Mario Meglio - Academia.edu (original) (raw)

Papers by Mario Meglio

Advances in Stereotactic and Functional Neurosurgery 7, 1987

We studied the effects of spinal cord stimulation (SCS) on motor performances in patients with sp... more We studied the effects of spinal cord stimulation (SCS) on motor performances in patients with spastic hemiparesis due to cerebrovascular ischemic accident. 11 patients were evaluated before and after 7 days of SCS by means of the Albert's motor scale and a surface polyelectromyography. SCS significantly improved motor performances in 63% of the patients. It reduced agonist-antagonist coactivation and clonus. Such an effect was particularly evident during voluntary movements and gait.

14th Meeting of the World Society of Stereotactic and Functional Neurosurgery WSSFN, 2005

In recent years, it is a new trend to neurophysiologically locate and test functional connectivit... more In recent years, it is a new trend to neurophysiologically locate and test functional connectivity between different parts of the eloquent cortices. We present neurophysiologic methods to: a) locate primary motor cortex for laryngeal muscles, b) test corticobulbar pathways from primary motor cortex to the brainstem vagal motor nuclei innervating laryngeal muscles, and c) elicit laryngeal responses after stimulation of inferior frontal gyrus (Broca area) in the patients under general anesthesia.

Acta Neurochirurgica Supplementum, 1991

We investigated the antinociceptive activity of Lysine Acetylsalicylate (LAS) after intracerebrov... more We investigated the antinociceptive activity of Lysine Acetylsalicylate (LAS) after intracerebroventricular (icv) injection in experimental animals. The effect on tonic pain was studied by means of the Formalin test on 140 male Swiss mice. In a first group of animals icv LAS was injected at different doses (0.25-0.5-1 mg in saline solution 5 microliters). A second group received icv morphine 1 microgram in 5 microliters saline, and finally a third control group received icv 5 microliters saline. The effect of the compounds on the Formalin test was evaluated under blind conditions. Icv LAS had no effect on the nociceptive behaviour at doses of 0.25 and 0.5 mg, while a reduction of the licking time was evident after the injection of 1 mg of the drug. The time course and the degree of the analgesic effect of icv LAS was investigated and compared to the effect of icv morphine.

Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, 2014

Surgery of complex spinal dysraphisms can be challenging. A number of surgical maneuvers can plac... more Surgery of complex spinal dysraphisms can be challenging. A number of surgical maneuvers can place the conus and the cauda equina at risk for neurological injury during cord untethering, and the identification of functional neural structures within the lumbosacral region is often not possible solely on the basis of anatomy. Therefore, the assistance of intraoperative neurophysiological monitoring can be invaluable during these procedures. We describe the intraoperative neurophysiological monitoring strategy developed at our institution over the past 12 years when dealing with tethered cord surgery. Monitoring and mapping techniques are described, with a focus on the invaluable role played by neurophysiological mapping. This latter, for a neurosurgeon, impacts tethered cord surgery at least as strongly as neurophysiological monitoring. Our results suggest that the combination of monitoring and mapping techniques increases the safety of these procedures, minimizing long-term morbidity...

Journal of Clinical Neuroscience, 2011

Acta Neurochirurgica, 1974

Stereotactic and Functional Neurosurgery, 1986

$Research paper thumbnail of Spinal cord stimulation in patients with refractory anginal pain and normal coronary arteries$

Italian heart journal : official journal of the Italian Federation of Cardiology, 2001

Spinal cord stimulation (SCS) has been shown to be effective in patients with refractory angina a... more Spinal cord stimulation (SCS) has been shown to be effective in patients with refractory angina and coronary artery disease. No previous study assessed the clinical effects of SCS in patients with refractory angina who present angiographically normal coronary arteries. SCS was performed in 7 patients (4 men, 3 women, mean age 59.3 +/- 11 years) with refractory angina and normal coronary arteries. Clinical status was assessed 1 month after SCS device implantation and at a mean follow-up of 11 months (range 2-17 months) by: 1) an estimate of the number of anginal attacks and nitrate consumption in the 2 weeks prior to implantation and to follow-up visits; 2) a score of quality of life by a visual analogic scale; 3) a five-item questionnaire assessing effort angina and satisfaction with treatment; 4) treadmill exercise testing. At the last follow-up the number of anginal episodes (p < 0.001) and nitrate consumption (p < 0.004) were both reduced by SCS. Visual analogic scale score...

