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1.
Eur Heart J Case Rep ; 7(5): ytad236, 2023 May.
Article in English | MEDLINE | ID: mdl-37252200

ABSTRACT

Background: Infective endocarditis (IE) is a major issue during follow-up of adults with congenital heart disease (ACHD), leading to significant mortality. Case summary: A 37-year-old woman with transposition of great arteries and previous Mustard operation developed a drug-resistant pneumonia shortly after a pacemaker implant procedure performed at a local hospital. After referral to the ACHD centre, the patient was diagnosed with multivalvular IE with biventricular involvement by methicillin-resistant Staphylococcus aureus. On admission, the patient was already in acute respiratory distress and presented both systemic and pulmonary embolization. Despite adequate treatment was promptly started, the patient developed multiorgan failure. Discussion: This case depicts a particularly aggressive of infective endocarditis forms caused with biventricular involvement and multiple embolization. Patients with congenital heart disease are at high risk of IE with adverse impact on the prognosis. Early recognition and treatment are the keys to improve prognosis. Therefore, suspicion should be high, especially following invasive procedure, which should be preferably performed at ACHD specialized centres.

2.
Neurosurg Rev ; 41(4): 985-998, 2018 Oct.
Article in English | MEDLINE | ID: mdl-28477043

ABSTRACT

During the last 10 years, microscope-integrated indocyanine green fluorescence (m-ICG) has been widely used for assessing real-time blood flow during aneurysm surgery. More recently, an endoscope-integrated indocyanine green fluorescence (e-ICG) has been adopted as a versatile tool during different endoscopic neurosurgical procedures. The purpose of the present report is to evaluate multimodal applications of e-ICG during different endonasal, intraventricular, aneurysm and brain tumor surgeries and provide technical nuances. In addition, we reviewed the literature and identified and compare several overlapping case series of patients treated via an endoscopic integrated indocyanine green fluorescence technique. A total of 40 patients were retrospectively evaluated. Patients were divided into four main groups: (1) endoscopic endonasal approaches (n = 14); (2) ventricular endoscopic approach including patients undergoing third ventriculostomy (n = 8) and tumor biopsy (n = 1); (3) aneurysms surgery (n = 9); and (4) brain parenchymal tumors (n = 8). All patients were successfully treated using the e-ICG dynamic endoscopic visualization, and there were no perioperative complications. Such unique features open up a promising field of applications beyond the use of m-ICG in different surgical field due to the longer duration of e-ICG fluorescence up to 35 ± 7 min. E-ICG represents a new and effective technique for longer real-time visualization of vascular structures preserving normal tissues and functions during different transcranial and endonasal approaches. As the technology and e-ICG resolution improves, the technique has the potential to become a critical tool for different applications in neurosurgery.


Subject(s)
Coloring Agents , Endoscopy/methods , Indocyanine Green , Multimodal Imaging/methods , Neurosurgical Procedures/methods , Animals , Brain/diagnostic imaging , Brain/surgery , Humans , Third Ventricle/diagnostic imaging , Third Ventricle/surgery
3.
World Neurosurg ; 104: 239-247, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28512039

ABSTRACT

BACKGROUND: Fluorescein sodium salt is widely used in medicine as fluorescein isothiocyanate and commonly named fluorescein (FL). This fluorophore has been used as a fluorescent tracer for many applications, especially in ophthalmic surgery. It was initially used in neuro-oncology in 1948 to control tumor resection margins. After a transient disuse, it has recently had a second spring with the development of dedicated filters for operating microscopes, although it is still under evaluation in clinical use. The aim of this study is to contribute to the investigation according to which FL-guided surgery for high-grade glioma (HGG) is related to better rates of gross total resection (GTR) and so to a better outcome. METHODS: We retrospectively analyzed 23 cases of patients with new diagnosis of HGG, operated on in our unit by intraoperative FL use with a filter system directly integrated into an operative microscope (group 1). Fluorescence was compared with histology by biopsies carried out both in the fluorescent areas and in the periphery of fluorescent areas. Group 1 was matched with a control group of 25 patients with HGG operated on in our unit during the last 2 years without FL guidance (group 2). RESULTS: No side effects occurred related to FL. Histology and intraoperative neuronavigation showed strong correspondence with fluorescent and nonfluorescent areas. GTR rate was significantly higher in group 1 (82.6%) than in group 2 (52%). CONCLUSIONS: Intraoperative fluorescein-guided surgery showed safety and feasibility. Our and other studies suggest an improvement of GTR rate in HGG than nonuse.


