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CORRADO IACCARINO

Professore Associato
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede ex-Neuroscienze

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Pubblicazioni

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 - 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.

2022 - Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study [Articolo su rivista]
Clark, D.; Joannides, A.; Adeleye, A. O.; Bajamal, A. H.; Bashford, T.; Biluts, H.; Budohoski, K.; Ercole, A.; Fernandez-Mendez, R.; Figaji, A.; Gupta, D. K.; Hartl, R.; Iaccarino, C.; Khan, T.; Laeke, T.; Rubiano, A.; Shabani, H. K.; Sichizya, K.; Tewari, M.; Tirsit, A.; Thu, M.; Tripathi, M.; Trivedi, R.; Devi, B. I.; Servadei, F.; Menon, D.; Kolias, A.; Hutchinson, P.; Abbas, G.; Abdallah, O. I.; Abdel-Lateef, A.; Abdifatah, K.; Abdullateef, A.; Abeygunaratne, R.; Aboellil, M.; Adam, A.; Adams, R.; Adeleye, A.; Adeolu, A.; Adji, N. K.; Afianti, N.; Agarwal, S.; Aghadi, I. K.; Aguilar, P. M. M.; Ahmad, S. R.; Ahmed, D.; Ahmed, N.; Aizaz, H.; Aji, Y. K.; Alamri, A.; Alberto, A. J. M.; Alcocer, L. A.; Alfaro, L. G.; Al-Habib, A.; Alhourani, A.; Ali, S. M. R.; Alkherayf, F.; Almenabbawy, A.; Alshareef, A.; Aminullah, M. A. S.; Amjad, M.; Amorim, R. L. O. D.; Anbazhagan, S.; Andrade, A.; Antar, W.; Anyomih, T. T. K.; Aoun, S.; Apriawan, T.; Armocida, D.; Arnold, P.; Arraez, M.; Assefa, T.; Asser, A.; Athiththan, S. P.; Attanayake, D.; Aung, M. M.; Avi, A.; Ayala, V. E. A.; Azab, M.; Azam, G.; Azharuddin, M.; Badejo, O.; Badran, M.; Baig, A. A.; Baig, R. A.; Bajaj, A.; Baker, P.; Bala, R.; Balasa, A.; Balchin, R.; Balogun, J.; Ban, V. S.; Bandi, B. K. R.; Bandyopadhyay, S.; Bank, M.; Barthelemy, E.; Bashir, M. T.; Basso, L. S.; Basu, S.; Batista, A.; Bauer, M.; Bavishi, D.; Beane, A.; Bejell, S.; Belachew, A.; Belli, A.; Belouaer, A.; Bendahane, N. E. A.; Benjamin, O.; Benslimane, Y.; Benyaiche, C.; Bernucci, C.; Berra, L. V.; Bhebe, A.; Bimpis, A.; Blanaru, D.; Bonfim, J. C.; Borba, L. A. B.; Borcek, A. O.; Borotto, E.; Bouhuwaish, A. E. M.; Bourilhon, F.; Brachini, G.; Breedon, J.; Broger, M.; Brunetto, G. M. F.; Bruzzaniti, P.; Budohoska, N.; Burhan, H.; Calatroni, M. L.; Camargo, C.; Cappai, P. F.; Cardali, S. M.; Castano-Leon, A. M.; Cederberg, D.; Celaya, M.; Cenzato, M.; Challa, L. M.; Charest, D.; Chaurasia, B.; Chenna, R.; Cherian, I.; Ching'O, J. H.; Chotai, T.; Choudhary, A.; Choudhary, N.; Choumin, F.; Cigic, T.; Ciro, J.; Conti, C.; Correa, A. C. D. S.; Cossu, G.; Couto, M. P.; Cruz, A.; D'Silva, D.; D'Aliberti, G. A.; Dampha, L.; Daniel, R. T.; Dapaah, A.; Darbar, A.; Dascalu, G.; Dauda, H. A.; Davies, O.; Delgado-Babiano, A.; Dengl, M.; Despotovic, M.; Devi, I.; Dias, C.; Dirar, M.; Dissanayake, M.; Djimbaye, H.; Dockrell, S.; Dolachee, A.; Dolgopolova, J.; Dolgun, M.; Dow, A.; Drusiani, D.; Dugan, A.; Duong, D. T.; Duong, T. K.; Dziedzic, T.; Ebrahim, A.; El Fatemi, N.; El Helou, A. E.; El Maaqili, R. E.; El Mostarchid, B. E.; El Ouahabi, A. E.; Elbaroody, M.; El-Fiki, A.; El-Garci, A.; El-Ghandour, N. M. F.; Elhadi, M.; Elleder, V.; Elrais, S.; El-shazly, M.; Elshenawy, M.; Elshitany, H.; El-Sobky, O.; Emhamed, M.; Enicker, B.; Erdogan, O.; Ertl, S.; Esene, I.; Espinosa, O. O.; Fadalla, T.; Fadelalla, M.; Faleiro, R. M.; Fatima, N.; Fawaz, C.; Fentaw, A.; Fernandez, C. E.; Ferreira, A.; Ferri, F.; Figaji, T.; Filho, E. L. B.; Fin, L.; Fisher, B.; Fitra, F.; Flores, A. P.; Florian, I. S.; Fontana, V.; Ford, L.; Fountain, D.; Frade, J. M. R.; Fratto, A.; Freyschlag, C.; Gabin, A. S.; Gallagher, C.; Ganau, M.; Gandia-Gonzalez, M. L.; Garcia, A.; Garcia, B. H.; Garusinghe, S.; Gebreegziabher, B.; Gelb, A.; George, J. S.; Germano, A. F.; Ghetti, I.; Ghimire, P.; Giammarusti, A.; Gil, J. L.; Gkolia, P.; Godebo, Y.; Gollapudi, P. R.; Golubovic, J.; Gomes, J. F.; Gonzales, J.; Gormley, W.; Gots, A.; Gribaudi, G. L.; Griswold, D.; Gritti, P.; Grobler, R.; Gunawan, R.; Hailemichael, B.; Hakkou, E.; Haley, M.; Hamdan, A.; Hammed, A.; Hamouda, W.; Hamzah, N. A.; Han, N. L.; Hanalioglu, S.; Haniffa, R.; Hanko, M.; Hanrahan, J.; Hardcastle, T.; Hassani, F. D.; Heidecke, V.; Helseth, E.; Hernandez-Hernandez, M. A.; Hickman, Z.; Hoang, L. M. C.; Hollinger, A.; Horakova, L.; Hossain-Ibrahim, K.; Hou, B.; Hoz, S.; Hsu, J.; Hunn, M.; Hussain, M.; Iacopino, G.; Ideta, M. M. L.; Iglesias, I.; Ilunga, A.; Imtiaz, N.; Islam, R.; Ivashc
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 - 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 - The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study [Articolo su rivista]
Picetti, E.; Iaccarino, C.; Coimbra, R.; Abu-Zidan, F.; Tebala, G. D.; Balogh, Z. J.; Biffl, W. L.; Coccolini, F.; Gupta, D.; Maier, R. V.; Marzi, I.; Robba, C.; Sartelli, M.; Servadei, F.; Stahel, P. F.; Taccone, F. S.; Unterberg, A. W.; Antonini, M. V.; Galante, J. M.; Ansaloni, L.; Kirkpatrick, A. W.; Rizoli, S.; Leppaniemi, A.; Chiara, O.; De Simone, B.; Chirica, M.; Shelat, V. G.; Fraga, G. P.; Ceresoli, M.; Cattani, L.; Minardi, F.; Tan, E.; Wani, I.; Petranca, M.; Domenichelli, F.; Cui, Y.; Malchiodi, L.; Sani, E.; Litvin, A.; Hecker, A.; Montanaro, V.; Beka, S. G.; Di Saverio, S.; Rossi, S.; Catena, F.
abstract

Background: Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. Methods: The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. Results: There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80–90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80–100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35–40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. Conclusions: Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.

2022 - The course of intracranial pressure after antipyretic therapy in acute brain injury [Articolo su rivista]
Picetti, E.; Ceccarelli, P.; Malchiodi, L.; Mensi, F.; Risolo, S.; Servadei, F.; Iaccarino, C.; Rossi, I.; Rossi, S.
abstract

BACKGROUND: The present study was performed to evaluate intracranial pressure (ICP) variations after antipyretic therapy and their relationship to ICP at baseline (ICPbas) in acute brain injury (ABI) patients. METHODS: We completed a retrospective analysis on data derived from 2 previously published prospective observational studies. The first study involved 32 ABI patients and was performed to elucidate the cerebral and hemodynamic effects of intravenous (IV) paracetamol. The second study involved 30 ABI patients and was performed to investigate cerebral and hemodynamic effects of intramuscular IM diclofenac sodium (DCF). Overall patient population was divided into 2 groups: 1) group A (G-A) when ICPbas was ≤15 mmHg; and 2) group B (G-B) when ICPbas was >15 mmHg. The main objective was to evaluate if ICPbas affects the time course of ICP after antipyretics administration. RESULTS: Data from 62 ABI patients were analyzed. We failed to observe a significant change in ICP after antipyretic treatment in the overall group of patients (P1=0.486). A significant difference, however, was found between the two groups (P2<0.001). We observed that in the G-A, ICP increased in response to antipyretic administration, whereas in the G-B, ICP decreased. These opposite responses are reflected in the statistically significant interaction (P3<0.001). CONCLUSIONS: Variation in ICP after antipyretic therapy is influenced by ICPbas. Specifically, patients with ICPbas≤15 mmHg showed a significant increase in ICP after antipyretic therapy, while a significant reduction in ICP was observed in patients with ICPbas>15 mmHg.

2021 - Do neurosurgeons follow the guidelines? A world-based survey on severe traumatic brain injury [Articolo su rivista]
Saraceno, G.; Servadei, F.; Di Bergamo, L. T.; Iaccarino, C.; Rubiano, A. M.; Zoia, C.; de Bonis, P.; Raffa, G.; Hawryluk, G.; Grotenhuis, A.; Demetriades, A. K.; Sala, F.; Belotti, F.; Zanin, L.; Doglietto, F.; Panciani, P. P.; Biroli, A.; Agosti, E.; Serioli, S.; Rasulic, L.; Bruneau, M.; Germano, I. M.; Bosnjak, R.; Thome, C.; Regli, L.; Vukic, M.; Tessitore, E.; Schaller, K.; Chaurasia, B.; El-Ghandour, N. M. F.; Di Ieva, A.; Bongetta, D.; Borghesi, I.; Fazio, M.; Esene, I. N.; Rosseau, G.; El Abbadi, N.; Baccanelli, M.; Vajkoczy, P.; Fontanella, M. M.
abstract

BACKGROUND: Traumatic brain injury (TBI) is going to be the third-leading cause of death worldwide, according to the WHO. Two european surveys suggested that adherence to brain trauma guidelines is poor. No study has compared compliance between low- (LMICs) and high-income (UHICs) countries. Hence, this study aimed to investigate differences in the management of severe TBI patients, comparing low- and high-income, and adherence to the BTF guidelines. METHODS: a web-based survey was spread through the global Neuro foundation, different neurosurgical societies, and social media. RESULTS: a total of 803 neurosurgeons participated: 70.4 from UHICs and 29.6% from LMICs. Hypertonic was administered as an early measure by the 73% and 65% of the responders in LMICs and UHICs, respectively (P=0.016). an invasive intracranial pressure monitoring was recommended by the 66% and 58% of the neurosurgeons in LMICs and UHICs, respectively (P<0.001). antiseizure drugs (P<0.001) were given most frequently in LMICs as, against recommendations, steroids (87% vs. 61% and 86% vs. 81%, respectively). in the LMICs both the evacuation of the contusion and decompressive craniectomy were performed earlier than in UHICs (30% vs. 17% with P<0.001 and 44% vs. 28% with P=0.006, respectively). In the LMICs, the head CT control was performed mostly between 12 and 24 hours from the first imaging (38% vs. 23%, P<0.001). CONCLUSIONS: The current Guidelines on TBI do not always fit to both the resources and circumstances in different countries. Future research and clinical practice guidelines should reflect the greater relevance of TBI in low resource settings.

2021 - Epidemiology of Traumatic Brain Injury [Capitolo/Saggio]
Iaccarino, Corrado; Gerosa, A.; Viaroli, and E.
abstract

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 - Head Injuries [Capitolo/Saggio]
Diomedi, M.; Consoli, D.; Iaccarino, C.; Lunardi, P.; Novegno, F.; Provinciali, L.
abstract

A cranio-encephalic trauma (TBI) is defined as a traumatically induced structural insult and/or an alteration of physiological brain functions as a result of an external force that produces the onset or worsening of clinical symptoms, and a prompt and structured clinical observation is mandatory. To promotes effective clinical assessment and right care for the severity of head injury, early management, observation, therapy, indications for and timing of CT scans and transport decisions are addressed in this chapter.

2021 - How do you manage ANTICOagulant therapy in neurosurgery? The ANTICO survey of the Italian Society of Neurosurgery (SINCH) [Articolo su rivista]
Prior, A; Fiaschi, P; Iaccarino, C; Stefini, R; Battaglini, D; Balestrino, A; Anania, P; Prior, E; Zona, G
abstract

Background: Anticoagulant assumption is a concern in neurosurgical patient that implies a delicate balance between the risk of thromboembolism versus the risk of peri- and postoperative hemorrhage. Methods: We performed a survey among 129 different neurosurgical departments in Italy to evaluate practice patterns regarding the management of neurosurgical patients taking anticoagulant drugs. Furthermore, we reviewed the available literature, with the aim of providing a comprehensive but practical summary of current recommendations. Results: Our survey revealed that there is a lack of knowledge, mostly regarding the indication and the strategies of anticoagulant reversal in neurosurgical clinical practice. This may be due a lack of national and international guidelines for the care of anticoagulated neurosurgical patients, along with the fact that coagulation and hemostasis are not simple topics for a neurosurgeon. Conclusions: To overcome this issue, establishment of hospital-wide policy concerning management of anticoagulated patients and developed in an interdisciplinary manner are strongly recommended. Keywords: Anticoagulant, Reversal therapy, Neurosurgery, Traumatic brain injury, Spontaneous intracerebral hemorrhage

2021 - Improvement in neurological outcome and brain hemodynamics after late cranioplasty [Articolo su rivista]
Oliveira, A. M. P.; Amorim, R. L. O.; Brasil, S.; Gattas, G. S.; de Andrade, A. F.; Junior, F. M. P.; Bor-Seng-Shu, E.; Iaccarino, C.; Teixeira, M. J.; Paiva, W. S.
abstract

Background: Early cranioplasty has been encouraged after decompressive craniectomy (DC), aiming to reduce consequences of atmospheric pressure over the opened skull. However, this practice may not be often available in low-middle-income countries (LMICs). We evaluated clinical improvement, hemodynamic changes in each hemisphere, and the hemodynamic balance between hemispheres after late cranioplasty in a LMIC, as the institution’s routine resources allowed. Methods: Prospective cohort study included patients with bone defects after DC evaluated with perfusion tomography (PCT) and transcranial Doppler (TCD) and performed neurological examinations with prognostic scales (mRS, MMSE, and Barthel Index) before and 6 months after surgery. Results: A final sample of 26 patients was analyzed. Satisfactory improvement of neurological outcome was observed, as well as significant improvement in the mRS (p = 0.005), MMSE (p < 0.001), and Barthel Index (p = 0.002). Outpatient waiting time for cranioplasty was 15.23 (SD 17.66) months. PCT showed a significant decrease in the mean transit time (MTT) and cerebral blood volume (CBV) only on the operated side. Although most previous studies have shown an increase in cerebral blood flow (CBF), we noticed a slight and nonsignificant decrease, despite a significant increase in the middle cerebral artery flow velocity in both hemispheres on TCD. There was a moderate correlation between the MTT and contralateral muscle strength (r = − 0.4; p = 0.034), as well as between TCD and neurological outcomes ipsilateral (MMSE; r = 0.54, p = 0.03) and contralateral (MRS; p = 0.031, r = − 0.48) to the operated side. Conclusion: Even 1 year after DC, cranioplasty may improve cerebral perfusion and neurological outcomes and should be encouraged.

