Emanuela Crobeddu

Università degli Studi di Brescia, Brescia, Lombardy, Italy

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Publications (16)35.57 Total impact

  • Brain Stimulation 07/2014; · 4.54 Impact Factor
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    ABSTRACT: Abstract Purpose: a literature review was made to investigate the role of nitric oxide (NO) in spinal cord injury, a pathological condition that leads to motor, sensory, and autonomic deficit. Beside we were interested in potential therapeutic strategies interfering with NO mechanism of secondary damage. Materials: literature search using PubMed Medline database. Results: excessive nitric oxide production after spinal cord injury promote oxidative damage perpetuating the injury causing neuronal loss at the injured site and in the surrounding area. Conclusion: different therapeutic approaches for contrasting or avoiding nitric oxide secondary damage have been studied, these include Nitric oxide synthase inhibitors, compounds that interfere with inducible NO synthase expression and molecules working as antioxidant. Further studies are needed to explain the neuroprotective or cytotoxic role of the different isoforms of NO synthase and the other mediators that take part or influence the NO cascade. In this way it would be possible to find new therapeutic targets and furthermore to extend the experimentation to humans.
    The International journal of neuroscience 04/2014; · 0.86 Impact Factor
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    ABSTRACT: ABSTRACT Objective: The worldwide population aging and the nowadays medical advances impose to consider new management guidelines for elderly. Aim of this study was to assess the best treatment in elderly with multiple intracranial aneurysms (MIA). Methods: From 1994 to 2011 we admitted 1462 patients with ruptured cerebral aneurysm. Among those aged ≥ 65 yo, 43 had MIA (15% of elderly). Size and aneurysm location, timing and type of treatment were analyzed. Patients were thus stratified according to Hunt-Hess grade on admission and evaluated at six months using the Glasgow Outcome Scale. Results: We had 87 aneurysms in the final series. Three patients died because of the impossibility to treat the ruptured aneurysm. No new bleeding from untreated aneurysms was observed; no retreatment after previous coiling was performed. Conclusions: MIA lead to significantly poorer outcomes, especially in elderly, because of their general clinical condition, presence of risk factors, and lower capacity of reaction to stressful events. In patients without large hematomas, coiling of the ruptured aneurysm represents the procedure with high effectiveness. The clinical conditions on admission represent the most important factor for the treatment results. To reduce the treatment-related risks we do recommend a conservative approach for the unruptured aneurysms.
    The International journal of neuroscience 12/2013; · 0.86 Impact Factor
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    ABSTRACT: There is little information about clinical characteristics, management, and outcome of patients with intracranial aneurysms and internal carotid artery occlusion. We will describe clinical characteristics, treatment and outcome of patients with coexistent internal carotid artery occlusion and intracranial aneurysms. We conducted a retrospective chart review of 22 patients (eight males and 14 females) with coexistent internal carotid artery (ICA) occlusion and intracranial aneurysms. This series includes 14 females and eight males with a mean age of 63 years (range, 49 to 80). These patients harbored a total of 35 aneurysms, which were located on the same side of the ICA occlusion in five cases, on the contralateral side in 20 cases, while in ten cases the aneurysm had a midline location (AcomA 9, Basilar tip 1). Treatment consisted of surgery for eight aneurysms and endovascular embolization for 13 aneurysms. No invasive treatment was recommended for 14 aneurysms (eight patients with single aneurysm). No permanent perioperative or periprocedural complications occurred in the selected group of patients undergoing invasive treatment. At a mean follow-up of 57 months (range, 3-203), no patient had a subarachnoid hemorrhage and three patients had died of causes not related to the aneurysm. Surgical and endovascular treatment can be accomplished safely in selected patients with coexistent ICA occlusion and intracranial aneurysms. Conservative treatment is a valid alternative, especially in elderly patients or in patients with very small aneurysms, especially if not located along the collateral pathway.
    Acta Neurochirurgica 09/2013; · 1.55 Impact Factor
