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Biomedical subjects

R Da Pian

Publications and source records attributed to R Da Pian.

At least 37 records · Page 2Linked to original sources
PubMed1985

Childhood cerebrovascular diseases not associated with vascular malformations.

Of 76 patients in the pediatric age group suffering from cerebrovascular diseases treated in the years 1970-1983, 26 patients (34%) did not harbor intracranial vascular malformations (aneurysms or arteriovenous malformations). Two groups of patients were identified: (a) those suffering from a spontaneous intracranial hemorrhage (16 cases); (b) those suffering from an ischemic stroke (10 cases). Of those with spontaneous intracranial hemorrhage, 10 patients underwent surgery and evacuation of the hematoma. In 2 cases the hematoma was located in the posterior fossa, in 1 case in the upper brain stem, and in 3 cases in the basal ganglia; in the remainder the hematoma was supratentorial. Two patients died soon after the hemorrhage. Eight of the surviving patients completely recovered. In those with ischemic stroke, none suffered from congenital heart disease, a well-known predisposing factor. In this second group 1 patient died and 9 survived. Only one patient showed complete recovery. The data indicate that a hemorrhagic stroke is more common than an ischemic stroke in a child presenting with acute onset of hemiparesis and/or loss of consciousness: thus the value of CT scan as the first diagnostic procedure is clear, owing to the possibility of emergency surgical treatment. In children with ischemic strokes, a complete laboratory/clinical evaluation should be undertaken in order to exclude preexisting heart disease, coagulation disorders or lipoprotein abnormalities, and less common systemic diseases.

Adolescent↗
PubMed1985

Spontaneous disappearance of intracranial arterio-venous malformations.

4 cases of spontaneous disappearance of intracranial arteriovenous malformations are reported. All the malformations were in the rolandic-parietal area, and fed in most cases by the MCA. In one case, the malformation was associated with a proximal aneurysm. One malformation was large, one medium-sized, and two small. Venous drainage was towards the longitudinal sinus in all cases. Presenting symptoms consisted of epilepsy in 2 cases, and intracerebral haemorrhage in 2 cases. Disappearance of the AVM was documented by angiography from 1 to 15 years after diagnosis, and was preceded by a new haemorrhage in 2 cases. Acute or gradual thrombosis of the AVM is suggested as the most likely cause of the disappearance of an AVM. Spontaneous thrombosis of an AVM should be considered as an aspect of the pathological entity known as "thrombosed AVM". Guidelines for the management of patients exhibiting spontaneous disappearance of an AVM are briefly discussed.

Adolescent↗
PubMed1984

Surgical versus medical treatment of spontaneous posterior fossa haematomas: a cooperative study on 205 cases.

22 Italian centres have joined together in a cooperative study aiming to define the ideal management of spontaneous posterior fossa haematomas. 205 cases have been evaluated: 155 cerebellar haematomas and 50 brainstem haematomas. Out of these, 190 cases, all studied by CT scan, are the subject of the present study. Cerebellar haematomas have been divided, according to a tomographic classification, into 3 groups: group 1 (4th ventricle not shifted), group 2 (4th ventricle shifted or obliterated) and group 3 (intraventricular blood). Each group has been subdivided into: A (no hydrocephalus), and B (hydrocephalus). Regardless of therapeutical modalities, mortality rate was 38% for cerebellar haematomas; level of consciousness a few hours after haemorrhage and size of the lesion appeared to be significant prognostic factors. As a whole, medical treatment gave better results than surgical treatment. Considering each tomographical group in detail, surgery should be limited to patients in group 2B and 3B, especially when exhibiting neurological deterioration. For brainstem haematomas, overall mortality was 57%. The possibility of survival was linked to the presence or absence of initial loss of consciousness and to the size of the lesion; while hydrocephalus did not influence the final outcome, ventricular blood was a risk factor. Surgical evacuation showed some value in chronic cases. However, medical treatment appears to be the best policy for brainstem haematomas of limited size; for larger lesions, the outcome appears to be uniformly fatal, regardless of the treatment employed.

