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M Domenicucci

Publications and source records attributed to M Domenicucci.

At least 19 recordsLinked to original sources
PubMed2005

Spinal subarachnoid hematomas: our experience and literature review.

STUDY DESIGN: Spinal subarachnoid hematomas are unusual and difficult to diagnose and the outcome of treatment is influenced by the lesions that frequently accompany them. OBJECTIVES: To clarify the neuroradiological diagnostic aspects of spinal subarachnoid hematoma as well as the results of treatment. BACKGROUND: Only recently has subarachnoid hematoma been clearly distinguished from more common subarachnoid hemorrhage and its characteristics have still not been dealt with in detail. METHODS: A total of 69 cases (3 personal case, 66 published cases) were revised in terms of etiology, diagnostic imaging and the results of both surgical and conservative treatment. RESULTS: The most common causes of spinal subarachnoid hematoma are coagulopathies (either pharmacologically-induced or resulting from systemic diseases) (40.5%), lumbar puncture for diagnostic or anesthesiological purposes (44.9%) and traumatic injuries (15.9%): these factors may be present singly or variously combined. They may be spontaneous (17.3%) or, in rare cases, associated with aortic coarctation or degenerative vascular diseases. Overall mortality is 25.7%. In the 50 cases in whom long-term follow-up was possible, the outcome of treatment, which is almost exclusively always surgical, was good in 93.5% of 31 patients in whom neurological status on admission was satisfactory and in 15.8% of 19 cases with severe neurological deficits. CONCLUSIONS: MRI and CT are not usually diagnostic because they are not able to differentiate between a subarachnoid lesion and a subdural one. However, diagnosis may be possible when these investigations detect the CSF or the contrast medium surrounding the hematoma. Although the risks of producing spinal subarachnoid hematoma as a result of LP are remote, this is, in fact, the primary cause in patients with coagulopathies. The results of treatment depend on the patient's initial neurological condition, the severity of any concomitant pathologies, the position of the hematoma and the eventual association of a subdural hematoma.

Aged↗
PubMed1999

Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature.

Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. Spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.

Acute Disease↗
PubMed1999

Surgical treatment of penetrating orbito-cranial injuries. Case report.

Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. The patient in this case was a young man involved in a road accident who presented orbito-cerebral penetration caused by a metal rod with a protective plastic cap. Following the accident, the plastic cap (2.5x2 cm) was partially retained in the orbit. At initial clinical examination, damage appeared to be exclusively ophthalmological. Subsequent CT scan demonstrated the degree of intracerebral involvement. The damaged cerebral tissue was removed together with bone fragments via a bifrontal craniotomy, the foreign body was extracted and the dura repaired. Postoperative recovery was normal and there were no neuro-ophthalmological deficits at long-term clinical assessment. Orbito-cranial penetration, which is generally associated with violent injuries caused by high-velocity missiles, may not be suspected in traumas produced by low-velocity objects. Diagnostic orientation largely depends on precise knowledge of the traumatic event and the object responsible. When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion.

Adult↗
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↗
PubMed1998

Acute posttraumatic subdural hematomas: "intradural" computed tomographic appearance as a favorable prognostic factor.

OBJECTIVE: Posttraumatic acute subdural hematoma carries a high postoperative mortality rate. Preservation of subarachnoid spaces in preoperative computed tomographic (CT) scans may be interpreted as a favorable prognostic factor. METHODS: Thirty-one cases of posttraumatic acute subdural hematoma operated on consecutively, with an interval from trauma to surgery of less than 4 hours and a Glasgow Coma Scale score of less than 8, were reviewed. The immediate and long-term results were evaluated with reference to preoperative CT images, distinguishing cases with preserved subarachnoid spaces from the others. RESULTS: In 5 of the 31 cases, preoperative CT scans showed intact subarachnoid spaces and the absence of blood in the cerebrospinal fluid. These cases presented a much better postoperative course than did the others. CONCLUSION: The presence of intact subarachnoid spaces in CT scans for patients with acute subdural hematomas may be interpreted as an extremely favorable prognostic factor; this may be attributed to the protective effect of the integral visceral membrane of the hematoma, which prevents the diffusion of neurotoxic and vasoactive substances into the subarachnoid spaces. This group of hematomas was classified as "intradural," with reference to the concept of the "subdural compartment" described in studies conducted using an electron microscope.

