be treated with traditional methods.
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http://dx.doi.org/10.3390/s21030978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867150PMC
February 2021

Post-crisis debriefing: A tool for improving quality in the medical emergency team system.

Intensive Crit Care Nurs 2021 Apr 6;63:102977. Epub 2021 Jan 6.

Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy. Electronic address:

Objectives: To examine clinicians' perception of quality of technical and non-technical response to emergencies and application of post crisis debriefing.

Design: Descriptive, anonymous, self-reporting survey on the needs and perception of a post-crisis debriefing implementation.

Setting: Multi-specialist medical institute in Italy focused on solid organ transplantation and organ failure support.

Main Outcomes: Perception of application of guidelines and evaluation of debriefing implementation during in-hospital emergencies.

Results: Response rate to the survey was 25% (148 health care workers). Of all respondents, 86% were employed >10 years, 75% were involved in ≤5 emergencies over the previous year. Resuscitation guidelines were considered fully applied by 55%; 64% of respondents considered the teaching programme as sufficient. Of all participants, 97% were aware of the importance of teamwork dynamics, 79% were aware of the importance of the personal performance, and 52% considered emergencies as valid opportunities for professional growth. Leadership was considered important by 45% of respondents; debriefing implemented by 41%, and considered a potentially useful tool by 85%.

Conclusion: Post-crisis debriefing is a way to diffuse self-reflective and life-long learning culture; it is perceived as a powerful tool for improving quality of the rapid response system by the vast majority of those surveyed.
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http://dx.doi.org/10.1016/j.iccn.2020.102977DOI Listing
April 2021

Vitamin D levels in liver transplantation recipients and early postoperative outcomes: Prospective observational DLiverX study.

Clin Nutr 2021 04 24;40(4):2355-2363. Epub 2020 Oct 24.

Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy.

Background & Aims: In critically ill patients with liver disease, vitamin D deficiency is associated with higher disease severity, increased frequency of infections, and worse outcomes. This study sought to describe the trend of vitamin D in orthotopic liver transplantation (OLT) recipients and its association with outcomes.

Methods: Prospective observational study of 67 consecutive OLT recipients enrolled between September, 2016 and August, 2017 at IRCCS-ISMETT, Palermo (Italy). Trend of vitamin D levels and potential factors influencing it levels were evaluated through a generalized linear mixed regression model.

Results: Sixty-four (95.5%) recipients were vitamin D deficient (<20 ng/ml), with a median value of 8.8 ng/ml [6.2-12.9], and forty-seven of these (70.1%) showed severe deficiency (<12 ng/ml) at baseline, 7.9 ng/ml [5.4-8.9]. The baseline vitamin D showed an inverse correlation with liver disease severity: Child-Pugh, MELD score, bilirubin, INR, and organ failure (p < 0.01) at baseline. Vitamin D increased on postoperative day (POD) 28 compared with POD1: +4.5 ng/ml, C.I. 95% 3.6-5.3 ng/ml, p < 0.01. Lower baseline vitamin D, donor age, transfusion of fresh frozen plasma (negative impact, all p < 0.05), and intra-operative bypass (positive impact at POD 28, p < 0.01) were associated with variation of vitamin D levels after transplantation. Incomplete graft recovery was associated with lower vitamin D on POD28: 8.2 ± 4.4 versus 13.8 ± 9.4 ng/ml, p < 0.01; the odds ratio (OR) was 0.84; CI 95% 0.73-0.97, p = 0.014. The OR for infections within POD 28 was inversely associated with baseline vitamin D: 0.87; CI 95% 0.79-0.98, p = 0.02, and with vitamin D level at baseline <12 ng/ml: OR 6.44; CI 95% 1.66-24.94; p < 0.01.

Conclusions: Preoperative Vitamin D is correlated with disease severity, and was highly associated with invasive infection in the first 28 PODs. After OLT, the value on POD 28 had a strong association with graft function.
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http://dx.doi.org/10.1016/j.clnu.2020.10.027DOI Listing
April 2021

Human amniotic stem cells improve hepatic microvascular dysfunction and portal hypertension in cirrhotic rats.

Liver Int 2020 10 9;40(10):2500-2514. Epub 2020 Aug 9.

Liver Vascular Biology Research Group, Hepatic Hemodynamic Lab. IDIBAPS-Hospital Clínic, CIBEREHD, Barcelona, Spain.

