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A Bricolo

Publications and source records attributed to A Bricolo.

At least 19 recordsLinked to original sources
PubMed1996

The long history of a cerebello-pontine angle epidermoid tumour--a case report and lessons learned.

The authors present the case of a patient accurately diagnosed and operated on for an epidermoid cyst in the CPA region, 30 years after the clinical onset with the initial symptom of hypoacusis. At the time of the operation, the patient presented with advanced CPA syndrome, and the tumour had grown to an enormous size. Complete capsule removal was not attempted due to its tenacious adherence to vital neurovascular structures. Thirteen years after surgery, the patient underwent a second operation due to tumour regrowth. The case provides supporting evidence that the clinical findings of a CPA epidermoid cyst may be minimal, and remain so for extended periods of time until the tumour has spread widely. Epidermoids tend to insinuate in the cisterns around cranial nerves, blood vessels, and the brainstem, rather than compressing these structures. The importance of early detection and radical removal, presently facilitated by Magnetic Resonance Imaging, is emphasized.

Cerebellar Diseases↗
PubMed1996

Endosellar meningiomas: report of 2 cases and review of the literature.

Two cases of endosellar meningiomas are presented. The clinical and radiological picture is not always sufficiently specific to distinguish meningiomas from other types of sellar lesions, but pre-operative diagnosis is of fundamental importance in choosing the best surgical approach. In both cases, the transsphenoidal approach was used, and due to the dense consistency of the tumors, only biopsies were performed. One of the two patients was reoperated on using the sub-frontal approach for radical removal of the tumor. In the authors' experience, craniotomy proved to be the more favorable approach than the transsphenoidal route for radical excision of endosellar meningiomas. Literature on the classification of sellar meningiomas for radiological diagnosis and surgical strategy of endosellar meningiomas is reviewed.

Brain Neoplasms↗
PubMed1996

Gamma Knife radiosurgery for intracranial metastases: from local tumor control to increased survival.

We have analyzed a series of 225 patients with intracranial metastases (343 lesions), treated in our department by Gamma Knife radiosurgery over a 30-month period. We have used a modified Pittsburgh protocol and performed 242 procedures on 164 single/78 multiple lesions. Primary tumors were mostly carcinomas of the lung (52%) and breast (11.6%). Neuroradiological localization of the target was usually performed by stereotactic computed tomography. Magnetic resonance imaging was only used in special circumstances. Routine dose planning was assisted by three-dimensional reconstruction programs. Mean tumor volume was larger than expected (5.7 ml). Mean prescription dose and average dose were 21.1 and 29.9 Gy, respectively. Middle- and long-term results were evaluated in a subset of 152 patients (236 lesions) with adequate (> 4 months) follow-up. Mean follow-up was 53.1 weeks with 61/152 patients still living. There was a predominance of retrospectively classified 'not fully eligible cases' among the survivors, mainly because of uncontrolled primary tumor. The 1-year local tumor control rate was 88.2%. Treatment-related radiological (3.9%) and clinical (1.6%) sequelae were minimal. Overall mean survival in these patients (40 weeks) turned out to be higher than that commonly reported after conventional surgical-radiation treatments. It was encouraging that the mean survival of 'fully' eligible patients was 51 weeks. Karnofsky performance status and neurological (Order Grading) performance scores were consistently high for most of the follow-up period. Functional Independence and the Palliative Index were not far from the value of mean survival. The main cause of death remains uncontrolled systemic disease (64.8%). On the other hand, the relative incidence of intracranial tumor progression was considerably decreased. This indicated that these patients should perhaps be treated more aggressively and underlines the need for randomized trials to determine the optimal treatment.

Adult↗
PubMed1995

Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients.

A retrospective uni-multivariate statistical analysis was performed on 32 prognostic factors to investigate their importance in predicting survival in a series of 76 adult patients with low-grade supratentorial astrocytomas treated over a 13-year period. The end point used for this study was the length of survival. The median survival time was 40 months. Overall actuarial survival at 2, 5, and 10 years was 69%, 38%, and 22%, respectively. Radical resection of the neoformation, a higher preoperative Karnofsky performance status (KPS) score, and an age younger than 50 years are strongly correlated with survival; postoperative radiotherapy appears to be associated with increased survival only in patients under 50 years of age.

