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GIACOMO PAVESI
Professore Associato
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede ex-Neuroscienze
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Pubblicazioni
2024
- Autologous anti-GD2 CAR T cells efficiently target primary human glioblastoma
[Articolo su rivista]
Chiavelli, C.; Prapa, M.; Rovesti, G.; Silingardi, M.; Neri, G.; Pugliese, G.; Trudu, L.; Dall'Ora, M.; Golinelli, G.; Grisendi, G.; Vinet, J.; Bestagno, M.; Spano, C.; Papapietro, R. V.; Depenni, R.; Di Emidio, K.; Pasetto, A.; Nascimento Silva, D.; Feletti, A.; Berlucchi, S.; Iaccarino, C.; Pavesi, G.; Dominici, M.
abstract
Glioblastoma (GBM) remains a deadly tumor. Treatment with chemo-radiotherapy and corticosteroids is known to impair the functionality of lymphocytes, potentially compromising the development of autologous CAR T cell therapies. We here generated pre-clinical investigations of autologous anti-GD2 CAR T cells tested against 2D and 3D models of GBM primary cells. We detected a robust antitumor effect, highlighting the feasibility of developing an autologous anti-GD2 CAR T cell-based therapy for GBM patients.
2024
- Cerebellar mutism syndrome caused by bilateral cerebellar hemorrhage in adults: a case report and review of the literature
[Articolo su rivista]
Zedde, Marialuisa; Grisendi, Ilaria; Assenza, Federica; Napoli, Manuela; Moratti, Claudio; Di Cecco, Giovanna; Pavone, Claudio; Bonacini, Lara; D’Aniello, Serena; Pezzella, Francesca Romana; Romano, Antonio; Pavesi, Giacomo; Valzania, Franco; Pascarella, Rosario
abstract
: Cerebellar mutism syndrome (CMS) is a frequent complication of surgical intervention on posterior fossa in children. It has been only occasionally reported in adults and its features have not been fully characterized. In children and in young adults, medulloblastoma is the main reason for neurosurgery. A single case of postsurgical CMS is presented in an adult patient with a cerebellar hemorrhage and a systematic review of the published individual cases of CMS in adults was done. Literature review of individual cases found 30 patients, 18/30 (60%) males, from 20 to 71 years at diagnosis. All but one case was post-surgical, but in one of the post-surgical cases iatrogenic basilar artery occlusion was proposed as cause for CMS. The causes were: primary tumors of the posterior fossa in 16/22 (72.7%) metastasis in 3/30 (10%), ischemia in 3/30 (10%) cerebellar hemorrhage in 3/30 (10%), and benign lesions in 2/30 (6.7%) patients. 8/30 patients (26.7%) were reported as having persistent or incomplete resolution of CMS within 12 months. CMS is a rare occurrence in adults and spontaneous cerebellar hemorrhage has been reported in 3/30 (10%) adult patients. The generally accepted hypothesis is that CMS results from bilateral damage to the dentate nucleus or the dentate-rubro-thalamic tract, leading to cerebro-cerebellar diaschisis. Several causes might contribute in adults. The prognosis of CMS is slightly worse in adults than in children, but two thirds of cases show a complete resolution within 6 months.
2024
- Intraoperative ECoG in bottom-of-the-sulcus syndrome using a novel flexible strip electrode
[Articolo su rivista]
Biagioli, N.; Morandi, S.; Vaudano, A. E.; Pugnaghi, M.; Moriconi, E.; Pavesi, G.; Tramontano, V.; Meletti, S.
abstract
The recording of epileptiform discharges from bottom-of-sulcus focal cortical dysplasia (BOSD) is often difficult during intraoperative electrocorticography (ECoG) due to the deep localization. We describe the use in this scenario of a new-generation electrode strip with high flexibility, easily adapted to cortical gyri and sulci. A right-handed 20-year-old male with drug-resistant focal epilepsy due to BOSD of the inferior frontal gyrus and daily focal aware seizures was evaluated for epilepsy surgery. Based on electroclinical and neuroimaging results, a focal cortectomy guided by ECoG was proposed. ECoG recordings were performed with new-generation cortical strips (Wise Cortical Strip; WCS (R)) and standard cortical strips. ECoG, performed on the convexity of the frontal cortical surface, recorded only sporadic spikes with both types of strips. Then, after microsurgical trans-sulcal dissection, WCS was molded along the sulcal surface of the suspected BOSD based on 3D-imaging reconstruction, showing continuous/subcontinuous 3-4-Hz rhythmic spike activity from the deepest electrode. Registration after resection of the BOSD did not show any epileptiform activity. Pathology showed dysmorphic neurons and gliosis. No surgical complications occurred. The patient is seizure-free after 12 months. This single case experience shows that highly flexible electrode strips with adaptability to cortical gyrations can identify IEDs originating from deep location and could therefore be useful in cases of bottom of the sulcus dysplasia.
2024
- Longitudinal Neuropsychological Assessment of Symptomatic Edema after Subthalamic Nucleus Deep Brain Stimulation Surgery: A Case Series Study
[Articolo su rivista]
De Ieso, S.; Di Rauso, G.; Cavallieri, F.; Beltrami, D.; Marti, A.; Napoli, M.; Pascarella, R.; Feletti, A.; Fioravanti, V.; Toschi, G.; Rispoli, V.; Antonelli, F.; Puzzolante, A.; Pavesi, G.; Gasparini, F.; Valzania, F.
abstract
Severe non-infectious or non-haemorrhagic brain edema surrounding the electrode represents a rare complication of subthalamic nucleus deep brain stimulation (STN-DBS) surgery. The aim of this study is to report three patients with advanced Parkinson's Disease (PD) who developed symptomatic brain edema after STN-DBS surgery treated with intravenous steroids with a specific profile of reversible cognitive alterations. Patients were both assessed with a comprehensive neuropsychological battery including attention, memory, visuo-spatial and executive tasks. They were also briefly assessed for emotional and behavioural alterations, and for possible limitations in the activities of daily living. Normative data for an Italian population were available for all neuropsychological tests. The patients were firstly assessed before the surgery (baseline) as soon as they became symptomatic for the post-surgery edema and a few more times in follow-up up to ten months. In all patients we observed the resolution of cognitive deficits within six months after surgery with the corresponding reabsorption of edema at brain CT scans. The appearance of post-DBS edema is a fairly frequent and clinically benign event. However, in some rare cases it can be very marked and lead to important clinical-albeit transient-disturbances. These events can compromise, at least from a psychological point of view, the delicate path of patients who undergo DBS and can prolong the post-operative hospital stay. In this setting it could be helpful to perform a brain CT scan in 2-3 days with the aim of detecting the early appearance of edema and treating it before it can constitute a relevant clinical problem.
2024
- The Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19): Italian language translation and validation
[Articolo su rivista]
Burani, M.; Giovannini, G.; Pugnaghi, M.; Orlandi, N.; Cioclu, M. C.; Vaudano, A. E.; Moriconi, E.; Pavesi, G.; Meletti, S.
abstract
ObjectiveEpilepsy surgery can be proposed as a treatment option in people with focal epilepsy, however satisfaction with epilepsy surgery in Italy remains unknown. We aimed to validate in Italy an instrument to measure patient satisfaction with epilepsy surgery, the 19-item Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19).MethodsConsecutive patients with epilepsy who received epilepsy surgery between the years 2018-2021 at Modena Academic Hospital were recruited and provided clinical and demographic data. The Italian version of the ESSQ-19 and other three questionnaires were completed to assess construct validity. To evaluate the validity and reliability of the tool Spearman's rank correlation, and internal consistency analysis were performed.Results66 out of 79 eligible patients participated in the study (22 females; median age 37 years). The mean values of satisfaction for each domain of the IT-ESSQ-19 were: seizure control 83.4; (SD 16.7), psychosocial functioning 79.3 (SD 17.1), surgical complications 90.8 (SD 14.9), and recovery from surgery 81.4 (SD 16.9). The mean summary score was 83.7 (SD 13.3). The questionnaire was shown to have high internal consistency in the four domains (Cronbach's alpha = 0.82-0.93), and no significant floor/ceiling effects of the summary score. The ESSQ-19 scores significantly correlated with other instruments to support construct validity. It also demonstrated good discriminant validity for being seizure free [AUC 0.72; 95% CI = 0.56-0.88], and to endorse depression [AUC 0.76, 95% CI = 0.56-0.96].SignificanceThe Italian version of the ESSQ-19 is a reliable and valid self-reported questionnaire for assessing patient satisfaction with epilepsy surgery.
2023
- Cadaver Homologous Banked Fascia Lata in Skull Base Reconstruction: Preliminary Multidisciplinary Experiences
[Articolo su rivista]
Alicandri-Ciufelli, M.; Serafini, E.; Pavesi, G.; Marchioni, D.; Mantovani, M.; Dallari, D.; Iaccarino, C.
abstract
Skull base reconstruction has been a widely debated issue. Both autologous and heterologous materials have been proposed, however the formers are usually preferred due to their optimal healing outcomes and integration. Nevertheless they are still associated with donor-site functional and aesthetic morbidity. The aim of this study is to report a preliminary experience of different sites defects skull base repair with Cadaver homologous banked fascia lata graft. Patients who underwent reconstruction of skull base defects with Cadaver homologous banked fascia lata between January 2020 until July 2021 were included in the study. Three patients were finally identified for the study. Patient 1 underwent combined craniotomic-endoscopic surgical access for extended anterior skull base neoplasm with subsequent repair with homologous cadaver fascia lata. Patient 2 underwent endoscopic transphenoidal surgery for sellar-parasellar neoplasm. After tumor debulking the surgical cavity was obliterated with homologous cadaver fascia lata. Patient 3 finally had politrauma with otic capsule-violating fracture with profused CSF leak. An endoscopic obliteration of external and middle ear was performed using homologous cadaver fascia lata with blind sac closure of external auditory canal. No graft displacement or reabsorption was observed in these patients at the last follow-up. Cadaver homologous banked fascia lata has proved safety, efficacy and ductility in reconstruction of different skull base defects. Level of Evidence: Level IV-retrospective cohort study.
2023
- Cavernous malformations of the central nervous system: An international consensus statement
[Articolo su rivista]
Tasiou, A.; Brotis, A. G.; Kalogeras, A.; Tzerefos, C.; Alleyne, C. H.; Andreou, A.; Demetriades, A. K.; Foroglou, N.; Friedlander, R. M.; Karlsson, B.; Kitchen, N.; Meling, T. R.; Mitsos, A.; Panagiotopoulos, V.; Papasilekas, T.; Pavesi, G.; Rasulic, L.; Santos, A. N.; Spetzler, R. F.; Sure, U.; Tjoumakaris, S.; Tolias, C. M.; Vajkoczy, P.; Fountas, K. N.
abstract
Introduction: Cavernous malformations (CM) of the central nervous system constitute rare vascular lesions. They are usually asymptomatic, which has allowed their management to become quite debatable. Even when they become symptomatic their optimal mode and timing of treatment remains controversial. Research question: A consensus may navigate neurosurgeons through the decision-making process of selecting the optimal treatment for asymptomatic and symptomatic CMs. Material and methods: A 17-item questionnaire was developed to address controversial issues in relation to aspects of the treatment, surgical planning, optimal surgical strategy for specific age groups, the role of stereotactic radiosurgery, as well as a follow-up pattern. Consequently, a three-stage Delphi process was ran through 19 invited experts with the goal of reaching a consensus. The agreement rate for reaching a consensus was set at 70%. Results: A consensus for surgical intervention was reached on the importance of the patient's age, symptomatology, and hemorrhagic recurrence; and the CM's location and size. The employment of advanced MRI techniques is considered of value for surgical planning. Observation for asymptomatic eloquent or deep-seated CMs represents the commonest practice among our panel. Surgical resection is considered when a deep-seated CM becomes symptomatic or after a second bleeding episode. Asymptomatic, image-proven hemorrhages constituted no indication for surgical resection for our panelists. Consensus was also reached on not resecting any developmental venous anomalies, and on resecting the associated hemosiderin rim only in epilepsy cases. Discussion and conclusion: Our Delphi consensus provides an expert common practice for specific controversial issues of CM patient management.
