Paolo Perrini - Academia.edu (original) (raw)

Papers by Paolo Perrini

Acta Neurochirurgica, 2007

Tumour-to-tumour metastasis is a rare pathological entity. Meningioma is the most common intracra... more Tumour-to-tumour metastasis is a rare pathological entity. Meningioma is the most common intracranial tumour to host metastases, the majority of which arise from breast and lung cancers. We present the first report of a colonic cancer metastasis within an intracranial meningioma.

British journal of neurosurgery, Jan 27, 2015

Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therape... more Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therapeutic approach for the repair of unclippable intracranial aneurysms (IAs). Wrapping materials can stimulate foreign-body inflammatory reactions and parent artery narrowing with resultant ischemic stroke. In this study, a single-center retrospective review of the outcome with wrapping of IAs is presented beside an analysis of existing literature. For the institutional analysis, all patients who underwent wrapping of IAs in the last five years were analyzed. For the analysis of the literature, a MEDLINE search between 1990 and the present was performed for clinical series reporting wrapping of IAs. Specifically, the risk of rebleeding, cerebrovascular complications, and the incidence of granuloma formation were evaluated. Two hundred and ninety patients with IA were surgically treated in our department. Fifteen patients (5.2%) underwent wrapping of IA. Early parent artery narrowing occurred...

Neurol Sci, 2004

We read with interest the letter by Modrego et al.

Neurosurgery, Sep 1, 2010

Meningeal melanocytomas are low-grade primary melanocytic tumors with benign histological feature... more Meningeal melanocytomas are low-grade primary melanocytic tumors with benign histological features and a favorable clinical prognosis. Transition from meningeal melanocytoma to primary melanoma of the central nervous system is exceptionally rare, with only 5 cases having been previously reported. Here, we discuss a case of malignant transformation of an intramedullary melanocytoma to primary melanoma and review the pertinent literature.

British Journal of Neurosurgery

Dural plasmacytomas are very rare and often disregarded in the differential diagnosis of more com... more Dural plasmacytomas are very rare and often disregarded in the differential diagnosis of more common lesions of the convexity. We report two cases. Both patients exhibited headache as a main symptom. Computed tomography and magnetic resonance showed a homogeneously enhanced lesion without calcification and without bone involvement.

European Journal of Cancer

Background: The incidence rates of malignant brain cancers have increased over the last 3 decades... more Background: The incidence rates of malignant brain cancers have increased over the last 3 decades and despite optimal multimodal treatment recurrence is inevitable. Currently there is no standard treatment for patients with recurrent Glioblastoma (rGBM); chemotherapy, additional surgery and Stereotactic irradiation can be used but haven't an established role. The significance of a second resection and systemic therapy in rGBM is still unclear.

Journal of neurosurgical sciences

We propose an easy-to-construct digital video editing system ideal to produce video documentation... more We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high...

BioMed Research International, 2015

Neurosurgery, 2005

We report an extremely rare case of a primary orbital germinoma in a previously healthy 56-year-o... more We report an extremely rare case of a primary orbital germinoma in a previously healthy 56-year-old man. The patient had a 3-month history of progressive left proptosis and visual deterioration. A magnetic resonance imaging scan revealed an intraconal enhancing mass superomedially displacing the optic nerve and abutting the ocular globe. The patient underwent a lateral orbitotomy with en bloc tumor resection. Histologically, the tumor was found to be a germinoma. The patient's postoperative course was uneventful, and no adjuvant therapy was performed. Periodic imaging study results of the testes, mediastinum, and the whole body were negative for tumors. At the last follow-up, 24 months after surgery, proptosis had resolved, visual acuity in the left eye had improved, and magnetic resonance images confirmed complete tumor removal. To our knowledge, this is the first report of a primary germinoma of the orbit. Although highly unusual, orbital germinomas widen the spectrum of descr...

