Maurizio Bignami

Università degli Studi di Sassari, Sassari, Sardinia, Italy

Are you Maurizio Bignami?

Claim your profile

Publications (59)85.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-traumatic optic neuropathy (TON) is a rare, but very much feared event. It is a traumatic injury of the optic nerve at any level along its course (often inside the optic canal), with partial or total loss of visual acuity, temporarily or permanently. Until now, an univocal treatment strategy does not exist. The clinical records of 26 patients, treated from 2002 to 2013, were reviewed. The most frequent cause of injury was road traffic accident (63 %), followed by iatrogenic damage, work injuries, sport or home accidents. All patients underwent pre-operative ophthalmological evaluation, neuro-imaging (angio-CT or angio-MRI scans) and systemic corticosteroid therapy. All patients required a surgical treatment, due to poor response to medical therapy; it consisted of an endonasal endoscopic decompression of the intracanalicular segment of the optic nerve, performed by removing the bony wall of the optical canal and releasing the perineural sheath. Improvement of visual acuity was reached in 65 % of cases. No minor or major complication occurred intra- or post-operative, with a maximum follow-up time of 41 months. An improvement in visual acuity was achieved, although very limited in some cases, when surgery was performed as close as possible to the traumatic event. In the literature, there is no evidence-based data evaluating both of the two main treatment options (medical therapy versus surgical decompression), to state which is the gold standard in the treatment for TON. We discuss the pro and cons of our protocol: medical endovenous steroid treatment, within 8 h of injury, and endoscopic surgical decompression within 12-24 since the beginning of medical therapy, represent the best solution in terms of risk-benefit ratio for the patients.
    12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Respiratory epithelial adenomatoid hamartomas (REAHs) are rare benign tumors and may manifest as either isolated lesions or in association with sinonasal polyposis. The aim of this study is to report our experience in the management of patients with REAH and to analyze the long-term results of the endoscopic endonasal approach.
    International Forum of Allergy and Rhinology 11/2014; · 1.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The palatovaginal or pharyngeal artery is a small branch of the internal maxillary artery supplying the nasopharynx. Bleeding from this artery is exceptional and only one case of traumatic epistaxis from this artery has been reported previously. We report a case of a 66-year-old male presenting with right recurrent posterior epistaxis. Endoscopic dissection of the pterygopalatine fossa and direct visualization of the palatosphenoidal canal permitted to identify the origin of bleeding, and coagulation of the pharyngeal artery solved the epistaxis. Although rare, intractable posterior epistaxis may arise from the pharyngeal artery. The anatomical knowledge of this artery and of the palatosphenoidal canal is of outmost importance in endoscopic transpterygoid and nasopharyngeal procedures, to identify the vidian canal, evaluate nasopharyngeal cancer spread in the pterygopalatine fossa, reduce bleeding during surgery of the nasopharynx, and harvest adequately the pedicle of the nasoseptal flap.
    Archives of Oto-Rhino-Laryngology 10/2014; 271(10):2839-2843. · 1.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: the aim of this study was to evaluate the clinical behaviour of oncocytic Schneiderian papillomas in relation to the rate of malignant transformation and recurrences and to report the long-term results of the endoscopic endonasal treatment. Methods: a retrospective analysis was carried out on patients with oncocytic papilloma, endoscopically managed over the past 20 years, at two university centres following a uniform policy. Results: thirty-three patients were treated between November 1991 and December 2010. The mean follow-up period was 62 months. We observed 2 cases of persistence (6%) at maxillary sinus level. Both of these patients underwent endoscopic surgical revision. Squamous cell carcinoma was observed in one patient (3%). Conclusion: the endonasal endoscopic technique proved to be a safe and effective approach for the treatment of oncocytic papillomas. An oncocytic papilloma is not to be considered a negative prognostic factor in terms of malignant transformation or recurrence. Head Neck, 2013.