Background And Aims: Portal hypertension is the main consequence of cirrhosis, responsible for the complications defining clinical decompensation. The only cure for decompensated cirrhosis is liver transplantation, but it is a limited resource and opens the possibility of regenerative therapy. We investigated the potential of primary human amniotic membrane-derived mesenchymal stromal (hAMSCs) and epithelial (hAECs) stem cells for the treatment of portal hypertension and decompensated cirrhosis.

Methods: In vitro: Primary liver sinusoidal endothelial cells (LSECs) and hepatic stellate cells (HSCs) from cirrhotic rats (chronic CCl inhalation) were co-cultured with hAMSCs, hAECs or vehicle for 24 hours, and their RNA profile was analysed. In vivo: CCl-cirrhotic rats received 4x10 hAMSCs, 4x10 hAECs, or vehicle (NaCl 0.9%) (intraperitoneal). At 2-weeks we analysed: a) portal pressure (PP) and hepatic microvascular function; b) LSECs and HSCs phenotype; c) hepatic fibrosis and inflammation.

Results: In vitro experiments revealed sinusoidal cell phenotype amelioration when co-cultured with stem cells. Cirrhotic rats receiving stem cells, particularly hAMSCs, had significantly lower PP than vehicle-treated animals, together with improved liver microcirculatory function. This hemodynamic amelioration was associated with improvement in LSECs capillarization and HSCs de-activation, though hepatic collagen was not reduced. Rats that received amnion derived stem cells had markedly reduced hepatic inflammation and oxidative stress. Finally, liver function tests significantly improved in rats receiving hAMSCs.

Conclusions: This preclinical study shows that infusion of human amniotic stem cells effectively decreases PP by ameliorating liver microcirculation, suggesting that it may represent a new treatment option for advanced cirrhosis with portal hypertension.
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http://dx.doi.org/10.1111/liv.14610DOI Listing
October 2020

Continuous Glucose Monitoring System in Acromegalic Patients: Possible Role in the Assessment of Glycemia Control.

J Diabetes Sci Technol 2020 Aug 13:1932296820949882. Epub 2020 Aug 13.

Department of Experimental Medicine, Endocrinology, "Sapienza" University of Rome, Italy.

Background: Acromegaly is characterized by an insulin resistance condition. There is a significant difference between the different types of therapy in relation to the glycometabolic framework. The blinded continuous glucose monitoring system (CGMS), throughout a period of maximum 6 days for a total of 288 glycemic registrations per day, identifies glycemic excursions and could constitute a valid device to understand the 24-hour glycemic profiles.

Aim Of The Study: To compare the oral glucose tolerance test (OGTT) and CGMS methods in acromegalic patients to evaluate their glycemic profiles, in relation to different treatments for acromegaly.

Methods: Thirty-five acromegalic patients were divided into 18 somatostatin analogs (SSA), 9 pegvisomant, and 8 successfully surgically treated. A 72-hour CGM was performed and, immediately after, an OGTT.

Results: Results obtained from OGTT: 11/35 impaired fasting glucose, 6/35 impaired glucose tolerance, and 4/35 diabetes mellitus. A positive significant correlation was demonstrated between the OGTT peak and CGM peak in all of the patients, CGM peak of patients treated with SSA and those surgically treated, OGTT average and CGM area under concentration-time curve (AUC) for hyperglycemia of patients treated with SSA and those surgically treated, and CGM AUC for hyperglycemia of patients treated with SSA and those surgically treated.

Conclusions: Our results show a significantly higher response in terms of mean and peak OGTT in patients treated with SSA, both compared to the CGM study, and compared to the group of patients receiving pegvisomant. The CGM system could represent an instrument for the evaluation of the glycemic trend of acromegalic patients.
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http://dx.doi.org/10.1177/1932296820949882DOI Listing
August 2020

How can we optimise antifungal use in a solid organ transplant centre? Local epidemiology and antifungal stewardship implementation: A single-centre study.

Mycoses 2020 Jul 18;63(7):746-754. Epub 2020 May 18.

Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy.

Purpose: We aimed to implement and to assess the impact of the antifungal stewardship programme (AFSp) on prescription appropriateness of antifungals, management and outcomes of candidaemia patients, and antifungal consumption and costs at our solid organ transplant (SOT) institute.

