Giulio Bertani

• Neurological surgeon at Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico

Frailty indices have emerged as robust predictors of morbidity and mortality following neurosurgical interventions. However, their impact on long-term functional and cognitive outcomes remains insufficiently characterised. This study evaluated the prognostic significance of frailty in patients undergoing emergency neurosurgical care and subsequent...

Aim: The microscope represents a fundamental tool in the neurosurgical treatment of cranial and spinal pathologies. The development of new digital technologies and the surgeon's need for greater freedom of movement and improved comfort have led to the widespread use of the 3D exoscope. This survey studies the level of satisfaction of neurosurgeons...

Aim: The microscope represents a fundamental tool in the neurosurgical treatment of cranial and spinal pathologies. The development of new digital technologies and the surgeon's need for greater freedom of movement and improved comfort have led to the widespread use of the 3D exoscope. This survey studies the level of satisfaction of neurosurgeons...

Background Learning is a long-term memory process, influenced by working memory control processes, including recognition of semantic properties of items by which subjects generate a semantic structure of engrams. Aim The aim of the study is to investigate the verbal learning strategies of Parkinson’s disease patients. Methods Thirty patients with...

Granular cell tumors of the neurohypophysis (GCT) are rare benign neoplasms belonging, along with pituicytoma and spindle cell oncocytoma, to the family of TTF1-positive low-grade neoplasms of the posterior pituitary gland. GCT usually present as a solid sellar mass, slowly growing and causing compressive symptoms over time, occasionally with supra...

Neuroimaging differentiation of glioblastoma, primary central nervous system lymphoma (PCNSL) and solitary brain metastasis (BM) represents a diagnostic and therapeutic challenge in neurosurgical practice, expanding the burden of care and exposing patients to additional risks related to further invasive procedures and treatment delays. In addition,...

Diffusion tensor imaging (DTI) allows visualization of the main white matter tracts while intraoperative neurophysiological monitoring (IONM) represents the gold standard for surgical resection of gliomas. In recent years, the use of small craniotomies has gained popularity thanks to neuronavigation and to the low morbidity rates associated with sh...

Object: To investigate those parameters affecting early and follow-up functional outcomes in patients undergoing resection of meningiomas and to design a dedicated predictive score, the Milan Bio(metric)-Surgical Score (MBSS) is hereby presented. Methods: Patients undergoing transcranial surgery for intracranial meningiomas were included. The mo...

Background Neuroimaging differentiation of glioblastoma, primary central nervous system lymphoma (PCNSL) and solitary brain metastasis (BM) remains challenging in specific cases showing similar appearances or atypical features. Overall, advanced MRI protocols have high diagnostic reliability, but their limited worldwide availability, coupled with t...

Purpose: Neuroimaging differentiation of glioblastoma, primary central nervous system lymphoma (PCNSL) and solitary brain metastasis (BM) remains challenging in atypical cases. Advanced MRI protocols have high diagnostic reliability but some atypical tumors may show overlapping neuroimaging features, majorly complicating the planning and management...

Introduction: Meningiomas are the most common primary brain tumor and their prevalence increase in the aging population. Among current tendencies among researchers, there is the need of predicting surgical outcomes, complications occurrence and quality of life (QOL) to offer a personalized treatment, especially to elderly patients. Object: The aim...

Cerebral cavernous malformations (CCM) consist of clusters of irregular dilated capillaries and represent the second most common type of vascular malformation affecting the central nervous system. CCM might be asymptomatic or cause cerebral hemorrhage, seizures, recurrent headaches and focal neurologic deficits. Causative mutations underlining CCM...

Several guidelines on the evaluation of patients with suspected cervical spine trauma in the Emergency Department (ED) exist. High heterogeneity between different guidelines has been reported. Aim of this study was to find areas of agreement and disagreement between guidelines, to identify topics in which further research is needed and to provide a...

Artificial Intelligence (AI) and Machine Learning (ML) augment decision-making processes and productivity by supporting surgeons over a range of clinical activities: from diagnosis and preoperative planning to intraoperative surgical assistance. We reviewed the literature to identify current AI platforms applied to neurosurgical perioperative and i...

Background: Despite advances in endoscopic transnasal transsphenoidal surgery (ETNS) for pituitary adenomas (PAs), cerebrospinal fluid (CSF) leakage remains a life-threatening complication predisposing to major morbidity and mortality. In the current study we developed a supervised ML model able to predict the risk of intraoperative CSF leakage by...