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 - Odontoid Type II fractures in elderly: what are the real management goals and how to best achieve them? A multicenter European study on functional outcome [Articolo su rivista]
Chibbaro, S.; Mallereau, C. -H.; Ganau, M.; Zaed, I.; Teresa Bozzi, M.; Scibilia, A.; Cebula, H.; Ollivier, I.; Loit, M. -P.; Chaussemy, D.; Coca, H. -A.; Dannhoff, G.; Romano, A.; Nannavecchia, B.; Gubian, A.; Spatola, G.; Signorelli, F.; Iaccarino, C.; Pop, R.; Proust, F.; Baloglu, S.; Todeschi, J.
abstract

Odontoid fractures constitute the most common cervical fractures in elderly. External immobilization is the treatment of choice for Type I and III; there is still no wide consensus about the best management of Type II fractures. Observational multicenter study was conducted on a prospectively built database on elderly patients (> 75 years) with Type II odontoid fracture managed conservatively during the last 10 years. All patients underwent CT scan on admission and at 3 months; if indicated, selected patient had CT scan at 6 and 12 months. All patients were clinically evaluated by Neck Disability Index (NDI), Charlson Comorbidity Index (CCI), and American Society of Anaesthesiologists classification (ASA) on admission; NDI was assessed also at 6 weeks, 3, 6, 12, and 24 months; furthermore, a quality of life (QoL) assessment with the SF-12 form was performed at 3 and 12 months. Among the 260 patients enrolled, 177 (68%) were women and 83 (32%) men, with a median age of 83 years. Patients were followed up for a minimum of 24 months: 247 (95%) showed an excellent functional outcome within 6 weeks, among them 117 (45%) showed a good bony healing, whereas 130 (50%) healed in pseudo-arthrosis. The residual 5% were still variably symptomatic at 12 weeks; however, only 5 out of 13 (2% of the total cohort) required delayed surgery. This study showed that a conservative approach to odontoid Type II fracture in elderly is an effective and valid option, resulting in an excellent functional outcome (regardless of bony fusion) in the majority of cases. Failure of conservative treatment can be safely addressed with surgical fixation at a later stage.

2021 - The management of pediatric severe traumatic brain injury: Italian guidelines [Articolo su rivista]
Bussolin, L.; Falconi, M.; Leo, M. C.; Parri, N.; de Masi, S.; Rosati, A.; Cecchi, C.; Spacca, B.; Grandoni, M.; Bettiol, A.; Lucenteforte, E.; Lubrano, R.; Falsaperla, R.; Melosi, F.; Agostiniani, R.; Mangiantini, F.; Talamonti, G.; Calderini, E.; Mancino, A.; de Luca, M.; Conti, G.; Petrini, F.; Angileri, S.; Baldazzi, M.; Bertuetti, R.; Biermann, K. P.; Bigagli, E.; Carai, A.; Coniglio, C.; Conio, A.; Crescioli, M.; D'Amato, L.; Grassi, A.; Iaccarino, C.; Macchiarini, A.; Magnoni, S.; Masotti, A.; Meneghini, L.; Minardi, C.; Moscatelli, A.; Pedretti, M.; Piazza, S.; Picardo, S. G.; Pittalis, A.; Pizzi, S.; Pompucci, A.; Pugi, A.; Rizzo, G.; Sagredini, R.; Silipo, R.; Stoppa, F.; Tuccinardi, G.
abstract

Introduction: the aim of the work was to update the “guidelines for the Management of severe traumatic Brain Injury” published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients. eViDeNce acQUisitioN: MeDliNe and eMBase were searched from January 2009 to october 2017. inclusion criteria were english language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. the guideline development process was started by the Promoting group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient associations. the panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. the documentarists of the University of Florence oversaw the bibliographic research strategy. a group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question. EVIDENCE SYNTHESIS: The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations. coNclUsioNs: in recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. this has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.

2020 - Clinical practice for antiplatelet and anticoagulant therapy in neurosurgery: data from an Italian survey and summary of current recommendations – part I, antiplatelet therapy [Articolo su rivista]
Fiaschi, P.; Iaccarino, C.; Stefini, R.; Prior, E.; Prior, A.; Zona, G.
abstract

The use of antiplatelet medication is widespread as reducing risk of death, myocardial infarction, and occlusive stroke. Currently, the management of neurosurgical patients receiving this type of therapy continues to be a problem of special importance. In this paper, we present the results of an Italian survey focused on the management neurosurgical patient under antiplatelet therapy and, for any item of the investigation, the relative advices coming from literature. This survey was conducted including 129 neurosurgery units in Italy. The present paper was designed by following each question posed in the survey by a brief discussion on literature data. There is a considerable lack of consensus regarding management of antiplatelet therapy in neurosurgery, with critical impact on patient’s treatment. What is clearly evident from the present survey is the considerable variability in neurosurgical care for antiplatelet patients; it is reasonable to assume that this scenario reflects the paucity of evidence regarding this issue.

2020 - Consensus statement from the international consensus meeting on post-traumatic cranioplasty [Articolo su rivista]
Iaccarino, C.; Kolias, A.; Adelson, P. D.; Rubiano, A. M.; Viaroli, E.; Buki, A.; Cinalli, G.; Fountas, K.; Khan, T.; Signoretti, S.; Waran, V.; Adeleye, A. O.; Amorim, R.; Bertuccio, A.; Cama, A.; Chesnut, R. M.; De Bonis, P.; Estraneo, A.; Figaji, A.; Florian, S. I.; Formisano, R.; Frassanito, P.; Gatos, C.; Germano, A.; Giussani, C.; Hossain, I.; Kasprzak, P.; La Porta, F.; Lindner, D.; Maas, A. I. R.; Paiva, W.; Palma, P.; Park, K. B.; Peretta, P.; Pompucci, A.; Posti, J.; Sengupta, S. K.; Sinha, A.; Sinha, V.; Stefini, R.; Talamonti, G.; Tasiou, A.; Zona, G.; Zucchelli, M.; Hutchinson, P. J.; Servadei, F.
abstract

Background: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

2020 - Cranioplasty Following Decompressive Craniectomy [Articolo su rivista]
Iaccarino, C.; Kolias, A. G.; Roumy, L. -G.; Fountas, K.; Adeleye, A. O.
abstract

Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.

2020 - Extracranial metastases in secondary glioblastoma multiforme: a case report [Articolo su rivista]
Rossi, J.; Giaccherini, L.; Cavallieri, F.; Napoli, M.; Moratti, C.; Froio, E.; Serra, S.; Fraternali, A.; Ghadirpour, R.; Cozzi, S.; Ciammella, P.; Iaccarino, C.; Pascarella, R.; Valzania, F.; Pisanello, A.
abstract

Background: Glioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to IDH wild-type (primary) GBM evolution. Case presentation: We present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion. Conclusions: Our case highlights that grade II Astrocytoma may evolve to a GBM and rarely lead to a secondary metastatic diffusion, which can progress quite rapidly; any symptoms referable to a possible systemic involvement should be carefully investigated.

2020 - Frequency and outcome of olfactory impairment and sinonasal involvement in hospitalized patients with COVID-19 [Articolo su rivista]
Jalessi, M.; Barati, M.; Rohani, M.; Amini, E.; Ourang, A.; Azad, Z.; Hosseinzadeh, F.; Cavallieri, F.; Ghadirpour, R.; Valzania, F.; Iaccarino, C.; Ahmadzadeh, A.; Farhadi, M.
abstract

Background: Olfactory dysfunction has shown to accompany COVID-19. There are varying data regarding the exact frequency in the various study population. The outcome of the olfactory impairment is also not clearly defined. Objective: To find the frequency of olfactory impairment and its outcome in hospitalized patients with positive swab test for COVID-19. Methods: This is a prospective descriptive study of 100 hospitalized COVID-19 patients, randomly sampled, from February to March 2020. Demographics, comorbidities, and laboratory findings were analyzed according to the olfactory loss or sinonasal symptoms. The olfactory impairment and sinonasal symptoms were evaluated by 9 Likert scale questions asked from the patients. Results: Ninety-two patients completed the follow-up (means 20.1 (± 7.42) days). Twenty-two (23.91%) patients complained of olfactory loss and in 6 (6.52%) patients olfactory loss was the first symptom of the disease. The olfactory loss was reported to be completely resolved in all but one patient. Thirty-nine (42.39%) patients had notable sinonasal symptoms while rhinorrhea was the first symptom in 3 (3.26%). Fifteen patients (16.3%) had a taste impairment. Patients with sinonasal symptoms had a lower age (p = 0.01). There was no significant relation between olfactory loss and sinonasal symptoms (p = 0.07). Conclusions: Sudden olfactory dysfunction and sinonasal symptoms have a considerable prevalence in patients with COVID-19. No significant association was noted between the sinonasal symptoms and the olfactory loss, which may suggest that other mechanisms beyond upper respiratory tract involvement are responsible for the olfactory loss.

2020 - Management and outcomes following emergency surgery for traumatic brain injury – A multi-centre, international, prospective cohort study (the Global Neurotrauma Outcomes Study) [Articolo su rivista]
Clark, D.; Joannides, A.; Ibrahim Abdallah, O.; Olufemi Adeleye, A.; Hafid Bajamal, A.; Bashford, T.; Bhebhe, A.; Biluts, H.; Budohoska, N.; Budohoski, K.; Cherian, I.; Marklund, N.; Fernandez Mendez, R.; Figaji, T.; Kumar Gupta, D.; Iaccarino, C.; Ilunga, A.; Joseph, M.; Khan, T.; Laeke, T.; Waran, V.; Park, K.; Rosseau, G.; Rubiano, A.; Saleh, Y.; Shabani, H. K.; Smith, B.; Sichizya, K.; Tewari, M.; Tirsit, A.; Thu, M.; Tripathi, M.; Trivedi, R.; Villar, S.; Devi Bhagavatula, I.; Servadei, F.; Menon, D.; Kolias, A.; Hutchinson, P.
abstract

Introduction: Traumatic brain injury (TBI) accounts for a significant amount of death and disability worldwide and the majority of this burden affects individuals in low-and-middle income countries. Despite this, considerable geographical differences have been reported in the care of TBI patients. On this background, we aim to provide a comprehensive international picture of the epidemiological characteristics, management and outcomes of patients undergoing emergency surgery for traumatic brain injury (TBI) worldwide. Methods and analysis: The Global Neurotrauma Outcomes Study (GNOS) is a multi-centre, international, prospective observational cohort study. Any unit performing emergency surgery for TBI worldwide will be eligible to participate. All TBI patients who receive emergency surgery in any given consecutive 30-day period beginning between 1st of November 2018 and 31st of December 2019 in a given participating unit will be included. Data will be collected via a secure online platform in anonymised form. The primary outcome measures for the study will be 14-day mortality (or survival to hospital discharge, whichever comes first). Final day of data collection for the primary outcome measure is February 13th. Secondary outcome measures include return to theatre and surgical site infection. Ethics and dissemination: This project will not affect clinical practice and has been classified as clinical audit following research ethics review. Access to source data will be made available to collaborators through national or international anonymised datasets on request and after review of the scientific validity of the proposed analysis by the central study team.

2020 - Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma [Articolo su rivista]
Adeleye, A. O.; Idowu, O. K.; Ghadirpour, R.; Iaccarino, C.
abstract

Background: Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. Methods: We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. Results: The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4–15). The median trauma to surgery time was 25 hours (range, 13–192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. Conclusions: Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.

2020 - Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review [Articolo su rivista]
Nasi, D.; Iaccarino, C.; Romano, A.; De Bonis, P.; Farneti, M.; Servadei, F.; Ghadirpour, R.
abstract

Post-traumatic supra and infratentorial acute extradural hematomas (SIEDHs) are an uncommon type of extradural hematoma with only few small series published. In this scenario, the purposes of the present study are to present our experience in the management of 8 patients with acute SIEDH and to perform a systematic literature review. The clinical and radiological data of 8 patients operated for SIEDH at our department were analyzed retrospectively. Using the PRISMA guidelines, we reviewed the articles published from January 1990 to January 2018 reporting data about SIEDH. A total of 3 articles fulfilled the inclusion criteria and were analyzed. The incidence of SIEDHs is very rare constituting < 2% of all traumatic extradural hematomas (EDH). SIEDHs are associated with non-specific symptoms. Only 20% of patients were in coma (GCS < 8) at admission. A “lucid interval” was not reported. The source of bleeding of SIEDH was venous in all cases due to the following: bone fracture with diploe bleeding (50%), transverse/sigmoid sinus injury (22%), oozing meningeal venous vessel (8%), detachment of transverse sinus without wall injury (6%), and unknown in the other cases. Due to the venous nature of the source of hemorrhage, the clinical manifestation of a SIEDH may develop in a slow way, but once a critical volume of hematoma is reached, the deterioration can become rapid and fatal for acute brain stem compression. Surgery is the mainstay of SIEDHs treatment: among 42 cases with SIEDH included in this review, 40 (95.23%) patients were treated with surgery while only two were managed conservatively. Also in our series, all patients underwent surgery. A combined supratentorial craniotomy and suboccipital craniotomy leaving in a bone bridge over the transverse sinus for dural tenting sutures resulted the most used and safe surgical approach. SIEDH is a rare type of EDH. Early diagnosis of SIEDH and prompt surgical evacuation with a combined supratentorial and suboccipital approach provide excellent recovery.

2019 - Comparison between the different types of heterologous materials used in cranioplasty: A systematic review of the literature [Articolo su rivista]
Morselli, C.; Zaed, I.; Tropeano, M. P.; Cataletti, G.; Iaccarino, C.; Rossini, Z.; Servadei, F.
abstract

INTRODUCTION: The choice of heterologous materials for cranioplasty after decompressive craniectomy is still difficult. The aim of this study is to examine the association between material of choice and related complications to suggest the best treatment option. eViDeNce acQuisiTioN: a systematic review was performed for articles reporting cranioplasty comparing the following heterologous implants: titanium, poli-methyl-methacrylate (PMMa), polyetheretherketone (PeeK) and hydroxyapatite (Ha). extracted data included implant materials and incidence of the most frequent complications. EVIDENCE SYNTHESIS: The final selection resulted in 106 papers but according to our rules only 27 studies were included in the final analysis. among a total of 1688 custom-made prosthesis implanted, 649 were titanium (38.49%), 298 PMMa (17.56%), 233 PeeK (13.82%), and 508 were Ha (30.13%). a total of 348 complications were recorded out of 1688 reported patients (20.64%). in the titanium group, 139 complications were recorded (21.42%); in the PMMa group 57 (19.26%), in the PeeK group 49 (21.03%) and in the Ha group 103 (20.3%). if we examine a summary of the reported complications clearly related to cranioplasty (postoperative infections, fractures and prosthesis displacement) versus type of material in multicentric and prospective studies we can see how Ha group patients have less reported infections and cranioplasty explantation after infections than PMMa, PeeK and titanium. on the contrary Ha patients seem to have a higher number of prosthesis displacement again if compared with the other materials. since these data are not derived from a statistically correct analysis they should be used only to help to differentiate the properties of the various heterologous cranioplasties. CONCLUSIONS: The ideal material for all heterologous cranioplasty has not yet been identified. The choice of material should be based on the clinical data of patients, such as the craniectomy size, presence of seizures, possibility of recovery, good long-term outcome associated with a cost analysis.

2019 - Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury: Consensus statement [Articolo su rivista]
Hutchinson, P. J.; Kolias, A. G.; Tajsic, T.; Adeleye, A.; Aklilu, A. T.; Apriawan, T.; Bajamal, A. H.; Barthelemy, E. J.; Devi, B. I.; Bhat, D.; Bulters, D.; Chesnut, R.; Citerio, G.; Cooper, D. J.; Czosnyka, M.; Edem, I.; El-Ghandour, N. M. F.; Figaji, A.; Fountas, K. N.; Gallagher, C.; Hawryluk, G. W. J.; Iaccarino, C.; Joseph, M.; Khan, T.; Laeke, T.; Levchenko, O.; Liu, B.; Liu, W.; Maas, A.; Manley, G. T.; Manson, P.; Mazzeo, A. T.; Menon, D. K.; Michael, D. B.; Muehlschlegel, S.; Okonkwo, D. O.; Park, K. B.; Rosenfeld, J. V.; Rosseau, G.; Rubiano, A. M.; Shabani, H. K.; Stocchetti, N.; Timmons, S. D.; Timofeev, I.; Uff, C.; Ullman, J. S.; Valadka, A.; Waran, V.; Wells, A.; Wilson, M. H.; Servadei, F.
abstract

Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

2019 - Functional Outcome after odontoid fractures in the elderly [Articolo su rivista]
De Bonis, P.; Trapella, G.; Mongardi, L.; Olei, S.; Musio, A.; Iaccarino, C.; Lofrese, G.; Molinari, F.; Dugoni, D.; Ghadirpour, R.; Servadei, F.; Cavallo, M. A.
abstract

While several papers on mortality and the fusion rate in elderly patients treated surgically or non-surgically for odontoid fractures exist, little information is available on quality of life after treatment. The aim of treatment in these patients should not be fracture healing alone but also quality of life improvement. A literature search using PubMed identified seven papers including information on functional evaluation of 402 patients. Patients treated with anterior screw fixation had a good functional outcome in 92.6% of cases. This percentage seemed to decrease in octogenarians. Less information was available for patients treated with posterior approaches; it would seem that up to a half of such patients experienced pain and limitations in activities of daily living after surgery. Patients treated with a halo device had a functional outcome that was worse (or at least no better) than that of patients treated with surgery, with absence of limitations in activities of daily living in 77.3% of patients. Patients treated with a collar had a good functional outcome in the majority of cases, with absence of limitations in activities of daily living in 89% of patients. More studies are needed for evaluation of functional outcome, especially in patients treated with a collar, a halo device or a posterior approach.

