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Biomedical subjects

F Maiuri

Publications and source records attributed to F Maiuri.

At least 55 records · Page 3Linked to original sources
PubMed1998

Neuroendoscopy. Personal experience, indications and limits.

The authors report a series of 40 patients treated by endoscopic neurosurgery. It includes 31 cases of obstructive hydrocephalus, 4 paraventricular or intraventricular CSF cysts, 3 cases of multiloculated hydrocephalus, one suprasellar arachnoid cyst and one cystic astrocytoma with mural tumor nodule. Third ventriculostomy is the most frequent indication of the endoscopic neurosurgery, which is very useful also for performing fenestration of CSF cysts and multiloculated hydrocephalus. The surgical endoscopic techniques in the different above mentioned pathologies are exposed. The criteria for patient selection, the clinical results and the postoperative radiological findings, that confirm the patency of the fenestration, are discussed.

Adolescent↗
PubMed1997

Spondylodiscitis. Clinical and magnetic resonance diagnosis.

STUDY DESIGN: This study reviews 65 patients with spondylodiscitis, both spontaneous and postoperative and of different etiology, studied by magnetic resonance imaging. OBJECTIVES: To define the magnetic resonance imaging characteristics of infections of the spine in acute and chronic stages and to evaluate the role of magnetic resonance imaging in defining their etiology. BACKGROUND DATA: Early diagnosis of spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography scan provide insufficient data. METHODS: Among 65 patients with spondylodiscitis studied by magnetic resonance imaging, 24 were examined in the acute stage (clinical evolution between 7 days and 20 days), and 41 were examined in the chronic stage (3-6 weeks). The etiologic agent was staphylococcus in eight cases, Brucella in 13, Mycobacterium tuberculosis in 29, Salmonella in four, and unknown in 11. RESULTS: In cases observed in the acute stage, the disc and the vertebral bodies were hypointense in T1 and hyperintense in T2; this relatively constant finding was not correlated with the etiologic agent. In the chronic stage, cases caused by Brucella or of unknown etiology showed long T1 and T2 relaxation times, with precocious contrast enhancement of the disc; in cases of tubercular etiology there was slight shortening of T1, with inhomogeneous enhancement of the involved vertebral bodies and late disc enhancement. CONCLUSIONS: Magnetic resonance imaging is the investigation method of choice in diagnosing spondylodiscitis, especially in very early stages of the disorder, when other investigations still yield negative results. In chronic stages, magnetic resonance imaging also allows tubercular spondylodiscitis to be distinguished from cases of different etiology.

Adult↗
PubMed1997

Cyst of the velum interpositum treated by endoscopic fenestration.

BACKGROUND: The cavum veli interpositi is a not infrequent radiologic finding in both children and adults, as confirmed by computed tomography (CT) and magnetic resonance (MR). A moderate enlargement of the cavum may sometimes be observed; on the other hand, a true large cyst may be considered exceptional, with only one reported case. CASE HISTORY: This 9-year-old boy with psychomotor retardation and epileptic seizures had a large CSF cyst in the region of the cavum veli interpositi, diagnosed by CT and MR. The patient was treated by endoscopic surgery, with introduction of the endoscope into the occipital horn of the right lateral ventricle and multiple fenestrations from the right ventricle to the cyst, and then from the cyst to the left lateral ventricle. The surgery resulted in decrease in the size of the cyst and reduction of the frequency of seizures. DISCUSSION AND CONCLUSIONS: Children with dilated or cystic cavum veli interpositi present with a large head, mental retardation, seizures, and hydrocephalus. On CT and MR, the cyst shows a typical triangular configuration on the axial plane and lies on the roof of the third ventricle in the coronal plane. Endoscopic ventricular fenestration is the treatment of choice for these as well as all other intraventricular and intracerebral CSF cysts, because it ensures communication between the cyst and the ventricular system and avoids definitive shunting of the cyst.

Brain Diseases↗
PubMed1997

Arachnoid cyst of the lateral ventricle.

BACKGROUND: Arachnoid cysts rarely occur within the lateral ventricles, with only 10 reported cases in the literature. They may arise from the arachnoid layer that is present in the choroidal fissure. CASE DESCRIPTION: This 25-year-old man with headache and a left jacksonian seizure had an intraventricular arachnoid cyst of the right occipital horn and trigone found on radiologic examination by computed tomography (CT) and magnetic resonance imaging (MRI). He was successfully treated by evacuation of the cyst and removal of its wall through a right parietooccipital craniotomy. Histologic studies of the cyst wall confirmed the presence of arachnoid cells and connective tissue. CONCLUSIONS: Arachnoid cysts of the lateral ventricles occur in the occipital horns and trigone (all but 1 of 10 cases) in young patients with symptoms of intracranial hypertension. MRI well defines the relationship of the cyst with the ventricular wall. Surgical removal of the cyst wall or cystoperitoneal shunt have been successfully performed in the reported cases; however, endoscopic fenestration of the cyst must be considered today as the treatment of choice.

