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Biomedical subjects

G Iaconetta

Publications and source records attributed to G Iaconetta.

At least 19 recordsLinked to original sources
PubMed2006

Prognostic and survival-related factors in patients with well-differentiated oligodendrogliomas.

Oligodendrogliomas are brain tumors with unpredictable biological and clinical behavior. Prognostic factors related to survival are still controversial. The present study reviews 50 patients with well-differentiated (WHO grade II) oligodendrogliomas, located in the cerebral hemispheres and operated upon between 1980 and 1998. Prognostic factors studied include patient's age and sex, tumor location and extent, preoperative KPS, and extent of the surgical resection. The Ki-67 and the proliferative cell nuclear antigen (PCNA) levels were studied in all patients and some growth factors (GFs), including vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), platelet-derived growth factor (PDGF) and tenascine were examined in 20 patients. The long-term outcome and survival are not significantly correlated with the patient's age and sex, tumor location and extent, preoperative KPS and procedure for resection. Patients with lower Ki-67 and PCNA showed a significantly longer survival time (p < 0.001 and p < 0.019, respectively). Between 45 and 70 % of the tumors stained positive for one or more growth factors. Interestingly, cases with late recurrences (more than 4 years after surgery) and longer survival are significantly associated to negative GF expression or slight positivity, as compared with the variable and more often moderate immunoreactivity of cases with early anaplastic recurrences and shorter survival time. The presented data suggest that low proliferation indices and negative GF expression are associated with longer survival in well-differentiated oligodendrogliomas.

Adolescent↗
PubMed2006

Arachnoid cyst with intracystic haemorrhage and subdural haematoma: case report and literature review.

Arachnoid cysts (AC) are usually asymptomatic. However, very rarely they can become symptomatic due to cyst enlargement or haemorrhage, often after head trauma. In such cases bleeding is often confined to the subdural space, but intracystic haemorrhage has rarely been observed. We report a case of a child who had intracranial hypertension syndrome due to a right middle cranial fossa AC with intracystic bleeding and subdural haematoma.

Adolescent↗
PubMed2005

Simultaneous presentation of meningiomas with other intracranial tumours.

Fifteen patients with simultaneous presentation of meningiomas with other intracranial tumours are reviewed. The associated tumours included a brain metastasis in six cases, glioma in three, pituitary adenoma in two, craniopharyngioma in one,acoustic schwannoma in two and brain lymphoma in one. A correct preoperative radiological diagnosis was made in 12 patients; in three others the associated tumour was discovered at operation and by histological studies. A one-stage removal of both tumours through the same approach was performed in nine patients, whereas six others underwent two-stage operations with an interval of 1 - 13 months. The literature relating to meningiomas associated with other intracranial tumours is reviewed and the possible pathogenetic correlations are discussed. A diagnostic pitfall may occur for metastasis into a meningioma, glioma surrounding a meningioma and different suprasellar lesions. The surgical indication and management of meningiomas may be significantly influenced by the presence of another different intracranial tumour.

Adult↗
PubMed2002

Peduncular hallucinations associated with large posterior fossa meningiomas.

Peduncular hallucinosis may be observed in patients with thalamic or brain stem ischemia or hemorrhage, while it has been less often described in association with brain stem or cerebellar tumors. We report in this paper two cases associated with large posterior fossa meningiomas. In the first patient hallucinosis appeared preoperatively as a result of brain stem compression and ceased after the tumor removal. In the second patient hallucinosis occurred after the surgery, as a result of surgical trauma with local brain stem edema, and ceased 4 days after treatment with desamethasone and carbamazepine.

Adult↗
PubMed2002

Meningiomas associated with brain metastases.

The authors report a series of 6 patients with simultaneous occurrence of meningioma and single brain metastasis, who underwent surgical removal with histological verification of both lesions. The site of the primary tumor was the breast in 3 cases, the ovary in one, the lung in one, and was unknown in one. Among the six patients, two had a carcinomatous metastasis accidentally found into a meningioma after histological examination of the meningiomatous mass. Two others had a brain metastasis in the cerebral parenchyma surrounding the meningioma; both lesions were removed in an one-stage operation. Finally, two patients, whose lesions were distant, first underwent removal of the brain metastasis, whereas the meningioma was excised 10 and 13 months later. The pathogenetic relationships between meningiomas and tumors of the female reproductive system are discussed. The occurrence of a metastasis into a meningioma is a rather unusual event, which has been described in 50 previously reported cases. The correct differential diagnosis between meningioma and metastasis is very important in these patients. An intracranial mass lesion occurring in patients with known malignant tumors elsewhere in the body (mainly females with breast cancers) has a small but real chance of being a meningioma.

Adult↗
PubMed2001

Intracerebral epidermoid tumor: a case report and review of the literature.

