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P Lunardi

Publications and source records attributed to P Lunardi.

At least 19 recordsLinked to original sources
PubMed2005

Fifth ventricle: an unusual cystic lesion of the conus medullaris.

STUDY DESIGN: Cystic dilatation of the fifth ventricle on its own is an extremely rare pathological event in adults whose pathogenesis is uncertain. The authors describe a personal case of 'fifth ventricle' and review the pertinent literature. OBJECTIVE: To emphasize the importance of including the fifth ventricle in differential diagnosis of lesions of the conus medullaris to ensure proper treatment. SETTING: Italy. METHODS: A 30-year-old woman was referred to us for recurrent low back pain. The patient was assessed by clinical, electrophysiological (motor evoked potential, somatosensorial evoked potential and electromyography of the perineal and lower limb muscles) and urodynamic investigations as well as a magnetic resonance imaging (MRI) of the lumbar-sacral segment with and without gadolinium enhancement, subsequently extended to the entire vertebral column and brain. Follow-up consisted of periodic clinical evaluation and lumbar-sacral MRI after 1 and 2 years. RESULTS: General physical examination, electrophysiological and urodynamic investigations were all negative, confirming the subjective nature of the patient's symptoms. Lumbar-sacral MRI demonstrated the presence of a cyst lesion containing cerebrospinal fluid (CSF), which did not enhance after gadolinium, compatible with the diagnosis of the terminal ventricle. By extending the MRI investigation to the entire vertebral column and brain, it was possible to exclude an association with other malformations of the central nervous system. Clinical and radiological follow-up confirmed the nonevolutive nature of the lesion 1 and 2 years later. CONCLUSIONS: The lack of clinical symptoms and the stability of the radiological situation at 1 and 2 years follow-up motivated our choice of conservative treatment.

Adult↗
PubMed2004

Vertebroplasty and kyphoplasty in the treatment of malignant vertebral fractures.

The purpose of this retrospective study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF). We treated 33 oncologic patients with these new techniques (2 pts with aggressive haemangiomas, 8 pts with myelomas and 23 pts with metastases) suffering from severe motion pain in the back, notwithstanding conservative treatment with medication and corset therapy, in the absence of neurological signs. In 3 selected patients we associated radiofrequency heat ablation with vertebroplasty in the treatment of metastases. The aim is to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus before stabilizing the vertebra.

Aged↗
PubMed1999

Cervical synovial cysts: case report and review of the literature.

The authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient's symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1- and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary.

Cervical Vertebrae↗
PubMed1999

The role of MRI in the surgical selection of cerebral metastases.

BACKGROUND: About one third of patients operated on for a "single" cerebral metastasis diagnosed by CT scan have probably more than one lesion. In fact, Gd-DTPA enhanced MRI has proved to be more sensitive than CT in detecting the number of cerebral metastases, reducing the number of patients candidate to surgery. METHODS: Thirty-five patients with a CT scan picture of a single cerebral neoplasm of presumable metastatic nature performed a Gd-DTPA enhanced cerebral MRI. In 25 cases MR images confirmed a single lesion, while in other 10 (28.6%) showed a number of metastases ranging from 2 to 6. In order to assess the utility of MRI in surgical selection of patients and then to reconsider the concept of operability limited to single brain metastases only, we compared the survival of the 25 cases who preoperatively performed MRI (MRI group) with that of other 25 consecutive patients operated on in pre-MR era (during a 24-month period), with a CT picture of single cerebral metastasis (non-MRI group). RESULTS: The median survival was 36 +/- 5 weeks for MRI group and 40 +/- 15 for non-MRI group. The Kaplan-Meier product-limit survival analysis and the log-rank test do not reveal any statistically significative difference of survival between the two groups. CONCLUSIONS: Even if the number of patients is limited for definitive considerations, our preliminary results seem to suggest that the further selection of surgical cases obtained with MRI could not impact significatively the survival. Therefore, in selected patients with multiple cerebral metastases a surgical treatment could be reasonable.