Stereotactic and Functional Neurosurgery - STEREOTACT FUNCT NEUROSURG, 1994

We have reviewed our experience with spinal cord stimulation (SCS) in patients with low back and ... more We have reviewed our experience with spinal cord stimulation (SCS) in patients with low back and leg pain. 33 patients complaining of leg and low back pain underwent percutaneous tests of SCS. 28 patients had failed back surgery syndromes, 1 patient had pain related to an L1 vertebral body fracture, another from Tarlow cysts and the remaining 3 patients had lumbosacral spondyloarthrosis and osteoporosis without radiological signs of root compression. 28 patients showed mono- or pluriradicular deficits. At the end of the test period (5–65 days), 21 patients (63.6%) reported more than 50% of pain relief (mean analgesia 75%) and were submitted to chronic stimulation. The mean follow-up was 45.5 months. At maximum available follow-up, 40% of the patients (13 out of the 33 initial patients) were successfully using the stimulator (mean analgesia 66.6%).

Value in Health, 2013

Kong SLE patients compared to standard care. METHODS: A lifetime microsimulation model was adapte... more Kong SLE patients compared to standard care. METHODS: A lifetime microsimulation model was adapted with epidemiological and cost data from Hong Kong. The model compares the use of belimumab against standard care and incorporates the BLISS-52 and BLISS-76 trial data for the short term outcomes within one year, while long-term outcomes were based on a natural history model developed using the Johns Hopkins Lupus registry. The natural history model describes the relationship between disease activity and other covariates on the risk of dying and developing organ damage. Data available from the SLE population in Hong Kong was used as input in the modified model. The analysis was performed from a Hong Kong health-care perspective. In the base case, cost and effectiveness were discounted to the year of analysis at 5% p.a. RESULTS: The base case analysis showed that compared to standard care, treatment with belimumab increased life expectancy by 0.80 (2.77 undiscounted) and QALY by 0.60 (1.68 undiscounted) years respectively.

Pacing and Clinical Electrophysiology, 1989

CIONI, B., ET AL.: Spinal Cord Stimulation (SCS) in Spastic Hemiparesis. Thirfeen patients with p... more CIONI, B., ET AL.: Spinal Cord Stimulation (SCS) in Spastic Hemiparesis. Thirfeen patients with poststroke spastic hemiparesis underwent a percutaneous test trial of spinal cord stimulation fSCSJ in order to modify their motor disturbances. Clinical evaluation based on Albert's motor scale and neurophysioJogcial evaluation consisting of surface EMG during voJunfary, involuntary, and reflex motor activity were performed be/ore and during SCS. At the end of the test period, eight patients showed a signi/icanl improvement in their motor per/ormance. The EMG analysis confirmed the clinical data. SCS was followed by a reduction or disappearance of synergic coactivation with better agonist-antagonist coordination, a decrease of clonus both in duration and spreading, and better endurance. The e^ecf on motor controi did not increase with time after the first month o/SCS, but was long lasting (mean follow-up: 2 years). There was a correlation between sensory deficit and motor outcome suggesting that the enhancement a/sensory input put into piay by SCS and the consequent deveiopmeni of new sensory-motor integration might be responsible/or the improvement in mo(or performance.

Stereotactic and Functional Neurosurgery - STEREOTACT FUNCT NEUROSURG, 1986

The effect of spinal cord stimulation (SCS) on heart rate (HR) was studied in 25 patients without... more The effect of spinal cord stimulation (SCS) on heart rate (HR) was studied in 25 patients without cardiological symptoms, who were undergoing SCS for various reasons. HR at rest signifïcantly decreased during SCS. Physiological and pharmacological maneuvers of sympathetic and parasympathetic activation or blockade before and during SCS indicate that SCS interferes with the central mechanisms of regulation of HR mainly by inducing a functional sympathectomy, and that such an effect is mediated by an action on spinal cord ascending fibers.

