Carlo Giussani

Cervical spine malformation in cornelia de lange syndrome: A report of three patients

Cornelia de Lange syndrome (CdLS) is a complex genetic disease with skeletal involvement mostly related to upper limb malformations. We report on three males with clinical and molecular diagnoses of CdLS. Besides typical CdLS features, all showed different cervical spine malformations. To the best of our knowledge, this is an unusual malformation in the CdLS phenotypic spectrum.

Incidence of pain after craniotomy in children

There is very few information regarding pain after craniotomy in children.

Collagenopathy with a phenotype resembling silver–russell syndrome phenotype

Collagenopathy With a Phenotype Resembling Silver–Russell Syndrome Phenotype Paola Cianci, Giuseppe Paterlini, Paolo Tagliabue, Maria Verderio, Patrizia Vergani, Maria Luisa Bianchi, Carlo Giussani, Gaia Kullmann, Fabio Mazzoleni, Alberto Bozzetti, and Angelo Selicorni* Pediatric Department at Monza Brianza per il Bambino e la sua Mamma (MBBM) Foundation, Pediatric Genetic Unit, San Gerardo Hospital, Monza, Italy Pediatric Department at MBBM Foundation, Neonatal Intensive Care Unit, San Gerardo Hospital, Monza, Italy Obstetrics and Gynecology Department at MBBM Foundation, San Gerardo Hospital, Monza, Italy Bone Metabolism Unit, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy Neuroscience and Biomedical Technology Department, Neurosurgery Unit, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy Childhood Neuropsychiatry Department, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy Maxillofacial Surgery Department, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy

Multimodal Imaging in Glioma Surgery

In this chapter, the authors present current possibilities of intraoperative visualization of brain gliomas. These tumors are often macroscopically similar to the normal brain but typically well visualized by magnetic resonance imaging (MRI). Therefore, neuronavigation based on preoperative MRI is often used in order to localize glioma tissue. However, the accuracy of neuronavigation is limited due to the brain shift, and after some tumor debulking, it becomes unreliable. Intraoperative imaging techniques – intraoperative MRI and intraoperative ultrasound – represent a solution to this problem as these modalities enable an update of the neuronavigation data during the surgical procedure. In malignant gliomas, utilization of fluorescent agents is another possibility of intraoperative tumor tissue visualization. Benefits and pitfalls of aforementioned methods are discussed, with special emphasis on intraoperative ultrasound.

Indocyanine Green Videoangiography in Aneurysm Surgery: Systematic Review and Meta-Analysis

BACKGROUND Although digital subtraction angiography (DSA) may be considered the gold standard for intraoperative vascular imaging, many neurosurgical centers rely only on indocyanine green videoangiography (ICG‐VA) for the evaluation of clipping accuracy. Many studies have compared the results of ICG‐VA with those of intraoperative DSA; however, a systematic review summarizing these results is still lacking. OBJECTIVE To analyze the literature in order to evaluate ICG‐VA accuracy in the identification of aneurysm remnants and vessel stenosis after aneurysm clipping. METHODS We performed a systematic literature review of ICG‐VA accuracy during aneurysm clipping as compared to microscopic visual observation (primary endpoint 1) and DSA (primary endpoint 2). Quality of studies was assessed with the QUADAS‐2 tool. Meta‐analysis was performed using a random effects model. RESULTS The initial PubMed search resulted in 2871 records from January 2003 to April 2016; of these, 20 articles were eligible for primary endpoint 1 and 11 for primary endpoint 2. The rate of mis‐clippings that eluded microscopic visual observation and were identified at ICG‐VA was 6.1% (95% CI: 4.2‐8.2), and the rate of mis‐clippings that eluded ICG‐VA and were identified at DSA was 4.5% (95% CI: 1.8‐8.3). CONCLUSION Because a proportion of mis‐clippings cannot be identified with ICG‐VA, this technique should still be considered complementary rather than a replacement to DSA during aneurysm surgery. Incorporating other intraoperative tools, such as flowmetry or electrophysiological monitoring, can obviate the need for intraoperative DSA for the identification of vessel stenosis. Nevertheless, DSA likely remains the best tool for the detection of aneurysm remnants.

