Publications by authors named "Luigino Tosatto"

20 Publications

  • Page 1 of 1

De Novo Dural Arteriovenous Fistula on Draining Veins of Previously Treated Pial Arteriovenous Malformation: a Case Report.

J Stroke Cerebrovasc Dis 2021 Apr 17;30(7):105798. Epub 2021 Apr 17.

Department of Neuroradiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy. Electronic address:

A 71-year-old man, with a pial micro-arteriovenous malformation (pAVM) draining into the confluence of the vein of Trolard and the vein of Labbé was surgically removed, sparing these cortical veins. 4-months MR and angiographic controls showed a de novo dural arteriovenous fistula (dAVF) draining into the previously spared cortical veins. It was removed using intraoperative motor evoked potentials (MEP). This is the first case of iatrogenic dAVF developing on the same draining vein of a previously treated pAVM. De novo dAVFs are generally iatrogenic. This case suggests that the unresected venous drainage of an AVM might be the substratum for neo-angiogenetic processes; moreover inflammation related to surgery might be the trigger factor for the development of the dAVF.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105798DOI Listing
April 2021

"Single-step" resection and cranio-orbital reconstruction for spheno-orbital metastasis with custom made implant. A case report and review of the literature.

Int J Surg Case Rep 2021 Apr 11;81:105755. Epub 2021 Mar 11.

Department of Neurosurgery, Hospital "M. Bufalini" - AUSL della Romagna, 286 Viale Ghirotti, 47521 Cesena, Italy.

Introduction And Importance: Brain metastasis involving the skull base is a rare complication of malignant tumors. Besides radiotherapy, surgical treatment is a therapeutical option even though it may apply complex technical procedures that may delay complementary therapies. However, in recent days, the innovation of custom-made implants allows treating selected patients with fewer complications and better results.

Case Presentation: We describe a single case of a complex fronto-orbital skull base metastasis requiring skull bone reconstruction that we treated with a single-step surgery and custom-made implant. Our procedure consists of two steps: in the first one, we perform a "virtual" craniotomy on a 3D phantom model previously built on a high-resolution bone CT scan. In the second step, the actual surgical procedure, the patient undergoes the resection and reconstruction of the cranial defect with an implant of PMMA custom-made cranioplasty. A three-month clinical and radiological follow-up is reported, which documented the extent of resection and good aesthetic results.

Clinical Discussion: In our case, we performed a skull reconstruction of cranio-orbital region with macroscopic gross-total resection of the tumor. Complementary radiotherapy was obtained after one month. Three-month follow-up showed good esthetic results and progression-free disease. A recent review of the literature is provided to discuss different reconstruction techniques.

Conclusion: "Single-Step" resection and custom-made reconstruction is a relatively new technique that could be helpful not only for benign tumors, which remains its main application but also in selected cases of malignant tumors when immediate reconstruction and faster complementary treatments are needed.
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http://dx.doi.org/10.1016/j.ijscr.2021.105755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010640PMC
April 2021

High-pressure oxygen rewires glucose metabolism of patient-derived glioblastoma cells and fuels inflammasome response.

Cancer Lett 2021 May 27;506:152-166. Epub 2021 Feb 27.

Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. Electronic address:

Human glioblastoma (GBM) is one of the most feared primary malignant brain tumors. We investigated the effect of hyperbaric oxygen (HBO) on GBM patient-derived cells and on microglia cell biology (CHME-5). HBO administered to GBM cells inhibited cell proliferation, downregulated hypoxia-inducible factor 1 α (HIF-1α) expression, and induced glucose metabolism reprogramming (glucose rewiring). It also affected the ability of a cell to perpetuate its lineage, give rise to differentiated cells and interact with its environment to maintain a balance between quiescence, proliferation and regeneration (stemness features). Such an effect may be ascribable to an increase in intracellular ROS levels and to the triggering of inflammasome signaling by HBO itself through caspase1 activation. Moreover, the results obtained from the combination of HBO and radiotherapy (RT) clearly showed a radiosensitising effect of HBO on GBM cells grown in both 2D and 3D, and a radioprotective effect of HBO in CHME-5. In addition, the exposure of M0 microglia cells to exhausted medium or extracellular vesicles (EVs) of HBO-treated GBM cells upregulated the expression of pro-inflammatory cytokines IL1β, IL6 and STAT1, whilst also downregulating the anti-inflammatory cytokine PPARγ. Collectively, these data provide a scientific rationale for the use of HBO in combination with RT for the treatment of patients with GBM.
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http://dx.doi.org/10.1016/j.canlet.2021.02.019DOI Listing
May 2021

Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience.

