[Show abstract][Hide abstract] ABSTRACT: A reversed-phase high-performance liquid chromatographic method for the detection of boronophenylalanine is described. Determination was obtained by precolumn reaction of o-phthalaldehyde with a mixture of standard amino acids containing boronophenylalanine and separating the corresponding o-phthalaldehyde derivatives, using a Kromasil C-18, 250 x 4.6 mm, 5-microm particle size column, a step gradient with two buffers, a flow rate of 1.2 ml/min, a column temperature of 23 degrees C, and fluorimetric detection (excitation and emission wavelengths of 330 and 430 nm, respectively). The use of such a method for assaying boronophenylalanine in biological samples was tested in neutralized perchloric acid blood and cerebral tissue extracts of rats treated with intracarotid administration of 300 mg/kg of body weight boronophenylalanine. Results of these experiments showed that the present HPLC method represents a valid alternative to currently available analytical techniques for assaying boronophenylalanine based on boron determination in terms of reproducibility, recovery, or sensitivity. Therefore, it is suggested that the present method may routinely be used in all preclinical and clinical studies in which quantification of circulating and tissue concentrations of boronophenylalanine is critical for the application of boron neutron capture therapy.
No preview · Article · Oct 2000 · Analytical Biochemistry
[Show abstract][Hide abstract] ABSTRACT: Ulnar nerve entrapment at the elbow is an important and relatively frequent pathological condition that may be related to different causes depending on individual or external factors. The cause of the nerve lesion is also idiopathic in about one-quarter to one-third of cases. This variable aetiopathogenetic presentation has often suggested different diagnostic and clinical approaches and, moreover, various surgical procedures. We present our 8-years surgical experience with 290 cases of ulnar nerve entrapment at the elbow analysing the salient clinical features and the results of the surgical treatment in the light of the relevant literature available on this topic.
No preview · Article · Feb 2000 · Acta Neurochirurgica
[Show abstract][Hide abstract] ABSTRACT: Intraosseous cavernous hemangiomas are a rare finding in the calvarium. It is a benign tumor arising from the intrinsic vasculature of the bone. We report one case observed in a 20 year-old male. The diagnostic peculiarities and therapeutic implications of this lesion are discussed and the available literature on this subject is reviewed. These tumors do not recur once a radical surgical removal is performed.
[Show abstract][Hide abstract] ABSTRACT: The surgical treatment of pituitary adenomas in elderly patients (i.e., over 70 years of age) is a special problem because of the increased rate of perioperative complications and the reduced tolerance of postoperative fluid and electrolyte imbalance. Therefore, the unquestionable progress in the pharmacological and radiotherapy may not allow these patients the option of radical surgical treatment. We report our experience with the transsphenoidal procedure for pituitary adenomas in aged patients in an attempt to contribute to a better definition of the actual role of surgery.
Transsphenoidal surgery was performed in 11 patients over 70 years of age affected by various histological types of pituitary micro- and macroadenomas, ranging from Hardy Grade I through IIIc. Special care was dedicated to the postoperative treatment, in particular to water and electrolyte balances, and to the immediate treatment of any pathological variation of these parameters.
We had no mortality and no postoperative adjunctive morbidity. All the patients recovered well from the operation with an average hospital stay of 20 days. The tumor removal was complete in six cases and partial in the remaining five. With an average follow-up of 2 years, we did observe only one case of symptomatic recurrence of the disease.
Transsphenoidal surgery in the elderly is feasible and quite safe in the hands of an experienced team, if special care is devoted to the preoperative selection of patients and to the postoperative treatment of fluid and electrolyte imbalance.
No preview · Article · Apr 1999 · Surgical Neurology
[Show abstract][Hide abstract] ABSTRACT: 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. Skull base location is a very rare occurrence, mainly because the path of irradiation does not significantly involve this region.
We describe a rare case of simultaneous occurrence of two skull base meningiomas in a 66-year-old female. This patient underwent low-dose irradiation for tinea capitis when she was 8 years old. The patient complained of nuchal pain, paresthesias in both hands, and progressive weakness on her right side. She was admitted to the hospital in September 1994. An MRI showed two masses, one located at the level of the tuberculum sellae and the other at the foramen magnum. These seemed very likely to be multiple meningiomas. The latter lesion, which was more symptomatic and dangerous, was operated on first. Six months later, elective treatment of the suprasellar meningioma was performed with success.
