Francesco Tomasello's research while affiliated with Università degli Studi di Messina and other places

Publications (334)

Article
Background Since January 2020, 3 months ago, when the pathogen causing the Coronavirus-disease was identified in humans, the literature on COVID-19 has grown exponentially to over 4000 publications. There is the need to provide an update for each single medical discipline, including neurosurgery, to be used by single professionals or to be distribu...
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BACKGROUND Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. We recently proposed some technical nuances for complication avoidance related to MVD. OBJECTIVE To verify the efficacy of the proposed refinement...
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The anterior cranial fossa is involved by many different disorders (such as benign tumors, malignancies, vascular abnormalities and even malformations) requiring different surgical strategies. Successfully dealing with the management of these disorders requires a deep anatomical knowledge of anterior cranial base and adjacent structure. Both transc...
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Background: Petrous meningiomas (PMs) represent a subset of posterior fossa tumors accounting for ∼8% of all intracranial meningiomas. Surgical treatment of PMs is challenging because of their relationships with vital neurovascular structures of the cerebellopontine angle. Objective: To investigate independent pre- and intraoperative predictors...
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Objectives: Awake surgery and intraoperative monitoring represent the gold standard for surgery of brain tumors located in the perisylvian region of the dominant hemisphere due to their ability to map and preserve the language network during surgery. Nevertheless, in some cases awake surgery is not feasible. This could increase the risk of postope...
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Background: Unruptured intracranial aneurysms (UIAs) are increasingly identified and are an important health-care burden; in the past they were commonly treated by surgical clipping, but nowadays endovascular coil embolization is increasingly employed as an alternative. Methods: The Unruptured Aneurysms Italian Study (UAIS) is a multicentric coo...
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Although there is recent evidence for the role of intraoperative neurophysiological monitoring (IONM) in spine surgery, there are no uniform opinions on the optimal combination of the different tools. We analyzed the impact of the multimodal IONM (mIONM) on the preservation of neuronal structures and on functional restoration in a prospective serie...
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Background: Navigated transcranial magnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMS with diffusion tensor imaging fiber tracking (DTI-FT) of the corticospinal tract (CST) has been described; however, its impact on surgery of motor-eloquent lesions has not been addressed. Objective: To ana...
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Background: Trigeminal neuralgia (TN) affects 7% of patients with multiple sclerosis (MS). In such patients, TN is difficult to manage either pharmacologically and surgically. Radiosurgical rhizotomy is an effective treatment option. The non-isocentric geometry of radiation beams of CyberKnife introduces new concepts in the treatment of TN. Its ef...
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Background Surgery of low-grade gliomas (LGGs) in eloquent areas still presents a challenge. New technologies have been introduced to enable the performance of “functional”, customized preoperative planning aimed at maximal resection, while reducing the risk of postoperative deficits. We describe our experience in the surgery of LGGs in eloquent ar...
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Although there is recent evidence for the role of intraoperative neurophysiological monitoring (IONM) in spine surgery, there are no uniform opinions on the optimal combination of the different tools. At our institution, multimodal IONM (mIONM) approach in spine surgery involves the evaluation of somatosensory evoked potentials (SEPs) and motor evo...
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Introduction The need to improve surgical efficacy in patients affected by high-grade gliomas has led to development of advanced pre-surgical MRI-based techniques such as tractography. This study investigates pre-surgical planning of optic radiations (ORs) in patients affected by occipito-temporo-parietal high-grade gliomas, by means of constrained...
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Background Although pituitary adenomas are considered benign lesions, a small group may exhibit a clinically aggressive behavior, sometimes independently from the classic markers of aggressiveness, including the Ki67 labeling index and/or p53 expression. Methods We selected 7 subjects harboring a pituitary tumor with clinical features of aggressiv...
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Gliomas account for around 45% of primary brain tumors. The treatment of malignant gliomas depend on the person’s age, the type of tumor, and the location of the tumor. These tumors tend to grow into the normal brain tissue, with the result that complete surgical removal can be very difficult to reach. Current therapy is unsatisfactory due to low t...