Global Spine J 2021 Feb 16:2192568220988272. Epub 2021 Feb 16.

Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy.

Study Design: Retrospective multicenter.

Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH.

Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA.

Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( = 0.12) to the burr ( = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( = 0.15). Use of curved chisel reduced the surgical times ( = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( = 0.04) and shorter waiting times for surgery ( < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery.

Conclusion: The "age of DISH" counts more than patients' age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.
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http://dx.doi.org/10.1177/2192568220988272DOI Listing
February 2021

Two Cases of Double Pituitary Adenomas in a Surgical Series over 16 Years in a Single Centre

Endocr Metab Immune Disord Drug Targets 2021 02 3. Epub 2021 Feb 3.

Endocrinology and Diabetology Unit, Hospital "M. Bufalini", Cesena, . Italy.

Background: Double pituitary adenomas (DA) are two morphologically and immunohystochemically different tumors in the same gland. They are rare, generally small adenomas and divided in: separated, when clearly recognizable before or during surgery, and contiguous, when diagnosed only in the following histopathological examination. Acromegaly and Cushing’s disease are the main prevalent clinical presentation.

Objective: We described two cases of DA in a surgical series over 16 years in a single center.

Method: In September 2018 we diagnosed a DA in a man with acromegaly (case 1). In order to assess the presence of other cases of DA, we performed a retrospective analysis of the endonasal endoscopically operated sellar adenomas from January 2004 to December 2019

Results: 468 pituitary adenomas were found. A DA with a Pit-1 positive small macroadenoma (GH-TSH- PRL positive) and an ACTH microadenoma clinically silent in an acromegalic woman was retrospectively found (case 2).

Conclusion: Our analysis confirms that DA are rare (0.4 % of the pituitary adenomas) and often associated with acromegaly. Their pre-operatively diagnosis is difficult but clinician’s awareness of DA can improve the diagnosis. The use of pituitary transcription factors could be useful in detecting DA.
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http://dx.doi.org/10.2174/1871530321666210203213758DOI Listing
February 2021

Synchronized "One-Step" Resection and Cranio-Orbital Reconstruction for Spheno-Orbital Lesions With Custom Made Implant.

J Craniofac Surg 2021 Jan 29. Epub 2021 Jan 29.

Department of Neurosurgery Department of Maxillofacial Surgery, "M. Bufalini" Hospital, Romagna Health System, Cesena, Italy.

Background: In the last few years, skull base tumors involving the fronto-orbital region have been approached with complex, invasive, and time-consuming cranial reconstruction techniques. On the other hand, recent custom-made implants allow easier and faster procedures, with excellent aesthetic results. The authors propose an easy surgical-planned protocol with a synchronized "one-step" resection and reconstruction of these complex lesions, with a preformed poly-methyilmethacrylate (PMMA) cranioplasty.

Methods: Our technique consists of a 2-phases procedure. In the first one, the so-called "virtual" phase, the authors get a tailored 3D-PMMA model based on high-resolution (HR) CT-scans of the patient's skull. Afterward, the authors perform the planned craniotomy on the 3D-PMMA model with the assistance of intraoperative navigation system. Therefore, a further CT-scan of the resected model is performed to develop the final implant. In the second phase, the "surgical phase," a single procedure consisting in a cranial resection and custom reconstruction is performed with the assistance of stealth-navigation. The authors describe 6 cases of complex fronto-orbital-sphenoidal benign tumors that required skull reconstruction. All patients were examined 3 months after surgery through cosmetic (facial and eyes symmetry and globe position) and ophthalmology tests (visual field, visual impairment, and diplopia). Postsurgical HR CT-scans of the head and MRI-scans of the brain documented a total resection of the tumor and an optimal accuracy of skull reconstruction.

