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Biomedical subjects

M Salvati

Publications and source records attributed to M Salvati.

At least 19 recordsLinked to original sources
PubMed2006

Gliomatosis cerebri treatment in 11 elderly patients.

The Authors report their experience in the treatment of eleven patients over 70 years old (range from 70 to 83, average age 74.8, 7 males and 4 females), with histologically proven diagnosis of glioblastoma multiforme. The GC golden standard treatment is still debated, particularly in elderly patients. All the patients underwent a first line treament with chemotherapy (Temozolomide), followed by Whole Brain Radiotherapy (WBRT) and PCV schedule without Vincristine in case of progression of the disease. The median survival was 16.3 months, ranging from 13 to 22 months. According to our experience, elderly patients should undergo the same treatment of younger patients, provided they are in good health conditions.

Aged↗
PubMed2006

Paragangliomas of the cauda equina. Report of one case and review of the literature.

The authors report one case of cauda equina paraganglioma and review the neurosurgical, radiological and pathological literatureon this rare tumour. Although it is difficult to distinguish preoperatively the paraganglioma from other tumours of the cauda equina, like neurinoma or ependymoma, this neuroendocrine tumour should be included in differential diagnosis.

Cauda Equina↗
PubMed2005

Spinal glioblastoma with brain relapse in a child: clinical considerations.

STUDY DESIGN: Case report. OBJECTIVES: To describe a child with intramedullary glioblastoma at T9-T10-T11, and to discuss the clinical features of this rare pathology. SETTING: Department of Neurological Sciences, Italy. CASE REPORT: Spinal cord glioblastoma in children has only rarely been reported. It most frequently involves the thoracic region with a predilection for the second and third decades of life. This report describes one case of thoracic glioblastoma multiforme in a 6-year-old child and reviews other cases reported in the literature. RESULTS: Laminectomy and excision of the tumour were performed. Postoperative radiotherapy and chemotherapy were given, but 4 months later the patient presented with a brain relapse of the tumour. At 9 months after diagnosis the patient died from cerebral tumour regrowth. CONCLUSIONS: Full neuraxis MRI is always recommended in order to detect possible metastases. The prognosis after multimodality therapy (surgery, radiotherapy, chemotherapy) remains poor. From the literature, only four cases of paediatric patients with long-term survival have been reported.

Brain Neoplasms↗
PubMed2005

High-dose radiation-induced meningioma in children - case report and critical review of the literature.

OBJECT: High-dose radiation-induced meningiomas in children are a rare occurrence. We discuss the clinical data and the differences of these rare tumors from those of spontaneous counterpart and radiation-induced meningiomas of the adult population. CASE REPORT: We report a case of meningothelial meningioma, which occurred in a 9-year-old boy who underwent radiotherapy for a parieto-occipital cutaneous angioma. In addition, we collected 18 cases of high-dose radiation-induced meningiomas in children from a literature review with Medline. RESULTS: Radiation-induced meningiomas in children show a female predominance, a short latency period that seems to be related to the age at irradiation, and an aggressive behaviour. CONCLUSION: Exposure to the potentially carcinogenic effects of radiotherapy should be reserved only for tumors that demonstrate subsequent progression. A meticulous follow-up of patients treated with radiation therapy is mandatory.

Child↗
PubMed2005

Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature.

Brain metastasis from prostate carcinoma occurs very rarely. We describe 13 patients with single brain metastasis from prostatic cancer. Total removal of the lesions was performed in ten patients. Three patients underwent stereotactic biopsy. All patients were treated with postoperative whole brain radiotherapy (WBRT). Eight patients died for systemic disease after a mean time of 9.2 months with a diagnosis of metastasis. Five patients are still alive at 20, 14, 11, 7 and 6 months, respectively. Even if brain metastasis from prostate cancer is often a terminal event with death occurring within few months from diagnosis, we suggest the same protocol (surgery and/or radiosurgery plus postoperative WBRT) usually adopted to treat brain metastasis from other primitive tumours. A non specific neurological symptomatology and a possible normal dosage of serum specific antigen may contribute to a delay in diagnosis. However, considering the rarity of brain metastasis from prostate carcinoma, standard brain MRI follow-up in men with prostatic cancer does not seem to be necessary yet.