Adult↗
PubMed1997

Symptomatic subependymomas of the lateral ventricles. Report of eight cases.

Subependymomas are rare, slow-growing, benign intraventricular tumors, which often are asymptomatic and are discovered incidentally. The review of the literature shows more than 100 symptomatic cases, less than half located in the lateral ventricles. Here we report 8 cases of symptomatic subependymomas of the lateral ventricles, studied by CT and/or MR and treated by direct surgical approach. The suspicion of a subependymoma should arise when a patient older than 10-15 years with long clinical history presents an intraventricular tumor isodense on CT and isointense in T1 and hyperintense in T2 on MR, with scarce or discrete contrast enhancement. Surgical treatment is indicated in symptomatic subependymomas of the lateral ventricles and usually allows complete tumor removal. The prognosis is usually good, also without postoperative irradiation.

Adolescent↗
PubMed1997

Coiling of the vertebral artery presenting with neuralgic pain.

A rare case of radicular pain in the arm due to compression of the C6 nerve root by coiling of the vertebral artery is reported; the diagnosis was confirmed by computed tomography (CT), magnetic resonance (MR) angiography and echocolordoppler. Although the enlargement of an intervertebral foramen by a tortuous vertebral artery has been described previously, the occurrence of radicular pain is exceptional. Magnetic resonance imaging (MRI), MR angiography and echocolordoppler allow to differentiate foraminal enlargement due to vascular anomalies of the vertebral artery from that more commonly due to tumor compression, mainly from neurinoma. Surgical decompression may be considered in symptomatic cases.

Adult↗
PubMed1997

Supratentorial cavernous malformations and epilepsy: seizure outcome after lesionectomy on a series of 35 patients.

Epilepsy is the most frequent presenting sign in patients with cavernous angiomas and is the major cause of morbility. Persistence of seizures after surgical treatment prompted many authors to examine the possibility of removing the cavernoma and the surrounding tissue. In our series of 53 cavernous angiomas, all the 35 patients with preoperative seizures underwent surgery by means of lesionectomy alone. One hundred percent of patients with less than five preoperative seizures and/or an history under 12 months was seizure free, while only 62.5% of patients with more than five seizures and/or an history longer than 12 months was seizure free. Number and duration of seizures before surgery seems to be the most important factor in the seizure outcome after surgical treatment.

Adolescent↗
PubMed1997

The role of intraoperative sonography in reducing invasiveness during surgery for spinal tumors.

The authors describe the ultrasound-guided surgical approach to 20 spinal tumors (13 extramedullary and 7 intramedullary). Intraoperative sonography (IOS) is important to reduce the extent of the laminectomy and dural opening, thus avoiding useless removal of bone structures. In cases of intramedullary tumors, IOS defines the extent of the posterior myelotomy, the presence of syringomyelic cavities caudal and/or cranial to the tumor and the deep extension of the tumor to the anterior cord surface. For these reasons, the routine use of IOS during surgery for spinal tumors reduces the surgical invasivity of this approach. The advantages and limits of the ultrasound-guided spinal surgery and the operative ultrasonographic findings of different spinal neoplasms are discussed.

Adolescent↗
PubMed1996

Endoscopic ventricular fenestration of intracranial fluid cysts.

The authors report 5 patients with paraventricular or intraventricular fluid cysts, successfully treated by fenestration into the ventricular system using a neuroendoscopic technique. The series includes three paraventricular malformative CSF cysts, a cyst of the velum interpositum and a cystic astrocytoma with small, deeply located and unresectable mural nodule. In all cases the endoscopic fenestration was the unique treatment and allowed to avoid the definitive ventriculoperitoneal shunt. The surgical endoscopic technique and the postoperative radiological findings which indirectly confirm the patency of the fenestration are discussed. The authors conclude that endoscopic ventricular fenestration represents the treatment of choice for most paraventricular and intraventricular CSF collections.

Adolescent↗
PubMed1996

Fronto-ethmoidal and orbital osteomas with intracranial extension. Report of two cases.

Osteomas involving the anterior cranial base are quite rare lesions. Intracranial and orbital extension of these tumors, causing neurological and ophthalmological symptoms and signs is a rare event. Two such cases are reported. In the first one, the tumor arose from the frontal sinus and extended upward to the medial and superior wall of the right orbital cavity and the lower part of the right frontal convexity. In the second case the osteoma arose from the left orbital roof and extended to the lower part of the homolateral frontal convexity and the splenoid wing. After the operation the symptoms disappeared and the cosmetic deficits were corrected. Skull-films, CT and MR well define the bony extension and the displacement of the orbital and intracranial structures. Indications to the surgery include progressive ophthalmologic and neurologic signs and significant cosmetic deformations. The surgical techniques and the postoperative complications are briefly discussed.

Adult↗
PubMed1996

Giant spinal cord ependymoma in a child. Case report.