Results: In all cases, the authors obtained a highly accurate skull reconstruction following cranio-orbital tumor resection, with a less aggressive and faster procedure compared to autologous bone graft. Final cosmetic and functional results were excellent, with good results in cases of presurgical exophthalmos and orbital asymmetry. None of the patients developed implant-related complications.

Conclusions: The "one-step" resection and reconstruction of benign tumors involving the spheno-orbital region with neuronavigation assistance is a technique that allows an accurate tumor removal and a cranial-bone reconstruction within a single surgical procedure, with fewer complications and excellent cosmetic and functional results.
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http://dx.doi.org/10.1097/SCS.0000000000007385DOI Listing
January 2021

Incidence of hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 national quarantine in Italy.

Clin Neurol Neurosurg 2021 03 19;202:106503. Epub 2021 Jan 19.

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

Background: hemorrhagic cerebrovascular disease due to vascular malformations represents an emergency for neurosurgery and neuro-interventional departments. During the COVID-19 pandemic, a dramatic reduction in the number of hospitalizations for acute myocardial infarction or stroke and a larger time interval from symptom onset to first medical contact have been reported. This study aims to verify the hypothesis that there would also have been a reduction of admissions for hemorrhagic cerebrovascular disease during the Italian lockdown.

Material And Method: s A multicenter, observational survey was conducted to collect data on hospital admissions for hemorrhagic cerebrovascular disease due to vascular malformations throughout two-months (March 15th to May 15th); the years 2020 (COVID-19 Italian lockdown), 2019 and 2018 were compared. Cases were identified by ICD-9 codes 430, 431, 432.1, 432.9, 747.81 of each hospital database. The statistical significance of the difference between the event rate of one year versus the others was evaluated using Poisson Means test, assuming a constant population.

Results: During the 2020 lockdown, the total number of admissions for hemorrhagic cerebrovascular disease was 92 compared with 116 in 2019 and 95 in 2018. This difference was not significant. GCS upon admission was 3-8 in 44 % of cases in 2020 (41 patients), 39.7 % in 2019 (46 patients) and 28 % in 2018 (27 patients).

Conclusion: Reduction of admissions for hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 lockdown was not confirmed. Nevertheless, some patients reached the emergency rooms only several days after symptoms onset, resulting in a worse clinical condition at admission.
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http://dx.doi.org/10.1016/j.clineuro.2021.106503DOI Listing
March 2021

Epidermoid cyst of the anterior clinoid process: report of a unique finding and literature review of the middle cranial fossa locations.

Clin Neurol Neurosurg 2021 Jan 27;200:106381. Epub 2020 Nov 27.

Maurizio Bufalini Hospital, Neurosurgery Department, Cesena, Italy.

Background: Epidermoids cysts are relatively rare, benign, congenital tumours, representing from 0.3% to 1.8% of all intracranial lesions. When extradural, they are most commonly reported in the temporal or parietal bones as intradiploic lesions; when intradural their most common location is the cerebellopontine angle and less frequently the middle cranial fossa. Herein we present a unique case of an extradural-intraosseous epidermoid cyst of the anterior clinoid process, integrating our single-case experience into a focused literature review of these lesions, when located in the middle cranial fossa.

Case Description: A 49 years old man came to our attention with history of head trauma. Urgent brain CT and elective brain MRI showed imaging suggestive for an anterior clinoid process epidermoid cyst. Through a pterional approach, the lesion was completely removed with microsurgical endoscope assisted technique. MRI at one year follow up showed no recurrence.

Methods: Current literature on epidermoid cysts located in middle cranial fossa was reviewed. A total of 22 papers, containing 70 epidermoid cyst were selected for the review. Symptoms at presentation; anatomic location; surgical approach; extent of resection and recurrence; outcome after surgery and at follow up were analysed for each case.

Conclusions: In the 70 published cases of middle fossa epidermoid cysts, the majority presented with trigeminal neuralgia. Most of the cases were operated through a pterional approach, while recent literature showed an increasing interest in endonasal endoscopic techniques. Subtotal resection is not a straight predictive value for recurrence; post-operative neurological deficits incidence is low and generally resolve at follow-up.
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http://dx.doi.org/10.1016/j.clineuro.2020.106381DOI Listing
January 2021

Influence of Intratumor Heterogeneity on the Predictivity of MGMT Gene Promoter Methylation Status in Glioblastoma.