2019 - Functional Outcome of Elderly Patients Treated for Odontoid Fracture: A Multicenter Study [Articolo su rivista]
De Bonis, P.; Iaccarino, C.; Musio, A.; Martucci, A.; De Iure, F.; Donati, R.; Cultrera, F.; Tosatto, L.; Servadei, F.; Alesi, D.; Cavallo, M. A.; Ghadirpour, R.; Molinari, F.; Lofrese, G.
abstract

Study Design.Retrospective multicenter study.Objective.Analysis of impact of conservative and surgical treatments on functional outcome of geriatric odontoid fractures.Summary of Background Data.Treatment of odontoid fractures in aged population is still debatable.Methods.One hundred fourty-seven consecutive odontoid fractures in elderly patients were classified according to Anderson-D'Alonzo and Roy-Camille classifications. Philadelphia type collar was always positioned and kept as a treatment whenever acceptable. Halo-vest, anterior screw fixation, C1-C2 posterior arthrodesis, and occipito-cervical fixation were the other treatments adopted. Conservative or surgical treatment strategy was more significantly influenced by antero-posterior displacement (< or >5 mm) and by surgeon decision. On admission ASA, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI) were assessed. Modified Rankin scale (mRS-post), Neck Disability Index (NDI), and Smiley Webster Pain Scale (SWPS) were administered 12 to 15 months after treatment to estimate functional outcome in terms of general disability, neck-related disability, and ability to return to work/former activity. Risk of treatment crossover was calculated considering factors affecting outcome. Fracture healing process in terms of fusion-stability, no fusion-stability, no fusion-no stability was evaluated at 12 months through a cervical computed tomography (CT) scan. Dynamic cervical spine x-rays were obtained whether necessary. No fusion-stability was considered an adequate treatment goal in our geriatric population. Chi square/Fisher exact test and logistic regression were performed for statistical anal.Results.Overall 67 patients were treated conservatively whereas 80 underwent surgery. Collar was adopted in 45 patients, while anterior odontoid fixation and C1-C2 posterior arthrodesis were preferred for 30 patients each. 79.8% of patients showed good outcomes according to NDI. No significant differences were observed between patients of 65 to 79 years and more than or equal to 80 years (P=0.81). CCI greatly correlated with mRS-post, with higher indexes in 68.8% of cases characterized by good outcomes (P=0.05). mRS-pre correlated with NDI (P<0.000001) and mRS-post (P=0.04). CCI, mRS-pre, and surgery were associated with worse NDI, while both C1-C2 posterior arthrodesis and occipito-cervical stabilization were associated with worse mRS-post, respectively in 40% and 30% of cases. Younger patients had a higher risk of treatment crossover.Conclusion.mRS-pre and CCI provided two independent predictive values respectively for functional outcome and post-treatment disability. Compared with conservative immobilizations, surgery revealed no advantages in the elderly in terms of functional outcome.Level of Evidence: 3.

2019 - Grisel’s syndrome: Non-traumatic atlantoaxial rotatory subluxation—report of five cases and review of the literature [Articolo su rivista]
Iaccarino, C.; Francesca, O.; Piero, S.; Monica, R.; Armando, R.; de Bonis, P.; Ferdinando, A.; Trapella, G.; Mongardi, L.; Cavallo, M.; Giuseppe, C.; Franco, S.
abstract

Background: In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel’s syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Surgical stabilization is indicated when high-grade instability or failure of stable reduction are observed. The instability is graded according to the classification system devised by Fielding and Hawkins. Several recommendations for treatment are available in the literature, but there are no common guidelines. In this paper, the authors discuss the need for prompt diagnosis and treatment considerations. Case Description: Five children with Fielding type I–III rotatory subluxation are reported. Three patients were treated with a cervical collar, and one patient was treated with skull traction and sternal–occipital–mandibular immobilizer (SOMI) brace application. Surgical treatment was necessary for one patient after failure of initial conservative management. The intervals between the onset of torticollis and radiological diagnosis ranged from 12 to 90 days. A relationship between an increased grade of instability and delayed diagnosis was observed. Conclusion: In children with painful torticollis following ENT procedures or nasopharyngeal inflammation, Grisel’s syndrome should always be suspected. Cervical magnetic resonance imaging (MRI) allows prompt and safe diagnosis, and a three-dimensional computed tomography (CT) scan provides better classification of the instability. Surgery, which is indicated in cases of high-grade instability or failure of conservative treatment, may be avoided with prompt diagnosis.

2019 - Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: Predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience [Articolo su rivista]
Ghadirpour, R.; Nasi, D.; Iaccarino, C.; Romano, A.; Motti, L.; Sabadini, R.; Valzania, F.; Servadei, F.
abstract

OBJECTIVE The purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors. METHODS Clinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research “ASMN” of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed. The IONM included SSEPs, MEPs, and—whenever possible—D-waves. All patients were evaluated using the modified McCormick Scale at admission and at 3, 6, and 12 months of follow-up . RESULTS A total of 108 patients were included in this study. A monitorable D-wave was achieved in 71 of the 77 patients harboring cervical and thoracic IDEM tumors (92.2%). Recording of D-waves in IDEM tumors was significantly associated only with a preoperative deeply compromised neurological status evaluated using the modified McCormick Scale (p = 0.04). Overall, significant IONM changes were registered in 14 (12.96%) of 108 patients and 9 of these patients (8.33%) had permanent loss of at least one of the 3 evoked potentials. In 7 patients (6.48%), the presence of an s18278 caudal D-wave was predictive of a favorable long-term motor outcome even when the MEPs and/or SSEPs were lost during IDEM tumor resection. However, in 2 cases (1.85%) the D-wave permanently decreased by approximately 50%, and surgery was definitively abandoned to prevent permanent paraplegia. Cumulatively, SSEP, MEP, and D-wave monitoring significantly predicted postoperative deficits (p = 0.0001; AUC = 0.905), with a sensitivity of 85.7% and a specificity of 97%. Comparing the area under the receiver operating characteristic curves of these tests, D-waves appeared to have a significantly greater predictive value than MEPs and especially SSEPs alone (0.992 vs 0.798 vs 0.653; p = 0.023 and p < 0.001, respectively). On multiple logistic regression, the independent risk factors associated with significant IONM changes in the entire population were age older than 65 years and an anterolateral location of the tumor (p < 0.0001). CONCLUSIONS D-wave monitoring was feasible in all patients without severe preoperative motor deficits. D-waves demonstrated a statistically significant higher ability to predict postoperative deficits compared with SSEPs and MEPs alone and allowed us to proceed with IDEM tumor resection, even in cases of SSEP and/or MEP loss. Patients older than 65 years and with anterolateral IDEM tumors can benefit most from the use of IONM.

2019 - Traumatologia Cranica [Capitolo/Saggio]
Paolo Mattogno, Pier; Iaccarino, Corrado; Servadei, Franco
abstract

2019 - Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal? [Articolo su rivista]
Lofrese, G.; Musio, A.; De Iure, F.; Cultrera, F.; Martucci, A.; Iaccarino, C.; Essayed, W. I.; Ghadirpour, R.; Servadei, F.; Cavallo, M. A.; De Bonis, P.
abstract

Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Methods: A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI). From 12–15 months after treatment, functional evaluations were performed employing a second modified Rankin Scale (mRS-post) together with Neck Disability Index (NDI) and Smiley-Webster pain scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine X-rays at 3 months and cervical spine CT scans 6 months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap > 2 mm, an antero-posterior displacement > 5 mm, an odontoid angulation > 11° or neurological deficits occurred. Results: Among the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p = 0.60), CCI (p = 0.85) and mRS-pre (p = 0.14) were noted. Similarly, no differences in mRS-post (p = 0.96), SWPS (p = 0.85) and NDI (p = 0.51) were observed between patients who reached an osseous fusion and those with a stable fibrous non-union. No effects of age, sex, ASA, mRS-pre, fracture dislocation and radiological outcome were discovered on functional outcome. At logistic regression analysis, female sex and high values of CCI emerged associated with worse NDI. Conclusions: In geriatric type II odontoid fractures, pre-injury clinical status and comorbidities overcome imaging in determining post-treatment level of function. Hard collar immobilization led to a favourable functional outcome with mRS-post, NDI and SWPS values diffusely encouraging whatever a bony union or a fibrous non-union was obtained. Graphical Abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

2018 - Complications after surgery for chronic subdural hematomas [Capitolo/Saggio]
Viaroli, E.; Iaccarino, C.; Maduri, R.; Daniel, R. T.; Servadei, F.
abstract

Chronic subdural hematoma (CSDH) is an increasing issue worldwide, due to the increasing age of the population. Despite the simple surgical technique it may be burdened by a high rate of complications (such as recurrence, acute rebleeding, infections, . ..). A consensus about the right management of those events. In this chapter we clarify what are the most common complications of CSDH through a literature review and through a description of some clinical cases in order to better udestand these problems.

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 - Decompressive craniectomy: Surgical indications in developed versus developing countries [Capitolo/Saggio]
Servadei, F.; Iaccarino, C.; Picetti, E.; Nasi, D.; Honeybul, S.
abstract

There continues to be a debate regarding the role of decompressive craniectomy in the management of neurological crises. There is now clear evidence from recent randomized controlled trials that surgical decompression reduces mortality. However, in most of the trials this reduction in mortality was almost directly translatable into an increase in the number of survivors with either severe disability or in a vegetative state. The implications that these findings have for the ongoing use of the procedure in high income countries are significant given the socioeconomic implications of converting death into survival with complete dependency. However, there are limitations when applying the results of these trials to patients who require surgical intervention in low and middle income countries. There are significant and evolving differences in terms of global epidemiological disease patterns, prehospital care, in-hospital diagnostic facilities and rehabilitation facilities. The implications of performing "life-saving" surgery differ depending on the resources available and the application of outcome data from well-funded trials and the impact that use of such surgical techniques has on health care resources will vary markedly.

2018 - Diagnostic performances of [18f]fluorocholine positron emission tomography in brain tumors [Articolo su rivista]
Sollini, M(1); Sghedoni, R; Erba, Pa; Cavuto, S; Froio, A; De Berti, G; Pisanello, A; Fraternali, A; Iori, M; Iaccarino, C; Iori, M; Asti, M; Filice, A; Versari, A.
abstract

AIM: Brain tumors characterization by molecular imaging that allow the depiction of brain lesions metabolic pattern is crucial. Our study aimed: (1) to evaluate the diagnostic performances of [18F]fluoroethylcholine positron emission tomography/computed tomography ([18F]FECH PET/CT), and (2) to correlate PET imaging derived parameters of [18F]FECH to survival in brain tumors. METHODS: from 2009 to 2012, we enrolled 30 patients who underwent [18F]FECH PET/CT. Final diagnosis was established by clinical and radiological follow-up. RESULTS: final diagnosis was consistent with tumor disease in 27/30 cases. In 3/30 cases tumor disease was ruled out. [18F]FECH PET/CT resulted true positive and negative in 21/30 and 9/30 patients, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [18F]FECH PET/CT were 78%, 100%, 100%, 33%, and 80%, respectively. Mean and maximum standardized uptake value (SUVmean and SUVmax) resulted statistically correlated to histology (pvalue= 0.0255 and =0.0222, respectively). Using a SUVmax cut-off of 2.0 or 3.2 we distinguished between low- and high-grade gliomas with a good specificity (70% and 80%, respectively). SUVmax and histology resulted correlated to overall survival and disease related survival at multivariate analysis. CONCLUSIONS: our results, worthy of further investigations, show (1) high diagnostic performances of [18F]FECH PET/CT, (2) a correlation between PET imaging derived parameters and survival.

2018 - Epidemiology of severe traumatic brain injury [Articolo su rivista]
Iaccarino, C.; Carretta, A.; Nicolosi, F.; Morselli, C.
abstract

About 5.48 million people are estimated to suffer from severe traumatic brain injury (TBI) each year (73 cases per 100,000 people). The WHO estimates that almost 90% of deaths due to injuries occur in low- and middle-income countries (LMICs), where the 85% of population live. Of these trauma-related deaths TBI is the main cause of one-third to one-half and represents the greatest cause of death and disability globally among all trauma-related injuries. The primary causes of TBI vary by age, socioeconomic factors, and geographic region, so any planned interventions must take in account this variability. The road traffic injuries (RTI) scenario is still strictly connected to the analysis of the global incidence of TBI, and to the reason why the LMICs experience nearly 3 times as many cases of TBI proportionally than high-income countries (HICs). The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). In HICs, falls and RTIs were reported most frequently as cause of TBI, but the traumas attributable to RTIs dropped from 39% in 2003 to 24% in 2012, while those attributable to falls increased from 43% to 54% respectively, with an increase TBI in the elderly (>65 years) due to falls. Differently from HICs, the population with the peak of TBI incidence is younger in LMICs, with an age between 28.8 and 33.1, as extensively reported. The burden of disease is significant; between 1,730,000 and 1,965,000 lives could be saved if global trauma care were improved in LMICs. Clinical practice recommendation should be developed and created in environments where the severe TBI mainly occurs. The applicability of high-income-country clinical research standards in LMICs is an important topic for future international research.

2018 - Septic complication following porous hydroxyapatite cranioplasty: prosthesis retention management [Articolo su rivista]
Iaccarino, C; Mattogno, Pp; Zanotti, B; Bellocchi, S; Verlicchi, A; Viaroli, E; Pastorello, G; Sgulò, F; Ghadirpour, R; Servadei, F
abstract

BACKGROUND: After failing of autologous cranioplasty or when the bone flap is unavailable, the alloplastic (heterologous) materials are the choice for cranial reconstruction. No agreement has been reported about the material with a significant lower risk of septic complications. This is due to extremely heterogeneous prognostic factors related not only to the material used but also to the surgical procedures and/or to the timing of the procedure. More attention should be focused on the material whose characteristic could enable a delay in bacterial colonization, where an antibiotic therapy could be effective, without need of prosthesis removal. MATERIALS: Four cases of severe septic complication following cranioplasty with porous hydroxyapatite (HA) prosthesis are presented. Patients were conservatively treated, without heterologous bone flap removal. RESULTS: All of our patients presented reasons for delaying HA cranioplasty removal: Patients 1, 3 and 4 had an associated shunted hydrocephalus and the need for non- removing the prosthesis was related to the predictable recurrence of overshunting and/or sinking skin flap syndrome. In case 4 the revision surgery would have also damaged the microvascular flap with latissimus dorsi muscle used by plastic surgeon for skin reconstruction. In case 2 the patient refused revision surgery. In all cases systemic and/or radiological signs of infection were observed. In Case 2 the infective process surrounded completely the HA prosthesis, while it was located in the epidural region in Case 1 and 4. In Case 3 a surgical curettage of the infected wound was performed over the HA prosthesis. Following prosthesis retention management with antibiotic therapy, all patients revealed systemic and/or radiological signs of sepsis resolution at follow-up. CONCLUSIONS: The possibility to avoid a prosthesis removal with effective antibiotic treatment is mainly due to the combination of three factors: targeted antibiotic therapy, good anatomical area revascularization (resulting of an "in situ" intake of antibiotics), and the biomimetism of HA prosthesis. Further investigations in a larger number of cases need to confirm these observations.

2018 - The Current Status of Decompressive Craniectomy in Traumatic Brain Injury [Articolo su rivista]
Kolias, A. G.; Viaroli, E.; Rubiano, A. M.; Adams, H.; Khan, T.; Gupta, D.; Adeleye, A.; Iaccarino, C.; Servadei, F.; Devi, B. I.; Hutchinson, P. J.
abstract

Purpose: This review describes the evidence base that has helped define the role of decompressive craniectomy (DC) in the management of patients with traumatic brain injury (TBI). Recent Findings: The publication of two randomized trials (DECRA and RESCUEicp) has strengthened the evidence base. The DECRA trial showed that neuroprotective bifrontal DC for moderate intracranial hypertension is not helpful, whereas the RESCUEicp trial found that last-tier DC for severe and refractory intracranial hypertension can significantly reduce the mortality rate but is associated with a higher rate of disability. These findings have reopened the debate about (1) the indications for DC in various TBI subtypes, (2) alternative techniques (e.g., hinge craniotomy), (3) optimal time and material for cranial reconstruction, and (4) the role of shared decision-making in TBI care. Additionally, the role of primary DC when evacuating an acute subdural hematoma is currently undergoing evaluation in the context of the RESCUE-ASDH randomized trial. Summary: This review provides an overview of the current evidence base, discusses its limitations, and presents a global perspective on the role of DC, as there is growing recognition that attention should also focus on low- and middle-income countries due to their much greater TBI burden.

