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Biomedical subjects

B Guidetti

Publications and source records attributed to B Guidetti.

At least 37 records · Page 2Linked to original sources
PubMed1985

Meningiomas of the lateral ventricles. Clinical, neuroradiologic, and surgical considerations in 19 cases.

The clinical and neuroradiologic findings and surgical results in a series of 19 patients with lateral ventricle meningioma, operated on during a 33-year period, are described. This experience is compared with that of previous workers and the following conclusions are drawn: these tumors have no characteristic symptoms; preoperative diagnosis requires both computed tomography scans and carotid and vertebral angiography; the safest surgical approach is through a sagittal or oblique parietooccipital cortical incision to avoid damage to motor, visual, and speech areas of the cortex.

Adolescent↗
PubMed1985

Cystic pilocytic astrocytomas of the cerebral hemispheres. Surgical experience with 51 cases and long-term results.

This study concerns 51 cases of cystic pilocytic astrocytoma of the cerebral hemispheres. At operation these tumors closely resembled cerebellar astrocytomas, presenting as a big cyst contiguous with the lateral ventricle and containing a small mural nodule. The nodule was in a deep location in 26 cases, and always showed marked contrast enhancement on computerized tomography scans. The most frequent presenting symptom was epilepsy (68%), and the most common sign was papilledema (85%). The major goal of surgery was extirpation of the nodule. The follow-up period of the 34 cases available for long-term review ranged from 6 to 31 years (mean 17 years). Of these, 28 patients (82%) had a good outcome; four (12%) had a fair result, and two (6%) had a poor response. An analysis of these results shows that total extirpation of the mural tumor was associated with the best outcome, whether or not the cyst wall was completely removed. Radiation therapy was irrelevant to the prognosis for these patients. On the other hand, partial excision of the nodule, correlated with the deep location of the tumor, was the cause of the two poor results in this series and resulted in multiple operations for recurrences in two other patients. Nevertheless, two of these patients are still alive and well many years after incomplete surgical treatment. On the basis of this study, the importance of recognizing the occurrence of this "benign" tumor of the cerebral hemispheres is stressed, and the hypothesis of a common origin from subependymal glia of all pilocytic astrocytomas is supported.

Adolescent↗
PubMed1983

Electron-microscopic visualization of binding of antibodies from sera of glioma patients on cultured glioma cells.

Several human cell lines (normal and neoplastic glia, cerebral metastases from adenocarcinoma, fibroblasts) were incubated with sera from patients with well and poorly differentiated glioma and with sera from healthy donors and then stained with PAP complex to define and localize the antibody reaction with cell surface antigens by means of electron microscopy. The sera of glioma patients proved to contain antibodies which bound the tumor-associated antigenic determinants on the cell membranes of gliomas and of cerebral metastases from adenocarcinoma in tissue cultures. Further, absorption testing of the reactive sera on normal brain, well-differentiated astrocytoma and cultured glioblastoma cells, together with cross-reactivity experiments suggests that at least two antigens or groups of antigens are expressed on the glioma cell surface: one shared by well and poorly differentiated glioma cells and the other by poorly differentiated glioma cells and the cells of cerebral metastases from adenocarcinoma.

Antibodies↗
PubMed1982

The management of arteriovenous malformations of the corpus callosum.

A series of 15 arteriovenous malformations (AVMs) of the corpus callosum--9% of 170 intracranial AVMs admitted to the School of Medicine of the University of Rome during a 30-yr period--was studied. In all cases the lesion concerned mainly the corpus callosum, although in some it also involved the surrounding structures, such as septum pellucidum, tela choroidea, and the mesial hemisphere. These malformations are divided into three groups, namely, those involving mainly the genu, the truncus, or the splenium of the corpus callosum. The last predominated in the present series. Each type has a peculiar angiographic appearance. In general these lesions are fed by branches from the anterior cerebral and/or posterior cerebral arteries, although in some cases minor contributions from the middle cerebral artery may also be present. Vascularization is often bilateral. Venous drainage occurs through the inferior and/or superior sagittal sinuses and/or the Galen system. As to clinical presentation, Subarachnoid Hemorrhage (SAH) is the usual presenting symptom and tends to recur frequently. Neurological localizing symptoms are infrequent, as are seizures; psychological symptoms are an exception. Of the 4 cases managed conservatively, only one had no further episodes of bleeding and remained free of complaints. On the other hand, surgical results of the 11 operated patients were satisfactory, in the sense that no mortality and low morbidity were recorded. Accordingly, surgical treatment of AVMs of the corpus callosum is recommended as a rule.