2023
- Efficacy and Tolerability of Perampanel in Brain Tumor-Related Epilepsy: A Systematic Review
[Articolo su rivista]
Rossi, Jessica; Cavallieri, Francesco; Bassi, Maria Chiara; Biagini, Giuseppe; Rizzi, Romana; Russo, Marco; Bondavalli, Massimo; Iaccarino, Corrado; Pavesi, Giacomo; Cozzi, Salvatore; Giaccherini, Lucia; Najafi, Masoumeh; Pisanello, Anna; Valzania, Franco
abstract
(1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of glutamatergic activity in the tumor microenvironment may favor epileptogenesis, but also tumor growth and invasiveness. The selective non-competitive -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist perampanel (PER) was demonstrated to be efficacious and well-tolerated in patients with
focal seizures. Moreover, preclinical in vitro studies suggested a potential anti-tumor activity of this drug. In this systematic review, the clinical evidence on the efficacy and tolerability of PER in brain tumor-related epilepsy (BTRE) is summarized. (2) Methods: Five databases and two clinical trial registries were searched from inception to December 2022. (3) Results: Seven studies and six clinical trials were included. Sample size ranged from 8 to 36 patients, who received add-on PER (mean dosage from 4 to 7 mg/day) for BTRE. After a 6–12 month follow-up, the responder rate (% of patients achieving seizure freedom or reduction 50% of seizure frequency) ranged from 75% to 95%, with a seizure freedom rate of up to 94%. Regarding tolerability, 11–52% of patients experienced non-severe adverse effects (most frequent: dizziness, vertigo, anxiety, irritability). The retention rate ranged from 56% to 83%. However, only up to 12.5% of patients discontinued the drug because of the adverse
events. (4) Conclusions: PER seems to be efficacious, safe, and well-tolerated in patients with BTRE. Further randomized studies should be conducted in more homogeneous and larger populations, also
evaluating the effect of PER on tumor progression, overall survival, and progression-free survival.
2023
- Insights into healthcare professionals’ perceptions and attitudes toward nanotechnological device application: What is the current situation in glioblastoma research?
[Articolo su rivista]
Ragucci, Federica; Sireci, Francesca; Cavallieri, Francesco; Rossi, Jessica; Biagini, Giuseppe; Tosi, Giovanni; Lucchi, Chiara; Molina-Pena, Rodolfo; Helen Ferreira, Natalia; Zarur, Mariana; Ferreiros, Alba; Bourgeois, William; Berger, François; Abal, Miguel; Rousseau, Audrey; Boury, Frank; Alvarez-Lorenzo, Carmen; Garcion, Emmanuel; Pisanello, Anna; Pavesi, Giacomo; Iaccarino, Corrado; Ghirotto, Luca; Bassi, Maria Chiara; Valzania, Franco
abstract
Nanotechnology application in cancer treatment is promising and is likely to quickly spread worldwide in the near future. To date, most scientific studies on nanomaterial development have focused on deepening the attitudes of end users and experts, leaving clinical practice implications unexplored. Neuro-oncology might be a promising field for the application of nanotechnologies, especially for malignant brain tumors with a low-survival rate such as glioblastoma (GBM). As to improving patients’ quality of life and life expectancy, innovative treatments are worth being explored. Indeed, it is important to explore clinicians’ intention to use experimental technologies in clinical practice. In the present study, we conducted an exploratory review of the literature about healthcare workers’ knowledge and personal opinions toward nanomedicine. Our search (i) gives evidence for disagreement between self-reported and factual knowledge about nanomedicine and (ii) suggests the internet and television as main sources of information about current trends in nanomedicine applications, over scientific journals and formal
education. Current models of risk assessment suggest time-saving cognitive and affective shortcuts, i.e., heuristics support both laypeople and experts in the decision-making process under uncertainty, whereas they might be a source of error. Whether the knowledge is poor, heuristics are more likely to occur and thus clinicians’ opinions and perspectives toward new technologies might be biased.
2023
- Interplay between speech and gait variables in Parkinson's disease patients treated with subthalamic nucleus deep brain stimulation: A long-term instrumental assessment
[Articolo su rivista]
Cavallieri, Francesco; Gessani, Annalisa; Merlo, Andrea; Campanini, Isabella; Budriesi, Carla; Fioravanti, Valentina; DI RAUSO, Giulia; Feletti, Alberto; Damiano, Benedetta; Scaltriti, Sara; Guadagno, Noemi; Bardi, Elisa; Corni, MARIA GIULIA; Antonelli, Francesca; Cavalleri, Francesca; Molinari, MARIA ANGELA; Contardi, Sara; Menozzi, Elisa; Puzzolante, Annette; Vannozzi, Giuseppe; Bergamini, Elena; Pavesi, Giacomo; Fraix, Valérie; Fraternali, Alessandro; Versari, Annibale; Lusuardi, Mirco; Biagini, Giuseppe; Pinto, Serge; Moro, Elena; Valzania, Franco
abstract
Objective
To evaluate correlations between speech and gait parameters in the long-term and under different medication and subthalamic nucleus deep brain stimulation (STN-DBS) conditions in a cohort of advanced Parkinson’s
Disease (PD) patients.
Methods
This observational study included consecutive PD patients treated with bilateral STN-DBS. Axial symptoms were evaluated using a standardized clinical-instrumental approach. Speech and gait were assessed by
perceptual and acoustic analyses and by the instrumented timed up and go test (iTUG) respectively. Disease motor severity was evaluated with the total score and subscores of the UPDRS part III. Different stimulation
and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication.
Results
Twenty-five PD patients with a five-year median follow-up after surgery (range 3-7) were included (18 M; disease duration at surgery:10.44 [sd:4.62] years; age at surgery:58.40 [sd:5.73] years). In the offstimulation/
off-medication and on-stimulation/on-medication conditions, patients who spoke louder had also the greater acceleration of the trunk during gait whereas, in the on-stimulation/on-medication condition only,
patients with the poorer voice quality were also the worse to perform sit to stand and gait phases of the iTUG. On the contrary, patients with the higher speech rate performed well the turning and walking phases of the iTUG.
Conclusions
This study underlines the presence of different correlations between treatment effects of speech and gait parameters in PD patients treated with bilateral STN-DBS. This may allow us to better understand the common pathophysiological basis of these alterations and to develop a more specific and tailored rehabilitation approach for axial signs after surgery.
2023
- Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson’s disease: a clinical-instrumental study
[Articolo su rivista]
Cavallieri, Francesco; Campanini, Isabella; Gessani, Annalisa; Budriesi, Carla; Fioravanti, Valentina; DI RAUSO, Giulia; Feletti, Alberto; Damiano, Benedetta; Scaltriti, Sara; Guagnano, Noemi; Bardi, Elisa; Corni, MARIA GIULIA; Rossi, Jessica; Antonelli, Francesca; Cavalleri, Francesca; Molinari, MARIA ANGELA; Contardi, Sara; Menozzi, Elisa; Puzzolante, Annette; Vannozzi, Giuseppe; Bergamini, Elena; Pavesi, Giacomo; Meoni, Sara; Fraix, Valérie; Fraternali, Alessandro; Versari, Annibale; Lusuardi, Mirco; Biagini, Giuseppe; Merlo, Andrea; Moro, Elena; Valzania, Franco
abstract
Objective
To assess the long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait in a cohort of advanced Parkinson’s Disease (PD) patients.
Methods
This observational study included consecutive PD patients treated with bilateral STN-DBS. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Each patient performed the instrumented Timed Up and Go test (iTUG). The instrumental evaluation of walking ability was carried out with a wearable inertial sensor containing a three-dimensional (3D) accelerometer, gyroscope, and magnetometer. This device could provide 3D linear acceleration, angular velocity, and magnetic field vector. Disease motor severity was evaluated with the total score and subscores of the Unified Parkinson Disease Rating Scale part III.
Results
Twenty-five PD patients with a 5-years median follow-up after surgery (range 3–7) were included (18 men; mean disease duration at surgery 10.44 ± 4.62 years; mean age at surgery 58.40 ± 5.73 years). Both stimulation and medication reduced the total duration of the iTUG and most of its different phases, suggesting a long-term beneficial effect on gait after surgery. However, comparing the two treatments, dopaminergic therapy had a more marked effect in all test phases. STN-DBS alone reduced total iTUG duration, sit-to-stand, and second turn phases duration, while it had a lower effect on stand-to-sit, first turn, forward walking, and walking backward phases duration.
Conclusions
This study highlighted that in the long-term after surgery, STN-DBS may contribute to gait and postural control improvement when used together with dopamine replacement therapy, which still shows a substantial beneficial effect.
2023
- Posterior wiring with sublaminar polyester bands, titanium-peek fixation system for C2 fracture management: a 4-patient case series with a maximum of 18 months’ follow-up
[Articolo su rivista]
Zanasi, M.; Chahine, R.; Pavesi, G.; Iaccarino, C.
abstract
Background: C2 fractures can be classified differently when dens, pedicles or body are injured. With regards to the best management of Type-II Anderson-D’Alonzo fractures, Hangman’s fractures of pedicles and C2 body fractures are more debatable. However, vertebral pedicle and/or articular screw and dorsal wiring are the most common surgical posterior approaches opted for. Compared to the screw technique, dorsal wiring provides certain benefits such as a lower risk of vertebral artery injury, no need for navigation, less lateral dissection of the paraspinal muscles, shorter surgery time and lower medical costs. Case Description: Two patients with failed conservative treatment for Anderson-D’Alonzo Type-III fractures (Cases 1A and 1B), a patient suffering from a Type-II Hangman’s fracture (Case 2) and a patient with failed conservative treatment for a C2 transversal body fracture (Case 3) underwent surgery at the Neurosurgery Division of the University Hospital of Modena (Italy) between July 2020 and September 2021. All patients were treated with posterior wiring with 5 mm Polyester bands, titanium-peek fixation system (Jazz-Lock system MediNext®-Implanet) inserted through the C1 posterior arch and either the C2 or C3 laminae. A fracture diastasis reduction was observed ranging between 4.5 and 1 mm. No intraoperative and post-operative complications were encountered. The duration of the period of hospitalisation ranged between 5 and 12 days. All patients who had worked prior to the traumatic event were able to return to work 18 months following surgery. Conclusions: In reducing C2 fractures, a sublaminar fixation with polyester bands and a titanium-peek fixation system can be proposed for fragile and elderly patients.
2023
- Spinal Cord Compression from Widespread Extramedullary Hematopoiesis in Polycythemia Vera
[Articolo su rivista]
Valluzzi, A.; Rechberger, J. S.; Palandri, F.; Nasi, D.; Pavesi, G.; Palandri, G.
abstract
2022
- Delayed Effect of Dendritic Cells Vaccination on Survival in Glioblastoma: A Systematic Review and Meta‐Analysis
[Articolo su rivista]
Cozzi, S.; Najafi, M.; Gomar, M.; Ciammella, P.; Iotti, C.; Iaccarino, C.; Dominici, M.; Pavesi, G.; Chiavelli, C.; Kazemian, A.; Jahanbakhshi, A.
abstract
Background: Dendritic cell vaccination (DCV) strategies, thanks to a complex immune response, may flare tumor regression and improve patients’ long‐term survival. This meta‐analysis aims to assess the efficacy of DCV for newly diagnosed glioblastoma patients in clinical trials. Meth-ods: The study databases, including PubMed, Web of Knowledge, Google Scholar, Scopus, and Cochrane, were searched by two blinded investigators considering eligible studies based on the following keywords: “glioblastoma multiforme”, “dendritic cell”, “vaccination”, “immunother-apy”, “immune system”, “immune response”, “chemotherapy”, “recurrence”, and “te-mozolomide”. Among the 157 screened, only 15 articles were eligible for the final analysis. Results: Regimens including DCV showed no effect on 6‐month progression‐free survival (PFS, HR = 1.385, 95% CI: 0.822–2.335, p = 0.673) or on 6‐month overall survival (OS, HR = 1.408, 95% CI: 0.882–2.248, p = 0.754). In contrast, DCV led to significantly longer 1‐year OS (HR = 1.936, 95% CI: 1.396–2.85, p = 0.001) and longer 2‐year OS (HR = 3.670, 95% CI: 2.291–5.879, p = 0.001) versus control groups. Hence, introducing DCV could lead to increased 1 and 2‐year survival of patients by 1.9 and 3.6 times, respectively. Conclusion: Antitumor regimens including DCV can effectively improve mid-term survival in patients suffering glioblastoma multiforme (GBM), but its impact emerges only after one year from vaccination. These data indicate the need for more time to achieve an anti‐GBM immune response and suggest additional therapeutics, such as checkpoint inhibitors, to empower an earlier DCV action in patients affected by a very poor prognosis.