Objective To assess the organization and technical difficulties of neurosurgical procedures during the COVID-19 pandemic and their possible impact on survival and functional outcome; in addition, to evaluate the virological exposure risk of the medical personnel. Methods We prospectively collected data for all urgent surgical procedures performed...

Introduction Syndrome of inappropriate antidiuresis (SIAD) can be a complication of hypothalamus-pituitary surgery. The use of tolvaptan in this setting is not well established, hence the primary aim of this study was to assess the sodium correction rates attained with tolvaptan compared with standard treatments (fluid restriction and/or hypertonic...

Background For a long time, surgery of insular gliomas was considered at high risk for postoperative cognitive deficits, but recent studies highlighted the feasibility of the surgical approach. The aims of our study were to investigate the presence of language impairment before and after surgery and the relationship between language impairment and...

Objective This study aims to assess the feasibility and reliability of our endoscopic trans-nasal technique for the repair of cribriform and sellar high-flow CSF leaks. Methods A comparison between patients suffering from high-flow rhinorrhea and treated through a free grafting endoscopic technique or the “parachute” technique, our nasal packing p...

PurposeThe aim of the present study is to assess the predictive value of the suprasellar volume (SSV) of nonfunctioning pituitary adenomas (NFPAs) for visual field (VF) impairment in order to guide clinical decision-making and improve neurosurgical management.Methods Two independent samples of patients with NFPAs (exploratory population N = 50, tes...

Background Spindle cell oncocytomas are extremely rare neoplasms of the sellar, para- and suprasellar regions which can frequently mimic pituitary adenomas. Less than 50 cases have been ever reported in literature and there is no consensus on best treatments to be provided. Case description We hereby present a challenging case of sellar and supras...

Background: Cerebral cavernous malformations (CCMs) are vascular malformations characterized by clusters of enlarged leaky capillaries in the central nervous system. They may result in intracranial haemorrhage, epileptic seizure(s), or focal neurological deficits, and potentially lead to severe disability. Globally, CCMs represent the second most...

Background Patients affected by a high-grade glioma (HGG) have a poor prognosis with a median survival of 12–16 months. Such poor prognosis affects the perception of the remaining life by patients and the neuropsychological status can strongly affect every-day functioning of these patients. Monitoring changes of neuropsychological functioning (NPF)...

Background First-line therapy of Cushing disease (CD) is transsphenoidal surgery (TSS) aimed to obtain a complete removal of the pituitary adenoma and remission of disease. Purpose To analyse the surgical outcome of patients with CD who underwent TSS in our Centre. Methods Retrospective analysis on patients with CD who underwent TSS between 1990...

Objective: Some studies have highlighted psychological and neuropsychological difficulties and a potential reduction in health-related quality of life (HRQOL) in patients with pituitary tumors, despite hormone deficits or excess. To the authors' knowledge, this study is the first prospective longitudinal case-control study with the aim of simultan...

Objective: Recent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors' aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalu...

Objectives: To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment. Design: Prospective, monocentric, pilot study. Setting: University hospital. Participants: Thirty-nine patients aged 75 years and older, ineligible for shuntin...

Background Patients with high grade gliomas (HGG) have a poor prognosis and experience cognitive deficits which depend on location, size, mass effect and edema of the tumor. Neuropsychological functioning (NPF) can be assessed by a battery of tests which objectivise the cognitive status of the patients. These tests are time-consuming and fatiguing...

Context: Treatment of primary spinal syringomyelia is still controversial. Among others, shunting syrinx fluid to the subarachnoid, peritoneal or pleural space has been utilized with varying success. Shunt obstruction, migration, and infection represent the most common complications of these procedures. Findings: The authors present the case of...

Surgical treatment of elderly patients with meningioma is has proved to be safe, especially when patients are selected using dedicated surgical scores. These scores take into account tumor size, edema, location and patient’s co-morbidities. Neuropsychological functioning (NPF) of this kind of patients has been poorly studied in literature and it is...

Background: The optic radiation (OR) is a white matter bundle with a very complex anatomy. Its anterior component bends sharply around the tip of the temporal horn, forming the Meyer's Loop, whose sparing during surgery is crucial to preserve the visual function of the patient. Its exact anatomy is still challenging to define and its position is n...