Adolescent↗
PubMed1984

Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage.

The role of computed tomography (CT) in the management of vasospasm from subarachnoid hemorrhage was evaluated in 242 consecutive cases with CT performed within 7 days after hemorrhage. Only 20% of these cases did not show a detectable subarachnoid hemorrhage on CT. Subsequent angiograms showed vessel narrowing in 56% of the cases; associated clinical deterioration was noted in 34% of the cases. On later CT, clear ischemic areas were detected in 20% of the cases. A strict correlation between the amount of cisternal blood and the subsequent development of vasospasm was observed: although absent or thin cisternal depositions were rarely associated with vasospasm, consistent or thick depositions were frequently linked to vasospasm (72% of the cases) and to ischemic disturbances (51% of the cases), as well as to clear ischemic areas on later CT (30% of the cases). Regarding the morphology of the cisternal blood collection, the risk of developing vasospasm was at its lowest (42%) for depositions only in the frontal interhemispheric fissure and was at its highest (79%) for depositions in multiple cisterns. The site of cisternal deposition corresponded closely to the area of ischemia on later CT. The persistence of subarachnoid blood more than 72 hours after hemorrhage probably increases the risk of vasospasm, although our data are not conclusive. The definition of a CT scan "at risk" for vasospasm--based on the previous findings--gives practical advantages: proper selection of patients in regard to timing of operation, closer observation and the possibility of prophylactic treatment in patients "at risk," and more adequate evaluation of different therapeutic modalities for vasospasm. With regard to the last point, the incidence of vasospasm was not statistically different between two groups of patients uniformly "at risk": the first group submitted to early operation and the second awaiting operation.

Adolescent↗
PubMed1984

Cerebral vasospasm after head injury.

Cerebral vasospasm occurs frequently after head injury. Correlation between neurological deterioration and vasospasm has been reported previously, but delayed neurological deterioration secondary to vasospasm in head injury is a rare occurrence. We report the case of a 57-year-old man who, after a motorcycle accident, developed an acute subdural hematoma and a thick subarachnoid deposition of blood in the left sylvian-insular cistern. After surgical evacuation of the hematoma, the patient improved until the 10th postoperative day, when he developed aphasia and a right hemiparesis. Angiography demonstrated multitapering spasm, and a computed tomographic (CT) scan showed persistence of the cisternal deposition of blood. Despite therapy with hypervolemia, the patient improved only slightly. The association of head injury with substantial subarachnoid hemorrhage producing vasospasm has been considered rarely. Delayed posttraumatic vasospasm secondary to blood degradation products seems to play some role in the vasospasm after head injury. CT scanning may be useful in predicting vasospasm in such patients, and digital subtraction angiography might be useful in demonstrating it.

Brain Injuries↗
PubMed1983

Intracranial arteriovenous malformations in the pediatric age: experience with 24 cases.

24 patients below 16 years of age with intracranial arteriovenous malformations are considered. Presenting history has been constituted mainly by intracranial hemorrhage, followed by epilepsy and hydrocephalus. The utility of angiography and CT scan is stressed, especially for preoperative evaluation. The arteriovenous malformation was located in noncritical cortical areas in 7 cases, in critical cortical areas in 6 cases, in the midline structures or in the basal ganglia in 8 cases, in the posterior fossa in 2 cases, and was only dural in 1 case. Complete surgical resection of the lesion has been carried out in 18 cases, and embolization in 1 case. The operative microscope, induced hypotension, and the 'backward technique' have been very useful during surgery. Following the operation, good results have been achieved in 83% of cases; mortality has been 11%. In most cases epilepsy has shown improvement after surgery. It is concluded that direct surgical extirpation of the angioma is the treatment of choice for pediatric patients, even in the presence of epilepsy alone.

Adolescent↗
PubMed1982

Traumatic extradural haematomas in children: experience with 62 cases.