Aged↗
PubMed2005

Central nervous system mesenchymal chondrosarcoma.

Central nervous system mesenchymal chondrosarcomas are rare malignant tumors that constitute a separate entity from the classical chondrosarcoma and myxoid variant. Clinical behaviour of central nervous system chondrosarcomas is still unknown. We describe two rare examples of intracranial mesenchymal chondrosarcoma with a review of the literature, in an attempt to clarify the clinical characteristics, prognosis and treatment of choice of these unusual tumors. Among the 55 reported cases, 23 had postoperative radiotherapy. Although there is no statistical significance according to the Log-Rank test (p=0.7), the patients treated with radiation therapy seem to have a better chance of survival. Patients who had adjuvant chemotherapy (only 5) showed survival times similar to those patients who had none. Although clinical behaviour of central nervous system chondrosarcomas remains to be defined, data from our series as well as literature show that radical removal is the best therapeutic choice. In addition, patients treated with postoperative radiotherapy seem to show a trend toward increased survival.

Adolescent↗
PubMed2005

Sylvian subarachnoid and extra-pial cavernous angioma.

Cavernous angiomas are one of the four types of vascular malformations of the central nervous system. Lesions situated subarachnoidally are rare although some cases with an infratentorial localization have been reported. Our case represents an unusual localization of a subarachnoid cavernous angioma. A 35- year-old patient was admitted to our department with signs of subarachnoid hemorrhage. A 1 cm hyperdense lesion placed at the right Sylvian fissure was distinguished by CT-scan examination and no arterial supply was revealed on cerebral angiography. Surgical intervention showed a lesion placed extra-pial and totally encased in the subarachnoid space in the superficial part of the Sylvian cistern. This case represents a radiologically visible supratentorial extra-pial subarachnoidal cavernous angioma. This case provides confirmation of one of the supposed causes of subarachnoid hemorrahage ''sine materia''.

Adult↗
PubMed2004

Cerebral astroblastoma.

BACKGROUND: Astroblastoma is a rare glial tumour about which little is known. METHOD: We report a case of cerebral high grade astroblastoma and discuss the clinical, histopathological, surgical, radiological and prognostic features of this tumour, in the light of the pertinent literature. RESULT: Present patient had an initial histological diagnosis of glioblastoma multiforme. Three years later an histological reevaluation was performed and revealed a high grade astroblastoma. Our patient underwent surgical removal and radiotherapy; five years after the operation he is alive and without evidence of recurrence. INTERPRETATION: Classification and histogenesis of this tumour is still debated. The lack of a clinicopathological correlation makes the prognosis of this tumour unpredictable. The optimal management is not defined, but total resection and post-operative radiotherapy seem to be the effective means to treat the astroblastoma.

Adult↗
PubMed2004

Transsphenoidal adenomectomy for GH-, PRL- and ACTH-secreting pituitary tumours: outcome analysis in a series of 125 patients.

Transsphenoidal surgery (TSS) is a well recognised treatment for secreting pituitary adenomas, however a very wide variation of clinical outcomes and recurrence rates has been reported, depending on the different criteria used to define the cure. We reported the clinical outcome of a large series of patients operated on for a secreting pituitary adenoma according to the most recent stringent criteria of biochemical remission nowadays accepted. One hundred and twenty-five consecutive patients with a secreting pituitary adenoma (42 PRL-, 67 GH- and 16 ACTH-secreting adenomas) who were operated on by the two same neurosurgeons were considered for the study. Biochemical remission of disease was achieved in 56% of patients; 78% for patients with microadenoma and 47% for patients with macroadenomas, respectively. No cases of mortality or major immediate postoperative complications were observed. Tumour size, high hormone levels and dural invasion were significantly correlated to a poor surgical outcome. The recurrence rates ranged between 0 and 24%, being higher for PRL-secreting tumours. In conclusion, TSS is safe and effective in secreting pituitary tumours. It is still the first treatment for GH- and ACTH-secreting adenomas, whereas in patients with prolactinomas, surgery should be reserved for cases of resistance or intolerance to dopamine agonists.

