Publications by authors named "Lorenzo Cirignotta"

2 Publications

  • Page 1 of 1

Infra-Temporal and Pterygo-Palatine Fossae Tumors: A Frontier in Endoscopic Endonasal Surgery-Description of the Surgical Anatomy of the Approach and Report of Illustrative Cases.

Int J Environ Res Public Health 2022 05 25;19(11). Epub 2022 May 25.

Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy.

Infratemporal and pterygopalatine fossae (ITF and PPF) represent two complex paramedian skull base areas, which can be defined as jewelry boxes, containing a large number of neurovascular and osteomuscular structures of primary importance. They are in close communication with many craniofacial areas, such as nasal/paranasal sinuses, orbit, middle cranial fossa, and oral cavities. Therefore, they can be involved by tumoral, infective or inflammatory lesions spreading from these spaces. Moreover, they can be the primary site of the development of some primitive tumors. For the deep-seated location of ITF and PPF lesions and their close relationship with the surrounding functional neuro-vascular structures, their surgery represents a challenge. In the last decades, the introduction of the endoscope in skull base surgery has favored the development of an innovative anterior endonasal approach for ITF and PPF tumors: the transmaxillary-pterygoid, which gives a direct and straightforward route for these areas. It has demonstrated that it is effective and safe for the treatment of a large number of benign and malignant neoplasms, located in these fossae, avoiding extensive bone drilling, soft tissue demolition, possibly unaesthetic scars, and reducing the risk of neurological deficits. However, some limits, especially for vascular tumors or lesions with lateral extension, are still present. Based on the experience of our multidisciplinary team, we present our operative technique, surgical indications, and pre- and post-operative management protocol for patients with ITF and PPF tumors.
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May 2022

Along-tract analysis of the arcuate fasciculus using the Laplacian operator to evaluate different tractography methods.

Magn Reson Imaging 2018 12 27;54:183-193. Epub 2018 Aug 27.

Department of Biomedical and NeuroMotor Sciences, Functional MR Unit, University of Bologna, Bologna, Italia; IRCCS Istituto delle Scienze Neurologiche di Bologna, Diagnostica Funzionale Neuroradiologica, Bologna, Italia.

Purpose: We propose a new along-tract algorithm to compare different tractography algorithms in tract curvature mapping and along-tract analysis of the arcuate fasciculus (AF). In particular, we quantified along-tract diffusion parameters and AF spatial distribution evaluating hemispheric asymmetries in a group of healthy subjects.

Methods: The AF was bilaterally reconstructed in a group of 29 healthy subjects using the probabilistic ball-and-sticks model, and both deterministic and probabilistic constrained spherical deconvolution. We chose cortical ROIs as tractography targets and the developed along-tract algorithm used the Laplacian operator to parameterize the volume of the tract, allowing along-tract analysis and tract curvature mapping independent of the tractography algorithm used.

Results: The Laplacian parameterization successfully described the tract geometry underlying hemispheric asymmetries in the AF curvature. Using the probabilistic tractography methods, we found more tracts branching towards cortical terminations in the left hemisphere. This influenced the left AF curvature and its diffusion parameters, which were significantly different with respect to the right. In particular, we detected projections towards the middle temporal and inferior frontal gyri bilaterally, and towards the superior temporal and precentral gyri in the left hemisphere, with a significantly increased volume and connectivity.

Conclusions: The approach we propose is useful to evaluate brain asymmetries, assessing the volume, the diffusion properties and the quantitative spatial localization of the AF.
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December 2018