Aldo Spallone

NCL-Isituto di Scienze Neurologiche; University of Rome Tor Vergata; · Clinical Neurosciences

BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis. OBJECTIVE To prospectively evaluate the efficacy of V to VII anastomosis after FP. METHODS In a pros...

The increase in life expectancy during the 20th century ranks as one of society’s greatest achievements, with massive growth in the numbers and proportion of the elderly, virtually occurring in every country of the world. The burden of chronic diseases is one of the main consequences of this phenomenon, severely hampering the quality of life of eld...

Objectives: Intraoperative tumor visualization with 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence is widely applied for improved resection of high-grade gliomas. However, visible fluorescence is present only in a minority of low-grade gliomas (LGGs) according to current literature. Nowadays, antiepileptic drugs (AEDs)...

Modern management of intracranial aneurysms is matter of great debate between supporters of “traditional” microsurgical treatment and those of relatively new endovascular management. This paper briefly reports the experience of two experienced microvascular “traditional” neurosurgeons who shares the same management philosophy favouring open microsu...

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Objective: To evaluate the long-term results of using the BacJac interspinous device (Pioneer Surgical Technology Inc.) in a series of patients with degenerative lumbar spine disease. Methods: Forty-one patients undergoing lumbar surgery with implantation of a BacJac device from 2009 to 2012 were enrolled in the present study. Patients were eval...

Fluorescence diagnostics has been extensively applied in surgery of malignant brain gliomas. However, the use of this technique in surgery of intracranial meningiomas has remained controversial. Objective: The study objective was to assess the sensitivity of 5-aminolevulinic acid-based (5-ALA) fluorescence diagnostics in surgery of brain meningio...

Li-Fraumeni syndrome (LFS) is a clinically and genetically heterogeneous hereditary syndrome with predominantly oncological manifestations, which is associated with mutations in the TP53, MDM2, and CHEK2 genes. The most common variant is a TP53 mutation. Objective: To analyze the literature and present a clinical case of a patient with Li-Fraumen...

Background In this study we evaluated the role of a unilateral intertransversarii microsurgical approach for the treatment of extraforaminal lumbar disk herniations (ELDHs), with short-, medium-, and long-term follow-up. Methods We retrospectively evaluated 96 patients who had undergone surgery for ELDH between 2001 and 2012 at our Institution. All...

Background Legs burning for treating lumbar radicular pain are still in use nowadays in low socioeconomical environments. They are dangerous as the case we report shows clearly. Clinical case A 49-year-old man came to our attention with severe flaccid paraparesis occurred 10 days before, almost immediately after he had immersed his legs in boiling...

5-aminolevulinic acid (5-ALA) is a natural precursor of protoporphyrin IX (PP IX), which possesses fluorescent properties and is more intensively accumulated in tumor cells than in normal tissue. Therefore, the use of 5-ALA in the surgical treatment of intracranial tumors, particularly gliomas, has gained popularity in the last years, whereas its u...

When preparing the review, we analyzed publications available at the Medline database; a total of 1,083 publications related to the review's subject were analyzed. After more careful analysis, we selected 117 publications devoted to the development of neuronavigation in craniocerebral surgery, historical prerequisites of neuronavigation emergence,...

The present study describes the case of a 63-year-old woman presenting with headache, dizziness and vomiting due to a an ovoid mass in the left pre-bulbar cistern, apparently arising from the lower clivus and the foramen magnum. The clinical history revealed the subtotal removal of a right cerebellar low-grade glioma 15 years previously and subsequ...

The paper analyzes application of orbitozygomatic approaches at the Department of Skull Base and Craniofacial Surgery of the Burdenko Neurosurgical Institute for a 14-year period. During this time, 723 patients were operated on using the orbitozygomatic approach, which has become the workhorse of surgery for skull base tumors spreading into the orb...

Early/intensive mobilization may improve functional recovery after stroke but it's not clear which kind of "mobilization" is more effective. Proprioceptive Neuromuscular Facilitation (PNF) and Cognitive Therapeutic Exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investig...