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    ABSTRACT: Flow-diverters are used in the treatment of large and complex intracranial aneurysms. One major concern with this concept is the potential for compromise of side branches and perforators covered by the device. We describe three patients treated with the Pipeline embolization device (PED; ev3 Endovascular, Plymouth, MN, USA) who developed immediate compromise of flow into an eloquent side branch covered by the device. Three patients, two with giant posterior circulation aneurysms and one with recurrence of a previously clipped and subsequently coiled middle cerebral artery aneurysm, were each treated by placement of a single PED. Shortly after placement of the devices, despite adequate antiplatelet and anticoagulation regimens, partial or complete occlusion of a major side branch occurred. In all three patients, the occlusion was promptly reversed with intra-arterial administration of abciximab with no clinical sequelae. These cases are concerning because branch occlusion occurred even in the setting of patients appropriately premedicated with dual antiplatelet therapy and in whom genetic testing suggested clopidogrel responsiveness. Close monitoring of patients treated with these devices is critical to establish the frequency of this and other unanticipated complications.
    Journal of Clinical Neuroscience 08/2013; · 1.25 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE:Flow diversion is a new strategy for the treatment of complex paraclinoid aneurysms. However, flow diverters have, to date, not been tested in direct comparison with other available treatments. We present a matched-pair comparison of paraclinoid aneurysms treated with the PED versus other endovascular techniques.MATERIALS AND METHODS:Twenty-one eligible patients with 22 paraclinoid aneurysms treated with the PED at our institution were matched with historic controls with aneurysms of similar size and location.RESULTS:There were no statistically significant differences between the 2 groups in terms of aneurysm size, location, risk factors, or comorbidities. Mean dome size was 13.9 ± 6.7 mm in the control group and 14.9 ± 6.3 mm in the PED group (P = .52). Balloon and stent assistance were used in 31.8% and 9.1% of controls, respectively, while carotid sacrifice was used in 36.4% of the controls. There was a significant difference in the rate of complete occlusion favoring PED at radiologic follow-up (P = .03).CONCLUSIONS:Flow diverters achieve a much higher rate of complete angiographic obliteration compared with other standard endovascular techniques in the treatment of internal carotid artery aneurysms. In this series, this higher angiographic obliteration rate did not occur at the expense of an increased rate of complications. Careful long-term follow-up is of the utmost importance to definitively validate flow diversion as a superior therapeutic strategy for proximal internal carotid artery aneurysms.
    American Journal of Neuroradiology 07/2012; · 3.17 Impact Factor
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    ABSTRACT: BACKGROUND: Flow diversion represents a major paradigm shift in the treatment of unruptured intracranial aneurysms. The potential impact of this technique on coil utilization and adjunctive techniques such as balloon-assisted and stent-assisted coiling is unknown. In this study, the effect of introduction of flow diversion devices on the utilization of coil and adjunctive techniques was assessed. METHODS: A retrospective review was conducted of consecutive patients with unruptured aneurysms treated at our institution comparing two groups: Group 1 (patients treated in the 2-year interval preceding the introduction of the Pipeline Embolization Device (PED) and Group 2 (patients treated during the 2-year interval following introduction in our practice of the PED). RESULTS: Mean aneurysm diameter was 8.7±6.3 mm in Group 1 and 8.5±6.1 mm in Group 2 (p=0.79). PED therapy was employed in 38 (21.7%) of 175 aneurysms in Group 2. The proportion of stent-assisted procedures was significantly less in Group 2 than in Group 1 (6.9% vs 14.7%, p=0.04), as was the proportion of patients undergoing parent artery sacrifice (0.6% vs 3.9%, p=0.046). The mean and median number of coils used per aneurysm were 5.4±3.6 and 5 (range 1-18) for Group 1 and 3.2±3.2 and 3 (range 0-19) for Group 2 (p≤0.0001). CONCLUSIONS: Flow diversion represents a disruptive technology. More than one-fifth of unruptured aneurysms at our institution were treated with PED after introduction of this technology, resulting in marked decreases in coil and stent utilization.
    Journal of Neurointerventional Surgery 04/2012; · 2.50 Impact Factor