2022
- Freezing of gait in Parkinson’s disease patients treated with
bilateral subthalamic nucleus deep brain stimulation: A
long-term overview
[Articolo su rivista]
DI RAUSO, Giulia; Cavallieri, Francesco; Campanini, Isabella; Gessani, Annalisa; Fioravanti, Valentina; Feletti, Alberto; Damiano, Benedetta; Scaltriti, Sara; Bardi, Elisa; Corni, MARIA GIULIA; Antonelli, Francesca; Rispoli, Vittorio; Cavalleri, Francesca; Molinari, MARIA ANGELA; Contardi, Sara; Menozzi, Elisa; Puzzolante, Annette; Rossi, Jessica; Meletti, Stefano; Biagini, Giuseppe; Pavesi, Giacomo; Fraix, Valerie; Lusuardi, Mirco; Fraternali, Alessandro; Versari, Annibale; Budriesi, Carla; Moro, Elena; Merlo, Andrea; Valzania, Franco
abstract
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson’s Disease (PD). However, the effects of STN-DBS on freezing of gait (FOG) are still debated, particularly in the long-term follow-up (>/=5-years). The main aim of the current study is to evaluate the long-term effects of STN-DBS on FOG. Twenty STN-DBS treated PD patients were included. Each patient was assessed before surgery through a detailed neurological evaluation, including FOG score, and reevaluated in the long-term (median follow-up: 5-years) in different stimulation and drug conditions. In the long term follow-up, FOG score significantly worsened in the off-stimulation/off-medication condition compared with the preoperative off-medication assessment (z = -1.930; p = 0.05) but not in the on-stimulation/off-medication (z = -0.357; p = 0.721). There was also a significant improvement of FOG at long-term assessment by comparing on-stimulation/off-medication and off-stimulation/off-medication conditions (z = -2.944; p = 0.003). These results highlight the possible beneficial long-term effects of STN-DBS on FOG.
2022
- Management and safety of intraoperative ventriculostomy during early surgery for ruptured intracranial aneurysms
[Articolo su rivista]
Pavesi, Giacomo; Nasi, Davide; Moriconi, Elisa; Stanzani, Riccardo; Puzzolante, Annette; Lucchesi, Lucio; Cavallo, Selene Marika; Iaccarino, Corrado
abstract
Brain edema and/or acute hydrocephalus are common features that limit working space during early surgery of aneurysmal subarachnoid hemorrhage (aSAH). Intraoperative ventriculostomy offers an immediate brain relaxation. However, management and complications related to the routine use of intraoperative external ventricular drainage (iEVD) are not well investigated.
2022
- Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives
[Articolo su rivista]
Di Cristofori, A.; Remida, P.; Patassini, M.; Piergallini, L.; Buonanno, R.; Bruno, R.; Carrabba, G.; Pavesi, G.; Iaccarino, C.; Giussani, C. G.
abstract
Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases that affect elderly and fragile patients and as a consequence, management can be challenging. Surgery represents the standard treatment; however, alternative options are under investigation. Middle meningeal artery (MMA) embolization is considered a minimally invasive treatment although with poor evidence. In this review, we tried to summarize the findings about MMA embolization as a treatment for a CSDH to provide a useful guidance for clinical practice and for future speculative aspects. Methods: Literature review on PubMed until March 2021 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We conducted a research on PubMed with a various combinations of the keywords "CSDH"and "middle meningeal artery"and "embolization,""refractory subdural hematoma,"and then we reviewed the references of the relevant studies as additional source of eligible articles. Results: Among the 35 studies eligible for this review, 22 were case series, 11 were case reports, one was a technical note, and 1 was a randomized trial. A total of 746 patients were found in the literature. Failure rate of MMA embolization was between 3.9 and 8.9% of the cases according the indication to treat CSDH (upfront vs. after surgery). Conclusion: The global impression deriving from the data available and the literature is that MMA embolization is a safe procedure with very low complications and with a low failure rate, both when associated with surgery or in case of a standalone treatment.
2022
- Remodulation of neurosurgical activities in an Italian region (Emilia-Romagna) under COVID-19 emergency: maintaining the standard of care during the crisis
[Articolo su rivista]
Mazzatenta, Diego; Zoli, Matteo; Cavallo, Michele A; Ferro, Salvatore; Giombelli, Ermanno; Pavesi, Giacomo; Sturiale, Carmelo; Tosatto, Luigino; Zucchelli, Mino
abstract
2022
- Spinal hemangioblastomas: analysis of surgical outcome and prognostic factors
[Articolo su rivista]
Feletti, A.; Boaro, A.; Giampiccolo, D.; Casoli, G.; Moscolo, F.; Ferrara, M.; Sala, F.; Pavesi, G.
abstract
The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. Sixty-one patients (31 F, 30 M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients. A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome.
2021
- A light on the dark side: In vivo endoscopic anatomy of the posterior third ventricle and its variations in hydrocephalus
[Articolo su rivista]
Feletti, A.; Fiorindi, A.; Lavecchia, V.; Boscolo-Berto, R.; Marton, E.; Macchi, V.; De Caro, R.; Longatti, P.; Porzionato, A.; Pavesi, G.
abstract
Despite the technological advancements of neurosurgery, the posterior part of the third ventricle has always been the "dark side" of the ventricle. However, flexible endoscopy offers the opportunity for a direct, in vivo inspection and detailed description of the posterior third ventricle in physiological and pathological conditions. The purposes of this study were to describe the posterior wall of the third ventricle, detailing its normal anatomy and surgical landmarks, and to assess the effect of chronic hydrocephalus on the anatomy of this hidden region.
2021
- Clipping of unruptured middle cerebral artery aneurysms in an average caseload center: a sustainable procedure?
[Articolo su rivista]
Pavesi, G.; Nasi, D.
abstract
2021
- Endoscopic-assisted removal of ventricular catheter in high-risk patients
[Articolo su rivista]
Puzzolante, A.; Pavesi, G.; Feletti, A.
abstract
Introduction. Ventriculoperitoneal shunt carries a non-negligible failure rate often requiring multiple surgical procedures during patient-s lifetime. The most common cause is obstruction of the ventricular catheter that can be embedded in adhesions with choroid plexus, ependymal tissue, and fibrous material. In such cases, or when an intraventricular tumor is present, particular attention must be paid when removal of the ventricular catheter is required. The potential adhesions with the tip of the ventricular catheter results in an increased risk of life-threatening hemorrhage. Materials and methods. We present the case of a ventriculoperitoneal shunt proximal revision in a von Hippel-Lindau affected patient. The neuroendoscopic exploration to restore the patency of the ventricular system made it possible to notice a fibrous adhesion between the tip of the catheter and a pituitary hemangioblastoma abutting into the third ventricle. Discussion. Pituitary stalk hemangioblastoma is an infrequent localization, although it represents the most common supratentorial site of hemangioblastoma in patients affected by von Hippel-Lindau syndrome. In this and in similar cases, endoscopic-assisted shunt revision allows visualizing the tip of the ventricular catheter and eventual adhesions that can be coagulated and cut by simple maneuvers, without any morbidity for patients. Conclusion. In a ventriculoperitoneal shunt revision with the concomitant presence of an intraventricular tumor or lesion at risk of bleeding, the surgical procedure should be performed under neuroendoscopic observation to reduce the risk of intraventricular hemorrhage.
2021
- GD2 CAR T cells against human glioblastoma
[Articolo su rivista]
Prapa, M.; Chiavelli, C.; Golinelli, G.; Grisendi, G.; Bestagno, M.; Di Tinco, R.; Dall'Ora, M.; Neri, G.; Candini, O.; Spano, C.; Petrachi, T.; Bertoni, L.; Carnevale, G.; Pugliese, G.; Depenni, R.; Feletti, A.; Iaccarino, C.; Pavesi, G.; Dominici, M.
abstract
Glioblastoma is the most malignant primary brain tumor and is still in need of effective medical treatment. We isolated patient-derived glioblastoma cells showing high GD2 antigen expression representing a potential target for CAR T strategy. Data highlighted a robust GD2 CAR antitumor potential in 2D and 3D glioblastoma models associated with a significant and CAR T-restricted increase of selected cytokines. Interestingly, immunosuppressant TGF β1, expressed in all co-cultures, did not influence antitumor activity. The orthotopic NOD/SCID models using primary glioblastoma cells reproduced human histopathological features. Considering still-conflicting data on the delivery route for targeting brain tumors, we compared intracerebral versus intravenous CAR T injections. We report that the intracerebral route significantly increased the length of survival time in a dose-dependent manner, without any side effects. Collectively, the proposed anti-GD2 CAR can counteract human glioblastoma potentially opening a new therapeutic option for a still incurable cancer.
2021
- Management of intracranial hypertension following traumatic brain injury: A best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy: Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
[Articolo su rivista]
Iaccarino, C.; Lippa, L.; Munari, M.; Castioni, C. A.; Robba, C.; Caricato, A.; Pompucci, A.; Signoretti, S.; Zona, G.; Rasulo, F. A.; Aimar, E.; Amato, S.; Angileri, F. F.; Anile, C.; Assietti, R.; Baratto, V.; Barbanera, A.; Basile, L.; Battaglia, R.; Bellocchi, S.; Bertuccio, A.; Blanco, S.; Bolognini, A.; Boniferro, B.; Bordi, L.; Bortolotti, C.; Brandini, V.; Broger, M.; Brollo, M.; Caffarella, D. D.; Caggiano, C.; Cantisani, P. L.; Capone, C.; Cappelletto, B.; Capuano, C.; Carangelo, B.; Caruselli, G.; Chessa, M. A.; Chiara, M.; Chibbaro, S.; Cioffi, V.; Ciprianocecchi, P.; Colistra, D.; Conti, C.; Contratti, F.; Costella, G. B.; Cuoci, A.; D'Avella, D.; D'Ercole, M.; Deangelis, M.; Defalco, R.; de Luca, G.; de Marinis, P.; Del Vecchio, C.; Delfinis, C.; Denaro, L.; Deodato, F.; Desogus, N.; Disomma, A.; Domenicucci, M.; Dones, F.; Fina, M.; Fiori, L.; Fricia, M.; Gaetani, P.; Gazzeri, R.; Gentile, M.; Germano, A.; Ghadirpour, R.; Gianfreda, C. D.; Gigante, N.; Gigli, R.; Giorgetti, J.; Giusa, M.; Gravina, U. G.; Grippi, L.; Guida, F.; Guizzardi, G.; Iannuzzo, G.; Kropp, M.; Lattanzi, L.; Lucantoni, D.; Maffei, L.; Magliulo, M.; Marconi, F.; Marruzzo, D.; Martellotta, N.; Marton, E.; Maugeri, R.; Mauro, G.; Meli, F.; Menniti, A.; Merciadri, P.; Milanese, L.; Nardacci, B.; Nasi, D.; Orvieto, P.; Pacca, P.; Pansini, G.; Panzarasa, G.; Passanisi, M.; Pavesi, G.; Pizzoni, C.; Pulera, F.; Rapana, A.; Ricci, A.; Rispoli, R.; Rotondo, M.; Russo, N.; Santilli, S.; Scarano, E.; Schwarz, A.; Servadei, F.; Simonetti, G.; Stefini, R.; Talamonti, G.; Turrisi, A.; Valente, V. M.; Villa, A.; Vindigni, M.; Visocchi, M.; Vitali, M.; Wierzbicki, V.; Zambon, G.; Zanotti, B.; Zenga, F.; Alampi, D.; Alessandri, F.; Aloj, F.; Amigoni, A.; Aspide, R.; Bertuetti, R.; Betti, V.; Bilotta, F.; Bonato, V.; Bosco, E.; Brita, M.; Buscema, G.; Cafiero, T.; Cappuccio, D.; Caradonna, M.; Caria, C. G.; Casartelliliviero, M.; Ciritella, P.; Cirrincione, S.; Citerio, G.; Colelli, S.; Coletta, F.; Concordia, L.; Congedo, E.; Covotta, M.; Crimella, F.; Dall'Acqua, G.; De Cassai, A.; Defulviis, S.; Deperi, E.; Deana, C.; Delgaudio, A.; Denittis, N.; Dicolandrea, S.; Divezza, F.; Ferri, F.; Flocco, R.; Fontana, C.; Forastierimolinari, A.; Frangiosa, A.; Fumagalli, P.; Fuselli, E.; Garbarino, M. M.; Gelormini, D.; Geraci, C.; Geraldini, F.; Giacomucci, A.; Giampaoli, V.; Giorgetti, D.; Gritti, P.; Gualdani, S.; Iacovazzo, C.; Iermano, C.; Latronico, N.; Lugari, S.; Lusenti, F.; Maglione, C.; Magnoni, S.; Maiarota, F.; Malla, M.; Marchesi, M.; Martino, C.; Matteotti, I.; Mazzeo, A. T.; Morello, G.; Nardiello, I.; Paticchio, F.; Pegoli, M.; Perotti, V.; Piazzolla, M.; Picciafuochi, F.; Rachedi, N.; Radolovich, D. K.; Recchia, A.; Riccardi, S.; Romagnoli, S.; Sala, S.; Scafuro, M. A.; Sgarlata, P.; Soragni, A.; Stefani, F.; Stival, E.; Stofella, G.; Terranova, F.; Tinturini, R.; Togni, T.; Toto, R.; Trapani, D.; Tringali, E.; Tullo, L.; Valente, A.; Valeo, T.; Varelli, G.; Villani, R.; Zamacavicchi, F.; Zanello, M.; Zarrillo, N.; Zugni, N.
