Publications by authors named "Elena Solli"

10 Publications

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Primary and Secondary Optic Nerve Sheath Meningioma.

J Neurol Surg B Skull Base 2021 Feb 18;82(1):27-71. Epub 2021 Feb 18.

Divisions of Neuro-ophthalmology and Oculoplastics/Orbital Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States.

 This study was aimed to review issues relating to the recognition, radiographic diagnosis, monitoring, and management of primary and secondary optic nerve sheath meningioma (ONSM).  This study is a review of peer-reviewed literature combined with illustrative case studies.  A literature search was conducted via the PubMed database using pertinent search terms. Selected articles were limited to those written or translated into English. Additional works cited within articles were also included. Individual cases were drawn from the experience of a tertiary academic neuroophthalmic and orbital practice. Tables summarize radiotherapeutic and surgical studies, excluding single case reports and studies focusing on meningioma of intracranial origin.  Review of reported surgical and radiotherapeutic series is the primary measurement.  The natural history of optic nerve sheath meningiomas is primarily characterized by progressive ipsilateral vision loss. Diagnosis is typically based on radiographic imaging findings, with biopsy remaining indicated in some patients. Management strategies may include observation, radiation, and/or surgical intervention, or a combination of these approaches. The role of surgery, especially with respect to primary ONSM (pONSM), remains controversial. Advancement of radiotherapy techniques has shifted modern treatment paradigms in pONSM toward radiation as primary treatment, as surgical outcomes are inferior in major studies. Although radiation remains the treatment of choice in many cases, selected patients may benefit from surgery, especially in the setting of secondary ONSM (sONSM).  A wide variety of radiotherapeutic and surgical treatment modalities for ONSM exist. The specific indications for each management strategy continue to be redefined.
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http://dx.doi.org/10.1055/s-0041-1723801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987404PMC
February 2021

Posterior Approach for a Ventral Intradural Extramedullary Meningioma: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 12;20(1):E50

Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School University Hospital, Rutgers University, New Brunswick, New Jersey.

Ventral thoracic meningiomas are rare entities in which the spinal cord is attenuated and draped over the meningioma symmetrically. This is a challenging surgical entity compared to typical intradural meningiomas, which nearly always eccentrically displace the cord. In these more common meningiomas, surgical access is fairly straightforward as the meningioma is often visualized upon opening the meninges. Resection can be more safely performed with the cord largely shifted. In cases of ventral meningioma, the tumor is hidden ventral to the spinal cord, and techniques to safely mobilize the spinal cord must be utilized. We demonstrate that an entirely posterior approach allows complete resection of a ventrally situated mass. After careful identification and sectioning of the dentate ligament at multiple levels on the right side of the canal, we then suture and rotate the dentate ligament at each site, thereby allowing progressive visualization of the ventral meningioma. A narrow, but viable, working corridor to the tumor allows safe debulking. Once it is felt that the tumor can no longer be safely excised through the created corridor, we then disconnect our dentate sutures and move to the other side of the canal. Similarly, the dentate is sectioned and sutured so that the contralateral aspect of the meningioma can be visualized and debulked. The tumor can then be safely removed. A standard posterior approach and midline durotomy allows this bilateral approach to a ventrally situated meningioma and, therefore, in our mind, represents a safe and also highly effective road to resection.  Patient consent was obtained prior to publication.
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http://dx.doi.org/10.1093/ons/opaa252DOI Listing
December 2020

Deciphering the surgical treatment gap for drug-resistant epilepsy (DRE): A literature review.

Epilepsia 2020 07 19;61(7):1352-1364. Epub 2020 Jun 19.

New Jersey Neuroscience Institute, Morristown, NJ, USA.

Patients with drug-resistant epilepsy (DRE) rarely achieve seizure freedom with medical therapy alone. Despite being safe and effective for select patients with DRE, epilepsy surgery remains heavily underutilized. Multiple studies have indicated that the overall rates of surgery in patients with DRE have stagnated in recent years and may be decreasing, even when hospitalizations for epilepsy-related problems are on the rise. Ultimately, many patients with DRE who might otherwise benefit from surgery continue to have intractable seizures, lacking access to the full spectrum of available treatment options. In this article, we review the various factors accounting for the persistent underutilization of epilepsy surgery and uncover several key themes, including the persistent knowledge gap among physicians in identifying potential surgical candidates, lack of coordinated patient care, patient misconceptions of surgery, and socioeconomic disparities impeding access to care. Moreover, factors such as the cost and complexity of the preoperative evaluation, a lack of federal resource allocation for the research of surgical therapies for epilepsy, and difficulties recruiting patients to clinical trials all contribute to this multifaceted dilemma.
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http://dx.doi.org/10.1111/epi.16572DOI Listing
July 2020

Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature.