Adult↗
PubMed1997

Three-dimensional computed tomographic imaging in the diagnosis of vertebral column trauma: experience based on 21 patients and review of the literature.

OBJECTIVE: To compare standard x-ray films, two-dimensional computed tomographic reconstructions and three-dimensional (3-D) computed tomographic reconstructions for assessing the grade, extent, and severity of vertebral fracture. PATIENTS AND METHODS: 3-D images were created from standard computed tomographic scans obtained using a General Electric PACE scanner. In 21 patients (17 men and four women) these images were obtained during both the acute phase and at long-term follow-up; there were six cervical, four dorsal, five dorso-lumbar, and six lumbar fractures. RESULTS: The 3-D images supplied useful information in complex traumas with rotation and/or dislocation of the vertebral body and in cases with loss of spinal alignment. The 3-D images also proved to be useful as an adjunctive imaging method for evaluation of bone fusion integrity. CONCLUSION: 3-D images produced by recently available software provide a 3-D understanding much more readily than do multiple two-dimensional images. Because it would be very difficult to standardize this method of imaging, it seems best that the specialist (orthopedic surgeon, neurosurgeon, neuroradiologist) be present during the investigation to decide the viewing angles. An important limitation to this method is the presence of degenerative disease or osteoporosis, mainly in elderly patients.

Adolescent↗
PubMed1996

Thoracolumbar fractures without neurosurgical involvement: surgical or conservative treatment?

The decision whether to treat amyelic thoracolumbar fractures conservatively or by surgical approach depends mainly on radiographic and clinical evaluation of their potential stability. An angle of kyphosis of 20 degrees or more evaluated using the sagittal index (s.i.) described by Farcy et al. in 1990, may be a valid indication for invasine treatment using pedicular systems for correction and stabilization; on the other hand, conservative treatment may be adequate for ensuring satisfactory results in fractures with an angle of less than 20 degrees, which are less likely to become unstable in clinically negative patients. This study confronts the immediate and long-term radiographic and clinical results in 2 groups of patients treated for amyelic thoracolumbar fractures, one treated conservatively, the other surgically; in particular, angle of kyphosis, vertebral compression and clinical conditions (pain and functional impairment) at long-term follow-up were assessed. The study was extended to include an assessment of outcome in relation to the angle of post-traumatic kyphosis in both operated and non-operated patients. Thirty-one patients with a diagnosis of non-neurological thoracolumbar trauma of the segment between D11 and L3 were studied. Twenty patients (group A) were treated conservatively (reduction on Cotrel bed and plaster vest) and 11 (group B) surgically (Diapason instrumentation). The 31 patients were subdivided into 2 groups according to the initial angle of kyphosis calculated using the s.i.: the first consisted of 16 patients (group C) with a s.i. of 20 degrees or more and the other of 15 patients (group D) with a s.i. less than 20 degrees. Six of the 16 group C patients and 5 of the 15 group D patients had been surgically treated. On the basis of the case-material considered, we found that satisfactory short-term radiographic results may be obtained by both conservative and surgical treatment. However, long-term outcome is less favorable in patients treated conservatively because maintainance of the initial improvement of the deformity in the injured segment is not as good as in those treated surgically. This limitation of conservative treatment does not however appear to negatively influence clinical conditions in patients with a s.i. of less than 20 degrees. In other words, although conservative treatment is not as effective as surgery for maintaining radiographic improvement, this does not necessarily signify clinical deterioration in cases with a s.i. of less than 20 degrees in whom the two types of treatment gave similar results.

Adolescent↗
PubMed1995

Delayed post-traumatic epidural hematoma. A review.

Post-traumatic acute epidural hematoma (EDH) is generally visible on the CT scan done immediately after admission: occasionally, it only comes to light at a later scan and is then termed delayed (DEDH). Since the introduction of CT, the frequency of this occurrence has gone up from 6-13% to 30%. The mechanisms responsible for the delayed appearance of the epidural hematoma a "tamponade" effect are usually increased endocranial pressure and post-traumatic arterial hypotension as well as, in a limited number of cases, coagulopathy, CSF drainage, and arterio-venous shunt. The authors report 5 of their own cases and 45 published cases and discuss the characteristics of this particular form of hematoma and its outcome.

Adult↗
PubMed1993

Meningiomas in elderly patients. Clinico-therapeutic considerations.