Neurosurgery, 2010

Niels Stensen (1638-1686) was a prominent Danish scientist who laid the foundations of paleontolo... more Niels Stensen (1638-1686) was a prominent Danish scientist who laid the foundations of paleontology, geology, and crystallography. He undertook a personal search for the truth, rejecting many assumptions of his time, and he struggled to acquire a firm foundation of knowledge based on close observation and rigorous experimentation. Niels Stensen is known eponymously for the discovery of the duct of the parotid gland (ductus stenonianus) but most clinicians are not familiar with his contributions to anatomy beyond his studies on the glands. In 1665, he delivered a lecture in Paris on the anatomy of the brain, the Discours sur l'anatomie du cerveau ("A Dissertation on the Anatomy of the Brain"), which is a seminal investigation on methods in neuroscience. His scientific letter on a hydrocephalic calf represents an early pathophysiological investigation on hydrocephalus. In 1667 Stensen converted to Catholicism and in 1677 he was consecrated titular bishop of Titiopolis. He spent the last years of his life in poverty and traveled continuously trying to bring back northern Europe to Catholicism. This essay highlights the life and the scientific contributions of Niels Stensen, with emphasis on his contributions to neuroscience.

Case Reports in Neurological Medicine, 2012

Primary spinal non-Hodgkin's lymphoma is extremely rare, and the occurrence of spinal dumbbell-sh... more Primary spinal non-Hodgkin's lymphoma is extremely rare, and the occurrence of spinal dumbbell-shaped lymphoma is exceptional. We present a case of primary spinal dumbbell-shaped lymphoma to clarify the diagnosis and the management of these lesions. A 45-year-old man presented with sensory symptoms for 8 months. Magnetic resonance imaging of the thoracic spine demonstrated a dumbbell-shaped lesion at the D4-D6 level with spinal cord compression and right foraminal extension at D4-D5 level. The patient underwent D4-D6 laminectomy, with a subtotal resection of the mass. Diffuse large B-cell lymphoma was diagnosed in the pathological examination. He underwent local spinal radiotherapy and chemotherapy. Follow-up evaluation at one year demonstrated no evidence of relapse. Although highly unusual, lymphoma should be included in the differential diagnosis for spinal dumbbell-shaped tumours. After surgery and adjuvant therapy a long-term clinical and neuroradiological followup is mandatory.

Neurosurgical Review, 2013

The microsurgical anatomy of cerebellar peduncles and their relationships with neighbouring fasci... more The microsurgical anatomy of cerebellar peduncles and their relationships with neighbouring fasciculi were investigated by using a fibre dissection technique. As the dissection progressed, photographs of each progressive layer were obtained and stereoscopic images were created using the 3D anaglyphic method. These findings provided the anatomical basis for a conceptual division of cerebellar peduncles into segments. The middle cerebellar peduncle (MCP) was divided into two segments: cisternal and intracerebellar segments. The inferior cerebellar peduncle (ICP) was divided into three segments: cisternal, ventricular and intracerebellar segments. The superior cerebellar peduncle (SCP) was divided into three segments: intracerebellar, intermediate and intrategmental segments. The fibre dissection technique disclosed a constant course of peduncular fibres inside the white core of the cerebellum. The pontocerebellar fibres of the MCP pass over and laterally to the bundles of the ICP and SCP. The centripetal fibres of the ICP wrap around the radiation of the SCP and the dentate nucleus, directed towards the cortex of the vermis. The centrifugal bundle of the SCP ascends towards the mesencephalon where it sinks passing below the fibres the lateral lemniscus. The knowledge gained by studying the intrinsic anatomy of the cerebellum is useful to accomplish appropriate surgical planning and, ultimately, to understand the repercussions of surgical procedures on the white matter tracts in this region.

