Gennaro Lapadula

Spontaneous regression of a thoracic calcified disc herniation in a young female: A case report and literature review

Thoracic intersomatic disc herniation (TDH) is a rare entity, hose incidence is about one case over one million of habitants er year [1]; incidence of asymptomatic one is approximately 37% 2]. The majority of dorsal disc herniations goes through a calcifiation process, first described by Von Luschka, and may penetrate he dura mater [3]. Intervertebral disc calcification (IDC) is common n adults and it is often observed in degenerating discs. While in hildren treatment should be conservative, given its benignity and ikelihood to spontaneously regress, in adults it is considered to be n expression of disc degeneration and, despite its rate of regression s unknown, it is likely to be rare. For patients showing an active ymptomatology, treatment should be surgical. While few years go surgery was followed by important and often life-threatening omplications, nowadays new surgical techniques, above all mininvasive, come in handy [3]. We describe a case of a spontaneous egression of a dorsal calcified extruded disc herniation with an ssociated calcification of the intersomatic disc, which, till date, it s the only case reported in literature, CT and MRI documented.

Epidural hematoma with detachment of the dural sinuses

Epidural hematoma (EH) is a neurosurgical emergency that requires early surgical treatment. It is rarely extended bilaterally causing a detachment of the dural sinus or sinuses. The authors present two rare cases of EH with dural sinus detachment and describe how they suspend them. In these cases it is crucial to firmly suspend the dura mater and the dural sinus to the inner skull surface to prevent postoperative rebleeding.

Assessment of the utility of the 2‐µ thulium laser in surgical removal of intracranial meningiomas

Since the 1960s, lasers have been used in neurosurgery for surgical removal of intracranial tumors. Because of its limited penetration (2 mm) through tissues and its wavelength, which is useful in water medium, the 2‐µ thulium laser has been applied primarily in urology. Its features are attractive for application under microscope magnification during neurosurgical procedures. The aim of this study was to evaluate the usefulness of the 2‐µ thulium laser during microsurgical removal of intracranial meningiomas.

Chordoid meningioma: a retrospective series of seven consecutive cases

Chordoid meningioma is a rare variant of meningioma characterized by a more aggressive behavior. The present study documents the histological, radiological and clinical features of seven cases treated at the Policlinico Umberto I of Rome from 1999 to 2010. There were five males and two females. Most of the cases were located in the supratentorial space, especially the convexity. Surgical gross total resection was achieved in four cases. Of the remaining three cases, two relapsed and underwent further surgeries and adjuvant treatment. The MIB-1 index had a mean value of 7.5 (range 0.3–25.8). Tumors were composed of epithelioid cells or plump to spindle cells, forming cords, cribriforms or nests, in a mucoid matrix. All tumors showed diffuse positive immunoreactivity to vimentin and epithelial membrane antigen. Surgery is the first line of treatment for this kind of lesion. Gross total resection guaranteed a survival free from recurrences in our series. On the other hand, radiation therapy must be considered in patients submitted to a subtotal resection.

Pleomorphic rhabdomyosarcoma of the cerebellopontine angle in an adult: a review of literature

Rhabdomyosarcoma (RMS) is a rare and aggressive neoplasm characterised by rapid growth and metastatic invasion. The most frequent localisation is the skeletal musculature of the limbs. The head and the neck are rarely involved. A 50-year-old woman presented to our attention because of a progressively increasing headache, ataxia and vomiting. MRI showed a lesion at the right cerebellopontine angle. Thereafter, the patient was submitted to a piece-meal removal of the neoplasm. Despite the postoperative MRI showed no signs of remnant, 7 months after the surgery, the disease recurred with multiple localisations, and the patient died a few days later. This report is the first description in the literature of a pleomorphic RMS of the cerebellopontine angle. This particular tumour carries a bad prognosis because of the vicinity of nervous structures and of the impossibility of achieving a one-piece resection. More than ever, the adjunctive treatments had to be effective against a potential remnant and in controlling recurrences.