Sixty-two children with traumatic extradural haematomas are considered According to the clinical history presented--often atypical--and to the grade of neurological impairment, patients have been divided into different clinical groups. Nearly 50% of patients sustained a minor injury, and 26% did not lose consciousness after trauma. Twenty-four per cent of patients did not show fractures on skull X-rays. Atypical location of the haematoma was noted in 22 cases, mainly in the anterior fossa (19 cases). Sixty patients were operated on, while two patients were conservatively treated, owing to the limited size of the haematomas and to the absence of neurological deficits. Associated brain lesions were discovered at surgery in 40% of cases. The overall mortality rate has been 17%, the operative mortality rate 14%. The morbidity rate has been 6%, with 3% of patients presenting severe disability. Morbidity and mortality have been shown to be affected by age--with better prognosis in patients under 10 years of age, by the clinical history presented, by the preoperative conditions, and, mainly, by the presence of associated brain lesions. As regards location, frontal haematomas have shown a better prognosis and a slower course than convexity haematomas. Finally, prognosis of extradural haematomas in children has improved to some extent in the last years with the advent of the CT scan, possibly due to speed and accuracy of diagnosis.

Adolescent↗
PubMed1982

Midline giant arterio-venous malformations in infants.

Three rare cases of giant midline arterio-venous malformations are presented. The first case is an infant girl with a vein of Galen malformation, who died from a subarachnoid haemorrhage a few weeks after shunt insertion for the control of hydrocephalus. The second case is an infant girl with a massive dilatation of the superior longitudinal sinus, who died from acute cardiac decompensation following direct surgery on the malformation. The third case is an infant boy with very large bilateral angiomas of the basal ganglia, who was not treated surgically. Some unusual features of these cases are discussed. Anatomically, the lesion can be quite different from a typical vein of Galen malformation. Clinically, the presence of cardiac failure and hydrocephalus is not always the case, and the possibility of a subarachnoid haemorrhage must be considered. For these reasons, infants with giant midline AVMs should be treated individually, balancing various considerations.

Basal Ganglia↗
PubMed1982

An analysis of vasospasm following early surgery for intracranial aneurysms.

41 patients with ruptured intracranial aneurysms were all submitted to an early operation, (within 3 days from SAH), and evaluated with regard to the results of treatment. In this group, vasospasm has influenced the outcome more than other causes, accounting for 58% of morbidity and 64% of mortality. On the basis of our experience with 380 patients suffering from SAH and all submitted to a CT scan, the presence of consistent intracisternal blood in the CT scan at admission has shown to be the main risk factor resulting in vasospasm. Therefore, the group with early surgery has been compared, on the basis of the CT scan picture, to a group of 76 patients in which surgery had been delayed at least 10 days after SAH. Whilst the incidence of vasospasm has been very similar in the groups compared, the incidence of neurological deterioration brought about by spasm has been higher in patients waiting for surgery (55%, against 36% in the group with early surgery). Avoidance of clinical deterioration has not been always possible with early surgery, even after careful cleansing of the cisterns from clots, as was shown by 2 of our cases. It is concluded that vasospasm does not seem to influence the outcome of early surgery to a greater extent than it would during the natural course of subarachnoid haemorrhage.

Humans↗
PubMed1982

Microsurgical treatment of juxtapeduncular angiomas.

Five patients harboring juxtapeduncular angiomas were all treated by a direct microsurgical approach. Anatomic considerations, angiographic data on the feeding arteries, and related anomalies are discussed. The operating microscope and deep hypotension were very useful for the complete removal of these lesions, which were approached in most cases by a "backward" technique. Diffuse bleeding from the paraventricular area was difficult to handle. There were no postoperative deaths. At follow-up examination, 1 patient had hemiparesis and hemianopia, 2 patients had mild visual field defects, and 2 patients had normal neurological examinations. All but one of the patients have resumed their previous occupations. It is concluded that microsurgery constitutes the best treatment for these malformations.

Adult↗
PubMed1981

Treatment of medulloblastoma in children: long-term results following surgery, radiotherapy and chemotherapy.

