Transcondylar approach.
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Cervical Vertebrae↗
Biomedical subjects
P Ciappetta
Publications and source records attributed to P Ciappetta.
Thoracolumbar fractures without neurosurgical involvement: surgical or conservative treatment?
The decision whether to treat amyelic thoracolumbar fractures conservatively or by surgical approach depends mainly on radiographic and clinical evaluation of their potential stability. An angle of kyphosis of 20 degrees or more evaluated using the sagittal index (s.i.) described by Farcy et al. in 1990, may be a valid indication for invasine treatment using pedicular systems for correction and stabilization; on the other hand, conservative treatment may be adequate for ensuring satisfactory results in fractures with an angle of less than 20 degrees, which are less likely to become unstable in clinically negative patients. This study confronts the immediate and long-term radiographic and clinical results in 2 groups of patients treated for amyelic thoracolumbar fractures, one treated conservatively, the other surgically; in particular, angle of kyphosis, vertebral compression and clinical conditions (pain and functional impairment) at long-term follow-up were assessed. The study was extended to include an assessment of outcome in relation to the angle of post-traumatic kyphosis in both operated and non-operated patients. Thirty-one patients with a diagnosis of non-neurological thoracolumbar trauma of the segment between D11 and L3 were studied. Twenty patients (group A) were treated conservatively (reduction on Cotrel bed and plaster vest) and 11 (group B) surgically (Diapason instrumentation). The 31 patients were subdivided into 2 groups according to the initial angle of kyphosis calculated using the s.i.: the first consisted of 16 patients (group C) with a s.i. of 20 degrees or more and the other of 15 patients (group D) with a s.i. less than 20 degrees. Six of the 16 group C patients and 5 of the 15 group D patients had been surgically treated. On the basis of the case-material considered, we found that satisfactory short-term radiographic results may be obtained by both conservative and surgical treatment. However, long-term outcome is less favorable in patients treated conservatively because maintainance of the initial improvement of the deformity in the injured segment is not as good as in those treated surgically. This limitation of conservative treatment does not however appear to negatively influence clinical conditions in patients with a s.i. of less than 20 degrees. In other words, although conservative treatment is not as effective as surgery for maintaining radiographic improvement, this does not necessarily signify clinical deterioration in cases with a s.i. of less than 20 degrees in whom the two types of treatment gave similar results.
Adolescent↗
Ossifying fibroma of the skull: clinical and therapeutic study.
AIMS AND BACKGROUND: Ossifying fibroma is a tumor with benign course that rarely affects the cranial bones. METHODS: The authors report 5 cases of ossifying fibroma of the skull and analyze the clinical course and treatment of this lesion. RESULTS: 3 patients were females and 2 males. The mean clinical history was 3.2 years. 4 patients underwent total removal and 1 partial. At mean follow-up of 19 years, all patients who underwent total removal showed improvement of neurological deficit, whereas the patient who underwent partial removal had clinical regrowth. CONCLUSION: The authors conclude that total removal of fibroma should be extended to normal bone and in cases in which total removal is not possible the residue should be checked for regrowth by serial MRI.
Adult↗
Osteosarcoma of the skull. Report of a post-Paget and post-radiation case in an elderly woman.
Osteosarcomas rarely affect the skull, preferring the long bones. As at other sites, osteosarcomas of the skull may be classified chiefly as de novo, post-radiation and post-Paget cases. Plain films of the skull and, even more, CT and MRI are the key diagnostic procedures for this disease. The treatment is surgery plus chemotherapy, in some cases radiotherapy. We report an odd case of post-radiation and post-Paget osteosarcoma in an elderly woman whose sister had been similarly affected.
Aged↗
Choice of neurosurgical approach in the treatment of cranial base lesions.
