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1.
AJNR Am J Neuroradiol ; 27(10): 2104-11, 2006.
Article En | MEDLINE | ID: mdl-17110676

BACKGROUND AND PURPOSE: Several techniques, including chymopapain, mechanical aspiration, laser-based disk decompression, and endoscopic keyhole surgery, have been proposed as minimally invasive alternatives to fusion for treating cervical disk herniation, though none has gained wide acceptance. The purpose of this study was to assess feasibility, safety, and preliminary clinical results of percutaneous plasma-mediated radio-frequency-based diskectomy for cervical disk herniation. METHODS: Patients (N = 55) with cervical soft disk protrusion were treated over a 29-month period. They had radicular pain; 3 patients also had moderate myelopathy. The procedure was performed with the Perc-DC SpineWand by using an anterior approach. Most cases were conducted with local anesthetic on an outpatient basis. Clinical outcomes were graded by using the Macnab criteria. RESULTS: At 2 months, outcomes were good or excellent in 44/55 (80%) patients; the success rate was similar at 6 months, when 44 (85%) patients (n = 52/55) had good or excellent results. One clinically relevant complication (infectious diskitis) occurred within the first month postprocedure and was successfully treated. One technical complication (in situ rupture of the device tip) was observed; however, the patient remained asymptomatic during the 2-year follow-up. The 3 patients with clinical myelopathy experienced regression of cord compression symptoms; MR imaging in 2 patients showed morphologic evidence of reduction of cord compression. CONCLUSIONS: Plasma radio-frequency-based diskectomy in the cervical spine appears to be a minimally invasive low-risk approach, which is easy to perform, associated with only minimal discomfort to the patient, and effective in the short term.


Catheter Ablation , Cervical Vertebrae , Diskectomy/methods , Intervertebral Disc Displacement/surgery , Adult , Catheter Ablation/adverse effects , Diskectomy/adverse effects , Feasibility Studies , Female , Humans , Male , Middle Aged , Prospective Studies
2.
J Neuroradiol ; 32(2): 109-17, 2005 Mar.
Article En | MEDLINE | ID: mdl-15984402

The aim of this study is to assess safety, reliability, ease of use and usefulness of filter protection devices during angioplasty and stenting of stenotic lesions of the cervical carotid bifurcation. Over a period of 42 months, 53 patients harboring a cervical carotid bifurcation stenotic lesion were treated, by angioplasty and/or stenting using filter protection devices of different kinds. The stenosis was atherosclerotic in 48 cases, post-surgical in four and post-radiation in one case. In all cases, the treatment was successful, with good restoration of the luminal diameter. There were three major strokes (5.6%) and one minor stroke (1.9%). Two of these (one major, one minor) occurred a few hours after the stenting procedure and both seemed by all evidence due to a hemorrhagic hyperperfusion syndrome. One hemiparesis and dysphasia occurred two days after the procedure, secondary to subacute thrombosis with occlusion of the stent. One patient complained of three episodes of decrease in visual acuity of the eye ipsilateral to the stenting in the two weeks following treatment. In conclusion, in our experience, use of the devices adds only few minutes to the procedure time; direct lesions of the arterial wall, such as dissections or intraluminal thrombi, related to the use of filters were never observed, and spasm of the distal I.C.A. also proved rapidly regressive. The content of all filters, if any, was histologically examined, but plaque material was found only in one case, probably owing to our primary stenting technique without use of pre-dilation. The major technical drawback is in-filter coagulation, which occurred in 16 cases, occluding the membrane of the filter and thus slowing or blocking intracranial flow. Such an event can be counteracted by a more aggressive anti-coagulation protocol, which could, however, be responsible for the two complications with hemorrhagic brain infarction. Furthermore, we observed two other major neurological events, which bring the incidence of neurological complications in this series as high as 7.5%. Therefore, it is our opinion that safety of filters is not yet proven, and consequently great care must be taken in their use.


