Jacopo Lenzi

Sapienza University of Rome, Roma, Latium, Italy

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Publications (33)52.64 Total impact

  • International Journal of Oral and Maxillofacial Surgery 10/2015; 44:e96-e97. DOI:10.1016/j.ijom.2015.08.653 · 1.57 Impact Factor
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    ABSTRACT: The full endoscopic interlaminar approach (FEILA) is a minimally invasive procedure to treat intracanal lumbar disc herniation not approachable by endoscopic transforaminal access. Disc prolapses have been classified into three categories according to their position and passing nerve root displacement: (i) type A, in which the nerve root is displaced medially; (ii) type B, in which the nerve root is displaced laterally; and (iii) type C, in which the nerve root is ventrally displaced. We focused on the FEILA technique because it was likely to involve few complications and that provided the advantages of the endoscopic approach. We prospectively evaluated 100 consecutive cases of L5-S1 disc herniations operated on with FEILA, including 85 type A cases, 13 type B, and 2 type C. Patients were evaluated at discharge, 3 months, 6 months and 2 years. The operating time varied from 15 to 40 min. The use of drills and burrs was necessary to treat type B disc herniations; thus, it was preferable that these cases were operated on later in the learning curve. After surgery, 90% of neurological deficits improved. The Oswestry Disability Index and visual analog scale leg at last follow-up were 15 and 9, respectively. There were no major complications. There were five cases of recurrence; four of which were treated with same technique and with good results. FEILA is a safe procedure for the removal of intracanal L5-S1 disc herniations. The late follow-up confirms the stability of the results. We suggest treating type A prolapse at the beginning of the learning curve and type B herniations after sufficient experience in the use of the burrs has been achieved. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
    Asian Journal of Endoscopic Surgery 08/2015; DOI:10.1111/ases.12214
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    ABSTRACT: Piezosurgery is an alternative surgical technique, now widely tested, that uses ultrasounds for bone cutting. This device uses ultrasounds to section hard tissues without harming surrounding soft tissues. The authors analyzed their experience in craniomaxillofacial procedures with piezosurgery. A comparison between operation timing and complication rates between piezosurgery and traditional cutting instruments has been performed. A total of 27 patients were examined (15 females and 12 males; average age, of 5.5 months) affected by craniosynostosis. The aim of this study was to analyze the advantages and disadvantages of piezosurgery in pediatric craniofacial procedures. Piezoelectric device in this study has shown being a valid instrument for bone cutting in accurate procedures, because it allows performing a more precise and safer cutting, without the risk of harming surrounding tissues.
    The Journal of craniofacial surgery 05/2015; 26(3):840-2. DOI:10.1097/SCS.0000000000001574 · 0.68 Impact Factor
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    ABSTRACT: The purpose of this study was to assess the feasibility of the use of the 2μ-thulium laser in harvesting nasal septal flaps. Nasal septal flaps are routinely performed in almost every trans-sphenoidal surgery. The preservation of the arterial vasculature is a mainstay of the procedure. However, the margins of the flap should be sufficiently healthy to regenerate faster, reducing the risk of possible complications. Eight patients underwent trans-sphenoidal surgery and removal of pituitary adenomas. Reparation of the defect was performed with the positioning of a rotational vascularized nasal-septal flap. The flaps were harvested with the aid of the 2μ-thulium laser. Every patient was then monitored for 6 months through seriated endoscopic endonasal controls. There were no complications related to the use of the laser, either intraoperatively, or postoperatively. The operative timing did not significantly differ from that of traditional techniques. The use of the 2μ-thulium laser for the harvesting of nasal septal vascularized flaps can be considered safe and feasible. The limited number of treated patients could be considered as the only restriction to the study. A larger study might have uncovered possible instrumentation-related complications, which were not observed in the present study.