Methods: Local epidemiology of invasive fungal infections (IFIs) from 2009 to 2017 was analysed in order to prepare an effective AFSp, implemented in January 2018. It included suspension of empirical antifungal prescriptions after 72 hours (antifungal time-out), automated alert and infectious disease (ID) consult for empirical prescriptions and for every patient with IFI, and indication for step-down to oral fluconazole when possible. We used process measures and results measures to assess the effects of the implemented programme.

Results: The ASFp led to significant improvements in selection of the appropriate antifungal (40.5% in pre-AFS vs 78.6% in post-AFS), correct dosing (51.2% vs 79.8%), correct length of treatment (55.9% vs 75%) and better management of patients with candidaemia. Analysis of prescribed empirical antifungal revealed that defined daily doses (DDDs) per 100 patient days decreased by 36.7% in 2018 compared to the average of pre-AFSp period, with important savings in costs.

Conclusion: This AFSp led to a better use of antifungal drugs in terms of appropriateness and consumption, with stable clinical and microbiological outcomes in patients with IFI.
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http://dx.doi.org/10.1111/myc.13098DOI Listing
July 2020

Role of endoscopic surgical biopsy in diagnoses of intraventricular/periventricular tumors: review of literature including a monocentric case series.

Acta Neurol Belg 2020 Jun 27;120(3):517-530. Epub 2020 Feb 27.

Human Neurosciences Department, Neurosurgery Division, "Sapienza" University, AOU Policlinico Umberto I, Rome, Italy.

The intra- and periventricular location tumor (IPVT) of a brain remains a hard challenge for the neurosurgeon because of the deep location and eloquent anatomic associations. Due to this high risk of iatrogenic injury, many surgeons elect to perform biopsies of such lesions to establish a diagnosis. On the one hand, stereotaxic needle biopsy (SNB) is a minimally invasive procedure but with a significant risk of complications and a high risk of lack of tissue for molecular analyses for this region [Fukushima in Neurosurgery 2:110-113 (1978)]; on the other hand, the use of endoscopic intraventricular biopsy (EIB) allows for diagnosis with minimal surgical intervention [Iwamoto et al. in Ann Neurol 64(suppl. 6):628-634 (2008)]. IPVTs and related CSF pathway obstructions can be safely and effectively treated with endoscopic techniques. It is not possible to compare EIB with diagnoses made by any other method or with the established treatment. We aim to analyze the accuracy of EIB results by comparing them with results of biopsies performed later, in other methods and thereby evaluating the treatment evolution considering our personal experience. The difficulties and complications encountered are presented and compared with those reported in the literature to obtain the best review possible for this topic. A systematic review of literature was done using MEDLINE, the NIH Library, PubMed, and Google Scholar yielded 1.951 cases for EIB and 1912 for SNB, according to standard systemic review techniques. Review was conducted on 50 studies describing surgical procedures for lesions intra- and para-ventricular. The primary outcome measure was a diagnostic success. We also consider 20 patients with IPVT treated in our department. Clinical characteristics and surgical outcome were evaluated and a systematic review of the literature was performed. Overall, all our biopsies were diagnostic, with a positive histologic sample in 100% of our patients. 8 patients underwent a concurrent endoscopic third ventriculostomy. 4 patients underwent a concurrent ventriculostomy combined with septostomy. For 1 patient was necessary the only septostomy combined with biopsy. Every case has obtained a histological diagnosis. The percentage of complications was very low with only 1 case of post-operative infection and 1 case of hemorrhage. It was impossible to create a specific comparison from literature data of IPVTs between a stereotactic and endoscopic procedure, it presents only the collection of pineal gland tumor [Kelly in Neurosurgery 25(02):185-194 (1989); Quick-Weller in World Neurosurgery 96:124-128 (2016)] or unknown location of the lesion in major review [Marenco-Hillembrand et al. in Front Oncol 8:558 (2018)]. The present study aims to report our experience with the surgical management of IPVTs. The EIB sample yields an accurate histologic diagnosis tumor, with a positive histologic sample in 87, 95% of patients. The choice of the appropriate procedure should consider not only the preference and the experience of the neurosurgeon but also the several other variables as the location. While some periventricular lesions are better approached by endoscopic techniques, others are more suited for stereotactic-guided approaches. The ability to perform an EIB and relieve tumor-associated hydrocephalus by neuroendoscopy is considered to be a benefit of this procedure since this is less invasive than other treatments.
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http://dx.doi.org/10.1007/s13760-020-01299-1DOI Listing
June 2020

Radiation exposure during transjugular intrahepatic portosystemic shunt creation in patients with complete portal vein thrombosis or portal cavernoma.