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 - Trauma vertebrale midollare [Capitolo/Saggio]
Iaccarino, Corrado; Rapanà, Armando
abstract

La vita moderna aumenta i rischi di infortuni e la traumatologia assume ogni giorno un'importanza maggiore. Accertare una lesione, identificarne le complicanze, valutarne la gravità, prevedere e quantificare l'estensione dei postumi sino al reinserimento della vita professionale e sociale è l'iter per la valutazione del quadro anatomico-clinico post-traumatico. Il trauma è la terza causa di morte dopo le malattie cardio-vascolari e oncologiche e la prima causa nella popolazione al di sotto dei 50 anni. Dal Giuramento di Ippocrate, l'odierna deontologia si è arricchita di obblighi giuridici e di orientamenti specifici rispetto ai quali la società impone un controllo pubblico. Al medico in servizio al Pronto Soccorso s'impone il dovere di prestare le prime cure, effettuare gli accertamenti indicati e necessari, valutare e gestire la situazione "in urgenza", facendosi carico del paziente nel minor tempo possibile. Difatti, la gestione del trauma mediante i sistemi integrati per l'assistenza al trauma, coordinati dalla Centrale del 118, fanno sì che il traumatizzato sia trasportato nella struttura più vicina e idonea al caso di specie, ecc...

2017 - Anterior trans-frontal endoscopic resection of third-ventricle colloid cyst: how I do it [Articolo su rivista]
Nasi, D.; Iaccarino, C.; Romano, A.
abstract

Background: The endoscopic technique has been recognised as a viable and safe alternative to microsurgery for the treatment of third-ventricle colloid cyst. However, the standard precoronal endoscopic approach does not always provide an adequate visualisation of the attachment of the cyst to the velum interpositum. Using a more anterior approach, it is easier to reach the roof of the cyst and its possible adherences with the tela choroidea. Method: The authors describe step by step the anterior trans-frontal endoscopic approach for management of third ventricle colloid cyst. Conclusions: The described approach has shown to be safe, quick and effective for the treatment of third-ventricle colloid cyst.

2017 - Erratum to: Incidence of neuroepithelial primary brain tumors among adult population of Emilia-Romagna Region, Italy [Articolo su rivista]
Baldin, E; Testoni, S; de Pasqua, S; Ferro, S; Albani, F; Baruzzi, A; D'Alessandro, R; PERNO study group Participants: Agati, R.; Ambrosetto, G.; Bacci, A.; Baldin, E.; Baldrati, A.; Barbieri, E.; Bartolini, S.; Bellavista, E.; Bisulli, F.; Bonora, E.; Bunkheila, F.; Carelli, V.; Cerasoli, S.; 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.; Visani M., (Bologna); Dall’Agata, M.; Faedi, M.; Frattarelli, M.; Gentili, G.; Giovannini, A.; Iorio, P.; Pasquini, U.; Galletti, G.; Guidi, C.; Neri, W.; Patuelli, A. .; Strumia S., (ForlI´-Cesena); Casmiro, M.; Gamboni, A.; Rasi F., (Faenza; RA), ; Cruciani G., (Lugo; RA), ; Cenni, P.; Dazzi, C.; Guidi, A. R.; Zumaglini F., (Ravenna); Amadori, A.; Pasini, G.; Pasquinelli, M.; Pasquini, E.; Polselli, A.; Ravasio, A.; Viti B., (Rimini); Sintini M., (Cattolica; RN), ; Ariatti, A.; Bertolini, F.; Bigliardi, G.; Carpeggiani, P.; Cavalleri, F.; Meletti, S.; Nichelli, P.; Pettorelli, E.; Pinna, G.; Zunarelli E., (Modena); Artioli, F.; Bernardini, I.; Costa, M.; Greco, G.; Guerzoni, R.; Stucchi C., (Carpi; MO), ; Iaccarino, C; Ragazzi, M.; Rizzi, R.; Zuccoli G., (Reggio Emilia); Api, P.; Cartei, F.; Fallica, E.; Granieri, E.; Latini, F.; Lelli, G.; Monetti, C.; Saletti, A.; Schivalocchi, R.; Seraceni, S.; Tola, M. R.; Urbini B., (Ferrara); Giorgi, C.; Montanari E., (Fidenza; PR), ; Cerasti, D.; Crafa, P.; Dascola, I.; Florindo, I.; Giombelli, E.; Mazza, S.; Ramponi, V.; Servadei, F.; Silini, Em.; Torelli P., (Parma); Immovilli, P.; Morelli, N.; Vanzo C., (Piacenza); Nobile, C. (Padova).
abstract

Erratum to: Neurol Sci DOI 10.1007/s10072-016-2747-y Unfortunately, some of the participants of the PERNO Study Group are missing in the original publication of the article. The correct details are given below

2017 - First Case of Primary Sellar/Suprasellar-Intraventricular Ewing Sarcoma: Case Report and Review of the Literature [Articolo su rivista]
Mattogno, P. P.; Nasi, D.; Iaccarino, C.; Oretti, G.; Santoro, L.; Romano, A.
abstract

Background Intracranial Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare and poorly differentiated neoplasms. Immunohistochemical and cytogenetic findings support the possibility of a unique nosologic entity. Primary intracranial localization of this tumor is extremely rare; a few cases are reported in the literature, with only some confirmed by genetic studies. Case Description We report a 12-year-old patient with a sellar/suprasellar mass with intraventricular extension that in all its features mimicked a transinfundibular craniopharyngioma. The patient underwent complete resection of the lesion via an endoscopic endonasal transtuberculum approach 6 days after ventriculoperitoneal shunt for acute obstructive hydrocephalus. Histopathologic and genetic examination demonstrated ES/pPNET. The diagnosis was confirmed by detection of a rearrangement of the EWSR1 gene by fluorescent in situ hybridization and identification of the diagnostic t(11;22) translocation by reverse transcriptase polymerase chain reaction. The patient remained in complete clinical remission 12 months after tumor resection followed by adjuvant chemotherapy with no radiologic evidence of tumor recurrence. Conclusions To our knowledge, this is the first case of primary intrasellar/suprasellar-intraventricular ES/pPNET confirmed by molecular genetic analysis. Extensive investigations, including pathologic, immunohistochemical, and genetic studies, are needed for differentiation of these tumors from other, more common sellar/suprasellar tumors. Our case highlights that an interdisciplinary therapeutic approach is mandatory to guarantee a favorable outcome.

2017 - Incidence of neuroepithelial primary brain tumors among adult population of Emilia-Romagna Region, Italy [Articolo su rivista]
Baldin, Elisa; Testoni, Stefania; de Pasqua, Silvia; Ferro, Salvatore; Albani, Fiorenzo; Baruzzi, Agostino; D’Alessandro, Roberto; On behalf of PERNO study group, Null; 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, M.; Fiorica, F.; Valentini, A.; Depenni, R.; Mucciarini, C.; Crisi, G.; Sasso, E.; Biasini, C.; Cavanna, L.; Guidetti, D.; Marcello, N.; 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, S.; Bellavista, E.; Bisulli, F.; Bonora, E.; Bunkheila, F.; Carelli, V.; Crisci, M.; Dall’Occa, P.; Ferro, S.; Franceschi, C.; Frezza, G.; Grasso, V.; Leonardi, M.; Mostacci, B.; Palandri, G.; Pasini, E.; Pastore Trossello, M.; Poggi, R.; Riguzzi, P.; Rinaldi, R.; Rizzi, S.; Romeo, G.; Spagnolli, F.; Tinuper, P.; Trocino, C.; Dall’Agata, M.; Faedi, 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.; Dazzi, C.; Guidi, A. R.; Zumaglini, F.; Amadori, A.; Pasini, G.; Pasquinelli, M.; Pasquini, E.; Polselli, A.; Ravasio, A.; Viti, B.; Sintini, M.; Ariatti, A.; Bertolini, F.; 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.; Fallica, E.; Granieri, E.; Latini, F.; Lelli, G.; Monetti, C.; Saletti, A.; Schivalocchi, R.; Seraceni, S.; Tola, M. R.; Urbini, B.; 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

Incidence of neuroepithelial Primary Brain Tumors (nPBT) varies, ranging from 7.3 to 11.6 cases/100,000/year across Europe. We present incidence and survival of nPBT in the Emilia-Romagna region (ER), Italy. This study is the largest in Southern Europe. Specialists in neurosurgery, neurology, neuroradiology, oncology, radiotherapy, genetics, and pathology of ER notified all suspected nPBT adult cases residing in ER (4,337,966 inhabitants) observed during 2009. Furthermore, through ICD-9 discharge codes, we identified and reviewed all possible cases. Neuroepithelial PBT diagnosis was based on histological or radiological findings. We included 400 incident nPBT cases, of which 102 (25%) were retrospectively identified. These latter were significantly older. The standardized incidence was 10.5/100,000/year (95% CI 9.4–11.5), higher for men. It was 9.2/100,000/year (95% CI 8.3–10.2) for astrocytic tumors, 0.6/100,000/year (95% CI 0.4–0.9) for oligodendroglial tumors, and 7.1 (95% CI 6.3–8.0) for glioblastoma (GBM). Among GBM patients, median survival was 249 days if prospectively identified vs. 132 days when identified through ICD-9 codes (p < 0.0001). The incidence of nPBT in the ER region is among the highest in the literature. Older patients were more likely to escape an active surveillance system. This should be considered when comparing incidence rates across studies, giving the increasing number of elderly people in the general population.

2017 - Incidence of traumatic spinal cord injury in Italy during 2013-2014: A population-based study [Articolo su rivista]
Ferro, S.; Cecconi, L.; Bonavita, J.; Pagliacci, M. C.; Biggeri, A.; Franceschini, M.; Bellentani, M.; Cavina, A.; Bonavita, J.; Pagliacci, M. C.; Biggeri, A.; Cecconi, L.; De Iure, F.; Gordini, G.; Redaelli, T.; Actis, M. V.; Del Popolo, G.; Bertagnoni, G.; Avesani, R.; Falabella, V.; Actis, M. V.; Stillittano, M.; Petrozzino, S.; Cisari, C.; Salvini, M.; Redaelli, T.; Tosi, R.; Borghi, C. M.; Bava, A.; Pistarini, C.; Molinero, G.; Signorelli, A.; Sandri, S.; Simeoni, F.; Brambilla, M.; Banchero, M. A.; Olivero, A.; Zanaboni, G.; Avesani, R.; Bertagnoni, G.; Leucci, M.; Lain, L.; Saia, M.; Zampa, A.; Del Fabro, P.; Saccavini, M.; Fanzutto, A.; Massone, A.; Bonavita, J.; Gaddoni, D.; Olivi, S.; Musumeci, G.; Pederzini, R.; Bazo, H. C.; Nicolotti, D.; Nora, M.; Brianti, R.; Iaccarino, C.; Volpi, A.; Lombardi, A.; Cavazza, S.; Casoni, F.; Gordini, G.; Piperno, R.; Teodorani, G.; Naldi, A.; Vergoni, G.; Maietti, E.; Botti, A.; Pagoto, G.; Del Popolo, G.; Moresi, M.; Postiglione, M.; Bini, C.; Tagliaferri, M.; Recchioni, M. A.; Pelaia, P.; Di Furia, L.; Pagliacci, M. C.; Maschke, R.; Caruso, L.; Speziali, L.; Zenzeri, M.; Fiore, P.; Marvulli, R.; Nardulli, R.; Lanzillotti, C.; Ruccia, M.; Onesta, M. P.; Di Gregorio, T.; Franchina, F.; Furnari, M. G.; Pilati, C.; Merafina, M.; Crescia, F.; Fletzer, D.; Scivoletto, G.; Di Lallo, N.
abstract

Study design: Observational prospective population-based incidence study. Objectives: The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. Setting: This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. Methods: Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. Results: From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4-16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. Conclusion: The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies.

2017 - Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study [Articolo su rivista]
Picetti, E.; Caspani, M. L.; Iaccarino, C.; Pastorello, G.; Salsi, P.; Viaroli, E.; Servadei, F.
abstract

Background: Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation. Methods: Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18&nbsp;years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) &lt;1&nbsp;day and pregnancy. Major objectives were: (1) to analyze changes in ICP/cerebral perfusion pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC. Results: A total of 34 patients were enrolled. Over 308&nbsp;days of ICP/CPP monitoring, 130&nbsp;days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57&nbsp;days with at least one episode of CPP &lt;60&nbsp;mmHg (22 patients, 64.7%) were recorded. A statistically significant relationship was discovered between the Glasgow Outcome Scale (GOS) scores and mean post-decompression ICP (p &lt; 0.04) and between GOS and CPP minimum (CPPmin) (p &lt; 0.04). After DC, persisting intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%). Conclusion: Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.

2017 - Letter: Guidelines for the Management of Severe Traumatic Brain Injury Fourth Edition [Articolo su rivista]
Picetti, E.; Iaccarino, C.; Servadei, F.
abstract

2017 - Primary pituitary neuroendocrine tumor: Case report and literature review [Articolo su rivista]
Nasi, D.; Perano, D.; Ghadirpour, R.; Iaccarino, C.; Servadei, F.; Romano, A.
abstract

Background: Neuroendocrine tumors (NET) originate from the diffuse neuroendocrine system. These can arise in almost every organ of the body, although they are most commonly found in the gastrointestinal tract and respiratory system. The skull base and sellar region are extremely rare sites for neuroendocrine carcinoma. Consequently, in this case, both diagnosis and definition of surgical goals, as well as further treatment strategies were challenging. Case Description: A 65-year-old woman was admitted to our Neurosurgery Department with a rapidly progressive visus reduction, drowsiness, polyuria, and polydipsia. Neuroimaging showed a sellar/suprasellar mass (diameter of 2 cm) with a heterogeneous signal compressing the optic chiasm and extending laterally toward the cavernous sinus. Differential diagnosis based on imaging included pituitary macroadenoma or metastasis. The patient underwent endoscopic endonasal transsphenoidal surgery. A total resection of the mass was impossible because of the infiltration of the optic chiasm and the intraoperative histological diagnosis of malignant epithelial neoplasm. Further histological evaluation revealed that the lesion was a NET with no other primary or metastatic sites detectable. Subsequently, the patient was successfully treated with fractioned stereotactic radiotherapy and polychemotherapy. Four years after the surgery, follow-up magnetic resonance imaging showed stability of the residual disease. Neurologic examination revealed a complete visual recovery. Conclusions: Primary pituitary NET, though rare, should be included in the differential diagnosis of sellar lesions. A multimodality treatment approach is needed. Finally, the present case highlights, that in the case of a pituitary lesion infiltrating the optic chiasm, including NET, the endoscopic endonasal transsphenoidal subtotal resection followed by fractioned stereotactic radiotherapy and chemotherapy may represent an effective and safe choice of treatment.

2017 - The role of short fixation in the treatment of thoracolumbar and lumbar traumatic fractures: indications and limits [Capitolo/Saggio]
Rapanà, Armando; Iaccarino, Corrado
abstract

2016 - Pure endoscopic management of fourth ventricle arachnoid cyst: Case report and literature review [Articolo su rivista]
Aljohani, H; Romano, A; Iaccarino, C; Ganau, M; Diemidio, P; Chibbaro, S
abstract

Arachnoid cysts (ACs) within the fourth ventricle are rare, and only a few cases have been reported in the literature. These are benign lesions within the arachnoid membrane, and they have been reported to occur in almost all locations where arachnoid is present. Different procedures have been performed to restore a normal cerebrospinal fluid dynamic and/or pressure, including shunting and partial or complete excision of the cyst by open microsurgery or endoscopic fenestration. We report the case of a fourth ventricle AC successfully treated using only endoscopic anterior trans‑frontal cyst fenestration/marsupialization and standard third ventriculostomy. Clinical and technical features are discussed, along with the pertinent literature.

