Hand dystonia and neuralgic pain due to neurovascular contact to cervical spinal root.
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Electromyography↗
Biomedical subjects
G Broggi
Publications and source records attributed to G Broggi.
Interstitial chemotherapy with mitoxantrone in recurrent malignant glioma: preliminary data.
We undertook a phase I-II trail of loco-regional mitoxantrone in 12 patients affected by malignant gliomas. Mitoxantrone was delivered at tumor recurrence by Ommaya reservoir, with 2 cycles and a 1 month interval between each cycle, in conjunction with systemic chemotherapy (8 pts) or not (4 pts). Treatment tolerability was good, and 9 of the patients showed either response or stable disease at the end of the treatment schedule. Regardless of associated chemotherapy, time to further tumor progression was at 6 months. A combination of early systemic and loco-regional chemotherapy with surgery and radiotherapy seems worth while pursuing in the therapeutic approach to malignant gliomas.
Adult↗
A possible pharmacological treatment of baclofen overdose.
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Baclofen↗
Acquired hemidystonia in childhood: a clinical and neuroradiological study of thirteen patients.
A retrospective study of 13 patients (4 males/9 females) with acquired hemidystonia in childhood is reported. The mean age of onset of hemidystonia was 6.4 years (range 1-13.4 years); the mean duration of dystonia at the time of last follow-up was 11.4 years (range 3.6-23 years). Hemidystonia was caused by ischemic infarction in 9 patients and was attributed to perinatal trauma in 1; in 4 of the 9 patients with stroke and in the remaining 3 patients laboratory investigations were suggestive of primary antiphospholipid syndrome. Eleven of the 13 patients had delayed onset of dystonia: between 1 month and 8.9 years (mean 3.4 years). Ten patients had neuroradiological evidence of contralateral basal ganglia damage. A history of hemiparesis and evidence of striatal damage on CT or MRI were important risk factors for the development of dystonia. Response to medical treatment (trihexyphenidyl dose as high as 40 mg daily) in 5 patients was disappointing; 4 of the 5 patients who underwent functional stereotaxic operations were improved, but dystonia was still present at the end of the follow-up. Our study provides additional evidence that lesions of the striatum may induce dystonia, supporting the theory of striatopallido-thalamic disconnection. Furthermore, our results indicate that the occurrence of delayed dystonia must be considered in the diagnostic approach to childhood-onset dystonia.
Adolescent↗
Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome.
OBJECTIVE: Patients operated on for supratentorial cavernous angiomas were studied to define the incidence and the course of seizures in their clinical history. Electroclinical and neuroradiological data were correlated with the location of cavernomas. The impact of lesionectomy on the outcome of seizures was evaluated. METHODS: Preoperative clinical data on the history of the seizures, semeiology, incidence, severity, and response to antiepileptic drugs were analyzed. The location of the cavernomas, revealed by magnetic resonance imaging, was correlated with electroencephalographic and clinical data. Postoperative clinical and neuroradiological data were evaluated, with particular consideration to the outcome of the seizures, antiepileptic drug withdrawal, and the completeness of the lesion excision. RESULTS: A higher incidence of severe epilepsy was observed in the patients with mesiotemporal and cortical angiomas. In most of the patients (78.7%), a good concordance between the site of the lesion and the electroclinical data was found. The complete removal of the lesion led to a favorable outcome, with discontinuation of antiepileptic drugs achieved in one-quarter of the patients. CONCLUSION: A high percentage of patients with cortical cavernomas had epileptic seizures. They often presented with chronic intractable epilepsy (44.7% in our series). In cases of good concordance between the electroclinical data and the location of the angioma, complete lesionectomy led to the disappearance of seizures. Removal of the hemosiderin ring did not correlate with better outcome. Preoperative ictal scalp recordings to assess the topographic relationship between the cavernoma and the epileptic seizures could improve outcome, which suggests different surgical strategies (lesionectomy versus enlarged resection) in patients without a clear-cut concordance between the site of the lesion and the ictal semeiology.
Adult↗
Bleomycin for cystic craniopharyngioma.