Radiol Med 2020 Jul 18;125(7):609-617. Epub 2020 Feb 18.

Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi, 5, 90127, Palermo, PA, Italy.

Background: This study aims to evaluate radiation exposure in patients with complete portal vein thrombosis (CPVT) or portal cavernoma (PC) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation using real-time ultrasound guidance for portal vein targeting.

Materials And Methods: This is a single institution retrospective analysis. Between August 2009 and September 2018, TIPS was attempted in 49 patients with CPVT or PC. Radiation exposure (dose area product [DAP], air KERMA (AK) and fluoroscopy time [FT]), technical success, clinical success, complications and survival were analyzed.

Results: In total, 29 patients had CPVT and 20 patients had PC. 41/49 patients had cirrhosis. TIPS indications were refractory ascites (n =  25), variceal bleeding (n = 16) and other (n = 8). TIPS was successfully placed in 94% (46/49) of patients via a transjugular approach alone (n = 40), a transjugular/transhepatic approach (n = 5) and a transjugular/transsplenic approach (n = 1). Median DAP was 261 Gy * cm (range 29-950), median AK was 0.2 Gy (range 0.05-0.5), and median FT was 28.2 min (range 7.7-93.7). Mean portosystemic pressure gradient decreased from 16.8  ±  5.1 mmHg to 7.5  ±  3.3 mmHg (P <  0.01). There were no major procedural complications. Overall clinical success was achieved in 77% of patients (mean follow-up of 21.1 months). Encephalopathy was observed in 16 patients (34%), grade II-III encephalopathy in 7 patients (15%). TIPS revision was performed in 15 patients (32%). Overall survival rate was 75%.

Conclusion: In our experience, the use of real-time ultrasound guidance allowed the majority of the TIPS to be performed via a transjugular approach alone with a reasonably low radiation exposure considering the high technical difficulties of the selected cohort of patients with CVPT or PC.
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http://dx.doi.org/10.1007/s11547-020-01155-5DOI Listing
July 2020

The RNA-Binding Ubiquitin Ligase MEX3A Affects Glioblastoma Tumorigenesis by Inducing Ubiquitylation and Degradation of RIG-I.

Cancers (Basel) 2020 Jan 30;12(2). Epub 2020 Jan 30.

Department of Molecular Medicine, Sapienza University, Viale Regina Elena 291, 00161 Rome, Italy.

Glioblastoma multiforme (GB) is the most malignant primary brain tumor in humans, with an overall survival of approximatively 15 months. The molecular heterogeneity of GB, as well as its rapid progression, invasiveness and the occurrence of drug-resistant cancer stem cells, limits the efficacy of the current treatments. In order to develop an innovative therapeutic strategy, it is mandatory to identify and characterize new molecular players responsible for the GB malignant phenotype. In this study, the RNA-binding ubiquitin ligase MEX3A was selected from a gene expression analysis performed on publicly available datasets, to assess its biological and still-unknown activity in GB tumorigenesis. We find that MEX3A is strongly up-regulated in GB specimens, and this correlates with very low protein levels of RIG-I, a tumor suppressor involved in differentiation, apoptosis and innate immune response. We demonstrate that MEX3A binds RIG-I and induces its ubiquitylation and proteasome-dependent degradation. Further, the genetic depletion of MEX3A leads to an increase of RIG-I protein levels and results in the suppression of GB cell growth. Our findings unveil a novel molecular mechanism involved in GB tumorigenesis and suggest MEX3A and RIG-I as promising therapeutic targets in GB.
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http://dx.doi.org/10.3390/cancers12020321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072305PMC
January 2020

A rare case of Meckel's cave primary lymphoma: a case report and elaboration of the diagnostic algorithm.

Acta Neurol Belg 2021 Aug 25;121(4):907-914. Epub 2020 Jan 25.

Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.