Preparation of nasoseptal flap in trans-sphenoidal surgery using 2-μ thulium laser: Technical note

OBJECTIVE The purpose of this study was to assess the feasibility of the use of the 2μ-thulium laser in harvesting nasal septal flaps. BACKGROUND DATA Nasal septal flaps are routinely performed in almost every trans-sphenoidal surgery. The preservation of the arterial vasculature is a mainstay of the procedure. However, the margins of the flap should be sufficiently healthy to regenerate faster, reducing the risk of possible complications. MATERIALS AND METHODS Eight patients underwent trans-sphenoidal surgery and removal of pituitary adenomas. Reparation of the defect was performed with the positioning of a rotational vascularized nasal-septal flap. The flaps were harvested with the aid of the 2μ-thulium laser. Every patient was then monitored for 6 months through seriated endoscopic endonasal controls. RESULTS There were no complications related to the use of the laser, either intraoperatively, or postoperatively. The operative timing did not significantly differ from that of traditional techniques. CONCLUSIONS The use of the 2μ-thulium laser for the harvesting of nasal septal vascularized flaps can be considered safe and feasible. The limited number of treated patients could be considered as the only restriction to the study. A larger study might have uncovered possible instrumentation-related complications, which were not observed in the present study.

Endoscopic interlaminar approach for intracanal L5-S1 disc herniation: Classification of disc prolapse in relation to learning curve and surgical outcome.

The full endoscopic interlaminar approach (FEILA) is a minimally invasive procedure to treat intracanal lumbar disc herniation not approachable by endoscopic transforaminal access. Disc prolapses have been classified into three categories according to their position and passing nerve root displacement: (i) type A, in which the nerve root is displaced medially; (ii) type B, in which the nerve root is displaced laterally; and (iii) type C, in which the nerve root is ventrally displaced. We focused on the FEILA technique because it was likely to involve few complications and that provided the advantages of the endoscopic approach.

Disseminated Cerebrospinal Embryonal Tumor in the Adult

Introduction. According to the 2016 World Health Organization classification of Tumors of the Central Nervous System, the term Primitive Neuroectodermal Tumor has been replaced by the term Embryonal Tumor (ET). We present a case of disseminated cerebrospinal ET presenting in an adult patient. Illustrative Case. A 49-year-old male presenting with low back pain, dysuria, and hypoesthesia of the lower extremities referred to our emergency department. Brain and whole spine contrast-enhanced MRI documented a diffusively disseminated heterogeneous neoplasm with intradural extra- and intramedullary involvement of the cervicothoracic tract and cauda equina. A primary biopsy of the lumbosacral localization was performed through L5 bilateral laminectomy. Histologic diagnosis was Embryonal Tumor Not Otherwise Specified. The patient underwent chemotherapy with postoperative adjuvant alternating Vincristine-Doxorubicin-Ifosfamide (VAI) and Ifosfamide-Etoposide (IE). Discussion. Spinal ETs are exceedingly rare especially when presenting in the adult patient. Neurosurgical and oncologic management is still unclear. When feasible, surgical removal should always be performed to obtain a histologic diagnosis. Postoperative adjuvant therapy might entail both chemo- and radiotherapy; however a consensus on this matter is still lacking.

Delayed Intraparenchymal Hematoma Following Diagnostic Lumbar Puncture.

Lumbar puncture is a safe and commonly performed procedure, with an overall complication rate of 0.1% to 0.5%. Well-known contraindications to lumbar puncture are an intracranial tumor, noncommunicating hydrocephalus, coagulopathy, and ruptured aneurysm with subarachnoid hemorrhage. We report a case of a young man with epilepsy who, after a lumbar puncture performed for research purposes, presented with an intracerebral hematoma and neurological deficits. To the best of our knowledge, post-tap intraparenchymal hematoma is extremely rare and only 1 case has been reported previously. In consideration, all patients undergoing a lumbar puncture should be informed about this possible rare complication, even in the absence of documented hemorrhagic risk factors.

Proximal-Type Epithelioid Sarcoma: Report of Two Cases with Unusual Location and Review of the Literature

Proximal-Type Epithelioid Sarcoma: Report of Two Cases with Unusual Location and Review of the Literature Epithelioid sarcoma usually occurs at the distal extremities of young adults. The proximal-type variant is characterized by a more aggressive course and resistance to treatment. We report two extremely rare cases with unique sites of origin. Due to anatomical issues, in both cases, a one-piece resection was not performed. Both presented a local relapse without any metastasis. Given the rarity of the disease, every report is fundamental for a future characterization of its features.