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    ABSTRACT: Proximal aneurysms of the medullary postero-inferior cerebellar artery (PICA) tract are peculiar due to critical anatomical location, small size and tortuosity of the parent vessel, close origin to brainstem perforators, and fragility of the sac wall. Moreover, most patients present after bleeding, increasing the challenges. Aim of this study is to evaluate the treatment modality and outcome of these patients during the last decade at the University Clinic of Torino. Databases of the Neurosurgical and Neuroradiological Department of the University of Torino were analyzed to retrieve patients treated for aneurysms of the medullary PICA tract. Charts and neuroradiological documentation were revised to complete the database. Of 621 patients treated for an intracranial aneurysm, 23 had PICA aneurysm, 18 located at the medullary tract. Only two were unruptured and 16 were ruptured aneurysms. Sixteen underwent endovascular treatment and two underwent surgery. In six cases the aneurysm was cured by parent vessel occlusion. At 6 months follow-up, the Glasgow outcome scale was high (5 and 4) in 16 patients; two patients had died in the acute phase, for reasons unrelated to the procedure. If not adequately compensated, parent vessel occlusion associates with high risks of ischemia and related brain swelling. In the present series sufficient collateral flow contributed to a good tolerance toward occlusion in all cases. Despite the small size of the present series, most treated cases presented a good outcome. Nevertheless, distal revascularization of the occluded artery would be indicated where collateral flow is insufficient.
    Neurological Sciences 04/2012; · 1.41 Impact Factor
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    ABSTRACT: SUMMARY:Angiographic recurrence following endovascular therapy is an indirect measure of the potential for hemorrhage. Because patients and physicians consider recurrence to be a suboptimal outcome with some chance of future hemorrhage, much effort has been expended to reduce the incidence of recurrence. The literature regarding aneurysm recurrence following endovascular therapy, spanning 2 decades, is extensive. We will review and summarize the effort to reduce recurrence following endovascular treatment of cerebral aneurysms.
    American Journal of Neuroradiology 03/2012; · 3.17 Impact Factor
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    ABSTRACT: SUMMARY:Cerebral aneurysms are treated to prevent hemorrhage or rehemorrhage. Angiographic recurrences following endovascular therapy have been a problem since the advent of this treatment technique, even though posttreatment hemorrhage remains rare. Notwithstanding its unclear clinical significance, angiographic recurrence remains not only a prime focus in the literature but also frequently leads to potentially risky retreatments. The literature regarding aneurysm recurrence following endovascular therapy, spanning 2 decades, is immense and immensely confusing. We review the topic of recurrence following endovascular treatment of cerebral aneurysms in an effort to distill it down to fundamental material relevant to clinical practice.
    American Journal of Neuroradiology 03/2012; · 3.17 Impact Factor
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    ABSTRACT: Patients with aneurysmal subarachnoid hemorrhage are typically kept in the intensive care unit to be monitored for signs of delayed cerebral ischemia (DCI). Identifying patients at lower risk for DCI could have a positive financial impact by allowing earlier transfer from the intensive care unit. We analyzed 307 consecutive patients admitted to the intensive care unit. Demographic, clinical, and neuroimaging data were recorded. The relationship with absent DCI was analyzed using univariate and multivariate logistic regression models. DCI did not develop in 169 patients (57.9%). Among factors at admission, age 68 years or older (P=0.0003; OR, 3.16; 95% CI, 1.66-6.39), World Federation of Neurological Surgeons (WFNS) I to III at presentation (P=0.0003; OR, 2.73; 95% CI, 1.57-4.79), WFNS I to III at worst (P=0.0003; OR, 2.39; 95% CI, 1.48-3.87), WFNS I to III after resuscitation (P=0.0006; OR, 2.85; 95% CI, 1.56-5.32), modified Fisher grade 1 to 2 (P=0.0021; OR, 2.43; 95% CI, 1.37-4.47), absence of intracranial hematoma (P=0.0042; OR, 2.26; 95% CI, 1.29-4.01), and aneurysm in the posterior circulation (P=0.025; OR, 1.74; 95% CI, 1.07-2.87) were associated with absence of DCI. On multivariate analysis, a model including age 68 years or older, WFNS I to III at presentation and a modified Fisher grade 1 to 2 were independently predictive of the absence of DCI, with a specificity of 100% and a positive predictive value of 100%. We propose a new model that can reliably identify patients with aneurysmal subarachnoid hemorrhage who are at very low risk for DCI. These patients could be candidates for early transfer to the general ward.