The actual role of previous head irradiation in the oncogenesis of the present meningiomas remains somewhat unclear. Proper management and judicious use of skull base surgery techniques were key factors in the successful treatment of the patient.
No preview · Article · Apr 1999 · Surgical Neurology
[Show abstract][Hide abstract] ABSTRACT: Although resection of cervical "chondromas" had been reported since the late twenties, the true nature of this condition was not recognized at that time. This paper reports a case of "inferior cervical radiculitis by herniation of nucleus pulposus" operated by Prof. Angelo Chiasserini Sr, one of the founders of Italian neurosurgery, in January 1937. To our knowledge this represents one of the first examples of correct etiopathogenetic interpretation of cervical disc disease. Surgery was followed by excellent recovery, a quite remarkable result in those times. The case history is reported in detail, and a short historical sketch of cervical disc disease is depicted.
No preview · Article · Jan 1999 · Journal of the History of the Neurosciences
[Show abstract][Hide abstract] ABSTRACT: Among many factors contributing to the birth of Neurosurgery, the "awareness of feasibility" of neurosurgical procedures is especially significant. June 1st, 1885 is the arbitrary birthdate of Neurosurgery in Rome: Francesco Durante, Professor of Surgery at the Royal University, successfully resects an olfactory groove meningioma, arising admiration worldwide. Roberto Alessandri succeeds Durante in 1919. In roman hospitals outstanding surgeons perform from time to time neurosurgical procedures, sometimes with satisfactory results: Paolo Postempski, Cesare Antonucci, Guido Egidi and Raffaele Bastianelli, first director of the "Regina Elena" Cancer Institute (IRE) (April 1933) and friend of Harvey Cushing. Angelo Chiasserini sr. is however the first roman surgeon constantly committed to Neurosurgery and founder of the first neurosurgical unit in Italy, in 1937; also, from 1941 to 1944 he directs a neurosurgical service at the "Celio" military hospital of Rome, to which patients from the various battle theatres are referred. While Mario Margottini and Piero Frugoni follow Bastianelli's steps at the IRE, the roman neurosurgeons Felice Visalli and Libero Ugelli serve in the Army, during the greek-albanian conflict and in Russia, respectively. In May 1955 Beniamino Guidetti, an Olivecrona pupil, is called at "La Sapienza" University of Rome and elevates the neurosurgical clinic at the highest standards. The other main neurosurgical pole is founded in 1958 at the San Camillo Hospital: within both institutions modern neurosurgical teams are formed along with neuroradiological and neuroanesthesiological staffs.
No preview · Article · May 1998 · Annali italiani di chirurgia
[Show abstract][Hide abstract] ABSTRACT: This report describes the fundamental contribution made by Davide Giordano, proposing the transglabellar surgical approach in a period in which transfacial and transbasal operative approaches to the pituitary gland were considered inadvisable because of their risk. His idea was to gain access through bilateral paranasal and frontal skin incisions, allowing removal of the ethmoid bone and the anterior wall of the sphenoidal cube. With the anterior and inferior aspects of the sella turcica thus exposed, bone is removed and the gland is exposed by incision of the dura mater. The technique proposed by Giordano is undoubtedly a forerunner of the transsphenoidal route to the pituitary gland. The importance of his contribution was confirmed by Cushing, who reported his first use of the approach of Giordano in 1909 in a patient with a pituitary adenoma. The efforts of Giordano clearly inspired surgeons of his era to perform this operation clinically, giving impetus to the further development of neurosurgery.
[Show abstract][Hide abstract] ABSTRACT: Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques.
No preview · Article · May 1998 · Annali italiani di chirurgia
[Show abstract][Hide abstract] ABSTRACT: The Authors provide an overview of the current knowledge on the epidemiology and etiopathogenesis of spontaneous, i.e. non-traumatic, intracerebral hemorrhages. Malformative and neoplastic haemorrhages have been intentionally overlooked in order to favor a deeper analysis of other causal and risk factors. Moreover the physiopathology of the haemorrhagic event, its complications and natural history of parenchymal clots are discussed.
No preview · Article · Jan 1998 · Nuova Rivista di Neurologia
[Show abstract][Hide abstract] ABSTRACT: Cerebrospinal fluid (CSF) fistula represents a fearful complication of transsphenoidal surgery and, despite careful intraoperative repair and prolonged postoperative lumbar CSF drainage, need for a new surgical intrasphenoidal plasty is not uncommon.
