Daniele Rigamonti

• Johns Hopkins Medicine

Despite being recognized as a preventable serious adverse event more than a century ago, Unintentionally Retained Foreign Objects (URFOs) continue to occur. They, in fact, remain the second most common Sentinel Event (SE) reported to The Joint Commission (TJC). A large private Hospital, after many years of URFO-free practice, experienced four (4) c...

Hydrocephalus is a clinical condition caused by active distention of the ventricular system due to a restriction in the cerebral spinal fluid (CSF) pathways from the sites of CSF production to the sites of resorption (Rekate, Cerebrospinal Fluid Res 5(1):1–7, 2008; Rekate, Seminars in pediatric neurology, WB Saunders, Philadelphia, 9–15, 2009). It...

OBJECTIVE International research fellows have been historically involved in academic neurosurgery in the United States (US). To date, the contribution of international research fellows has been underreported. Herein, the authors aimed to quantify the academic output of international research fellows in the Department of Neurosurgery at The Johns Ho...

As is the case in many areas of medicine and science in general, there has been a dramatic acceleration in the acquisition of understanding during the last few decades. This is also the case for cerebral cavernous malformations (CCMs). We like to artificially divide the progress that we have personally witnessed into three phases: pre-magnetic reso...

Following the emergence of the COVID-19 pandemic, Healthcare organizations began concentrating on the preparation for and management of the surge of COVID-19 cases, while trying to protect the healthcare workers and other patients from getting COVID-19. Changing the way people work requires innovative approaches and questioning some long-held medic...

Background and purpose: Imaging evaluation of ventriculostomy tubes, despite the frequency of malfunction, has remained inadequate due to the absence of a systematic way of assessing the catheter itself. In this retrospective review, we assessed the utility of high-resolution 3D MR imaging techniques, including CISS and volumetric interpolated bre...

Background: Early diagnosis of NPH during its initial stages is almost impossible, given the delayed onset of clinical symptoms, making the study and the understanding of the CSF dynamics very challenging in human subjects. In this study, we explore these dynamics in a novel animal model with induced chronic communicating hydrocephalus with the aim...

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a cause of dementia that can be reversed when treated timely with cerebrospinal fluid (CSF) diversion. Understanding CSF dynamics throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts. Objective: To explore the cerebral...

Introduction: Diffusion tensor imaging (DTI) has been used to characterize microstructural alterations of the brain parenchyma. The onset of this microstructural damage in iNPH patients is unknown given our current limitations in the early identification of this syndrome before symptoms presentation. This study aims to explore the fractional anisot...

Background: Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has improved over the last decade, the...

Background: To describe the outcome for a cohort of patients with non-functioning pituitary macroadenomas (NFPMA), managed by debulking surgery with radiation therapy delayed until progression. Methods: Two hundred and sixty-seven patients were treated surgically for pituitary tumors at our institution between 1997 and 2005. One hundred and twenty-...

Annual Meeting of the Congress-of-Neurological-Surgeons, San Francisco, CA, OCT 19-23, 2019

Background and purpose: Radiologic imaging plays a key role in diagnosing chronic adult hydrocephalus, but its role in predicting prognosis is still controversial. We sought to evaluate the effectiveness of cardiac-gated phase-contrast MR imaging through the cerebral aqueduct in predicting the clinical response to diagnostic lumbar puncture/lumbar...

Background and purpose: Endoscopic third ventriculostomy is a well-accepted treatment choice for hydrocephalus and is used most frequently with a known impediment to CSF flow between the third ventricle and basal cisterns. However, there are scarce data on the imaging evolution of the defect in the floor of the third ventricle and how this affects...

Background and purpose: The DESH (disproportionately enlarged subarachnoid-space hydrocephalus) pattern of "tight high-convexity and medial subarachnoid spaces, and enlarged Sylvian fissures with ventriculomegaly" is used to determine which patients undergo an operation for adult hydrocephalus at many centers. Our aim was to review adult hydroceph...

Because of his exceptional and pioneering contributions to the understanding and treatment of neurosurgical conditions, Walter Dandy is considered to be one of the founders of both neurosurgery and neuroradiology. In the field of hydrocephalus, Dandy developed revolutionary research models, imaging modalities, and operative procedures. His laborato...

