Biomedical subjects
F Chiappetta
Publications and source records attributed to F Chiappetta.
Surgical treatment of spasmodic torticollis: is there a role for microvascular decompression? With an illustrative case report.
Spasmodic torticollis (ST) is a puzzling movement disorder, characterized by involuntary tonic or clonic contractions of various neck muscles. From time to time, psychogenic, extrapyramidal and neuroperipheral origins have been postulated and reflecting the variety of theories proposed, as many different treatments have been attempted, none of which has shown absolute effectiveness. Surgery of ST classically includes destructive procedures such as myotomies, stereotactically placed lesions, rhizotomies and neurectomies. The recent application of the concept of "neurovascular conflict" to ST induced several authors to perform microvascular decompression (MVD) in these patients, with encouraging and in some cases long-lasting results. Our case report joins this group. From the analysis of pertinent literature we conclude that: a. Spasmodic torticollis is probably a collection of separate clinical entities; b. Even in the so-called "ST of neuroperipheral origin" some coexising central factor must be admitted; c. Neurovascular compression underlies at least some cases of ST. Historical, anatomical, physiopathological and clinical aspects of ST are extensively discussed.
Aneurysms of the sphenoid segment of the middle cerebral artery.
Aneurysms of the M1 segment of the middle cerebral artery are rare. Anatomically they are classified into a "temporal" variety, projecting supero-laterally and a "striate" variety projecting infero-laterally. Between 1960 and 1992, 13 such aneurysms were treated at our Institution. Among them, 11 underwent surgery: 8 (73%) had an excellent or good outcome, 1 (9%) a poor outcome and 2 (18%) died. Two patients treated conservatively carried thrombosed aneurysms: one was a giant unruptured aneurysm with complete occlusion of the parent vessel; the other one was found at autopsy following transsphenoidal surgery and unexplained SAH. All these cases were carefully reviewed with special reference to their clinical and anatomo-surgical features. Exact knowledge of the anatomy of lenticulostriate and temporal branches and awareness of all possible anatomical variants are crucial for correct opening of the Sylvian fissure and successful surgical approach to M1 segment aneurysms.
Pituitary abscess. A case report and review of the literature.
The pituitary abscess is a rare pathology which presents an high mortality and morbidity. The diagnosis of pituitary abscess has to be excluded in case of tumoral hypophyseal syndrome; a correct diagnosis leads to an early treatment and to a decreasing of the mortality and morbidity. Antibiotics have to be associated to neurosurgical treatment in order to reduce the pre- and post- operative infectious complications. A case of pituitary abscess is reported: the preoperative diagnosis has been based on the clinical symptoms (visual field defect and meningeal syndrome) and on the neuroradiological images (CT, MRI).
Acromegaly and pituitary tumors: early anatomoclinical observations.
The elucidation of pituitary physiopathology has been a major challenge for physicians since early ages. Due to the unawareness of the endocrine system, acromegaly, the most striking pituitary disorder, was commonly regarded as an intrinsic bone disease. Andrea Verga and Vincenzo Brigidi, Italian authors of the 19th century, reported the first macroscopic and microscopic descriptions of pituitary adenomas in acromegalic patients. Although far from providing a correct pathogenetic interpretation of the disease, they opened the way to forthcoming observations and discoveries. A short history of acromegaly and pituitary physiopathology is drawn.
Frontoethmoidal osteoma complicated by intracranial mucocele and hypertensive pneumocephalus: case report.
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Celebrating the centennial (1894-1994): Leonardo Gigli and his wire saw.
In spite of the recent introduction of craniotomes in neurosurgical practice, the simple but brilliant wire saw invented by Leonardo Gigli still holds an important place in neurosurgical instrumentation. Born in Florence in 1863, Gigli was forced by circumstances to leave Italy soon after getting his medical degree. He first spent 2 years attending the most celebrated obstetrical clinics in Paris and London and then, in 1892, moved to Breslau where he worked with Fritsch and Mikulicz. During this successful and rewarding period, Gigli proposed the lateralized pubiotomy (Gigli's operation) for safe delivery in cases of maternal pelvic deformities and, inspired by the sight of a jagged knife during a country banquet, conceived his wire saw to simplify the procedure. In 1894, at Professor Obalinski's suggestion, he successfully tested a modified saw type with a whalebone guide for the preparation of osteoplastic cranial flaps. In spite of his great popularity and the high esteem in which he was held abroad, Gigli's aims were systematically belittled in Italy, where he never qualified for a university teaching position. He died in 1908, at age 44. Although the once celebrated Gigli's operation has merely historical interest today, the favorable features of his wire saw make it a safe and efficient tool in the hands of twentieth-century neurosurgeons worldwide.
Diffuse leptomeningeal gliomatosis with osteoblastic metastases and no evidence of intraaxial lesions.