Actuarial Analysis↗
PubMed1995

Gamma Knife stereotactic radiosurgery of ocular metastases: a case report.

A case of a choroidal metastasis treated with Gamma Knife stereotactic radiosurgery is reported. A 48-year-old Caucasian man afflicted with lung cancer (adenocarcinoma) was referred to the University Hospital of Verona, Italy, for loss of vision in his left eye due to a choroidal mass with exudative retinal detachment. Clinical investigation was conclusive of a well-defined, bilobed choroidal metastasis located in the temporal and inferior portion of the posterior pole of the eye. The lesion was characterized by a maximum thickness of 5.2 mm and a maximum lateral extension of 14 mm. The staging was negative for other metastatic localizations. Using the Gamma Knife technique, a surface dose of 25 Gy was administered at the 50% isodose line using the 8-mm collimator (5 shots) with equally weighted fields. After a 3-month follow-up period, a marked reduction in the lesion size as well as in the exudative retinal detachment was observed. This improvement was unchanged 6 months after the treatment, and the lesion appeared completely controlled. To the best of our knowledge, this is the first case report of an ocular metastasis treated with stereotactic Gamma Knife radiosurgery.

Adenocarcinoma↗
PubMed1995

Stereotactic radiosurgery of uveal melanomas: preliminary results with Gamma Knife treatment.

Twelve cases of uveal melanoma (T3N0M0:11 patients, T4N0M0:1 patient) treated with Gamma Knife stereotactic radiosurgery are reported. Our protocol includes preoperative ocular and systemic assessments with complete ocular examination, ophthalmoscopy, fundus photography, fluorangiography, standardized echography, CT and MRI, chest X-rays, liver echography and blood tests. The follow-up program is mainly based on echographic evaluation of tumor thickness and size. The procedures include fixation of the eye, application of the stereotactic Leksell frame G, CT/MRI localization of the melanoma, dose planning and treatment with the Gamma Knife (B type). A mean surface dose of 55 +/- 10 Gy was administered at the 60-90% isodose curve using 4- to 14-mm collimators and a number of shots ranging from 1 to 6. A significant reduction (10-41%) in echographic thickness of the tumor was shown in 6 cases with a follow-up of 3-12 months. In 4 patients, the tumor size was still unchanged after 1-10 months. The single high-dose radiation delivered to the target and the high spatial accuracy are the main advantages of stereotactic radiosurgery for the treatment of posterior uveal melanomas. A longer followup is needed to further validate this new application of Gamma Knife radiosurgery.

Adult↗
PubMed1995

Quality assessment of magnetic resonance stereotactic localization for Gamma Knife radiosurgery.

Artifacts in magnetic resonance imaging (MRI) may lead to anatomical distortion and inaccurate stereotactic coordinates. A special phantom for MRI and computed tomography (CT) was built to test the quality and precision of the two neuroradiological procedures. The phantom is fixed with the Leksell frame, and it has 15 orthogonal markers visible by CT and MRI techniques. The coordinates of the markers were calculated first on the CT scans and then on MR images. Two groups of different distortions were analysed: artifacts depending on the frame and its components and artifacts depending on the MR unit and image characteristics. A good target-coordinate correlation was found between CT and MRI in the axial plane, while in the coronal plane there was always a small error. This error is not constant, but changes from test to test, consequently it is hard to reform the image.

Artifacts↗
PubMed1995

Cavernous malformation of the internal auditory canal. A case report.

A 51 year-old male, complaining of progressive left-sided hearing loss, tinnitus, and unsteady gait, underwent surgery with a probable diagnosis of intracanalicular acoustic neuroma, based on neurological, neurotologic, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) findings. During surgery, the Internal Auditory Canal (IAC) was opened and a reddish-colored, soft, vascular lesion was found within the VII and VIII cranial nerve complex. The lesion, which resulted to be a cavernous malformation, was removed without any postoperative deficits. This report stresses the diagnostic difficulty to differentiate preoperatively the more frequent acoustic neuromas from other lesions that may develop within the IAC.

Cavernous Sinus↗
PubMed1994

Microgyria associated with Sturge-Weber angiomatosis.