Background: A previous study of the Medicare database has shown that Normal Pressure Hydrocephalus (NPH) is an underdiagnosed condition affecting the elderly population and that the costs associated with its surgical management are less than those associated with conservative management. Objective: To determine if the rate of diagnosis of NPH has i...

Introduction: The pathophysiology of normal-pressure hydrocephalus and the correlation with its symptomatology is not well understood. Objective: To monitor and evaluate the enlargement patterns of the ventricular system for each ventricle and its correlation with the presenting symptoms. Methods: Bilateral kaolin injection into the subarachnoid sp...

Purpose The aim of this study is to evaluate long-term treatment outcome and toxicities among vestibular schwannoma (VS) patients treated with hypofractionated stereotactic radiotherapy (HSRT). Methods 383 patients with unilateral VS treated with HSRT (25 Gy, five fractions) between 1995 and 2007 were retrospectively reviewed. Treatment failure wa...

Shunts that are used for the treatment of hydrocephalus have a propensity towards malfunction, however, diagnosing a shunt malfunction can sometimes be a challenge. The purpose of this study was to investigate whether ultrasound technology can be safely and effectively used to assess for distal shunt malfunction. This was a prospective cohort study...

We aimed to determine whether presence of AD neuropathology predicted cognitive, gait and balance measures in patients with idiopathic normal pressure hydrocephalus (iNPH) after shunt surgery. This is a prospective study of gait and balance measured by Timed Up and Go (TUG) and Tinetti tests, and cognitive function measured by Mini Mental Status Ex...

OBJECTIVE Factors associated with emergency department admission and/or shunt revision for idiopathic intracranial hypertension (IIH) are unclear. In this study, the associations of several factors with emergency department admission and shunt revision for IIH were explored. METHODS The authors performed a retrospective review of 31 patients (169...

Background: Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. Objective: To develop guidelines for CCM management. Methods: The Angioma Alliance ( www.angioma.org ), the patient support group in the United States advocating on behalf of patients and rese...

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a devastating condition that affects the elderly population. Although ventriculoatrial (VA) shunts can be used to manage iNPH, concerns for associated cardiopulmonary and renal complications have decreased their use. However, the rate of these complications is not well understood withi...

BACKGROUND: There is no consensus regarding the optimal management of inoperable high-grade arteriovenous malformations (AVMs). This long-term study of 42 patients with high-grade AVMs reports obliteration and adverse event (AE) rates using planned multistage repeat stereotactic radiosurgery (SRS). OBJECTIVE: To evaluate the efficacy and safety of...

Purpose: We evaluated the toxicity associated with stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) in elderly and very elderly patients with brain metastases, as the role of SRS in geriatric patients who would traditionally receive WBRT is unclear. Methods and materials: We conducted a retrospective review of elderly pat...

Purpose/objectives: The complex planning and quality assurance required for spine SBRT are a barrier to implementation in time-sensitive or limited resource clinical situations. We developed and validated an automated inverse planning algorithm designed to streamline planning and allow rapid delivery of conformal single fraction spine SBRT using w...

BACKGROUND: The pathogenesis of adult chronic hydrocephalus is not fully understood, and the temporal relationship between development of the radiological changes and neurological deterioration is unknown. OBJECTIVE: To clarify the progression of radiological-histological changes and subsequent clinical manifestations of adult chronic hydrocephalu...

OBJECTIVE A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postop...

Introduction: Early treatment of normal pressure hydrocephalus (NPH) yields better postoperative outcomes. Our current tests often fail to detect significant changes at early stages. We developed a new scoring system (LP log score) to determine if this tool is more sensitive in detecting clinical differences than current tests. Material and metho...

Long-term anticoagulation is often considered to be a relative contraindication to shunt surgery for patients with normal pressure hydrocephalus (NPH). While the overall risk of bleeding associated with shunt placement is low, the risk of bleeding in the elderly is increased, particularly with regard to immediate intracerebral hemorrhage or delayed...

Purpose: Stereotactic radiosurgery (SRS) is widely used to treat brain metastases in place of whole brain radiation therapy (WBRT), with the goal of reducing treatment toxicity balanced against the risk of developing new metastases. We evaluated outcomes of repeated courses of SRS in the management of new brain metastases as an alternative to salv...