    Stroke 12/2011; 43(3):697-701. · 6.16 Impact Factor
  • Giuseppe Lanzino, Emanuela Crobeddu
    World Neurosurgery 09/2011; 76(3-4):253-4. · 1.77 Impact Factor
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    ABSTRACT: Brain arteriovenous malformations (BAVMs) are a rare but important cause of hemorrhagic stroke in young adults. Functional polymorphisms in proinflammatory cytokines have been associated with various cerebrovascular phenotypes, including ischemic stroke, aneurysmal subarachnoid hemorrhage, and BAVM. To investigate whether functional polymorphisms in the IL-1α, IL-1β, and IL-1RN genes are associated with both susceptibility and clinical characteristics in BAVM patients. Allelic and genotypic frequencies of IL-1α (-889 C>T), IL-1β (-511 C>T), and IL-1RN (VNTR) polymorphisms were analyzed in 101 unrelated BAVM patients and in 210 healthy subjects. Main clinical characteristics of the disease were compared according to different genotypes. Both allelic and genotypic frequencies of IL-1α -889 C>T showed a significant association with BAVM (P < .001). The carriage of the T allele was related to a 2.47 increased risk of BAVM (odds ratio, 2.47; 95% confidence interval: 1.72-3.56). Allelic and genotypic frequencies of IL-1RN VNTR were different between cases and controls (P = .009). Allele 1 was associated with about a twofold increased disease risk (95% confidence interval: 2.01-5.58). Haplotype analyses confirmed these findings. Several clinical characteristics of the disease were significantly modified by IL-1α and IL-1β genotypes. Our data suggest that functional polymorphisms within the IL-1 complex gene are associated with BAVMs and influence the clinical characteristics of the disease, supporting a role for proinflammatory cytokines in disease etiopathogenesis.
    Neurosurgery 07/2011; 70(1):12-7. · 2.53 Impact Factor
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    ABSTRACT: Subarachnoid hemorrhage (SAH) from aneurysm rupture accounts for approximately 3% of all strokes. A significant improvement in surgery and endovascular procedures has reduced mortality and morbidity. Nowadays, endovascular treatment is a viable alternative to conservative treatment in elderly patients. We designed a retrospective observational study on all endovascular procedures carried out in our department in order to evaluate the outcome in elderly patients compared with a younger cohort. A total of 378 patients with aneurysmal SAH were treated with detachable platinum coils in our department (1994-2009). Of these, 310 patients were aged 20-69 years and 68 were aged over 70 years. Data were stratified according to Hunt-Hess (H-H) grade at admission. The mean follow up was 4.8 years. The final outcome was evaluated through the Glasgow Outcome Scale (GOS). We observed a favorable outcome (GOS 5-4) in both groups of patients admitted with moderately good clinical conditions (H-H 1-3), with no statistically significant difference. In contrast, in the case of H-H grade at admission > 3, we observed a statistically significant poor outcome in elderly patients. We consider the endovascular treatment as first choice for elderly patients presenting with a good H-H grade at admission. Quick functional recovery and reduced hospitalization time were observed. Unlike young patients, a chance of recovery in elderly patients with H-H 4-5 is more difficult to achieve. Therefore, a conservative approach should be considered.
    Geriatrics & Gerontology International 07/2011; 12(1):46-9.
  • Neurology India 01/2011; 59(3):461-3. · 1.04 Impact Factor
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    ABSTRACT: Knowledge of spinal cord arteriovenous malformations (AVMs) has recently been improved by studies on pathophysiology, neuroimaging, and genetic data. Nevertheless, the natural history of these lesions remains poorly understood. The authors present the case of an angiographic regression of a nidal-type spinal AVM at T-12 to L-1 in a 46-year-old woman with no risk factors. The natural course of untreated lesions is reviewed and discussed. To the best of the authors' knowledge, this is the first study that reports an angiographically proven complete spontaneous occlusion of a spinal AVM.
    Journal of neurosurgery. Spine 04/2010; 12(4):397-401. · 1.61 Impact Factor

Publication Stats

35 Citations
35.57 Total Impact Points

Institutions

  • 2013
    • Università degli Studi di Brescia
      Brescia, Lombardy, Italy
  • 2011–2013
    • Università degli Studi di Torino
      • Dipartimento di Neuroscienze
      Torino, Piedmont, Italy
    • Mayo Foundation for Medical Education and Research
      • Department of Neurology
      Scottsdale, AZ, United States
  • 2011–2012
    • Mayo Clinic - Rochester
      • Department of Radiology
      Rochester, Minnesota, United States