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A Raco

Publications and source records attributed to A Raco.

At least 19 recordsLinked to original sources
PubMed2006

Post-radiation intramedullary malignant peripheral nerve sheath tumor.

We report the intramedullary growth of a malignant peripheral nerve sheath tumour (MPNST). A 50year-old man developed a severe tetraparesis over a 4-month period. Following irradiation of a chronic tonsillitis during his childhood, the patient had later experienced a number of post-radiation diseases, including a laryngeal cancer that required permanent tracheotomy. Before admission, a magnetic resonance imaging (MRI) study had disclosed a C4-C5 intramedullary lesion. On admission to our Department, the patient had a nearly complete tetraparesis. At surgery, the lesion was exposed through a posterior midline myelotomy. A friable neoplasm, with no clear plane of cleavage, was found. The tumour was subtotally resected. Histological examination, which intraoperatively had not yielded a specific diagnosis, eventually revealed a MPNST, grade intermediate, with ultrastructural and immunohistochemical features consistent with a schwannian differentiation. No postoperative radiotherapy was undertaken. The patient died 9 months later from pneumonial complications. MPNSTs may develop within the spinal cord similarly to their benign schwannian counterpart. The reported sequence of events might support a possible relation between irradiation of the spinal cord and induction, followed by malignant transformation, of intramedullary schwannosis. This unique case must be added to the growing list of radiation-induced spinal cord tumours.

Cell Movement↗
PubMed2006

Chronic expanding intracerebral hematoma treated by mini-invasive ultrasonography-guided needle aspiration.

Chronic expanding intracerebral hematoma (CEIH) is a rare cerebrovascular disease that behaves as a slowly expanding lesion with a gradual onset of progressive neurological deficit or recurrent seizures. The etiology of the CEIH is still not clear. Even if about a half of these lesions are associated with vascular malformations, the remaining cases are post-traumatic, associated with coagulative disorders or are cryptogenic. Treatment of these lesions is controversary: while some neurosurgeons remove the hematoma with its capsule, others prefer to wait and observe it if the patient is neurologically stable. We discuss the opportunity of treating selected patients bearing a CEIH by means of ultrasonography(US)-guided aspiration in selected patients. A 42-year-old hepatopathic man with coagulation disorders was referred to us with a 2-month history of progressive right-sided weakness, speech disorders and difficulty in swallowing solid foods. Radiological findings supported a CEIH with a thin surrounding capsule. The patient underwent to US-guided aspiration of the lesion with a complete resolution of the hematoma, confirmed intraoperatively by real-time US-control and postoperatively by early and long term neuroradiological controls. US-guided aspiration is a low cost, not time consuming technique, that allows an intraoperative real-time control of the lesion and seems to be an effective alternative to open surgery in cases of CEIHs with a thin capsule.

Adult↗
PubMed2005

Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine.

Surgical exposure of intradural lesions in the thoracic spine requires intraoperative landmarks to identify the vertebral level. If spinal neuronavigation is not available, the surgeon must rely on alternative localizing methods. Intraoperative fluoroscopy is traditionally used to count the vertebrae throughout the whole spine. In the high thoracic spine, counting the vertebrae is often hampered by the scapular shadows. In these cases, a preoperative marking procedure seems preferable. Magnetic resonance imaging (MRI) based techniques have been increasingly reported, but they share an intrinsic risk of error due to the skin shift occurring at the time of surgery. We describe here a simple technique for unequivocal identification of the vertebral target. In six patients undergoing surgery for intradural lesions of the high thoracic spine, the spinous process of the vertebra corresponding to the lesion was preoperatively identified on an anteroposterior radiograph view and marked infiltrating its tip with a blue dye. At surgery, the vertebral target was identified easily and immediately. No errors occurred. No complications related to the technique were observed. Preoperative marking of the vertebral spinous process with a coloured dye is a simple and unequivocal guide to expose intradural lesions in the high thoracic spine.

Coloring Agents↗
PubMed2005

Sylvian subarachnoid and extra-pial cavernous angioma.

Cavernous angiomas are one of the four types of vascular malformations of the central nervous system. Lesions situated subarachnoidally are rare although some cases with an infratentorial localization have been reported. Our case represents an unusual localization of a subarachnoid cavernous angioma. A 35- year-old patient was admitted to our department with signs of subarachnoid hemorrhage. A 1 cm hyperdense lesion placed at the right Sylvian fissure was distinguished by CT-scan examination and no arterial supply was revealed on cerebral angiography. Surgical intervention showed a lesion placed extra-pial and totally encased in the subarachnoid space in the superficial part of the Sylvian cistern. This case represents a radiologically visible supratentorial extra-pial subarachnoidal cavernous angioma. This case provides confirmation of one of the supposed causes of subarachnoid hemorrahage ''sine materia''.

