Under 2$ hand anesthesia? Our first 800 cases with Wide-Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery.

INTRODUCTION: The Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) technique is being used progressively more and more in hand surgery as it avoids tourniquet-related complications and saves money. MATERIALS AND METHODS: In the present study, we analyzed our cases of carpal tunnel syndrome or trigger finger operated upon with this technique from January 1, 2018 to December 31, 2022. RESULTS: We obtained 822 cases (426 carpal tunnel syndrome, 396 trigger finger) with an overall anesthesiologic efficacy (no need of additional anesthetic) of 97.8%. Patients were satisfied or very satisfied with the anesthetic choice in 99.8% of cases. CONCLUSIONS: We believe WALANT to be a safe and effective technique that every hand surgeon should have in his/her repertoire.

Detection and distribution of culturable Human Enteroviruses through environmental surveillance in Milan, Italy.

AIMS: Human Enteroviruses (HEVs) infections have a significant impact on public health, being implicated in outbreaks of meningitis, encephalitis, hand-foot-mouth disease and other acute and chronic manifestation. In the strategic plan for poliomyelitis eradication, the environmental surveillance of poliovirus (PV) has been identified by the World Health Organization (WHO) as an activity that can complement the surveillance of polio. Having wastewater samples available for PV surveillance allows us to study nonpolio enteroviruses (NPEVs) circulating in the study population, which are widely spread. METHODS AND RESULTS: This study was carried out according to the WHO guidelines for environmental surveillance of PV and analysed the circulation of PV and NPEVs through the isolation of viruses in cell cultures in Milan area; from 2006 to 2010, 321 wastewater samples were collected, regularly over time, at the inlet of three diverse waste water treatment plants (WWTPs). Culturable HEVs were isolated in 80% of sewage samples: all isolates belonged to the HEV-B group and those circulating more intensely were CVB5 and Echo 6, while CVB4 was the predominant serotype found in 2010. In this study, two type 2 PVs were isolated, both characterized as Sabin like. CONCLUSION: Environmental monitoring of HEVs in Milan has proved to be an interesting tool to investigate the circulation and distribution of viruses. SIGNIFICANCE AND IMPACT OF THE STUDY: The detection of PV and other NPEV could be predictive of possible re-emergence of these viruses with an impact on public health. NPEV monitoring could also be a powerful public health tool to investigate the possible role of NPEV in different clinical manifestations.

Audiological findings in a case of cerebellar angioreticuloma.

The aetiology of neurosensorial damage with unilateral hearing loss and/or tinnitus and dizziness can often be difficult to determine because they may be caused wide variety of pathologic processes and a variety of diagnostic tests are needed in initial evaluation. In this paper, the authors describe, the techniques and indications of neuroimaging for evaluation of auditory symptoms. Auditory brainstem response (ABR) testing is still the choice when condition is suspected. We present a study of one patient with unilateral tinnitus, with no significant hearing loss and normal ABR: the patient underwent MRI of the district brain and the internal auditory channel (AIC) that showed the presence of a rare intracranial neoplasm, namely cerebellar angioreticuloma.

Neurocysticercosis treated with praziquantel. Long-term follow-up of a case.

The Authors report a case of neurocysticercosis treated with praziquantel and ventriculoperitoneal shunt. The patient presented, at CAT, multiple intracranial calcifications and cysts located in the cerebral parenchyma, ventricular system and subarachnoid cisterns. Praziquantel was orally administered at a daily dosage of 50 mg/kg. Two 15 day cycles of therapy were administered with an interval of one month between them. No significant side effects were observed during the treatment. Serial follow-up CAT scans demonstrated a gradual decrease in size and, finally, total disappearance of the cystic lesions. No neurological disfunction was observed at the last follow-up examination 4 years after treatment.

Distal posterior inferior cerebellar artery saccular and giant aneurysms: report of two new cases and a comprehensive review of the surgically-treated cases.

Aneurysms of the distal posterior inferior cerebellar artery are rare comprising less than 0.5 to 3% of all aneurysms. The authors report two cases of distal PICA aneurysms: a case of a ruptured saccular aneurysm arising on the tonsillomedullary segment of the PICA and a case of a giant aneurysm arising on junctional site of lateral-medullary and tonsillo-medullary segments. In the first case subarachnoid and intraventricular hemorrhage was diagnosed by CT and four vessel-angiography visualized the aneurysm which was clipped successfully. In the second case MRI was suggestive for posterior fossa giant aneurysm; four vessel angiography confirmed the suspicion, detected distal PICA origin of the giant aneurysm and disclosed the association with a middle cerebral artery saccular aneurysm. Because of lacking of a clippable neck and important perforating vessels to brainstem, the aneurysm was trapped and excised successfully. The literature is exhaustively reviewed. Discussion regarding to distal PICA aneurysm distribution (location, age, sex, multiplicity and associated vascular anomalies), pathophysiology, clinical presentation, neuroradiological findings, surgery and outcome is presented.