The authors describe a series of surgical approaches that they found particularly useful for the exposure and removal of lesions involving the skull base. These are: 1) fronto-naso-orbital approach; 2) fronto-temporo-orbito-zygomatic approach; 3) subtemporal transpetrosal approach; 4) temporo-suboccipital transpetrosal approach (retrolabyrinthine presigmoid; transsigmoid; translabyrintine amend transcochlear presigmoid); 5) dorsolateral approach to the foramen magnum and lower clivus. As the approaches are complex and carry potential risks of morbidity, not only it is important to have a good knowledge of basic anatomy but also to closely follow the indications for each one. In this type of surgery where it is often difficult to achieve complete removal of the lesion by a single route of attack, more than one approach may be employed in different surgical steps. Finally, all these approaches demand extremely scrupulous surgical reconstruction to avoid dangerous postoperative complications that may jeopardize the previous work of the surgeon.
Craniotomy↗
Surgical treatment of petroclival meningiomas: experience with 16 cases.
This article presents the surgical results in a series of 16 petroclival meningiomas operated on from 1984-1990. Tumors with marked infiltration of the cavernous sinus, which belong to the category of spheno-petro-clival meningiomas, were excluded. The 16 petroclival meningiomas were all surgically treated using the combined transmastoid temporosuboccipital approach that offers a number of possible variants: retrosigmoidal, with or without recision of the sinus; presigmoidal retro-, or translabyrinthine. The choice of one or another of these variants depends on certain clinical (preoperative hearing status) and anatomic (size and extension, central or lateral, of the tumor; patency of the transverse sinuses; size and position, more or less anterior, of the sigmoid sinus; position, more or less high, of the jugular bulb) factors. The principle indications for each of these approaches are given with particular emphasis on their relative advantages and limitations.
Cranial Fossa, Posterior↗
Solitary plasmacytoma of the skull: report of two cases.
We report two cases of solitary plasmacytoma of the skull, a very unusual presentation and location of this tumor. There seems to be no difference in prognosis between the tumor originating from the skull (osseous form) and from the dura mater (non-osseous form), differently from the data of other parts of the body. The risk of secondary multiple myeloma appears to be low but the mean follow-up is too short for any conclusion on this point.
Aged↗
Radiation-induced osteosarcomas of the skull: report of two cases and review of the literature.
Osteosarcoma of the skull as a second neoplasm after radiation therapy is unusual. This neoplasm generally occurs after doses of over 10 Gy. CT, MRI and biopsy are the main diagnostic procedures for this lesion. We report two other cases of osteosarcomas of the skull and review the pertinent literature.
Adenoma↗
Osteosarcomas of the skull. Clinical remarks on 19 cases.
BACKGROUND: Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post-Paget and post-radiation therapy. METHODS: The authors reviewed the osteosarcomas of the skull diagnosed at the Division of Neurosurgery of "La Sapienza" University of Rome. The patients were placed into two groups, according to the treatment received (prechemotherapeutic era and chemotherapeutic era). In the last five patients, a diagnostic-therapeutic protocol was adopted. RESULTS: The most effective investigations are plain radiographs, computed tomography (CT) with bone windows, and magnetic resonance imaging (MRI), with the latter two allowing assessment of the extraosseous extent of the disease. Chemotherapy has changed the prognosis dramatically, achieving cure in some cases (especially in de novo osteosarcomas). Before the age of chemotherapy, the median survival length was 16 months, but since its introduction, five of nine patients in this study are alive 2 years after diagnosis. The onset of metastases, chiefly to the lung, does not necessarily imply a poor prognosis. The authors propose a schedule for the diagnosis and treatment of new cases of osteosarcoma of the skull. CONCLUSIONS: Plain radiographs, CT targeted on the bone, and MRI are the most important diagnostic tools. Aggressive chemotherapy together with surgery (eventually including local radiation therapy in nontotal macroscopic surgical removal of the lesions) can drastically modify the prognosis of de novo and post-radiation therapy osteosarcomas.
Adolescent↗
Osteosarcoma of the skull in a child: case report and review of the literature.
