Emanuela Crobeddu

Brain arteriovenous malformations are associated with interleukin-1 cluster gene polymorphisms.

BACKGROUND Brain arteriovenous malformations (BAVMs) are a rare but important cause of hemorrhagic stroke in young adults. Functional polymorphisms in proinflammatory cytokines have been associated with various cerebrovascular phenotypes, including ischemic stroke, aneurysmal subarachnoid hemorrhage, and BAVM. OBJECTIVE To investigate whether functional polymorphisms in the IL-1 &agr;, IL-1 &bgr;, and IL-1RN genes are associated with both susceptibility and clinical characteristics in BAVM patients. METHODS Allelic and genotypic frequencies of IL-1 &agr; (−889 C>T), IL-1 &bgr; (−511 C>T), and IL-1RN (VNTR) polymorphisms were analyzed in 101 unrelated BAVM patients and in 210 healthy subjects. Main clinical characteristics of the disease were compared according to different genotypes. RESULTS Both allelic and genotypic frequencies of IL-1 &agr; −889 C>T showed a significant association with BAVM (P < .001). The carriage of the T allele was related to a 2.47 increased risk of BAVM (odds ratio, 2.47; 95% confidence interval: 1.72-3.56). Allelic and genotypic frequencies of IL-1RN VNTR were different between cases and controls (P = .009). Allele 1 was associated with about a twofold increased disease risk (95% confidence interval: 2.01-5.58). Haplotype analyses confirmed these findings. Several clinical characteristics of the disease were significantly modified by IL-1 &agr; and IL-1 &bgr; genotypes. CONCLUSION Our data suggest that functional polymorphisms within the IL-1 complex gene are associated with BAVMs and influence the clinical characteristics of the disease, supporting a role for proinflammatory cytokines in disease etiopathogenesis.

Subarachnoid hemorrhage in elderly: Advantages of the endovascular treatment.

Aim:  Subarachnoid hemorrhage (SAH) from aneurysm rupture accounts for approximately 3% of all strokes. A significant improvement in surgery and endovascular procedures has reduced mortality and morbidity. Nowadays, endovascular treatment is a viable alternative to conservative treatment in elderly patients. We designed a retrospective observational study on all endovascular procedures carried out in our department in order to evaluate the outcome in elderly patients compared with a younger cohort.

Say “no” to spinal cord injury: is nitric oxide an option for therapeutic strategies?

Purpose: a literature review was made to investigate the role of nitric oxide (NO) in spinal cord injury, a pathological condition that leads to motor, sensory, and autonomic deficit. Besides, we were interested in potential therapeutic strategies interfering with NO mechanism of secondary damage. Materials: A literature search using PubMed Medline database has been performed. Results: excessive NO production after spinal cord injury promotes oxidative damage perpetuating the injury causing neuronal loss at the injured site and in the surrounding area. Conclusion: different therapeutic approaches for contrasting or avoiding NO secondary damage have been studied, these include nitric oxide synthase inhibitors, compounds that interfere with inducible NO synthase expression, and molecules working as antioxidant. Further studies are needed to explain the neuroprotective or cytotoxic role of the different isoforms of NO synthase and the other mediators that take part or influence the NO cascade. In this way, it would be possible to find new therapeutic targets and furthermore to extend the experimentation to humans.

Does intraoperative microrecording really increase the risk of hemorrhagic complications in deep brain stimulation

