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Biomedical subjects

S Giombini

Publications and source records attributed to S Giombini.

33 records · Page 2Linked to original sources
PubMed1989

Spinal meningiomas: review of 174 operated cases.

The long-term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow-up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow-up). Twenty-nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results.

Adolescent↗
PubMed1988

Surgical approach to giant aneurysms of the anterior circulation.

The surgical approach to cerebral giant aneurysms is still a source of great concern. We describe our experience with giant aneurysms of the anterior circulation and discuss the different surgical techniques adopted. During the period January 1972-December 1985, a total of 33 patients were operated upon at the Istituto Neurologico "C. Besta" of Milan for a giant aneurysm of the anterior circulation. Nineteen cases had suffered subarachnoid haemorrhage before admission; in 14 cases the hospitalization was due to evidence of mass effect on the surrounding neurovascular structures. All aneurysms were directly approached: in 24 cases the neck was occluded by a suitable clip, in 4 cases intramural thrombosis was attempted, in 3 cases the aneurysms were definitively trapped and in one case aneurysmorrhaphy was performed after resection of the sac. Operative mortality was 12%. Long-term follow-up shows good results whenever exclusion of the aneurysm from cerebral circulation had been achieved, either after removal of the sac or not; on the contrary, only fair or poor results were evident when other surgical techniques were adopted, either electively or out of necessity. The importance of intraoperative protection and monitoring of brain function is stressed.

Adult↗
PubMed1988

Microsurgical treatment of intramedullary spinal cord tumours.

A series of 81 patients operated for intramedullary spinal cord tumours over a span of 12 years (1975-1986) is presented. The mean age of the patients was about 37 years and 9 patients were in the paediatric age (0-15 years). In 29 cases (36%) the tumours were located within the cervical region; in 34 cases the tumours were located in the thoracic region (42%) and in 18 cases the tumours were located within the medullary cone (22%). Ependymoma accounted for 52% of the cases (42 cases), astrocytoma for 20% (16 cases), lipoma for 7% (6 cases), hemangioblastoma for 6% (5 cases), metastatic tumours for 5% (4 cases); in the remaining 8 cases (10%) rare or very rare spinal tumours were found. The 9 patients in the paediatric age and 8 additional cases who had undergone previous surgery were then excluded from this review. In 59% of the patients with ependymoma and in 90% of the patients with astrocytoma severe neurological deficit were already present before the operation. Total tumour removal was accomplished in 81% of the cases with ependymoma, total or subtotal removal was achieved in 50% of the cases with astrocytoma. At long term follow-up study fair or good functional results were observed in 19 out of 41 cases of ependymoma (46%) and in 3 cases out of 10 of astrocytoma (30%). The surgical outcome was mostly related to the preoperative neurological conditions and to tumour malignancy grade.

Adolescent↗
PubMed1988

Subarachnoid hemorrhage of unexplained cause.

During a 7-year period, we observed 58 patients with signs and symptoms of subarachnoid hemorrhage (SAH) in whom clinical and neuroradiological investigations failed to reveal a reasonable cause of the bleeding. Repeat panangiography was negative in the 2 patients with spasm. Rebleeding episodes soon after admission were rare, and the overall rebleeding rate was 3.4% (equivalent to an annual recurrence of 0.6%). In 1 case, a second extensive angiographic evaluation showed a small cerebral arteriovenous malformation, which was successfully treated surgically. On follow-up, 89% of the patients experienced a good outcome, with return to normal activities. This study confirms a good prognosis for patients with SAH of unknown cause. The necessity of performing a second angiographic study and the role of small infundibular dilations of the cerebral arteries are discussed.

Activities of Daily Living↗
PubMed1984

Late outcome of operations for supratentorial convexity meningiomas. Report on 207 cases.

Brief remarks on the immediate outcome of operations on 207 convexity meningiomas are followed by a fuller discussion of the late sequelae, the problem of recurrences and relevance of histology, and the persistence or de novo onset of epilepsy. While the immediate outcome is more than satisfactory, there is still room for improvement in the late outcome of surgical treatment for this category of intracranial tumor.

Adult↗
PubMed1984

Extra-intracranial arterial bypass in typical carotid reversible ischaemic deficits: long-term follow-up in 100 patients.

The long-term follow-up of 100 consecutive patients who suffered from a reversible ischaemic attack (RIA) in the carotid territory and were submitted to extra-intracranial arterial bypass (EIAB) surgery in seven Italian Neurosurgical Centres is reported. The preoperative angiographic and clinical features, and the surgical complications are reported. The follow-up ranged from two to seven years with a mean of thirty-five months. In this period in the territory served by the bypass only two completed strokes and six RIAs occurred. Four patients died, only one for cerebral ischaemic problems. The results of the present series have been compared with those of the literature: they appeared consistent with other surgical series and clearly better than those of medical treated patients. The EIAB can then be considered a good therapeutic choice for the treatment of RIAs in carotid territory.

Adult↗
PubMed1978

Cavernous angiomas of the brain. Account of fourteen personal cases and review of the literature.

Fourteen cases of cerebral cavernous angiomas are reported and the literature pertaining to the subject is reviewed. Some of these rare malformations remain asymptomatic throughout life, some give rise to symptoms (epileptic seizures with or without haemorrhage or slowly evolving focal nervous deficits) which usually appear in adult life. Precise pre-operative diagnosis is difficult, as at angiography they most often appear as avascular space-occupying lesions. Surgical removal is easy in most cases, and the operative outcome is good.

Adolescent↗