Operative Neuromodulation, 2007

Motor cortex stimulation (MCS) was proposed by Tsubokawa in 1991 for the treatment of post-stroke... more Motor cortex stimulation (MCS) was proposed by Tsubokawa in 1991 for the treatment of post-stroke thalamic pain. Since that time, the indications have been increased and included trigeminal neuropathic pain and later other types of central and peripheral deafferentation pain. The results reported in the literature are quite good; the mean long-term success rate is 80% in facial pain and 53% in non-facial pain. Our own results are less impressive: 4 of 14 patients (28%) experienced a greater than 40% pain relief, but in 2 of them the effect faded with time. Only few minor complications have been reported. The accurate placement of the epidural electrode over the motor cortex that somatotopically corresponds to the painful area is believed to be essential for pain relief. Predictive factors included the response to pharmacological tests, the relative sparing from the disease process of the cortico-spinal tract and the sensory system, and the analgesic response achieved during the test period of MCS. A possible predictive factor might be a test of repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. MCS may act by rebalancing the control of non-nociceptive sensory inputs over nociceptive afferents at cortical, thalamic, brainstem and spinal level. In addition, it may interfere with the emotional component of nociceptive perception. Biochemical processes involving endorphins and GABA may also be implicated in the mechanism of MCS. It is time for a large multicenter prospective randomized double blind study evaluating not only the effect of MCS on pain (based on the available guidelines for assessment of neuropathic pain), but also the optimal electrode placement and stimulation parameters, and the possible relationship with the response to rTMS. New electrode design and a new generation of stimulators may help in improving the results.

Health and quality of life outcomes, Apr 19, 2018

Failed back surgery syndrome (FBSS) represents one main cause of chronic neuropathic or mixed pai... more Failed back surgery syndrome (FBSS) represents one main cause of chronic neuropathic or mixed pain, functional disability and reduced Health Related Quality of Life (HRQoL). Spinal Cord Stimulation (SCS) can be a value for money option to treat patients refractory to conventional medical management (CMM). We estimated from real-world data: 1) the amount of reduced levels of HRQoL of target patients compared to general population, 2) the relationship between pain intensity, functional disability, and overall HRQoL, and 3) the improvement of patients’ health from SCS intervention, and 4) we give some insights and make some suggestions on the selection of a battery of patients’ reported health instruments for use in routine clinical practice. At recruitment (before SCS) and every 6 months for 2 years after SCS a battery of questionnaires/tests were completed: the generic EQ-5D and SF-36 for HRQoL, the specific Numerical Rating Scale (NRS) to measure pain intensity, and Oswestry Disabil...

Operative neurosurgery (Hagerstown, Md.), Jan 7, 2017

Tentorial meningiomas are a broad and consistent category of tumors but their definition is still... more Tentorial meningiomas are a broad and consistent category of tumors but their definition is still unclear and their classification uncertain. To report the clinical and surgical characteristics of tentorial hiatus meningiomas based on a revised classification of tentorial meningiomas. We reviewed the records of 14 patients who had undergone microsurgical removal of incisural tentorial meningioma. Two tumor subgroups, anterolateral (AL) and posteromedial (PM), were distinguished according to their site of attachment: the middle third and the posterior third of the tentorial free margin, respectively. Clinical presentation, radiological findings, surgical approaches, extent of resection, and outcome were compared. The 2 subgroups differed by tumor size (larger in PM), incidence of the direction of growth (infratentorial in PM), and hydrocephalus (only in PM), as well as by some clinical aspects. Surgical approach depended on tumor location: lateral (pterional, subtemporal, and retroma...

Cancer Genetics, 2017

A next-generation FISH probe mapping to the MDM2 locus-specific region has recently been designed... more A next-generation FISH probe mapping to the MDM2 locus-specific region has recently been designed. The level of MDM2 gene amplification (high versus low) may allow selection of patients for cancer treatment with MDM2 inhibitors and may predict their responsiveness. We investigated the spectrum of MDM2 gene alterations using the new probes in vivo after visualizing single neoplastic cells in situ from a series of glioblastomas. Signals from next-generation repeat-free FISH interphase probes were identified in tissue microarrays that included 3 spots for each of the 48 cases. The murine double minutes (MDM2)-specific DNA probe and the satellite enumeration probe for chromosome 12 were used. Three cases (6%) showed more than 25 signals (high gene amplification), and 7 (15%) showed 3-10 signals (gains); among these, 4 cases (8%) had an equal number of MDM2 and centromeric signals on chromosome 12 (polyploidy). Genomic heterogeneity was observed only in 3 cases with low gene amplification. In our series, 6% of glioblastomas exhibited high MDM2 amplification (in vivo) with a pattern related to the known double minutes/chromothripsis phenomenon (in situ), and only cases with low amplification showed genomic heterogeneity. We concluded that the rate of MDM2 gene amplification can be a useful predictive biomarker to improve patient selection.