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Objectives: Gelatin-thrombin hemostatic matrix (FloSeal®) use is associated with shorter surgical times and less blood loss, parameters that are highly valued in neurosurgical procedures. We aimed to assess the effectiveness of gelatin-thrombin in neurosurgical procedures and estimate its economic value. Patients and methods: In a 6-month retros...
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Background: Metaplastic meningiomas are characterized by mesenchymal differentiation with formation of bone, cartilage, fat, or xanthomatous elements. However the presence of extensive areas of ossification is rare in meningiomas. In addition, intracranial location of ossified meningiomas is uncommon. Surgical management represents the optimal tre...
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In this retrospective study, we evaluated the overall survival (OS) and local control (LC) of brain metastases (BM) in patients treated with stereotactic radiosurgery (SRS). The scope was to identify host, tumor, and treatment factors predictive of LC and survival and define implications for clinical decisions. A total of 223 patients with 360 BM f...
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Objective: A modification of other reported endoscopic Intracerberal clot evacuation is reported. Methods: From January 2014 to December 2014 we operated on 6 patients harboring a spontaneous supratentorial intracerebral hemorrhage (ICH) using a fully endoscopic free hand technique. The surgical technique is described and illustrated. Clinical c...
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Background: Microvascular decompression (MVD) represents the most effective and safe surgical option for the treatment of trigeminal neuralgia since it was first popularized by Jannetta 50 years ago. Despite several advances have been proposed, the rate of complications as cerebellar and vascular injury, hearing loss, muscular atrophy, cerebrospin...
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Background: Fibrin sealants are widely used in neurosurgery to seal the suture line, provide watertight closure, and prevent cerebrospinal fluid leaks. The aim of this systematic review is to summarize the current efficacy and safety literature of fibrin sealants in dura sealing and the prevention/treatment of cerebrospinal fluid leaks. Methods:...
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Prisma 2009 checklist completed form. Modified from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097. (DOC)
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As the conclusions of the ARUBA Study are strongly oriented towards therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study might have on the health of patients, if not properly evaluated. The vast majority of patients (76-81%) included in the study was treated...
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Object: Meningiomas constitute 25% of primary spinal tumors and predominantly involve the thoracic spinal cord. Although calcifications are commonly seen in intracranial meningiomas, gross calcifications are observed in only 1-5% of all spinal meningiomas. We report the clinical findings, surgical strategy and histological features of 9 patients w...
Chapter
The transcallosal approach is indicated for craniopharyngiomas that are primarily located in the third ventricle cavity with a significant expansion into the superior-posterior part of the ventricular cavity. Relationship with the third ventricle floor should be identified preoperatively. In some cases craniopharyngiomas displace upward the roof of...
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As the conclusions of the Aruba Study are strongly directed towards the therapeutic abstention, we think it is appropriate to express the concern of the Italian Society of Neurosurgery for the impact that this study can have on the health of patients, if not properly evaluated. The vast majority of pts. (76-81%) was treated with endovascular or rad...
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Background: The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel's cave (MC) causing symptomatic TN is very rare. Case description: We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia....
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MR imaging tractography is increasingly used to perform noninvasive presurgical planning for brain gliomas. Recently, constrained spherical deconvolution tractography was shown to overcome several limitations of commonly used DTI tractography. The purpose of our study was to evaluate WM tract alterations of both the corticospinal tract and arcuate...
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A noninvasive method to predict the grade of a meningioma would be desirable since it would anticipate information about tumour nature, recurrence and improve tumour management and outcomes. The aim of the present study was to assess the ability of perfusion computed tomography (PCT) technique in predicting the meningioma grade before surgery. Data...
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Introduction Metastases are the most frequent malignant lesions of the spine. Around 5 to 10% of the patients with a systemic tumor have got spinal metastases. More than 95% of spinal metastases are extradural lesions. The residual cases are intradural extramedullary lesions and only 0.5% are intramedullary lesions. Prostate, lung, breast, clear ce...
