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Biomedical subjects

A Brunori

Publications and source records attributed to A Brunori.

At least 19 recordsLinked to original sources

Solitary fibrous tumor of the meninges: two new cases and review of the literature.

BACKGROUND: Solitary fibrous tumor (SFT), a mesenchymal neoplasm originally described in the pleura has been more recently reported to arise in a number of other sites, including the meninges. Nowadays immunohistochemistry facilitates the otherwise problematic differential diagnosis with regard to other benign and malignant spindle cell neoplasms of the central nervous system. METHODS: Two recently treated cases of meningeal SFT (one craniospinal, one spinal) are presented and discussed in the light of the present knowledge and a review of the literature. RESULTS: Total resection was followed by complete recovery and both patients are presently asymptomatic and without evidence of disease. The microscopic and immunohistochemical profiles (CD 34, vimentin positive; S-100, EMA negative) were consistent with those of previously reported cases. CONCLUSIONS: The majority of SFTs behave in a benign fashion and do not recur unless subtotally resected. Malignant variants may account for up to 37% of SFTs in other locations but have never been reported to occur in the meninges. Meningeal SFTs are to be considered a new pathological entity. Wider use of immunohistochemical screening should enable the determination of their real incidence; larger series and longer follow-up will provide conclusions about their treatment and prognosis.

Adolescent

An early approach to controlled hypotension: Felice Visalli and the "pneumoanemizator.".

In this historical vignette, the authors describe the conception and realization of the "pneumoanemizator," an ingenious pneumatic apparatus originally designed in the 1940s for the purpose of controlled hypotension. The authors also give a biographical sketch of its inventor, the pioneering Italian neurosurgeon Felice Visalli. The general working features of this nearly forgotten device and its performance in experimental and clinical trials are evoked in the light of a brief history of controlled hypotension.

Anesthesiology

Pediatric migration and hepatitis A risk in host population.

Hepatitis A virus (HAV) circulation in a given area is closely related to socioeconomic standards. Following the improvement of living conditions, HAV seroprevalence rates in the population have decreased steadily during the last decades in many Western European countries, including Italy, thereby leading to a shift of risk of disease towards older age groups. Since the severity of the disease closely parallels age, a higher incidence of symptomatic cases in adults is now reported in Europe and the United States, being travel-related to a large extent. Intrafamilial person-to-person spread is also an important source of infection and transmission from children to parents may occur due to the lack of immunity in the general population. In the last two decades, Italy has been the destination of an increasing number of migrants from developing countries, where HAV is highly endemic. Furthermore, international adoption programmes cause pediatric populations from HAV endemic countries to increase in low endemic areas, possibly leading to secondary cases in close contacts.7 The aim of this paper is to report the epidemic HAV outbreak which occurred among the voluntary nursing staff of a pediatric Rwandan refugee community hosted in a village of the Brescia Province, in northern Italy.

Adult

Dumbbell tumor of the anterior skull base. Meningioma? No, adenoid cystic carcinoma!

BACKGROUND: Adenoid cystic carcinoma (ACC) is a rare neoplasm of the exocrine glands. Because of its tendency for skull base involvement and intracranial spread, ACC should be diagnosed promptly by the neurosurgeon, although discrimination from meningioma is often difficult. Radical resection of such tumors requires familiarity with complex craniofacial approaches. CASE DESCRIPTION: An unusual case of dumbbell-shaped ACC centered over the planum sphenoidale is presented. Regular margins and neuroimaging features suggested a preoperative diagnosis of meningioma. The lesion was gross, totally resected in a two-staged procedure through frontobasal and transfacial approaches, with good functional and aesthetic result. CONCLUSION: The epidemiologic, histologic, and clinical features of ACC are reviewed. ACC is rarely encountered by the neurosurgeon; however it should always be considered in the differential diagnosis of skull base tumors. Interdisciplinary surgical approaches represent the major advance in the treatment of these complex neoplasms.

Aged

Management of intracranial aneurysms: "state of the art".

The authors provide an overview of the past, present and future of intracranial aneurysms management. Excellent results achieved today by neurovascular surgeons are to be ascribed not only to refinements in microsurgical technique but also to an always more aggressive and effective treatment of vasospasm, the most feared complication of aneurysmal SAH. "Triple H" therapy, calcium channel blockers, rTPA and balloon angioplasty represent the corner-stones of arterial spasm treatment. Hopefully new agents such as lazaroids, endothelins inhibitors and nitric oxyde modulators will become available for clinical use in the next future. Although clipping of aneurysmal neck is still considered the "gold standard", obliteration of the aneurysmal sac can now be safely achieved by coil embolization: the exact role and respective indications of each technique are yet to be defined. Further prognostic improvement will be possible through an early diagnosis, i.e. before the occurrence of SAH, as shown by negligible morbidity and mortality associated with the treatment of "incidental" and "unruptured" aneurysms.

Embolization, Therapeutic

Successful excision of hemorrhagic cavernous angioma in a patient with severe factor VII deficiency: perioperative treatment with factor VII concentrate.