Background: Constructional apraxia (CA) is a neuropsychological impairment of either basic perceptual and motor abilities, or executive functions, in absence of any kind of motor or perceptual deficit. Considering patients with focal brain tumors, CA is common in left or right parietal and parieto-occipital lesions. In neuropsychology, Rey-Osterri...

High grade gliomas (HGG) are tumors with a rapidly progressive course and the standard of care consists of surgery and chemo-radiotherapy. Elderly patients with HGG usually have a worse prognosis due to their comorbidities and difficulties in accessing or completing adjuvant treatments. The purpose of our study was to assess the influence of pre-op...

Neuroprotection after traumatic brain injury (TBI) is an important goal pursued strenuously in the last 30 years. The acute cerebral injury triggers a cascade of biochemical events that may worsen the integrity, function, and connectivity of the brain cells and decrease the chance of functional recovery. A number of molecules acting against this de...

Background Autoimmune hypothalamitis, which is among the causes of acquired central diabetes insipidus, has been described very rarely in the literature. This condition is probably provoked by the production of anti-vasopressin secreting cells antibodies and anti-hypothalamus antibodies, and is often associated with pituitary or polyendocrine autoi...

The optic radiation is a white matter bundle which carries the visual information from the lateral geniculate nucleus to the visual cortex, and it is characterised by a very complex anatomy. It runs together with other large white matter tracts in the deep of the temporal and parietal lobes and its anterior component, which forms the Meyer’s Loop,...

Background: The transsphenoidal approach (TNS) is considered the gold standard for resection of pituitary adenomas and other sellar region lesions. This approach is guided by few fundamental anatomical landmarks that conduct the surgeon toward the sellar floor. Some anatomical structures may vary a lot (e.g. intrasphenoidal septa, intercarotid dis...

A772 Effects of lipid emulsions based on n-3 polyunsaturated fatty acids on metabolic and infectious complications compared with MCT/LCT lipid emulsion in critically ill patients receiving parenteral nutrition R. del Olmo1, M.J. Esteban2, C. Vaquerizo3, R. Carreño3, V. Gálvez3, G. Kaminsky3, B. Nieto3, M. Fuentes3, M.A. De la Torre3, E. Torres3, A...

Background: The thalamus is a deep-seated and crucial structure for the sensory-motor system. It has been longly considered a surgically inaccessible area due to the morbidity associated with surgical resections. In fact, astrocytomas of the thalamus usually undergo bioptic procedures followed by adjuvant treatments. Intra-operative neurophysiolog...

Transsphenoidal route is now considered the gold standard for the removal of pituitary adenoma. Up to date, no clear superiority in terms of efficacy has been demonstrated between transsphenoidal microscopic and endoscopic approaches. Surgical safety may be a relevant argument in favor or against the choice of one of the two surgical approaches. In...

Background and purpose: Cerebral cavernous malformation (CCM) is characterized by multiple lumen vascular malformations in the central nervous system that can cause neurological symptoms and brain hemorrhages. About 20% of CCM patients have an inherited form of the disease with ubiquitous loss-of-function mutation in any one of 3 genes CCM1, CCM2,...

Axonal injury is a major contributor to adverse outcomes following brain trauma. However, the extent of axonal injury cannot currently be assessed reliably in living humans. Here, we used two experimental methods with distinct noise sources and limitations in the same cohort of 15 patients with severe traumatic brain injury to assess axonal injury....

INTRODUCTION: The thalamus is a deep-seated and crucial structure for the sensory-motor system. It has been longly considered a surgically inaccessible area due to the morbidity associated with surgical resections. In fact, astrocytomas of the thalamus usually undergo bioptic procedures followed by adjuvant treatments (if indicated). Intra-operativ...

BACKGROUND: Glioblastoma (GBM) is a primary malignant brain tumor and its evolution is generally rapidly fatal. The current standard of care for this disease is surgical resection followed by concomitant radiationtherapy plus chemiotherapy as described by Stupp and Colleagues. In this study we described our experience in a series of 100 consecutive...

INTRODUCTION: Intra-operative neurophysiological monitoring and brain mapping techniques represent nowadays the gold standard for surgical resection of brain tumors. Brain mapping usually requires the exposure of a large area of brain cortex in order to identify the different eloquent sites (e.g. primary motor strip, speech arrest sites). Thus, rel...

