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E Passacantilli

Publications and source records attributed to E Passacantilli.

8 recordsLinked to original sources
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↗
PubMed2002

Atypical tentorial meningioma 30 years after radiotherapy for a pituitary adenoma.

Although the human central nervous system used to be considered relatively resistant to the carcinogenic action of ionizing radiation, several lines of evidence now document a high incidence of secondary tumors in irradiated patients. The numerous reports of radiation-induced cerebral meningiomas generally distinguish those induced by high-dose radiation from those induced by low-dose radiation. We describe the case of patient who underwent subtotal resection of a chromophobe pituitary adenoma at the age of 18 years, who was successively treated by conventional fractionated radiotherapy with gamma rays emitted by a source of 60Co until a total dose of 41 Gy. Over the next 30 years the patient experienced all the known late effects of radiation, including panhypopituitarism, cranial-nerve deficits (II, III and VI), massive radiation necrosis involving the left cerebral hemisphere and causing right hemiparesis and aphasia and, ultimately, an atypical tentorial meningioma with early recurrence after total resection.

Adenoma, Chromophobe↗
PubMed2001

Cerebral hemodynamics on MR perfusion images before and after bypass surgery in patients with giant intracranial aneurysms.

BACKGROUND AND PURPOSE: Preoperative assessment of the anatomy and dynamics of cerebral circulation for patients with giant intracranial aneurysm can improve both outcome prediction and therapeutic approach. The aim of our study was to use perfusion MR imaging to evaluate cerebral hemodynamics in such patients before and after extraintracranial high-flow bypass surgery. METHODS: Five patients with a giant aneurysm of the intracranial internal carotid artery underwent MR studies before, 1 week after, and 1 month after high-flow bypass surgery. We performed MR and digital subtraction angiography, and conventional and functional MR sequences (diffusion and perfusion). Surgery consisted of middle cerebral artery (MCA)-internal carotid artery bypass with saphenous vein grafts (n = 4) or MCA-external carotid artery bypass (n = 1). RESULTS: In four patients, MR perfusion study showed impaired hemodynamics in the vascular territory supplied by the MCA of the aneurysm side, characterized by significantly reduced mean cerebral blood flow (CBF), whereas mean transit time (MTT) and regional cerebral blood volume (rCBV) were either preserved, reduced, or increased. After surgery, angiography showed good canalization of the bypass graft. MR perfusion data obtained after surgery showed improved cerebral hemodynamics in all cases, with a return of CBF index (CBFi), MTT, and rCBV to nearly normal values. CONCLUSION: Increased MTT with increased or preserved rCBV can be interpreted as a compensatory vasodilatory response to reduced perfusion pressure, presumably from compression and disturbed flow in the giant aneurysmal sac. When maximal vasodilation has occurred, however, the brain can no longer compensate for diminished perfusion by vasodilation, and rCBV and CBFi diminish. Bypass surgery improves hemodynamics, increasing perfusion pressure and, thus, CBFi. Perfusion MR imaging can be used to evaluate cerebral hemodynamics in patients with intracranial giant aneurysm.

Adult↗
PubMed2001

Spinal intradural endodermal cyst located anterior to the cervical spinal cord.

Spinal endodermic cysts are rare and may be associated with other congenital anomalies (mediastinal cysts, bony defects of the vertebral body), derive from defective displacement of the endoderm of the intestinal tract or, more rarely, the respiratory one. The authors describe a case of endodermic cyst of the cervical spine localized anteriorly to the spinal cord. In the case we treated the patient was a 17-year-old male who presented hypostenia of the lower limbs accompanied by hyperreflexia and spasticity; physical examination was negative. MRI, CT and CT-myelography documented a well-defined mass situated anteriorly to the spinal cord at C2-C4 level. A total-body CT-scan excluded the existence of other malformations. Surgery was performed via an anterior approach and the cyst completely removed. Histological examination confirmed the endodermal nature of the cyst. At long-term follow-up examination the patient was neurologically intact. Postoperative MRI showed a small residue of the cyst wall without spinal cord compression. Endodermic spinal cysts are very rare intradural lesions, predominantly with an anterior cervical localization, which derive from misplaced embryonic and endodermic cells. In the majority of cases, clinical onset is insidious and has a discontinuous progression. The best diagnostic tool is MRI. Treatment of choice is total surgical removal or emptying of the cyst followed by fenestration.

Adolescent↗
PubMed1998

Chronic subdural haematoma: a possible relationship with tamoxifen.

Five patients operated on between 6 months and 7 years earlier for breast cancer were surgically treated for chronic subdural haematoma. This unusual association may be explained on the basis of known factors such as coagulative impairment subsequent to chemotherapy, a degree of cerebral atrophy or mild trauma. On the other hand, since four of the patients were taking antioestrogen therapy to control the disease, it is speculated that the oestrogenic properties of tamoxifen may have contributed to subdural bleeding.

Aged↗
PubMedDate not supplied

Symptomatic cervicogenic headache.

Cervicogenic headache is a little-known clinical condition whose true importance has only recently been recognized. A number of causes may lie at the basis of the onset of headache (symptomatic cervicogenic headache). However, despite exhaustive attempts, sometimes it is not possible to identify a clear cause responsible for the onset of the syndrome (primitive cervicogenic headache). The genesis of symptomatic cervicogenic headaches sometimes may be easy to identify as a result of a close, pre-existing, cause-effect relationship (i.e. trauma). On other occasions it may be much more laborious to pinpoint the pathology responsible for headache (some cranio-cervical anomalies, etc.). Clinically, it is necessary to perform a thorough preliminary clinical and anamnestic evaluation which can orient subsequent investigations to achieve a diagnosis in the least time possible with the minimum discomfort to the patient and his relatives, not to mention lower costs for society.

Arthritis, Rheumatoid↗
PubMedDate not supplied

The results of the surgical and conservative treatment of non-neurologic comminuted thoracolumbar fractures.

A retrospective radiologic study of 40 non-neurologic thoracolumbar fractures allowed for the evaluation of the long-term results of surgical and conservative treatment in terms of correction of the post-traumatic deformity. The Magerl classification and the McCormack scale were used to select compressive type fractures (type A), and fractures characterized by comminution of the vertebral body without involvement of the posterior elements. Instability related to comminution and to considerable diastasis of the fragments is at the basis of failure of conservative (plaster brace) and surgical (short posterior fixation and posterolateral fusion) treatments. Severe type A fractures treated conservatively have, in fact, at follow-up shown significant residual deformity, while failure of the instrumentation or loss of correction in 40% of cases treated surgically has been revealed.

Adult↗