Angioplasty, Balloon/instrumentation , Carotid Stenosis/therapy , Micropore Filters , Stents , Aged , Aged, 80 and over , Angioplasty, Balloon/adverse effects , Feasibility Studies , Female , Humans , Intracranial Embolism/etiology , Intracranial Embolism/prevention & control , Male , Middle Aged , Prospective Studies , Treatment Outcome
3.
Acta Neurochir (Wien) ; 143(5): 457-63; discussion 463-4, 2001.
Article En | MEDLINE | ID: mdl-11482695

BACKGROUND: Carotid endarterectomy has been reported to increase the time free from cerebral ischemic events in both symptomatic and asymptomatic patients with a high grade of stenosis of the internal carotid artery. In cases in whom the compensatory circulation during the carotid clamp time is not sufficient, the use of intraluminal shunts has been proposed. However, the use of intraluminal shunts present several problems, such as the technical difficulties in positioning the shunt, the variability of time requested for the placement, the inconstancy of the blood flow during surgery, and the need to clamp off the carotid to introduce and remove the shunt. For these reasons, most operators prefer not to employ intraluminal shunts, while others do use them only in selected cases. The purpose of this work is to present, for the first time, a new type of temporary extraluminal shunt, connecting the femoral to the internal carotid artery with the interposition of a roller pump to regulate the blood flow. This method allows one to perform carotid endarterectomy without interrupting the blood flow to the brain. METHODS: 407 consecutive patients, who underwent carotid endarterectomy between August 1992 and April 2000, were considered. 35 patients presented an absolutely insufficient collateral circulation, demonstrated by important modifications of the electroencephalographic monitoring during the carotid clamp time. In these patients the endarterectomy was performed using a new femoral-carotid extraluminal shunt. FINDINGS: In all the cases in whom the femoral-carotid extraluminal shunt was positioned, the normalisation of electroencephalographic monitoring was achieved by regulating the blood flow with the interposed roller pump. The use and the placement of the shunt was simple and easy. None of the patients showed postoperative complications, except for one who had a stroke two days after surgery. INTERPRETATION: The results obtained, although to be confirmed by further studies, seem to demonstrate the effectiveness of our femoral-carotid extraluminal shunt, which was simple to use and safe.


Brain Ischemia/prevention & control , Carotid Artery, Internal/surgery , Carotid Stenosis/surgery , Endarterectomy, Carotid/methods , Femoral Artery/surgery , Aged , Aged, 80 and over , Anastomosis, Surgical , Brain/physiopathology , Brain Ischemia/physiopathology , Carotid Stenosis/physiopathology , Cerebrovascular Circulation , Collateral Circulation , Electroencephalography , Endarterectomy, Carotid/adverse effects , Female , Humans , Male , Middle Aged , Treatment Outcome
4.
J Clin Neurosci ; 8(1): 48-50, 2001 Jan.
Article En | MEDLINE | ID: mdl-11148079

Spinal cord subependymoma is a rare tumour with only 39 reported cases in the literature. The authors report a further case of this neoplasm in a 53 year old man with a progressive paraparesis, paraesthesias of the lower limbs and sphincter disturbance. The tumour was partly removed, without progression 5 years after surgery. After a careful review of the literature, the optimal treatment of this spinal tumour is debated.


Glioma, Subependymal/pathology , Spinal Cord Neoplasms/pathology , Glioma, Subependymal/physiopathology , Glioma, Subependymal/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Recovery of Function/physiology , Spinal Cord Neoplasms/physiopathology , Spinal Cord Neoplasms/surgery , Thoracic Vertebrae , Treatment Outcome
6.
J Neurosurg Sci ; 42(4): 189-93, 1998 Dec.
Article En | MEDLINE | ID: mdl-10404746

BACKGROUND: The Carotid Sinus Syndrome (CSS) is a rare condition causing spontaneous syncopal attacks or marked dizziness. METHODS: We studied 28 patients affected by CSS from January 1991 to October 1996. Eleven patients affected by cardioinhibitory type were treated by pace-maker (PM) implant. Seventeen patients had mixed type and all, but one who refused any treatment, entered this study. Carotid Sinus Denervation (CSD) was first performed in 2 of 10 patients who remained symptomatic after PM and in 6 patients as first choice therapy. RESULTS: At a mean follow-up of 30 months no patient submitted to CSD had recurrent syncopal attacks or dizziness. CONCLUSIONS: CSD is a safe and simple technique to abolish either the cardioinhibitory or the vasodepressor response in CSS.