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Bleomycin↗
Transillumination in minimally invasive surgery for carpal tunnel release. Technical note.
An alternative technique for performing minimally invasive release of carpal tunnel syndrome is described. The suggested methodology is based on transillumination of the carpal tunnel during surgery. The advantages of the technique are discussed and compared with other available surgical procedures including endoscopy. The authors also describe preliminary operative results in 50 consecutive patients.
Adult↗
A neurophysiological method for the evaluation of motor performance in spastic walking patients.
Intrathecal baclofen is at present the best treatment for severe spasticity of various etiologies. In walking patients affected by severe spasticity a careful evaluation of the motor performance is needed for a correct indication for this treatment. The examination should focus on the delicate balance between spasticity and voluntary muscle activation which is crucial for an improvement of motor performance during gait. Seven patients have been neurophysiologically evaluated by the use of a Cibex apparatus measuring torque and movement velocity of the lower limbs simultaneously with static and dynamic recordings of the EMG.
Adult↗
Neurophysiological monitoring of cranial nerves during posterior fossa surgery.
Intraoperative neurophysiological monitoring of cranial nerve functions in surgery for microvascular decompression and tumors of the posterior fossa is important for minimizing risk of permanent damage to the nerves. In particular, intraoperative BAEP and the EMG function of muscle innervated by trigeminal and facial muscle have been found useful. We report here our experiences with intraoperative monitoring of brainstem auditory evoked potentials (BAEP) and EMG recorded from muscles supplied by the trigeminal and facial nerves.
Blinking↗
Pain syndrome and focal myokymia due to anterior interosseous neurovascular relationships: report of a case and neurophysiological considerations.
The anterior interosseous nerve can become entrapped within the antecubital fossa at its origin from the median nerve, which results in the so-called Kiloh-Nevin syndrome. In this report, the authors describe an atypical anterior interosseous nerve syndrome due to neurovascular relationships with the anterior interosseous artery. The patient complained of unbearable analgesic-resistant pain within the forearm and focal myokymia in muscles innervated by branches of the anterior interosseous and distal median nerves. Pain and myokymia were alleviated by inflated blood pressure cuff compression in the bicipital region when the arterial pulse was abolished distally. Microsurgical correction of the pulsatile arterial compression resulted in relief from pain and myokymia. Neurophysiological considerations of the mechanism underlying "irritative" neuropathy and myokymia are discussed.
Arteries↗
Increasing complexity of the karyotype in 50 human gliomas. Progressive evolution and de novo occurrence of cytogenetic alterations.
We studied the karyotypes of eight differentiated gliomas, 19 anaplastic gliomas, and 23 glioblastomas (GBM). Normal stemlines were present in 70% of the differentiated and anaplastic gliomas; abnormalities were mostly characterized by loss of sex chromosomes. In GBM, on the contrary, only 13% of the stemlines were normal and three groups, 45,XO, near-diploid, and near tetraploid, could be identified. The most frequent alterations among GBM were: total or partial loss of chromosome 10 in nine cases, structural abnormalities of chromosome 9 in seven cases, and loss of the Y chromosome in stemline clones of seven cases. Less frequent abnormalities included chromosomes 7, 1, 3, and 19. Our data support the cytogenetic model of gliomas as multi-stage tumors. GBM, in particular, can originate from the evolution of astrocytomas but can also develop de novo. In both cases loss of genetic material on chromosome 10 seems to play a crucial role.
Adult↗
Loco-regional immunotherapy with recombinant interleukin-2 and adherent lymphokine-activated killer cells (A-LAK) in recurrent glioblastoma patients.
Nine patients with recurrent glioblastoma were given autologous adherent lymphokine-activated killer (A-LAK) cells and interleukin-2 (IL-2) administered directly into the tumor cavity through an Ommaya tube placed during surgery/biopsy. The immunotherapy was well tolerated and the response rate was 33% (one complete response, two partial responses, four with stable disease and two with progressive disease). However, survival 18 months from initial diagnosis did not differ from that reported in the literature for patients treated conventionally. Serial determinations of IL-2 in the tumor cavity during the course of treatment revealed that IL-2 concentrations were sufficient to maintain lymphocyte activation. Since steroid medication was discontinued during treatment and A-LAK cells have greater antitumor activity than standard LAK cells, other factors are discussed that might explain the limited results.