abstract
No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “TBISection” of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TB Imanagement is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.
2021
- Osteoid Osteoma of the Atlas in a Boy: Clinical and Imaging Features-A Case Report and Review of the Literature
[Articolo su rivista]
Valluzzi, A.; Donatiello, S.; Gallo, G.; Cellini, M.; Maiorana, A.; Spina, V.; Pavesi, G.
abstract
Osteoid osteoma is a benign osteoblastic tumor, quite uncommon in the spine. We report a case of an osteoid osteoma involving the atlas in a 6-year-old boy, who presented with suboccipital pain and torticollis. Initial radiological findings were ambiguous as magnetic resonance imaging showed mainly edema of upper cervical soft tissues. The subsequent computed tomography depicted a lesion of left lamina of C1. As conservative treatment failed, the lesion was surgically resected and the patient became pain free. To our knowledge, this is the first case of osteoid osteoma involving the atlas associated with abnormal soft tissue reaction reported in literature.
2021
- Spontaneous Regression of a Giant Traumatic Herniated Thoracic Disk: A Case Report and Review of the Literature
[Articolo su rivista]
Valluzzi, A.; Sorenson, T.; Nasi, D.; Acciarri, N.; Palandri, G.; Pavesi, G.
abstract
Thoracic disk herniation (TDH) after traumatic injury is a relatively uncommon disease with few cases reported in the literature. Herniated disks in this location typically may result in progressive myelopathy and refractory pain. In the presence of these symptoms, surgical treatment may be indicated since spontaneous regression in this area is less common than that of disk herniations in the cervical or lumbar spine. Herein, we present the case of giant traumatic TDH that occurred at the T9-T10 level and spontaneously resolved after 5 months. We highlight the fact that regression of a herniated disk at the thoracic level may occur even in the absence of treatment. When considering this phenomenon, conservative management of these cases with clinical and radiological monitoring may be an appropriate first-line management for patients without signs of progressive myelopathy or severe refractory pain.
2021
- Temporal Lobe Spikes Affect Distant Intrinsic Connectivity Networks
[Articolo su rivista]
Mirandola, L.; Ballotta, D.; Talami, F.; Giovannini, G.; Pavesi, G.; Vaudano, A. E.; Meletti, S.
abstract
Objective: To evaluate local and distant blood oxygen level dependent (BOLD) signal changes related to interictal epileptiform discharges (IED) in drug-resistant temporal lobe epilepsy (TLE). Methods: Thirty-three TLE patients undergoing EEG–functional Magnetic Resonance Imaging (fMRI) as part of the presurgical workup were consecutively enrolled. First, a single-subject spike-related analysis was performed: (a) to verify the BOLD concordance with the presumed Epileptogenic Zone (EZ); and (b) to investigate the Intrinsic Connectivity Networks (ICN) involvement. Then, a group analysis was performed to search for common BOLD changes in TLE. Results: Interictal epileptiform discharges were recorded in 25 patients and in 19 (58%), a BOLD response was obtained at the single-subject level. In 42% of the cases, BOLD changes were observed in the temporal lobe, although only one patient had a pure concordant finding, with a single fMRI cluster overlapping (and limited to) the EZ identified by anatomo-electro-clinical correlations. In the remaining 58% of the cases, BOLD responses were localized outside the temporal lobe and the presumed EZ. In every patient, with a spike-related fMRI map, at least one ICN appeared to be involved. Four main ICNs were preferentially involved, namely, motor, visual, auditory/motor speech, and the default mode network. At the single-subject level, EEG–fMRI proved to have high specificity (above 65%) in detecting engagement of an ICN and the corresponding ictal/postictal symptom, and good positive predictive value (above 67%) in all networks except the visual one. Finally, in the group analysis of BOLD changes related to IED revealed common activations at the right precentral gyrus, supplementary motor area, and middle cingulate gyrus. Significance: Interictal temporal spikes affect several distant extra-temporal areas, and specifically the motor/premotor cortex. EEG–fMRI in patients with TLE eligible for surgery is recommended not for strictly localizing purposes rather it might be useful to investigate ICNs alterations at the single-subject level.
2021
- Use of Foley catheter in control of internal carotid hemorrhage during endoscopic endonasal surgery
[Articolo su rivista]
Alicandri-Ciufelli, M.; Maccarrone, F.; Botti, C.; Pavesi, G.; Presutti, L.
abstract
Internal carotid artery (ICA) injuries during endoscopic endonasal surgery (EES) are rare life-threatening events. We describe a technique to manage ICA injuries based on the use of Foley catheters.A 26-year-old female underwent endoscopic transnasal trans-sphenoidal removal of pituitary adenoma. Cerebrospinal fluid leak occurred 4 days postoperatively. During repair procedure, accidental injury of ICA occurred. Emergency nasal packing through positioning of four Foley urologic catheters was successfully performed to stop bleeding. The patient did not report neurologic deficits.In author's opinion, Foley catheters are suitable to obtain immediate bleeding control since they are rapidly available and easily usable.
2021
- Von Hippel-Lindau disease and multispecialist team
[Articolo su rivista]
Pavesi, G.; Feletti, A.; Ferrara, A. M.; Anglani, M.; Scarpa, B.; Schiavi, F.; Boaretto, F.; Zovato, S.; Taschin, E.; Gardi, M.; Zanoletti, E.; Piermarocchi, S.; Murgia, A.; Opocher, G.
abstract
2021
- fMRI-Based Effective Connectivity in Surgical Remediable Epilepsies: A Pilot Study
[Articolo su rivista]
Vaudano, A. E.; Mirandola, L.; Talami, F.; Giovannini, G.; Monti, G.; Riguzzi, P.; Volpi, L.; Michelucci, R.; Bisulli, F.; Pasini, E.; Tinuper, P.; Di Vito, L.; Gessaroli, G.; Malagoli, M.; Pavesi, G.; Cardinale, F.; Tassi, L.; Lemieux, L.; Meletti, S.
abstract
Simultaneous EEG-fMRI can contribute to identify the epileptogenic zone (EZ) in focal epilepsies. However, fMRI maps related to Interictal Epileptiform Discharges (IED) commonly show multiple regions of signal change rather than focal ones. Dynamic causal modeling (DCM) can estimate effective connectivity, i.e. the causal effects exerted by one brain region over another, based on fMRI data. Here, we employed DCM on fMRI data in 10 focal epilepsy patients with multiple IED-related regions of BOLD signal change, to test whether this approach can help the localization process of EZ. For each subject, a family of competing deterministic, plausible DCM models were constructed using IED as autonomous input at each node, one at time. The DCM findings were compared to the presurgical evaluation results and classified as: "Concordant" if the node identified by DCM matches the presumed focus, "Discordant" if the node is distant from the presumed focus, or "Inconclusive" (no statistically significant result). Furthermore, patients who subsequently underwent intracranial EEG recordings or surgery were considered as having an independent validation of DCM results. The effective connectivity focus identified using DCM was Concordant in 7 patients, Discordant in two cases and Inconclusive in one. In four of the 6 patients operated, the DCM findings were validated. Notably, the two Discordant and Invalidated results were found in patients with poor surgical outcome. Our findings provide preliminary evidence to support the applicability of DCM on fMRI data to investigate the epileptic networks in focal epilepsy and, particularly, to identify the EZ in complex cases.
2020
- A metabolomic data fusion approach to support gliomas grading
[Articolo su rivista]
Righi, V.; Cavallini, N.; Valentini, A.; Pinna, G.; Pavesi, G.; Rossi, M. C.; Puzzolante, A.; Mucci, A.; Cocchi, M.
abstract
Magnetic resonance imaging (MRI) is the current gold standard for the diagnosis of brain tumors. However, despite the development of MRI techniques, the differential diagnosis of central nervous system (CNS) primary pathologies, such as lymphoma and glioblastoma or tumor-like brain lesions and glioma, is often challenging. MRI can be supported by in vivo magnetic resonance spectroscopy (MRS) to enhance its diagnostic power and multiproject-multicenter evaluations of classification of brain tumors have shown that an accuracy around 90% can be achieved for most of the pairwise discrimination problems. However, the survival rate for patients affected by gliomas is still low. The High-Resolution Magic-Angle-Spinning Nuclear Magnetic Resonance (HR-MAS NMR) metabolomics studies may be helpful for the discrimination of gliomas grades and the development of new strategies for clinical intervention. Here, we propose to use T2-filtered, diffusion-filtered and conventional water-presaturated spectra to try to extract as much information as possible, fusing the data gathered by these different NMR experiments and applying a chemometric approach based on Multivariate Curve Resolution (MCR). Biomarkers important for glioma's discrimination were found. In particular, we focused our attention on cystathionine (Cyst) that shows promise as a biomarker for the better prognosis of glioma tumors.
2020
- Anatomic and radiologic relationships of neck structures to cervical spine: Implications for anterior surgical approaches
[Articolo su rivista]
Alicandri-Ciufelli, M.; Fermi, M.; Molinari, G.; Cavazza, E. A.; Billi, A. M.; Giliberto, G.; Cavalleri, F.; Pavesi, G.; Presutti, L.
abstract
The position of the pharyngolaryngeal framework is very important in choosing the best surgical approach for cervical spine disease. The aim of the present paper is to investigate the position of the hyoid bone and cricoid cartilage in relation to the cervical spine. Moreover, the surgical implications for anterior transcervical approaches to the upper spine and the prevertebral space are discussed. To minimise complication rates and increase surgical effectiveness, the location and extent of the cervical spine disease should be evaluated in the context of the patient’s specific anatomy. A retrospective analysis of 100 cervical spine MRIs was conducted. Patients with diseases that could alter anatomic relationships of cervical structures were excluded. The mid-sagittal view of the hyoid and the inferior margin of the cricoid cartilage were projected perpendicularly to the anterior surface of the cervical vertebrae. The distance between these two landmarks was measured on the same view. The distribution of hyoid projections ranged between C2-C3 and C4-C5 intervertebral space, while the cricoid cartilage ranged between C4-C5 and C7-T1 intervertebral spaces. The mean distance between these two landmarks was 49.1 ± 7.7 mm, with statistically significant differences between males and females. The position of the cricoid cartilage significantly influenced the length of the pharyngolaryngeal framework, while the position of hyoid did not. A wide range of variability in the position of the hyoid bone and the cricoid cartilage in relation to cervical levels exists. This implies that an a priori association of a cervical level to neck structures at risk might be inaccurate. The use of these easily identifiable landmarks on pre-operative imaging may help to guide the choice among different anterior surgical approaches to cervical spine and reduce the risk of surgical complications.