Adult↗
PubMed2001

Spontaneous cerebellar hemorrhage: clinical remarks on 50 cases.

BACKGROUND: Only during the past 10 years have spontaneous cerebellar hemorrhages became a well-defined nosological entity. The surgical indication remains debatable. Our primary objective in this study was to set the criteria for undertaking surgery by determining the critical diameter of the hematoma and considering the patients' neurological status (Glasgow Coma Scale). METHODS: During the 8-year period 1990 through 1997 a series of 50 consecutive patients with spontaneous cerebellar hemorrhage were admitted to the Emergency Neurosurgery Unit, University of Rome "La Sapienza" (Italy). On admission all patients underwent a standard neurological examination, (Glasgow Coma Scale) and a computed tomographic scan. The diameter and the site of the hematoma, a coexisting tight posterior fossa, and the presence of hypertensive hydrocephalus were the criteria, in association with the patients' neurological status, used as indications for surgery. RESULTS: Operative mortality was nil; and perioperative mortality eight patients (16%, increasing to 24% including the four patients who were deeply comatose on admission). Most patients who died (seven of eight) had two or more general medical risk factors (arterial hypertension and diabetes mellitus; arterial hypertension and liver disease; or liver disease and hematological disorders). CONCLUSION: In patients presenting with spontaneous cerebellar hemorrhage the essential criteria indicating surgery are a hematoma 40 mm x 30 mm on CT imaging in the cerebellar hemisphere or 35 mm x 25 mm on CT imaging in the vermis, the presence of a tight posterior fossa (critical size reduced by 10 mm), and a Glasgow Coma Score less than 13.

Aged↗
PubMed2000

Radiosurgery in the management of pediatric brain tumors.

A total of 114 patients with benign and malignant intracranial tumors were treated by Valentino at the Flaminia Radiosurgical Center using a Philips 6-MeV linear accelerator between 1987 and 1995. The tumor locations break down as follows: 36 in the cerebral hemispheres, 14 in the region of the hypothalamus/optic chiasm, 21 in the III ventricle/pineal region, 3 in the basal ganglia, 27 in the posterior fossa, 13 in the brain stem. Seventy-nine patients had multivariate/combined treatment consisting of surgery or biopsy followed by chemotherapy, radiotherapy and/or radiosurgery. Thirty-five were not operated on or biopsied but were treated primarily by radiosurgery, which was associated with chemotherapy and conventional radiotherapy. The short- and long-term results were evaluated separately for each pathology in an attempt to derive guidelines for future treatment. For tumors of the pineal region, we are of the opinion that radiosurgery is the treatment of choice in children and that more than one-third of patients can be cured by this means. The remaining patients require surgery and/or chemotherapy in addition. For medulloblastomas radiosurgery may be useful to control local recurrence if coupled with chemotherapy. In the case of ependymomas, partly because of the extreme malignancy of the lesions in our series, radiosurgery did not succeed in controlling local recurrence. We fear that limiting treatment to radiosurgery, rather than prescribing conventional radiotherapy when indicated, could permit CNS seeding. For craniopharyngiomas radiosurgery proved useful for controlling solid remnants. In glial tumors radiosurgery helped either to "sterilize" the tumor bed after removal or to treat remnants of the lesions in critical areas; for diffuse brain stem gliomas it should be considered the treatment of choice.

Adolescent↗
PubMed2000

Supratentorial hemangioblastoma in a patient with breast cancer. A case report.

Patients with breast cancer may develop cerebral metastasis. Radio- and chemotherapy are advocated as an alternative to surgery in such patients. A woman operated on for breast cancer 2 years earlier developed a cerebral lesion. A definite preoperative diagnosis of the lesion was not possible on the basis of CT and MRI findings. The lesion proved to be a supratentorial hemangioblastoma. Neurosurgical treatment is recommended for patients with breast cancer who present a cerebral lesion, since a correct diagnosis may only be possible in the operating theater.

Aged↗
PubMed1999

Congenital torticollis in association with craniosynostosis.