    Photomedicine and Laser Surgery 03/2015; 33(4). DOI:10.1089/pho.2014.3847 · 1.67 Impact Factor
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    ABSTRACT: Acromegaly is caused by a GH-secreting pituitary adenoma, associated with many comorbidities and increased risk of mortality. Surgery is the first-line therapy. Success of therapy is measured by symptomatic improvement, preservation of pituitary function and biochemical control. Trans-sphenoidal surgery (TSS), endoscopic or microscopic, is the preferred treatment. To evaluate surgery effectiveness and individuate the technique associated with a higher remission rate, patients undergoing TSS were retrospectively selected. Thirty-seven consecutive patients underwent surgery between 1996 and 2006. Tumors were classified into macroadenomas or microadenomas and into intrasellar, extrasellar and extrasellar with cavernous sinus invasion. Surgery was performed in 22 patients with endoscopic technique, in 15 patients with microsurgical approach. The hormonal assays were performed 6 months and yearly after surgery for an average of 5 years. Ten patients were affected by microadenoma, 27 by macroadenoma. In microadenomas remission rate was independent of the used technique. Within macroadenomas, remission percentage in endoscopic approach (68.75%) was significantly higher than in microscpic approach (18.18%) (P=0.018). Postsurgical biochemical remission was calculated combining the surgical technique and tumor extension: the endoscopic approach was associated with a significantly higher remission rate in extrasellar than both in intrasellar and extrasellar with cavernous sinus invasion. In the latter group, any technique had not reached biochemical remission. TSS is able to induce a long-term remission of acromegaly, with low risk of recurrence and complications. Endoscopic approach is more suitable than microscopic technique in macroadenomas and adenomas with suprasellar extension.
    Journal of neurosurgical sciences 03/2015; 59(1):11-18. · 1.16 Impact Factor
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    ABSTRACT: Introduction Cervical subaxial malalignment due to complete or partial post-traumatic dislocation is generally associated to neurological impairment of ranging severity. Literature lacks reporting this entity in patients with no neurological issues. Cervical traction is not widely accepted in treating this kind of injury, due to its potential for neurological damage, although surgery seems to represent the gold standard. Materials and methods We studied in detail 18 cervical subaxial severe dislocations and ptosis, especially analyzing 2 personal cases plus 5 from the literature without neurological impairment. We discuss the role of pre-operative cervical traction and its influence on the overall surgical planning and outcome. Results Sixteen cases of anterior complete luxation were described in detail by literature. Five patients were reported having no associated neurological impairment and three were treated by pre-operative traction. Our two cases of cervical subaxial dislocation due to bi-pedicular fractures without neurological deficits were treated by traction and surgical fixation. Conclusions Subaxial bi-pedicular fracture is a highly unstable condition of the cervical spine. Complete or incomplete dislocation requires instrumented fixation. An intact neurological status is very rare. Pathological canal enlargement seems to be able to protect the spinal cord, during trauma and/or traction. For these findings, cervical traction could be applied with no excessive worrying. We prefer a progressive traction up to 20 lb, administered in 7-10 days with no intubation and close neuro-vascular status monitoring. Good pre-operative realignment can be properly achieved in the majority of cervical dislocations, thus avoiding three-stage surgery and somatectomy.
    European Spine Journal 09/2014; 23(S6). DOI:10.1007/s00586-014-3560-z · 2.07 Impact Factor
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    ABSTRACT: Chordoid meningioma is a rare variant of meningioma characterized by a more aggressive behavior. The present study documents the histological, radiological and clinical features of seven cases treated at the Policlinico Umberto I of Rome from 1999 to 2010. There were five males and two females. Most of the cases were located in the supratentorial space, especially the convexity. Surgical gross total resection was achieved in four cases. Of the remaining three cases, two relapsed and underwent further surgeries and adjuvant treatment. The MIB-1 index had a mean value of 7.5 (range 0.3-25.8). Tumors were composed of epithelioid cells or plump to spindle cells, forming cords, cribriforms or nests, in a mucoid matrix. All tumors showed diffuse positive immunoreactivity to vimentin and epithelial membrane antigen. Surgery is the first line of treatment for this kind of lesion. Gross total resection guaranteed a survival free from recurrences in our series. On the other hand, radiation therapy must be considered in patients submitted to a subtotal resection.