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Cavernous malformations (CMs) of the optic chiasm are rare lesions often presenting with acute chiasmal syndrome or a progressive visual loss. The case of a 48-year-old female with an intrachiasmatic CM is presented. The patient presented with an insidious history of progressive visual loss. Magnetic resonance imaging (MRI) showed a CM in the supra...
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It is already known that the conditions of increased oxidative stress are associated to a greater susceptibility to vascular malformations including cerebral cavernous malformations (CCMs). These are vascular lesions of the CNS characterized by abnormally enlarged capillary cavities that can occur sporadically or as a familial autosomal dominant co...
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Fourth ventricle tumors have been traditionally approached by splitting of the cerebellar vermis. The "telovelar" approach is an alternative approach performed through the cerebello-medullary fissure to gain access to the fourth ventricle, avoiding neural tissue damage. We describe our experience with this approach and predictive factors for the ex...
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Background: The "telo-velar" approach is an alternative to cerebellar splitting to gain access to the fourth ventricle through the so-called cerebello-medullary fissure (CMF). Method: In this approach, the CMF is exposed and access to the ventricle is obtained by incising the tela chorioidea and inferior medullary velum. This approach enables th...
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Glossopharyngeal neuralgia (GN) is a rare condition characterized by severe, paroxysmal episodes of pain mainly localized to the external ear canal, pharynx, and tongue, usually caused by a neurovascular conflict between postero-inferior cerebellar artery (PICA) and IX cranial nerve. Sometimes there is also a compression of X c.n. We present a case...
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A PET-cyclotron-radiochemistry plant was built at Messina University Hospital, whose diagnostics section was equipped with a PET-CT scanner composed by a time of flight PET and a 16-slice CT. The present note reports about the results of tomograph's acceptance tests, which had been planned and carried out in order to verify the correspondence of th...
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Cerebral metastases are the most frequent brain tumors in adults and they are found in 15-30% of patients with a primary tumor. They develop mainly in the brain or cerebellum and less frequently in the meninges. Dural metastases are rare entities and are found in 9% of patients with terminal systemic cancer and in about 5% they represent the only i...
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INTRODUCTION: Surgery of brain tumors located near the motor pathway still represents a challenge because of the risk of significant post-operative morbidity. In the last few years, there have been an increasing interest for imaging techniques that could reliably define the spatial relationship between a tumor and the adjacent eloquent areas before...
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Abscess formation within brain tumor is uncommon. Intrasellar or parasellar tumors are among the most common neoplasms that developed such complications as the results of direct extension of microbial flora from contiguous infected sinuses. Cerebral gliomas with abscess are extremely rare. The major challenge is detection of a correct diagnosis. Th...
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A judicious approach to jugular foramen tumors may result in optimal long term control of tumor growth. Pre-operative diagnostic workup should be very extensive and guide the overall management strategy. Non-glomic tumors are generally easier to be controlled and most cases can be managed by a retrosigmoid approach. Given the satisfactory results o...
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•Microsurgical resection is the treatment of choice for all hemangioblastomas•When surgery is not suitable, radiosurgery may be the preferred treatment•A complete removal may be often achieved with acceptable mortality and morbidity•Radical resection still remains the main prognostic factor for hemangioblastomas
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Introduction Cavernous angiomas of the spinal cord are rare vascular malformations, which account for approximately 5 to 12 percent of spinal cord vascular lesions. They usually originate in the vertebrae, with occasional extension into the extradural space, and intramedullary cavernomas, even if reported in the literature, are very rare. Case pre...
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Background: Diffusion tensor imaging tractography provides 3-dimensional reconstruction of principal white matter tracts, but its spatial accuracy has been questioned. Navigated transcranial magnetic stimulation (nTMS) enables somatotopic mapping of the motor cortex. Objective: We used motor maps to reconstruct the corticospinal tract (CST) by i...