    Head & Neck 05/2014; 36(5):624-630. · 2.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite advances in endoscopic approaches, instrumentations and imaging guidance systems, the management of frontal sinus is still challenging. Failure of the endoscopic procedure and restenosis of the newly formed ostium have been demonstrated even with large frontal sinusotomy. We describe a newly designed double nasoseptal flap to cover the bare bone after endoscopic modified Lothrop procedure (EMLP). Five fresh, double-injected cadavers were dissected through an endoscopic endonasal approach. Posteriorly based nasoseptal flap on one side and laterally based nasoseptal flap on the other side were harvested before performing wide EMLP. Feasibility of the procedure, versatility of the flap, coverage area and measurements were calculated. Harvesting the mucoperichondrial/mucoperiosteal flap over the septectomy site was straightforward step. Two different designed flaps (one on each side) are more practical to avoid torsion of the flap. The flap measures 2 × 3 cm on average that was able to cover the bare bone of the anterior and posterior wall of frontal sinus. Osteoneogenesis and progressive osteoplastic activity after EMLP plays a major role in restenosis of frontal sinus. Vascularized nasoseptal flap helps in preventing closure of the newly formed ostium. Applying these flaps over the bare bone enhances the healing process and minimizes the crust formation.
    Archives of Oto-Rhino-Laryngology 03/2014; · 1.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Intestinal-type adenocarcinoma (ITAC) is a rare and locally-aggressive occupation-related tumour. Nowadays, endoscopic-assisted resection and advances in irradiation modalities (3D-CRT/IMRT) are emerging as an alternative to traditional open surgery and conventional radiotherapy. Methods. Retrospective analysis of 30 consecutive patients affected with sinonasal ITAC, primarily treated by an endoscopic approach followed by 3D-CRT/IMRT at a single Institution, from 2003 to 2010. Results. The 5-year overall, disease-specific, disease-free and recurrence-free survivals were 72.7±9.6%, 78±9.5%, 67.9±10.7% and 69.2±9.4%, respectively (mean follow-up, 48 months). No major complications or serious toxicities were observed. Prognostic factors were: stage of disease at diagnosis, development of recurrences, status of surgical margins, grading, tumoural pattern of growth and proliferative index (Ki67). Conclusion. The low morbidity of endoscopic approaches, the acceptable toxicity of modern irradiation modalities and this promising survival rates, indicate that this treatment strategy might be considered a safe, minimally-invasive and maximally-effective option for treating selected sinonasal ITAC. Head Neck, 2014.
    Head & Neck 03/2014; · 2.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The treatment of skull base malignancies has evolved significantly during recent decades, requiring the contribution of multidisciplinary teams. Surgery, which plays a pivotal role, ranges from traditional external procedures to endoscopic endonasal approaches (EEA). Recent reports have demonstrated that EEA is feasible, safe, and able to achieve the radical resection of selected lesions, while minimising the morbidity in patients. At the present time, the major criticisms that are made focus on oncologic outcomes, in view of the limited number of patients studied and the short/intermediate follow-up of larger series, which have grouped together different histologies associated with different prognoses. An extensive review of the pertinent literature is addressed here in order to analyse the endoscopic surgical techniques employed, the evolution of indications and the oncologic outcomes. The promising results that have emerged seem to indicate that EEA, when properly planned and performed by experienced surgeons, has nowadays acquired an accepted role with precise indications in the whole armamentarium available for the treatment of skull base malignancies.
    Current Otorhinolaryngology Reports. 12/2013; 1(4).
  • Source
    The Laryngoscope 11/2013; 123(11):2639-42. · 1.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Object For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection. Methods The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy. Results One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05). Conclusions Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.