Adult↗
PubMed1999

Intramedullary increased MR signal intensity and its relation to clinical features in cervical myelopathy.

BACKGROUND: Areas of intramedullary hyperintensity in patients with cervical spondylogenetic myelopathy (CSM) have been described and studied by several authors. METHODS: In the present study, 100 patients were reappraised and divided into 2 groups according to whether or not MRI detected areas of hyperintensity on T2-weighted images. RESULTS: Statistical analysis demonstrated that intramedullary hyperintensity is most frequently associated with severe impairment of deambulation, muscular hypotonus-hypotrophy and hypoesthesias of the upper limbs. CONCLUSIONS: These radiological findings probably correspond to various types of lesions which, when irreversible, may influence postoperative neurological recovery.

Adult↗
PubMed1998

Cytochemical and microbiological testing of CSF and catheter in patients with closed continuous drainage via a lumbar subarachnoid catheter for treatment or prevention of CSF fistula.

A study was performed to evaluate the efficacy of closed continuous drainage (CCD) via a lumbar subarachnoid catheter for prevention or treatment of CSF fistulas. In addition to the analysis of the physical, chemical and biological properties of the CSF obtained, the catheters themselves were tested on removal to identify any microorganisms contaminating them. Other factors taken into consideration were the symptoms reported by the patients during positioning of the catheter and while it was in place, any variations in body temperature and local inflammatory effects on the nerve roots of the cauda equine and surrounding tissues. The low percentage of systemic and local infections observed testifies to the safety of this method, regardless of the duration of treatment.

Adult↗
PubMed1998

Early surgical treatment of intracerebral hemorrhages caused by AVM: our experience in 10 cases.

Between February, 1980, and April, 1993. 10 patients with intraparenchymal hemorrhage due to the bleeding of an arteriovenous malformation (AVM) underwent emergency surgical procedures within an average time of 3 hours (min. 2-max. 7) from casualty to admission. Rapid neurological worsening and mass effect of the extensive intracerebral hemorrhage prompted early surgical treatment. Post-operative angiography was performed to confirm that the malformation had been excluded from the circulation. The aim of this study is to evaluate the role of early surgery in patients requiring emergency surgical procedures for severe neurological injury induced by extensive intracerebral hematoma produced by AVM bleeding.

Adolescent↗
PubMed1998

Intracranial actinomycosis in juvenile patients. Case report and review of the literature.

A case of actinomycotic brain infection in a juvenile patient is described. Cases of actinomycosis affecting the head and neck are rare, particularly in juvenile patients. In this case complete resolution of the infection was achieved by means of surgical treatment and prolonged antibiotic therapy. The authors emphasize the importance of a combined approach for treatment of this unusual brain infection and stress the difficulties involved in the diagnosis of this pathology.

Abscess↗
PubMed1998

Tamoxifen and carboplatin combinational treatment of high-grade gliomas. Results of a clinical trial on newly diagnosed patients.

Between April, 1992 and December, 1995, forty consecutive patients with a cerebral malignant glioma (WHO Grade III and IV) were enrolled in a trial consisting in surgery and post-operative administration of radiotherapy (4500-6000 cGy), carboplatin (CBDCA; dose of 450-600 mg/m2), and oral tamoxifen (TAM; at doses of 40, 80 or 120 mg/day). Two patients of the TAM group died in the postoperative period from a pulmonary embolism and myocardial infarction, respectively. The patients (all dosages combined) had a median survival time of 13 months from the time of diagnosis. The 12-month and 24-month survival rates were 52% and 32%, respectively. The median relapse-free survival time was 7 months. Patients treated with higher doses of TAM (80-120 mg/day) demonstrated a longer median survival rate (13 months both) and a longer 12-month survival result (58% and 76%, respectively). Patients who assumed TAM for a period longer than 3 months (group +3) have a higher median survival rate (16 months) and better 12-month and 24-month results (62% and 40%, respectively). Moreover, the median relapse-free survival time was 10 months (versus 6 months in group -3; p = 0.0038). However, it is not possible to exclude that patients of group +3 had a slower growing or a stable tumor and were well enough to assume TAM for a longer period. The results observed in the TAM-group have been compared with those of 40 matched controls treated with surgery, radiotherapy and CBDCA. These patients had a median survival time of 9 months (p = 0.04) and the 12-month and 24-month survival rates were 30% and 0%, respectively. The median relapse-free survival time was 4 months (p = 0.0014). These data suggest a potential role for combinational TAM-CBDCA therapy in the post-operative treatment of cerebral malignant gliomas; further clinical phase III trials, especially those with higher dosages of TAM are warranted.