The incidence of congenital torticollis in association with plagiocephaly is 1 in 300 newborns, with the torticollis resulting from pathologically sustained contraction of the sternocleidomastoid. Such conditions as facial asymmetries, craniovertebral anomalies, cervical hemivertebra, and mono- or polydysostoses may also be associated with torticollis diagnosed during the neonatal period. With particular reference to synostotic (coronal and/or lambdoidal) plagiocephaly, a clear distinction is made in this paper between posterior neurocranial flattening secondary to the sustained rotation of the skull resulting from torticollis and that seen in synostotic plagiocephaly. The rarity of torticollis with sustained contraction of the sternocleidomastoid muscle relative to the frequency of occipital-parietal flattening in newborn kept in the supine position has not been discussed in the literature and is therefore of clinical importance. In light of the fact that the prognosis and, consequently, the treatment plan vary directly with the presence or absence of synostoses, clinical evaluation also includes cephalometrics, plain skull X-rays, and CT imaging. If the torticollis is associated with neurocranial deformity but synostosis is absent, cervical traction and physiotherapy resolve the symptoms. When, however, the clinical picture is complicated by synostotic plagiocephaly, corrective surgery is necessary, though cervical traction and physiotherapy are essential to provide early and complete cure of the torticollis.

Craniosynostoses↗
PubMed1999

Meningiomas of the tuberculum sellae. Our experience in 69 cases surgically treated between 1973 and 1993.

BACKGROUND: Meningiomas of the tuberculum sellae are lesions with well-defined characteristics in terms of both site of origin and clinical evolution which require differential diagnosis with lesions of the supra- and para-sellar region. The aim of this study is to point out the importance of the size of the lesion and early identification of symptoms for prompt diagnosis, crucially important for evaluating the reversibility of functional damage, especially of the optic nerves. METHODS: Between 1953 and 1993, 110 cases of tuberculum sellae meningioma were operated at the Neurosurgical Institute, Department of Neurosciences, of Rome "La Sapienza" University; only 69 cases of these cases were operated on after 1973, the year in which microsurgical techniques were introduced into routine surgical practice. Tumor diameter ranged from 3 to 9 cm. Most of the patients presented severe visual loss. RESULTS: Removal was total in 63 cases (91.3%), sub-total in 6 (8.7%). Besides the surgeons firsthand impression, the grade of removal was evaluated by early CT and/or MRI (24-36 hours after surgery). A minimum follow-up of 3 years was taken into consideration for assessment of late functional results. Five patients died in the postoperative period (7.2%). CONCLUSIONS: This study clearly demonstrated that a tumor diameter greater than 4 cm is a critical factor for visual function. The size of the lesion was also found to be extremely important, in that it influences the amount of tumor resection possible. Therefore, in our opinion, alternative types of treatment such as radiosurgery should be confined to the tumor residue.

Adolescent↗
PubMed1999

Malignant cerebellar astrocytomas: clinico-pathological remarks on 10 cases.

BACKGROUND: Malignant glioma represent the 3rd¿4th most frequent cause of death from cancer. The cerebellar site is rare and life expectancy with cerebellar anaplastic astrocytoma is still dismall. The growth and clinical-pathological remarks of the tumor, is similar to the others gliomas of the central nervous system. MRI with Gd is the most useful diagnostic approach but lacks of specificity in detecting highly differentiated neoplasia areas. METHODS: Between 1980 and 1994 10 cases of malignant cerebellar astrocytomas were operated at the Neurosurgical Institute, Department of NeuroSciences, of Roma "La Sapienza" University. All patients were investigated pre-and postoperatively by CT scan with i.v. administration and/or MRI with Gd when possible. RESULTS: Of the 10 patients who followed various protocols, 7 died. Average survival was 13.7 months (range 5-21 months). 3 patients were still alive 12, 15 and 18 months after surgery. In 3 cases (50%) there was also radiological evidence of spinal cord spreading. CONCLUSIONS: Like cerebral lesions, malignant cerebellar astrocytoma still a pathology with a real unsatisfactory prognosis. Our experience probably showed that spinal spreading is underestimated. For this reason we believe that, despite the limited number of cases treated so far, it is important to extend postoperatively the radiotherapy to the entire spinal cord in all patients.

Adolescent↗
PubMed1998

Intracranial actinomycosis in juvenile patients. Case report and review of the literature.

A case of actinomycotic brain infection in a juvenile patient is described. Cases of actinomycosis affecting the head and neck are rare, particularly in juvenile patients. In this case complete resolution of the infection was achieved by means of surgical treatment and prolonged antibiotic therapy. The authors emphasize the importance of a combined approach for treatment of this unusual brain infection and stress the difficulties involved in the diagnosis of this pathology.

