Enrico Divitiis - Academia.edu (original) (raw)

Papers by Enrico Divitiis

Medical Oncology and Tumor Pharmacotherapy, 1992

A ten-year experience on 36 patients bearing macroprolactinomas (MP) and 86 others bearing microp... more A ten-year experience on 36 patients bearing macroprolactinomas (MP) and 86 others bearing microprolactinomas (raP) is reported in this study. Different therapeutical approaches were used: 1) trans-sphenoidal surgery in 24 patients with MP and in 25 with raP; 2) medical therapy with the oral form of bromocriptine (BRC) in all the 24 patients with MP previously subjected to surgery, in 48 patients with mP ab initio, and in 16 out of 25 patients with naP previously subjected to surgery; 3) medical therapy with the long-acting injectable forms of BRC in 12 MPand 13 rn_P-bearing patients, and 4) conventional radiotherapy in 12 of the 24 patients with MP previously subjected to surgery. The follow-up, performed five years after surgery, showed that: a) all the 24 patients with MP but one had normal PRL levels during BRC administration, with a rebound of hyperprolactinemia in all cases after withdrawal; b) during the treatment BRC caused normalization of PRL in 15 of the 16 raP-bearing patients surgically treated and in all the 48 mP-bearing patients only treated with BRC; c) in 20 of the 25 patients the treatment with injectable retard BRC caused the normalization of plasma PRL and the shrinkage of the tumor mass in all the patients with MP but one, as revealed by sedate CT scans. In conclusion, the surgical treatment of prolactinomas was ineffective to normalize plasma PRL levels in most patients whereas BRC, in standard or in retard forms, was able to normalize plasma PRL levels, reduce the tumoral mass and preserve the pituitary residual tissue. BRC should be, therefore, used as first choice therapy both for MP and mP.

Surgical Neurology, 1981

... The indications for and the re-sults of surgical treatment are reviewed. Spaziante R, de Divi... more ... The indications for and the re-sults of surgical treatment are reviewed. Spaziante R, de Divitiis E, Stella L, Cappabianca P, Genovese L: The empty sella. ... The absence of a synthetic overview of the features of this entity is det-rimental to the correct diagnosis of individual cases. ...

Stereotactic and Functional Neurosurgery, 1983

Because of the variability of the structural features of cerebral tumors, the characteristics obs... more Because of the variability of the structural features of cerebral tumors, the characteristics observed in biopsy samples may not be representative of the whole neoplasm. The reliability of cerebral stereotactic biopsy is therefore greatly debated. In order to test the value of diagnoses based on biopsy samples, the authors compared histological and cytological data obtained from a small fragment of a tumor with the definitive diagnosis obtained from surgical or necropsy specimens. An analysis of 64 cases is reported, where a correct diagnosis from the biopsy sample was achieved in 92.2% of the cases. Neuroglial tumors were more difficult to characterize than other types of intracranial tumors, with an accuracy of 81.5 %.

Neurosurgery Quarterly, 1997

Neurosurgery, 2004

ENDOSCOPY OFFERS INTERNAL visualization of many different cavities of the human body, with its sp... more ENDOSCOPY OFFERS INTERNAL visualization of many different cavities of the human body, with its specific vision inside the anatomy, close to the target area. The view of the surgical field in transsphenoidal surgery had been obtained with the naked eye from its beginning in 1907 up to the introduction of the operating microscope by Jules Hardy in the 1960s, which represented a great advance in terms of magnification and illumination. In the past decade, modern rigid endoscopes, with their wider view near the relevant anatomy, have permitted minimally traumatic transsphenoidal procedures in and around the sellar area, thus representing a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new wave&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in transsphenoidal history. An overview of the evolution of the endoscope as a visualizing and operating instrument particularly related to the transsphenoidal approach is presented here. The current possibilities of transsphenoidal endoscopy, with its related advantages and limitations, are presented.