Front Oncol 2020 20;10:533000. Epub 2020 Oct 20.

Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.

Glioblastoma is the most aggressive tumor of the central nervous system. Prognosis is poor, even in the presence of a methylated state of MGMT gene promoter, which represents the biomarker with the highest prognostic/predictive value for the standard treatment of patients. Among patients with a methylated MGMT status, we identified an intermediate range of methylation above the standard 9% cut-off (gray zone) in which the predictive strength of the marker was lost. In an effort to improve the evaluation of the biomarker in clinical decision-making, we are carrying out a retrospective study, performing an in-depth analysis of samples used for diagnosis to understand how molecular heterogeneity, a hallmark of glioblastoma, impacts the evaluation of MGMT gene promoter methylation. Preliminary data from samples belonging to the "gray zone" tend to confirm the hypothesis of a mismatch between methylation values used for clinical decision-making and those included in our in-depth analysis. Confirmation of these data would help to better define the predictive power of MGMT promoter methylation status and greatly facilitate clinical decision-making.
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http://dx.doi.org/10.3389/fonc.2020.533000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606920PMC
October 2020

Ruptured Isolated Aneurysm of a Coronal Branch of the Anterior Spinal Artery: Case Report and Discussion of Treatment Strategies.

World Neurosurg 2021 Jan 16;145:119-126. Epub 2020 Sep 16.

Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy.

Background: Isolated spinal artery aneurysms are an extremely rare cause of subarachnoid hemorrhage. A limited number of case reports and case series have been reported in the literature. Treatment options include conservative management, surgical clipping/trapping, and endovascular procedures. Owing to the uncertain natural history of these lesions, there is no consensus about the optimal treatment.

Case Description: A 64-year-old man presented with subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm at the C1 level. Following initial conservative management, surgical treatment was proposed owing to an increase in lesion size at angiographic follow-up. A partially thrombosed aneurysm was found during surgery, suggesting that spontaneous resolution of the aneurysm was occurring. Despite initial worsening of neurological symptoms, the patient gradually recovered after rehabilitation.

Conclusions: Treatment decisions for spinal aneurysms should be made on a case-by-case basis, the goal being to offer the patient the best option, while avoiding exposure to unnecessary invasive procedures. As spontaneous resolution of a spinal artery aneurysm is unpredictable, our case highlights the importance of performing a perioperative vascular study if surgery is planned.
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http://dx.doi.org/10.1016/j.wneu.2020.09.046DOI Listing
January 2021

Chylothorax in spine fractures: A rarely reported complication? Literature review with an example case.

J Trauma Acute Care Surg 2020 11;89(5):e140-e146

From the Neurosurgery Division (G.L., F.C., J.V., L.M., R.D., L.T.), "M. Bufalini" Hospital, Cesena; and Neurosurgery Division (A.S., P.D.B.), University Hospital S. Anna, Cona di Ferrara, Italy.

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http://dx.doi.org/10.1097/TA.0000000000002896DOI Listing
November 2020

Behavioural and functional changes in neglect after multisensory stimulation.

Neuropsychol Rehabil 2020 Jun 30:1-28. Epub 2020 Jun 30.

Centre for Studies and Research in Cognitive Neuroscience, University of Bologna, Cesena, Italy.

The present cohort study investigated whether systematic multisensory audio-visual stimulation might improve clinical signs of neglect. To this aim, patients with neglect (= 7) and patients with neglect associated with hemianopia ( = 12) were exposed to a course of audio-visual stimulation with spatially and temporally coincident audio-visual pairs of stimuli for 10 daily training sessions (4 h of training per day), over two weeks. Performance on neuropsychological tests assessing neglect was measured before training, immediately after the training and months after the training at a follow-up session. The results showed significant post-training improvements in clinical signs of neglect, which were stable at the follow-up. These findings suggest that intensive and prolonged multisensory audio-visual stimulation affects orientation towards the neglected hemifield, therefore inducing long-term improvements in visual exploration and neglect symptoms in both patients with neglect and patients with neglect associated with hemianopia. Previous evidence from hemianopic patients suggests that these post-training effects might be mediated by activity in spared subcortical structures, such as the superior colliculus, which are relevant to multisensory integrative processing and spatial orientation.
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http://dx.doi.org/10.1080/09602011.2020.1786411DOI Listing
June 2020

Remodulation of neurosurgical activities in an Italian region (Emilia-Romagna) under COVID- 19 emergency: maintaining the standard of care during the crisis.