BACKGROUND: Intracerebral epidermoid cysts are rare lesions and may account for only 1.5% of intracranial epidermoid tumors. Cell entrapment from the mesectodermal origin of the neural crest within the primitive cerebral hemisphere may lead to the formation of such rare intracerebral lesions. METHODS: An intracerebral epidermoid cyst located in the right temporal lobe that was surgically treated is presented. The origin, clinical course, radiological features, and surgical treatment of such uncommon lesions are discussed based on a review of the literature. RESULTS: Intraoperative findings revealed an epidermoid tumor. The postoperative course was uneventful and the patient was discharged with no neurological deficits. On long-term follow-up (2 years), there were no signs of recurrence. CONCLUSIONS: Truly intracerebral epidermoid tumors are rarely found. Cells originating from mesectodermal lines may migrate and remain trapped within the primitive cerebral hemisphere while the neural tube is closing, leading to the formation of such intraparenchymal epidermoid tumors. Accurate preoperative diagnosis can be very difficult due to the radiological similarities to other common intracerebral cysts (e.g., astrocytomas or gliomas). Magnetic resonance imaging (MRI) studies, especially with diffusion-weighted images, allow greater accuracy in the preoperative differential diagnosis. Radical surgical removal should be attempted, but a less aggressive surgical strategy should be considered if there is strong adherence between the tumor capsule and the brain tissue, particularly in eloquent areas.

Adult↗
PubMed2001

Dural arteriovenous malformation associated with recurrent subdural haematoma and intracranial hypertension.

An unusual case of intracranial hypertension and symptoms of a left parieto-occipital mass lesion due to a dural arteriovenous malformation (AVM) with a large and dilated draining vein is reported. The patient also had a history of homolateral recurrent subdural haematoma, 11 years before. Subdural haematoma is rarely associated to a dural AVM. We suggest that the recurrent subdural haematoma was due to the very slow and intermittent venous bleeding from the preexisting dural malformation, which progressively enlarged in the following years to become very large. The symptoms of intracranial hypertension and papilloedema may be explained by the increased pressure in the dural sinus and the cerebral venous system. On the other hand, focal neurological symptoms in our case resulted from the mass effect due to an aneurysmally dilated draining vein in the left parieto-occipital region.

Cerebral Angiography↗
PubMed2001

Spontaneous resolution of Chiari I malformation and syringomyelia: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Indications for surgery and the surgical technique of foramen magnum decompression for patients with Chiari I malformation and syringomyelia are controversial issues. This case report supports the view that observation may be adequate for patients without progressive symptoms or with mild clinical symptoms. CLINICAL PRESENTATION: A 37-year-old woman presented with a 3-month history of burning dysesthesias and hypesthesia in her right arm. A neurological examination revealed hypesthesia in the right trigeminal distribution. A magnetic resonance imaging scan revealed a Chiari I malformation with syringomyelia between C2 and T2. No hydrocephalus was observed. CLINICAL COURSE: Because the patient's symptoms regressed spontaneously, surgery was not performed. Thirty-two months after her initial examination, the patient was asymptomatic. A second magnetic resonance imaging scan was obtained, which demonstrated complete spontaneous resolution of the Chiari I malformation and syringomyelia. CONCLUSION: We attribute the regression of the patient's symptoms to spontaneous recanalization of cerebrospinal fluid pathways at the foramen magnum, which most likely was due to rupture of the arachnoid membranes that had obstructed cerebrospinal fluid flow.

Adult↗
PubMed2001

Duplicated abducent nerve and its course: microanatomical study and surgery-related considerations.

OBJECT: The anatomy of the abducent nerve is well known; its duplication (ranging from 5 to 28.6%), however, has rarely been reported in the literature. The authors performed a microanatomical study in 100 cadaveric specimens (50 heads) to evaluate the prevalence of this phenomenon and to provide a clear anatomical description of the course and relationships of the nerve. The surgery-related implications of this rare anatomical variant will be highlighted. METHODS: The 50 human cadaveric heads (100 specimens) were embalmed in a 10% formalin solution for 3 weeks. Fifteen of them were injected with colored neoprene latex. A duplicated abducent nerve was found in eight specimens (8%). In two (25%) of these eight specimens the nerve originated at the pontomedullary sulcus as two independent trunks: in one case the superior trunk was thicker than the inferior and in the other it was thinner. In the other six cases (75%) the nerve originated as a single trunk, splitting in two trunks into the cisternal segment: in two of them the trunks ran below the Gruber ligament, whereas in four specimens one trunk ran below and one above it. In all the specimens, the duplicated nerves fused again into the cavernous sinus, just after the posterior genu of the internal carotid artery. CONCLUSIONS: Although the presence of a duplicated abducent nerve is a rare finding, preoperative magnetic resonance imaging should be performed to rule out this possibility, thus tailoring the operation to avoid postoperative deficits.

Abducens Nerve↗
PubMed2000

Ossification of the yellow ligament causing thoracic cord compression.

Ossification of the yellow ligament (OYL) is not infrequent in the cervical and lumbar regions but is very rare in the thoracic spine, with no more than 40 cases reported in the literature. We describe a 50-year-old male with progressive paraparesis and sensory dysfunction, secondary to OYL at T10-T11, studied by computed tomography (CT) and magnetic resonance imaging (MRI). Decompressive laminectomy and removal of the ligament resulted in marked clinical improvement. Patients with OYL may initially develop sensory dysfunction associated with leg weakness. This pathological entity can be well defined by CT and MRI, and surgery by decompressive laminectomy is advised for all cases. The OYL should be removed both posteriorly and laterally to the dural sac to obtain sufficient decompression of the spinal canal.