Adolescent↗
PubMed1982

Craniovertebral junction malformations. Clinicoradiological findings, long-term results, and surgical indications in 63 cases.

The fate of a series of 63 patients operated on between 1953 and 1979 was studied retrospectively to assess the efficacy of neurosurgical treatment in relieving symptoms associated with craniovertebral junction (CVJ) malformations. Fifty-eight patients underwent posterior cervicomedullary decompression, and the other five underwent transoral clivus-atlanto-odontoidectomy. Long-term results with the posterior approach showed that 50% of the patients benefited from surgery, 25% remained unchanged, and 25% continued to deteriorate or died. Patients with dorsal nervous tissue and/or meningeal anomalies, such as Arnold-Chiari malformation, hydrosyringomyelia, dural fibrous ring, or obstruction of the cisterna magna, did better than patients with ventral cervicomedullary indentation caused by a clivus-atlanto-odontoid bone complex. Anterior decompression is preferable to a posterior approach only if the CVJ malformation involves a ventral deformity in the absence of dorsal compression by soft tissue.

Adolescent↗
PubMed1981

The surgical treatment of choroid plexus papillomas: the results of 27 years experience.

This paper reports the results of 27 choroid plexus papillomas surgically treated, out of 28 cases observed in the authors institute during the period 1952-1978. These were divided into two groups: a) those operated on before 1969; b) those operated on in 1969 and the following years, when microsurgical facilities were routinely employed. As a rule, neither ventricular shunting nor radiation therapy were used preoperatively. A total removal was attempted in all cases, and performed in all but three. The second group (1969-1978) showed better results as regards the number of totally removed tumours (92% against 87%), surgical deaths (16% against 31%), and long-term good results (67% against 44%). Considering both groups together, long-term good results were achieved in 15 patients (55%), followed up from 2 to 27 years. Radical operation is the treatment of choice for choroid plexus papilloma. As indicated by the author's experience, this produces satisfactory long-term results, whilst surgical mortality can be held within acceptable limits, provided that modern techniques are used properly. The value of radiation therapy, which in any event should be restricted to malignant cases, remains questionable.

Adolescent↗
PubMed1981

The role of antifibrinolytic therapy in the preoperative management of recently ruptured intracranial aneurysms.

In a retrospective study of the use of antifibrinolytic therapy in a series of patients with recently ruptured intracranial aneurysms, 131 patients were selected based on the following criteria: commencement of therapy within 3 days of the last subarachnoid hemorrhage (SAH); continuation of therapy for at least 6 days; and apparently uncomplicated surgery. Two main modalities of antifibrinolytic therapy were used: Group A, tranexamic acid (AMCA) 3 gm daily plus aprotinin k.i.u. (kallikrein inactivating units) daily (82 cases); Group B, AMCA 6 gm daily (41 cases). The remaining 8 patients were treated with epsilon-aminocaproic acid alone or in combination with aprotinin and were not considered to constitute a large enough group for statistical comparison. The rest of the preoperative treatment consisted of bed rest; mild sedation; antihypertensives, if the blood pressure exceeded 160 mm Hg; and osmotic diuretics as needed. The mean interval between last SAH and operation was about 13 days in both groups. The rates of rebleeding and thromboembolism were similar in the two groups but the rates of ischemic complications and post-SAH hydrocephalus were higher in Group B. The difference in the rate of severe cerebral ischemic complications was statistically significant (11 of 82 in Group A versus 12 of 41 in Group B, p less than 0.02), and in the main they were present preoperatively. The rates of rebleeding (approximately 10%) and of death from rebleeding (approximately 5%) are lower than in other published series on the natural history of this condition. In cases in which antifibrinolytics are indicated, present evidence indicates that low-dose AMCA plus aprotinin seems to be a rational combination for lowering the rebleeding, ischemic complication, and post-SAH hydrocephalus rates.

Adult↗
PubMed1981

Long-term results of the surgical treatment of 129 intramedullary spinal gliomas.

The authors report the late results of surgical treatment of 129 intramedullary gliomas (48 ependymomas, 53 astrocytomas, 13 spongioblastomas, five glioblastomas, one oligodendroglioma, and nine others), with follow-up periods ranging from 1 to 27 years. The value of surgical treatment is considered in relation to postoperative results.

Astrocytoma↗
PubMed1980

Intracranial arteriovenous malformations. Conservative and surgical treatment.