Purpose: To evaluate the prevalence, outcomes, and toxicities of concurrent delivery of systemic therapy with stereotactic radiosurgery (SRS) for treatment of brain metastases. Methods and materials: We conducted a retrospective review of 193 patients treated at our institution with SRS without prior whole-brain radiation therapy (WBRT) for brai...

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder that classically presents with a triad of progressive gait impairment, urinary incontinence, and cognitive deterioration. Treatment predominantly involves ventriculoperitoneal (VP) shunting, but one alternative is ventriculoatrial (VA) shunting. This study sou...

Placement of a ventriculoperitoneal (VP) shunt is the treatment of choice for communicating hydrocephalus; however, the extent to which VP shunting is able to relieve symptoms in patients who had previously been treated with cerebrospinal fluid diverting therapy at an outside institution remains unclear. A retrospective review of patients with idio...

Objective: Few studies have focused on predictive factors of ventriculoperitoneal (VP) shunt revision in patients with idiopathic normal pressure hydrocephalus (iNPH). This study aims to determine whether comorbidities and baseline symptoms are associated with the need for shunt revision. Methods: A retrospective review of patients with iNPH tre...

Objectives: This study seeks to validate the use of activity monitors to detect and record gait abnormalities, potentially identifying patients with idiopathic normal pressure hydrocephalus (iNPH) prior to the onset of cognitive or urinary symptoms. Methods: This study compared the step counts of four common activity monitors (Omron Step Counter...

OBJECT Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus; however, the success of ETV in patients who have previously undergone shunt placement remains unclear. The present study analyzed 103 adult patients with aqueductal stenosis who underwent ETV for obstructive hydrocephalus and evaluated the effect...

The pathogenesis and behavioral effects of normal pressure hydrocephalus (NPH) are not fully understood, and the temporal relationship between radiological changes and neurological deterioration is unknown.

Median age at presentation was 76 (71-80) years old. TUG (p 0.05). LP log improvement was associated with surgical indication OR: 24.5 95%CI (2.4248.12) (p=0.007). Conclusions LP log showed a higher sensitivity and diagnostic accuracy detecting clinical differences in NPH than the current diagnostic approach. Our next step is to conduct a cross-val...

Shunted patients with idiopathic intracranial hypertension (IIH) often present to the emergency department (ED) for symptoms related to their disease. Although brain imaging with computed tomography (CT) is often performed, particularly in the current medicolegal environment, its utility during these ED visits is unclear. The ED visits of all shunt...

Shunt series and shunt patency studies can be performed in the emergency department (ED) to evaluate for shunt malfunction in patients with idiopathic intracranial hypertension (IIH). Here, we examine the utility of these studies in this specific patient population. We retrospectively reviewed the ED visits of all shunted patients diagnosed with II...

Significance Outcomes for individuals with central nervous system (CNS) malignancies remain abysmal. A major challenge in managing these patients is the lack of reliable biomarkers to monitor tumor dynamics. Consequently, many patients undergo invasive surgical procedures to determine disease status or experience treatment delays when radiographic...

OBJECT The number of patients with spinal tumors is rapidly increasing; spinal metastases develop in more than 30% of cancer patients during the course of their illness. Such lesions can significantly decrease quality of life, often necessitating treatment. Stereotactic radiosurgery has effectively achieved local control and symptomatic relief for...

Endoscopic third ventriculostomy (ETV) is commonly used to treat obstructive hydrocephalus. Closure of the stoma can be associated with symptom recurrence and need for further surgical intervention. To describe the use of a side-cutting aspiration device for treatment of aqueductal stenosis in patients undergoing ETV. A retrospective review of 30 c...

To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI. This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measur...

A 25-year-old man with Crouzon syndrome complicated by pseudotumor cerebri and multiple shunt failures presented with progressive back and neck pain, intermittent headaches, and associated vomiting secondary to shunt infection. Due to his previous history of repeated failure of both ventriculoperitoneal and lumboperitoneal (LP) shunting procedures,...

Object To evaluate the effectiveness of stereotactic navigation in enhancing the accuracy of ventricular shunt placement in patients with hydrocephalus. Methods A retrospective cohort study at a single institution by a single surgeon was performed. Consecutive patients who underwent implantation of a ventricular shunt for the management of hydroce...

To report five patients who underwent lumbopleural (LPl) shunting for the treatment of idiopathic intracranial hypertension (IIH) and to describe the considerations, complications, and outcomes related to this rarely described procedure. The clinical data of five patients treated with LPl shunting over a 23-year period were retrospectively analyzed...