2020
- Cutaneous Metastasis from Cervical Spinal Chordoma: Case Report and Literature Review
[Articolo su rivista]
Berlucchi, Silvia; Nasi, Davide; Zunarelli, Elena; Valluzzi, Adelaide; ALICANDRI CIUFELLI, Matteo; Presutti, Livio; Pavesi, Giacomo
abstract
Chordomas are rare primary tumors of the bone that arise from embryonic notochord. They are locally aggressive tumors with high tendency for post-surgical recurrence. On the contrary, distant metastases are rare. When occurring, they involve lungs, liver, lymph nodes, and bones. Skin and subcutaneous tissue involvement is even rarer and usually occurs by direct extension of the primary tumor or by local recurrence. Then, distant cutaneous metastasis from chordoma is an exceptional finding, with less than 20 cases reported in the literature. All the cutaneous metastases described derive from sacral chordomas, except for two cases in which the source of metastasis are skull-base chordomas.
2020
- Early life-threating enlargement of a vestibular schwannoma after gamma knife radiosurgery
[Articolo su rivista]
Nasi, D.; Zunarelli, E.; Puzzolante, A.; Moriconi, E.; Pavesi, G.
abstract
Stereotactic gamma knife radiosurgery (GKS) may induce a transient enlargement of vestibular schwannomas (VS). This phenomenon, known as pseudoprogression or swelling, starts at about 3 months following GKS, peaks at about 6 months, and typically subsides thereafter, usually without significant neurological deterioration. We describe a 34-year-old female who developed an aggressive enlargement of a VS 1 month after GKS. The patient was treated with an immediate external ventricular drainage and surgical resection via retrosigmoid approach for an acute neurological deterioration due to hydrocephalus and brainstem compression. Histopathological examination revealed a VS with abundant intratumoral thrombosis and necrosis, suggesting that its rapid expansion could be related to massive radiation-induced tumor necrosis. The present case indicated that rapid life-threating enlargement of a VS may occur as an early complication following GKS.
2020
- Intraoperative neurophysiological monitoring in aneurysm clipping: Does it make a difference? A systematic review and meta-analysis
[Articolo su rivista]
Nasi, Davide; Meletti, Stefano; Tramontano, Vincenzo; Pavesi, Giacomo
abstract
2020
- Myelomeningocele Repair Combining a Double Cryopreserved Amniotic Membrane Homograft and the Keystone Flap in a 3-Year-Old Child: A Case Report
[Articolo su rivista]
Pignatti, Marco; Feletti, Alberto; Sapino, Gianluca; Marotti, Francesca; Pavesi, Giacomo; De Santis, Giorgio
abstract
Early repair in patients affected by myelomeningocele (MMC) is of paramount importance in order to prevent infection, minimize neural tissue damage, and reduce mortality. Treatment must include duraplasty and possibly an adequate soft tissue coverage. Delayed surgery in MMC patients can be more tedious due to the less clear borders between the placode and the skin. Moreover, the risks of wound infection and breakdown increase significantly.
2020
- Targeting GD2-positive glioblastoma by chimeric antigen receptor empowered mesenchymal progenitors
[Articolo su rivista]
Golinelli, Giulia; Grisendi, Giulia; Prapa, Malvina; Bestagno, Marco; Spano, Carlotta; Rossignoli, Filippo; Bambi, Franco; Sardi, Iacopo; Cellini, Monica; Horwitz, Edwin M.; Feletti, Alberto; Pavesi, Giacomo; Dominici, Massimo
abstract
Tumor targeting by genetically modified mesenchymal stromal/stem cells (MSCs) carrying anti-cancer molecules represents a promising cell-based strategy. We previously showed that the pro-apoptotic agent tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) can be successfully delivered by MSCs to cancer sites. While the interaction between TRAIL and its receptors is clear, more obscure is the way in which MSCs can selectively target tumors and their antigens. Several neuroectoderm-derived neoplasms, including glioblastoma (GBM), sarcomas, and neuroblastoma, express high levels of the tumor-associated antigen GD2. We have already challenged this cell surface disialoganglioside by a chimeric antigen receptor (CAR)-T cell approach against neuroblastoma. With the intent to maximize the therapeutic profile of MSCs delivering TRAIL, we here originally developed a bi-functional strategy where TRAIL is delivered by MSCs that are also gene modified with the truncated form of the anti-GD2 CAR (GD2 tCAR) to mediate an immunoselective recognition of GD2-positive tumors. These bi-functional MSCs expressed high levels of TRAIL and GD2 tCAR associated with a robust anti-tumor activity against GD2-positive GBM cells. Most importantly, the anti-cancer action was reinforced by the enhanced targeting potential of such bi-functional cells. Collectively, our results suggest that a truncated anti-GD2 CAR might be a powerful new tool to redirect MSCs carrying TRAIL against GD2-expressing tumors. This affinity-based dual targeting holds the promise to combine site-specific and prolonged retention of MSCs in GD2-expressing tumors, thereby providing a more effective delivery of TRAIL for still incurable cancers.
2020
- The efficacy of postoperative bracing after spine surgery for lumbar degenerative diseases: a systematic review
[Articolo su rivista]
Nasi, D.; Dobran, M.; Pavesi, G.
abstract
Purpose: Postoperative bracing treatment is widely used after surgery for lumbar degenerative diseases. However, the guidelines are lacking in this regard, and its use is mainly driven by individual surgeon preferences. The objective of the current review was to evaluate the available evidence on the use of postoperative bracing after surgery for degenerative disease of the lumbar spine. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed while conducting a systematic search of the PubMed/Medline, Scopus, and Cochrane databases from January 1990 to January 2019. High-quality studies were included that evaluated disability, pain, quality of life, the rate of fusion, complications, and rate of reoperations in patients who had surgery for lumbar degenerative disease, with and without postoperative bracing. The overall strength of evidence across the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results: Of the 391 citations screened, four randomized controlled trials met the inclusion criteria and were included in the review. Based on low- to moderate-quality evidence, postoperative bracing in patients with lumbar degenerative disease does not result in improved disability, pain, and quality of life compared to no bracing patients. Low-quality evidence suggests that there was no significant difference between the two groups in terms of the rate of fusion, complications, and the need for reoperation. Conclusions: To date, there is not a medical evidence to support the use of bracing after surgery for lumbar degenerative disease. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
2019
- Expert Consensus on the Management of Brain Arteriovenous Malformations
[Articolo su rivista]
Kato, Yoko; He Dong, Van; Chaddad, Feres; Takizawa, Katsumi; Izumo, Tsuyoshi; Fukuda, Hitoshi; Hara, Takayuki; Kikuta, Kenichiro; Nakai, Yasunobu; Endo, Toshiki; Kurita, Hiroki; Xu, Bin; Beneš, Vladimír; Christian, Raftopoulos; Pavesi, Giacomo; Hodaie, Mojgan; Kumar Sharma, Rajan; Agarwal, Harshal; Mohan, Krishna; Seng Liew, Boon
abstract
2019
- Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position
[Articolo su rivista]
Feletti, Alberto; Stanzani, Riccardo; Alicandri-Ciufelli, Matteo; Giliberto, Giuliano; Martinoni, Matteo; Pavesi, Giacomo
abstract
During surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.
2019
- Pineoblastoma in Adults: A Rare Case Successfully Treated with Multimodal Approach Including Craniospinal Irradiation Using Helical Tomotherapy
[Articolo su rivista]
Gaito, Simona; Malagoli, Marcella; Depenni, Roberta; Pavesi, Giacomo; Bruni, Alessio
abstract
Pineoblastomas (PBs) are rare and aggressive malignancies of the pineal gland. They are more commonly diagnosed in children between 1-12 years old, and are very rarely diagnosed in adults. For this reason, evidence in literature for adults is scarce and mainly derives from the paediatric practice. For their clinical behaviour and embryonal histology, PBs are often grouped together with medulloblastomas in clinical trials. In this report, we describe an adult PB case who was treated at our institution. We reference the literature to explain the clinical reasoning behind our decision-making process. A 46-year-old male patient was referred to our institution in November 2015 with three months history of headache. Imaging confirmed localised disease of the pineal gland. He underwent surgery which was radical and clinically uncomplicated. Histology showed PB. He then received adjuvant craniospinal radiotherapy with a boost to the tumour bed followed by consolidation chemotherapy. After 36 months follow-up, he remains disease-free without significant toxicities. Surgery followed by craniospinal irradiation and consolidation chemotherapy can be a safe and effective treatment option in adult PBs.
2019
- Sporadic and hereditary hemangioblastoma: The role of endothelial cells
[Articolo su rivista]
Feletti, A.; Bianchini, E.; De Gaetano, A.; Gibellini, L.; De Biasi, S.; Pavesi, G.; Mattioli, A. V.; Nasi, M.; Cossarizza, A.; Pinti, M.
abstract
2018
- Acquisition of surgical skills for endoscopic ear and lateral skull base surgery: A staged training programme
[Articolo su rivista]
Alicandri-Ciufelli, M.; Marchioni, D.; Pavesi, G.; Canzano, Federica; Feletti, A.; Presutti, L.
abstract
Endoscopic ear surgery is radically changing the treatment of several middle and inner ear pathology, but its learning presents well-known manual and technical difficulties. The aim of this paper is be to present a training programme based on a modular model of increased difficulties. The experience from 2007 to 2016 at the University Hospital of Modena and University Hospital of Verona was reviewed and analysed for further considerations and to establish stages of training. The increasing experience of expert surgeons who deal with this kind of surgery represented the main guide to establish the steps and progression of training. In addition, the potential risk of damage of vascular structures or nerves represents fundamental criteria for progression toward higher levels. Some not-mandatory skills were also suggested for stage of difficulty. Five stages of training were deemed appropriate for progressive learning of endoscopic ear and lateral skull base surgery, ranging from simple middle and external ear procedures to surgery of inner ear and internal auditory canal. Mastering of each level is suggested before attempting procedures at a higher level, in particular for procedures involving lateral skull base. Standardisation and adoption of modular incremental training are expected to facilitate improvement of otolaryngologists and neurosurgeons starting with endoscopic middle ear and lateral skull base surgery. Adherence to such a programme during the growth phase may potentially decrease the rate of complications, making the training programme safer.
2018
- Congenital Arteriovenous Malformation of the Scalp Involving the Orbit
[Articolo su rivista]
Feletti, Alberto; Dimitriadis, Stavros; Vallone, Stefano; Pavesi, Giacomo
abstract
Background Arteriovenous malformations (AVMs) of the scalp are rare and infrequently encountered by the neurosurgeon. Case Description We report a unique case of a 42-year-old patient who presented with a progressive worsening of visual acuity in the right eye (lower quadrantanopia) and palpebral ptosis. Physical examination revealed a right exophthalmos and a right frontoparietal scalp soft swelling when the patient was in the supine position. Neurologic work-up showed a scalp AVM extending into the orbit and connected to an intraorbital cavernous angioma. The patient was treated with a frontotemporal craniotomy and decompression of the orbit. Conclusions In the rare case of intraorbital extension of a scalp AVM, neurologic symptoms may appear when the size of the vascular malformation increases with age. The aims of surgery should be decompression of the orbit and aesthetic preservation, rather than complete excision. A review of the literature is also provided.