    Neurological Sciences 04/2013; 34(11). DOI:10.1007/s10072-013-1431-8 · 1.45 Impact Factor
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    ABSTRACT: Giant fusiform aneurysms of the distal middle cerebral artery (MCA) are rare lesions that, because of the absence of an aneurysm neck and the presence of calcified walls and partial thrombosis, can be difficult to clip without sacrificing the parent vessel. Moreover, when the aneurysm is located in the dominant hemisphere, it is not possible to test language and cognitive functions during surgical intervention, making the closure of the parent vessel extremely dangerous. A 46-year-old woman presented with a one-year history of frontal headache without neurological deficit. A magnetic resonance imaging and an angiography showed a giant fusiform aneurysm of the left M2 tract. Because of the location and the absence of a neck, the aneurysm was considered difficult to coil and not amenable to preoperative balloon occlusion; thus, the patient was a candidate for surgical treatment. After a preoperative psychological evaluation, patient underwent awake craniotomy with the asleep-awake-asleep technique. A standard left pterional approach was performed to expose the internal carotid artery, the MCA and the aneurysm originating from the frontal branch of the MCA. Neurological examination responses remained unchanged during temporary parent artery occlusion, and trapping was successfully performed. Awake craniotomy is a useful option in intracranial aneurysm surgery because it permits neurological testing before vessels are permanently clipped or sacrificed. With the asleep-awake-asleep technique, it is possible to perform a standard pterional craniotomy, which allows good exposure of the vascular structures without cerebral retraction.
    Surgical Neurology International 03/2013; 4:39. DOI:10.4103/2152-7806.109652 · 1.18 Impact Factor
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    ABSTRACT: Background and objective: Since the 1960s, lasers have been used in neurosurgery for surgical removal of intracranial tumors. Because of its limited penetration (2 mm) through tissues and its wavelength, which is useful in water medium, the 2-µ thulium laser has been applied primarily in urology. Its features are attractive for application under microscope magnification during neurosurgical procedures. The aim of this study was to evaluate the usefulness of the 2-µ thulium laser during microsurgical removal of intracranial meningiomas. Materials and methods: Twenty patients with a diagnosis of intracranial meningiomas were treated with surgical intervention using a 2-µ thulium laser together with bipolar forceps, cavitron ultrasonic surgical aspirator (CUSA) and traditional microdissection instruments. Surgical removal was divided in four phases: (1) dissection from the external structures; (2) coagulation and debulking; (3) dissection from the deep structures; and (4) coagulation and removal of the basal implant. During all these steps, we evaluated the percentage of usage of the 2-µ thulium laser comparing them with bipolar forceps and ultrasonic aspirator and blunt dissection. Results: Thulium laser was used mainly during phases 2 and 4 for 43% and 48.7% of the total removal, respectively. Although also useful during phases 1 and 3, it was only used for 2.2% and 31.3%, respectively: traditional dissection with scissors and forceps was preferred. Conclusions: Thulium laser seems to be a useful aid in the surgery of intracranial meningiomas, especially to debulk, shrink, and coagulate the mass and the basal implant.
    Lasers in Surgery and Medicine 03/2013; 45(3). DOI:10.1002/lsm.22123 · 2.62 Impact Factor
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    ABSTRACT: Background: This study reports the anatomopathological classification of Tarlov cysts and the various treatment techniques described in the literature. Methods: The authors present their patient series (19 cases) with a long follow-up (range 9 months to 25 years) treated by cyst remodeling around the root using titanium clips. Results: The technique is effective in both avoiding cerebrospinal fluid leakage and resolving bladder dysfunction when urinary symptoms are incomplete and discontinuous. Conclusions: The clipping technique for Tarlov cysts is easy, valid, safe, rapid, and effective.