A case of an uncomplicated neurosurgical procedure in a patient affected by a rare bleeding disorder is described. The interest is twofold: first because of the possible influence of underlying coagulopathy in disclosing the vascular anomaly. And second although surgery in factor VII deficiency has been reported before, with and without replacement therapy, to our knowledge, this is the first neurosurgical case in which factor VII concentrate was used. This treatment allowed safe surgery and protected the patient from complications associated with plasma and protrombin complex use.

Adult

Detection of cystathionine ketimine and lanthionine ketimine in human brain.

The sulfur containing imino acids cystathionine ketimine (CK) and lanthionine ketimine (LK) have been detected in the human brain by an HPLC procedure. The HPLC procedure takes advantage of the selective absorbance at 380 nm of the phenylisothiocyanate-ketimine adduct. Quantitation of cystathionine ketimine and lanthionine ketimine indicates a mean concentration (mean +/- SD, n = 4) of 2.3 +/- 0.8 nmol/g for CK and of 1.1 +/- 0.3 nmol/g for LK in four human cerebral cortex samples of neurosurgical source. The identification of these cyclic ketimine derivatives of L-cystathionine and L-lanthionine as normal human metabolites in human nervous tissue may have interesting metabolic and physiological implications.

Amino Acids, Sulfur

Non-acoustic neuroma tumor (NANT) of the cerebello-pontine angle: a 15-year experience.

Between 1980 and 1994, 145 patients affected by tumors of the CP angle underwent surgery at the Division of Neurosurgery of the San Camillo Hospital in Rome. The 56 (39%) "non-acoustic tumors" have been analyzed with regard to epidemiologic factors, clinical picture, neuroimaging findings in order to determine their distinctive diagnostic features. Moreover, the surgical outcome and follow-up results are presented and compared with those of the literature.

Adolescent

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently "spontaneous", required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in "spontaneous" SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.

Arteriovenous Malformations

Life threatening intracranial complications of frontal sinus osteomas: report of two cases.

Paranasal sinuses osteomas are known as biological benign tumours. However, due to the peculiar anatomical relationships, patients harbouring an osteoma within the frontal sinus are exposed to serious orbital and intracranial complications. We report two unusual cases of intracranial mucocoeles associated with frontal osteomas. In one of them, a superposed tension aerocoele required emergency surgery. Although aggressive treatment of asymptomatic osteomas is not warranted, these lesions must be carefully observed and resected as soon as they show clinical and/or radiological signs of progression. The physiopathological and clinical aspects are discussed.

Bone Neoplasms

Cystic extra-axial cavernoma of the cerebellopontine angle.

Besides acoustic neuromas, the cerebellopontine angle harbors a wide variety of masses, named "nonacoustic neuroma tumors," as a whole. Although magnetic resonance imaging has much improved our ability to differentiate among posterior fossa lesions, misdiagnoses may still occur when facing rare, controversial cases.

Cerebellar Neoplasms

Thoracic disc.

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Aged

Surgical treatment of spasmodic torticollis: is there a role for microvascular decompression? With an illustrative case report.

Spasmodic torticollis (ST) is a puzzling movement disorder, characterized by involuntary tonic or clonic contractions of various neck muscles. From time to time, psychogenic, extrapyramidal and neuroperipheral origins have been postulated and reflecting the variety of theories proposed, as many different treatments have been attempted, none of which has shown absolute effectiveness. Surgery of ST classically includes destructive procedures such as myotomies, stereotactically placed lesions, rhizotomies and neurectomies. The recent application of the concept of "neurovascular conflict" to ST induced several authors to perform microvascular decompression (MVD) in these patients, with encouraging and in some cases long-lasting results. Our case report joins this group. From the analysis of pertinent literature we conclude that: a. Spasmodic torticollis is probably a collection of separate clinical entities; b. Even in the so-called "ST of neuroperipheral origin" some coexising central factor must be admitted; c. Neurovascular compression underlies at least some cases of ST. Historical, anatomical, physiopathological and clinical aspects of ST are extensively discussed.

Decompression, Surgical

Aneurysms of the sphenoid segment of the middle cerebral artery.

Aneurysms of the M1 segment of the middle cerebral artery are rare. Anatomically they are classified into a "temporal" variety, projecting supero-laterally and a "striate" variety projecting infero-laterally. Between 1960 and 1992, 13 such aneurysms were treated at our Institution. Among them, 11 underwent surgery: 8 (73%) had an excellent or good outcome, 1 (9%) a poor outcome and 2 (18%) died. Two patients treated conservatively carried thrombosed aneurysms: one was a giant unruptured aneurysm with complete occlusion of the parent vessel; the other one was found at autopsy following transsphenoidal surgery and unexplained SAH. All these cases were carefully reviewed with special reference to their clinical and anatomo-surgical features. Exact knowledge of the anatomy of lenticulostriate and temporal branches and awareness of all possible anatomical variants are crucial for correct opening of the Sylvian fissure and successful surgical approach to M1 segment aneurysms.

Adult