J Neurosurg Sci 2020 Jun 11. Epub 2020 Jun 11.

Center of Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.

Background: The impact of COVID-19 outbreak in the neurosurgical practice has been dramatic, imposing several limitations. The aim of this study is to present how the neurosurgical departments of Emilia-Romagna, a northern Italian region, have re-set their organization to maintain the higher standard of care as possible.

Methods: All OR and out-patients activities performed during the COVID-19 emergency in the neurosurgical department of Emilia-Romagna have been collected and compared to the means of the same timeframe in 2018 and 2019.

Results: In 2020, 205 surgical procedures and 466 out-patients consultations have been performed, representing respectively 28.8% and 26.4% of the previous biennium. The most of OR procedures had been emergencies/urgencies and oncological patients (respectively 113 and 66 vs 164.5 and 84.5 of the previous biennium), while elective surgeries decrease up to -97.1%, as for spinal nerves and endoscopic skull base procedures. The patients phone contacts and telemedicine evaluations of their examinations have permitted to reduce the hospital access for outpatients of 75.6%, but these modalities have, also, permitted to follow-up a large number of cases.

Conclusions: The outbreak of COVID-19 has imposed several limits to our current practice, however this should not represent an excuse to reduce the standard of care. In our experience, the net integration of different local centers has permitted for each of them to effectively cope the crisis, managing the local cases requiring a prompt surgery and keeping the care continuity with already discharged patients.
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http://dx.doi.org/10.23736/S0390-5616.20.05018-3DOI Listing
June 2020

Long-term outcomes in major trauma patients and correlations with the acute phase.

World J Emerg Surg 2020 13;15. Epub 2020 Jan 13.

1Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Viale Ghirotti 286 - 47521, Cesena, Italy.

Background: Major trauma patients experience a 20% mortality rate overall, and many survivors remain permanently disabled.In order to monitor the quality of trauma care in the Trauma System, outcomes assessment is essential. Quality indicators on outcome can be expressed as quality of life, functional outcome, and others.The trauma follow-up system was created within the Romagna Trauma System (Italy) in order to monitor the trauma network and assess its long-term outcomes.The aim of this paper is firstly to evaluate the existence of correlations between epidemiological data, severity of injury, and clinical assessment characterizing the acute phase and the long-term outcomes in trauma patients and secondly, to explore the association between outcome variables have been modified.

Methods: We conducted a cross-sectional study over a 10-year period, including patients with severe trauma who survived and were discharged from the intensive care unit. The outcome measures were assessed with the use of the Extended Glasgow Outcome Scale and the Euro Quality of Life scale 5 dimension.Demographic data and clinical severity descriptors versus functional outcome were tested in a binary logistic regression model.

Results: In all, 428 major trauma patients participated in the study. At 1 year, 50.8% of trauma patients included had a good recovery and 49.2% had some degree of disability. The median value of quality of life was 0.725.At the multivariate analysis, variables showing significant impact on functional outcome were age ( = 0.052, OR 1.025), injury severity score ( = 0.001, OR 1.025), and Glasgow coma scale ≤ 8 ( = 0.001, OR 3.509)The Spearman's Rank correlation coefficient showed a strong correlation between the global level of function variables and quality of life at one year (Spearman's Rho Correlation Coefficient 0.760 ( < 0.0001)).

Conclusions: Increased age, increased injury severity score, and severe traumatic brain injury are predictors of long-term disability.Most of these trauma patients show impairments that affect not only the level of functional state but also the quality of life. The degree of functional independence has the greatest positive impact on quality of life.According to our results, after the recovery a prompt recognition of physical and psychological problems with systematic follow-up screening programs can help patients and doctors in defining specific therapeutic-rehabilitation pathways tailored to meet individual requirements.
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http://dx.doi.org/10.1186/s13017-020-0289-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958936PMC
March 2021

Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study.