These cases prompted us to develop a simple, minimally invasive, harmless repeatable technique consisting of a computed tomography (CT)-guided intrasphenoidal injection of fibrin glue through a 12-gauge spinal needle.
Five patients presenting with rhinoliquorrhea following a transsphenoidal approach for the excision of pituitary adenomas (three cases) and craniopharyngiomas (two cases) were treated successfully with the presented technique. In two cases the first attempt attained only partial success and therefore the procedure was repeated. In the last two cases, the injection of fibrin glue was preceded by 2 cc of fresh autologous blood, with the aim of enhancing the mechanisms of healing, possibly inducing adhesions and fibrosis.
The proposed method of treatment for CSF leakage following transsphenoidal surgery may represent a valid alternative to the surgical option.
No preview · Article · Nov 1997 · Surgical Neurology
[Show abstract][Hide abstract] ABSTRACT: In this experimental study is illustrated an original model of cerebral asymmetric ischemia and reperfusion in the rat, induced by unilaterally elevating ICP and clamping the corresponding common carotid artery, that allows a direct comparison of the two brain hemispheres, one normal and the other ischemic, of the same animal.
The experimental procedure consisted in grafting two screws through the skull on the right side of the sagittal suture, one of them being connected to a Queckenstedt manometer for monitoring ICP variations. A nitroprusside solution (1 mg/ml administered through the femoral vein at a flow rate of 0.103 ml/min) was infused to achieve a significant drop of MABP. At this time point, animals were subjected to 5 min of ischemia and 10 min of reperfusion induced by clamping and declamping the right common carotid artery. During the whole period of ischemia and reperfusion ICP and MABP were constantly monitored. In order to provide an outlook on the metabolic alterations of brain tissue occurring during ischemia and reperfusion phenomena, several biochemical parameters of cellular energy metabolism and of oxygen radical-induced membrane damage were determined by a sensitive and reproducible HPLC method on perchloric acid tissue extracts.
The validity of the present model was supported by the finding of significant intrahemispheric differences in the concentration of several compounds considered as biochemical markers of tissue injury, such as adenosine 5'-triphosphate catabolites and malondialdehyde, this last indicating the damaging action of oxygen free radicals on cell membrane phospholipids.
No preview · Article · Oct 1997 · Journal of neurosurgical sciences
[Show abstract][Hide abstract] ABSTRACT: Among German radiologists and orthopaedic surgeons Hermann Moritz Gocht (1869-1938) is one of the most prominent figures. In addition to his noteworthy contributions to the progress of orthopaedic surgery, in 1897 he introduced the use of radiotherapy for the treatment of trigeminal neuralgia. Subsequently the value of this technique was widely recognized by radiologists and neurosurgeons, and it is still acclaimed as the most brilliant intuition of this famous pioneer of radiology. Gocht made also important contributions to the technical development of X-ray apparatus and to the definition of the radiological anatomy of the skeleton, as well as to orthopaedic surgical pathology. The aim of this paper is to celebrate the centennial of Gocht's introduction of radiotherapy in the treatment of neuralgic syndromes and to express our appreciation of the work of this eminent scientist.
No preview · Article · Feb 1997 · Acta Neurochirurgica
[Show abstract][Hide abstract] ABSTRACT: Since XIX century, it has been assessed that complex functions are controlled by cortical areas. Sperimental studies have proved a large diffusion of functional lateralization in animals. During the neurogenesis the cell death mechanism (subjected to several inputs as availability of trophic materials or sex hormones) is an important moment for subsequent functional-anatomical organization. About anatomy, it has been observed that cortical areas and anatomic structures functionally connected with language have an asymmetric development or a specific biochemical activity. For example, the planum temporale is larger on the left side; the activity of choline acetyltransferase is more intensive into the area 22 of the left hemisphere; the thalamic lateralis posterior nucleus is larger on the left side; norepinephrine, then, is concentrated on the pulvinar. The statement that each hemisphere shows specific skills has been confirmed by neuropsychological, neurophysiological and functional neuroimaging studies. The left hemisphere would seem to be wired for verbal tasks, whereas the right one would be superior in solving perceptive-spatial problems. The speech function uses different circuits with consequent activation-inactivation of numerous cortical areas and subcortical structures, with particular functional competences. The conception of cerebral «dominance» have been replaced by «lateralization» of some functions, partly genetically predetermined, partly subsequented to enviromental influences.