Subject(s)
Brain Neoplasms/pathology , Brain Neoplasms/surgery , Fluorescein , Glioma/pathology , Glioma/surgery , Microsurgery/methods , Adult , Aged , Contrast Media , Female , Humans , Male , Middle Aged , Neoplasm Grading , Retrospective Studies , Surgery, Computer-Assisted , Treatment Outcome
6.
Clin Neurol Neurosurg ; 113(5): 387-92, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21292389

ABSTRACT

OBJECT: The purpose of this study was to identify the anatomy of pineal region venous complex using neuronavigation software when distorted by the presence of a space-occupying lesion and to describe the anatomical relationship between lesion and veins. Moreover we discuss its influence on the choice of the surgical strategy. METHODS: Of the 33 patients treated at our Institute for pineal region tumors between 2003 and 2008 we used the neuronavigation software to depict the venous system of the pineal region in 14 patients. We focused on depiction of the basal vein of Rosenthal (BV), the internal cerebral vein (ICV) and the vein of Galen: connection patterns between the veins and the type of anatomical distortion caused by the lesion were investigated and classified. RESULTS: Using the neuronavigation software for three-dimensional (3D) reconstruction of MRI images the ICV was clearly depicted in all patients on both sides (100%). Last segment of the BV was identified in 25 sides on a total of 28 (89.3%) and absent in 3 of the 28 sides (10.7%). Studying the distortion effect of the tumor on the galenic venous system, three directions of displacement were observed: craniocaudal, anteroposterior and lateral. Seven patients presented a cranial dislocation, 5 patients caudal dislocation and there was no craniocaudal shift in 2 patients. Considering the anteroposterior displacement: 3 subjects showed an anterior shift of the veins, 5 subjects posterior shift and no anterioposterior shift was present in 6 patients. Only 2 of the 14 patients presented lateral displacement of the veins. The principal approaches used in this series were: supracerebellar infratentorial and interhemispheric parieto-occipital. The craniocaudal displacement of the pineal veins seems to be the most important for the choice of the approach. CONCLUSION: The galenic venous system has a central role in the surgery pineal region tumors. Our study demonstrates that the architecture of the pineal veins and their anatomical relationship with the lesion can be depicted with great accuracy by using 3D neuronavigation software in order to facilitate surgical planning and intraoperative orientation.


Subject(s)
Neuronavigation/methods , Neurosurgical Procedures/methods , Pineal Gland/pathology , Pineal Gland/surgery , Pinealoma/pathology , Pinealoma/surgery , Adolescent , Adult , Aged , Biopsy , Cerebellar Diseases/etiology , Cerebral Veins/anatomy & histology , Cerebral Veins/pathology , Cerebrovascular Circulation/physiology , Child , Child, Preschool , Endoscopy , Female , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Middle Aged , Monitoring, Intraoperative , Pineal Gland/blood supply , Software , Young Adult
7.
J Neurosurg Pediatr ; 6(5): 489-97, 2010 Nov.
Article in English | MEDLINE | ID: mdl-21039175

ABSTRACT

OBJECT: In this paper, the authors' goal was to evaluate the role of neuroendoscopy in the treatment of arachnoid cysts of the quadrigeminal cistern. METHODS: Between March 1995 and February 2008, 14 patients affected by arachnoid cysts of the quadrigeminal cistern were treated endoscopically. The cysts were classified according to their anatomical and radiological appearance. The most frequent form (Type I) extended infratentorially and supratentorially with a dumbbell shape. Type II cysts were confined to the infratentorial space and were associated with the most severe and acute form of hydrocephalus. Type III cysts presented a significant asymmetric expansion toward the temporal fossa. Ten patients underwent an endoscopic procedure as primary treatment and 4 as an alternative to shunt revision. In 6 cases, the first endoscopic procedure was ventriculocystostomy (VC) together with endoscopic third ventriculostomy (ETV). In the other 8 cases, the first endoscopic procedure was VC alone. RESULTS: In the 6 cases in which VC was performed with an ETV, the procedure was successful, and the patients did not require further surgery. Of the 8 cases in which the first endoscopic procedure performed was VC without ETV, 7 underwent reoperation. Four of these patients underwent endoscopic procedures (by reopening the obstructed VC and performing ETV or cystocisternostomy) 2, 4, 4, and 5 months later with final success in all cases. Three patients (all of whom were previously treated using ventriculo- or cystoperitoneal shunts) required shunt reimplantation (complete failure). Subdural collection developed in 1 case, which was managed by transient insertion of a subduroperitoneal shunt. Neurological and developmental outcomes were good except for 1 patient who did not show improvement in preoperative developmental delay. No transient or permanent morbidity or mortality was observed. CONCLUSIONS: The analysis of this series suggests that arachnoid cysts of the quadrigeminal cistern and the associated hydrocephalus can be effectively treated by endoscopy; this approach allows the patient to be shunt independent in more than 78% of the cases. If endoscopy is used as first option, the success rate of endoscopic procedures observed in this series was 90%. Endoscopic third ventriculostomy should be associated with a VC to offer the highest success rate with a single procedure.