Management of lesions involving Meckel's cave can represent a challenge for neurosurgeons, because of the deep-seated location and the surrounding complex neurovascular structures. Very small lesions arising from MC are generally asymptomatic and radiological follow-up with head MRI and PET-CT is sufficient to control these lesions. In rare cases, the rapid increase in the size of lesions and the alteration of the neurologic status make early histological characterization mandatory in the plethora of lesions arising from Meckel's cave; a very small percentage is represented by central nervous system lymphomas. Primary diffuse large B-cell lymphoma is the most commonly found. Aggressive surgery, in case of suspicious Meckel's cave lesions, is strongly discouraged, because this procedure may increase the risk of postoperative deficit and provides no survival benefit compared with biopsy alone. The aim of the present paper is to report a very rare case of primary Meckel's cave diffuse large B-cell lymphoma (only seven cases were described in literature) and standardize an operative algorithm to avoid the risks of an incorrect surgical conduct.
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http://dx.doi.org/10.1007/s13760-020-01281-xDOI Listing
August 2021

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

Enhanced Recovery after Implementation of Surgery Protocol in Living Kidney Donors: The ISMETT Experience.

Transplant Proc 2019 Nov 9;51(9):2910-2913. Epub 2019 Oct 9.

Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy; University of Catania, Catania, Italy.

Introduction: Laparoscopic living donor nephrectomy (LLDN) has become the standard procedure for living kidney transplantation. Enhanced recovery after surgery (ERAS) is a multimodal perioperative management aimed at facilitating rapid patient recovery after major surgery by modifying the response to stress induced by exposure to surgery. This association can further reduce hospital stay, surgical stress, and perioperative morbidity of living kidney donors.

Material And Methods: In this retrospective analysis conducted at our institute, we compared the first 21 patients who underwent LLDN enrolled with the ERAS protocol with 55 patients who underwent LLDN with the fast-track protocol in the 5 years prior to ERAS protocol implementation.

Results: We evaluated 76 consecutive patients. After ERAS protocol implementation, elderly living donors had a shorter hospital stay and a faster return to normal life compared with the same age group of patients in the previous period. There were no major differences in median postoperative hospital stay and no meaningful differences in the percentage of complications after surgery and hospital readmissions.

Conclusions: The introduction of the ERAS protocol for patients undergoing LLDN compared with the traditional protocol led to a reduction in postoperative hospitalization in elder donors, without determining a raise in the number of hospital complications and readmissions.
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http://dx.doi.org/10.1016/j.transproceed.2019.04.089DOI Listing
November 2019

3D Virtual Reconstruction of the Ancient Roman of the Fucino Lake.

Sensors (Basel) 2019 Aug 10;19(16). Epub 2019 Aug 10.

Department of Industrial and Information Engineering and of Economics, University of L'Aquila, via G. 6 Gronchi 18, 67100 L'Aquila, Italy.

The construction of the artificial emissary of Fucino Lake is one of the most ambitious engineering buildings of antiquity. It was the longest tunnel ever made until the 19th century and, due to the depth of the adduction inlet, it required a monumental and complex , which, for functionality, cannot be compared to other ancient emissaries. The Roman emissary and its "" (Latin name of the inlet structure) were almost completely destroyed in the 19th century, when Fucino Lake was finally dried. Today, only few auxiliary structures such as wells, tunnels, and winzes remain of this ancient work. As evidence of the ancient remains a description made by those who also destroyed it and some drawings made by travelers who, on various occasions, visited the site. This paper presents a virtual reconstruction of the Roman , obtained both through the philological study of the known documentation, interpreting iconographic sources that represent the last evidence of this structure, and through the survey on the territory. The main purpose is to understand its technical functionalities, the original structures, and its evolution during the time, taking into account the evolution of the Fucino Lake water levels, technological issues, and finally offering its visual reconstruction.
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http://dx.doi.org/10.3390/s19163505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720298PMC
August 2019

A rare case of spinal epidural sarcoidosis: case report and review of the literature.

Acta Neurol Belg 2021 Apr 11;121(2):415-420. Epub 2019 Jul 11.

Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Viale del Policlinico 155, 00146, Rome, Italy.

Sarcoidosis is a rare systemic disease characterized by growth and organization of inflammatory cells in a granuloma. Granulomas can localize in any parts of the human body. The main localization is represented by lungs, lymph nodes, eyes and skin. Any organ, however, can be affected. Central nervous system (CNS) represents a rare localization of sarcoidosis, in fact, only 1% of patient with sarcoidosis present brain and/or spinal cord localization of the granulomas associated with this disease. This condition takes the name of Neurosarcoidosis. Its diagnosis and management pose a significant challenge, as its clinical manifestation and appearance in imaging studies are difficult to distinguish from more common lesion of the spinal cord. In this paper, we present the case of a 45-year-old woman who presented back pain associated with neurologic signs of myelopathy. Spinal cord MRI documented a T2 hyperintense signal around medullary conus. She underwent a gross total removal of the lesion. Histopathological examination revealed spinal sarcoidosis. Next total body CT scan did not show other localization of the disease. The aim of the present paper is to report a very rare case of spinal epidural sarcoidosis, actually only five cases have been described, without other localization of the disease. The present article underlines the difference between this forms of spinal sarcoidosis compared to intradural extramedullary and intramedullary spinal sarcoidosis.
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http://dx.doi.org/10.1007/s13760-019-01189-1DOI Listing
April 2021