Infected cerebral hemorrhage by ruptured infectious anterior communicating artery giant aneurysm in a patient with T cell acute lymphoblastic leukemia. Case report.

Although the majority of infectious (bacterial) intracranial aneurysms occur in patients with subacute bacterial endocarditis, septic cerebral embolization and infectious intracranial aneurysm formation can also occur in immunocompromised patients. We report the case of ruptured bacterial aneurysm occurring in a 19 years old man immunocompromised by vigorously treated acute lymphoblastic leukemia. This case confirms very poor prognosis for infectious aneurysms in immunocompromised patient reported in literature, suggesting that a high index of suspicion needs for early diagnosis and that a conservative approach (high dose antibiotic therapy with possible delayed surgery) should be preferred unless intracerebral hemorrhage or abscess with significant mass effect provides a clear indication for operative intervention.

A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis.

A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis is reported. Clinical course was characterized by multiple intraparenchimatous hemorrhages and hydrocephalus. NMR showed dural sinuses thrombosis better than CT even though cerebral angiography was more effective for the diagnosis. Intracranial hypertension due to hydrocephalus was relieved with a ventriculoperitoneal shunt. The authors suggest that the abnormal hemodynamic patterns due to the drainage of the malformation into the vein of Galen and dural sinuses led to venous occlusion and multiple intracranial hemorrhages.

Craniofacial pain and incomplete oculomotor palsy associated with ipsilateral primitive trigeminal artery. Case report.

A case is reported of persistent primitive trigeminal artery associated with recurrent facial pain and noncomitant strabismus by partial ipsilateral oculomotor palsy. Transcranial Doppler disclosed indirectly persistent carotid-basilar anastomosis. CT and angiography allowed complete diagnosis excluding a posterior communicating artery aneurysm, a Tolosa-Hunt syndrome and an ophthalmoplegic migraine. Steroid therapy is recommended treatment. Surgery should be considered when symptoms are intractable to medical therapy.

Cervical spinal epidural abscesses. A report on five cases.

The authors report a series of five cases of non tuberculous cervical spinal epidural abscesses. There were neither patients suffering from immunodeficiency syndromes nor drug addicts; all the patients were in their seventh decade; two patients were affected by diabetes mellitus refractory to medical treatment. Retropharyngeal abscess was the main etiological risk factor (two cases); Staphylococcus aureus was cultured in two cases. Gadolinium MRI was necessary for a preoperative diagnosis, planning surgical approach and postoperative prognosis. Surgical debridement was performed via an anterior approach in those cases where the collection was located lower than C4 and did not span more than three vertebral segments; posterior approach, via a laminectomy, was performed in a case of C1-C2 location of the lesion and in a case of involvement of the whole cervical spine. Surgical results were poor in those patients affected by diabetes mellitus, a lesion involving the high cervical segments (higher than C4) or a lesion spanning more than three levels. Medical treatment with MRI follow-up was not undertaken in any of the patients and we opted for surgical drainage in all the cases due to the possibility of a sudden neurological deterioration, caused both by spinal cord mechanical compression and vascular compromission.

Spinal malignant melanotic schwannoma. Case report.

The authors report a rare case of spinal cord compression syndrome due to a malignant melanotic schwannoma. Pathogenesis, diagnostic difficulty and therapeutical problems are discussed. The authors conclude that such tumours should be surgically treated due to the possibility of a benign clinical behaviour even in those cases showing malignant histological features.

Craniocerebral gunshot wounds in civilians. Report on 40 cases.

The Authors report an analysis on 40 cases of craniocerebral gunshot wounds treated in a civil hospital over a 8-year period. The important role of CT for a correct diagnosis and treatment planning is stressed even though patients with a G.C.S. lower than 4 die regardless of their CT findings; subdural and intracerebral hematomas are not a serious complication unless patient's neurological status is poor; timing of surgical treatment plays a major role in order to avoid infection of the wound.

Primary spinal epidural lymphomas. Report of ten cases.

The Authors report their results on the treatment of 10 cases of primary spinal epidural lymphoma. All patients underwent surgery followed by radiotherapy and 60% of them improved after treatment. The Authors stress the importance the preoperative neurological status and early diagnosis play on the prognosis. They conclude that only further studies on a large series can determine the influence of the histological type of the neoplasm on prognosis.

Cervical epidural abscess: serial MRI study.