Spine (Phila Pa 1976) 2019 Jul;44(13):951-958

Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy.

Study Design: Retrospective multicenter study.

Objective: Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures.

Summary Of Background Data: Treatment of odontoid fractures in aged population is still debatable.

Methods: One hundred fourty-seven consecutive odontoid fractures in elderly patients were classified according to Anderson-D'Alonzo and Roy-Camille classifications. Philadelphia type collar was always positioned and kept as a treatment whenever acceptable. Halo-vest, anterior screw fixation, C1-C2 posterior arthrodesis, and occipito-cervical fixation were the other treatments adopted. Conservative or surgical treatment strategy was more significantly influenced by antero-posterior displacement (< or >5 mm) and by surgeon decision. On admission ASA, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI) were assessed. Modified Rankin scale (mRS-post), Neck Disability Index (NDI), and Smiley Webster Pain Scale (SWPS) were administered 12 to 15 months after treatment to estimate functional outcome in terms of general disability, neck-related disability, and ability to return to work/former activity. Risk of treatment crossover was calculated considering factors affecting outcome. Fracture healing process in terms of fusion-stability, no fusion-stability, no fusion-no stability was evaluated at 12 months through a cervical computed tomography (CT) scan. Dynamic cervical spine x-rays were obtained whether necessary. No fusion-stability was considered an adequate treatment goal in our geriatric population. Chi square/Fisher exact test and logistic regression were performed for statistical anal.

Results: Overall 67 patients were treated conservatively whereas 80 underwent surgery. Collar was adopted in 45 patients, while anterior odontoid fixation and C1-C2 posterior arthrodesis were preferred for 30 patients each. 79.8% of patients showed good outcomes according to NDI. No significant differences were observed between patients of 65 to 79 years and more than or equal to 80 years (P = 0.81). CCI greatly correlated with mRS-post, with higher indexes in 68.8% of cases characterized by good outcomes (P = 0.05). mRS-pre correlated with NDI (P < 0.000001) and mRS-post (P = 0.04). CCI, mRS-pre, and surgery were associated with worse NDI, while both C1-C2 posterior arthrodesis and occipito-cervical stabilization were associated with worse mRS-post, respectively in 40% and 30% of cases. Younger patients had a higher risk of treatment crossover.

Conclusion: mRS-pre and CCI provided two independent predictive values respectively for functional outcome and post-treatment disability. Compared with conservative immobilizations, surgery revealed no advantages in the elderly in terms of functional outcome.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000002982DOI Listing
July 2019

The Prognostic Roles of Gender and O6-Methylguanine-DNA Methyltransferase Methylation Status in Glioblastoma Patients: The Female Power.

World Neurosurg 2018 Apr 11;112:e342-e347. Epub 2018 Jan 11.

Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy. Electronic address:

Background: Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients.

Methods: We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment.

Results: A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival.

Conclusions: Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.
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http://dx.doi.org/10.1016/j.wneu.2018.01.045DOI Listing
April 2018

Spinal angiolipoma.

J Neurosurg Sci 2019 Feb 7;63(1):98-99. Epub 2017 Sep 7.

Department of Neurosurgery, Ospedale M. Bufalini, Cesena, Italy.

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http://dx.doi.org/10.23736/S0390-5616.17.04024-3DOI Listing
February 2019

Unstable thoracic spine fracture with aortic encroachment: A potentially fatal association and a suggested treatment.

Int J Surg Case Rep 2017 18;39:181-184. Epub 2017 Aug 18.

Neurosurgery Department, Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy. Electronic address:

Background: The coexistence of an unstable spinal fracture with a pending aortic lesion is potentially catastrophic and a therapeutic challenge as to timing of treatment, assigning priorities and selecting the best approach.

Case Report: A 41 year-old healthy male victim of bike accident. Imaging revealed a fracture of 6th and 7th thoracic vertebrae with a bone fragment in close proximity to the descending thoracic aorta. After consultation with spine/vascular surgeons and interventional radiologists it was decided to secure the potential aortic injury with an endovascular stent-graft followed by posterior vertebral instrumentation for fracture's reduction.