Administration, Oral↗
PubMed1998

Actinomycosis of the central nervous system: surgical treatment of three cases.

Three cases of actinomycotic brain infection are described, 2 of which manifested as cerebral abscess, the third as epidural empyema. Complete resolution of the infection was always achieved by means of surgical treatment and prolonged antibiotic therapy. The cases reported emphasize the importance of a combined approach in the treatment of this unusual cause of brain infection.

Actinomycosis↗
PubMed1998

Peduncular hallucinosis following a transoral odontoidectomy for cranio-vertebral junction malformation. A case report.

This is a case report of a sixty-two years old man suffering from a cranio-vertebral malformation whose dens epistrophei was removed through a transoral approach. During the postoperative course, he experienced a transient peduncular hallucinosis probably caused by surgical trauma on his brainstem. The possible physiopathological, etiopathological, clinical, and therapeutic aspects of this rare phenomenon are discussed.

Hallucinations↗
PubMed1997

Surgically verified case of optic sheath nerve meningocele: case report with review of the literature.

Optic sheath meningocele is rare; only approximately 31 cases have been reported. The term optic sheath meningocele has recently been proposed by Garrity and Forbes to describe primary CSF cysts of the optic nerve sheath, without apical mass or malformation of the cranio-orbital junction. Presenting symptoms are often related to involvement of the optic nerve, with a slow or rapid decrease of visual acuity. CT and MRI studies reveal a tubular-cystic enlargement of the optic nerve/optic sheath complex (on/onsc), with thickening of the optic nerve. Radiological differential diagnosis should include optic nerve tumors such as gliomas, meningiomas, and arachnoid cysts involving the optic nerve sheath. Up to now, it seems that early surgical management by means of optic nerve/optic nerve sheath decompression affords an improvement of visual function with minimal morbidity in patients who present a rapid decrease of visual acuity within 3-6 months. We present an additional case and discuss the clinical, radiological, and operative features of this pathological condition of the optic nerve sheath.

Adolescent↗
PubMed1997

Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and review of the literature.

Idiopathic epidural spinal lipomas are rare: only 13 cases have been described in the literature. We report a further case in an obese patient without known etiological factors. Diagnosis of epidural lipomatosis was performed by MRI. Weight reduction was obtained by conservative treatment, reserving surgery in case symptoms did not disappear. Of the 8 obese patients with idiopathic epidural spinal lipomatosis described in the literature, 3 were treated conservatively, with complete regression of symptoms in 2 cases, partial in the other one. In our patient, the radicular symptomatology disappeared once he had lost weight.

Adult↗
PubMed1997

MRI in the diagnosis of cystic meningiomas: surgical implications.

Nine cases of cystic meningioma diagnosed by MRI are described. All cases were surgically confirmed. The lesion was extra-axial with a clear dural attachment. On T1-weighted images the solid component was iso-hypo-intense in 6 cases and iso-hyperintense in 3; on T2-weighted images it was hyperintense in 7 cases, iso-intense in 2. After i.v. injection of gadolinium, the solid component enhanced in all cases and a "dural tail" were visible in 8 cases. No gadolinium enhancement of the cyst wall was observed in Nauta's types II and III. The authors found MRI to be very useful for diagnosis of cystic meningioma but insufficient for differential diagnosis between types II and III according to Nauta. This aspect requires further study, especially in view of the implications of this differentiation in terms of surgical management.

Aged↗