2016 - Traumatic Brain Injury Guidelines and Outcome: Please Don't Forget Postacute Care! [Articolo su rivista]
Servadei, F; Picetti, E; Viaroli, E; Iaccarino, C
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 &gt;70&nbsp;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 &gt;70&nbsp;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&nbsp;months (95&nbsp;% CI 8.8–13.5), adding temozolomide concomitant and adjuvant to radiotherapy it was 11.6&nbsp;months (95&nbsp;% CI 8.6–14.6), and 9.3&nbsp;months (95&nbsp;% CI 8.1–10.6) in patients treated with RT alone (P&nbsp;=&nbsp;0.164). However, patients with MGMT methylated treated with RT/TMZ obtained a better survival (17.2&nbsp;months, 95&nbsp;% CI 11.5–22.9) (P&nbsp;=&nbsp;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 - Corrigendum to Expression of 19 microRNAs in glioblastoma and comparison with other brain neoplasia of grades I-III [Mol. Oncol. 8 (2) (2014) 417-30] [Articolo su rivista]
Visani, M.; de Biase, D.; Marucci, G.; Cerasoli, S.; Nigrisoli, E.; Bacchi Reggiani, M. L.; Albani, F.; Baruzzi, A.; Pession, A.; 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.; Ferro, S.; Franceschi, C.; Frezza, G.; Grasso, V.; Leonardi, M.; Morandi, L.; Mostacci, B.; Palandri, G.; Pasini, E.; Pastore Trossello, M.; Poggi, R.; Riguzzi, P.; Rinaldi, R.; Rizzi, S.; Romeo, G.; Spagnolli, F.; Tinuper, P.; Trocino, C.; Frattarelli, M.; Giovannini, A.; Iorio, P.; Pasquini, U.; Galletti, G.; Guidi, C.; Neri, W.; Patuelli, A.; Strumia, S.; Dall'Agata, M.; Faedi, M.; Gentili, G.; Zumaglini, F.; Casmiro, M.; Gamboni, A.; Rasi, F.; Cruciani, G.; Cenni, P.; Dazzi, C.; Guidi, A. R.; Amadori, A.; Pasini, G.; Pasquinelli, M.; Pasquini, E.; 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, G.; Zunarelli, E.; Artioli, F.; Bernardini, I.; Costa, M.; Greco, G.; Guerzoni, R.; Stucchi, C.; Ragazzi, M.; Iaccarino, C.; Rizzi, R.; Zuccoli, G.; Api, P.; Cartei, F.; Fallica, E.; Granieri, E.; Latini, F.; Lelli, G.; Monetti, C.; Saletti, A.; Schivalocchi, R.; Seraceni, S.; Tola, M. R.; Urbini, B.; 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

2015 - Erratum to: Survival prediction in high-grade gliomas using CT perfusion imaging [Articolo su rivista]
Yeung, Tp; Wang, Y; He, W; Urbini, B; Gafà, R; Ulazzi, L; Yartsev, S; Bauman, G; Lee TY, ; Fainardi, E; Project of Emilia-Romagna Region on Neuro-Oncology (PERNO) Study Group Participants :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., (Bologna); Dall’Agata, M.; Frattarelli, M.; Gentili, G.; Giovannini, A.; Iorio, P.; Pasquini, U.; Galletti, G.; Guidi, C.; Neri, W.; Patuelli, A.; Strumia S., (Forlı`-Cesena); Faedi, M.; (IRCCS Istituto Scientifico Romagnolo per lo Studio, e la Cura dei Tumori); Casmiro, M.; Gamboni, A.; Rasi, F. (Faenza R. A. ).; Cruciani G., (Lugo; RA), ; Cenni, P.; Dazzi, C.; Guidi, A. R.; Zumaglini F., (Ravenna); Amadori, A.; Pasini, G.; Pasquinelli, M.; Pasquini, E.; Polselli, A.; Ravasio, A.; Viti B., (Rimini); Sintini M., (Cattolica; RN), ; Ariatti, A.; Bertolini, F.; Bigliardi, G.; Carpeggiani, P.; Cavalleri, F.; Meletti, S.; Nichelli, P.; Pettorelli, E.; Pinna, G.; Zunarelli E., (Modena); Artioli, F.; Bernardini, I.; Costa, M.; Greco, G.; Guerzoni, R.; Stucchi, C. (Carpi M. O. ).; Iaccarino, C; Ragazzi, M.; Rizzi, R.; Zuccoli G., (Istituto di Ricovero e Cura a Carattere Scientifico; Reggio, Emilia); 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.; Urbini, B.; Zini G., (Ferrara); Giorgi, C.; Montanari, E. (Fidenza P. R. ).; Cerasti, D.; Crafa, P.; Dascola, I.; Florindo, I.; Giombelli, E.; Mazza, S.; Ramponi, V.; Servadei, F.; Silini, Em.; Torelli P., (Parma); Immovilli, P.; Morelli, N.; Vanzo C., (Piacenza); Nobile, C. (Padova).
abstract

Erratum to: J Neurooncol (2015) 123:93–102 DOI 10.1007/s11060-015-1766-5 Three participants were missing in the Appendix (listing the members of the PERNO study group) in the original publication. They are included in the complete list in the Appendix below.

2015 - Improving laboratory test ordering can reduce costs in surgical wards [Articolo su rivista]
Giordano, D; Zasa, M; Iaccarino, C; Vincenti, V; Dascola, I; Brevi, Bc; Gherli, T; Raso, Mg; Campaniello, G; Bonelli, P; Vezzani, A.
abstract

Background and Aim Laboratory blood tests for hospitalized patients are often overused. Excessive costs and no proof of benefit suggest re- evaluating the current approach to laboratory test ordering. The aim of the study is to improve the decision-making process of test ordering and to investigate what effect a rational, evidence-based use of laboratory test ordering in surgical wards would have on costs and healthcare resources. Methods Three-phase experimental prospective study carried out at the tertiary referral teaching hospital of Parma. Phase 1 (baseline status). The baseline status of laboratory test ordering was evaluated by recording the number of biochemical tests requested for patients undergoing elective surgery. Laboratory tests were grouped in "recommended" (RT) and "non recommended" (nRT) tests on the basis of pertinent literature. Phase 2 (improvement action): new guidelines were introduced into clinical practice. Phase 3 (feedback): Prospective data collection for first and second feedback was performed with no advance notice. Results A highly significant reduction in test ordering was found on occasion of the phases 2 and 3 of the study. The overall number of tests decreased, largely due to a decrease in the use of nRT. Conclusions Analysis was justified by the fact that most test requests proved not to be supported by clinical evidence. Inappropriate ordering of laboratory tests results in an unnecessarily high number of requests, which do not in turn improve patient management. Moreover, more appropriate, evidence-based laboratory test ordering for patients undergoing elective surgery may produce a significant reduction in costs, particularly in high-cost settings.

2015 - Incidentally Detected Pulmonary Metastasis from Recurrent Atypical Meningioma with Superior Sagittal Sinus Invasion – Case Report and Literature Review [Articolo su rivista]
Nasi, D; Iaccarino, C; Froio, E; Serra, S; Tagliavini, E; Eshraghi, N; Servadei, F; Ghadirpour, R
abstract

Meningioma is a common brain tumor but despite its high prevalence, extracranial metastasis is really rare, as it may be seen in lung, bone,intraspinal, liver and cervical lymph nodes decreasingly. We report a case of metastases to lung incidentally founded from an intracranial recurrent atypical meningioma with superior sagittal sinus invasion previously treated with good control. This report highlights that in the rare case of unique incidentally founded pulmonary lesion and apparent control of the intracranial disease, the differential diagnosis of metastastic meningioma, primary lung meningioma or others lung tumor can be very challenging . The revision of pertinent literature suggests that the invasion of venous sinuses should be considered as a major risk factor for distant metastases.

2015 - Intraoperative neurophysiological monitoring for intradural extramedullary tumors: Why not? [Articolo su rivista]
Ghadirpour, R; Nasi, D; Iaccarino, C; Giraldi, D; Sabadini, R; Motti L, ; Sala, F; Servadei, F
abstract

BACKGROUND: While intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM for intradural extramedullary tumors (IDEMs) is still under debate. The aim of this study is to evaluate the role of IOM during surgery for IDEMs. METHODS: From March 2008 to March 2013, 68 patients had microsurgery with IOM for IDEMs (31 schwannomas, 25 meningiomas, 6 ependymomas of the cauda/filum terminalis, 4 dermoid cysts and 2 other lesions). The IOM included somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), and - in selected cases - D-waves. Also preoperative and postoperative neurophysiological assessment was performed with SEPs and MEPs. All patients were evaluated at admission and at follow up (minimum 6 months) with the Modified McCormick Scale (mMCs). RESULTS: Three different IOM patterns were observed during surgery: no change in evoked potentials (63 cases), transitory evoked potentials change (3 cases) and loss of evoked potentials (2 cases). In the first setting surgery was never stopped and a radical tumor removal was achieved (no stop surgery group). In 3 cases of transitory evoked potentials change, surgery was temporarily halted but the tumors were at the end completely removed (stop and go surgery group). In 2 more patients the loss of evoked potentials led to an incomplete resection (stop surgery group). No patients presented a worsening of the pre-operative clinical conditions (at admission 47 patients presented mMCs 1-2 and 21 patients mMCs 3-5, while at follow up 62 patients are mMCS 1-2 and 6 patients mMCs 3-5). CONCLUSIONS: In our series significant IOM changes occurred in 5 out of 68 patients with IDEMs (7.35%), and it is conceivable that the modification of the surgical strategy - induced by IOM - prevented or mitigated neurological injury in these cases. Vice versa, in 63 patients (92.65%) IOM invariably predicted a good neurological outcome. Furthermore this technique allowed a safer tumor removal in IDEMs placed in difficult locations as cranio-vertebral junction or in antero/antero-lateral position (where rotation of spinal cord can be monitored) and even in case of tumor adherent to the spinal cord without a clear cleavage plane.

2015 - Preliminary Results of a Prospective Study on Methods of Cranial Reconstruction [Articolo su rivista]
Iaccarino, C; Viaroli, E; Fricia, M; Serchi, E; Poli, T; Servadei, F.
abstract

Purpose: Given its biological and anatomic features, autologous bone is the first choice for cranioplasty after bone decompression. When autologous bone is not available or must be replaced, surgeons can choose among various materials to create an alloplastic cranioplasty. The Italian Society for Neurosurgery promoted a prospective study conducted at 4 Italian neurosurgical units to compare different methods of cranioplasty and to assess the clinical results and incidence of complications. Materials and Methods: Patients older than 14 years who underwent repositioning of autologous bone or 3-dimensional image-guided reconstruction with prostheses made of an alloplastic material (polyetheretherketone, polymethylmethacrylate, or hydroxyapatite) after cranial decompression were enrolled prospectively from January 2008 through December 2013. The collected data included the material used to produce the prosthesis, the type of cranioplasty (primary or secondary), and complications that required surgical removal of the prosthesis (eg, infection, bone resorption, and fracture of the cranioplasty). Results: Ninety-six patients met the study criteria. Fifty cases were reconstructed with hydroxyapatite, 31 with bone, 13 with polymethylmethacrylate, and 2 with polyetheretherketone. Seven patients (7.3%) developed complications related to the cranioplastic implant that required reoperation. These complications included infection (4 cases), bone resorption (2 cases), and fracture of the cranioplastic prosthesis (1 case). Statistical analysis showed a higher rate of complications with the use of autologous bone versus alloplastic materials (P = .03). Owing to the limited number of cases, no statistically meaningful complication was seen among the different alloplastic materials or when the cranioplastic implant was placed as secondary treatment. Conclusions: These data and those of other reports suggest that cranioplasty conducted using alloplastic 3-dimensional reconstruction materials have a lower rate of complications than those conducted using autologous bone.

2015 - Prognostic value of MGMT promoter status in non-resectable glioblastoma after adjuvant therapy [Articolo su rivista]
Iaccarino, C; Orlandi, E; Ruggeri, F; Nicoli, D; Torricelli, F; Maggi, M; Cerasti, D; Pisanello, A; Pedrazzi, G; Froio, E; Crafa, P; D’Abbiero, N; Michiara, M; Ghadirpour, R; Servadei, F
abstract

Background: Methylation of MGMT promoter has been identified as a favourable predictive factor ofbenefit from XRT/TMZ → TMZ. Patients with non-resectable glioblastoma (GBM) generally exhibit a poorprognosis, even after XRT/TMZ. Few data are available concerning the predictive value of MGMT promotermethylation in this population.Methods: This is an observational retrospective study in patients with malignant brain glioma, treatedbetween June 2008 and October 2011 and followed up until April 2012 at the Neurosurgery-Neurotraumatology Unit of the University Hospital of Parma and at the Neurosurgery Unit of IRCCS“ASMN” of Reggio Emilia, Italy. The medical records of an overall number of 174 patients with a newlydiagnosed GBM were reviewed. Volumetry analysis of the lesions was performed on pre- and post-operative neuroimaging by Voxar 3D Ebit AET software. The genetic characterization was performedon paraffin embedded tissue from all resected tumours. Isolation of nucleic acids, bisulfite modifica-tion of DNA, methylation-specific PCR and sequencing analyses were done mainly on fresh tissue frombiopsy withdrawals. Within 3–4 weeks after either biopsy or surgery, patients were assigned to receiveXRT/TMZ → TMZ: treatment included XRT (60 Gy in 30 fractions)/TMZ (daily dose of 75 mg/m2)/TMZ(150–200 mg/m2per day for 5 days of every 28-day cycle).

2015 - Survival prediction in high-grade gliomas using CT perfusion imaging [Articolo su rivista]
Yeung, Timothy Pok Chi; Wang, Yong; He, Wenqing; Urbini, Benedetta; Gafà, Roberta; Ulazzi, Linda; Yartsev, Slav; Bauman, Glenn; Lee, Ting-Yim; Fainardi, Enrico; Meletti, S; Iaccarino, C
abstract

Patients with high-grade gliomas usually have heterogeneous response to surgery and chemoirradiation. The objectives of this study were (1) to evaluate serial changes in tumor volume and perfusion imaging parameters and (2) to determine the value of these data in predicting overall survival (OS). Twenty-nine patients with World Health Organization grades III and IV gliomas underwent magnetic resonance (MR) and computed tomography (CT) perfusion examinations before surgery, and 1, 3, 6, 9, and 12 months after radiotherapy. Serial measurements of tumor volumes and perfusion parameters were evaluated by receiver operating characteristic analysis, Cox proportional hazards regression, and Kaplan-Meier survival analysis to determine their values in predicting OS. Higher trends in blood flow (BF), blood volume (BV), and permeability-surface area product in the contrast-enhancing lesions (CEL) and the non-enhancing lesions (NEL) were found in patients with OS &lt; 18 months compared to those with OS ≥ 18 months, and these values were significant at selected time points (P &lt; 0.05). Only CT perfusion parameters yielded sensitivities and specificities of ≥ 70% in predicting 18 and 24 months OS. Pre-surgery BF in the NEL and BV in the CEL and NEL 3 months after radiotherapy had sensitivities and specificities &gt;80% in predicting 24 months OS in patients with grade IV gliomas. Our study indicated that CT perfusion parameters were predictive of survival and could be useful in assessing early response and in selecting adjuvant treatment to prolong survival if verified in a larger cohort of patients.

2015 - The therapeutic cranioplasty still needs an ideal material and surgical timing [Articolo su rivista]
Servadei, F; Iaccarino, C
abstract

2014 - Anterior trans-frontal endoscopic management of colloid cyst: an effective, safe, and elegant way of treatment. Case series and technical note from a multicenter prospective study [Articolo su rivista]
Chibbaro, S; Champeaux, C; Poczos, P; Cardarelli, M; Di Rocco, F; Iaccarino, C; Servadei, F; Tigan, L; Chaussemy, D; George, B; Froelich, S; Kehrli, P; Romano, A
abstract

Different management options are available for the treatment of colloid cysts. Goals of those procedures are to achieve a complete resection avoiding potential long-term recurrence along with CSF pathways restoration with minimal morbidity and mortality. The two main surgical options are endoscopic resection or direct removal by either transfrontal or transcallosal approach. The efficacy of endoscopic technique to achieve gross total colloid cyst excision has been well documented. In the present study, authors describe a series of 29 patients who underwent surgery by a variation of the standard worldwide implemented endoscopic technique. Using a more anterior approach, it is easier to reach the roof of the cyst, its possible adherences with the tela choroidea, plexus, and the internal cerebral veins. The described approach has shown to be safe, quick, and very effective with a total cyst removal rate of 86.2 %.

