Trigeminal Neuralgia: Toward a Multimodal Approach.

OBJECTIVES: Trigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slight prevalence in women. Antiepileptic drugs represent the mainstay of the medical treatment, whereas microvascular decompression is the best option in case of neurovascular conflict. Although these treatments showed a good rate of efficacy, they can be contraindicated in some patients and >50% of patients undergoing these treatments will present recurrence of pain in the following months. In this majority of patients, pain becomes chronic and can severely affect their quality of life and cause cognitive disturbances, such as anxiety and depression. METHODS: The purpose of this study was to review the efficacy and safety of current treatment modalities for TN, as well as to propose a multimodal approach for those patients presenting with a chronic form of TN. RESULTS: Current treatment modalities have been reviewed. Actual pain evaluation systems and the neuropsychologic features of TN have been analyzed in order to propose an alternative treatment algorithm. DISCUSSION: Chronic pain can also lead to the misperception of patients' own selves leading to enhanced pain perception and altering therapeutic outcomes. Thus, there is the need to define a personalized multimodal approach of treatment, taking into account other available TN therapies and the neuropsychologic aspect of chronic pain.

Comparative Anatomical Study on Operability in Surgical Approaches to the Anterior Part of the Third Ventricle.

BACKGROUND: Surgery of the third ventricle still represents a challenge in modern neurosurgery. To optimize the surgical planning, some aspects, related to ventricular anatomy, have to be taken into consideration. An operability score could represent a preoperative tool to evaluate these variables to choose a tailored surgical approach. METHODS: We compared the transcallosal transforaminal approach and the combined interhemispheric subcommissural translamina terminalis approach (CISTA) to the anterior part of the third ventricle, applying the operability score. RESULTS: Compared with the transcallosal transforaminal approach, the CISTA provides a statistically significant improvement in terms of depth of surgical field, surgical angle of attack, and maneuverability arc considering as 4 approach-related critical structures: the optic chiasm (P value: <0.0001, <0.0001, <0.0001, respectively), the anterior commissure (P value: <0.0001, <0.0001, <0.0001 respectively), the tuber cinereum (P value: <0.0001, 0.0224, 0.0173), and the interthalamic adhesion (P value: 0.2917, <0.0001, <0.0001 respectively). CONCLUSIONS: Tumors originating from the anterosuperior part of the third ventricle can be easily approached through a transcallosal transforaminal route, whereas lesions arising from the anteroinferior portion of the third ventricle might be safely and effectively approached through the CISTA.

Quality Characteristics of Wholemeal Flour and Bread from Durum Wheat (Triticum turgidum L subsp. durum Desf.) after Field Treatment with Plant Water Extracts.

The use of selected plant water extracts to control pests and weeds is gaining growing attention in organic and sustainable agriculture, but the effects that such extracts may exert on the quality aspects of durum wheat are still unexplored. In 2014, 5 plant water extracts (Artemisia arborescens, Euphorbia characias, Rhus coriaria, Thymus vulgaris, Lantana camara) were prepared and distributed on durum wheat cv Valbelice to evaluate their potential herbicidal effects. After crop harvesting, the major physicochemical and technological parameters of wholemeal flours obtained from each treatment were measured and compared with those from chemical weeding and untreated controls. A baking test was also performed to evaluate the breadmaking quality. In wholemeal flours obtained after the treatment with plant extracts protein and dry gluten content were higher than in control and chemical weeding. Wholemeal flours obtained after chemical weeding reached the highest Mixograph parameters, and that from durum wheat treated with R. coriaria extract demonstrated a very high α-amylase activity. We concluded that the treatments with plant water extracts may influence many quality traits of durum wheat. This occurrence must be taken into account in overall decisions concerning the use of plant extracts in pest and weed management practice.

Magnetic resonance imaging as predictor of functional outcome in craniopharyngiomas.

Quality of life of craniopharyngioma patients can be severely impaired by derangement of hypothalamic function. A classification, taking into account preoperative hypothalamic damage, evaluated by magnetic resonance imaging (MRI), and correlating it with postoperative weight change is still missing in the literature. The aim of our study is to identify objective radiological criteria as preoperative prognostic factors for hypothalamic damage. Pre- and post-operative MRI and clinical data of 47 patients, treated at our Institution for craniopharyngioma, were retrospectively analyzed, based on radiological variables, identified as prognostic factor for hypothalamic involvement. Main factors associated with postoperative obesity were hypothalamic hyperintensity in T2-weighted/FLAIR imaging (p < 0.033), mammillary body involvement according to Müller classification (p < 0.020), unidentifiable pituitary stalk (p < 0.001), dislocated chiasm (p < 0.038), either not visible infundibular recess (p < 0.019) or unrecognizable supra-optic recess (p < 0.004), and retrochiasmatic tumor extension (p < 0.019). Accordingly, postoperative hypothalamic syndrome was associated with peritumoral edema in T2-weighted/FLAIR images (p < 0.003), unidentifiable hypothalamus (p < 0.024), hypothalamic compression (p < 0.006), fornix displacement (p < 0.032), and unrecognizable supra-optic recess (p < 0.031). Ultimately, variables identified as predictive factors of postoperative hypothalamic syndrome were the degree of hypothalamic involvement according to the classification described by Sainte-Rose and Puget (p < 0.002; grade 0 vs 2 p < 0.001), Van Gompel (p < 0.002; grade 0 vs 1, p < 0.027; and grade 0 vs 2, p < 0.002), and Muller (p < 0.006; grade 0 vs 1, p < 0.05; and grade 0 vs 2, p < 0.004). The identification of these predictive factors will help to define and score the preoperative hypothalamic involvement in craniopharyngioma patients.