Timing of Low-Dose Aspirin Discontinuation and the Influence on Clinical Outcome of Patients Undergoing Surgery for Chronic Subdural Hematoma.

World Neurosurg 2019 Sep 11;129:e695-e699. Epub 2019 Jun 11.

Neurosurgery Division, Department of Morphology, Surgery, and Experimental Medicine, Ferrara University, Hospital S. Anna, Ferrara, Italy.

Background: An appropriate time (5-7 days) of discontinuation of low-dose acetylsalicylic acid (ASA) in patients undergoing surgery for chronic subdural hematoma (CSDH) is recommended. However, patient clinical deterioration often does not allow to wait the recommended time for surgery. Clear guidelines regarding the perioperative management of patients with ASA therapy are still lacking. The aim of this study is to compare the surgical outcome, complications, and mortality of patients suffering from CSDHs who underwent urgent surgery or before and after 5 days of discontinuation of low-dose ASA.

Methods: A retrospective 3-center study included patients treated for CSDH taking low-dose ASA. Aspirin was discontinued on hospital admission. Based on the timing of discontinuation, we classified patients in 3 groups: urgent (surgery at admission), surgery within 5 days, and surgery 5 days after discontinuation. Surgery consisted of minicraniotomy or burr holes. Variables analyzed were age, comorbidities, modified Rankin Scale, complications, rebleedings, and mortality. Outcome measures were acute rebleeding requiring surgery, recurrence, mortality, complications, and clinical conditions. The χ test and the Fisher exact test were used to compare variables. Logistic regression analysis was used for defining the impact on outcome measures.

Results: We enrolled 164 patients. After aspirin discontinuation, patients underwent surgery: on admission (69 cases [42.1%]), within 5 days (59 patients [36%]), and after 5 days (36 cases [22%]). No correlation was observed between time of discontinuation and outcome measures, including having a worse clinical outcome.

Conclusions: Our data showed that the time of discontinuation of ASA does not influence outcome.
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http://dx.doi.org/10.1016/j.wneu.2019.05.252DOI Listing
September 2019

Severe mitral valve stenosis due to a giant left atrial mass.

Eur J Cardiothorac Surg 2019 Dec;56(6):1207

Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy.

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http://dx.doi.org/10.1093/ejcts/ezz166DOI Listing
December 2019

Epidemiology and successful containment of a carbapenem-resistant Enterobacteriaceae outbreak in a Southern Italian Transplant Institute.

Transpl Infect Dis 2019 Aug 11;21(4):e13119. Epub 2019 Jun 11.

IRCCS-ISMETT, Palermo, Italy.

Introduction: Carbapenem-resistant enterobacteriaceae (CRE) infections are difficult to treat and pose a serious threat to solid organ transplant (SOT) recipients. At our institute we observed an infection burden in 2012.

Methods: In order to contain the spread of CRE infections, we established a taskforce to implement guidelines suggested by the Centers for Disease Control and Prevention (CDC) for this type of outbreak. Here, we describe the epidemiology of the outbreak in our SOT population, and the effectiveness of such interventions, by comparing levels of CRE hospital-acquired infection (HAI) pre- and post-task force intervention (from January 2009 to December 2012, and from September 2013 to December 2016, respectively) through a linear regression model.

Results: In this study, we included 933 patients who underwent a total of 1017 SOT procedures, 286 of whom had a CRE-positive culture (28.8%), of which 65 (22.7% of CRE positive) developed infection. One-year mortality post-SOT was significantly higher in patients with CRE infection. After the taskforce intervention, the CRE HAI rate in SOT showed a significant inverse trend (event rate: -1.28, CI -1.70 to 0.86; P < 0.01).