2014 - Blood derived biochemical markers and early clinical trends after severe traumatic brain injury: utility or futility? [Articolo su rivista]
Schiavi, P; Iaccarino, C; Compagnone, C; Servadei, F
abstract

2014 - Clinical applications of intracranial pressure monitoring in traumatic brain injury : report of the Milan consensus conference [Articolo su rivista]
Stocchetti, N; Picetti, E; Berardino, M; Buki, A; Chesnut, Rm; Fountas, Kn; Horn, P; Hutchinson, Pj; Iaccarino, C; Kolias, Ag; Koskinen, Lo; Latronico, N; Maas, Ai; Payen, Jf; Rosenthal, G; Sahuquillo, J; Signoretti, S; Soustiel, Jf; Servadei, F
abstract

Background Intracranial pressure (ICP) monitoring has been for decades a cornerstone of traumatic brain injury (TBI) management. Nevertheless, in recent years, its usefulness has been questioned in several reports. A group of neurosurgeons and neurointensivists met to openly discuss, and provide consensus on, practical applications of ICP in severe adult TBI. Methods A consensus conference was held in Milan on October 5, 2013, putting together neurosurgeons and intensivists with recognized expertise in treatment of TBI. Four topics have been selected and addressed in pro-con presentations: 1)ICP indications in diffuse brain injury, 2) cerebral contusions, 3) secondary decompressive craniectomy (DC), and 4) after evacuation of intracranial traumatic hematomas. The participants were asked to elaborate on the existing published evidence (without a systematic review) and their personal clinical experience. Based on the presentations and discussions of the conference, some drafts were circulated among the attendants. After remarks and further contributions were collected, a final document was approved by the participants. Summary and conclusions The group made the following recommendations: 1) in comatose TBI patients, in case of normal computed tomography (CT) scan, there is no indication for ICP monitoring; 2) ICP monitoring is indicated in comatose TBI patients with cerebral contusions in whom the interruption of sedation to check neurological status is dangerous and when the clinical examination is not completely reliable. The probe should be positioned on the side of the larger contusion; 3) ICP monitoring is generally recommended following a secondary DC in order to assess the effectiveness of DC in terms of ICP control and guide further therapy; 4) ICP monitoring after evacuation of an acute supratentorial intracranial hematoma should be considered for salvageable patients at increased risk of intracranial hypertension with particular perioperative features.

2014 - Delayed cervical epidural hematoma after intravenous thrombolysis for acute ischemic stroke: case report and review of literature [Articolo su rivista]
Ghadirpour, R; Nasi, D; Benedetti, B; Zedde, Ml; Iaccarino, C; Malferrari, G; Servadei, F
abstract

2014 - Expression of 19 microRNAs in glioblastoma and comparison with other brain neoplasia of grades I-III [Articolo su rivista]
Visani, M; de Biase, D; Marucci, G; Cerasoli, S; Nigrisoli, E; Bacchi Reggiani, Ml; Albani, F; Baruzzi, A; Pession, 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, M; Fiorica, F; Valentini, A; Depenni, R; Mucciarini, C; Crisi, G; Sasso, E; Biasini, C; Cavanna, L; Guidetti, D; Marcello, N; Pisanello, A; Cremonini, Am; 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; Ferro, S; Franceschi, C; Frezza, G; Grasso, V; Leonardi, M; Morandi, L; Mostacci, B; Palandri, G; Pasini, E; Pastore Trossello, M; 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, G; Cenni, P; Dazzi, C; Guidi, Ar; Zumaglini, F; Amadori, A; Pasini, G; Pasquinelli, M; Pasquini, E; 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, 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; Fallica, E; Granieri, E; Latini, F; Lelli, G; Monetti, C; Saletti, A; Schivalocchi, R; Seraceni, S; Tola, Mr; Urbini, B; Giorgi, C; Montanari, E; Cerasti, D; Crafa, P; Dascola, I; Florindo, I; Giombelli, E; Mazza, S; Ramponi, V; Servadei, F; Silini, Em; Torelli, P; Immovilli, P; Morelli, N; Vanzo, C; Nobile, C
abstract

Several biomarkers have been proposed as useful parameters to better specify the prognosis or to delineate new target therapy strategies for glioblastoma patients. MicroRNAs could represent putative target molecules, considering their role in tumorigenesis, cancer progression and their specific tissue expression. Although several studies have tried to identify microRNA signature for glioblastoma, a microRNA profile is still far from being well-defined. In this work the expression of 19 microRNAs (miR-7, miR-9, miR-9∗, miR-10a, miR-10b, miR-17, miR-20a, miR-21, miR-26a, miR-27a, miR-31, miR-34a, miR-101, miR-137, miR-182, miR-221, miR-222, miR-330, miR-519d) was evaluated in sixty formalin-fixed and paraffin-embedded glioblastoma samples using a locked nucleic acid real-time PCR. Moreover, a comparison of miRNA expressions was performed between primary brain neoplasias of different grades (grades IV-I). The analysis of 14 validated miRNA expression in the 60 glioblastomas, using three different non-neoplastic references as controls, revealed a putative miRNA signature: mir-10b and miR-21 were up-regulated, while miR-7, miR-31, miR-101, miR-137, miR-222 and miR-330 were down-regulated in glioblastomas. Comparing miRNA expression between glioblastoma group and gliomas of grades I-III, 3 miRNAs (miR-10b, mir-34a and miR-101) showed different regulation statuses between high-grade and low-grade tumors. miR-10b was up-regulated in high grade and significantly down-regulated in low-grade gliomas, suggesting that could be a candidate for a GBM target therapy. This study provides further data for the identification of a miRNA profile for glioblastoma and suggests that different-grade neoplasia could be characterized by different expression of specific miRNAs

2014 - Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution [Articolo su rivista]
Iaccarino, C; Schiavi, P; Picetti, E; Goldoni, M; Cerasti, D; Caspani, M; Servadei, F
abstract

Object. Traumatic parenchymal mass lesions are common sequelae of traumatic brain injuries (TBIs). Theyoccur in up to 8.2% of all TBI cases and 13%–35% of severe TBI cases, and they account for up to 20% of surgical intracranial lesions. Controversy exists concerning the association between radiological and clinical evolution of brain contusions. The aim of this study was to identify predictors of unfavorable outcome, analyze the evolution of brain contusions, and evaluate specific indications for surgery. Methods. In a retrospective, multicenter study, patients with brain contusions were identified in separate patient cohorts from 11 hospitals over a 4-year period (2008–2011). Data on clinical parameters and course of the contusion were collected. Radiological parameters were registered by using CT images taken at the time of hospital admission and at subsequent follow-up times. Patients who underwent surgical procedures were identified. Outcomes were evaluated 6 months after trauma by using the Glasgow Outcome Scale-Extended. Results. Multivariate analysis revealed the following reliable predictors of unfavorable outcome: 1) increased patient age, 2) lower Glasgow Coma Scale score at first evaluation, 3) clinical deterioration in the first hours after trauma, and 4) onset or increase of midline shift on follow-up CT images. Further multivariate analysis identified the following as statistically significant predictors of clinical deterioration during the first hours after trauma: 1) onset of or increase in midline shift on follow-up CT images (p < 0.001) and 2) increased effacement of basal cisterns on follow-up CT images (p < 0.001). Conclusions. In TBI patients with cerebral contusion, the onset of clinical deterioration is predictably associated with the onset or increase of midline shift and worsened status of basal cisterns but not with hematoma or edema volume increase. A combination of clinical deterioration and increased midline shift/basal cistern compression is the most reasonable indicator for surgery.

2014 - Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center? [Articolo su rivista]
Brandes, Alba A; Franceschi, Enrico; Ermani, Mario; Tosoni, Alicia; Albani, Fiorenzo; Depenni, Roberta; Faedi, Marina; Pisanello, Anna; Crisi, Girolamo; Urbini, Benedetta; Dazzi, Claudio; Cavanna, Luigi; Mucciarini, Claudia; Pasini, Giuseppe; Bartolini, Stefania; Marucci, Gianluca; Morandi, Luca; Zunarelli, Elena; Cerasoli, Serenella; Gardini, Giorgio; Lanza, Giovanni; Silini, Enrico Maria; Cavuto, Silvio; Baruzzi, Agostino; 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, M; Fiorica, F; Valentini, A; Depenni, R; Mucciarini, C; Crisi, G; Sasso, E; Biasini, C; Cavanna, L; Guidetti, D; Marcello, N; 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, 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; Mazzocchi, V; Morandi, L; Mostacci, B; Palandri, G; Pasini, E; Pastore Trossello, M; Pession, A; Ragazzi, M; Riguzzi, P; Rinaldi, R; Rizzi, S; Romeo, G; Spagnolli, F; Tinuper, P; Trocino, C; Cerasoli, S; Dall'Agata, M; Faedi, 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; Dazzi, C; Guidi, Ar; Zumaglini, F; Amadori, A; Pasini, G; Pasquinelli, M; Pasquini, E; Polselli, A; Ravasio, A; Viti, B; Sintini, M; Ariatti, A; Bertolini, F; 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; Rizzi, R; Zuccoli, G; Api, P; Cartei, F; Fallica, E; Granieri, E; Latini, F; Lelli, G; Monetti, C; Ramponi, V; Saletti, A; Schivalocchi, R; Seraceni, S; Tola, M. R; Urbini, B; Giorgi, C; Montanari, E; Cerasti, D; Crafa, P; Dascola, I; Florindo, I; Mazza, S; Servadei, F; Silini, Em; Torelli, P; Immovilli, P; Morelli, N; Vanzo, C.
abstract

BACKGROUND:As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS: Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS: Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS: The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.

2014 - Promising role of 18F-choline PET/CT in brain tumors [Abstract in Rivista]
Sollini, M; Sghedoni, R; Erba, P; Cavuto, S; Pisanello, A; De Berti, G; Iaccarino, C; Asti, M; Filice, A; Versari, A
abstract

2014 - Thoracolumbar Burst Fractures: Posterior Approach [Capitolo/Saggio]
Cardarelli, M; Gragnaniello, C; Iaccarino, C; Ippolito, S; Nader, R; Servadei, F
abstract

2013 - Decompressive Craniectomies: Time to Discuss not the Decra Study but the Comments to the Decra Study [Articolo su rivista]
Iaccarino, C; Schiavi, P; Servadei, F.
abstract

2013 - Definition of miRNAs expression profile in glioblastoma samples: the relevance of non-neoplastic brain reference. [Articolo su rivista]
M., Visani; D. d., Biase; G., Marucci; C., Taccioli; A., Baruzzi; A., Pession; A., Ariatti; B., Bertolini; G., Bigliardi; P., Carpeggiani; F., Cavalleri; Meletti, Stefano; Nichelli, Paolo Frigio; G., Pinna; E., Zunarelli; A., Pession; PERNO study, Group
abstract

Glioblastoma is the most aggressive brain tumor that may occur in adults. Regardless of the huge improvements in surgery and molecular therapy, the outcome of neoplasia remains poor. MicroRNAs are small molecules involved in several cellular processes, and their expression is altered in the vast majority of tumors. Several studies reported the expression of different miRNAs in glioblastoma, but one of the most critical point in understanding glioblastoma miRNAs profile is the comparison of these studies. In this paper, we focused our attention on the non-neoplastic references used for determining miRNAs expression. The aim of this study was to investigate if using three different non-neoplastic brain references (normal adjacent the tumor, commercial total RNA, and epileptic specimens) could provide discrepant results. The analysis of 19 miRNAs was performed using Real-Time PCR, starting from the set of samples described above and the expression values compared. Moreover, the three different normal RNAs were used to determine the miRNAs profile in 30 glioblastomas. The data showed that different non-neoplastic controls could lead to different results and emphasize the importance of comparing miRNAs profiles obtained using the same experimental condition.

2013 - Entrapment of temporal horn: First case of bilateral occurrence and review of literature [Articolo su rivista]
Iaccarino, C; Romano, A; Ramponi, V; Nasi, D; Maggi, M; Pascarella, R; Ghadirpour, R; Servadei, F.
abstract

The entrapped temporal horn is a rare entity, caused by an obstruction of the trigone of the lateral ventricle which seals off the temporal horn from the rest of the ventricular system. This form of focal hydrocephalus has been described in a variety of diseases including central nervous system infections, hemor- rhages, trauma, extra-axial or intra-axial tumors, postoperative scarring within the trigone, neurosarcoidosis and xanthogranu- lomatosis. Clinical presentation is often with headache, seizures, hemiparesis, and visual field deficits [9]. Within the trapped temporal horn, the choroid plexus continues to produce cerebro spinal fluid (CSF), resulting in progressive dilation; the dilated temporal horn then behaves as a mass lesion. Since 1947, thirty-six cases have been reported (Table 1). To the best of our knowledge this is the first case of bilateral entrapped temporal horn.

2013 - Epilepsy in primary cerebral tumors: The characteristics of epilepsy at the onset (results from the PERNO study - Project of Emilia Romagna Region on Neuro-Oncology). [Articolo su rivista]
R., Michelucci; E., Pasini; Meletti, Stefano; E., Fallica; R., Rizzi; I., Florindo; A., Chiari; C., Monetti; A. M., Cremonini; S., Forlivesi; F., Albani; A., Baruzzi; P. E., R.
abstract

Purpose: To present new information on the semiology and short-term evolution of seizures associated with primary brain tumors (PBTs) in a prospective study. Methods: This study is a section of the PERNO study - Project of Emilia Romagna Region on Neuro-Oncology, the main aim of which is to collect prospectively all cases of PBTs occurring in the Emilia-Romagna region, northeast Italy (3,983,346 population) from January 2009 to December 2011, to allow epidemiologic, clinical, and biomolecular studies. The epilepsy section of the PERNO study included all the patients who experienced seizures, either as first symptom of the tumor or appearing during the course of the disease. Each patient was interviewed by the referring neurologist with a specific interest in epilepsy. The patients who entered the study were followed up with visits on a quarterly basis. Key Findings: We collected 100 cases with full clinical, neuroradiologic, and pathologic data. The majority (79%) had high grade PBTs (glioblastoma in 50 cases), whereas the remaining patients had low-grade gliomas, mostly localized in the frontal (60%), temporal (38%), and parietal (28%) lobes. Seizures were the first symptom of the tumor in 72 cases. Overall, the initial seizures were tonic-clonic (48%) (without clear initial focal signs in more than half of the patients), focal motor (26%), complex partial (10%), and somatosensitive (8%). The majority of cases (60%) had isolated seizures or a low seizure frequency at the onset of the disease, whereas a high seizure frequency or status epilepticus was observed in 18% and 12% of cases, respectively. Ninety-two patients underwent surgical removal of the tumor, which was either radical (38%) or partial (53%). Seven patients underwent only cerebral biopsy. In the 72 patients in whom seizures were the first symptom, the mean time to the surgical treatment was 174days, with a significant difference between high grade (95days) and low grade (481days) gliomas. At the time of our first observation, the majority of patients (69%) had already undergone surgical removal, with a mean follow-up of 3months after the procedure. Overall, 39 patients (56%) were seizure free after tumor removal. The good outcome did not depend on presurgical seizure frequency or tumor type, although there was a trend for better results with low-grade PBTs. Significance: These data provide evidence that seizures are strictly linked to the tumoral lesion: They are the initial symptom of the tumor, reflect the tumor location and type, are usually resistant to antiepileptic treatment, and may disappear after the treatment of the lesion.

2013 - Expansion diverticulum of the suprapineal recess causing cerebellar ataxia. A case report [Articolo su rivista]
Tedeschi, E; Rapanà, A; Elefante, A; De Liso, M; Morrone, R; Iaccarino, C
abstract

As a result of long-standing cerebrospinal fluid (CSF) pulsation against the thinnest segments of the ventricular walls, focal enlargement of the ventricular system (diverticulum) may occur, mainly at the medial wall of the trigone of the lateral ventricles (atrial diverticula) or at the posterior wall of the third ventricle (expansion of the suprapineal recess). In the latter case, ocular signs are the most common symptoms, due to the severe deformation of the periaqueductal region. We describe a case of non-communicating hydrocephalus in a 36-year-old woman who presented a three-year history of cerebellar ataxia. Preoperative brain magnetic resonance (MR) scan showed marked supratentorial hydrocephalus with an apparently patent aqueduct of Sylvius, and an enlarged suprapineal recess causing cerebellar and tentorial dislocation. The patient was successfully treated by endoscopic third ventriculostomy and monitored by MR scans with phase-contrast sequences for assessment of CSF flow. Cerebellar ataxia is a very rare symptomatic onset for a suprapineal recess expansion diverticulum, which may cause obstructive hydrocephalus that can be effectively treated by endoscopic third ventriculostomy

2013 - Primary dural lymphoma mimicking a chronic epidural hematoma. Differential diagnosis of two rare conditions [Articolo su rivista]
Iaccarino, C; Schiavi, P; Crafa, P; Bronzoni, C; Ramponi, V; Mantenuto, G; Cavanna, L; Servadei, F
abstract

Primary Central Nervous System Lymphoma (PCNSL) is an extranodal Non-Hodgkin Lymphoma (NHL) that arises in the brain parenchyma, eyes, meninges, or spinal cord in the absence of lymphoma outside of the CNS at the time of the diagnosis. Pure primary leptomeningeal lymphoma (PLML) is a subtype of PCNSL, it represents less than 0.1% of all NHL. Primary dural lymphoma (PDL) is a subentity of PLML and it is described as dura mater involvement with no systemic disease. PDL represents less than 1% of all brain lymphomas. The diagnosis of PDL is very difficult because the imaging appearance usually is of an extra-axial mass mimicking a meningioma [1] or a hematoma [2,3]. We report a case of PDL with immunophenotype of chronic lymphocytic leukemia/small lymphocyte lymphoma (CLL/SLL), which was initially clinically diagnosed as a chronic extradural hematoma (EDH). In literature this is the third case of PDL mimicking hematoma and the seventh case of primitive CLL/SLL of the dura.

