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Biomedical subjects

P Missori

Publications and source records attributed to P Missori.

At least 19 recordsLinked to original sources
PubMed2006

Surgical exposure of lateral orbital lesions using a coronal scalp flap and lateral orbitozygomatic approach: clinical experience.

BACKGROUND: The lateral extraconal compartment is a typical localization of intra-orbital tumours. With the exception of anterior lesions, which can be reached by a transconjuntival route, most of these tumours are currently approached through the classic lateral orbitotomy originally described by Kronlein. We present here our experience in the management of lateral orbital lesions, using a coronal skin flap, followed by subfascial dissection of the temporalis muscle. The procedure was intended to overcome the potential drawbacks associated with the classic transtemporal approach. METHODS: The approach was used in eleven patients harbouring bone lesions of the lateral orbital wall or intra-orbital lesion of the lateral extra-ocular compartment. The postoperative results were assessed using a simple cosmetic outcome scale, which evalutated the temporalis muscle trophism and the function of the frontotemporal branch of the facial nerve. RESULTS: All lesions were satisfactorily exposed. The subfascial dissection of the temporalis muscle is a key manoeuvre which, at the same time, abolishes the risk of injury to the frontotemporal branch of the facial nerve and provides a wide exposure of the lateral orbital wall. The cosmetic outcome was excellent in 9 patients and good in 2 patients. CONCLUSIONS: The reported technique is a convenient surgical option to approach lateral intra-orbital lesions, with a minimal cosmetic impact.

Adult↗
PubMed2006

Ghost lesions in patient with cerebral-isolated neurosarcoidosis. A case report.

We present a case of isolated cerebral neurosarcoidosis with remitting nodular lesions resembling intraventricular neoplasms. The patient, admitted at our Department for surgical treatment of a magnetic resonance imaging (MRI) demonstrated fourth ventricle lesion, presented acute intracranial hypertension. A second MRI performed before the scheduled operation showed the disappearance of the fourth ventricle lesion and a tetra-ventricular hydrocephalus. The patient has been treated with a third-ventriculostomy, followed, after 15 days, by ventriculoperitoneal shunt. High doses of steroids have been administered. Cerebrospinal fluid analysis has been conducted and a high concentration of ACE, specific marker of neurosarcoidosis, has been found. No biopsy was performed to avoid surgical complications. A systemic chemotherapy with azathioprine has been started, but the patient died six months later for worsening of the clinical conditions. The autopsy confirmed the diagnosis of neurosarcoidosis. This is the first MRI documented case of neurosarcoidosis with remitting lesions. Diagnosis of isolated neurosarcoidosis is difficult and it is based on clinical and radiological exclusion of other entities. CSF examination is useful for diagnosis, for the reported specificity and sensibility of ACE. Medical treatment is based on corticosteroids and chemotherapic agents. Neurosurgical intervention can be related to treat hydrocephalus due to ependymal and arachnoidal involvement or to remove large lesions. In our opinion biopsy should be limited only to ACE negative patients and to those who do not respond to chemotherapy.

Brain Diseases↗
PubMed2005

Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine.

Surgical exposure of intradural lesions in the thoracic spine requires intraoperative landmarks to identify the vertebral level. If spinal neuronavigation is not available, the surgeon must rely on alternative localizing methods. Intraoperative fluoroscopy is traditionally used to count the vertebrae throughout the whole spine. In the high thoracic spine, counting the vertebrae is often hampered by the scapular shadows. In these cases, a preoperative marking procedure seems preferable. Magnetic resonance imaging (MRI) based techniques have been increasingly reported, but they share an intrinsic risk of error due to the skin shift occurring at the time of surgery. We describe here a simple technique for unequivocal identification of the vertebral target. In six patients undergoing surgery for intradural lesions of the high thoracic spine, the spinous process of the vertebra corresponding to the lesion was preoperatively identified on an anteroposterior radiograph view and marked infiltrating its tip with a blue dye. At surgery, the vertebral target was identified easily and immediately. No errors occurred. No complications related to the technique were observed. Preoperative marking of the vertebral spinous process with a coloured dye is a simple and unequivocal guide to expose intradural lesions in the high thoracic spine.