Acromegaly↗
PubMed2004

Solitary brain metastases from uterus carcinoma: report of three cases.

Solitary brain metastases from uterine carcinoma are uncommon. Intracranial metastases from uterus usually occur in widely disseminated disease. We report three cases of solitary brain metastasis from uterine cancer. In one of these patients metastasis was detected prior to diagnosis of primitive cancer. In a review of the literature only seven cases of solitary brain metastasis preceding the diagnosis of uterine cancer have been documented.

Brain Neoplasms↗
PubMed2004

Spontaneous, multiple meningiomas.

OBJECT: The aim of this study is to discuss the management strategy of patients with multiple meningiomas. METHODS: We describe 35 patients with multiple meningiomas. No patients carried stigmata of neurofibromatosis. All patients were studied using MR or CT after surgical treatment. RESULTS: All 35 patients received surgical treatment. A total of 40 operations was performed. The resection of 4 meningiomas was subtotal and all other tumors were radically resected. We had excellent results with reversible operative complications in only three patients. There were no recurrences. CONCLUSIONS: We suggest that surgery is suitable for the treatment of multiple meningiomas with the following characteristics: symptomatic meningioma, asymptomatic meningioma greater than 3 cm in size and surgically accessible, and asymptomatic expanding tumor. In patients with multiple tumors, each tumor must be treated as an individual entity. The mere presence of multiple tumors does not justify their removal.

Adult↗
PubMed2004

Multiple sclerosis and gliomas. Clinical remarks on 10 cases and critical review of the literature.

The association between multiple sclerosis and tumours of the central nervous system is unusual. The authors analyzed the clinico-pathological elements of the correlation. The pertinent literature on this subject is critically reviewed. Ten cases of patients with an history of multiple sclerosis for more than 15 years and a clinical and radiological evidence of brain tumour were submitted to surgery in order to remove the lesion and/or to chemo- and radiotherapy. The various aspects of the association were studied in detail. A patient with multiple sclerosis, particularly with atypical symptoms, should be evaluated by an annual MRI investigation with intravenous paramagnetic contrast medium. The diagnostic work-up should be: clinical and radiological assessment; MRI in the event of atypical symptoms; Sstereotactic or neuronavigation-aided biopsy in any suspected lesions. Patients with multiple sclerosis and glioma present survival times identical to those observed in patients not suffering from multiple sclerosis. The coexistence of multiple sclerosis and brain tumours does not seem to influence the clinical evolution of either of these pathologies. We believe that it is important to achieve an early diagnosis of brain tumour in such patients with a clinical and neuroradiological follow up, so that they can be treated promptly.

Adult↗
PubMed2003

Ethylene oxide sterilization of autologous bone flaps following decompressive craniectomy.

INTRODUCTION: In patients undergoing decompressive craniectomy, the bone flap is temporarily preserved either in the subcutaneous tissue of the patient or frozen. However, there are some drawbacks related to these methods. MATERIAL AND METHODS: In 16 patients in whom the bone flap was removed for decompressive craniectomy, the bone was firstly washed in hydrogen peroxide and then placed in hermetically-sealed bags and sterilized using ethylene oxide. The bone was repositioned after an average period of 4.3 months. RESULTS: One patient sustained an infection of the surgical wound which required permanent exclusion of the bone flap. In all the others, esthetic and functional results were good after an average follow-up of 20 months. Control CT-scan of the bone flap demonstrated preservation of its structural features with fusion of the bone margins and revitalization of the flap. On MRI a subdural space was again visible. CONCLUSIONS: Sterilization of the bone flap with ethylene oxide in patients undergoing decompressive craniectomy avoids some of the drawbacks related to the techniques currently used. The easiness, low cost, good aesthetic and functional results of this procedure make it a valid alternative to other techniques for preservation of autologous bone in decompressive craniectomies.

Adult↗
PubMed2003

Treatment of glioblastoma multiforme in the elderly in functionally non-critical areas. Clinical remarks on 22 patients.

The aim of this study was to evaluate the efficacy of multimodality treatment of glioblastoma multiforme in the elderly. Although several studies report a poor outcome in elderly patients with glioblastoma, in the light of our experience, treatment of elderly patients with glioblastoma in non-critical areas and Karnofsky Performance Status > 60 should be just as aggressive as in younger patients.