Operative Neurosurgery, 2005

OBJECTIVE: The aim of the present study was to compare the anatomy of the cavernous sinus via an ... more OBJECTIVE: The aim of the present study was to compare the anatomy of the cavernous sinus via an endoscopic transnasal route with the anatomy of the same region explored by the transcranial route. The purpose was to identify and correlate the corresponding anatomic landmarks both through the endoscopic transnasal transsphenoidal and the microscopic transcranial views. METHODS: Five fresh injected heads (10 specimens) were dissected by the endoscopic transnasal and microsurgical transcranial approaches. A comparison of different microsurgical corridors of the cavernous sinus with the corresponding endoscopic transnasal ones was performed. RESULTS: Through the endoscopic transnasal approach, it is possible to explore only some of the parasellar and middle cranial fossa subregions. Because of the complex multilevel architecture of the cavernous sinus, there is not always a correspondence between the surgical corridors bounded through the transcranial route and those exposed through the...

Neurosurgery, 2002

To demonstrate the flexibility of the endoscopic transsphenoidal approach, with respect to nasal ... more To demonstrate the flexibility of the endoscopic transsphenoidal approach, with respect to nasal and paranasal anatomic features and the extension of different sellar lesions, for customization of the procedure for specific conditions. In 16 of 170 consecutive endoscopic transsphenoidal operations, some modifications of the standard approach were adopted to optimize surgical removal of different lesions. These modifications consisted of a hemisphenoidotomy, a partial ethmoidectomy, extended sellar floor opening toward the planum sphenoidale or the clivus, enlarged opening of the sphenoid ostium area with ipsilateral removal of the superior turbinate, and a bilateral approach. The endoscopic endonasal procedure is easily adaptable to different specific conditions, with slight changes in the standard approach (more or less invasive). Therefore, this surgical procedure is satisfactory for different lesion locations and for the nasal and paranasal sinus anatomic features of individual patients. The endoscopic surgical route should be tailored to different sellar lesions, and some modifications of the procedure are recommended in selected cases.

min - Minimally Invasive Neurosurgery, 1978

After a review of the international literature, the authors report a case of intramedullary epend... more After a review of the international literature, the authors report a case of intramedullary ependymoma extending from the 1st cervical level to the 1st lumbar level completely removed in a one stage operation. The good functional recovery of the patient is emphasized.

min - Minimally Invasive Neurosurgery, 1984

Surgery of the intervertebral disc, despite its relative simplicity, has a high failure rate at t... more Surgery of the intervertebral disc, despite its relative simplicity, has a high failure rate at the functional level. There is often severe residual pain which is a real problem because it is so difficult to treat either the symptom or its cause. We report the results of 122 procedures in 100 patients, some of whom had multiple lesions, using a technique (already described in a preliminary paper) consisting of an interlaminar approach modified to provide greater preservations of neural, bony and joint structures. The results were very good, both soon after operation and at later follow-up (between six months and five years). There were no cases of recurrence or pseudo-recurrence, one case of contralateral recurrence (cured by further operation) and a very low incidence of residual backache. These results confirm that, provided the patients have been well selected so that not every patient with lumbar backache is operated on but only those with proven disc lesions, operation does fundamentally influence the quality of the results.