An autopsy-proved case of cerebral and medullary leptomeningeal gliomatosis and diffuse osteoblastic metastases without evidence of intraaxial tumor is described. MR findings included diffuse thickening of the cerebral and medullary leptomeninges on T1-weighted, proton density-weighted, and T2-weighted images and abnormal enhancement of the sulci and cisterns of the cerebrum, brain stem, cerebellum, and medulla on postcontrast T1-weighted images. MR also showed several areas of replacement of the normal bone marrow of the skull. No intraaxial lesion was seen.
Cervical locked facet: operative management.
Cervical locked facet represent 5.6% of cervical lesion. If an identity of views is present in the use of tractions, we can't say as for the setting fixation techniques. Our cases histories (13 cases) and the experience of other authors incline us to support a precocious surgical treatment characterized by a posterior approach and then anterior in the not reduced cases and a single anterior approach in the reduced cases in anesthesia. The good alignment and the attain stability with the double access, but still more the convinction that the lesions of intervertebral disk and ligamentous tissues (as demonstration at the RMN) is always to remove, support us in the undertaken therapeutic attitude.
Subarachnoid hemorrhage from cavernous angioma of the cauda equina: case report.
A case of spinal subarachnoid hemorrhage from a cavernous angioma of the cauda equina is reported. The patient was a 28-year-old man who complained of a sudden low-back pain and neck stiffness. Laminectomy at L1-L2 was performed with total removal of the tumor.
Halifax interlaminar clamps for posterior atlanto-axial arthrodesis with spinal fusion by "H" bone+graft.
The use of Halifax interlaminar clamps in posterior arthrodesis for atlanto-axial instabilities has recently been reported. The four Anderson II fractures submitted were surgically treated by posterior arthrodesis with Halifax clamps and bilateral "H" shaped bone-grafts obtained from the iliac crest. Only in the first case--initially treated without fusion--a review of the system became necessary due to the loosening of one clamp. No post-operative neurological complications appeared and non malunion or nonunion occurred at follow-up. Posterior arthrodesis with Halifax clamps does not involve any complication connected with the use of metal wire and the association of posterior fusion by lateral "H" shaped bone grafts ensures a stable and physiological reduction of dens fractures and atlanto-axial luxations/subluxations often associated.
Cruciate paralysis from a Jefferson's fracture. Report a case and review of the literature.
A case of post-traumatic cruciate paralysis with a Jefferson's fracture was observed in a 54-year-old patient who fell accidentally. Cruciate or Bell's paralysis is a condition caused by incomplete cervical spinal cord lesion linked to focal and reversible damage of the pyramidal tract at the level of the decussation. The patient was treated by S.O.M.I. brace and a Philadelphia collar with a complete neurological restitution.
[Clinical aspects and risk factors in posttransfusion hepatitis].
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Prospective study of posttransfusion hepatitis in cardiac surgery patients receiving only blood or also blood products.
The incidence, etiology and risk factors of posttransfusion (PT) hepatitis were evaluated in a prospective study of 297 consecutive open-heart surgery patients. PT hepatitis occurred in 63 (21.2%) patients with a significantly higher hepatitis attack rate in 51 recipients of commercial clotting factor concentrates (56.8%) compared to 246 recipients of blood units from single volunteer donors (13.8% p less than 0.001). Among the concentrates, Prothrombin-complex showed the highest relative hepatitis risk (24) while in patients receiving only blood, the incidence PT hepatitis was correlated with the blood volume transfused. Of the 63 patients with PT hepatitis, 2 (3%) had hepatitis B, 8 (13%) showed evidence of cytomegalovirus infection and 53 (84%) had non-A, non-B hepatitis. These results show that in Italy, as elsewhere, non-A, non-B PT hepatitis is frequent, particularly when commercial blood products are used.
[Clinico-statistical considerations on 150 cases of cerebral lacerations].
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[Observations on the septum posticum and dentate ligaments in myelography with iodized esters].
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[Spontaneous rupture of the ventricular walls in the course of obstructive hydrocephalus. 2 personal cases].
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Recent experience in the management of meningeal hemangiopericytomas.
Although the histogenesis of meningeal hemangiopericytomas (HMP) remains controversial, both biological and clinical evidence seems to identify these neoplasms as a separate entity with respect to meningiomas. In order to assess the current prognosis of HMP we reviewed our personal experience limited to the last decade (1986-1995): during this period 7 patients (4M, 3F) were treated by surgery alone or surgery combined with postoperative radiotherapy. In spite of meticulous attempts at radical resection, the tumors recurred in all but two cases with a mean interval of 85 months, and a total of 18 operations were performed (2.57/patient; range 1-4). Massive intratumoral hemorrhage determined acute deterioration and required emergency surgery in two cases while in one patient diffuse visceral metastases were discovered at autopsy. Five patients are still alive at follow-up but only 2 of them are in good neurological conditions and without evidence of disease. These results are similar to those reported in other series. In view of our results we conclude that intracranial hemangiopericytomas still have a dismal prognosis. Advances in neuroimaging, neuroanesthesia, microneurosurgery and adjuvant therapy do not seem to have significantly affected the recurrence rate, quality of life and mortality.