2013 - Use of “custom made” porous hydroxyapatite implants for cranioplasty: postoperative analysis of complications in 1549 patients [Articolo su rivista]
Stefini, R; Esposito, G; Zanotti, B; Iaccarino, C; Fontanella, Mm; Servadei, F
abstract

Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects, and should be considered the conclusion of a surgical act that began with bone flap removal. Autologous bone is still considered the treatment of choice for cranioplasty. An alternative choice is bioceramic porous hydroxyapatite (HA) as it is one of the materials that meets and comes closest to the biomimetic characteristics of bone. Methods: The authors analyzed the clinical charts, compiled by the neurosurgeon, of all patients treated with custom‑made porous HA devices (Custom Bone Service Fin‑Ceramica, Faenza) from which epidemiological and pathological data as well as material‑related complications were extrapolated. Results: From November 1997 to December 2010, 1549 patients underwent cranioplasty with the implantation of 1608 custom‑made porous HA devices. HA was used in 53.8% of patients for decompressive craniectomy after trauma or intracranial hemorrhage, while the remaining cases were for treated for comminuted fracture, cutaneous or osseous resection, cranial malformation, autologous bone reabsorption or infection or rejection of previously implanted material. The incidence of adverse events in patients treated for cranioplasty, as first line treatment was 4.78% (56 events/1171 patients), and 5.02%, (19 events/378 patients) at second line. Conclusion: This study demonstrates that HA is a safe and effective material, is well tolerated in both adult and pediatric patients, and meets the requirements necessary to repair craniolacunia.

2012 - Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases [Articolo su rivista]
Tagliaferri, F; Zani, G; Iaccarino, C; Ferro, S; Ridolfi, L; Basaglia, N; Hutchinson, P; Servadei, F
abstract

BACKGROUND: The aim of this article was to review the clinical practice of "bone flap decompression" in Regional Neurosurgical Units with no particular protocol in use. METHODS: From January 2005 to December 2008, a retrospective and multicentre study was conducted on patients who were treated with decompressive craniectomy (DC) in seven departments of neurosurgery in Italy. This study included patients with traumatic brain injury, stroke, aneurysmal subarachnoid haemorrhage and cerebral arteriovenous malformations. Data were retrieved from individual medical records. RESULTS: We identified 526 patients with DC. Age was the most significant predictor factor of survival, together with pupil reactivity, time of decompression and size of the bone flap. The effect of age in predicting survival was so important that in patients over 65 years old we did not find any other significant factor related to survival. In younger patients, the survival rate was much better with a large bone flap (p = 0.01). Unfortunately, 57% of patients were decompressed with a bone flap of less than 12 cm in diameter. This was probably due to the association in 80% of cases between haematoma evacuation and decompression. CONCLUSIONS: The current practice in many centres is different from published papers. Decompression is common over the age of 65 years, is associated with haematoma evacuation and often the bone flaps are inadequate in terms of size.

2012 - The value of the calcium binding protein S100 in the management of patients with traumatic brain injury [Articolo su rivista]
Schiavi, P; Iaccarino, C; Servadei, F
abstract

Background: From the first study in 1995 the role of calcium-binding protein S100B in Traumat- ic Brain Injury (TBI) has been variously investigated in many clinical works. The aim of this work is to an- alyze the recent published reports with a reference to serum and CSF levels and to identify a possible role of S100 in the management of TBI. Methods: A MEDLINE search with a various number of query related to “S100” and “TBI” was performed from 2000 to 2011. All identified articles and abstracts have been re- viewed Results: Serum and CSF samples of the marker well correlate in most of the papers to the degree of intracranial injury as determined by CT scans. Furthermore patients with the higher levels of S100B show a worse prognosis. In the paediatric age a relationship with the outcomes in spite of difficulties to determine normal values is also observed. Some proposal about a clinical use of S100B to decrease the number of neu- roradiological examinations are present. Conclusions: S100B shows some interesting potentialities, but we have not enough evidence to insert this marker of brain damage in the protocols for management of TBI. However its use in experts’ hands in association with others clinical and radiological features may help to im- prove medical practice in the treatment of TBI.

2012 - Traumatologia Cranica [Capitolo/Saggio]
Iaccarino, C; Esposito, D; Staffa, G; Servadei, F
abstract

2012 - miRNAs expression analysis in paired fresh/frozen and dissected formalin fixed and paraffin embedded glioblastoma using real-time pCR [Articolo su rivista]
de Biase, D; Visani, M; Morandi, L; Marucci, G; Taccioli, C; Cerasoli, S; Baruzzi, A; Pession, 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, M; Fiorica, F; Valentini, A; Depenni, R; Mucciarini, C; Crisi, G; Sasso, E; Biasini, C; Cavanna, L; Guidetti, D; Marcello, N; Pisanello, A; Cremonini, Am; Guiducci, G; de Pasqua, S; Testoni, S; 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; Ferro, S; Franceschi, C; Frezza, G; Grasso, V; Leonardi, M; Mostacci, B; Palandri, G; Pasini, E; Pastore Trossello, M; Poggi, R; Riguzzi, P; Rinaldi, R; Rizzi, S; Romeo, G; Spagnolli, F; Tinuper, P; Trocino, C; Dall'Agata, M; Faedi, 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; Dazzi, C; Guidi, Ar; Zumaglini, F; Amadori, A; Pasini, G; Pasquinelli, M; Pasquini, E; Polselli, A; Ravasio, A; Viti, B; Sintini, M; Ariatti, A; Bertolini, F; 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; Fallica, E; Granieri, E; Latini, F; Lelli, G; Monetti, C; Saletti, A; Schivalocchi, R; Seraceni, S; Tola, Mr; Urbini, B; Giorgi, C; Montanari, E; Cerasti, D; Crafa, P; Dascola, I; Florindo, I; Giombelli, E; Mazza, S; Ramponi, V; Servadei, F; Silini, Em; Torelli, P; Immovilli, P; Morelli, N; Vanzo, C; Nobile C., PERNO Study Group
abstract

miRNAs are small molecules involved in gene regulation. Each tissue shows a characteristic miRNAs epression profile that could be altered during neoplastic transformation. Glioblastoma is the most aggressive brain tumour of the adult with a high rate of mortality. Recognizing a specific pattern of miRNAs for GBM could provide further boost for target therapy. The availability of fresh tissue for brain specimens is often limited and for this reason the possibility of starting from formalin fixed and paraffin embedded tissue (FFPE) could very helpful even in miRNAs expression analysis. We analysed a panel of 19 miRNAs in 30 paired samples starting both from FFPE and Fresh/Frozen material. Our data revealed that there is a good correlation in results obtained from FFPE in comparison with those obtained analysing miRNAs extracted from Fresh/Frozen specimen. In the few cases with a not good correlation value we noticed that the discrepancy could be due to dissection performed in FFPE samples. To the best of our knowledge this is the first paper demonstrating that the results obtained in miRNAs analysis using Real-Time PCR starting from FFPE specimens of glioblastoma are comparable with those obtained in Fresh/Frozen samples.

2011 - Analysis of MGMT promoter methylation status on intraoperative fresh tissue section from frameless neuronavigation needle biopsy of 25 patients with brain tumor [Articolo su rivista]
Iaccarino, C; Nicoli, D; Serra, S; Froio, E; Pisanello, A; De Berti, G; Ghadirpour, R; Marcello, N; Servadei, F; Carinci, F
abstract

Formalin fixation under conditions that adversely affected the quality of the DNA, or indeterminant assay, or extensive tumor necrosis can compromise the genetic analysis of a brain bioptic sample. The success of DNA extraction and Methyl Guanine Methyl Transferase (MGMT) promoter methylation testing could be improved by freezing of fresh tumor tissue at the moment of biopsy. To ensure an increased concentration of the DNA samples the withdrawal should be performed in an area with high probability of neoplastic cells. From May 2007 to January 2011 fifty-two frameless neuronavigation brain needle biopsy were performed at the Neurosurgery Unit of the “Arcispedale Santa Maria Nuova” City Hospital of Reggio Emilia. The “image-guided” neuronavigated protocol sampling provided withdrawal specimens highly correlated with neuroimaging characteristics of the lesions. In this study the Authors report the genetic analysis on 24 cases of freezing fresh tissue from brain needle bioptic sample starting from July 2008. The molecular determination of MGMT promoter was assessed with the Nested-Methylation Specific-Polymerase Chain Reaction on fresh or cryopreserved needle bioptic tissue. The genetic characterization was feasible in all the bioptic samples. The MGMT promoter was methylated in eleven patients, including a brain infection. The diagnostic yield of brain biopsy could be increased by the neuronavigated trajectories and the intraoperative frozen sections. In the future the availability of the molecular-genetic characterization of a brain tumor before open surgery will provide important information for the optimal treatment. The MGMT promoter status analysis on needle bioptic fresh tissue could be available also for that patient not eligible for surgical remotion of the tumor

2011 - Calcium sulfate stimulates pulp stem cells towards osteoblast differentiation [Articolo su rivista]
Sollazo, V; Lucchese, A; Palmieri, A; Melloni, E; Iaccarino, C; Zauli, G; Pezzetti, F; Brunelli, G; Carinci, F
abstract

2011 - Comparison between endoscopic vs. microscopic removal of hypophyseal adenoma: a retrospective study [Articolo su rivista]
Romano, A; Ghadirpour, R; Iaccarino, C; Servadei, F; Perano, D; Oretti, G; Carinci, F
abstract

To compare endoscopic and neuronavigation-assisted microscopic removal of hypophyseal adenoma in order to detect those variables statistically associated to clinical failures of each technique. Forty-eight patients (27 males and 21 females) with hypophyseal adenoma were treated with microscopy (6 patients) or endoscopic removal (42 patients). Surgery was performed via endonasal trans-sphenoidal approach. Correlations between tumor dimensions (standard and macro-tumor) or surgical techniques (endoscopy vs. microscopic technique) vs. residual tumor, surgical complication (i.e. rhinoliquorrea) and persisting visual deficit, were evaluated. No statistical significance was detected among the studied variables. On the basis of reported data, both techniques are safe if the surgeon is well trained. Neuronavigation applied during endonasal trans-sphenoidal microscopic surgery can precisely define the localization and removal of lesions in the sella region with respect to the margins of important anatomical structures in the neighborhood, decreasing the rate of complications.

2011 - Detection of IDH1 Mutations and the status of MGMT promoter on intraoperative fresh tissue section from frameless neuronavigation needle biopsy. Analysis on 17 patients with brain glial tumor ineligible for craniotomy and tumor resection [Articolo su rivista]
Iaccarino, C; Nicoli, D; Serra, S; Froio, E; Pisanello, A; De Berti, G; Ghadirpour, R; Marcello, N; Servadei, F; Carinci, F
abstract

It is well known that primary and secondary glioblastomas are histologically largely indistinguishable. Therefore, the detection of IDH1 mutations or the status of the MGMT promoter on a simple bioptic sample could be one of major diagnostic and prognostic importance for glial patients that complements clinical criteria for distinguishing secondary from primary glioblastomas and to predict a more favorable prognosis. Currently, biopsy is the method of choice to obtain tissue from intracranial lesions with uncertain neurodiagnostic findings or in deep locations, with a minimal invasive approach. The needle biopsy with frameless neuronavigation could provide a sampling with elevated diagnostic yield and high concentration of DNA, due to the “image-guided” computer assisted technique of needle insertion through the most neurodiagnostic representative tumoral area. The freezing of fresh tumor tissue at biopsy could greatly improve the success of DNA extraction. The concentration of the DNA samples can also improved from a withdrawal in an area with high probability of neoplastic cells. The present study reports the results of 17 patients who had undergone frameless image-guided intracranial needle biopsy from April 2008 until July 2010 at Neurosurgery Unit of the “Arcispedale Santa Maria Nuova” of Reggio Emilia. For these patients the molecular determination of MGMT promoter was assessed with the Nested-Methylation Specific-Polymerase Chain Reaction and the screening of mutations in IDH1 e IDH2 genes was performer by polymerase chain reaction (PCR) and direct sequencing on fresh cryopreserved needle bioptic tissue

2011 - ENDOSCOPIC REMOVAL OF HYPOPHYSEAL ADENOMAS: A RETROSPECTIVE STUDY [Articolo su rivista]
Romano, A; Perano, D; Oretti, G; Servadei, F; Iaccarino, C; Ghadirpour, R; Carinci, F
abstract

In this study was assessed the role that the direct endonasal approach with the operating endoscope plays in assisting operations for pituitary adenomas. During a 5-year period, from October 2004 to December 2010 - 42 patients (24 males and 18 females) with hypophyseal adenoma were treated with endoscopic- surgery. Surgery was performed via endonasal trans-sphenoidal approach. Three patients had complications (nasal hemorragia, anosmia, and rhinoliquorrea) in the follow-up period (mean 3 months). No statistical significance was detected between tumor dimensions and complications. On the basis of our experience, it is our opinion that this technique has a low rate of complications, particularly when adequate surgical instruments are used by surgeons who have familiarity with the endoscopic anatomy of the sphenoid sinus.

2011 - Navigation-assisted microscopic removal of hypophyseal adenoma: a retrospective study [Articolo su rivista]
Ghadirpour, R; Iaccarino, C; Servadei, F; Romano, A; Carinci, F
abstract

Neuronavigation is a commonly used technology that provides continuous, three-dimensional information for the precise localization of and surgical trajectory to brain lesions. This study was performed to evaluate the role that navigation can play in assisting microsurgical trans-sphenoidal surgery for precise localization and removal of pituitary tumours while simultaneously preserving pituitary gland function. Six patients (3 males and 33 females)with hypophyseal adenomas were treated with neuronavigation-assisted removal. Surgery was performed via endonasal trans-sphenoidal approach. Three patients had residual adenomas and two of the relapsed. There was one post operative rhinoliquorrea. In two cases the visual deficit did not significantly improved after operation. No statistical significance was detected among tumor dimensions with residual tumor, surgical complication (i.e. rhinoliquorrea), persisting visual deficit and used of abdominal fat for closing the sphenoidal field, respectively. Microneurosurgical trans-sphenoidal techniques combined with neuronavigation systems can precisely define the localization and removal of lesions in the sella region with respect to the margins of important anatomical structures in the neighbourhood and the endocrinological functionality of the pituitary gland. Neuronavigation can be easy applied during endonasal trans-sphenoidal microscopic surgery and requires a minimal amount of time. It makes operation easier, faster, and probably safer.

2011 - Polylactide-polyglycolide resorbable plates stimulates adipose tissue-derived stem cells towards osteoblasts differentiation [Articolo su rivista]
Sollazzo, V; Lucchese, A; Palmieri, A; Melloni, E; Iaccarino, C; Zauli, G; Pezzetti, F; Brunelli, G; Carinci, F
abstract

Polylactide, polyglycolide materials or devices have been utilized routinely during maxillofacial, craniofacial, and orthopaedic reconstructive surgical procedures.(1) These materials combine the benefits of rigid fixation with the advantages of biodegradation, avoiding the need for implant removal and minimizing the risk of other complications.(2) To study how polylactide, polyglycolide acids plates (PLPG plates) can induce osteoblast differentiation and proliferation in mesenchymal stem cells, the expression levels of bone related genes (RUNX2, SP7, ALPL, SPP1, COL1A1, COL3A1 and FOSL1) and mesenchymal stem cells marker (ENG) were measured in adipose derived stem cells (ADSCs) and normal osteoblast (NO) cultivated on PLPG plates after 15 and 30 days of treatment using real time Reverse Transcription-Polymerase Chain Reaction. Significantly differentially expressed genes among ADSCs and NO were SP7, ENG, FOSL1, RUNX, ALPL and SPP1 in the first 15 days of treatment and SP7, ENG FOSL1, COL3A1 COL1A1, SPP1 and ALPL after 30 days. The present study demonstrated that PLPG plates strongly influences the behavior of ADSCs in vitro by enhancing proliferation, differentation and deposition of matirx.

