Anterior optic pathways gliomas are classifiable histologically and clinically with other pilocytic gliomas of the midline (of hypothalamus and brainstem), especially of childhood. The very slow course, sometimes imperceptible over the years, that characterizes the majority of them should not be taken to mean lack of growth. Tumultuous courses and acute episodic deteriorations are both possible. Hence the need for therapy. Indefinite abstention cannot be upheld, at least in the great majority of cases. In gliomas of a nerve only the object of surgery is usually removal, using the intraorbital, intracanalicular and intracranial approaches, but in gliomas of the chiasm or chiasm-hypothalamus the object is more exploratory and decompressive. Radiotherapy is generally accepted as affective only in the latter cases. No single standard protocol is possible: treatment had to be individualized case by case.

Adult↗

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[Surgery in the phakomatoses].

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Angiomatosis↗

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[Sturge-Weber syndrome with bilateral intracranial calcifications and no cutaneous nevus. A propos of 2 cases].

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Adolescent↗

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Cervical tumors of infancy and childhood.

Primary spinal cord tumors of childhood and adolescence affect the cervical segment with the same frequency as other segments. Apart from epidermoids and dermoids, all oncotypes are represented. Astrocytomas and lipomas seem to prefer these metameres. Differential diagnosis has been habitually problematic for cord compression in children. Cervical tumors are too often mistaken for congenital torticollis, birth palsy, cerebral palsy and posterior fossa tumors. Of the various diagnostic aids, CT is of great importance and in selected cases so is vertebral angiography. An aggressive surgical strategy is favored with radicality as the aim. However, the manipulation of solid intramedullary gliomas at cervical level carries the risk of immediate and severe complications (hyperthermia, respiratory failure, sleeping apnea) and the long term results are not satisfactory. There is less risk of postoperative spinal deformity at cervical than at lower levels.

Child↗

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[Neurosurgery in Rome: 1880-1970].

Among many factors contributing to the birth of Neurosurgery, the "awareness of feasibility" of neurosurgical procedures is especially significant. June 1st, 1885 is the arbitrary birthdate of Neurosurgery in Rome: Francesco Durante, Professor of Surgery at the Royal University, successfully resects an olfactory groove meningioma, arising admiration worldwide. Roberto Alessandri succeeds Durante in 1919. In roman hospitals outstanding surgeons perform from time to time neurosurgical procedures, sometimes with satisfactory results: Paolo Postempski, Cesare Antonucci, Guido Egidi and Raffaele Bastianelli, first director of the "Regina Elena" Cancer Institute (IRE) (April 1933) and friend of Harvey Cushing. Angelo Chiasserini sr. is however the first roman surgeon constantly committed to Neurosurgery and founder of the first neurosurgical unit in Italy, in 1937; also, from 1941 to 1944 he directs a neurosurgical service at the "Celio" military hospital of Rome, to which patients from the various battle theatres are referred. While Mario Margottini and Piero Frugoni follow Bastianelli's steps at the IRE, the roman neurosurgeons Felice Visalli and Libero Ugelli serve in the Army, during the greek-albanian conflict and in Russia, respectively. In May 1955 Beniamino Guidetti, an Olivecrona pupil, is called at "La Sapienza" University of Rome and elevates the neurosurgical clinic at the highest standards. The other main neurosurgical pole is founded in 1958 at the San Camillo Hospital: within both institutions modern neurosurgical teams are formed along with neuroradiological and neuroanesthesiological staffs.

History, 19th Century↗

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[Surgery of lumbar disk hernia: historical perspective].

Although the clinical picture of discogenic sciatica is well known already in the ancient world, it is not until 1933 that WJ Mixter and JS Barr provide the correct pathogenetic interpretation and suggest surgery as the treatment of choice. The work of the American Authors was however based on the knowledge acquired during the previous centuries starting with Domenico Cotugno, who first suggested the neurogenic nature of sciatica (1764) and later with the neurologists of the french school Valleix, Lasègue, Dejerine, Sicard who elucidated the semeiology and debated in detail the etiopathogenesis of the condition. The german pathologists Schmorl and Andrae (1927-29) are to be credited for their contribution to the pathology of intervertebral disc, recognizing the frequency and degenerative (not neoplastic) nature of nucleus pulposus herniation. Surgery of disc herniation starts with Oppenheim and Krause (1909). Mixter and Barr used laminectomy and a transdural route although a more limited approach to the spinal canal had already been proposed by the italian Bonomo (1902), unknown to many. Love, of the Mayo Clinic (1937-39) introduced the extradural/interlaminar approach while Caspar and Yasargil (1977) applied the concepts of microsurgery to the procedure. The latest advances are represented by percutaneous and endoscopic techniques.

Animals↗

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[Current trends and prospects of fetal neurosurgery].

Fetal surgery failed up to now to correct early in gestation nervous system pathologies before an irreversible damage occurs. The major hindrance is the induction of preterm labour considered for fetal surgery what rejection is for organ transplantation. Pharmacological tocolytic control seems an essential step before a routine surgery is established. In the meanwhile miniinvasive endoscopic surgery holds out the best promises, minimizing fetal and maternal stress. There are many convincing experimental evidences that endoscopic surgery may prevent secondary neurological damage of spinal cord in the myelomeningocele. Vascularized latissimus dorsi muscle flap or skin graft were effectively used, with endoscopic techniques, to create a protective patch to preserve the nervous tissue from mechanical and/or chemical damage. Endoscopic implant of neurons-rich grafts in damaged cerebral sites, with beneficial behavioural effects and increased learning capacity in the recipient animal with respect to controls, disclose further perspectives to fetoscopic surgery.

Animals↗