Conclusion: In the paucity of treatment options, the application of CDC measures in our SOT institute contributed significantly to containing CRE infections.
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http://dx.doi.org/10.1111/tid.13119DOI Listing
August 2019

Role of Allelic Imbalance in Predicting Hepatocellular Carcinoma (HCC) Recurrence Risk After Liver Transplant.

Ann Transplant 2019 Apr 24;24:223-233. Epub 2019 Apr 24.

Department for Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and High Specialization Therapies (IRCCS-ISMETT), Palermo, Italy.

BACKGROUND One of the most controversial problems for liver transplantation in patients affected by hepatocellular carcinoma (HCC) remains the lack of an oncologic staging system to predict cancer recurrence after liver transplantation (LT). We analyzed allelic imbalance (AI) in 19 microsatellites, and assessed the post-LT HCC recurrence risk. MATERIAL AND METHODS Seventy-one patients were included; 18 had tumor recurrence within 5 years post-transplant. Molecular analysis was done in the primary HCC and peripheral blood samples: a total of 19 microsatellites was used to assess AI. Specific AI was evaluated when outside of range value between 0.66 and 1.5. Based on data in the literature, we grouped the 19 microsatellites into 4 panels. We calculated the fractional allelic imbalance (FAI) to make comparisons between different panels including different subsets of microsatellites. RESULTS We report that AI was associated with HCC recurrence in 3 main loci (D3S2303, D9S251, and D9S254). Tumor recurrence was associated only with 2 specific panels with 9 microsatellites previously reported to be associated with high risk for HCC recurrence. Our data show that fractional allelic imbalance (FAI) index has good negative ability to predict HCC recurrence (Panel 2: negative predictive value of 95%). CONCLUSIONS AI analysis could have prognostic value in risk management of HCC recurrence after LT, especially for early recurrence.
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http://dx.doi.org/10.12659/AOT.913692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500106PMC
April 2019

Percutaneous recanalization of a segmental inferior vena cava occlusion in a patient with situs viscerum inversus and symptomatic Budd-Chiari syndrome.

Dig Liver Dis 2019 06 22;51(6):909. Epub 2019 Feb 22.

Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy.

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http://dx.doi.org/10.1016/j.dld.2019.02.007DOI Listing
June 2019

Atypical Manifestation of Direct Low-Flow Carotid-Cavernous Fistula: Case Report and Review of the Literature.

World Neurosurg 2019 05 26;125:456-460. Epub 2019 Feb 26.

Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.

Background: Carotid cavernous fistula (CCF) is a rare type of arteriovenous shunt that develops within the cavernous sinus (CS). Direct CCFs entail a direct communication between the cavernous internal carotid artery and the CS and are typically high-flow lesions. Most CCFs drain into the ophthalmic veins (typical venous drainage pattern), leading to the pathognomic ocular clinical triad associated with a CCF. When an obstruction of the typical venous outflow is present, the arterial pressure generated by the fistula is transmitted into the cerebral venous system via the sphenoparietal sinus, which might lead to intracerebral hemorrhage. We present a rare case of posttraumatic, direct, low-flow CCF associated with cerebral hemorrhage, a typical venous drainage pattern, and without ocular symptoms at presentation.

Case Description: A 76-year-old woman was hospitalized for a posttraumatic frontotemporopolar hemorrhage associated with multiple fractures of the maxillofacial and cranial base skeleton and midline shift >10 mm. On neurologic examination the Glasgow Coma Scale was 8 and right anisocoria was present. Immediate surgical evacuation of the hematoma was performed. Severe arterial bleeding from the anterior third of the middle cranial fossa floor was controlled intraoperatively. Postoperative brain angio-magnetic resonance imaging and digital subtraction angiography showed a direct CCF without theft phenomenon. Ocular symptoms, and ultimately loss of function of the right eye, appeared 2 weeks from surgery. Endovascular treatment of the CCF was attempted attaining partial closure of the shunt using coils.

Conclusions: Direct low-flow CCFs are exceedingly rare lesions. Five cases have been described in the literature, 4 of which were associated with spontaneous rupture of a cavernous carotid aneurysm while only 1 case was associated with posttraumatic rupture of a cavernous internal carotid artery pseudoaneurysm. In addition, despite our patient having developed an intraparenchymal hemorrhage most probably correlated to the CCF, the latter was associated with a typical venous drainage via the superior ophthalmic vein, which is uncommonly correlated to intraparenchymal bleeding.
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http://dx.doi.org/10.1016/j.wneu.2019.02.027DOI Listing
May 2019
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