    Journal of Neurosurgery 09/2013; · 3.15 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs).Study DesignCase series with chart review.SettingPatients affected by NPTs who underwent NER from 1997 to 2011 at two Italian referral centers.Subjects and MethodsNER was tailored to the NPT extension and classified as follows: type 1 NER, resection of the posterior nasopharyngeal wall; type 2 NER, resection superiorly extended to the sphenoid; type 3 NER, trans-pterygoid approach to the postero-lateral nasopharynx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal-petrous-cavernous segments of the internal carotid artery.ResultsThirty-six consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs were enrolled. The lesions were staged as follows: stage I, 16 (44.4%); stage II, 3 (8.4%); stage III, 15 (41.6%); and stage IVA, 2 (5.6%). Type 1 NER was performed in 6 cases, type 2 NER in 12, type 3 NER in 16, and bilateral-extended type 3 NER in 2. No perioperative mortality or major complications were observed. Postoperatively, 11 patients received intensity-modulated radiotherapy, with or without chemotherapy. Follow-up ranged from 2 to 173 months (mean: 38 months). Five years overall, disease-specific, and disease-free survivals were 75.1% ± 9.13%, 80.9% ± 7.79%, and 58.1% ± 14.8%, respectively.ConclusionNER is a feasible and minimally invasive surgical approach for the management of selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional procedures. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of the technique.
    Otolaryngology Head and Neck Surgery 06/2013; · 1.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.
    Case reports in otolaryngology. 01/2013; 2013:323210.
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is an increasing interest in intraoperative nerve monitoring (IONM), and numerous institutions have begun to perform monitored thyroidectomies. Attitudes have changed with the introduction of non-invasive devices, the publication of trials and guidelines defining standards, structured courses and descriptions of legal implications. The use of IONM helps to identify the nerve and give an objective evaluation of its function during the dissection. Recently, continuous IONM was introduced; it is a promising tool for early recognition of recurrent laryngeal nerve stress. This paper describes current issues in IONM.
    Current Otorhinolaryngology Reports. 01/2013;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To review our experience with the surgical treatment of frontoethmoidal osteomas, focusing on the osteomas that were either localized laterally in the frontal sinus or showing intraorbital involvement. Retrospective evaluation. Tertiary care center. Patients with symptomatic frontoethmoidal or intraorbital osteomas who had been treated surgically from 1996 through 2011. Sixty frontoethmoidal osteomas were treated surgically. The lesion involved the far lateral portion of the frontal sinus in 23 cases and the orbital region in 6 cases. In 31 cases, a purely endoscopic approach was performed while a combined procedure was used in 25 patients. In 4 patients, an exclusively external approach was required. No recurrence of osteoma. Radical resection was obtained, except in the case of 2 lesions. No osteoma recurrence was observed during a mean follow-up of 72.6 months. The size of the osteoma, far lateral extension of the tumor in the frontal sinus beyond the lamina papyracea, and intraorbital involvement are no longer absolute contraindications for purely transnasal endoscopic resection. What is important is that the surgeon should not be dogmatic but rather be ready to change his or her mind during surgery, shifting to an external approach when required.
    Archives of otolaryngology--head & neck surgery 05/2012; 138(5):498-504. · 1.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The ENT magnetic navigation system is potentially useful and offers the most accurate technique for harvesting frontal osteoplastic flaps. It represents a valid tool in the wide range of instruments available to rhinologists. Precise delineation of the boundaries of the frontal sinus is a crucial step when harvesting a frontal osteoplastic flap. We present a novel technique using the ENT magnetic navigation system. Nineteen patients affected by different pathologies involving the frontal sinus underwent an osteoplastic flap procedure using the ENT magnetic navigation system between January 2009 and April 2011. The ENT magnetic navigation system was found to be a safe and accurate tool for delineating the frontal sinus boundaries. No intraoperative complications occurred during the osteoplastic procedures.