Childs Nerv Syst 2020 12 6;36(12):3147-3152. Epub 2020 May 6.

New Jersey Pediatric Neuroscience Institute, 131 Madison Avenue, Morristown, NJ, 07960, USA.

A 16-month-old female was admitted for prolonged fever, gait ataxia, and neurogenic bowel and bladder. Neurological exam was significant for decreased sensory and motor functions in bilateral lower extremities. Initial MRI showed a thoracic spine hematoma and diagnostic angiogram revealed a large AVM and aneurysm. The patient underwent surgical resection of the hematoma and AVM, as well as clipping and later endovascular coiling of the aneurysm. Due to significant hemorrhage perioperatively, she developed spastic paraplegia improved by baclofen and onabotulinumtoxin A injections. The aims of this paper were to conduct a systematic review of the literature on pediatric spinal cord vascular malformations and analyze trends in treatment options and long-term neurological outcomes. PubMed searches were conducted using keywords "pediatric spinal vascular malformation" and "pediatric spinal AVM", yielding 34 results after abstract screening and cross-reference. Endovascular embolization was determined to have better long-term outcomes, with 10/19 (52.6%) patients with postoperative complications associated with open vascular surgeries. Open versus endovascular surgical decisions can be difficult with unique spinal AVM pathologies in pediatric patients. Important considerations such as size, location, neurological deficits, and risk of rupture are important factors to consider in treating these patients. We recommend endovascular treatment as a first-line approach due to lower risk of hemorrhage and postoperative deficits.
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http://dx.doi.org/10.1007/s00381-020-04624-4DOI Listing
December 2020

Resection of a posterior fossa arteriovenous malformation complicated by leaked Onyx: a case report and review of literature.

Acta Neurochir (Wien) 2020 04 30;162(4):923-928. Epub 2020 Jan 30.

Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School and University Hospital, New Brunswick, NJ, USA.

Extravasation of Onyx is a rare complication during embolization of arteriovenous malformations (AVM). We present a case of embolization that was complicated by leakage of Onyx into the cerebellum which was later encountered during surgical excision of the AVM. Our goal is to report this rare event and to outline successful treatment of this complication. The patient's records were reviewed for medical history, laboratory and radiologic workup, and outpatient clinical follow-up. A 62-year-old female presented with Hunt Hess grade 2 and modified Fisher grade 2 subarachnoid hemorrhage (SAH) secondary to ruptured left posterior inferior cerebellar artery (PICA) aneurysm associated with a superior cerebellar vermian AVM. Following endovascular intervention, the aneurysm was completely embolized; however, only 75% of the AVM could be safely obliterated. Extravasation of Onyx from the ruptured aneurysm was noted on her initial angiogram. Elective suboccipital craniectomy was subsequently planned for resection of the residual AVM where the extravasated Onyx posed an operative nuisance during resection. Post-op angiogram confirmed complete resection of the AVM, as well as the bulk of the extravasated Onyx. Patient did well post-operatively, remaining neurologically intact throughout her hospital course. Although infrequently reported in the literature, Onyx extravasation is a potential complication that neurosurgeons should be ready to face. Adherence of Onyx to surrounding parenchyma could hinder optimal surgical resection of AVM and increase complications. Therefore, careful surgical dissection should be performed with special care to delicate neurovasculature. In this case, complete resection of the AVM and Onyx mass was safely achieved.
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http://dx.doi.org/10.1007/s00701-019-04199-3DOI Listing
April 2020

Commentary: Laser Ablation of Abnormal Neurological Tissue Using Robotic Neuroblate System (LAANTERN): Procedural Safety and Hospitalization.

Neurosurgery 2020 04;86(4):E385-E386

Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

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http://dx.doi.org/10.1093/neuros/nyz293DOI Listing
April 2020

Temporal evolution of a patient with a spinal dural arteriovenous fistula on serial MRI.

Spinal Cord Ser Cases 2018 24;4:10. Epub 2018 Jan 24.

4Department of Radiology, Westchester Medical Center, Valhalla, NY USA.