Aged↗
PubMed2003

Fronto-temporo-orbito-zygomatic approach and variants. Surgical technique and indications.

AIM: In the last decade, development and refìnement of skull base surgery have widened the surgical options available for treatment of mtracramal lesions. Despite the enormous advances made m microsurgical technique, the bony phase is still extremely important for achievmg optimal exposure of vascular and tumoral skull base lesions. The role of anterolateral approaches for such lesions is discussed. METHODS: We collected 87 consecutive patients with 74 neoplasms and 13 vascular lesions involving the floor of the antenor and/or middle cranial fossae, cavernous sinus, orbit, petrous bone, clivus, parasellar region and infratemporal fossa operated throughout 8 and a half years by means of an anterolateral approach and we evaluated the results obtained employing different craniotomies. RESULTS: To simplify the parameters for evaluation of outcome, we considered 2 main aspects: comparison between pre- and postoperative neurological status and the extent of tumour removal on MR imaging. For vascular lesions, we took into consideration the neurological outcome and the successful clipping of the aneurysm or disappearance of the AVM (l case) on postoperative angiography. Satisfactory surgical results were obtained with each type of craniotomy employed (fronto-teniporo-orbito-zygomatic, fronto-temporo-orbital, fronto-temporo-zygomatic, fronto-orbito-zygomatic). CONCLUSION: On the whole, surgical results were satisfactory. By deliberately excluding the microsurgical aspects of the lesions treated, we can observe that the fronto-temporo-orbito-zygomatic approach is principally indicated for lesions requiring a multidirectional approach such as spheno-petro-clival tumours, aneurysms of the basilar tip and intracavemous lesions while the fronto-temporo-orbital approach proved excellent for more medial lesions such as meningiomas of the luberculum sellae and cramopharyngiomas. The fronto-temporo-zygomatic approach is our 1(st) choice for neoplasms involving the Gassenan ganglion and the intratemporal fossa. For lesions of the orbital apex, a fronto-orbito-zygomatic approach can be successfully employed. Introduction of these approaches is relatively recent but promises a further refinement of their indications and surgical technique aimed at mimmismg postoperative morbidity.

Adolescent↗
PubMed2003

Radiation-induced schwannomas of the nervous system. Report of five cases and review of the literature.

Radiation therapy has important delayed effects on the central nervous system. Prominent among these effects is radiation necrosis of nervous tissue, but an oncogenic effect is also recognized. Both benign and malignant intracranial tumors can develop in irradiated fields, particularly in children. Most of these tumors are sarcomas, meningiomas or gliomas and only occasionally schwannomas. We report 5 cases of postirradiation acoustic nerve schwannoma observed in our Department.

Adult↗
PubMed2002

Surgical approaches to tumours of the lateral ventricles in the dominant hemisphere.

BACKGROUND: Intraventricular neoplasms are rare tumours (1% of the tumours of the central nervous system). The surgical approach sometimes is quite difficult, particularly in the dominant hemisphere. The best choice of surgical approach is discussed. METHODS: The authors describe a series of 25 patients who underwent surgical treatment for tumours situated in the lateral ventricles of the dominant hemisphere. They discuss the most influential factors in the choice of surgical approach, which must allow maximum exposure of the lesion and vascular feeding branches without damaging highly functional areas (motor, visual and language areas). In particular, they report their experience using a low transtemporal route, between the middle and inferior gyri, for removing tumours localized in the temporal horn and/or trigone which made it possible to keep postoperative visual and phasic deficits to a minimum. RESULTS: In 5 patients the approach was transfrontal, in 10 temporal, in 6 superior parieto-occipital and in 4 transcallosal. Three patients died. Only 5 patients presented permanent deficits (anomia, apraxia and visual fields alterations). CONCLUSIONS: The size, site, hemisphere and vascularization of intraventricular tumours influence the choice of surgical approach. The basal transtemporal approach is particularly indicated to remove tumours of the temporal horn and trigone and it seems to reduce the risk of speech disturbances and alterations of posture.

Cerebral Ventricle Neoplasms↗