No preview · Article · Jan 1997 · Nuova Rivista di Neurologia
[Show abstract][Hide abstract] ABSTRACT: We expose a review of the various hypoteses on the genesis and evolution of the normal pressure hydrocephalus (NPH). Described in 1964 by Hakim, the NPH is characterized by a deterioration of intellective functions, gait difficulty and urinary incontinence. From the beginning few attention has been paid to the biomechanic properties of the cerebral tissue in the liquoral hydrodynamics genesis. Nor the cysternography nor other methods, like the liquoral infusion test, the intracranial pressure (ICP) continuous recording, the TC, the SPECT, the Xenon-CT led to definitive results. Various studies, demonstrated variations in the ICP curve prophile from normal values to higher ones with continuous "beta" activity, so that in the realm of NPH we must consider active hydrocephalic states alongsi- de with compensated ones. A key pathogenetic role has been attributed to the liquoral outflow resistance (RO) though still a demonstrated linear correlation between RO and ICP raising is lacking, as well as between RO and ventricular dilatation. Recently it has been introduced the concept of ventricles as three-dimensional space entities surrounded by cerebral tissue; the cndovcntricular pressure could influence the cerebral volume by interacting with the capillary pressure. The raising of ventricular volume (e.g. in the NPH) would provoke a shrinkage of the cerebral tissue, by a reduction in its interstitial fluid contains so. the NPH could be caused by an alteration in this mechanism.
No preview · Article · Jan 1997 · Nuova Rivista di Neurologia
[Show abstract][Hide abstract] ABSTRACT: Syringomielia could be classified according to the presence or absence of association with hindbrain pathology. Therefore, hindbrain-related syringomielia could either appear as a result of an hindrance to the cranio-spmal CSF flow, (3/4 cases) usually as a consequence of a malformation (Dandy-Walker, Chiari I-II, basilar impression), or could less frequently show up as an acquired form caused by tumors or foramen magnum arachnoiditis. In the non hindbrain-related syringomielia, the perimedullary CSF flow is slowed by a diffuse spinal meningeal fibrosis, caused by spinal trauma, bacterial or chemical (contrast medium) meningitis, Pott disease, scoliosis, spinal canal stenosis. The aim of the present review is to analyze the most convincing etiopathogenetic hypotheses regarding the so called non hindbrain syringomielia and, in the light of these etiologic concepts, to review the current therapeutic options. A typical case of primitive spinal syringomielia, associated with Pott disease, is also reported, describing the rationale of the adopted surgical procedure and the therapeutic result, also evaluated with spinal MRI.
No preview · Article · Nov 1996 · Nuova Rivista di Neurologia
[Show abstract][Hide abstract] ABSTRACT: SURGERY OF THE peripheral nerves has only recently achieved brilliant results thanks to technological advances in the development of neurosurgical instrumentation. In past centuries, few surgeons made relevant contributions to this topic and improvement was slow and difficult. Avicenna, Guglielmo da Saliceto, and Guido Lanfranchi reported some attempts to suture nerves directly, but Gabriele Ferrara was the first to give a lucid and succinct description of suturing of the stumps of a transected nerve. He described applying gentle traction on the retracted stumps, suturing using a special needle with an eye, after immersion in a decoction of red wine, rosemary, and roses (alcoholic disinfection?), and, finally, insulating the sutured segment with a mixture of oils. We are celebrating the 400th anniversary of the first edition of his fundamental work (1596-1996), and we truly esteem this surgeon, a pioneer of peripheral nerve surgery wo primarily contributed to its progress.
[Show abstract][Hide abstract] ABSTRACT: Paranasal sinuses osteomas are known as biological benign tumours. However, due to the peculiar anatomical relationships, patients harbouring an osteoma within the frontal sinus are exposed to serious orbital and intracranial complications. We report two unusual cases of intracranial mucocoeles associated with frontal osteomas. In one of them, a superposed tension aerocoele required emergency surgery.
Although aggressive treatment of asymptomatic osteomas is not warranted, these lesions must be carefully observed and resected as soon as they show clinical and/or radiological signs of progression. The physiopathological and clinical aspects are discussed.
No preview · Article · Feb 1996 · Acta Neurochirurgica