Changes in resting-state connectivity in pediatric temporal lobe epilepsy

OBJECTIVE Functional connectivity magnetic resonance imaging (fcMRI) is a form of fMRI that allows for analysis of blood oxygen level-dependent signal changes within a task-free, resting paradigm. This technique has been shown to have efficacy in evaluating network connectivity changes with epilepsy. Presurgical data from patients with unilateral temporal lobe epilepsy were evaluated using the fcMRI technique to define connectivity changes within and between the diseased and healthy temporal lobes using a within-subjects design. METHODS Using presurgical fcMRI data from pediatric patients with unilateral temporal lobe epilepsy, the authors performed seed-based analyses within the diseased and healthy temporal lobes. Connectivity within and between temporal lobe seeds was measured and compared. RESULTS In the cohort studied, local ipsilateral temporal lobe connectivity was significantly increased on the diseased side compared to the healthy temporal lobe. Connectivity of the diseased side to the healthy side, on the other hand, was significantly reduced when compared to connectivity of the healthy side to the diseased temporal lobe. A statistically significant regression was observed when comparing the changes in local ipsilateral temporal lobe connectivity to the changes in inter-temporal lobe connectivity. A statistically significant difference was also noted in ipsilateral connectivity changes between patients with and those without mesial temporal sclerosis. CONCLUSIONS Using fcMRI, significant changes in ipsilateral temporal lobe and inter-temporal lobe connectivity can be appreciated in unilateral temporal lobe epilepsy. Furthermore, fcMRI may have a role in the presurgical evaluation of patients with intractable temporal lobe epilepsy.

Negative pressure wound therapy in complex cranio‐maxillofacial and cervical wounds

The care and the management of the healing of difficult wounds at the level of the skull‐facial face many problems related to patient compliance and the need to perform multiple dressings, with long periods of healing and, occasionally, a very long hospitalisation period. The introduction and evolution of negative pressure wound therapy (NPWT) in the treatment of difficult wounds has resulted in better healing, with a drastic reduction in terms of time and biological costs to the patient and cost to the health care system. The main aim of this study is to describe and discuss, using out our experience, the usefulness of NPWT in the cranial‐facial‐cervical region. We studied 16 patients with complex wounds of the cranial‐facial‐cervical region treated with NPWT. We divided clinical cases in four groups: cervicofacial infectious disease, healing complications in oncological‐reconstructive surgery, healing complications of injury with exposure of bone and/or internal fixations and healing complications in traumatic injury with loss of substance. We evaluated complete or incomplete wound healing; application time, related also to hospitalisation time; days of intensive care unit (ICU) stay; management of the upper airways; timing of medication renewal; and patient comfort and compliance (on a scale of 1–5). Depression values were always between −75 and −125 mmHg in a continuous aspiration pattern. For every patient, we used the ActiVAC Therapy Unit, derived from the vacuum‐assisted closure system (Kinetic Concepts Inc., San Antonio, TX). Medication renewals were performed every 48–72 hours. The NPWT application time ranged from 4 to 22 days (mean of 11·57 day). Therapy was effective to gain a complete restitutio ad integrum in every patient included in the group of cervicofacial infectious disease. Therapy has, however, been well tolerated in our series; this is probably due to the decreased number of applications, the ease of use and the comfort of the system relative to traditional dressing. Results were satisfactory for most of cases treated; faster and more effective wound healing was achieved. The lower number of NPWT applications, relating to standard dressings, led to an increase in patient comfort and compliance and a decrease in the use of medical, and in some cases economic, resources according to international literature.

Brain ultrasound rehearsal before surgery: A pilot cadaver study

It has been shown that brain ultrasonography (US) is an efficient tool for improving three‐dimensional (3D) spatial orientation during neurosurgical interventions. However, it necessitates specific training as it is highly operator‐dependent. To date, neurosurgeons have relied solely on intraoperative practice to improve their mastery of brain US; this has obvious limitations. Herein, we consider whether a study of brain US on human cadavers could enable a training platform for neurosurgeons and residents to be developed. Standard two‐dimensional (2D) brain US was performed on two human cadavers (one fresh‐frozen and one Thiel‐prepared) through left frontoparietal, left frontal, right temporal, and left parietal craniotomies. US workflow and image quality were assessed in both preparations. It was possible to assess US in both cadaver preparations; however, the specimen prepared with Thiel‐fixation performed better, with superior image quality and specimen usability at room temperature. US images were obtainable through all surgical corridors with the main intracranial anatomical landmarks easily identifiable. US of cadaveric brains is feasible and delivers good quality results. This technique could allow neurosurgeons to develop the expertise required for a successful clinical application preoperatively. Clin. Anat. 30:1017–1023, 2017.