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Background: Hemifacial spasm (HS) and spasmodic torticollis (ST) are well-known disorders that are caused by a neurovascular conflict. HS is characterized by irregular, involuntary muscle contractions on one side of the face due to spasms of orbicularis oris and orbicularis oculi muscles, and is usually caused by vascular compression of the VII cra...
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Tumoral neoangiogenesis characterizes high grade gliomas. Relative Cerebral Blood Volume (rCBV), calculated with Dynamic Susceptibility Contrast (DSC) Perfusion-Weighted Imaging (PWI), allows for the estimation of vascular density over the tumor bed. The aim of the study was to characterize putative tumoral neoangiogenesis via the study of maximal...
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Cranial and intracranial involvement by myelomatous disease is relatively uncommon. Furthermore, systemic manifestations of multiple myeloma are present in the majority of these cases at the time of symptom onset. The authors report the case of a patient with serial appearance of multiple intracranial plasma cell tumor localizations as the first ma...
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Dear Editor, We have read with great interest the paper of Yuh et al.[4] reporting a case of symptomatic hydrocephalus due to vertebrobasilar dolichoectasia (VBD) compressing the brainstem. Ectatic or pathologically enlarged vertebrobasilar arteries have been reported with increasing frequency and associated with several clinical syndromes. These...
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Trigeminal neuralgia is a disabling form of facial pain that causes a considerable discomfort and a marked reduction in the quality of life. Although neurovascular compression is often associated with trigeminal neuralgia, other intracranial pathologies can result in compression along the nerve. The authors report a case of a patient suffering from...
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Background: Mild traumatic brain injury (mTBI) is a significant healthcare burden and its diagnosis remains a challenge in the emergency department. Serum biomarkers and advanced magnetic resonance imaging (MRI) techniques have already demonstrated their potential to improve the detection of brain injury even in patients with negative computed tom...
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The resection of tumors within or close to eloquent motor areas is usually guided by the compromise between the maximal allowed resection and preservation of neurological functions. Navigated transcranial magnetic stimulation (nTMS) is an emerging technology that can be used for preoperative mapping of the motor cortex. In the present study we repo...
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Malignant brain tumors represent a class of aggressive neoplasms generally associated with high rates of morbidity and mortality. Late diagnosis and the limitation of conventional therapies, which may result from inefficient delivery of the therapeutic or contrast agent to brain tumors are major reasons for this unsolved clinical problem. Recent ad...
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Background: Trigeminal schwannomas are uncommon intracranial tumors. Extracranial trigeminal schwannomas in the infratemporal fossa are rare. Methods: We present a case with a clinical history of facial pain. MRI and CT scans showed a mass arising from the infratemporal fossa extending into the intracranial space. Results: We performed a combi...
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Purpose: The aim of this study was to evaluate the advantages and limits of virtual magnetic resonance techniques in planning surgery for microvascular decompression in patients with neurovascular conflict. Materials and methods: Between December 2010 and December 2011, we prospectively observed 32 patients (30 with trigeminal neuralgia and two...
Article
Background: The transcallosal approach provides a direct corridor to the lesions lying in the third ventricle with distinct advantages over alternative routes, such as the possibility to use multiple corridors for tumor resection. Method: Here we present a personal perspective of the surgery of tumors of the anterior portion of the third ventric...
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Object: The integration of state-of-the-art neuroimaging into treatment planning may increase the therapeutic potential of stereotactic radiosurgery. Functional neuroimaging, including functional MRI, navigated brain stimulation, and diffusion tensor imaging-based tractography, may guide the orientation of radiation beams to decrease the dose to c...
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Purpose: Several authors have demonstrated that preoperative embolization of meningiomas reduces blood loss during surgery. However, preoperative embolization is still under debate. Aim of this study is the retrospective evaluation of necrosis score, surgical time, and transfused blood volume, on patients affected by intracranial meningiomas treat...
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Brain metastases (BM) are the most common intracranial tumors and their incidence is increasing. Untreated brain metastases are associated with a poor prognosis and a poor performance status. Metastasis development involves the migration of a cancer cell from the bulk tumor into the surrounding tissue, extravasation from the blood into tissue elsew...