Spontaneous idiopathic acute spinal subdural hematoma (SSDH) is a rare cause of acute back pain followed by signs and symptoms of nerve root and/or spinal cord compression, frequently associated with coagulopathies, blood dyscrasias and arterio-venous malformations. Standard management includes non-operative treatment and timely (within 24h) surgic...

Entrapment of the temporal horn is an extremely rare pathologic condition occurring as a result of surgery for tumors, intraventricular infections, hemorrhage, or traumatic events involving the peritrigonal area. We report a case of a 58-year-old man who presented with pure Wernicke aphasia (never described before in the albeit rare cases of isolat...

Introduction: Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. P...

Background: Limited outcome data suggested a minimal evidence for better clinical and radiographic outcome of polyetheretherketone cages compared with bone grafts in the anterior cervical discectomy and fusion. We proposed a "mini-invasive" surgical technique for harvesting iliac crest grafts that provides bicortical autografts of sufficient size t...

Background Pisa Syndrome or Pleurothotonus is a relatively rare truncal dystonia, characterized by tonic flexion of the trunk and head to one side with slight rotation of the body. Since frequently associated to specific drugs such as antipsychotics and cholinesterase inhibitors or to Parkinson Disease, a pathophysiological role of cholinergic-dopa...

Unlabelled: The method of fluorescent diagnosis (FD) using 5-ALA has been widely employed in surgery of primary intracerebral tumors over the last years. The issue of FD application in surgery of gliomas with continued growth has remained less studied. Objective: To investigate the efficacy of using FD with 5-ALA and laser spectral analysis in s...

Following the paper focused on surgery of skull base tumors invading the orbit, paranasal sinuses, nasal cavities, pterygopalatine and infratemporal fossae, the authors discuss particular issues of surgical treatment of the most common craniofacial mass lesions, including meningiomas, juvenile angiofibromas, trigeminal nerve tumors, chondroid tumor...

Laminoplasty has been proposed as a treatment for cervical stenotic myelopathy (CSM) as an alternative to standard laminectomy as this has been considered directly associated with an increased risk of postoperative deformity. We retrospective reviewed postoperative results of open door laminoplasty (unilateral approach technique) compared with lami...

Central sleep apnea is a breathing disorder that manifests as repetitive cessation of the breath during the sleep. The occurrence of breathing disorders after cervical laminectomy has been exceptionally described as a complication after cervical decompressive laminectomy for cervical stenotic myelopathy. In 1994, Naim-ur-Rahman reported the first c...

Following the paper focused on surgery of skull base tumors invading the orbit, paranasal sinuses, nasal cavities, pterygopalatine and infratemporal fossae, the authors discuss particular issues of surgical treatment of the most common craniofacial mass lesions, including meningiomas, juvenile angiofibromas, trigeminal nerve tumors, chondroid tumor...

Autograft bone provides an excellent substrate for multilevel arthrodesis after anterior discectomy and is inexpensive. However, the use of tricortical bone could increase the discomfort for the patient. We reviewed cases of cervical disc diseases operated on by a single neurosurgeon (AS), within the period June 2000-December 2011. A total of 221 p...

Carcinoma of unknown primary origin (CUP) is defined as the histological diagnosis of metastasis without the detection of a primary tumor. The incidence of CUP in all patients with a malignant disease has been reported to be between 3 and 15%. Esophageal cancer is the third most common type of cancer of the digestive tract and the seventh most comm...

For a long time, head injury has been considered as a possible causative factor for later development of brain tumors. However, the actual role of previous head trauma in the pathogenesis of intracranial tumors is still a matter of debate, also due to the possible medico-legal implications. Some authors have suggested several criteria for establish...

Background: Opening of the lamina terminalis is often used in surgery of the optico-chiasmatic region. Consequently, alteration of cerebral-spinal fluid (CSF) dynamics can occur after this manoeuvre, thus potentially translating into clinical complications. Herein, we describe 2 cases in which clinically relevant hypothalamic dysfunctions develope...