Carotid Artery Diseases/surgery , Carotid Sinus/surgery , Denervation , Dizziness/surgery , Syncope/surgery , Adult , Aged , Blood Pressure/physiology , Cardiac Pacing, Artificial , Carotid Artery Diseases/complications , Carotid Artery Diseases/physiopathology , Carotid Artery Diseases/therapy , Dizziness/complications , Electrocardiography , Female , Heart Conduction System/physiopathology , Heart Rate/physiology , Humans , Male , Middle Aged , Postoperative Period , Syncope/complications , Syndrome
7.
Neuroradiology ; 36(6): 483-6, 1994 Aug.
Article En | MEDLINE | ID: mdl-7991098

We assessed the feasibility of percutaneous treatment of a cervical herniated disc. In the lumbar region, the surgical instrument for percutaneous diskectomy passes only through the paravertebral muscles, while in the cervical region there is considerable risk of nervous, parenchymal and vascular lesions. Moreover, open surgery for cervical herniated nucleus pulposus is a well-established, low-risk procedure, with little risk of epidural fibrosis, the main complication of lumbar open surgery; a percutaneous procedure should therefore have a low morbidity rate. A safe percutaneous approach to cervical discs could be useful for biopsy and for treatment of high-risk patients for general anaesthesia. We treated 15 patients with cervical herniated nucleus pulposus; all gave informed consent and refused or were not eligible for open surgery. We used the Nucleotome described for treatment of lumbar herniated discs; except for the first three cases, we used colour Doppler sonography to detect hazardous structures in the path of the probe. We had one complication, a cervical haematoma due to damage to the inferior thyroid artery, prior to the use of ultrasound.


Cervical Vertebrae/surgery , Diskectomy/instrumentation , Intervertebral Disc Displacement/surgery , Nerve Compression Syndromes/surgery , Spinal Nerve Roots/surgery , Cervical Vertebrae/diagnostic imaging , Endoscopes , Follow-Up Studies , Humans , Intervertebral Disc Displacement/diagnostic imaging , Needles , Nerve Compression Syndromes/diagnostic imaging , Postoperative Complications/diagnostic imaging , Spinal Nerve Roots/diagnostic imaging , Tomography, X-Ray Computed
8.
J Neurosurg Sci ; 37(3): 179-82, 1993 Sep.
Article En | MEDLINE | ID: mdl-8126586

The authors describe the rare case of a 50-year-old man with lumbar neurinoma associated with hydrocephalus. The complete neuroradiological study is presented. The various explanations about the pathogenesis of the hydrocephalus and the management of this condition are debated.


Hydrocephalus/complications , Neurilemmoma/diagnosis , Spinal Cord Neoplasms/diagnosis , Humans , Hydrocephalus/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Neurilemmoma/complications , Neurilemmoma/diagnostic imaging , Neurilemmoma/surgery , Spinal Cord Neoplasms/complications , Spinal Cord Neoplasms/diagnostic imaging , Spinal Cord Neoplasms/surgery , Tomography, X-Ray Computed
9.
J Neurosurg Sci ; 36(2): 107-10, 1992.
Article En | MEDLINE | ID: mdl-1469471

The Authors report a rare case of isolated sphenoid sinus aspergillosis in a 69-year-old man. The patient had a complete recovery. The preoperative CT-scans and the preoperative and postoperative MRI are shown. The incidence, the pathology, the various clinical presentations, the prognosis and the management of this disease are debated.


Aspergillosis , Sinusitis/microbiology , Sphenoid Sinus , Aged , Aspergillosis/diagnosis , Aspergillosis/diagnostic imaging , Aspergillosis/epidemiology , Aspergillosis/therapy , Combined Modality Therapy , Fluconazole/therapeutic use , Humans , Incidence , Magnetic Resonance Imaging , Male , Sinusitis/diagnosis , Sinusitis/diagnostic imaging , Sinusitis/epidemiology , Sinusitis/therapy , Sphenoid Sinus/diagnostic imaging , Sphenoid Sinus/surgery , Tomography, X-Ray Computed
10.
Acta Otorhinolaryngol Ital ; 11(4): 437-41, 1991.
Article It | MEDLINE | ID: mdl-1792898