Stereotactic surgery represents a highly effective therapy for the treatment of Parkinson’s disease and other movement disorders refractory to medical treatment. Despite its demonstrated safety, some rare adverse events could result in potentially disabling outcomes.Amongthem,hemorrhagic complications (HC)areunarguably themost dangerous and dreaded. In a recent systematic survey of the literature, themost important patient-related factors associatedwith an increased risk of HC were age and hypertension, whereas risk factors related to surgical technique included the use of intraoperative microelectrode recording (MER), the number of MER penetrations, and the sulcal or ventricular involvement by the trajectory [1]. The incidence of HC in studies adopting MER was significantly higher than that reported with exclusively image-guided approaches [1e3]. Furthermore, the coexistence of hypertension and MER has been associated to an additional rise of bleeding incidence [4]. Herewe describe a large consecutive series of 221 patients undergoing surgery for Deep Brain Stimulation (DBS) lead placement at our institution mainly for advanced Parkinson’s disease without the occurrence of HC despite the routinely use of intraoperativeMER. Medical records and postoperative imaging studies of all patients who underwent bilateral DBS lead placement at Torino University Hospital between October 1998 and December 2013 were collected. Awritten informedconsentwasobtained for all participants. Theprocedures consisted of a single-session bilateral stereotactic lead implantation [5], performed under local anesthesia by a single primary surgeon (ML), using the CosmaneRobertseWells stereotactic frame (CRW, IntegraRadionics, Burlington,MA). Cranialmagnetic resonance imaging (MRI)/computed tomography (CT) image fusion (Image Fusion, Integra Radionics and I-Plan Stereotaxy, Brainlab AG, Feldkirchen, Germany) was used for anatomical targeting, adopting the Schaltenbrand-Wahren atlas as a reference [6]. Patients were positioned supine with their head slightly elevated (approximately 15 ). A 14-mmburr holewas located along the planned trajectory and specific lead-anchoring systemsfixed to the skull (burr-hole ring and cap early in the series; Stimloc, Medtronic, Minneapolis, MN, more recently). The dural and pial entry points were coagulatedwith bipolar electrocautery and opened sharply. To minimize the risk of HC, a trajectory avoiding sulci, arteries and ventricles was plotted. Intraoperative electrophysiological recording with a single-track MER was performed starting from 10 mm above the anatomical target (Microtargeting Electrodes BP, FHC Inc., Bowdoin,ME, early in the series, and

Rare Case of Dumbbell-Shaped Spinal Cavernous Hemangioma and Literature Review

BACKGROUND Spinal epidural cavernous hemangiomas are rare vascular malformations. Exceptionally, they present with dumbbell-shaped morphology. When they happen, its mandatory to include their pathology in the differential diagnosis because of their similarity to schwannomas. CASE DESCRIPTION We report the case of a 72-year-old woman with a dumbbell-shaped thoracic epidural cavernous hemangioma. A literature review of diagnostic features and current treatment options are also discussed. CONCLUSIONS Surgery is safe and effective in both improving patient condition and preventing acute hemorrhage that can worsen the outcome, causing neurologic and potentially irreversible deficits. The favorable result we obtained in our patient suggests that surgery should be evaluated as the first option, even in patients with large epidural cavernous hemangiomas.

Detailed anatomy knowledge: first step to approach petroclival meningiomas through the petrous apex. Anatomy lab experience and surgical series

Petroclival meningiomas are a challenge for neurosurgeons due to the complex anatomy of the region that is rich of vessels and nerves. A perfect and detailed knowledge of the anatomy is very demanding in neurosurgery, especially in skull base surgery. The authors describe the microsurgical anatomy to perform an anterior petrosectomy based on their anatomical and surgical experience and perform a literature review. The temporal bone is the most complex and fascinating bone of skull base. The apex is located in the angle between the greater wing of the sphenoid and the occipital bone. Removing the petrous apex exposes the clivus. The approach directed through the temporal bone in this anatomical area is referred to as an anterior petrosectomy. The area that must be drilled is the rhomboid fossa that is defined by the Kawase, premeatal, and postmeatal triangles. In Division of Neurosurgery - University of Turin, 130 patients, from August 2013 to September 2015, underwent surgical resection of intracranial meningiomas. In this group, we have operated 7 PCMs and 5 of these were approached performing an anterior petrosectomy with good results. In our conclusions, we feel that this surgery require an advanced knowledge of human anatomy and a specialized training in interpretation of radiological and microsurgical anatomy both in the dissection lab and in the operating room.