Pasquale Ciappetta

Spinal Glioblastomas: Report of Seven Cases and Review of the Literature

Intramedullary glioblastomas are uncommon tumors. They occur chiefly in the cervicothoracic segments, have a slight tendency to occur in the early decades of life, and have a short clinical history before diagnosis. We report seven cases and discuss the salient features of these tumors, particularly the pathological features and treatment, in light of the relevant literature.

Osteosarcomas of the skull : clinical remarks on 19 cases

Background. Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post‐Paget and post–radiation therapy.

Vertebral hemangiomas with cord compression: The role of embolization in five cases

Five new cases of vertebral hemangioma with cord compression are reported. The role of preoperative selective angiography with embolization in the management of these lesions is discussed in the light of the most important literature on this topic.

Intradiploic epidermoid cysts of the skull: report of 10 cases and review of the literature.

SummaryIntradiploic epidermoid cysts, fairly uncommon lesions in neurosurgical practice, are, as a rule, benign and slow-growing. Some attain great size, producing major neurological signs.Correct radiological assessment and complete removal of the tumour and its capsule are essential for adequate surgical treatment and good long-term prognosis.We report ten cases of intradiploic epidermoid cysts of the skull, three of which were giant lesions and one malignant, and analyze the clinicopathological and radiological features and treatment of these lesions in the light of the most important published data.

Surgical treatment of thoracic disc herniation: A reappraisal of Larson's lateral extracavitary approach

Twenty patients with thoracic disc herniations underwent removal of the transverse process, articular facet, pedicle, and rib--a procedure described by Larson as the lateral extracavitary approach. Eleven patients presented with myelopathy: five mild, nine moderate, and four severe. Fifteen patients showed significant neurologic improvement after the operation and five patients none. Postoperative follow-up ranged from 1 to 8 years. The pros and cons of each of the surgical approaches to this type of lesion are considered with reference to the published data.

Primary spinal epidural non-Hodgkin's lymphomas: A clinical study☆

BACKGROUND The spinal epidural space is an uncommon presenting site in primary non-Hodgkins lymphoma. The occurrence of spinal epidural disease ranges from 0.1%-6.5% among patients with non-Hodgkins lymphoma. METHODS We report a retrospective study regarding 19 patients with primary epidural non-Hodgkins lymphomas analyzing the factors influencing prognosis of this tumor with emphasis on treatment. RESULT Ten patients were females and nine males. The neurologic conditions of patients were assessed preoperatively and postoperatively according to Shaws classification for neurologic disability. All cases underwent surgery accompanied by radiotherapy in 16 cases as well as chemotherapy in 13 cases. Histologically, the tumor proved to be a low-grade non-Hodgkins lymphoma in three cases, intermediate-grade in four cases and, high-grade in 12 cases. At average follow-up of 7.2 years (range 5-15 years), 15 patients had died after an average interval of 31 months from treatment (range 3-130 months) and four patients are alive after an average interval of 61 months (range 32-86 months). CONCLUSION It appears that the outcome in these patients depends on the gravity of preoperative deficits, whereas the survival is influenced by the type of treatment.

Giant cell reparative granuloma of the skull base mimicking an intracranial tumor. Case report and review of the literature

Giant cell reparative granuloma is an infrequent nontumoral lesion affecting particularly the maxillary and mandibular bones and only rarely the cranial bones. The etiopathogenesis is still controversial and differential diagnosis, especially from giant cell tumors of bone, is arduous. We report a case of giant cell reparative granuloma of the middle cranial fossa which behaved like an intracranial tumor and which we followed up for 15 years. We discuss the relevant literature and describe the essential features of this controversial lesion.

Surgical treatment of petroclival meningiomas: Experience with 16 cases

This article presents the surgical results in a series of 16 petroclival meningiomas operated on from 1984-1990. Tumors with marked infiltration of the cavernous sinus, which belong to the category of spheno-petro-clival meningiomas, were excluded. The 16 petroclival meningiomas were all surgically treated using the combined transmastoid temporosuboccipital approach that offers a number of possible variants: retrosigmoidal, with or without recision of the sinus; presigmoidal retro-, or translabyrinthine. The choice of one or another of these variants depends on certain clinical (preoperative hearing status) and anatomic (size and extension, central or lateral, of the tumor; patency of the transverse sinuses; size and position, more or less anterior, of the sigmoid sinus; position, more or less high, of the jugular bulb) factors. The principle indications for each of these approaches are given with particular emphasis on their relative advantages and limitations.

A carbon fiber reinforced polymer cage for vertebral body replacement: technical note.

Objective We analyzed the surgical technique used for the replacement of damaged vertebral bodies of the thoracolumbar spine and the carbon fiber reinforced polymer (CFRP) cages that are used to replace the pathological vertebral bodies. We also evaluated the biomechanical properties of carbon composite materials used in spinal surgery. Technique The surgical technique of CFRP implants may be divided into two distinct steps, i.e., assembling the components that will replace the pathological vertebral bodies and connecting the cage to an osteosynthetic system to immobilize the cage. Instrumentation The CFRP cages, made of Ultrapek polymer and AS-4 pyrolytic carbon fiber (AcroMed, Rotterdam, The Netherlands), are of different sizes and may be placed one on top of the other and fixed together with a titanium rod. These components are hollow to allow fragments of bone to be pressed manually into them and present threaded holes at 15, 30, and 90 degrees on the external surface, permitting the insertion of screws to connect the cage to an anterior or posterior osteosynthetic system. Results To date, we have used CFRP cages in 13 patients undergoing corporectomies and 10 patients undergoing spondylectomies. None of our patients have reported complications. Conclusions CFRP implants offer several advantages compared with titanium or surgical grade stainless steel implants, demonstrating high versatility and outstanding biological and mechanical properties. Furthermore, CFRP implants are radiolucent and do not hinder radiographic evaluation of bone fusion, allowing for better follow-up studies.

Surgical treatment of subependymomas of the central nervous system. Report of 8 cases and review of the literature.

SummaryThe authors present a series of 8 pure subependymomas of the central nervous system surgically treated between 1965 and 1987. The clinico-pathological features and the results of surgical treatment of these benign tumours are discussed in the light of the most important literature on this topic.