2018
- Correction to: Which elderly newly diagnosed glioblastoma patients can benefit from radiotherapy and temozolomide? A PERNO prospective study (Journal of Neuro-Oncology, (2016), 128, 1, (157-162), 10.1007/s11060-016-2093-1)
[Articolo su rivista]
Franceschi, Enrico; Depenni, Roberta; Paccapelo, Alexandro; Ermani, Mario; Faedi, Marina; Sturiale, Carmelo; Michiara, Maria; Servadei, Franco; Pavesi, Giacomo; Urbini, Benedetta; Pisanello, Anna; Crisi, Girolamo; Cavallo, Michele A.; Dazzi, Claudio; Biasini, Claudia; Bertolini, Federica; Mucciarini, Claudia; Pasini, Giuseppe; Baruzzi, Agostino; Brandes, Alba A.; Baruzzi, A.; Albani, F.; Calbucci, F.; D’Alessandro, R.; Michelucci, R.; Brandes, A.; Eusebi, V.; Ceruti, S.; Fainardi, E.; Tamarozzi, R.; Emiliani, E.; Cavallo, M.; Franceschi, E.; Tosoni, A.; Cavallo, Marino; Fiorica, F.; Valentini, A.; Depenni, R.; Mucciarini, C.; Crisi, G.; Sasso, Enrico; Biasini, C.; Cavanna, L.; Guidetti, D.; Marcello, Norina; Pisanello, A.; Cremonini, A. M.; Guiducci, G.; de Pasqua, S.; Testoni, S.; Agati, R.; Ambrosetto, G.; Bacci, A.; Baldin, E.; Baldrati, A.; Barbieri, E.; Bartolini, Stefano; Bellavista, E.; Bisulli, F.; Bonora, E.; Bunkheila, F.; Carelli, V.; Crisci, M.; Dall’Occa, P.; de Biase, D.; Ferro, S.; Franceschi, C.; Frezza, G.; Grasso, Vincenzo; Leonardi, M.; Marucci, G.; Morandi, L.; Mostacci, B.; Palandri, G.; Pasini, E.; Pastore Trossello, M.; Pession, A.; Poggi, R.; Riguzzi, P.; Rinaldi, R.; Rizzi, S.; Romeo, G.; Spagnolli, F.; Tinuper, P.; Trocino, C.; Dall’Agata, M.; Frattarelli, M.; Gentili, G.; Giovannini, A.; Iorio, P.; Pasquini, U.; Galletti, G.; Guidi, C.; Neri, W.; Patuelli, A.; Strumia, S.; Faedi, M.; Casmiro, M.; Gamboni, A.; Rasi, F.; Cruciani, Giuseppe; Cenni, P.; Dazzi, C.; Guidi, A. R.; Zumaglini, F.; Amadori, A.; Pasini, G.; Pasquinelli, Mario; Pasquini, Elena; Polselli, A.; Ravasio, A.; Viti, B.; Sintini, M.; Ariatti, A.; Bertolini, F.; Bigliardi, G.; Carpeggiani, P.; Cavalleri, F.; Meletti, S.; Nichelli, P.; Pettorelli, E.; Pinna, Greta; Zunarelli, E.; Artioli, F.; Bernardini, I.; Costa, M.; Greco, G.; Guerzoni, R.; Stucchi, C.; Iaccarino, Corrado; Ragazzi, M.; Rizzi, R.; Zuccoli, G.; Api, P.; Cartei, F.; Colella, Margherita; Fallica, E.; Farneti, M.; Frassoldati, A.; Granieri, E.; Latini, F.; Monetti, C.; Saletti, A.; Schivalocchi, R.; Sarubbo, S.; Seraceni, S.; Tola, M. R.; Urbini, B.; Zini, G.; Giorgi, C.; Montanari, E.; Cerasti, D.; Crafa, P.; Dascola, I.; Florindo, I.; Giombelli, E.; Mazza, S.; Ramponi, V.; Servadei, F.; Silini, E. M.; Torelli, P.; Immovilli, P.; Morelli, N.; Vanzo, C.; Nobile, C.
abstract
The members of the PERNO Study Group were not individually captured in the metadata of the original publication. They are included in the metadata of this publication.
2018
- High speed flow cytometry allows the detection of circulating endothelial cells in hemangioblastoma patients
[Articolo su rivista]
De Biasi, Sara; Gibellini, Lara; Feletti, Alberto; Pavesi, Giacomo; Bianchini, Elena; Lo Tartaro, Domenico; Pecorini, Simone; De Gaetano, Anna; Pullano, Rosalberta; Nasi, Milena; Pinti, Marcello; Cossarizza, Andrea; Boraldi, Federica
abstract
Circulating endothelial cells (CECs) detach from the intima monolayer after endothelial damages. Their circulating endothelial progenitors (CEPs) represent less than 0.01% of nucleated blood cells. Increased levels of CECs and CEPs have been detected in patients with several types of cancer, suggesting that they could be a useful blood-based marker for detecting a tumor, or for monitoring its clinical course. However, their routine monitoring is time consuming and technically challenging. Here, we present a flow cytometry method for quantifying such cells in a cohort of patients with hemangioblastoma (HB). HB is a rare benign tumor, responsible for 1-2.5% of primary intracranial tumors and up to 10% of spinal cord tumors, and for which no tools are available to predict the onset or recurrence in patients undergoing surgical removal of tumor mass. This method allowed us to accurately quantifying CEC and CEP before and after surgery. CEPs are present at high levels in HB patients than control before intervention, and decrease after tumor removal, suggesting that their percentage could represent a valid tool to monitor the disease onset and recurrence.
2018
- Intraoperative measurement of arterial blood flow in aneurysm surgery
[Capitolo/Saggio]
Pasqualin, Alberto; Meneghelli, Pietro; Musumeci, Angelo; Della Puppa, Alessandro; Pavesi, Giacomo; Pinna, Giampietro; Scienza, Renato
abstract
Intraoperative flowmetry (IF) has been recently introduced during cerebral aneurysm surgery in order to obtain a safer surgical exclusion of the aneurysm. This study evaluates the usefulness of IF during surgery for cerebral aneurysms and compares the results obtained in the joined surgical series of Verona and Padua to the more recent results obtained at the neurosurgical department of Verona. In the first surgical series, between 2001 and 2010, a total of 312 patients were submitted to IF during surgery for cerebral aneurysm at the neurosurgical departments of Verona and Padua: 162 patients presented with subarachnoid hemorrhage (SAH) whereas 150 patients harbored unruptured aneurysms. In the second series, between 2011 and 2016, 112 patients were submitted to IF during surgery for cerebral aneurysm at the neurosurgical department of Verona; 24 patients were admitted for SAH, whereas 88 patients were operated on for unruptured aneurysms. Comparison of the baseline values in the two surgical series and the baseline values between unruptured and ruptured aneurysms showed no statistical differences between the two clinical series. Analysis of flowmetry measurements showed three types of loco-regional flow derangements: hyperemia after temporary arterial occlusion, redistribution of flow in efferent vessels after clipping, and low flow in patients with SAH-related vasospasm. IF provides real-time data about flow derangements caused by surgical clipping of cerebral aneurysm, thus enabling the surgeon to obtain a safer exclusion; furthermore, it permits the evaluation of other effects of clipping on the loco-regional blood flow. It is suggested that—in contribution with intraoperative neurophysiological monitoring—IF may now constitute the most reliable tool for increasing safety in aneurysm surgery.
2018
- The Prognostic Roles of Gender and O6-Methylguanine-DNA Methyltransferase Methylation Status in Glioblastoma Patients: The Female Power
[Articolo su rivista]
Franceschi, Enrico; Tosoni, Alicia; Minichillo, Santino; Depenni, Roberta; Paccapelo, Alexandro; Bartolini, Stefania; Michiara, Maria; Pavesi, Giacomo; Urbini, Benedetta; Crisi, Girolamo; Cavallo, Michele A.; Tosatto, Luigino; Dazzi, Claudio; Biasini, Claudia; Pasini, Giuseppe; Balestrini, Damiano; Zanelli, Francesca; Ramponi, Vania; Fioravanti, Antonio; Meletti, Stefano; Giombelli, Ermanno; De Biase, Dario; Baruzzi, Agostino; Brandes, ; Alba, A.; Iaccarino, Corrado
abstract
Background: Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. Methods: We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. Results: A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. Conclusions: Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.
2018
- Unruptured versus Ruptured AVMs: Outcome analysis from a multicentric consecutive series of 545 surgically treated cases
[Articolo su rivista]
Cenzato, M; Tartara, F; D'Aliberti, G; Bortolotti, C; Cardinale, F; Ligarotti, G; Debernardi, A; Fratianni, A; Boccardi, E; Stefini, E; Zenga, F; Boccaletti, R; Lanterna, A; Pavesi, G; Ferroli, P; Sturiale, C; Ducati, A; Cardia, A; Piparo, M; Valvassori, L; Piano, M.
abstract
BACKGROUND: Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent improvement of surgical instrumentation and treatment strategies (both surgical and interventional) yielded better outcomes than those achieved only a decade ago. Therefore, even among specialists, a wide variety of opinions, concerning the treatment of unruptured AVM, can be found.
METHODS: This multicenter retrospective study analyzes a consecutive series of 545 surgically treated AVMs in 10 different hospitals in Italy.
RESULTS: Patients with AVMs treated after hemorrhage had an unfavorable (modified Rankin Scale score >1) outcome in more than one third (37.69%) of the cases. Conversely, with proper indications, unruptured AVMs treated preventively have a good outcome in 93.8% of cases, increasing to 95.7%, with no death, if only Spetzler-Martin grades 1-3 are considered (P < 0.05).
Outcomes on discharge significantly (P < 0.05) improve at 6 months with the disappearance of many of the initial neurologic deficits that turn out to be transient.
CONCLUSIONS: In unruptured low-risk AVMs (Spetzler-Martin grades 1-3), over time, the risk of surgery-associated neurologic deficits becomes lower than that linked to spontaneous hemorrhage, with a crossover point at 6.5 years. Because the average bleeding age is less than 45 years, preventive surgery can be advocated to safeguard the patient and overcome the risks associated with the natural history of AVMs.
2017
- Awake craniotomy anesthetic management using dexmedetomidine, propofol, and remifentanil
[Articolo su rivista]
Prontera, A; Baroni, S; Marudi, A; Valzania, F; Feletti, A; Benuzzi, F; Bertellini, E; Pavesi, G
abstract
2017
- Cavernous angioma of the cerebral aqueduct
[Articolo su rivista]
Feletti, A; Dimitriadis, S; Pavesi, G
abstract
2017
- Complication avoidance during aneurysm clipping
[Capitolo/Saggio]
Feletti, A; Pavesi, G
abstract
2017
- Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment
[Articolo su rivista]
Feborl-hns, ; Pavesi, G; Marchioni, D; Alicandri-Ciufelli, M; Rubini, A; Masotto, B; Presutti, L.
abstract
2017
- Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study
[Articolo su rivista]
Presutti, Livio; Bonali, Marco; Marchioni, Daniele; Pavesi, G; Feletti, A; Anschuetz, L; Alicandri Ciufelli, M.
abstract
The aim of this paper is to describe and evaluate the feasibility of an expanded endoscopic transcanal transpromotorial approach (ExpTTA) to the internal auditory canal and the cerebellopontine angle. To this end, we performed a cadaveric dissection study in September 2015. In total, 2 heads (4 sides) were dissected focusing on anatomical landmarks and surgical feasibility. Data from dissections were reviewed and analysed for further consideration. In all 4 sides of the cadavers the procedure was feasible. In all cadavers, it was necessary to extensively drill the temporo-mandibular joint and to calibrate the external ear canal to allow adequate room to manoeuver the instruments and optics and to comfortably access the cerebellopontine angle. In addition, thorough skeletonisation of the carotid artery and the jugular bulb were necessary for the same purpose. In conclusion, ExpTTA appeared to be successful to access the internal auditory canal and cerebellopontine angle region. Potential extensive and routine application of this type of approach in lateral skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among otolaryngologists and neurosurgical community.