2011 - Porous hydroxyapatite custom made cranioplasty: the 3D design techniques prostheses in 21 patients [Articolo su rivista]
Iaccarino, C; Ramponi, V; Ghadirpour, R; Carinci, F; Servadei, F
abstract

2011 - Tricalcium phosphate stimulate adipose tissue-derived stem cells towards osteoblasts differentiation [Articolo su rivista]
Sollazzo, V; Fanali, S; Masiero, E; Girardi, A; Farinella, F; Elloni, E; Pezzetti, F; Iaccarino, C; Zauli, G; Carinci, F
abstract

2010 - Analysis of MGMT promoter methylation status on intraoperative fresh tissue section from frameless neuronavigation needle biopsy: a preliminary study of ten patients [Articolo su rivista]
Iaccarino, C; Nicoli, D; Gallo, C; Nasi, D; Pisanello, A; De Berti, G; Ghadirpour R, ; Marcello, N; Servadei, F.
abstract

Background After a brain biopsy, the genetic analysis can fail because of insufficient material, extensive tumor necrosis, and formalin fixation under conditions that adversely affected the quality of the DNA or because the assay result was indeterminant. The freezing of fresh tumor tissue at surgery could greatly improve the success of DNA extraction and methyl guanine methyl transferase (MGMT)promoter methylation testing. The concentration of the DNA samples can also be improved from a withdrawal in an area with a high probability of neoplastic cells. Methods The present study reports the results of ten frameless image-guided intracranial needle biopsies from April 2008 until February 2009, among a total of 28 frameless neuronavigation brain biopsy performed from May 2007 to February 2009. The protocol sampling provided withdrawal specimens correlated with neuroimaging characteristics of the lesions. The molecular determination of MGMT promoter was assessed with the nested methylation-specific polymerase chain reaction on fresh or cryopreserved needle bioptic tissue. Results: The genetic characterization was feasible in all the bioptic samples. The MGMT promoter was methylated in six patients, including a brain infection. The image-guided trajectory of the biopsy and the intraoperative frozen section increased the diagnostic yield. Conclusions: To the best of the authors' knowledge, this is the first report with the MGMT promoter status analysis on needle bioptic fresh tissue. In the future, the availability of the molecular genetic characterization of a brain tumor before open surgery will provide important information for the optimal treatment.

2010 - Combined endoscopic transsphenoidal-transventricular approach for resection of a giant pituitary macroadenoma [Articolo su rivista]
Romano, A; Chibbaro, S; Marsella, M; Oretti, G; Spiriev, T; Iaccarino, C; Servadei, F.
abstract

OBJECTIVES: Sellar lesions, such as pituitary adenomas, even when extended to the suprasellar space may be usually removed through a trans-sphenoidal approach. Larger lesions extending well beyond the edges of the sellar diaphragm such as giant adenomas are best controlled with craniotomy and/or a combined approach that implies both, transphenoidal and transcranial route. Currently, the availability of more sophisticated endoscopes in this type of surgery has provided optimal angles of view and rendered the trans-sphenoidal route less invasive yet, more effective. CASE DESCRIPTION: The authors report a case of a giant pituitary adenoma successfully managed by a simultaneous, combined endoscopic trans-sphenoidal- transventricular approach. CONCLUSION: In selected case of giant pituitary adenoma with ventricular extension, this technique may help to achieve a gross total removal avoiding the need of staged procedures allowing also a direct visualization of the extent of removal. Finally this approach can potentially improve gross total resection rate of different types of tumor involving this region such as cranipharyngiomas while reducing morbidity and mortality.

2009 - Is the distance between mammillary bodies predictive of a thickened third ventricle floor? [Articolo su rivista]
Iaccarino, C; Tedeschi, E; Rapanà, A; Massarelli, I; Belfiore, G; Quarantelli, M; Bellotti, A
abstract

Advances in the ETV technique have been based on a detailed understanding of third ventricular anatomy, surgical trajectories, and improved instrumentation.Knowledge of third ventricle anatomy is essential for the safety and reliability of intraventricular endoscopic procedures. Many anatomical variants or anomalies can complicate the ETV procedure and compromise the surgical results for example, thickening of the TVF, which disturbs the usual anatomical orientation and can render perforation of the floor technically difficult; a narrow foramen of Monro; or the so-called upward ballooning phenomenon, in which, after perforation of the TVF and withdrawal of a Fogarty catheter, the floor herniates into the third ventricle, hindering the endoscopic view. The operative results mainly depend on the selection of suitable hydrocephalic patients; therefore, specific MR imaging findings in the evaluation of the pathophysiological and anatomical prerequisites are a fundamental part of preoperative planning. Unfortunately, the consistency of the TVF cannot be adequately determined preopera-tively based on MR images, even with an advanced MR imaging protocol and 3D reconstruction. However, the distance between MBs, the fundamental anatomical landmarks for ETV, is a linear measure readily assessable on axial MR images and can provide indirect information about the conformation of the TVF. A thorough search of the medical literature failed to reveal any systematic MR imaging evaluation of this particular measure in healthy persons or in an ETV study. Because in neuroendoscopic studies variable IMDs and a thickened TVF have been commonly observed, we retrospectively evaluated the IMDs on routine MR images both in 23 patients with hydrocephalus who had undergone ETV and in 120 healthy persons to define normal values of the IMD, which to our knowledge has never been reported, and to assess the possible correlation between such preoperative measures and the thickness of the TVF in patients with hydrocephalus.

2009 - Trauma cranico e vertebromidollare [Capitolo/Saggio]
Iaccarino, C; Rapanà, A; Tagliaferri, F; Compagnone, C; Servadei, F
abstract

2008 - MR-Cisternography with T2-Weighted Single-Shot Fast Spin Echo Sequence in the Diagnosis of a Spontaneous CSF Fistula of the Sphenoid Sinus Causing Massive Pneumocephalus [Articolo su rivista]
Tedeschi, E; Iaccarino, C; Covelli, Em; Rapanà, A; Barretta, Ml; Piscitelli, V; Belfiore, G.
abstract

A spontaneous CSF fistula of the sphenoid sinus was preoperatively diagnosed in a young woman presenting with massive pneumocephalus and rhinorrhea. Diagnosis was established by MR cisternography using a heavily T2-weighted 3D single-shot FSE sequence with half-Fourier analysis (3D-EXPRESS®), originally developed for imaging the inner ear. While unenhanced CT failed to detect the site of the fistula, MR permitted complete evaluation of the sellar/sphenoid region and tracked the CSF signal down to the nasal cavity.

2008 - Teleradiology for traumatic brain injury management [Capitolo/Saggio]
Iaccarino, C; Rapanà, A; Compagnone, C; Tagliaferri, F; Servadei, F
abstract

2007 - Retropharyngeal cerebrospinal fluid collection as a cause of postoperative dysphagia after anterior cervical discectomy [Articolo su rivista]
Spennato, P; Rapanà, A; Sannino, E; Iaccarino, C; Tedeschi, E; Massarelli, I; Bellotti, A; Schönauer, M
abstract

Background: Transient dysphagia after anterior cervical discectomy is not uncommon. It is usually related to esophageal edema secondary to retraction, mechanical adhesions of the esophagus to the anterior spine, and stretch injuries to nerves involved in the swallowing mechanism. Structurally induced dysphagia, secondary to laceration of the neck viscera or to the presence of retropharyngeal masses, is by far less frequent, and it does not usually improve over time. Case Description: The authors present the case of a 36-year-old woman who complained of severe dysphagia both for solids and liquids after C4 through C5 anterior discectomy and fusion,complicated by a millimetric dural tear of the anterior thecal sac. Postoperative neuroimaging revealed retropharyngeal fluid collection, extending in front of the vertebral bodies of C3, C4, and C5, exerting a mass effect on the posterior wall of the pharynx. Taking into account both the MRI aspect of the collection and the dramatic improvement of symptoms after lumbar punctures, we conducted a diagnosis of CSF collection in continuity with the subarachnoid space. The dysphagia and the CSF collection resolved with conservative therapy (bed rest and 3 lumbar punctures). Conclusion: To the best of our knowledge, such a complication has never been described before in the literature. It should be included in the differential diagnosis of patients with postoperative dysphagia lasting more than 48 hours.

2006 - La carcinomatosi leptomeningea: aspetti di diagnosi e terapia [Articolo su rivista]
Bellotti, A; Spennato, P; Iaccarino, C; Rapanà, A; Pascale, M; Della Corte, M; Schönauer, M
abstract

// riscontro di carcinomatosi leptomeningea sta diventando sempre più frequente negli ultimi anni per il miglioramento delle tecniche diagnostiche ed il prolungamento della sopravvivenza dei pazienti neoplastici, soprattutto in caso di tumore delia mammella, del polmone e del melanoma. I! quadro dittico è in genere dominalo dal coinvolgimento multifocale de! sistema nervoso (encefalo, nervi cranici, midollo spinale e radici della cauda equina). La diagnosi può essere effettuata sulla scorta degli esami neiitvmdiologici (in particolare con la risonanza magnetica con mezzo di contrasto) e della citologia liquorale. I! trattamento della carcinomatosi leptomeningea è puramente palliativo: il suo scopo è il controllo dei sintomi neurologici e il miglioramento del "performance status ". La prognosi rimane, comunque, estremamente infausta. Gli autori discutono l'iter diagnostico dei pazienti affetti da carcinomatosi lepìomeningea. la selezione dei pazienti da indirizzare ad un trattamento specifico ed i risultati e le complicanze della terapia.

2004 - Intracranial pressure patterns after endoscopic third ventriculostomy. Preliminary experience [Articolo su rivista]
Rapanà, A; Bellotti, A; Iaccarino, C; Pascale, M; Schönauer, M
abstract

Background. Endoscopic Third Ventriculostomy (ETV) has become the treatment of choice for non-communicating hydrocephalus as it is able to couple high success rate (60–80%) with rare complications (about 5%). Nevertheless, which is the best postoperative care standard and whether or not it is possible to predict the success of the procedure is still discussed. Traditional neuro-imaging techniques show several limitations in the early postoperative period. Indeed, a decrease of the ventricular size is often minimal and not visible before three weeks, while, MRI visualization of a flow void signal through the third ventricle floor, seems to have a significant incidence of false positives. The use of postoperative ICP measurement after ETV has been suggested as a valid monitoring method, mostly in the early postoperative period. In previously unpublished data the authors observed the existence of different ICP patterns following ETV. This finding prompted the authors to search for a relationship among ICP patterns, stoma functioning and prediction of success. Method. At our institution 26 consecutive patients affected by obstructive triventricular hydrocephalus underwent ETV. Among them there were 11 primitive aqueductal stenosis (AS), 5 shunt malfunctions, 2 third ventricle mass, 3 intraventricular cysts, and 5 patients with different lesions (1 quadrigeminal cistern arachnoidal cyst, 1 pineal region mass, 2 tectal tumours, and 1 upracerebellar abscess) compressing the aqueduct of Sylvius from outside named ‘‘ab estrinseco’’ aqueductal stenosis. All patients underwent postoperative Intra Cranial Pressure (ICP) monitoring by means of a ventricular catheter. Findings: Transient ICP rises of any grade, mostly responsive to periodical liquoral subtractions, occurred shortly after ETV in as many as 50% of our patients. No major complications occurred. The effect of ETV on ICP trend was found to be variable among groups of patients thus identifying different ICP patterns. Patients with ab estrinseco Sylvian aqueduct compression showed the best effect on ICP, whilst, patients with intraventricular mass lesions causing triventricular hydrocephalus and shunt-dependent patients, revealed a clear trend to develop a more severe intracranial hypertension after ETV. Conclusions. Patients with shunt malfunction and patients with intraventricular mass lesions, showing a more pronounced trend to develop severe intracranial hypertension after ETV, should always be considered for postoperative ICP monitoring in order to detect and, eventually, treat any ICP rises which may occur. Unfortunately, it is still difficult to assign a predictive value to the different postoperative ICP patterns. The authors encourage postoperative ICP monitoring in all patients in order to define all the possible ICP patterns following ETV.

2002 - Exclusively intracranial and cranial fasciitis of the adult age [Articolo su rivista]
Rapanà, A; Iaccarino, C; Bellotti, A; Marsicano, C; Donnianni, T; Tedeschi, E
abstract

The unusual case of an exclusively intracranial localization of fasciitis (CF) in a man aged 47 is reported. The cystic lesion had been accidentally discovered 10 years before when the patient sustained a contralateral ischemic stroke; the cyst, being absolutely silent, was not operated on at that time. After 10 years, the patient complained of seizures and mild right-sided paresis. CT scan revealed a dramatic increase of the lesion whose mass effect caused an initial subfalcial herniation of the brain. The mass was grossly removed, the patient recovered and become seizure-free. CF, rare in childhood, is exceptional in the adult age. The importance of a correct histological diagnosis is hereby stressed, because CF is absolutely benign, self-limiting, and does not require further treatment, but may be misdiagnosed as sarcoma.

2001 - Intracranial pressure monitoring after endoscopic third ventriculostomy: an effective method to manage the 'adaptation period' [Articolo su rivista]
Bellotti, A; Rapanà, A; Iaccarino, C; Schonauer, M
abstract

Endoscopic third ventriculostomy (ETV) has become the treatment of choice for non-communicating hydrocephalus. Nevertheless, which technique should be considered of choice to identify features correlating with the failure of an endoscopic procedure and which is the optimal postoperative period care standard are still a matter of debate. Traditional neuroimaging techniques have several limitations in assessing the success of the procedure mostly in the early postoperative period. Indeed, a decrease in the ventricular size is often minimal and not visible before 3–4 weeks. MRI, able to detect the presence of a flow void signal through the third ventricle floor, has been reported to have a significantly high incidence of false positives. In our experience, the continuous measuring of intracranial pressure (ICP) by means of a ventricular catheter has been of great help in verifying the correct functioning of the communication between the ventricle and the subarachnoidal spaces during the first postoperative days. Furthermore, ICP monitoring allowed us to safely deal with the intracranial hypertension that may occur shortly after ETV.

2001 - Tumori Cerebrali [Capitolo/Saggio]
Merola, Mc; Martinelli, E; Iaccarino, C
abstract

1998 - Microneurosurgical treatment of Chiari I Malformation of the adult [Articolo su rivista]
Parlato, C; Iaccarino, C; Guarracino, A; Schönauer, C; Tessitore, E; Frascadore, L; Tartaro, G; Moraci, M
abstract

1995 - Tissue expansion in neurosurgical reconstructive technique: case report [Articolo su rivista]
Rotondo, M; Parlato, C; Iaccarino, C; Scrocca, A
abstract

BACKGROUND: Various reconstructive techniques using hair-bearing scalp to manage unsightly scalp defects have been described. In 1983, Fonseca and in 1984, Horowitz emphasized the use of galeal-pericranial flaps in scalp wounds with exposed bone. In 1986, Matthews and Missoten described early tissue expansion to close a traumatic defect of the scalp, and in 1990 Kiyono placed tissue expander in a pocket adjacent to the defect that was covered with Marlex Mesh. METHODS: The authors present a case of 23-year-old man with a scalp laceration over a depressed fracture of the skull and a dural tear, after a traffic accident. The repair procedures at another hospital failed, resulting in an area of scalp necrosis with a cerebrospinal fluid (CSF) leak. At our observation, the reconstructive technique using hair-bearing scalp with tissue expander was performed to manage unsightly scalp necrosis. Moreover the neurosurgical treatment was necessary to avoid the complications of the CSF leak. CONCLUSIONS: A 9-year review showed more than 40 patients treated by this technique that allows a pericranial flap of every size. When scalp defects are too large, the tissue expander allows good aesthetic results.

1992 - Cerebrospinal fluid T cell receptor gamma/delta+ lymphocyte subsets in patient with AIDS-dementia complex [Articolo su rivista]
Perrella, O; Soscia, M; Iaccarino, C; Carrieri, Pb
abstract

A subset of peripheral T cells, whose physiological function is little known, expresses a distinct CD3-associated receptor composed of gamma and delta chains. We used two monoclonal antibodies to characterize the TcR gamma/delta lymphocytes (TcR delta 1+) and their fraction (TcS delta 1+) in peripheral blood and cerebrospinal fluid of patients affected by AIDS dementia complex (ADC). Thirty patients with ADC and a control group of twenty individuals with other non-inflammatory neurological diseases (OND) were recruited. Our results demonstrate that the TcR gamma/delta cells were also present in cerebrospinal fluid of ADC patients, but we did not find any statistical difference between the two groups.

1990 - Sistema nervoso centrale e periferico: coinvolgimento in corso di AIDS [Articolo su rivista]
Gnarini, R; Postiglione, A; Conte, M; Galderisi, P; Manzillo, E; Pierri, P; Iaccarino, C; Guidetti, E; Sardu, A
abstract