Subject(s)
Arachnoid Cysts/surgery , Hydrocephalus/surgery , Neuroendoscopy/methods , Subarachnoid Space , Tectum Mesencephali/surgery , Adolescent , Arachnoid Cysts/diagnosis , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Hydrocephalus/diagnosis , Infant , Infant, Newborn , Lateral Ventricles/pathology , Lateral Ventricles/surgery , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Pregnancy , Reoperation , Tectum Mesencephali/pathology , Tomography, X-Ray Computed , Ultrasonography, Prenatal , Ventriculoperitoneal Shunt/adverse effects , Ventriculostomy/methods
8.
Neurosurgery ; 66(5): 991-8; discussion 998, 2010 May.
Article in English | MEDLINE | ID: mdl-20404706

ABSTRACT

OBJECT: The aim of this study was to demonstrate the anatomy of the quadrigeminal cistern, define the anatomic landmarks, and measure the extension of the cistern in the living by using magnetic resonance (MR) cisternography with 3-dimensional reconstruction. METHODS: The quadrigeminal cistern was examined in 38 patients. We focused on measurements of the superior, posterior, and lateral limits; the anterior and posterior maximal rostrocaudal diameter; the distance between the right and left superior colliculus and the right and left inferior colliculus; and the angle between the quadrigeminal plate and pineal gland. RESULTS: The highest variability was observed for the posterior rostrocaudal diameter with a standard deviation of 3.1 and a range from 8 to 21.1 mm followed by the anterior-posterior diameter with a standard deviation of 2.8 and a range from 6.4 to 16.5 mm. In all cases the distance between the right and left superior colliculus (13.3 +/- 1.8 mm; mean +/- SD) was longer than the distance between the right and left inferior colliculus (11.4 +/- 1.3 mm; mean +/- SD). We classified 2 types of cisterns: closed cisterns with angles between the quadrigeminal plate and the pineal gland ranging from 39 degrees to 63 degrees and open cisterns with angles ranging from 63 degrees to 76 degrees . The analysis of variability by age and sex showed no significant differences. CONCLUSIONS: The MR cisternography with 3-dimensional reconstruction was a simple and noninvasive tool providing detailed anatomic information in the living. It allowed measurement of the high variability of morphology of the quadrigeminal cistern. We defined the lateral landmarks and identified the lateral limit of the cistern. We classified the different shapes of the quadrigeminal cistern as open or closed cisterns. This can be helpful in the choice of the surgical approach to the lesions arising in this area.


Subject(s)
Cisterna Magna/anatomy & histology , Tectum Mesencephali/anatomy & histology , Adolescent , Adult , Aged , Female , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Male , Middle Aged , Neuronavigation , Young Adult
9.
Neurosurgery ; 64(5 Suppl 2): 247-51; discussion 251-2, 2009 May.
Article in English | MEDLINE | ID: mdl-19404105