Coloring Agents↗
PubMed2003

Progressive quadriparesis in adolescent with stenosis of the cervical spine.

INTRODUCTION: Progressive quadriparesis in adolescents suffering from cervical stenosis is a very rare entity. Only three cases have been reported in the literature. CASE REPORT: We report our own case of progressive quadriparesis in a young patient suffering from cervical stenosis, the first to be documented with pre- and postoperative magnetic resonance imaging.

Adolescent↗
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

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

Reconstruction of suboccipital craniectomy with autologous bone chips.

BACKGROUND: In patients submitted to suboccipital craniectomy in whom the bone is not repositioned, there may be a significant aesthetic defect due to lack of bone tissue, sometimes accompanied by paresthaesia and painful symptoms. METHOD: In 15 patients submitted to suboccipital craniectomy, the bone chips were repositioned during wound closure. FINDINGS: At a mean follow up of 19 months (from 6 to 36 months), 2 patients (13%) complained of mild wound discomfort or occasional local pain. Twelve patients underwent control CT-scan. In three cases (25%) the bone fragments had been partly reabsorbed whereas in the other 9 (75%) they either formed a thin (4 patients) or consistent (5 patients) bony wall, with variable degree of adaptation to the contour of the contralateral occipital bone. The best cosmetic and functional results were obtained in young patients in whom the cerebellar parenchyma was well-preserved, as opposed to those in whom a CSF collection had replaced areas of cerebellar tissue. INTERPRETATION: In the majority of cases in whom an osteoplastic suboccipital craniotomy is not possible, repositioning of the bone chips from suboccipital craniectomy is able to restore a bone table, thus allowing morphological and functional recovery of the occipital region.

Arnold-Chiari Malformation↗
PubMed2002

Atypical tentorial meningioma 30 years after radiotherapy for a pituitary adenoma.

Although the human central nervous system used to be considered relatively resistant to the carcinogenic action of ionizing radiation, several lines of evidence now document a high incidence of secondary tumors in irradiated patients. The numerous reports of radiation-induced cerebral meningiomas generally distinguish those induced by high-dose radiation from those induced by low-dose radiation. We describe the case of patient who underwent subtotal resection of a chromophobe pituitary adenoma at the age of 18 years, who was successively treated by conventional fractionated radiotherapy with gamma rays emitted by a source of 60Co until a total dose of 41 Gy. Over the next 30 years the patient experienced all the known late effects of radiation, including panhypopituitarism, cranial-nerve deficits (II, III and VI), massive radiation necrosis involving the left cerebral hemisphere and causing right hemiparesis and aphasia and, ultimately, an atypical tentorial meningioma with early recurrence after total resection.

Adenoma, Chromophobe↗
PubMed2000

Spontaneous acute subdural hematomas. A clinical comparison with traumatic acute subdural hematomas.

A comparison was made between factors influencing survival in patients operated on for acute spontaneous subdural hematomas (ASSH) and other groups of patients operated for acute, post-traumatic, subdural hematoma reported in the literature. The data of 17 patients operated on for ASSH were collected. Four variables: early surgical treatment, high Glasgow Coma Scale score on admission, pupillary reactivity and age were statistically analyzed. The most significant factors for good outcome, in order of importance, were early surgical treatment, a high Glasgow Come Scale score on admission, good pupillary reactivity and younger age. The prognostic factors in non-traumatic and traumatic acute subdural hematomas were found to be identical.

Acute Disease↗
PubMed2000

Chronic subdural haematomas in patients aged under 50.

The clinical findings in 31 patients with chronic subdural haematoma (CSH), aged between 20 and 50, are described. Aetiopathogenetic factors responsible for the formation of CSH match those of patients aged over 50 with CSH. A history of cranial trauma was present in 77% of the cases. In the remaining patients, a defect of haemostatic mechanisms was responsible for the subdural blood collection. On the computed tomography (CT) the haematoma generally appears as a thin subdural layer. The reliability of magnetic resonance imaging for detection of CSH makes it the most desirable investigation in such patients. Prognosis is influenced by preoperative clinical status and by the disease responsible for the formation of CSH.

Adult↗
PubMed2000

Immediate postoperative CT to assess the correct positioning of a ventricular catheter.