    World Neurosurgery 06/2012; 79(2). DOI:10.1016/j.wneu.2012.06.015 · 2.88 Impact Factor
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    ABSTRACT: The authors evaluated the histological effects of the 2-μm thulium laser on meningioma tissue, comparing them to the results obtained using bipolar forceps and an ultrasonic aspirator. The authors analyzed nine samples of intracranial meningiomas. Four slices were obtained for every sample, and one incision was performed on each slice. Two incisions were made with a 2-μm thulium laser (one set to a 6 W and another set to a 12 W power level). One incision was made using a bipolar forceps and the other using an ultrasonic aspirator. Tissue was addressed and analyzed. Upon microscope analysis, three zones of laser action were identified: (A) a central crater; (B) a vaporized zone; and (C) a shrunken layer. These three layers were measured and compared. When addressed with the laser, all nine meningiomas presented a crater having an average depth of 1 mm. Three layers were clearly distinguished and measured: A (average depth: 0.8 mm at 6 W and 1.24 mm at 12 W); B (average depth: 0.32 mm at 6 W and 0.72 mm at 12 W); and C (average depth: 0.39 mm at 6 W and 0.44 mm at 12 W). On slices treated with bipolar forceps incisions, only zones B and C were identified. Ultrasonic aspirator incisions showed a deeper A zone (average depth: 2.93 mm), no B zone, and a tiny C zone (average depth: 0.16 mm). Thulium laser can be safely used for the surgical removal of intracranial meningiomas; beyond 2 mm under the surface of action, no tissue alterations were found. The lesions produced on meningiomas were characterized by vaporization and shrinking. When compared with bipolar forceps, the thulium laser offers cutting precision and vaporization of the tissue. When compared to the cavitron ultrasonic surgical aspirator (CUSA), the laser offers shrinking and coagulation of small vessels.
    Photomedicine and laser surgery 03/2012; 30(5):286-92. DOI:10.1089/pho.2011.3137 · 1.67 Impact Factor

  • 12th National Congress of the Italian Skull Base Society - http://www.societabasicranio.it/pdf/programma.pdf; 01/2012

  • 1st International Congress on Minimally Invasive Neurosurgery - http://www.oic.it/icmins2012/abstracts/OP6-05.pdf; 01/2012
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    ABSTRACT: Papillary tumor of the pineal region (PTPR) is a rare variety of CNS neoplasms and, since its first definition in 2003, only 64 cases have been described. PTPR is a primary neoplasm morphologically characterized by papillary structure staining for cytokeratin, transthyretin, neurone-specific enolase and S-100 protein. We report on a case of about 4 years' clinical history and neuroradiological follow-up of PTPR, in a 47-year-old Indian patient, with the aim of increasing the knowledge of its natural history. We describe through CT and MRI scans the natural evolution of this neoplasm, enhancing changes and morphologic structures involved, together with the final surgical treatment and pathological details. A mean growth rate average was calculated for this kind of lesion. In conclusion, the inexorable progressive growing nature of this tumor leads us to advocate an aggressive attitude among neurosurgeons and radiotherapists, with a precocious surgical approach when the suspicion rises.
    Neurological Sciences 11/2011; 33(4):931-5. DOI:10.1007/s10072-011-0860-5 · 1.45 Impact Factor
  • G. Iannetti · J. Lenzi · V. Ramieri · G. Anichini · P. Cascone ·

    International Journal of Oral and Maxillofacial Surgery 10/2011; 40(10). DOI:10.1016/j.ijom.2011.07.1059 · 1.57 Impact Factor
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    ABSTRACT: Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery.