Primary cerebellar glioblastoma multiforme (GBM) is a rare tumor in adults that accounts for just 1% of all cases of GBM. Cerebellar GBMs are not yet completely understood also as far as the prognosis. We report a case of cerebellar GBM in a 27-year-old woman. Magnetic resonance imaging (MRI) showed a 3x3.6 cm-sized, ill-defined, heterogeneously en...

Pituitary adenomas invading the cavernous sinus represent a therapeutic challenge. Those tumors have been traditionally treated with incomplete surgical removal, observation and/ or adjunctive medical therapy, and radiotherapy. In relatively recent years, some authors have suggested a main direct surgical approach to cavernous sinus (CS) with the a...

A 42-year-old right-handed woman presented with a 1 year history of headache, localised in both frontoparietal regions, and a 6 month history of left-sided tremor and clumsiness; depression was another notable symptom of this patient. Neurological examination revealed left hemiparkinsonism, characterised by mixed tremor (postural, action and interm...

Pituitary adenomas represent a significant proportion (+o-13%) of all intracranial tumors. Surgical treatment is as rule performed by transsphenoidal approach. However, a small but not insignificant subgroup of pituitary adenomas (5 to 7%) invade the lateral parasellar structures and the cavernous sinus in particular, and poses obvious problems to...

Background: A new technique for harvesting autologous iliac bone grafts is described. Technique: This technique is mainly based on performing carefully a limited subperiosteal dissection, obliquely directed bone cuts, and avoiding the stripping of the anterior thigh musculature. Conclusion: This technique allowed to overcome almost all the pro...

Los adenomas hipofisarios representan el 13% de los tumores intracraneales. Generalmente el abordaje transesfenoidal es suficiente para su manejo, pero de un 5 a un 7% de los mismos se comporta de forma invasiva. El tratamiento de este subgrupo ha sido tradicionalmente incompleto (exéresis transesfenoidal parcial + radioterapia) y conduce a una ele...

The history of the founding of the Cuban Skull Base Surgery Group is reported. Under the author's supervision and coordination, the group has managed more than 100 major skull base cases over a 6-year period. The mortality rate was 13% and the rate of permanent morbidity was 23%. In the last 2 years, the mortality rate decreased to 8%. These result...

Intracranial lipomas are rare lesions, representing 0.02% of operated intracranial lesions. Lipomas of the pineal region are even rarer and are reported occasionally in the literature. This is possibly because of the fact that they may give rise to clinical symptoms rather infrequently. When they become symptomatic, some form of management must be...

The results of surgical treatment of epidermoid cysts of the pineal region in six cases are presented. Six patients with pineal epidermoid cysts underwent surgery at the Institute of Neurosurgery "N. N. Burdenko," in Moscow, during the period 1976 to 1995. The duration of the patients' preadmission clinical history varied from 6 months to 2 years (...

Petroclival meningiomas represent a difficult surgical challenge. The introduction of modern techniques of skull base surgery has stimulated the interest of the neurosurgical community in the surgical management of these lesions, although very good results have been obtained by experienced neurosurgeons in cases of petroclival meningioma operated u...

The incidence of multiple skull base meningiomas varies from 1 to 3% in different series. Skull base meningiomas are rare. The pathogenetic role of low-dose radiation seems to be fairly well established in the oncogenesis of meningiomas. Calvarial location and multiplicity seem to be among the distinctive features of radiation-induced meningiomas....

A case of a basal middle fossa giant cell tumor occurring in a 46-year-old man is described. The lesion appeared at the computed tomography (CT) scan examination as an hypodense mass with a peripheral "ring-like" enhancement, and no evident erosion of the skull base. The tumor, which infiltrated the basal temporal parenchyma, was removed via a temp...

To treat pathological processes, primarily tumors, in the base of the skull is one of the most intricate neurosurgical problems. In the past decade, interest in this problem has greatly increased due to the advent of new methods of diagnosis, up-to-date neurosurgical equipment and to a greater cooperation of physicians of related disciplines: ophth...