Forty-seven children with histologically confirmed medulloblastoma are considered. Forty-five cases were surgically by direct approach to the tumour, while two cases were treated only with a shunt. A shunt was inserted preoperatively in 14 cases, postoperatively in 4 cases. Surgical resection was total or subtotal in 52% of cases, partial in 35%, and limited to a biopsy in 13%. Radiation treatment to the entire neuraxis was done in 37 cases: 10 of these cases received additional chemotherapy--mostly with CCNU--as primary treatment for medulloblastoma. Ten patients died within 30 days after surgery. Twenty-two patients died months after treatment, mainly from tumour recurrence (19 cases). One patient was lost to follow-up. Thirteen patients are survivors from 10 months to 20 years after treatment. As a whole, the one year survival rate has been 67%, 3 year survival 43%, and 5 year survival 27%. Complications affecting prognosis have been presented by tumour recurrence and metastases. CSF shunting and lack of prophylactic irradiation to the cerebral hemispheres have been considered responsible for the high incidence of supratentorial metastases in our series. Factors influencing prognosis have been the extent of tumour resection and association of primary chemotherapy with radiotherapy. Within 3 years after surgery survival has been 52% in cases with total resection against 31% in cases with partial resection of tumour. As regards chemotherapy, 3 year survival has been 60% for patients with combined treatment (chemo- and radiotherapy) against 37% in patients with radiotherapy alone. It is concluded that the best results in children with medulloblastoma are achieved by a radical resection, associated with a combined primary treatment of radiotherapy and chemotherapy.

Adolescent↗
PubMed1980

Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus.

The authors present the results of surgical treatment in 165 children with nontumoral hydrocephalus, treated during a period of 11 years. The minimum period of follow-up was 1 year. The results in the group of children treated with a ventriculoatrial (VA) shunt were compared to those obtained in the group with a ventriculoperitoneal (VP) shunt. 45% of patients with VA shunts had one or more revisions, against 51% of patients with VP shunts. However, the incidence of revisions after 6 months from primary insertion was lower in the VP-shunted children. Most revisions were due to shunt malfunction: obstruction of the ventricular or abdominal catheter was the commonest finding. Among complications, the most serious was constituted by shunt infection (11% of cases). Most infections occurred at less than 2 months from surgery and were caused mainly by Staphylococci. 31% of infected patients died. Other frequent complications were due to shunt tubing lost in abdomen or in the ventricles and subdural hematoma. The overall mortality rate in the whole group was 18%, while the shunt-related mortality rate was 10.9%. Complications were more frequent in the VP-shunted patients, but were less than in VA-shunted patients and accounted for a lower mortality rate. Complications and mortality rate were prevalent in the patients presenting congenital communicating hydrocephalus or myelomeningocele. It is concluded that VP shunt is preferable to VA shunt in the treatment of infantile hydrocephalus.

Cerebrospinal Fluid Shunts↗
PubMed1980

Direct microsurgical approach to aneurysms of the internal carotid bifurcation.

In this report, a series of 21 aneurysms of the internal carotid bifurcation, all treated with a direct microsurgical approach, is discussed. A classification of these aneurysms, according to angiographic and anatomical considerations, is proposed. The surgical treatment of aneurysms of the internal carotid bifurcation is discussed, emphasizing the importance of avoiding damage to perforating vessels. One of the patients presented in this report died from postoperative vascular spasm and three had transient disturbances in the postoperative course. All surviving patients recovered completely.

Adolescent↗
PubMed1976

Local cooling in spinal cord injury.

Eight patients with acute spinal cord injury at different levels were treated by local cooling. Early laminectomy was performed and the subdural space was irrigated with saline at 5degreesC for about two hours. In addition to this treatment, five patients, after closure of the operative wound, received local epidural cooling that was prolonged for a few days. All patients before treatment had a complete loss of function of the spinal cord below the injured segment. Four of these regained some sensory and motor functions and two were able to walk. Somatosensory cortical evoked responses were consistent with the results obtained, thus demonstrating their prognostic value. The clinical application of local spinal cord hypothermia in order to minimize the catastrophic effects of spinal cord trauma is discussed. The results obtained in these eight patients agree with the several experimental observations and seem to justify the application of this procedure to human beings.

Adolescent↗