A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh.

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A biological mesh might offer a solution for CAWD repair, but the clinical outcomes are unclear. Here, we evaluated the efficacy of a cross-linked, acellular porcine dermal collagen matrix implant (Permacol) for CAWD repair in a cohort of 60 patients. Here, 58.3% patients presented with a grade 3 hernia (according to the Ventral Hernia Working Group grading system) and a contaminated surgical field. Permacol was implanted as a bridge in 46.7%, as an underlay (intraperitoneal position) in 38.3% and as a sublay (retromuscolar position) in 15% of patients. Fascia closure was achieved in 53.3% of patients. The surgical site occurrence rate was 35% and the defect size significantly influenced the probability of post-operative complications. The long-term (2 year) hernia recurrence rate was 36.2%. This study represents the first large multi-centre Italian case series on Permacol implants in patients with a CAWD. Our data suggest that Permacol is a feasible strategy to repair a CAWD, with acceptable early complications and long-term (2 year) recurrence rates.

Diastematomyelia and tumor in adults: report of two cases and literature review.

STUDY DESIGN: Case report and review of the literature. OBJECTIVE: To report on 2 rare cases of association of diastematomyelia with dysembryogenetic tumors and revision of the literature. SUMMARY OF BACKGROUND DATA: Diastematomyelia is an occult spinal diastrophism pathologically characterized by a clefting of the spinal cord with/without its overlying structures. It is often associated with vertebral bony abnormalities, cutaneous lesions, myelomeningocele, hydrocephalus, hydromyelia, Chiari syndrome or Klippel-Feil syndrome. The association of diastematomyelia with dysembryogenetic spinal tumors in adults is extremely rare. Only 13 cases were detected in a literature review since 1951. We report on our experience with 2 new cases. METHODS: An 87-year-old man and a 38-year-old woman presented to our department with incomplete cauda equina syndrome. Both patients underwent complete preoperative imaging. Complete surgical removal of the tumor was performed. Details of these were compared with the ones encountered in literature. RESULTS: Both patients presented complete recovery in the follow-up. From the review of 15 adults described in literature including the present cases, the age ranged between 11 and 87 proving an open rage of onset of symptoms. CONCLUSION: The results of surgery were unclear in literature. In our experience, radical surgery was feasible and good clinical results were obtained.

Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature.

BACKGROUND: We present a series of 179 spinal neurinomas consecutively observed at the Department of Neurosurgery at the University of Florence for a period of 30 years (between 1967 and 1997). We decided to limit the retrospective study to obtain at least 5 years of follow-up. Therefore, 20 additional neurinomas treated between 1997 and 2002 were excluded. METHODS: All the cases are evaluated under statistical, clinical, neuroradiological, and surgically technical profiles based on data from clinical records and from periodic check-ups after surgery. In particular, the results are analyzed on the basis of an accurate pre- and postsurgical evaluation using Karnofsky's scale and Kleklamp-Samii's scoring system. RESULTS: We treated 179 spinal neurinomas in 152 (93 male and 59 female) patients. The mean age was 44.3. In 33 cases the neurinoma was sited in the cervical tract, in 59 cases in the dorsal tract, and in 87 cases in the lumbo-sacral tract. Eleven patients harbored Recklinghausen's neurofibromatosis (7 NF1 and 4 NF2 of which 1 was intramedullary). In 123 cases the neurinoma was intradural, in 11 cases it was extradural, in 2 intra/extradural, in 9 it had a dumbbell form, and in 2 cases it was intramedullary; the remaining cases had neurofibromatosis. The most common presurgical symptom was segmental pain. Total removal of the lesion was possible in the first operation for 174 neurinomas. We encountered 3 cases of malignant neurinoma of which 1 was in NF2. The result of surgery was recovery in 108 cases; 2 patients with NF2 died, and local recurrence occurred even after total exeresis (excision) and radiotherapy in the cases of malignant neurinoma. CONCLUSIONS: Schwannomas represent the most frequent tumor lesions of the spine with prevalence for the cervical-inferior tract and the dorso-lumbar passage. Intramedullary neurinomas are rarely observed. The total surgical removal of neurinomas is often an attainable goal, and clinical improvement is the common outcome with exception to malignant forms and NF2 neurofibromatosis. We describe a series of 179 treated schwannomas.