The authors present a consecutive series of 145 patients admitted to the Institute of Neurosurgery of Rome University with an intracranial arteriovenous malformation (AVM). Of these, 95 received surgical care, and 50 were treated conservatively. Total removal of the AVM was performed in all but three of the patients treated surgically, and all underwent postoperative angiography. The postoperative mortality was 6.3%. A long-term follow-up study showed a mortality rate of 20% in the group of patients receiving conservative treatment, while no recurrence of bleeding was observed in the surgical group. The choice of treatment of these malformations is still an open question. The authors' contribution to the discussion is based on the late results of both surgical and conservative treatment.

Adolescent↗
PubMed1980

Benign extramedullary tumors of the foramen magnum.

This paper analyzes the clinical, diagnostic and surgical data of 18 benign extramedullary tumors at the foramen magnum extending into the posterior fossa and the spinal canal. These cases represent 30% of 60 foramen magnum tumors operated on between 1952 and 1978, among 4187 brain tumors and 587 tumors of the spinal cord. Foramen magnum meningiomas constitute 11 of this series (1.2% of 873 meningiomas, 113 of which were spinal). The considerable difficulty in early diagnosis is emphasized. However, in the present series, myelography showed positive findings in all cases, and angiography in most of them. CT scan, performed in one case, demonstrated the lesion. Surgical mortality was 11% (two deaths). On both patients who died after the operation, multiple surgical procedures had been performed because of erroneous diagnoses made in another unit. At the time of operation neurological symptoms were very advanced, and large tumors were located anteriorly. The review of the remaining patients showed a regression of preoperative symptoms with good to excellent results in all. No recurrences were recorded.

Adult↗
PubMed1979

Modern trends in surgical treatment of trigeminal neuralgia.

From 1955 to July 1978, 560 patients suffering from trigeminal neuralgia, who had not responded to medical treatment underwent various alternative procedures. Considering some of these to be out of date, some as showing too high a number of relapses and some as having potentially unjustified risks in an affection in itself not fatal, the authors report only the results observed in a series of 175 patients operated on by retrogasserian rhizotomy according to Frazier (1931), and the results of a series of 184 patients treated by controlled thermocoagulation according to Sweet and Wepsic (1974).

Aged↗
PubMed1979

[Selective partial posterior radiculotomy in the therapy of spasticity].

Report on the immediate and late results obtained in the period from January 1973 to December 1976 in a series of 44 patients suffering from a spastic syndrome who were operated on by selective partial lumbar radiculotomy. The intervention which mainly consisted of a partial separation of the individual radiculae of the posterior lumbar and first sacral roots was followed by a distinct improvement of the clinical picture in 30 patients without observing aneurlogical, especially sensitive deficit or immediate or later complications. The indication for this intervention is established together with the other specialists concerned with the care and the rehabilitation of the patient. Only such patients are selected in whom the spasticity is not useful and who still can carry their body-weight. No operation is in particular carried out in the presence of considerable paresis of the extensors and in patients who have for a long time been able to walk and stand. Favourable results can be expected in para-tetraspasticity and in patients who, when standing with support, show equinism, hyperadduction or crossing of the legs, hyperextension and internal rotation.

Adolescent↗
PubMed1978

Lymphocytic infiltrates in primary glioblastomas and recidivous gliomas. Incidence, fate, and relevance to prognosis in 228 operated cases.

The correlation existing in several human malignancies between lymphocytic infiltration and prolonged survival prompted this study. Two hundred selected patients who were operated on for glioblastoma were reviewed to investigate the incidence of the lymphocytic infiltration in the histological slides and its possible relevance to a better clinical course. The group that exhibited a definite lymphocytic infiltration (Group A, 11.5%) had a significantly longer preoperative history and postoperative survival (p less than 0.01) than the other two groups that presented slight or no infiltration (Group B, 23%, and Group C, 65%, respectively). In addition, biopsies of 28 recidivous gliomas were reviewed to study the fate of this lymphocytic infiltration in relation to time and therapy, such as irradiation and steroids which are known to depress the immune response. The authors found that severe lymphocytic infiltration is a rare immunobiological reaction which significantly improves the prognosis of a malignant brain tumor and seems not to be influenced by time, local x-ray therapy, or steroids.

Adolescent↗
PubMed1977

Neurosurgical treatment of spasticity and dyskinesias.

122 Patients suffering from spasticity and/or dyskinesias underwent a total of 171 operations: 88 stereotactic dentatolyses, 24 posterior partial rootlet section D12-S1 or L1-S1, 16 posterior partial root section D12-S1 or L1-S1, 16 posterior cervical rhizotomies, 21 stereotactic pulvinolyses, 6 stereotactic associated V.L. thalamolysis and pulvinolysis. Results and indications are discussed.

Cerebellar Nuclei↗