2017
- Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience
[Articolo su rivista]
Presutti, Livio; Alicandri Ciufelli, Matteo; Bonali, Marco; Rubini, Alessia; Pavesi, Giacomo; Feletti, Alberto; Masotto, Barbara; Anschuetz, Lukas; Marchioni, Daniele
abstract
The aim of this study was to describe and evaluate the feasibility of an expanded transcanal transpromontorial approach, developed from the exclusive endoscopic transcanal transpromontorial approach.
2017
- Indocyanine green videoangiography: The thin border between a useful tool and an illusion of safety
[Articolo su rivista]
Pavesi, G; Prontera, A; Feletti, A
abstract
2017
- Transcanal surgery for vestibular schwannomas: a pictorial review of radiological findings, surgical anatomy and comparison to the traditional translabyrinthine approach
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Federici, Gaia; Anschuetz, Lukas; Pavesi, Giacomo; Todeschini, Alessandra; Presutti, Livio; Marchioni, Daniele
abstract
The most popular approaches for vestibular schwannoma (VS) removal are retrosigmoid, middle cranial fossa and translabyrinthine (TL). All require a certain degree of invasivity, bone removal, or brain manipulation. Recently, the authors described the transcanal transpromontorial approaches (TTA), which allow the inner ear to be accessed directly through the external auditory canal (EAC), either with a microscopic (Expanded TTA, or ExpTTA) or even an exclusive endoscopic technique (Endoscopic TTA, or EndoTTA). The advantages compared to traditional approaches are a direct view of the internal auditory canal (IAC) from lateral to medial, very little or no superficial tissue dissection and very little petrous bone drilling. In summary, from an anatomical point of view, they could be considered to be minimally invasive approaches. The radiologic outcome and the anatomical correspondence of these new approaches are described so as to share with the readers the possible radiologic findings and to compare and differentiate them from classic transpetrous approaches such as the TL approach.
2016
- If it can be done, it should be done,… or not? Response to Prof. Grotenhuis
[Articolo su rivista]
Feletti, Alberto; Alicandri Ciufelli, Matteo; Pavesi, Giacomo
abstract
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2016
- Management of Subarachnoid Hemorrhage in Two Important Italian Political Leaders: A Paradigm of Ethical and Technological Evolution of Neurosurgery During the Past Half-Century
[Articolo su rivista]
Longatti, P; Giombelli, E; Pavesi, G; Carteri, A; Feletti, A
abstract
2016
- Transaqueductal trans-Magendie fenestration of arachnoid cyst in the posterior fossa
[Articolo su rivista]
Feletti, Alberto; Alicandri Ciufelli, Matteo; Pavesi, Giacomo
abstract
Neuroendoscopy is currently recommended as the first choice to treat posterior fossa arachnoid cysts. It has proven to be effective, providing improved outcome, and safe, having a low complication rate. Compared to craniotomy and shunt placement, it has lower surgical morbidity, minimizing or avoiding risks of subdural fluid collections, shunt infection, malfunction, overdrainage, and dependence. Usually, rigid scopes maneuvered through a suboccipital approach are used. When symptomatic obstructive hydrocephalus develops, CSF diversion is the first aim of surgery.
2016
- Von Hippel-Lindau disease: An evaluation of natural history and functional disability
[Articolo su rivista]
Feletti, A; Anglani, M; Scarpa, B; Schiavi, F; Boaretto, F; Zovato, S; Taschin, E; Gardi, M; Zanoletti, E; Piermarocchi, S; Murgia, A; Pavesi, G; Opocher, G
abstract
2016
- Which elderly newly diagnosed glioblastoma patients can benefit from radiotherapy and temozolomide? A PERNO prospective study
[Articolo su rivista]
Franceschi, Enrico; Depenni, R.; Paccapelo, Alexandro; Ermani, Mario; Faedi, M.; Sturiale, Carmelo; Michiara, Maria; Servadei, F.; Pavesi, Giacomo; Urbini, B.; Pisanello, A.; Crisi, G.; Cavallo, Michele A.; Dazzi, C.; Biasini, C.; Bertolini, F.; Mucciarini, C.; Pasini, G.; Baruzzi, Agostino; Brandes, Alba A; Albani, F.; Calbucci, F.; D’Alessandro, R.; Michelucci, R.; de Pasqua, S.; Testoni, S.; Brandes, A.; Franceschi, E.; Tosoni, A.; Eusebi, V.; Ceruti, S.; Fainardi, E.; Tamarozzi, R.; Emiliani, E.; Cavallo, M.; Fiorica, F.; Sasso, E.; Cavanna, L.; Guidetti, D.; Marcello, N.; Cremonini, A. M.; Guiducci, G.; Agati, R.; Ambrosetto, G.; Bacci, A.; Baldin, E.; Baldrati, A.; Barbieri, E.; Bartolini, S.; Bellavista, E.; Bisulli, F.; Bonora, E.; Bunkheila, F.; Carelli, V.; Crisci, M.; Dall’Occa, P.; de Biase, D.; Ferro, S.; Franceschi, C.; Frezza, G.; Grasso, V.; Leonardi, M.; Marucci, G.; Morandi, L.; Mostacci, B.; Palandri, G.; Pasini, E.; Pastore Trossello, M.; Pession, A.; Poggi, R.; Riguzzi, P.; Rinaldi, R.; Rizzi, S.; Romeo, G.; Spagnolli, F.; Tinuper, P.; Trocino, C.; Dall’Agata, M.; Frattarelli, M.; Gentili, G.; Giovannini, A.; Iorio, P.; Pasquini, U.; Galletti, G.; Guidi, C.; Neri, W.; Patuelli, A.; Strumia, S.; Casmiro, M.; Gamboni, A.; Rasi, F.; Cruciani, G.; Cenni, P.; Guidi, A. R.; Zumaglini, F.; Amadori, A.; Pasquinelli, M.; Pasquini, E.; Polselli, A.; Ravasio, A.; Viti, B.; Sintini, M.; Ariatti, A.; Bigliardi, G.; Carpeggiani, P.; Cavalleri, F.; Meletti, Stefano; Nichelli, Paolo Frigio; Pettorelli, E.; Pinna, G.; Zunarelli, E.; Artioli, F.; Bernardini, I.; Costa, M.; Greco, G.; Guerzoni, R.; Stucchi, C.; Iaccarino, C.; Ragazzi, M.; Rizzi, R.; Zuccoli, G.; Api, P.; Cartei, F.; Colella, M.; Fallica, E.; Farneti, M.; Frassoldati, A.; Granieri, E.; Latini, F.; Monetti, C.; Saletti, A.; Schivalocchi, R.; Sarubbo, S.; Seraceni, S.; Tola, M. R.; Zini, G.; Giorgi, C.; Montanari, E.; Cerasti, D.; Crafa, P.; Dascola, I.; Florindo, I.; Giombelli, E.; Mazza, S.; Ramponi, V.; Silini, E. M.; Torelli, P.; Immovilli, P.; Morelli, N.; Vanzo, C.; Nobile, C.
abstract
The role of temozolomide concurrent with and adjuvant to radiotherapy (RT/TMZ) in elderly patients with glioblastoma (GBM) remains unclear. We evaluated the outcome of patients >70 years in the context of the Project of Emilia-Romagna Region in Neuro-Oncology (PERNO), the first Italian prospective observational population-based study in neuro-oncology. For this analysis the criteria for selecting patients enrolled in the PERNO study were: age >70 years; PS 0–3; histologically confirmed GBM; postoperative radiotherapy (RT) after surgery with or without concomitant temozolomide (TMZ) or postsurgical TMZ alone. Between January 2009 and December 2010, 76 GBM elderly patients were identified in the prospective PERNO study. Twenty-three patients did not receive any treatment after surgery, and 53 patients received postsurgical treatments (25 patients received RT alone and 28 patients RT/TMZ). Median survival was 11.1 months (95 % CI 8.8–13.5), adding temozolomide concomitant and adjuvant to radiotherapy it was 11.6 months (95 % CI 8.6–14.6), and 9.3 months (95 % CI 8.1–10.6) in patients treated with RT alone (P = 0.164). However, patients with MGMT methylated treated with RT/TMZ obtained a better survival (17.2 months, 95 % CI 11.5–22.9) (P = 0.042). No difference in terms of survival were observed if patients with MGMT unmethylated tumor received RT alone, or RT/TMZ or, in MGMT methylated tumor, if patients received radiotherapy alone. In elderly patients RT/TMZ represent a widely used approach but it is effective with methylated MGMT tumors only.
2015
- Adult idiopathic occlusion of Monro foramina: Intraoperative endoscopic reinterpretation of radiological data and review of the literature
[Articolo su rivista]
Prontera, A.; Feletti, A.; Chahine, R.; Pavesi, G.
abstract
2015
- Facial nerve grading scales: systematic review of the literature and suggestion for uniformity
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Pavesi, Giacomo; Presutti, Livio
abstract
N/D
2015
- Intraoperative Functional and Perfusion Monitoring During Surgery for Giant Serpentine Middle Cerebral Artery Aneurysms
[Articolo su rivista]
Pavesi, G; Dimitriadis, S; Baroni, S; Vallone, S; Valzania, F; Costella, Gb; Feletti
A,
abstract
2015
- Letter to the Editor: Gamma Knife
radiosurgery for vestibular schwannoma
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Pavesi, Giacomo; Presutti, Livio
abstract
N/D
2014
- Cavernous Angioma of the Corpus Callosum Presenting with Acute Psychosis
[Articolo su rivista]
Pavesi, G; Causin, F; Feletti, A
abstract
2014
- Combined approach for tegmen defects repair in patients with cerebrospinal fluid otorrhea or herniations: our experience
[Articolo su rivista]
Marchioni, Daniele; Bonali, Marco; ALICANDRI CIUFELLI, Matteo; Rubini, Alessia; Pavesi, Giacomo; Presutti, Livio; Bonali, Marco
abstract
Objectives To describe our departmental experience in the surgical repair of tegmen tympani defects using a combined transmastoid/minicraniotomic approach. Design Retrospective review of videos from surgery and patients' charts. Setting Tertiary university referral center. Participants Twenty-two patients who underwent surgical repair of tegmen defects associated with cerebrospinal fluid (CSF) leakage and/or meningocele/meningoencephalocele by a combined transmastoid/minicraniotomic approach. Main Outcome Measures A retrospective review of videos of surgery and charts of patients with tegmen tympani or tegmen antri defects and CSF leakage, temporal lobe encephalocele, and/or meningoencephalocele. Results All patients underwent the combined approach and had their defects closed, without significant intraoperative or postoperative complications. Conclusions Mastoidectomy with temporal minicraniotomy represents an effective approach in patients with tegmen tympani dehiscence; the advantages of this technique are the control of the floor of the middle cranial fossa and the possibility to reach bony defects located anteriorly without manipulation of the ossicular chain and temporal lobe.
2014
- Combined endoscopic-microscopic approach for vestibular schwannoma removal: outcomes in a cohort of 81 patients
[Articolo su rivista]
Presutti, L.; Magnaguagno, F.; Pavesi, G.; Cunsolo, E.; Pinna, G.; Alicandri Ciufelli, M.; Marchioni, D.; Prontera, A.; Gioacchini, F. M.
abstract
Patients affected by vestibular schwannomas typically report a number of symptoms and minor disabilities after surgery. Therefore, surgeons dealing with this pathology should also try to achieve a good QoL for patients who have undergone tumour removal. The aim of this study was to analyse QoL in subjects undergoing surgery for vestibular schwannomas and to try to establish a relationship with both the tumour size and post-surgical alterations (e.g. facial motor dysfunctions, difficulties in balance, persistence of headache and tinnitus). A retrospective analysis was performed on a consecutive series of 81 patients affected by vestibular schwannomas and treated by a combined microscopic-endoscopic approach. Three groups of patients were identified on the basis of tumour size. Group 1 (lesions < 25 mm) with 31 patients (38%); Group 2 (lesions > 26 mm and < 40 mm) with 39 patients (48%); Group 3 (lesions > 41 mm) with 11 patients (14%). Data obtained with the Short Form Questionnaire showed a statistically significant difference in QoL in those undergoing intervention compared with a control group of healthy subjects. The Glasgow Benefit Inventory Questionnaire showed that 25 (31%) patients felt better, 11 (14%) felt similarly, and 45 (55%) felt poorer health conditions in comparison to the pre-surgical period. Concerning the relationship between preservation of facial nerve function and QoL, using the Glasgow Health Status Inventory, it appeared that only 34% of subjects with good facial nerve function (RGS grade I-II) complained of worsening of QoL, while 45% of those with serious facial nerve injury (RGS grade IV-V) referred poorer QoL. Moreover, the possibility of recovery of facial nerve function during the months following surgery was clearly highlighted by our analysis. Our study confirmed the close relation between tumour size and post-surgical QoL, which is worse for patients affected by larger lesions.