    Acta oto-laryngologica 04/2012; 132(6):645-50. · 0.98 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Nowadays endoscopic skull base reconstruction is safely and effectively performed by means of two-dimensional (2-D) endoscopic technique. The aim of our study is to compare our 2-D experience with the novel 3-D technology in the field of skull base reconstruction techniques. In this study four patients treated with various kinds of planned duraplasty are included. The new 3-D technology was compared with the high-definition 2-D scopes during the different steps of the procedures. The 3-D endoscopic skull base reconstruction obtained primary closure without complications in all cases. According to the subjective opinion of experienced endosurgeons, this novel technique improved depth perception, distance and size estimation, ability to identify specific anatomic structures, and hand-eye coordination. The main drawbacks detected were inferior sharpness, contrast and lighting that impaired the application of the technique in narrow sinonasal spaces. According to our preliminary impressions, 3-D endoscopic skull base reconstruction is an effective and safe procedure and could represent a significant advantage for accurate managing of the skull base region.
    Journal of neurological surgery. Part B, Skull base. 04/2012; 73(2):85-9.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The surgical treatment of sinonasal malignancies is in continuous evolution. In selected patients, endoscopic resection has become a sound alternative to traditional external approaches. Further improvements are necessary to enhance the possibilities of endoscopic transnasal resection of sinonasal malignancies. We present a case of intestinal-type adenocarcinoma of the left nasal fossa eroding the skull base that affected a 56-year-old male. The patient was surgically-treated by means of a four-hand binarial endoscopic transnasal resection using a 3D endoscopic system and neuronavigation. Surgery was completed in 5 hours without significant complications. Surgeons were able to recognize and manage anatomical structures, and to control bleeding easily thanks to the bimanual technique and 3D visualization. The new 3D scopes and the bimanual technique under the guidance of a navigation system represent an interesting solution that can overcome the traditional limits of the traditional set up currently used.
    Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 04/2012; 32(3):189-91. · 0.79 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: During the last years, multiple methods and a wide set of materials for skull base reconstruction have been described. In our experience, the ideal graft for duraplasty is the iliotibial tract due to its favorable characteristics in terms of thickness, pliability, and strength. In this report, we show the iliotibial tract-harvesting technique under endoscopic guidance with a minimally invasive approach using a cadaveric model. Two longitudinal incisions of 1 cm each were made at 4 cm down a line drawn between the anterior-superior iliac spine and the lateral margin of patella at the extremities of the middle third of the thigh. By using a set of instruments for endoscopic face-lifting, the graft was easily set up and harvested. The endoscopic approach is associated with less visible scars, but longer operative time in comparison with open traditional procedure. The pros and cons in terms of morbidity need to be evaluated by further studies on actual cases.
    Skull Base 05/2011; 21(3):185-8. · 0.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgical approaches to the parapharyngeal spaces are challenging. Little is known about the transoral perspective of the anatomy of the parapharyngeal space. Thus, transoral approaches are seldom performed, and only for small-sized tumors. Six freshly injected cadaver heads were dissected to illustrate the transoral surgical anatomy of the parapharyngeal space. The transoral window dominates the parapharyngeal space from the medial pterygoid muscle laterally to the superior constrictor muscle medially. The stylopharyngeus and styloglossus muscles seem to be critical landmarks in this approach. Posterior to these muscles and laterally to the superior constrictor muscle, the internal carotid artery, internal jugular vein, and lower cranial nerves are identifiable. This anatomic study emphasizes the critical role of the superior constrictor, styloglossus, and stylopharyngeus muscles and highlights the concept of a logical step by step technique that allows the identification of important structures and the creation of safe surgical corridors.
    Head & Neck 04/2011; 33(4):557-61. · 2.83 Impact Factor

Publication Stats

447 Citations
85.63 Total Impact Points

Institutions

  • 2012–2014
    • Università degli Studi di Sassari
      Sassari, Sardinia, Italy
  • 2006–2014
    • University of Insubria
      Varese, Lombardy, Italy
  • 2003–2014
    • Ospedale di Circolo e Fondazione Macchi Varese
      Varese, Lombardy, Italy
  • 2007–2013
    • Università degli Studi dell'Insubria
      Varese, Lombardy, Italy
  • 2001–2011
    • University of Pavia
      Ticinum, Lombardy, Italy
  • 2010
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2008–2010
    • Università degli Studi di Brescia
      • Department of Clinical and Experimental Sciences
      Brescia, Lombardy, Italy