Abscess↗
PubMed1998

Malignant cerebellar astrocytomas in childhood. Experience with four cases.

The most frequent type of cerebellar astrocytoma in children is the pilocytic variety, for which the treatment of choice and prognosis are now well established. In contrast, an anaplastic lesion in this site is extremely rare. The authors present four cases of high-grade astrocytoma in a cerebellar site. They discuss the best type of treatment for this pathology, with particular reference to postoperative radiotherapy and chemotherapy, in the light of their results.

Adolescent↗
PubMed1998

[Early versus delayed surgery for treatment of aneurysmal subarachnoid hemorrhage].

Notwithstanding large cooperative epidemiological studies, in depth pathophysiological studies on subarachnoid hemorrhage, a unique surgical strategy has not emerged on the timing of aneurysmal subarachnoid hemorrhage. We define as early surgery the one which is practiced in the first 72 hours after the hemorrhage, and delayed surgery the one which is practiced more than 72 hours after the bleeding. Early and delayed surgery have both advantages and disadvantages, but as shown in the "International Cooperative Study on the Timing of Aneurysm Surgery" there are no significant differences in term of mortality and morbidity between early and delayed surgery. In fact the postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery. The novelty in the surgical timing of patients harboring an aneurysm which has bleed, is on one hand the "Ultra early surgery" which is performed not longer than 24 hours after the bleeding and on the other hand the attempt to individualize the timing of surgery on each single patient.

Humans↗
PubMed1997

Primary spinal epidural non-Hodgkin's lymphomas in childhood: a review of 6 cases.

We report a retrospective study regarding 6 children with primary epidural non-Hodgkin's lymphomas and analyse the factors influencing prognosis with emphasis on treatment. Four patients were females and 2 males. The neurological condition of patients was assessed pre- and postoperatively according to Shaw's classification for neurological disability. All patients were submitted to surgery, radiotherapy and chemotherapy. Histologically, the tumour proved to be a high-grade non-Hodgkin's lymphoma in all cases. At follow-up, all patients are alive after a median interval of 52 months (range 24-72 months). This study showed that the outcome of patients depends on the gravity of pre-operative deficits whereas the survival is influenced by the type of treatment.

Adolescent↗
PubMed1997

Malignant supratentorial astrocytomas of late childhood. Our experience with 25 cases.

The authors present 25 patients ranging in age from 8 to 16 years who had malignant supratentorial astrocytomas. This type of lesion represents one of the most important and statistically significant causes of morbidity and mortality in late childhood. Compared to adult malignant supratentorial astrocytomas, these lesions seem to show a better survival rate. The reason is unknown. The authors present their experience regarding the importance of radical removal and histology for a better prognosis.

Adolescent↗
PubMed1996

Intramedullary astrocytomas and ependymomas in the pediatric age group: a retrospective study.

A series of 45 pediatric patients underwent surgery for intramedullary astrocytoma or ependymoma at the Cook County Hospital or the Children's Memorial Hospital of Chicago (Northwestern University) and the Neurosurgical Department of Rome "La Sapienza" University. Results showed that intramedullary astrocytomas and ependymomas in children differ from one another in terms of prognosis, and particularly as regards surgical strategy as an element of therapeutic management. Gross total removal of 70% of the ependymomas was achieved, in comparison to 33% of the astrocytomas. In astrocytomas the extent of resection did not significantly influence prognosis. Neurological condition on admission, regardless of oncotype, was found to be extremely influential: patients operated in good condition tended to remain neurologically stable or improve in the long term, while those operated on while in poor condition did not show any improvement at all. No definitive conclusions were possible regarding the value of radiotherapy, because it was only performed in 6 of the 45 cases. The authors limited its use to highly malignant lesions in view of the well-known sensitivity of the spinal cord to radiation, especially in children.

Adolescent↗
PubMed1996

Primary spinal epidural non-Hodgkin's lymphomas: a clinical study.

BACKGROUND: The spinal epidural space is an uncommon presenting site in primary non-Hodgkin's lymphoma. The occurrence of spinal epidural disease ranges from 0.1%-6.5% among patients with non-Hodgkin's lymphoma. METHODS: We report a retrospective study regarding 19 patients with primary epidural non-Hodgkin's 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 Shaw's 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-Hodgkin's 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.

Adult↗