A case is reported of an infant affected with Sturge-Weber disease who underwent left hemispherectomy due to untreatable seizures when 97 days old. Pathological analysis of the surgical specimens revealed the presence of four-layered microgyric cortex below the angiomatosis, intense gliosis, and the presence of calcifications of both the abnormal cortex and the underlying white matter. These findings suggest that the early infantile form of Sturge-Weber disease is associated with a developmental disorder of the cortical organization. Such abnormalities are consistent with the presence of an epileptogenic condition that is unresponsive to pharmacological treatment.

Atrophy↗
PubMed1991

Direct surgery for brainstem tumours.

Updating a previous report, the authors offer a review of 45 patients between age 2 and 63 treated by direct surgical excision for brainstem tumours of various description. Since 1986 all candidate patients were examined by NMR imaging in addition to CT scanning, sometimes with the further addition of digital-subtraction vertebral angiography. By Epstein and McLeary's criteria, 24 of the tumours were focal, 12 were cervicomedullary and 9 were diffuse. The most frequent histological diagnosis was glioma (36 cases between low-grade astrocytoma, anaplastic astrocytoma and glioblastoma); the balance was provided by cavernoma (6 cases), haemangioblastoma (2 cases), and lipoma (2 cases). Gross total resection was achieved in 28 patients, namely all those with ependymoma or vascular tumours and 14 of 17 with low-grade astrocytoma. Resection was subtotal in 16 cases and confined to a generous biopsy in one. There was no operative mortality, but 2 deaths occurred in the early postoperative period. At discharge, neurological status was unchanged or improved in 35 cases. At 3-month follow-up examination, 12 patients were improved, 27 were unchanged and 3 were worsened. By January 1990 (6 to 72 months postoperatively) 27 of the first 40 patients treated were alive: 13 had resumed normal life, 6 were self-sufficient and 8 were disabled. The authors conclude that present-day microsurgical resection of intra-axial brainstem tumours is associated with low mortality and morbidity and affords favourable results for which they credit high-quality NMR imaging, efficient microsurgery, adequate anesthesia, and competent postoperative intensive care.

Adolescent↗
PubMed1987

Changes produced by CT scanning in the outlook of severe head injury.

This is a study of the changes that have occurred in the field of severe head injury since the advent of CT scanning, comparing two homogeneous series of patients selected by clinical status (Glasgow Coma Scale less than or equal to 8), namely a series of 1,000 cases admitted to our Department between 1973 and 1976, already published in this Journal, and one of 385 cases cared for between 1979 and 1980, when CT scanning had become generally available. The two series of patients compare very closely in many respects, particularly in the incidence of surgical cases. In the more recent series the overall outcome was better both in surgical and in non-surgical cases. Among patients in the CT scan series the incidence of brain contusion associated with haematoma was greater than that of pure subdural haematomas. In non-surgical patients the CT scan, unlike cerebral angiography, afforded better identification of traumatic lesions and the grouping of patients into homogeneous categories correlating with a given outcome. On admission, cerebral angiography and CT scanning were equally effective in detecting lesions of surgical import; later in the course of the illness, however, CT scanning proved far more effective in detecting changes, with fully 15% of the patients being referred for surgery in the light of repeat CT scan findings as opposed to only 4% undergoing surgery on the indications of repeat angiography. Also, in the new series the mean interval from injury to surgery was shorter, with 64% of patients being operated on within 6 hours of the injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗
PubMed1987

Electrophysiological monitoring in the intensive care unit.

Spontaneous electrical activity (EEG) and event-related computer averaged brain electrical potentials (EPs) are becoming an integral part of CNS function monitoring in neurological intensive care patients. EEG monitoring using the compressed spectral array (CSA) computer analysis offers continuous information about cerebral electrical activity, permitting an accurate definition of the severity of brain injury, forecasting patient's course, and early detection of secondary intracranial changes. It offers more precise indications for treatment and prognosis. Combining EEG with multimodality EPs permits a finer diagnosis of the location and extent of CNS damage and contributes information, not otherwise obtainable, on the integrity of CNS pathways. Changes is electrophysiological patterns are often related to changes in other physiological parameters or events affecting the patient. Consequently, it appears advantageous to monitor simultaneously other CNS and body functions and record, process and display the data obtained in the patient care area. To make this comprehensive monitoring system reliable and useful, a wise application of advanced computer technology and a high degree of understanding of intracranial dynamics are required.

Brain↗
PubMed1987

[Open-door decompressive cervical laminotomy. Technic and initial experiences].

The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.

Adult↗