Introduction: A spinal dural arteriovenous fistula is a rare type of vascular malformation. If left untreated, these fistulas can result in significant neurological deficits secondary to spinal cord infarct or hemorrhage.

Case Presentation: A 70-year-old female with a longstanding history of episodic progressive bilateral lower extremity weakness and sensory disturbances was previously misdiagnosed with multiple sclerosis. Imaging revealed a T2 signal change from T7 to the conus with associated signal change and she subsequently underwent a T10-L1 laminectomy for clip ligation of a spinal dural arteriovenous fistula. Here we present the clinical and radiographic progression of one patient with a spinal dural arteriovenous fistula.

Discussion: Spinal dural arteriovenous fistulas are a rare but treatable cause of myelopathy, so it is important to understand its natural progression and radiologic findings as it is frequently misdiagnosed.
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http://dx.doi.org/10.1038/s41394-018-0039-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802505PMC
January 2018

Delayed Tension Pneumocephalus following Gunshot Wound to the Head: A Case Report and Review of the Literature.

Case Rep Surg 2016 15;2016:7534571. Epub 2016 Dec 15.

Department of Neurosurgery, New York Medical College, Westchester, Valhalla, NY, USA.

Tension pneumocephalus is a rare complication of head trauma and neurosurgical procedures, amongst other causes. It is defined by the combination of intracranial air, increased intracranial pressure, and mass effect. Although it often presents soon after surgery, it can also rarely present in a delayed fashion. We present a case of delayed tension pneumocephalus, occurring approximately 16 weeks after bifrontal craniectomy for a self-inflicted gunshot wound. Following a month of rhinorrhea, postnasal drip, and cough, the patient presented with a sensation of expansion in the area of the right forehead. As tension pneumocephalus is an emergency that can be fatal, this patient was treated expediently and avoided severe neurological deficits. The case recounted here is important as a demonstrative example that tension pneumocephalus does not always follow a defined course immediately after trauma or neurosurgery but rather can develop insidiously without obvious signs.
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http://dx.doi.org/10.1155/2016/7534571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198091PMC
December 2016

Spinal Cord Compression Secondary to Extramedullary Hematopoiesis: Case Report and Review of the Literature.

Case Rep Oncol 2016 May-Aug;9(2):290-7. Epub 2016 May 31.

Department of Neurosurgery, New York Medical College, Westchester Medical Center, Westchester, N.Y., USA.

Extramedullary hematopoiesis (EMH) is a rare cause of spinal cord compression (SCC). EMH represents the growth of blood cells outside of the bone marrow and occurs in a variety of hematologic illnesses, including various types of anemia and myeloproliferative disorders. Although EMH usually occurs in the liver, spleen, and lymph nodes, it may also occur within the spinal canal. When this occurs, the mass effect can compress the spinal cord, potentially leading to the development of neurological deficits. We present a case of SCC secondary to EMH. This report illustrates the importance of considering EMH in the differential diagnosis of SCC, even in the absence of signs of its most common etiologies.
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http://dx.doi.org/10.1159/000446473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939688PMC
July 2016

Metastatic Mantle Cell Lymphoma to the Pituitary Gland: Case Report and Literature Review.

Case Rep Oncol 2016 Jan-Apr;9(1):25-32. Epub 2016 Jan 13.

Department of Neurosurgery, New York Medical College, Valhalla, N.Y., USA.

We present an unusual case of a metastatic mantle cell lymphoma (MCL) to the pituitary gland. The patient had a known history of MCL for which she previously received chemotherapy. She presented with new-onset diplopia and confusion, and reported a history of progressive vision blurriness associated with headache, nausea, and vomiting. MRI of the brain showed an enhancing lesion within the sella turcica involving the cavernous sinuses bilaterally, extending into Meckel's cave on the left, and abutting the optic nerves bilaterally. Following surgical excision, histopathology revealed the tumor to be a MCL. Metastatic pituitary tumors are rare and have been estimated to make up 1% of tumors discovered in the sellar region. The two most common secondary metastatic lesions to the sella are breast and lung carcinoma followed by prostate, renal cell, and gastrointestinal carcinoma. Metastatic lymphoma to the pituitary gland is especially rare and is estimated to constitute 0.5% of all metastatic tumors to the sella turcica. To our knowledge, this is the first reported case of MCL metastasizing to the pituitary gland.
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http://dx.doi.org/10.1159/000443682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748791PMC
March 2016
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