Subcutaneous CSF (CSF "pseudocyst") may occur following complex skull base operations. They may respond to a trial of compressive bandages and continuous lumbar drainage that can resolve over months. When this management strategy fails, reoperation is an option, which however would require complex reconstructive procedures at the base of the skull,...

A case of fat graft prolapse into the prepontine cistern with clinical deterioration is presented. The patient had undergone a transpetrosal approach for a very large craniopharyngioma and had autologous thigh fat strips to obliterate the mastoid cavity; postoperatively she suffered an important deterioration from adipose graft prolapse. Clinical p...

The aim of our study was to evaluate the contrast-enhanced MR imaging (MRI) findings, in the early postoperative period, in unselected patients undergoing lumbar microdiscectomy (15/16 had total resolution of their symptoms). Contrast-enhanced imaging studies were performed, in all 16 patients of our series, before surgery, and at the third postope...

MRI is routinely used in the evaluation and management of patients with failed back surgery syndrome (FBSS). However, its value is unclear in the early detection of signs that can negatively affect that later course of surgical cases. The purpose of the present study is to describe the MR images of early postoperative MRI at 3 days in 30 unselected...

Watertight durai closure is usually very difficult when performing surgery at the base of the skull, and virtually impossible to be achieved when dealing with extensive recurrent lesions infiltrating the basal dura. In these cases, the usual technical adjuncts which are used for sealing the dura, such as fascia lata, fat grafts , fibrin glue, etc.,...

Ten cases of meningioma of the pineal region were histologically verified at a single institution during an 8-year period. These represented 0.3% of 3061 intracranial meningiomas, as well as 6.2% of 164 pineal tumors. Patients were predominantly women. Symptoms and signs of increased intracranial pressure were most common, whereas Parinaud's syndro...

Chondrosarcomas located in the anterior cranial fossa are rare. They usually invade the ethmoid sinus and may involve the orbit. We observed two such cases in the last five years, during which approximately 10.000 patients with histologically verified brain tumors were admitted to our Institution. CT and MRI represented the chief diagnostic tests....

Klippel-Trenaunay syndrome is a rare neurocutaneous disorder in which skeletal hypertrophy, vascular nevi, and vessel anomalies coexist. Involvement of the cranial bone is rare, and intracranial anomalies associated with features of this syndrome are exceptional. We report a case of an adult Klippel-Trenaunay woman with a huge cranial hypertrophy h...

Neurinomas arising from the trigeminal nerve are rare (0.1–0.4% of intracranial tumours; 1–8% of all intracranial neurinomas). A series of 111 trigeminal neurinomas operated on at the Institute of Neurosurgery “N. N. Burdenko” of Moscow, Russia, during the period 1961–1994 is presented. Clinical features, diagnostic radiology, surgery and results o...

The fronto-orbito zygomatic approach is part of the surgical armamentarium of modern skull base surgery. As described in the literature, it requires costly technological tools such as powerful drills and saws, to be performed. In the present communication we describe a technical modification that allows the zygoma to be elevated "en bloc" together...

The endolymphatic sac is part of the membranous labyrinth; it plays an important role in the hearing mechanism. Injury to the endolymphatic sac may, over time, severely compromise hearing. The endolymphatic sac is located in a duplication of the dura of the posterior aspect of the petrous pyramid and is, therefore, in the surgical field of many neu...

Distal anterior inferior cerebellar artery aneurysms are rare. We recently treated one of these in a 46-year-old woman suffering from SAH and right facial and auditory deficit. The aneurysm was trapped 3 weeks after haemorrhage. Review of the pertinent literature revealed 36 similar cases which we analysed in detail. Guidelines for the proper manag...

Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobi...

The temporal branch of the facial nerve may be saved in a pterional-transzygomatic craniotomy if the dissection is carried beneath the superficial temporal fascia. The anatomical and technical aspects of this exposure are described in this report.

