Transnasal endoscopic management of frontal sinus mucopyocele with orbital and frontal lobe displacement as minimally invasive surgery.

AIM: An obstructive condition of paranasal sinus secondary to surgery, trauma, flogosis or neoplasms could become a predisposing state to the occurrence of mucocele. Frontal sinus mucoceles, which can turn into mucopyoceles due to bacterial super-infections, may invade the orbit, erode the skull base and displace respectively the ocular bulb and the frontal lobe. The surgical treatment of this disease ranges from mini-invasive approaches, such as the transnasal endoscopic marsupialization, to a more aggressive surgery such as osteoplasty through coronal flap and frontal sinus exclusion by fat tissue. METHODS: From 2005 to 2007, we treated with transnasal endoscopic surgery 10 patients, affected by frontal sinus mucopyoceles displacing both the ocular bulb and the frontal lobe. RESULTS AND DISCUSSION: In the present study, we report the clinical and diagnostic features of this series, the treatment modalities and the achieved results and confirm the effectiveness of the mini-invasive transnasal endoscopic technique in the treatment of the frontal sinus mucopyocele.

Endoscopic sinus surgery for a tension pneumocephalus after severe cranio-facial trauma.

Tension pneumocephalus is a rare form of pneumocephalus in which the air is under pressure; it is generally due to communication between the atmosphere and the intracranial cavity, and is an infrequent (0.88%) complication of cranial trauma. Tension pneumocephalus causes an increase in intracranial pressure with deterioration of the neurological situation and requires emergency treatment. Endoscopic surgery of the paranasal sinuses, which is generally applied in the diagnosis and treatment of fistulas with cerebrospinal fluid leakage, was here used to treat a case of pneumocephalus due to cranio-ethmoidal communication, in a patient we had treated previously for severe cranio-facial trauma.

Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis.

The failed back surgery syndrome (FBSS) is a severe, long-lasting, disabling and relatively frequent (5-10%) complication of lumbosacral spine surgery. Wrong level of surgery, inadequate surgical techniques, vertebral instability, recurrent disc herniation, and lumbo-sacral fibrosis are the most frequent causes of FBSS. The results after repeated surgery on recurrent disc herniations are comparable to those after the first intervention, whereas repeated surgery for fibrosis gives only 30-35% success rate, and 15-20% of the patients report worsening of the symptoms. Computerized tomography (CT) with contrast medium and, in particular, Gd-DPTA enhanced MRI have recently allowed a differentiation between these two pathologies permitting us to adopt different therapies. In 1982-92 we applied spinal cord stimulation (SCS) as a first therapy of FBSS with proven lumbo-sacral fibrosis. Fifty-five patients underwent percutaneous trial SCS with a mono/multipolar electrode placed at the level of Th9-12. In the 36 patients who had a positive response to the trial stimulation, the electrode was connected to an implantable neurostimulator. On January '94 a third party, not involved in the treatment of the patients, controlled 34 of the 36 patients with a mean follow-up of 55 months. We classified the patients reporting at least 50% pain relief and satisfaction with result as successful, and 56% of the patients fell in that category. 10 out of 34 patients were able to resume their work. The success rate was significantly higher in females (73%) than in males, and in radicular rather than axial pain. Our data have led us to consider SCS as a first choice treatment in FBSS due to lumbo-sacral fibrosis.

Automated percutaneous discectomy in herniated lumbar discs treatment: experience after the first 200 cases.

Two hundred patients presenting lumbo-sacral radicular pain were treated with automated percutaneous discectomy and were divided into two groups, on the ground of their symptomatology: group A included those patients that, otherwise, would undergo conservative therapy, because of their moderate pain; group B gathered patients whose severe pain needed undelayed surgery. The success rate that we reported in group A was 85%, while, in group B, it was 64%. Recurrences needing open surgery occurred in 15% of group B. Although characterized by delayed recovery, this technique seems to have good results even in so called surgical patients, in comparison with open surgery.

[Cerebral abscess as a result of a ventriculo-peritoneal shunt]. / Ascesso cerebrale da shunt ventricolo-peritoneale.

The authors relate a rare case of cerebral abscess, complication of a ventriculo-peritoneal derivation. They discuss its etiopathogenesis and underline the importance of cerebral TAC for both diagnostical and post-operatory checking purposes.

[Chronic epidural hematoma. 53 cases subjected to surgery]. / L'ematoma epidurale cronico. Studio di 53 casi operati.

The authors report the observation of 53 cases of supratentorial Chronic Epidural Hematomas submitted to surgical operation. After discussing their physiopathology, the authors, dwell upon some characteristics of these traumatic lesions: their high incidence among young people, the association between fracture lesions of the vault and the poverty of symptomatology. Lastly, they underline the great importance of the TAC in this kind of pathology.

[Treatment of hydrocephalus using ventriculo-peritoneal diversion. 15 years of experience]. / Trattamento dell'idrocefalo con derivazione ventricolo-peritoneale. 15 anni di esperienza.

The authors report their 15 years experience about 177 cases of adult patients cured for various pathologies with ventriculo-peritoneal derivation. They describe the different complications and point out their incidence.

[Evaluations of vision recovery after removal of pituitary adenomas via the transsphenoidal approach]. / Valutazioni sul recupero visivo dopo asportazione di adenoma ipofisario per via trans-sfenoidale.

The AA. relate upon the results obtained in 42 patients treated with transsphenoidal surgery for hypophyseal adenomas, concerning 1 week and 6 months follow up in ophthalmologic deficits recovery. They emphasize the importance of early diagnosis and treatment.

[Anterior communicating artery: morphologic and structural aspects]. / L'arteria communicante anteriore: aspetti morfologici e strutturali.

The gross anatomy of the anterior communicating artery has been studied in 40 adult brains removed at autopsy. We have observed 6 different anatomicals variant of the artery. A histological study shows that the wall of the artery is constituted with three layers: intima, media and adventitia. Moreover the structure of the arterial wall is different in some anatomicals variant. The findings are discussed.

[Primary spinal tumors of multiple localization]. / Tumori primitivi spinali a localizzazione multipla.

The authors report the case of a patient submitted to an operation of spinal tumors with multiple localization which, beside enriching the rare observations existing in literature, presents and hypertensive hypertension hydrocephalus with non common pathogenesis and points out considerable difficulties of interpretation of the histologic picture. After examining literature and describing the case in detail, the authors discuss the etiopathogenesis of hydrocephalus and examine the histologic aspect of extirpated tumors.