2014
- Hemangioblastoma of the Filum Terminale Resected with the Aid of Intraoperative Indocyanine Green Angiography in a Patient Affected by Von Hippel Lindau Disease
[Articolo su rivista]
A, Puzzolante; A, Prontera; Pavesi, G
abstract
2014
- Hemifacial spasm:clinical features and management
[Capitolo/Saggio]
Pavesi, G; Costella, Gb; Zara, G
abstract
2014
- Papillary glioneuronal tumor as a cause of superficial siderosis. A case report
[Articolo su rivista]
A., Puzzolante; A., Prontera; S., Dimitriadis; Pavesi, G
abstract
2014
- Symptomatic Anterior Cerebral Artery Vasospasm after Brainstem Hemangioblastoma Resection: A Case Report
[Articolo su rivista]
A, Prontera; A, Puzzolante; P, Carpeggiani; Pavesi, G
abstract
2013
- Intraventricular melanoma metastases
[Articolo su rivista]
Feletti, A; Magrini, S; Manara, R; Orvieto, E; Pavesi, G
abstract
na
2012
- Ex vivo HR-MAS NMR, in vivo MRS-MRI and Multiivariate analysis to Highlight Biomarkers in Gliomas
[Abstract in Atti di Convegno]
Righi, V.; Schenetti, Luisa; Valentini, A.; Nocetti, L.; Pavesi, G.; Tugnoli, V.; Mucci, Adele
abstract
Gliomas account for about 40% of total primitive brain tumors, and discrimination between high and low glioma grade remains a vital diagnostic decision, determining the most effective treatment and having an important impact on patient management and outcome. The in vivo MRS is considered a tool able to help the diagnosis based on MRI in the evaluation of several human pathologies, including cancer. In vivo MRS provides the spectra of living tissues, directly correlated to their chemical composition, but it can be used when the molecular markers of tissues are well established by means of a detailed biochemical picture. This last can be derived from the spectroscopic analysis of ex vivo biopsy samples using High Resolution Magic Angle Spinning (HR-MAS) NMR technique. The ex vivo HR-MAS NMR spectra provide more details about metabolites (aminoacids, carbohydrates, osmolites, organic acids, mobile lipids) than in vivo MRS and permits to produce a metabolic picture of the tissues. Accurate biochemical assignment of metabolites will improve our interpretation of HR-MAS data and the translation of NMR tumor biomarkers to in vivo studies. 1D and 2D HR-MAS NMR experiments were used to determine metabolites of brain tumor (astrocytoma grade II, grade III gliomas, glioblastomas). We developed this project on gliomas with the aim to gain a better insight into the discrimination among different grades and subtypes using ex vivo HR-MAS NMR, in vivo MRS, MRI, clinical data and statistical analysis. We report experiments performed on 15 specimen already collected from different grade glioma. Different amount of some small metabolites such as alanine, lactate, glutamine, glutamate, myo-inositol and glycine in two different ex vivo high grade glioma samples. The ex vivo spectra obtained on samples from different locations, line-broadened in order to be compared with the in vivo MR spectrum, obtained from the same selected voxel. A number of metabolites have been identified as potential biomarkers of tumor type; now we need to combine all the in vivo, ex vivo, histological and clinical data to obtain a unique tumor fingerprints. Results gathered from this study should lead to the development of tools that can facilitate the distinction of tumor types and grade that cannot be readily distinguished by histopathology or by routine neuroimaging.
2011
- Acute endovascular treatment (<48 hours) of uncoilable ruptured aneurysms at non-branching sites using silk flow-diverting devices
[Articolo su rivista]
Causin, F; Pascarella, R; Pavesi, G; Marasco, R; Zambon, G; Battaglia, R; Munari, M
abstract
2011
- Increased Rate of Intracranial Saccular Aneurysms in Acromegaly: An MR Angiography Study and Review of the Literature
[Articolo su rivista]
Manara, R; Maffei, P; Citton, V; Rizzati, S; Bommarito, G; Ermani, M; Albano, I; Della Puppa, A; Carollo, C; Pavesi, G; Scanarini, M; Ceccato, F; Sicolo, N; Mantero, F; Scaroni, C; Martini, C.
abstract
2010
- Prevalence of asymptomatic cerebral aneurysms in acromegalic patients
[Articolo su rivista]
Manara, R; Citton, V; Rizzati, S; Pavesi, G
abstract
2010
- clinical and surgical features of lower brainstem hemangioblastomas in von hippel-Lindau disease
[Articolo su rivista]
Pavesi, G; Berlucchi, S; Munari, M; Manara, R; Scienza, R; Opocher, G
abstract
2009
- Aneurisma della vena di Galeno nell'adulto. Malformazione, dilatazione o fistola?
[Abstract in Rivista]
Causin, F; Marasco, R; Calderone, M; Dal Pos, S; Manara, R; Rolma, G; Pavesi, G; De Caro, R; Faggi, G; Mangiafico, S
abstract
2009
- Trattamento chirurgico degli emangioblastomi del tronco encefalico nella sindrome di von Hippel-Lindau
[Articolo su rivista]
Pavesi, G; Berlucchi, S; Scienza, R; Munari, M; Manara, R; Murgia, A; Opocher, G
abstract
2009
- Trattamento delle Mav cerebrali con colla acrilica. Quali indicazioni ancora?
[Abstract in Rivista]
Causin, F; Marasco, R; Calderone, M; Dal Pos, S; Manara, R; Rolma, G; Pavesi, G; Carollo, C
abstract
2009
- Trattamento endovascolare degli aneurismi microbici: differenti opzioni
[Abstract in Rivista]
Marasco, R; Calderone, M; Dal Pos, S; Manara, R; Rolma, G; Iannucci, G; Pavesi, G; Faggi, G; Causin, F
abstract
2009
- acute surgical removal of low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations
[Articolo su rivista]
Pavesi, G; Rustemi, O; Berlucchi, S; Frigo, Ac; Gerunda, V; Scienza, R
abstract
2008
- Intraventricular hemorrhage caused by peripheral anterior choroidal artery aneurysm rupture: A case report
[Articolo su rivista]
Pavesi, G; Amistà, P; Munari, M; Gardiman, Mp; Scienza, R
abstract
2008
- Neurosurgical treatment of von Hippel-Lindau-associated hemangioblastomas: benefits, risks and outcome
[Articolo su rivista]
Pavesi, G; Feletti, A; Berlucchi, S; Opocher, G; Martella, M; Murgia, A; Scienza, R
abstract
2007
- Digisonic SP auditory brainstem implant in NF2 patients
[Articolo su rivista]
Trabalzini, F; Scienza, R; Pavesi, G
abstract
2007
- Intracranial stenting in four patients with acute ischemic stroke
[Articolo su rivista]
Amistà, P; Munari, M; Sartori, Mt; Volipin, Sm; Pavesi, G; Basile, Am; Cavasin, N
abstract
2006
- Endothelial cells from human cerebral aneurysms and arteriovenous malformation release ET-1 in response to vessel rupture
[Articolo su rivista]
Boscolo, E; Pavesi, G; Zampieri, P; Conconi, Mt; Calore, C; Scienza, R; Parnigotto, Pp; Folin, M
abstract
2006
- Hemangioblastoma of the obex mimicking anorexia nervosa
[Articolo su rivista]
Pavesi, G; Berlucchi, S; Feletti, A; Opocher, G; Scienza, R
abstract
2006
- Unruptured aneurysm italian study (UAIS). Background and method
[Articolo su rivista]
Versari, ; Tartara, F; Pavesi, G; Et, Al
abstract
2005
- Risk of hemorrhage in hemangioblastomas of the central nervous system: Comments
[Articolo su rivista]
Schackert, G.; Niemela, M.; Hernesniemi, J.; Ishii, K.; Pavesi, G.; Awad, I. A.; Barrow, D. L.
abstract
2004
- Impairment of executive functions in a patient with a focal lesion in the anterior cingulate cortex. Evidence from neuropsychological assessment
[Articolo su rivista]
Peru, A; Pavesi, G; Campello, M
abstract
2003
- Flowmetry-assisted aneurysm clipping. A cooperative study
[Relazione in Atti di Convegno]
Scienza, R; Pavesi, G; Pasqualin, A; Benericetti, E; Boccaletti, R; Pinna, Gp; Profeta, G; Santoro, A
abstract
2003
- Intraoperative cerebral angiography: superficial temporal artery method and results
[Articolo su rivista]
Lee, Mc; Macdonald, Rl; Niemela, M; Hernesniemi, J; Pavesi, G
abstract
2003
- Terapia chirurgica degli aneurismi cerebrali
[Articolo su rivista]
Scienza, R; Pavesi, G
abstract
2002
- MAV cerebrali, la nostra esperienza chirurgica
[Articolo su rivista]
Scienza, R; Pavesi, G
abstract
2001
- Aspetti clinici e chirurgici dei neurinomi del trigemino
[Relazione in Atti di Convegno]
Della Puppa, A; Pavesi, G; Scienza, R
abstract
2000
- Trattamento dei meningiomi del seno cavernoso
[Articolo su rivista]
Scienza, R; Pavesi, G; Berlucchi, S; Zampieri, P
abstract
1999
- Cerebral blood flow-guided phenylephrine-induced hypertensive therapy after subarachnoid hemorrhage
[Articolo su rivista]
Karakus, A; Yonas, H; Pavesi, G; Jungreis, Ca; Kromer, Ha; Pentheny, Sl; Kassam, A
abstract
1994
- Intracranial ependymomas in children: long-term prognosis in relation to age
[Articolo su rivista]
Sala, F; Mazza, C; Talacchi, A; Pavesi, G; Bricolo, A
abstract
1993
- The influence of various factors on transcranial Doppler flow velocity and resistance index after subarachnoid hemorrhage
[Relazione in Atti di Convegno]
Pasqualin, A; Pavesi, G; Battaglia, R; Acerbi, G
abstract
1993
- The value of hemodynamic measurements in the early stage of subarachnoid hemorrhage
[Capitolo/Saggio]
Pasqualin, A; Talacchi, A; Pavesi, G; Da Pian, R
abstract
1992
- Combined pterional-subtemporal approach to upper basilar artery aneurysms
[Capitolo/Saggio]
Da Pian, R; Pasqualin, A; Scienza, R; Pavesi, G; Licata, C
abstract
1992
- Combined transcranial doppler sonography and rCBF measurements in the early stage of subarachnoid hemorrhage
[Capitolo/Saggio]
Pasqualin, A; Talacchi, A; Chioffi, F; Pavesi, G; Da Pian, R
abstract
1992
- The importance of transcranial doppler sonography in the management of cerebral AVMs: pre-treatment evaluation and post-embolization changes
[Capitolo/Saggio]
Chioffi, F; Pasqualin, A; Acerbi, G; Pavesi, G
abstract
1992
- evaluation of cerebral perfusion after subarachnoid hemorrhage using transcranial doppler and rCBF measurements
[Capitolo/Saggio]
Pasqualin, A; Talacchi, A; Pavesi, G; Da Pian, R
abstract