min - Minimally Invasive Neurosurgery, 2007

This study was made to define the mechanism of endoscopic third ventriculostomy (ETV) in the vari... more This study was made to define the mechanism of endoscopic third ventriculostomy (ETV) in the various forms of hydrocephalus. One hundred and forty patients with various forms of hydrocephalus treated by ETV are reviewed. The series includes 75 cases (53.5%) of triventricular obstructive hydrocephalus (group 1), 20 (14.3%) with hydrocephalus following CSF infection or hemorrhage (group 2) and 45 (32.3%) with idiopathic normal pressure hydrocephalus (group 3). Factors which have been considered include type and etiology of the hydrocephalus, intraoperative evidence of downward and upward movement of the third ventricular floor after the stomy, patient outcome and rate of shunt-independent cases. The overall rate of successful ETV was 79.3% (111/140 shunt-free patients). The success rate was 88% (66/75) in group 1, 60% (12/20) in group 2 and 73.4% (33/45) in group 3. The intraoperative finding of significant movement of the third ventricular floor after the stomy was evidenced in 121/140 cases (86.4%) and particularly in all cases of group 1, in 9/20 (45%) of group 2 and in 37/45 (82%) of group 3. The relatively high rate of success of ETV in various forms of hydrocephalus and the intraoperative finding of mobility of the third ventricle floor after the stomy suggest that the first mechanism of the ETV is the restoration of pulsatility of the ventricular walls. This results in restoration of the CSF flow from the ventricular system into the subarachnoid spaces and normalization of the CSF dynamics. Accordingly, ETV is not only an internal shunt, but it primarily influences the capacity of the brain pulsatility to ensure CSF flow.

min - Minimally Invasive Neurosurgery, 2002

We describe three patients with symptomatic septum pellucidum cysts treated by endoscopic fenestr... more We describe three patients with symptomatic septum pellucidum cysts treated by endoscopic fenestration and discuss the different endoscopic approaches to these cysts. The patients are an 8-year-old boy, a 7-year-old boy and a 21-year-old woman; this last also had a right frontal cavernous angioma and a pituitary microadenoma. All patients presented with headache, associated with vomiting in two and behavioral changes in one. In all cases magnetic resonance showed a septum pellucidum cyst. Two patients were operated upon by posterior approach through a right occipital burr hole and underwent fenestration from the right occipital horn to the cyst, with a second fenestration from the cyst to the left lateral ventricle in one. Another patient underwent microsurgical removal of a right frontal cavernoma and endoscopic cyst fenestration with both lateral ventricles through a right frontal craniotomy. Postoperatively, headache and vomiting resolved in all cases and behaviour changes improved in one. Endoscopic fenestration is the treatment of choice for septum pellucidum cysts, where it results in immediate relief of the mass effect of the cyst and in the remission of the associated symptoms. We suggest a posterior approach through a right occipital burr hole. It allows one to easily cannulate the occipital horn, which is usually larger than the frontal one, thus avoiding the risk of damaging the vascular and neural structures surrounding the foramen of Monro. Besides, the endoscopic trajectory is in our opinion more direct. The two-window technique, with fenestration of the cyst into both lateral ventricles, improves the chances of long-term patency.

Journal of Neurosurgery, 1989

✓ Inversion and prolapse into the sella of the superior capsule and the diaphragma sellae is the ... more ✓ Inversion and prolapse into the sella of the superior capsule and the diaphragma sellae is the only condition that warrants, at least macroscopically, radical removal of tumors with suprasellar extension operated on via the transsphenoidal route. If this does not occur spontaneously, air can be introduced into the subarachnoid space through a lumbar spinal catheter to produce forced dissection of the suprasellar cisterns and collapse of the tumor capsule (“pumping technique”). This method permits complete removal of the neoplastic tissue. In a series of 124 transsphenoidal operations for tumors with suprasellar extension, spontaneous descent of the capsule occurred in only 26 cases. Forced dissection using air distension of the cisterns was carried out in 88 cases, with complete success in 56 cases, partial success in 20, and no effect in 12. There were no complications or unwanted side effects in any patient.

Journal of Neurosurgery, 1995

✓ The fissure separating the motor from the sensory cortex and the substantia gelatinosa capping ... more ✓ The fissure separating the motor from the sensory cortex and the substantia gelatinosa capping the posterior horn of the spinal cord are still known by the name of the Italian anatomist Rolando. Luigi Rolando was born in Turin, Italy, in 1773 and died in 1831. His life was not easy, the first of his problems being the death of his father when Rolando was still very young. Three people were to be influential in his life and career: Father Maffei, his maternal uncle who raised him; Dr. Cigna, the anatomy professor who discovered his talent; and Dr. Anformi, a general practitioner who introduced him to the practice of medicine and to the best circles of the city. Forced to leave Turin by the Napoleonic invasion of the country, Rolando first stopped in Florence, where he learned about anatomical dissection, drawing, and engraving and studied the appearance of nervous tissue under the microscope. Later he went to Sardinia where, although cut off from European cultural circles, he devel...