    Neurological Sciences 07/2011; 33(2):313-6. DOI:10.1007/s10072-011-0704-3 · 1.45 Impact Factor
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    ABSTRACT: Since the early 1980s, CO(2), neodymium-doped yttrium aluminum garnet (Nd:YAG), and other laser prototypes have been widely used in neurosurgery as an intraoperative aid along with the cavitron ultrasonic surgical aspirator (CUSA), bipolar forceps, and microdissection. However, the English literature contains almost no reports on the use of thulium lasers during neurosurgical procedures. We report our experience with a thulium laser during the surgical removal of a tentorial meningioma. The intraoperative technique utilized, as well as the clinical and radiological results of the procedure, are described. The thulium laser proved to be a useful tool during coagulation, shrinking, and resection of the basal implant of the tumor. Use of the laser made the surgical procedure faster and easier, and no intraoperative bleeding was noted. No side effects were observed. Our experience indicates that thulium lasers are a valid aid during resection of benign intracranial tumors under microscope magnification. Additional studies are required to define fully the role of these lasers in neurosurgical procedures.
    Photomedicine and laser surgery 12/2010; 29(6):437-40. DOI:10.1089/pho.2010.2809 · 1.67 Impact Factor
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    ABSTRACT: Intracranial cavernous hemangiomas are benign vascular malformations that can be divided into intra-axial and extra-axial types. Extra-axial cavernous angiomas (or hemangiomas) are rare lesions; intracranially, they arise in relation to the dura mater or at a spinal level mimicking meningiomas. They are very rarely reported in the posterior cranial fossa. The authors report a case of a cavernous angioma that occurred in the cerebellar falx of a 58-year-old man. The lesion was discovered during cranial computed tomography (CT) and magnetic resonance imaging (MRI) examinations. The patient underwent surgery with en-bloc removal of the tumor. No significant intraoperative bleeding or complications occurred during the postoperative course. Intra-axial and extra-axial cavernous angiomas are histopathologically identical lesions, but by the radiological features, it is very difficult to distinguish the extra-axial cavernous angiomas from meningiomas, especially when dural tail sign and calcification are present.
    World Neurosurgery 10/2010; 74(4-5):501-4. DOI:10.1016/j.wneu.2010.07.015 · 2.88 Impact Factor
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    ABSTRACT: The goal in this study was to review a series of patients who underwent surgical removal of intramedullary high-grade gliomas, focusing on the functional outcome, recurrence rates, and technical problems continually debated in neurosurgical practice. Between December 1976 and December 2006, 22 patients underwent removal of intramedullary high-grade gliomas. Lesions were located in the cervical spinal cord in 12 patients, and in the thoracic cord in 10. Histological examinations showed 10 Grade III astrocytomas and 12 glioblastomas. Only 2 of the 22 high-grade astrocytomas could be completely removed. The clinical postoperative status worsened in 14 patients (63.6%), was unchanged in 7 patients (31.8%), and there was 1 case of intraoperative death (4.5%). None of the 22 patients showed improvement in their neurological status postoperatively. In this series, excluding the 1 intraoperative death, all patients died of progression of the malignancy. Surgical treatment did not ameliorate the postoperative neurological status; instead, in the majority of cases, it prompted a worsening of the deficit. Radiotherapy and chemotherapy have a little influence on the length of survival. In this series, multimodality treatment of intramedullary high-grade astrocytomas has been shown to increase length of survival without improving the neurological status.
    Journal of neurosurgery. Spine 02/2010; 12(2):144-53. DOI:10.3171/2009.6.SPINE08910 · 2.38 Impact Factor
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    ABSTRACT: We wish to describe the position of the superior medullary velum (SMV) in midline posterior fossa tumours as a sign in helping to distinguish between midline medulloblastoma and midline astrocytoma. Sagittal T1-weighted MRI images of 21 consecutive patients with histologically documented posterior fossa midline astrocytomas (nine cases) and medulloblastomas (12 cases) were reviewed, with respect to the position of the velum medullare superius. In all medulloblastomas the SMV was superiorly dislocated; in eight astrocytomas it was anteriorly and/or inferiorly disclocated; only in one astrocytoma the SMV presented upward dislocation. In the differential diagnosis between medulloblastoma and astrocytoma the upward dislocation of the SMV is strongly suggestive of medulloblastoma.
    Child s Nervous System 06/2008; 24(9):1037-41. DOI:10.1007/s00381-008-0635-3 · 1.11 Impact Factor