Discussion/conclusion: A multi-specialists teamwork approach is mandatory. Vascular lesion is priority, followed by vertebral surgery. As to the treatment options, we suggest a "best but still safest" philosophy: endovascular repair and posterior spinal instrumentation should be considered first in the acute stage.
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http://dx.doi.org/10.1016/j.ijscr.2017.08.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573841PMC
August 2017

Neuroendoscopic biopsy of ventricular tumors: a multicentric experience.

Neurosurg Focus 2011 Apr;30(4):E2

Department of Neurosurgery, National Cancer Institute IFO-Regina Elena, Roma, Italy.

Object: Although neuroendoscopic biopsy is routinely performed, the safety and validity of this procedure has been studied only in small numbers of patients in single-center reports. The Section of Neuroendoscopy of the Italian Neurosurgical Society invited some of its members to review their own experience, gathering a sufficient number of cases for a wide analysis.

Methods: Retrospective data were collected by 7 centers routinely performing neuroendoscopic biopsies over a period of 10 years. Sixty patients with newly diagnosed intraventricular and paraventricular tumors were included. No patient harboring a colloid cyst was included. Data regarding clinical presentation, neuroimaging findings, operative techniques, pathological diagnosis, postoperative complications, and subsequent therapy were analyzed.

Results: In all patients, a neuroendoscopic tumor biopsy was performed. In 38 patients (64%), obstructive hydrocephalus was present. In addition to the tumor biopsy, 32 patients (53%) underwent endoscopic third ventriculostomy (ETV), and 7 (12%) underwent septum pellucidotomy. Only 2 patients required a ventriculoperitoneal shunt shortly after the endoscopy procedure because ETV was not feasible. The major complication due to the endoscopy procedure was ventricular hemorrhage noted on the postoperative images in 8 cases (13%). Only 2 patients were symptomatic and required medical therapy. Infection occurred in only 1 case, and the other complications were all reversible. In no case did clinically significant sequelae affect the patient's outcome. Tumor types ranged across the spectrum and included glioma (low- and high-grade [27%]), pure germinoma (15%), pineal parenchymal tumor (12%), primary neuroectodermal tumor (4%), lymphoma (9%), metastasis (4%), craniopharyngioma (6%), and other tumor types (13%). In 10% of patients, the pathological findings were inconclusive. According to diagnosis, specific therapy was performed in 35% of patients: 17% underwent microsurgical removal, and 18% underwent chemotherapy or radiotherapy.

Conclusions: This is one of the largest series confirming the safety and validity of the neuroendoscopic biopsy procedure. Complications were relatively low (about 13%), and they were all reversible. Neuroendoscopic biopsy provided meaningful pathological data in 90% of patients, making subsequent tumor therapy feasible. Cerebrospinal fluid pathways can be restored by ETV or septum pellucidotomy (65%) to control intracranial hypertension. In light of the results obtained, a neuroendoscopic biopsy should be considered a possible alternative to the stereotactic biopsy in the diagnosis and treatment of ventricular or paraventricular tumors. Furthermore, it could be the only surgical procedure necessary for the treatment of selected tumors.
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http://dx.doi.org/10.3171/2011.1.FOCUS10326DOI Listing
April 2011

Co-localisation of meningioma and craniopharyngioma mimicking a single skull base tumour in an elderly patient.

J Neurooncol 2011 Mar 9;102(1):167-70. Epub 2010 Jul 9.

Department of Neurosurgery, Padua University Hospital, Via Giustiniani 2, Azienda Ospedaliera di Padova, 35128 Padova, Italy.

According to WHO Classification meningioma and craniopharyngioma represent two distinct pathological entities. They may present the same skull base localisation therefore age distribution and peculiarity of imaging are pivotal in order to obtain a correct preoperative diagnosis. Although they are both characterized by a benign biological behaviour and a quite good prognosis, they need different and specific treatment strategies. The simultaneous occurrence of meningioma and craniopharyngioma is rare, and even more rare is their co-localisation. The authors present the case of an old female patient with concurrent craniopharyngioma and meningioma in the parasellar region mimicking a single tumour.
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http://dx.doi.org/10.1007/s11060-010-0300-zDOI Listing
March 2011