Clinical Neurology and Neurosurgery, 2000

The clinicopathological features of a lipomatous meningioma of the falx cerebri with an unusual h... more The clinicopathological features of a lipomatous meningioma of the falx cerebri with an unusual histological pattern are presented.

Child's Nervous System, 2000

The endoscopic endonasal transsphenoidal approach to the sellar region for the removal of pituita... more The endoscopic endonasal transsphenoidal approach to the sellar region for the removal of pituitary adenomas and of other neoplasms in the same area has proved its reliability and effectiveness for the very wide vision it offers, coupled with minimal surgical trauma. Indications and advantages of such a technique are reported, focused on the treatment of lesions of the sellar and parasellar environment in pediatric age-group patients, and based on a consecutive series of 100 patients, 3 of them adolescents, treated during the last 3 years.

Journal of Neurosurgery, 2012

February 2011), which reported the result of management of selected pituitary adenomas, using an ... more February 2011), which reported the result of management of selected pituitary adenomas, using an extended endoscopic endonasal approach. The authors presented convincing evidence that such treatment confers greater benefits, as compared with the standard approach. Initial results are promising and may justify a widening of the current classical indications of transsphenoidal surgery for this kind of pituitary adenoma. As I have a special interest in articles that bear on the transnasal approach to the skull base, I was most interested in reading this article, and above all particularly honored to have been quoted on a number of occasions in the article. Indeed, I would like to express my gratitude to the authors. However, I was slightly disappointed to notice that my surgical contribution in performing many of the 92 extended procedures, reported in the article, has been neglected. Indeed, I respectfully point out, just for the pursuit of truth, that the majority of patients have undergone extended endonasal surgeries at the Neurosurgical Department of Federico II University of Naples, between 2003 and 2008 (when I retired), carried out by myself together with Dr. Cavallo (such a tandem surgery needs 2 surgeons to perform a "four hand technique"). It is easily provable by reading what is reported in the papers of references 19 and 21 cited in Patients and Methods, where surgeons are indicated, in contrast to what is reported in the Results of the present article, where the authors state: "…92 EEEAs have been performed by the senior authors… (L.M.C., P.C.)." In such a way they lead to a misconception because this information, in reality, does not adhere to the truth. Nevertheless, I'm sure that it was a misunderstanding, maybe due to a mere oversight on the part of the authors. Otherwise, it would be quite disconcerting, particularly for the fact that 2 of the authors, serving as my alumni, have shared with me, right from the start, the exciting experience of the evolution of endoscopic endonasal pituitary and skull base surgery. Finally, while I congratulate the authors on this timely and excellent paper, which is likely to be very influential, I would exhort them not to forget Newton's old aphorism: "nos quasi nanos gigantium humeris insidientes" (we are as dwarfs on the shoulders of giants, and can see far…, for we have been lifted high by their gigantic grandeur). enrico de diviTiis, M.d.

Acta Neurochirurgica, 2013

L'Endocrinologo, 2001

RiassuntoL’acromegalia è una malattia rara ma severa, il cui trattamento prevede un approccio int... more RiassuntoL’acromegalia è una malattia rara ma severa, il cui trattamento prevede un approccio integrato tra terapia medica, chirurgica e radioterapia. Tale schema terapeutico consente attualmente di curare la malattia nel 75% dei casi. In questo articolo, presenteremo le più recenti acquisizioni e le nuove prospettive nel trattamento terapeutico dell’acromegalia.