Osteosarcoma does not often affect the bones of the skull, occurring preferentially in the appendicular skeleton. The patient's age at onset seems to be later when the tumor is in the skull than in other sites. CT and MRI are at present the best means of establishing the extent of the tumor. Surgical removal of the lesion combined with polychemotherapy is the basis of treatment. We report a case of osteosarcoma of the skull in a child and review relevant publications.
Child↗
Cranio-facial approaches for tumours involving the anterior half of the skull base.
Teamwork between neurosurgeons and head and neck surgeons has increased the possibility of managing tumours involving the skull base. The authors distinguish the anterior half of the skull base into a median and two lateral portions and describe the surgical approaches utilized to expose it. The authors present their clinical experience in 27 patients with extensive lesions of the anterior half of the skull base and their results.
Cavernous Sinus↗
The acrylic-wire option in cervical spine fixation. A retrospective study.
This retrospective study was undertaken to assess the stability of the cervical spine after fixation with acrylic wire implants. Of the 44 patients with various pathological conditions of the cervical spine selected for this treatment in the course of 20 years, 36 were considered suitable for long-term follow-up evaluation. In 30 cases (83%) the stability of the spine was rated good. It is concluded that the acrylic-wire combination is a valuable surgical option in certain conditions i.e. old age, short life expectancy, poor general health, mental disease, in which long confinement in bed or in orthopaedic appliances is poorly tolerated.
Acrylic Resins↗
Mucoceles of the paranasal sinuses with intracranial and intraorbital extension: report of 28 cases.
Twenty-eight patients received surgical treatment for a paranasal sinus mucocele with intracranial and/or intraorbital extension. The lesions were classified by site and extension: anterior without intracranial extension (Type 1), 7 patients; anterior with intracranial extension (Type 2), 11 patients; posterior midline without intracranial extension (Type 3), 5 patients; and posterior with intracranial extension (Type 4), 5 patients. The surgical approaches were: transnaso-orbital, transfrontonaso-orbital, transsphenoidal, transmaxillosphenoidal, and subfrontal transbasal; the choice depended on the site and extension of the lesion, with the aim of securing maximum exposure to ensure total removal of the lesion with its capsule. A transcranial approach was reserved for mucoceles possessing an intracranial extension or causing distension of the bone structures with optic pathway neurological symptoms. With a coronal or transfacial skin incision along the lines of the forehead, nose, and orbital muscles of expression and careful reconstruction, the patients' natural cast of features was spared or restored in a single operation.
Adolescent↗
[Anterior approaches to the spinal column: considerations of the surgical technic].
The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.
Female↗
Radiation-induced schwannomas of the neuraxis. Report of three cases.
We report 3 cases of possible radiation-induced schwannomas observed in our Department. Their salient clinical and pathogenetic features are analyzed and the role of radiation therapy in the oncogenesis of these lesions is discussed. Several cases of radiation-induced tumors, including some of the nervous system, have been reported, but schwannomas have only occasionally been reported in connection with ionizing radiation. The possible adjuvant role of antineoplastic drugs is also discussed, and the literature on this topic is reviewed.
Adult↗
Intramedullary metastasis of unknown origin: a case report.
We report a case of cervicothoracic intramedullary metastasis with long survival. The patient is in satisfactory neurological condition 18 months after operation and has resumed her normal lifestyle. Despite meticulous examinations, the primary lesion could not be identified. We discuss the relevant published work.
Adult↗
Meningioma of the fourth ventricle: a case report.
A rare case of fourth ventricle meningioma with a combined intraventricular-intracerebellar localization, successfully removed by surgical treatment, is reported. The features of this type of meningioma as compared to the purely intra-ventricular variety are discussed.
Adult↗
Subependymoma of the spinal cord. Case report and review of the literature.
Subependymoma is an uncommon, benign and, as a rule, asymptomatic lesion of the central nervous system, only rarely recorded at spinal level. The case reported here brings the total number of spinal subependymomas so far described to 16. The relevant literature is reviewed and the salient features of these tumors are discussed.
Adult↗