We evaluated if patients with idiopathic normal pressure hydrocephalus (iNPH) showed functional improvement after primary endoscopic third ventriculostomy (ETV). The efficacy of ETV for iNPH remains controversial. We retrospectively reviewed 10 consecutive patients treated between 2009 and 2011 with ETV for iNPH. Seven patients with a median age of...

For the past half-century, the lumboperitoneal shunt (LP shunt) has been the leading surgical treatment for idiopathic intracranial hypertension (IIH). More recently in Japan, this procedure has been offered in the management of Normal Pressure Hydrocephalus (NPH). In some institutions, the LP shunt comprises up to 40 % of all cerebrospinal fluid (...

Over the past 10 years, transverse sinus stenting has grown in popularity as a treatment for idiopathic intracranial hypertension. Although promising results have been demonstrated in several reported series, the vast majority of patients in these series have been treated on an elective basis rather than in the setting of fulminant disease with acu...

Background: Idiopathic intracranial hypertension (IIH) when no underlying etiology is found, is a clinical syndrome characterized by elevated intracranial pressure (ICP) (>25 cm H2O), which may lead to headaches and visual symptoms. In patients with IIH who are found to have transverse sinus stenosis, placement of a venous stent across the stenosi...

Introduction: For the past half century, the mainstay of cerebrospinal fluid (CSF) shunting for Idiopathic Intracranial Hypertension (IIH) has been lumboperitoneal (LP) shunt surgery. LP shunt has been associated with higher failure rates compared to ventriculoperitoneal shunts. However, there is no uniformity in the reporting of complication and...

Purpose: Stereotactic radiation surgery (SRS) is one of the therapeutic modalities currently available to treat cerebral arteriovenous malformations (AVM). Conventionally, magnetic resonance imaging (MRI) and MR angiography (MRA) and digital subtraction angiography (DSA) are used in combination to identify the target volume for SRS treatment. The...

Hydrocephalus can develop secondarily to a disturbance in production, flow and/or absorption of cerebrospinal fluid. Experimental models of hydrocephalus, especially subacute and chronic hydrocephalus, are few and limited, and the effects of hydrocephalus on the subventricular zone are unclear. The aim of this study was to analyze the effects of lo...

To compare visual outcomes in pseudotumour cerebri (PTC) patients who underwent either optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) diversion (shunt) for treatment of visual loss from papilloedema. Comparative case series of thirty-three patients (33 eyes) who underwent either ONSF (14 patients) or CSF shunt (19 patients) for...

A familiar challenge for neuroradiologists and neuro-oncologists is differentiating between radiation treatment effect and disease progression in the CNS. Both entities are characterized by an increase in contrast enhancement on MRI and present with similar clinical signs and symptoms that may occur either in close temporal proximity to the treatme...

For the past half century, the mainstay of cerebrospinal fluid shunting for normal pressure hydrocephalus (NPH) has been ventriculoperitoneal shunt surgery. Lumboperitoneal (LP) shunt has been used occasionally and seemed to be associated with higher failure rates compared to ventriculoperitoneal shunts. There is no uniformity in the reporting of c...

Stereotactic radiosurgery has become standard adjuvant treatment for patients with metastatic intracranial lesions. There has been a growing appreciation for benign imaging changes following radiation that are difficult to distinguish from true tumor progression. These imaging changes, termed pseudoprogression, carry significant implications for pa...

The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, deve...

Patients with cerebellar and non-cerebellar metastases are often included in the same study population, even though posterior fossa lesions typically have different presenting symptoms, clinical outcomes, and complications. This is because the outcomes for patients with cerebellar metastases are unclear. Adult patients who underwent surgery for an...

Patients with a variety of different primary cancers can develop intracranial metastases. Patients who develop intracranial metastases are often grouped into the same study population, and therefore an understanding of outcomes for patients with different primary cancers remain unclear. Adults who underwent intracranial metastatic tumor surgery fro...

Objective Skull base metastases (SBMs) are rare lesions in close proximity to critical neural and vasculature structures. This rarity and complexity have led many to only offer nonsurgical therapies. The surgical outcomes for patients with SBM therefore remain unknown. Design Retrospective, comparison analyses. Setting Johns Hopkins Hospital. Parti...