ABSTRACT

OBJECTIVE: The purpose of this study was to delineate the anatomy of the precentral cerebellar vein, superior vermian vein, and internal occipital vein using reconstructions of computed tomographic and magnetic resonance imaging scans with navigation software. These data were compared with previous anatomic and angiographic findings to show the resolution and accuracy of the system. METHODS: We retrospectively reviewed 100 patients with intracranial pathologies (50 computed tomographic scans with contrast and 50 magnetic resonance imaging scans with gadolinium) using a neuronavigation workstation for 3-dimensional reconstruction. Particular attention was paid to depiction of the precentral cerebellar vein, superior vermian vein, and internal occipital vein. The data were reviewed and analyzed. RESULTS: The precentral cerebellar vein, superior vermian vein, and its tributary, the supraculminate vein, were depicted in 52 (52%) patients. The internal occipital vein was delineated on 99 (49.5%) sides and joined the basal vein and vein of Galen in 39 (39.4%) and 60 (60.6%) hemispheres, respectively. Comparing these results with previous angiographic studies, the ability of the neuronavigation system for depicting these vessels is similar to that of digital subtraction angiography. CONCLUSION: This study illustrates the possibility of depicting the small vessels draining into the pineal region venous complex using 3-dimensional neuronavigation with an accuracy comparable to that of digital subtraction angiography. This tool provides important information for both surgical planning and intraoperative orientation.


Subject(s)
Cerebral Veins/surgery , Magnetic Resonance Imaging/methods , Neuronavigation/methods , Neurosurgical Procedures/methods , Preoperative Care/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Angiography, Digital Subtraction/standards , Brain/blood supply , Brain/surgery , Cerebral Veins/anatomy & histology , Cerebral Veins/diagnostic imaging , Female , Humans , Image Processing, Computer-Assisted/instrumentation , Image Processing, Computer-Assisted/methods , Intraoperative Complications/prevention & control , Magnetic Resonance Imaging/instrumentation , Male , Middle Aged , Neuronavigation/instrumentation , Neurosurgical Procedures/instrumentation , Pineal Gland/anatomy & histology , Pineal Gland/blood supply , Pineal Gland/surgery , Postoperative Hemorrhage/prevention & control , Preoperative Care/instrumentation , Retrospective Studies , Software , Software Validation , Tomography, X-Ray Computed/instrumentation , Young Adult
10.
Childs Nerv Syst ; 25(5): 521-2, 2009 May.
Article in English | MEDLINE | ID: mdl-19107491

ABSTRACT

Aicardi syndrome is an X-linked dominant disorder characterized by the pathognonomic association of three clinical signs: agenesis of the corpus callosum, infantile spasms, and chorioretinal lacunae. This is a severe syndrome with an estimated survival rate of 76% at 6 years and 40% at 14 years and a maximum developmental level like a 12-month-old baby in 91% of cases. We illustrate a case of Aicardi syndrome with bilateral, small chorioretinal lacunae, infantile spasms with a typical hypsarrhythmia, defects of thoracic vertebra and bilateral absence of the 12th rib associated with an arachnoid cyst of the quadrigeminal cistern, and presence of the corpus callosum with a favorable outcome.


Subject(s)
Agenesis of Corpus Callosum , Arachnoid Cysts/pathology , Brain Diseases/diagnosis , Retinal Diseases/pathology , Spasms, Infantile/pathology , Tectum Mesencephali/abnormalities , Brain Diseases/pathology , Female , Humans , Infant , Magnetic Resonance Imaging , Prenatal Diagnosis , Syndrome
11.
Neurosci Lett ; 394(1): 57-62, 2006 Feb 06.
Article in English | MEDLINE | ID: mdl-16257120

ABSTRACT

Immunohistochemical and biochemical investigations showed that significant protein nitration occurs in human gliomas, especially in grade IV glioblastomas at the level of astrocytes and oligodendrocytes and neurones. Enhanced alpha-tubulin immunoreactivity was co-present in the same elements in the glioblastomas. Proteomic methodologies were employed to identify a nitrated protein band at 55 kDa as alpha-tubulin. Peptide mass fingerprinting procedures demonstrated that tubulin is nitrated at Tyr224 in grade IV tumour samples but is unmodified in grade I samples and in non-cancerous brain tissue. These results provide the first characterisation of endogenously nitrated tubulin from human tumour samples.


Subject(s)
Brain Neoplasms/metabolism , Glioma/metabolism , Tubulin/metabolism , Tyrosine/analogs & derivatives , Aged , Astrocytes/metabolism , Blotting, Western/methods , Chromatography, High Pressure Liquid/methods , Female , Glioma/pathology , Humans , Immunohistochemistry/methods , Male , Middle Aged , Neurons/metabolism , Proteomics/methods , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , Tyrosine/metabolism
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