Six hundred cases of carotid body tumors are reported in Literature. This tumor originates from ganglia cells which are able to produce catecholamines. The percentage of bilateral involvement is 32%. The hystological examination of specimens of this tumor reveals atypical cellular features in 30% of the cases. Clinically we divide this tumor into two classes: the first includes tumors whose growth is limited in the adventitial layer of the artery, while the second includes tumors with invasive growth in the arterial wall. In this paper a case of a large carotid body is reported. The importance of a correct pre-operative diagnosis based on supra-aortic-trunk angiography is stressed. A peri-adventitial surgical approach carried out with the aid of the operatory microscope is described. Particular emphasis is placed on intra-operative electroencephalographic monitoring which allows a safe vascular reconstructive surgery of the carotid complex when required.


Carotid Body Tumor/surgery , Carotid Body Tumor/diagnostic imaging , Humans , Male , Middle Aged , Tomography, X-Ray Computed
11.
Radiol Med ; 80(3): 325-8, 1990 Sep.
Article It | MEDLINE | ID: mdl-2236694

Fifty patients suffering from cerebral ischemic attacks, transient or not, were studied with both 99mTc HM-PAO single photon emission computed tomography (SPECT) and computed tomography (CT). In 31 patients both SPECT and CT showed pathologic areas, the max diameters of which were measured on CT images and SPECT orbitomeatal reconstructed sections, and then compared. We observed that: only SPECT images are positive for pathologic conditions in transient ischemic attacks and in the very early phases of infarctions; in recent infarctions (less than 15 days earlier) both SPECT and CT scans are positive but SPECT lesion areas are greater than CT ones; pathologic areas, with clear-cut outlines, having the same dimensions on both CT and SPECT images, are supposed to result from old static infarctions. A persistent perilesional hypoactive area on SPECT images means, in our opinion, a hypoperfusional area liable to new vascular troubles; in which case, medical/surgical therapy seems necessary.


Brain Ischemia/diagnosis , Organotechnetium Compounds , Oximes , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Female , Humans , Male , Middle Aged , Technetium Tc 99m Exametazime
12.
J Neurosurg Sci ; 31(2): 65-6, 1987.
Article En | MEDLINE | ID: mdl-2444681

Fifty-three patients were operated on with the transsphenoidal approach and a biologic tissue adhesive was used, in order to fix the mucoperiosteal flap. Results and advantages of the technique are discussed.


Surgical Flaps , Suture Techniques , Aprotinin , Drug Combinations , Factor XIII , Fibrin Tissue Adhesive , Fibrinogen , Follow-Up Studies , Humans , Mouth Mucosa/surgery , Periodontal Ligament/surgery , Sella Turcica/surgery , Sphenoid Bone , Thrombin , Tissue Adhesives
13.
J Endocrinol Invest ; 6(5): 353-8, 1983 Oct.
Article En | MEDLINE | ID: mdl-6420458

Nomifensine, TRH and insulin-induced hypoglycemia tests were carried out in 37 cases of hyperprolactinemia: 25 were due to PRL-secreting pituitary tumors, 6 cases to GH and PRL-secreting pituitary tumors and 6 to pituitary and suprasellar non secreting tumors. Nomifensine failed to suppress the serum PRL in all subjects and PRL responses to TRH and insulin-induced hypoglycemia were impaired in all patients, irrespective of the origin of hyperprolactinemia. The uniform pattern of PRL response to the above tests in patients with hyperprolactinemia of variable etiology suggests that none of them is specific for prolactinomas.


Blood Glucose/metabolism , Insulin , Isoquinolines , Nomifensine , Pituitary Neoplasms/metabolism , Prolactin/metabolism , Thyrotropin-Releasing Hormone , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Pituitary Neoplasms/diagnosis
14.
Radiol Med ; 67(4): 205-16, 1981 Apr.
Article It | MEDLINE | ID: mdl-7313151

Lumbar epidural venography was used as the examination of choice in the investigation of suspected disc herniation in 270 patients. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. In 110 patients operated on, the reliability of lumbar epidural venography was equal to 97.2%.


Intervertebral Disc Displacement/diagnostic imaging , Phlebography , Adolescent , Adult , Aged , Female , Humans , Lumbar Vertebrae , Male , Middle Aged
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