Cervical epidural abscess (CEA) at first often goes unrecognized and it is to be suspected in patients suffering by spinal ache, root pain, neurological deficit and fever. Staphylococcus aureus is the most frequent etiologic agent. At present MRI is the study of choice for the diagnosis of CEA. We suggest a serial MRI study in close time in at first doubtful cases of CEA. When the responsible organism is not identified and there are also compressive signs of the spinal cord, the treatment of choice is surgical decompression followed by selective antibiotic therapy. The duration of antibiotic therapy may be established not only by clinical judgement, but also by serial MRI study, which gives direct information about disease evolution.

Developmental venous anomaly responsible for hemifacial spasm.

Hemifacial spasm (HFS) is a facial movement disorder characterized by involuntary, unilateral and intermittent contractions of the facial muscles. It is one of the syndromes related to neurovascular conflict, first described by Jannetta et al. in 1979. Typically, HFS is due to pulsatile compression by the anterior inferior cerebellar artery. We describe a rare case of left developmental venous anomaly in a 59-year-old man referred to us with a six-month history of left-sided HFS. We performed an MR study of the brain and cerebellopontine angles, which demonstrated a compression of the ipsilateral facial nerve by the developmental venous anomaly.

Traumatic labyrinthine concussion in a patient with sensorineural hearing loss.

Blunt head trauma without any temporal bone fracture or longitudinal temporal bone fracture, with an associated fracture of the labyrinth may cause labyrinthine injury with sensor neural hearing loss and vertigo because of a concussive injury to the membranous labyrinth. Sudden sensory neural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding or concussion, which were difficult to diagnose before the advent of magnetic resonance imaging. Vertigo without a demonstrable fracture may also be the result of labyrinthine concussion, cupololithiasis and perilymphatic fistula. We describe the clinical case of a patient with acute traumatic hearing loss and vertigo, without skull base fracture detected on computed tomography. Magnetic resonance study was also performed. We have integrated the discussion with features that allow the differential diagnosis from other similar conditions.

Vascular cerebral anomalies associated with Septo-Optic Dysplasia. A case report.

We describe a case of Septo-Optic Dysplasia (SOD) characterized by the presence of anomalous cerebral vessels. In our young patient the classical features of SOD were associated with vascular anomalies including absence of the vein of Galen, right Rosenthal vein leading to the superior petrosal sinus, and anomalous origin of the anterior choroidal arteries. These findings have never been associated with SOD in the literature but their revelation supports the hypothesis of a vascular disruption as a possible cause of the SOD.

Spontaneous ruptured cavernous aneurysm treated by stenting and embolization in a young patient. A case report and literature review.

We describe a case of endovascular management of a ruptured aneurysm of the intracavernous portion of the left internal carotid artery with sphenoid extension. The exclusive use of coils to embolize the aneurysm in acute and young patients offers the advantage of avoiding both pre-implant antiplatelet therapy and long-term anticoagulant therapy required after stent or vascular plug placement, but it is complicated by the non-negligible risk of recurrence. Indeed, the only secure method to treat ruptured aneurysms of the intracavernous portion of the internal carotid artery is to use coils in the first stage to stop the haemorrhage without antiplatelet therapy and to use stents in the second narrow stage to prevent revascularization.

An occult spinal neurenteric cyst associated with congenital hemivertebrae. A case report.

We describe a case of an occult spinal neurenteric cyst associated with congenital hemivertebrae. Different intraspinal anomalies, such as neurenteric cysts (representing 0.3 to 0.5 % of all spinal tumors) have been reported in association with congenital hemivertebrae. Indeed, although CT is the best examination to study vertebral anomalies, MRI should be performed in order to exclude a more complex dysraphic condition.

Guillain-barré syndrome associated with acute onset bilateral facial nerve palsies. A case report and literature review.

Guillain-Barré syndrome is a post infectious, immune-mediated disease with cranial nerve involvement observed in 45-75% of patients. Bilateral facial nerve palsy is rather uncommon and occurs in 0.3% to 2% of all facial palsies. We describe a rare case of a 29-year-old man with bilateral facial palsy caused by a Guillain-Barré syndrome with an unusual onset and progression of neurological symptoms. Neuroradiological findings in our patient are described and compared with data from literature on bilateral facial palsies to make differential diagnosis easier for neuroradiologists.

Advanced ossification of the posterior longitudinal ligament in a mildly symptomatic patient. A case report and literature review.

We describe the imaging findings of a man who developed neurologic symptoms due to ossification of the posterior longitudinal ligament with narrowing of the spinal canal and compression of the spinal cord. CT study allowed a detailed evaluation of the stenosis and the extension of the ossification while MRI gave an excellent visualization of the spinal lesions caused by spinal cord compression by the mass. The neurological status of patients with ossification of the posterior longitudinal ligament depends on many factors such as the degree of spinal canal stenosis, life style, accidental mechanical stress and trauma.