Positioning of the ventricular catheter is safe using standard techniques, but in some cases there may be failure of a shunt because of incorrect placement. We carried out CT at the end of the surgical operation on 10 patients who had undergone cerebrospinal fluid shunting while still anaesthetized. In three cases a malpositioned catheter was detected. Immediate reoperation allowed readjustment of the ventricular catheter. Early postoperative CT appears to be useful for verifying correct placement.

Catheterization↗
PubMed2000

Supratentorial hemangioblastoma in a patient with breast cancer. A case report.

Patients with breast cancer may develop cerebral metastasis. Radio- and chemotherapy are advocated as an alternative to surgery in such patients. A woman operated on for breast cancer 2 years earlier developed a cerebral lesion. A definite preoperative diagnosis of the lesion was not possible on the basis of CT and MRI findings. The lesion proved to be a supratentorial hemangioblastoma. Neurosurgical treatment is recommended for patients with breast cancer who present a cerebral lesion, since a correct diagnosis may only be possible in the operating theater.

Aged↗
PubMed1999

Gunshot wound of the atlas in a youth.

The case of a bullet retained, without causing neurological symptoms, in the anterior arch of a youth's atlas after a gun had been fired a short distance from his mouth is reported. The patient was managed with external stabilization.

Adolescent↗
PubMed1999

Cavernous angiomas of the brain stem. Intra-axial anatomical pitfalls and surgical strategies.

BACKGROUND: We review the surgical anatomy of the brain stem in relation to the surgical approaches adopted for treatment of cavernomas and identify possible "safe entry zones" on the anterior face of the brainstem. METHODS: Twelve symptomatic patients with cavernoma or telangectasia of the brain stem were surgically treated. The brain stem was divided into the following anatomical areas: ventral medulla, dorsal medulla, dorsal pons, ventral pons, ventral mesencephalon, and dorsal mesencephalon, so that the surgical approach could be "individualized" according to the position of the cavernoma, the nerve fasciculi and nuclei. RESULTS: On the anterior surface of the brain stem a medullar paramedian oblique access to the anterolateral sulcus and a paramedian sagittal pons access seem to avoid the main nerve fasciculi and nuclei. CONCLUSIONS: Although the parenchymal window produced by the cavernoma is the most important parameter for the choice of approach, fairly safe entry zones may be identified even on the anterior surface of the medulla and pons.

Adult↗
PubMed1998

Chronic subdural haematoma: a possible relationship with tamoxifen.

Five patients operated on between 6 months and 7 years earlier for breast cancer were surgically treated for chronic subdural haematoma. This unusual association may be explained on the basis of known factors such as coagulative impairment subsequent to chemotherapy, a degree of cerebral atrophy or mild trauma. On the other hand, since four of the patients were taking antioestrogen therapy to control the disease, it is speculated that the oestrogenic properties of tamoxifen may have contributed to subdural bleeding.

Aged↗
PubMed1996

Primary benign tumors of the orbital cavity: comparative data in a series of patients with optic nerve glioma, sheath meningioma, or neurinoma.

BACKGROUND: Patients operated on for the most common benign pathologies of the orbital cavity-optic nerve glioma, sheath meningioma and neurinoma-should be surgically treated. However, postoperative visual impairment is frequently inevitable. A wait-and-see policy due to a slow rate of growth of these lesions is criticized. METHODS: Collecting data from three series of patients operated, we compare the surgical procedures and long-term results. RESULTS: "En bloc" removal in patients with optic nerve glioma led to complete visual deficit but ensures excellent long-term prognosis. Because optic nerve meningiomas are typically circumferential to the optic nerve and adhere tightly to the perineural pial microvascular structures, it is impossible to avoid trauma to the optic nerve and recurrences. Patients with neurinoma of the orbital cavity have the most favourable prognosis both in terms of visual function as well as long-term quality of life. Due to its slow rate of growth, a wait-and-see policy can be adopted for optic nerve glioma before deciding on surgical removal, whereas surgical treatment of meningioma may be postponed if symptoms are slight and steady. Removal of orbital cavity neurinoma should not be postponed since surgical outcome is excellent.

Adolescent↗