Adult↗
p53 mutations and microsatellite analysis of loss of heterozygosity in malignant gliomas.
We have studied alterations of the p53 gene in 27 patients with malignant gliomas. Loss of heterozygosity (LOH) was investigated by microsatellite analysis in 23 patients (22 informative) and detected in nine. Exons 5 through 9 were amplified by polymerase chain reaction (PCR) in these nine patients: alterations were found in five cases (three missense mutations, one non-sense mutation, and one putative deletion), while in four the DNA sequence was normal. In the four patients where LOH could not be studied, the p53 sequence from tumor DNA was normal. These results indicate that microsatellite analysis is a convenient tool for LOH detection at the p53 locus and that mutations of the p53 gene are present in only part of the patients with LOH, implying the possibility that another tumor suppressor gene is located in the proximity of the p53 locus.
Adult↗
Role of stereotactic biopsy in multifocal brain lesions: considerations on 100 consecutive cases.
One hundred patients affected by multifocal brain lesions were investigated by serial stereotactic biopsy. Systemic diseases and primary neoplasms elsewhere were previously ruled out. The histological diagnosis obtained in this series comprises malignant gliomas in 37% of patients; primary non-Hodgkin's brain lymphoma in 15%; metastatic brain tumours in 15% (no evidence of the primary tumour at the time of stereotactic surgery); low grade gliomas in 12%; infective diseases in 10% (including brain abscesses and multifocal viral encephalitis); and ischaemic lesions in 6%. In addition, two patients with germinomas, two with primitive neuroepithelial tumours, two with multiple telangiectases, and one with a teratoma were also included in this series. Histological findings obtained by stereotactic procedures guided the choice of treatment, avoiding the risks of blind treatments. Indications and future perspectives for stereotactic surgery in multifocal brain lesions are discussed with emphasis on advances in diagnostic and therapeutic tools.
Adolescent↗
Italian multicentric study on pain treatment with epidural spinal cord stimulation.
A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. The diagnosis was failed back surgery syndrome in 45%, reflex sympathetic dystrophy in 15%, phantom limb pain in 14%, postherpetic neuralgia in 8%, peripheral nerve injury in 5%, others 13%. 84% received noninvasive unsuccessful treatment (10 tensor acupuncture). All had previous pharmacological therapy which was not always discontinued when SCS took place. Pain assessment had been done with the visual analog scale and verbal scale both subjectively and by the physician and nurses. Neuropsychological profile with minimal mental test or MMPI was obtained in 68% of the patients. These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.
Adolescent↗
Cell kinetic investigations in craniopharyngioma: preliminary results and considerations.
In vitro determination of 3H-thymidine labeling index (LI%) was carried out in craniopharyngiomas from 16 patients submitted to repeated surgical procedures. This study showed a poor correlation between LI% values and prognosis, but allowed to detect a high LI% variation in the same tumor investigated in serial different times. The spatial distribution of S-phase proliferative cells in squamous epithelium of cystic components suggests a rationale for intracavitary treatment of cystic and mixed craniopharyngioma and may help explain its success.
Adolescent↗
Low-grade glial tumors in basal ganglia and thalamus: natural history and biological reappraisal.
The natural history of 70 patients affected by low-grade astrocytomas was recorded after the histological diagnosis was obtained by serial stereotactic biopsy. Forty-three percent of these patients died within 3 years. The value of cell kinetics assessment at the time of stereotactic biopsy was investigated, and the labeling index percent may be considered the most accurate prognostic factor in these histologically homogeneous astrocytomas. It has been confirmed that the young age of patients predicts a more favorable course, but the value of this also seems to be linked to and dependent on cell kinetics. These data are discussed in view of the opportunity to perform more aggressive "cytoreductive" treatments in deep brain tumors when these indices support an expected poor prognosis.
Adolescent↗
A case of posttraumatic tremor treated by chronic stimulation of the thalamus.
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Adult↗