The surgical anatomy of the temporal branch of the facial nerve was studied bilaterally in 10 embalmed cadaveric heads. Particular attention was paid to the relationships between the temporal branch, the galeal-fascial layers, and the fat pads of the temporal-zygomatic region. The temporal branch of the facial nerve pierces the parotidomasseteric f...

Two hundred patients underwent clean elective neurosurgical operative procedures in a 5-year period (48 cranial, 134 spinal and 18 peripheric). All the patients received the same antibiotic treatment. Gentamicin 80 mg was given intramuscularly just before the induction of anesthesia; vancomycin 1 g mixed in 250 ml of a dextrose solution was given i...

A split-calvaria osteoplastic rotational flap to repair the anterior fossa floor after tumor excision was devised and tested clinically. At surgery, the flap is outlined between the glabella and the vertex. After the pericranium between the glabella and the flap's anterior pole is elevated to form its pedicle, a full-thickness craniotomy is perform...

40 patients underwent lumbosacral microdiscectomy in a 12 months period covering the years 1988–1989 in our center. For the purpose of the present study, we considered the 30 cases who underwent CT control of the operated interspaces and of the adjacent vertebral endplates. This was routinely carried out on the 3rd postoperative day. The present st...

The present report describes the case of a 48 year-old woman who had undergone two separate lumbar laminectomies for a L4-L5 disc. She was admitted for a recurrent sciatica of 6-months duration, which failed to respond to conservative treatment. Myelogram on admission was negative. However CT showed a far laterally placed bulging L4-L5 disc. The pa...

The simultaneous occurrence of meningioma and glioma is extremely rare. Three new cases and 54 adequately described in the literature are analyzed. Clinical diagnosis may be difficult due to discrepancy between clinical and radiological findings. Unexpected clinical deterioration following removal of a tumour and relapse simulating recurrence may o...

Nine patients with brain-stem hematoma were admitted to the authors' institute during the period from 1985 to 1988. Clinical symptoms and signs pointed to pontine involvement in most cases. Progressive clinical deterioration was quite common and usually led to a clinical diagnosis of brain-stem intra-axial tumor. Angiography was noncontributory; co...

Nine patients with giant internal carotid artery (ICA) aneurysms (greater than 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficie...

Muscular exercise is accompanied by evident and perfectly matched cardiovascular and respiratory adjustments to avoid changes in arterial blood gases. The mechanisms responsible for this perfect regulation have not yet been defined. Our previous experimental investigations have shown that a consistent rate of cardiorespiratory reflex responses to e...

The present study deals with 15 cases of choroid plexus papilloma, out of approximately 500 cases of brain tumors observed in children up to 16 years old. Several features are considered, including clinical symptoms and signs--mostly related to increased intracranial pressure--radiological diagnosis, pathology and surgical treatment, and results. S...

Two hundred cases of verified brain tumors occurring in patients under 15 years of age were studied in relation to possible etiologic, genetic, and environmental risk factors. They were compared with 100 age-matched patients harboring solid neoplasms outside the nervous system, as well as with 100 normal children. In our study, first-degree relativ...

The present study was designed to assess the occurrence of cerebral vasospasm following an experimental subarachnoid hemorrhage model in rabbits. Sixty-nine New Zealand albino rabbits were used in this study. One milliliter of fresh arterial blood was injected through the surgically exposed atlanto-occipital membrane over a period of 20 seconds. Th...

445 cases of chronic subdural hematomas have been operated on during the last 35 years (1951-1986). The ages of the patients ranged from 14 to 91 years and averaged 54 years. Two groups of patients were considered and compared: (A) extremely aged patients, who were over 75 years old, and (B) patients in their sixth decade of life whose age was in f...

Epidermoid tumors located in the fourth ventricle are exceedingly rare. Seven cases of this pathological condition were observed during a 10-year period. Patients were mostly middle-aged men, with a clinical history of relatively short duration (5 months). Clinical symptoms consisted of vertigo and ataxia, followed by incoordination, dysmetria, and...