Decompression, Surgical↗
PubMed2000

Cervical spine stenosis due to ossification of the posterior longitudinal ligament in Italian patients: surgical treatment and outcome.

Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is a frequent pathological entity in people of Japanese and Asian extraction and is reported with increasing frequency also in the USA; on the contrary, reports in the European and particularly in the Italian literature remain rare. This paper describes 8 Italian patients with cervical spine stenosis due to OPLL extending three to five vertebral segments (and above C3 in four cases). Magnetic resonance imaging shows the extent of the ossification well in terms of height and cord compression, while computed tomography is useful to measure the thickness of the bone mass and the residual spinal canal. Anterior cervical decompression by discectomy, corpectomy, and removal of the ossified ligament is the treatment of choice and results in clinical improvement in most cases. Decompressive laminectomy may be reserved for patients with ossification extending to four or five levels and above C3. The surgical technique and intraoperative findings are discussed.

Aged↗
PubMed2000

Epidermoid cyst of the cavernous sinus: clinical features, pathogenesis and treatment.

Epidermoid cyst may rarely arise within the lateral wall of the cavernous sinus (CS) and produce clinical symptoms mimicking the Tolosa-Hunt syndrome. Pathogenically, it is suggested that some of the subpopulation of cells arising from the neural crest which give rise to skin, may remain entrapped in the meninges around the nerves in the lateral wall in an uncompleted stage of maturation and may develop epidermoid cysts. A case is presented of a 68-year-old man with a 4-week history previously diagnosed as Tolosa-Hunt syndrome. MRI is the investigation of choice. Surgical resection can result in excellent recovery of preoperative deficits of cranial nerves (CN) III through VI.

Aged↗
PubMed2000

Intraoperative sonography for spinal tumors. Correlations with MR findings and surgery.

BACKGROUND: To investigate the role of intraoperative ultrasonography during surgery for spinal tumors and the correlation between echographic, magnetic resonance and surgical findings. METHODS: Twenty patients with spinal tumor, explored by MRI of the spine, have been treated with ultrasound-guided surgery. The ultrasound exploration has been performed during laminectomy on the dural surface in all cases and, after the dural opening, on the spinal cord surface for intramedullary tumors. RESULTS: In all patients the ultrasound exploration has allowed to exactly define the extent of the laminectomy, the dural opening and the myelotomy. Meningiomas were hyperechoic and homogeneous, with well defined margins and often visible hyperechoic dural attachment; neurinomas were less hyperechoic and less homogeneous than meningiomas. Intramedullary tumors showed hyperechoic solid and hypoechoic cystic-necrotic components, although a specific tissue characterization (tumor infiltration, gliosis, edema) is not possible. CONCLUSIONS: Intraoperative ultrasonography should be used routinely during surgery for spinal tumors in order to reduce the extent of the laminectomy, dural opening and myelotomy. A good correlation exists between signal intensity on T1-weighted images of MR, the echographic aspect of the tumor and the pathological findings at operation.

Adolescent↗
PubMed1999

Intracranial meningiomas: correlations between MR imaging and histology.

The authors have examined the relationship between magnetic resonance imaging (MRI) and histopathological features in 35 surgically verified intracranial meningiomas. Tumor signals on T1-weighted images were rather similar regardless of the histologic subtype of the tumors. On T2-weighted images, hypointense meningiomas were mainly fibroblastic and hyperintense tumors were mainly syncytial and angioblastic, and partly transitional. Isointense tumors were mainly transitional and partly fibroblastic and syncytial. The authors conclude that the signal intensity of the MRI may be useful in the preoperative characterization of intracranial meningiomas. T1-weighted images may predict the presence of cysts and intratumoral blood vessels; whereas T2-weighted images can give information about histological subtype, vascularity and consistency. Meningiomas hyperintense to the cortex on T2 are usually soft, more vascular and more frequently of syncytial or angioblastic subtype; tumors hypointense or hypo-isointense on T2 tend to have a more hard consistency and are more often of fibroblastic or transitional subtype.

Adult↗
PubMed1998

Neuroendoscopy. Personal experience, indications and limits.

The authors report a series of 40 patients treated by endoscopic neurosurgery. It includes 31 cases of obstructive hydrocephalus, 4 paraventricular or intraventricular CSF cysts, 3 cases of multiloculated hydrocephalus, one suprasellar arachnoid cyst and one cystic astrocytoma with mural tumor nodule. Third ventriculostomy is the most frequent indication of the endoscopic neurosurgery, which is very useful also for performing fenestration of CSF cysts and multiloculated hydrocephalus. The surgical endoscopic techniques in the different above mentioned pathologies are exposed. The criteria for patient selection, the clinical results and the postoperative radiological findings, that confirm the patency of the fenestration, are discussed.

Adolescent↗