Neurosurgical Review, 2008

The occurrence of subdural cerebrospinal fluid collections and ventricular dilatation (external h... more The occurrence of subdural cerebrospinal fluid collections and ventricular dilatation (external hydrocephalus) after foramen magnum decompression is extremely rare. The authors report on a 37-year-old man who developed symptomatic subdural fluid collections (SFC) after uncomplicated foramen magnum decompression for Chiari I-syringomyelia complex. Postoperative magnetic resonance imaging revealed a supratentorial SFC with prominent midline shift. In addition, bilateral infratentorial SFCs extending supratentorially through the tentorial notch, pseudomeningocele and initial shrinkage of the syrinx were observed. Few days after evacuation of supratentorial collection, the patient experienced increasing headache and a computerized tomography scan demonstrated a contralateral subdural collection as well as ventricular dilatation. A programmable ventriculoperitoneal shunt was placed with resolution of supratentorial collection and progressive improvement of infratentorial collections and pseudomeningocele. Although previous reports described the occurrence of extra-axial fluid collections and hydrocephalus after foramen magnum decompression for Chiari malformation, to our knowledge, this is the only report of acute external hydrocephalus after foramen magnum decompression requiring urgent evacuation of SFC in order to reduce the mass effect.

Neurosurgical FOCUS, 2006

NTRACRANIAL vascular malformations were originally classified by McCormick 31 into four types: di... more NTRACRANIAL vascular malformations were originally classified by McCormick 31 into four types: discrete venous, arteriovenous, capillary, and CMs, each with distinct pathological criteria for definition. The range of imaging characteristics and clinical manifestations that generally differentiate them have been characterized in several studies. Recently, mixed or transitional vascular malformations with pathological features of more than one type of malformation within the same lesion have been described. The detection of a wide spectrum of intermediate forms of McCormick's original categories suggests that these lesions might be a continuum of progression of a single pathological process. Investigators have described the simultaneous occurrence of venous malformations and CMs, arteriovenous and venous malformations, CMs with arteriovenous or capillary components, 25,34,47 and capillary telangiectasias associated with venous malformations. In addition, authors have described venous malformations associated with both a CM and a capillary telangiectasia. The coexistence of a CM and a DVA is the most common mixed vascular malformation. The natural history of this mixed phenotype is unclear, making it difficult to determine a long-term prognosis for symptomatic and asymptomatic patients. Moreover, much controversy exists about the biological behavior and the management of the DVAs associated with the CM. Even though most authors agree that microsurgical resection of the CM alone provides protection against future bleeding, 35-37,40 some reports raise the question whether the abnormal draining vein is the actual area of disease that induces the blood flow disturbances, which in turn result in the formation of a CM (de novo and recurrent). Developmental venous anomalies (DVAs) are often associated with intracranial cavernous malformations (CMs). The frequency of this association and the observation of de novo CMs located near a known, preexisting DVA raise speculations as to the possible etiopathogenetic relationship between the two. In this article, the authors review the recent literature dealing with the potential etiopathogenetic, prognostic, and therapeutic implications of the association between DVAs and CMs.

Neurosurgery, 2005

Endovascular techniques for the treatment of intracranial aneurysms are rapidly evolving. Modific... more Endovascular techniques for the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

Neurosurgery, 2013

1840-1898) was a prominent Italian anatomist, neuroscientist, and professor at the University of ... more 1840-1898) was a prominent Italian anatomist, neuroscientist, and professor at the University of Turin. Early in his career, he conducted clinical investigations with the physiologist Angelo Mosso that culminated in the first recording of brain pulsations in a human subject. Anatomic features named after him include the limbus Giacomini, Giacomini vertebrae, and the vein of Giacomini. Pushing anatomy research to reconsider anthropological studies of the late 19th century, Giacomini strongly refuted the theory connecting criminality to atavistic morphological characteristics. A tireless scientist, he was the first to describe the os odontoideum in 1886 and to suggest that the presence of an incompetent odontoid process may alter the motion of craniovertebral junction, anticipating the concept of spinal instability. In this essay, we highlight the life and scientific contributions of Carlo Giacomini, with emphasis on his contributions to neuroscience.