BACKGROUND: The treatment of patients with primary CNS lymphomas (PCNSL) has dramatically changed since the 1970's when whole brain radiation generated median survivals of about 12 months, significant neurotoxcity, and few long term survivors. High dose methotrexate (HD-MTX) monotherapy without radiation provides excellent response rates and 30% lo...

Background / Purpose: Early and delayed cognitive dysfunctions are an understudied issue after aneurismal subarachnoid hemorrage (aSAH).The aim of this study is to describe early and late changes after aSAH in terms of cognitive functions, activities of everyday life and quality of life. Main conclusion: Cognitive dysfunction has different tim...

This work reports the analysis of the relationship between inferior fronto-occipital fasciculus (IFO), neoplastic lesions and surgical resection, in patients operated for gliomas located in the frontal, temporal and insular lobes of the dominant hemisphere. Aim of the study is evaluating the predictive value of inferior fronto-occipital fasciculus...

In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative morbidity and mortality in eld...

Medulloblastoma is a malignant and invasive embryonal tumour of the cerebellum (WHO grade IV), and it is the most frequent histologic type of malignant brain tumour in childhood (0 to 18 years), representing 16.3% of all pediatric tumor. Cystic lesions within the pineal gland can be of neoplastic or non-neoplastic origin. In this study we report a...

List of differentially expressed proteins identified by MALDI-TOF after two- dimensional PAGE analysis by comparing glioblastomas treated with PF4-DLR for 10 days with corresponding untreated tumors. The graph indicates the ratio PF4-DLR treated/untreated tumors (PF4-DLR/Crtl) normalized spot volume values of the identified proteins. (3.13 MB TIF)

Two-dimensional PAGE gels analysis of PF4-DLR treated glioblastomas. In order to identify protein expression changes in mice treated with PF4-DLR, samples of treated and untreated glioblastomas were analyzed by means of two-dimensional PAGE gels. A) example of gel obtained from untreated glioblastomas which has been compared with PF4-DLR treated tu...

Proteomic analysis scheme. (0.04 MB DOC)

List of differentially expressed proteins identified by MALDI-TOF after two- dimensional PAGE analysis by comparing glioblastomas treated with PF4-DLR for 20 days with corresponding untreated tumors. The graph indicates the ratio PF4-DLR treated/untreated tumors (PF4-DLR/Crtl) normalized spot volume values of the identified proteins. (2.68 MB TIF)

ILK1 knockdown experiment scheme. (0.03 MB DOC)

In order to improve our understanding of the molecular pathways that mediate tumor proliferation and angiogenesis, and to evaluate the biological response to anti-angiogenic therapy, we analyzed the changes in the protein profile of glioblastoma in response to treatment with recombinant human Platelet Factor 4-DLR mutated protein (PF4-DLR), an inhi...

Glioblastoma patients are still not cured by the treatments available at the moment. We investigated the therapeutic properties of temozolomide in combination with F16-IL2, a clinical-stage immunocytokine consisting of human interleukin (IL)-2 fused to the human antibody F16, specific to the A1 domain of tenascin-C. We conducted three preclinical t...

Bilateral intracavernous carotid artery aneurysms are very rare and can be usually observed in patients with multiple intracranial aneurysms. Here we present the case of a 73 year-old woman who experienced worsening diplopia due to progressive bilateral paresis of the lateral rectus muscles. Computed tomography (CT) and magnetic resonance imaging (...

This article describes the rationale, indications, and modality for intraoperative brain mapping for safe and effective surgical removal of tumors located within functional brain areas.

Low-grade gliomas ([LGGs] WHO Grade II) are slow-growing intrinsic cerebral lesions that diffusely infiltrate the brain parenchyma along white matter tracts and almost invariably show a progression toward malignancy. The treatment of these tumors forces the neurosurgeon to face uncommon difficulties and is still a subject of debate. At the authors'...

Preoperative DTI Fiber Tracking (DTI-FT) reconstruction of functional tracts combined with intraoperative subcortical mapping (ISM) is potentially useful to improve surgical procedures in gliomas located in eloquent areas. Aims of the study are: (1) to evaluate the modifications of fiber trajectory induced by the tumor; (2) to validate preoperative...

Surgery for gliomas aims to remove as much of the tumour mass as possible while at the same time preserving the patient's functional integrity. This policy particularly applies to resection of gliomas located close to or within the so-called 'eloquent' areas, i.e. areas that are involved in motor, language or visuospatial functions. In these cases,...