Journal of Clinical Neuroscience, 2016

Few papers have been published about the anterior cervical discectomy and fusion (ACDF) with impl... more Few papers have been published about the anterior cervical discectomy and fusion (ACDF) with implant of porous tantalum cages. These studies included patients submitted to operation at a single level. To our knowledge, we report the results of the largest series of ACDF with implant of porous tantalum cages. Our series included patients operated at a single or double level with a long follow-up (FU). We also discuss the pertinent literature. Clinical and outcome data of 99 consecutive patients (47 men, 52 women) submitted to ACDF with implant of porous tantalum cages (Trabecular Metal TM-S Cervical Fusion Device, Zimmer Spine, Minneapolis, MN) from June 2007 to September 2012, were retrospectively reviewed. Mean FU was 67.47±19.63months. The changes in pain were assessed using the Visual Analogue Scale (VAS). Patients were evaluated pre-operatively and at FU with the Short Form-36 Score Health Survey Version 2.0 (SF-36v2) for Physical Health and Mental Health Scores and the Neck Disability Index. We globally found a statistically significant improvement of all evaluated scores. Patients operated at two levels experienced a statistically significant improvement of all scores, with no statistical difference compared to patients operated at one level. No major complications occurred post-operatively and at FU. Only one patient (operated at two level) experienced an infection during FU. We conclude that ACDF with porous tantalum cages is a safe procedure, with long term clinical benefits (also in patients operated at two levels) and a very low rate of complications.

Acta Neurochirurgica, 2006

ABSTRACT Since 2003 we applied MCS in patients with advanced PD. Inclusion criteria were: – idiop... more ABSTRACT Since 2003 we applied MCS in patients with advanced PD. Inclusion criteria were: – idiopathic PD; – at least 5 years disease’s length; – disease in the advanced state; – DBS not accepted by the patient or contraindicated. Exclusion criteria were: – history of epilepsy or EEG epileptic activity; – alcohol or drug abuse; – mental deterioration; – psychiatric symptoms. 7 patients met these criteria, and were submitted to the implant of an epidural plate electrode over the motor cortex. Stimulation parameters were: 120 ms, 80 Hz, 3–4V, delivered continuously. The clinical assessment before implant and at 1, 3, 6, 12, 18 and 24 months included: – UPDRS; – PDQL (Parkinson Disease Quality of Life scale); – MMSE (Mini Mental State Evaluation); – EEG: – oral medications and adverse events. The clinical evaluation was performed both in the off and in the on medication state and was videotaped.Mean follow up was 18 months (min 12,max 24 months) 1 patient (14.28%) was unresponsive. At 12 months the remaining 6 patients showed a statistically significant improvement in the global UPDRS, in the UPDRS II, in the UPDRS III and in the PDQL-39. The mean global UPDRS in off med improved by 35.4% at 3 months, by 20% at 12 months and by 25.3% at 18 months. The neuropsycological evaluation showed no impairment of superior cortical functions, particularly of verbal fluency. No adverse event or complication was reported. Our data confirm the efficacy and the safety of MCS in PD.

Neurosurgery, Jul 1, 2002

Neurosurgery at the Catholic University in Rome was initiated by Gian Franco Rossi in 1969 and ha... more Neurosurgery at the Catholic University in Rome was initiated by Gian Franco Rossi in 1969 and has gradually expanded since then. From the beginning, research has been regarded as an essential part of training and daily activities in the university&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s neurosurgery programs. The professional and research education of all faculty members includes at least 1 year abroad in a reputable neurosurgical center. Subspecialization is encouraged. Today, the faculty is composed of 3 full professors, 4 associate professors, and 16 assistant professors. The university&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s neurosurgery programs include the Institute of Neurosurgery, the residency program, and the following clinical units: a Division of General Neurosurgery; three subspecialty sections comprising Neurotraumatology, Pediatric Neurosurgery, and Functional and Spine Surgery; a day hospital; and dedicated laboratories. More than 1700 surgical patients are treated annually. Epilepsy, pain management, parkinsonism, spinal cord and vertebral pathologies, clinical and basic neuro-oncology, cerebrospinal fluid and intracranial pressure dynamics, cerebrovascular disease, neurotrauma, developmental malformations, and peripheral and central nervous system neuroregeneration are the main fields of clinical and research activities. The results of the research performed thus far at the Catholic University in Rome have been reported in more than 900 publications, most of which have appeared in prominent journals and books. Members of the faculty are involved in relevant editorial activities and serve as officers of national and international scientific and professional societies. In 1999, Giulio Maira succeeded Dr. Rossi in directing the Institute of Neurosurgery and the Division of General Neurosurgery. In addition to the history of neurosurgery at the Catholic University in Rome, this article describes present challenges and plans for the future in neurosurgery at the university.