Ependymomas of the spinal cord extending to more than ten vertebral segments are rare. A case of a 14-month-old child is described and the other 13 reported cases are reviewed. The finding of a very extensive tumor (from T5 to L5) after only 14 months of life suggests that in our case the tumor was present since birth. Magnetic resonance well shows the real extent of the tumor in height and its different components. Complete removal is often possible even in very extensive ependymomas and results in clinical improvement. Postoperative radiotherapy is necessary only for incompletely removed or malignant ependymomas.

Ependymoma↗
PubMed1995

Intracranial meningeal melanocytoma: case report.

A case of meningeal melanocytoma of the left sphenoid wing is reported and the other nine cases in the literature are reviewed. Meningeal melanocytoma is a benign melanotic tumor that derives from the melanocytes of the leptomeninges and may occur anywhere in the cranial and spinal meninges. Electron microscopy well demonstrates melanin and melanosomes within the tumor cells. The immunohistochemical pattern of this tumor includes strong positivity for S-100 protein, vimentin, and antimelanoma antibody and negativity for epithelial membrane antigen, neuron-specific enolase, cytokeratin, and glial fibrillary acidic protein. Complete surgical removal is the treatment of choice, whereas radiotherapy is usually unnecessary. In spite of benign biologic behavior of meningeal melanocytoma, the prognosis remains uncertain, because of the possible local recurrences.

Aged↗
PubMed1995

Central neurocytoma: clinico-pathological study of 5 cases and review of the literature.

Five cases of central neurocytoma, confirmed by immunohistochemical and electron microscopy studies, are reported and 127 cases from the literature are reviewed. Central neurocytomas are more frequent than previously thought, and will be diagnosed with increasing frequency in the future, if intraventricular tumors with histological aspect of oligodendroglioma or ependymoma will be routinely studied by immunohistochemistry and electron microscopy. The occurrence of an intraventricular tumor with a typical MR aspect in a young patient should suggest preoperatively the diagnosis of neurocytoma. The positivity for synaptophysin and neuron specific enolase, the negativity for neurofilament protein and glial fibrillary acid protein, and the finding of elements of neuronal differentiation on electron microscopy, are the main pathological features of these tumors. Complete removal of the tumor mass without radiotherapy is the treatment of choice. The prognosis is usually favorable without recurrence.

Adult↗
PubMed1995

'De novo' aneurysm formation: report of two cases.

We report 2 cases of 'de novo' aneurysm formation in a vessel which appeared to be normal at a previous angiography. The first patient developed an anterior communicating artery aneurysm nine years after occlusion of the right internal carotid artery by Gianturco coils for the treatment of a giant intracavernous carotid aneurysm. In the second case a 'de novo' aneurysm of the internal angle A1-A2 segment of the left anterior cerebral artery developed 6 years after successful clipping of another aneurysm of the same location. De novo formation of an aneurysm in a vessel which was found to be normal in a previous angiographic study, may occur as result of hemodynamic changes, such as after internal carotid occlusion or in presence of an arteriovenous malformation or variations of the circle of Willis. However, definite hemodynamic changes may also be absent. We conclude that patients operated on for aneurysm clipping must be periodically explored by magnetic resonance angiography to evaluate the possibility of de novo appearance of another aneurysm.

Adult↗
PubMed1995

[Solitary capillary hemangioblastoma, cellular variant. Clinical, radiological, and anatomo-pathological study of 2 cases].

Two cases of the rare cellular variant of the solitary capillary haemangioblastoma are reported. On MR study both tumors appeared as cerebellar contrast-enhancing masses, without evidence of intra- or perilesional blood vessels. Histologically, they showed compact groups of polygonal or rectangular cells separated by compressed small capillaries. There were no reticulin fibres among cell clusters. The stromal cells were found to be immunopositive for neuron-specific enolase (NSE), factor VIII-related antigen (von Wille-brand factor), Ulex europaeus lectin, and glial frillary acidic protein (GFAP). The findings are discussed in light of the pertinent literature.

Aged↗
PubMed1994

Post-radiation cerebral lesions in adults.

For many years, the human brain was considered relatively resistant to therapeutic doses of radiation. With the increasing length of survival of patients irradiated for brain tumors, there have been reported long-term effects of radiation therapy due to inappropriate dosage, period of delivery, fractionation or field. Thus, randomized studies are needed both to optimize the radiation therapy technique than to integrate new therapeutic modalities into the management of patients with primary brain tumors.

Brain↗
PubMed1994

Intraplaque hemorrhage of the carotid arteries: diagnosis by duplex scanning.

Eighty-three patients with intraplaque hemorrhage of the carotid arteries, explored by Duplex scanning, are reported; 36 among them were also studied by digital angiography and 28 were operated on. The echographic aspect suggesting the presence of an intraplaque hemorrhage is that of a hypo-anechogenic stria separating the intimal plaque from the media-adventitia complex. On the contrary, the angiographic findings are aspecific and unrelated to the presence of intramural blood clots. We think that duplex scanning is the investigation of choice in detecting intraplaque hemorrhage of the carotid arteries. The role of other radiological techniques, such as computed tomography of the neck and magnetic resonance, is also discussed.

Aged↗