This study examines the immediate and long-term results of surgical treatment for intracranial meningioma in patients aged 65 and over. Average patient age was 69 years. The most frequent localizations were the convexity (29.8%) and the sphenoid wing (20.1%). Preoperative risk factors included hypertension (16.1%), cardiopathies (16.1%), diabetes (12.9%) pneumopathies (12.9%) and peripheral vascular diseases (9.6%). All patients were assessed according to the Karnofsky Performance Status (KPS). Operative mortality was 18.5% (23 cases). At long term follow up (minimum 4 months, maximum 12 years, average 5 years) 31.5% of patients were cured, 32.3% had improved and 4% had worsened. The risk factors that mainly influenced results included poor preoperative clinical condition as expressed by low KPS, while the most frequent medical postoperative complications that increased the rate of operative mortality were brain edema, infections and lung embolism.

Aged↗
PubMed1992

Meningioma of the fourth ventricle: a case report.

A rare case of fourth ventricle meningioma with a combined intraventricular-intracerebellar localization, successfully removed by surgical treatment, is reported. The features of this type of meningioma as compared to the purely intra-ventricular variety are discussed.

Adult↗
PubMed1992

Electrocardiographic changes in subarachnoid hemorrhage secondary to cerebral aneurysm. Report of 70 cases.

Electrocardiographic (ECG) alterations in the course of sub-arachnoid hemorrhage (SAH) have frequently been reported. The most frequent anomalies reported were lengthening of the QT interval, very negative or positive deep T waves, elevation or depression of the ST segment and the presence of U waves. We report 70 cases of SAH secondary to rupture of intracranial aneurysm (part of a larger group of 150) with ECG changes. We review the literature with particular regard to discussion of the possible pathogenesis of ECG changes and to the way they may affect the general clinical course.

Adult↗
PubMed1992

Histologically benign recurrent meningioma metastasizing to the parotid gland: case report and review of the literature.

This report presents a very rare case of metastatic meningioma of the parotid gland from a recurring intracranial lesion. The primary tumor, intracranial residues, and parotid metastasis were histologically benign. Meningiomas rarely metastasize; even rarer are cases in which both the primary and the secondary tumors have benign histological characteristics. The 11 cases reported in the literature have been critically reviewed. The case we present is noteworthy also for the exceptional localization of the metastasis in the parotid gland.

Cerebral Cortex↗
PubMed1992

Meningiomas of Meckel's cave.

A series of 16 patients with meningiomas of Meckel's cave is reported. Trigeminal neuralgia, typical or atypical, was the initial symptom in 10 patients (62.5%). At admission, trigeminal signs and symptoms were present in 15 patients (93.7%); in 7 patients (43.7%), trigeminal dysfunction was combined with the impairment of other cranial nerves. On retrospective analysis, these patients fall into two clinical groups that differ also in prognosis. Group 1 comprises eight patients with trigeminal signs and symptoms only. These patients had small meningiomas strictly affecting Meckel's cave. Total removal of the tumor was achieved in seven of eight patients, without adjunctive postoperative neurological deficits. In this group, there were no tumor recurrences. Group 2 comprises the other eight patients in whom trigeminal dysfunction was combined with impairment of other cranial nerves. These patients had large tumors arising from Meckel's cave and secondarily invading the cavernous sinus (five patients) or extending into the posterior fossa (two patients) or largely growing into the middle fossa (one patient). Total removal was achieved in only one patient, and a worsening of the preoperative neurological status was observed in four patients; there were three cases of tumor progression. A subtemporal intradural approach (used in the past in every case) is still used for the small tumors of Group 1 with good results. Since 1985, for tumors involving the cavernous sinus, we have employed a frontotemporal craniotomy with extradural clinoidectomy and superior and lateral approach to the cavernous sinus. When the tumor extends toward the posterior fossa, we use a combined temporosuboccipital-transpetrosal approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Multiple intracranial meningiomas.

The authors report 14 cases of multiple intracranial meningiomas representing 1.1% of all meningiomas operated on at their hospital in the past 35 years. Differentiation of multiple meningiomas, especially from meningiomatosis, must be strict. Since the introduction of computerized tomography scanning, the frequency of these cases has risen from 0.58% to 4.5% in the authors' meningioma series. Despite the multiplicity of sites, multiple meningiomas do not differ in prognosis from benign solitary meningiomas.

Adult↗