Neurosurgery, 2009

Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of ce... more Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of cerebrospinal fluid homeostasis. Direct intervention on the syrinx is a difficult choice and should be considered a rescue procedure. Data in the literature examining the various options are scanty, with generally unsatisfying results. We report our experience with shunting of the syrinx into the pleural space. Twenty patients with syringomyelia refractory to cerebrospinal fluid flow restoration underwent a procedure for placement of a syringopleural shunt between 1998 and 2008. Modified Japanese Orthopaedic Association Scale scores and magnetic resonance imaging were available for each patient preoperatively and at the latest follow-up evaluation. A 2-tailed Wilcoxon signed-rank test was used for statistical analysis. Complications related to the operative procedure and to hardware failure were noted. Nineteen patients were available for follow-up with a mean duration of 37.5 (standard deviation, 31.1) months. The condition of 1 patient deteriorated, 2 remained stable, and the remainder improved. The overall mean improvement on the Modified Japanese Orthopaedic Association Scale was 19.5% (95% confidence interval, 8.5-30.5). The median improvement was 4 points on the 17-point scale. Results were statistically significant (P < 0.001). Follow-up magnetic resonance imaging showed syrinx collapse in 17 cases and marked shrinkage in 2 cases. Except for 1 case of meningitis followed by fatal pulmonary embolism, no significant complications were noted. A syringopleural shunt should, in our view, be the syrinx diversion procedure of choice. More series of institutional experiences with a homogeneous approach would be helpful to verify this recommendation.

Acta Neurochirurgica, 2007

Tumour-to-tumour metastasis is a rare pathological entity. Meningioma is the most common intracra... more Tumour-to-tumour metastasis is a rare pathological entity. Meningioma is the most common intracranial tumour to host metastases, the majority of which arise from breast and lung cancers. We present the first report of a colonic cancer metastasis within an intracranial meningioma.

British journal of neurosurgery, Jan 27, 2015

Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therape... more Circumferential wrapping of the aneurysm wall with a variety of materials is a well-known therapeutic approach for the repair of unclippable intracranial aneurysms (IAs). Wrapping materials can stimulate foreign-body inflammatory reactions and parent artery narrowing with resultant ischemic stroke. In this study, a single-center retrospective review of the outcome with wrapping of IAs is presented beside an analysis of existing literature. For the institutional analysis, all patients who underwent wrapping of IAs in the last five years were analyzed. For the analysis of the literature, a MEDLINE search between 1990 and the present was performed for clinical series reporting wrapping of IAs. Specifically, the risk of rebleeding, cerebrovascular complications, and the incidence of granuloma formation were evaluated. Two hundred and ninety patients with IA were surgically treated in our department. Fifteen patients (5.2%) underwent wrapping of IA. Early parent artery narrowing occurred...

Neurol Sci, 2004

We read with interest the letter by Modrego et al.

Neurosurgery, Sep 1, 2010

Meningeal melanocytomas are low-grade primary melanocytic tumors with benign histological feature... more Meningeal melanocytomas are low-grade primary melanocytic tumors with benign histological features and a favorable clinical prognosis. Transition from meningeal melanocytoma to primary melanoma of the central nervous system is exceptionally rare, with only 5 cases having been previously reported. Here, we discuss a case of malignant transformation of an intramedullary melanocytoma to primary melanoma and review the pertinent literature.

British Journal of Neurosurgery

Dural plasmacytomas are very rare and often disregarded in the differential diagnosis of more com... more Dural plasmacytomas are very rare and often disregarded in the differential diagnosis of more common lesions of the convexity. We report two cases. Both patients exhibited headache as a main symptom. Computed tomography and magnetic resonance showed a homogeneously enhanced lesion without calcification and without bone involvement.

European Journal of Cancer

Background: The incidence rates of malignant brain cancers have increased over the last 3 decades... more Background: The incidence rates of malignant brain cancers have increased over the last 3 decades and despite optimal multimodal treatment recurrence is inevitable. Currently there is no standard treatment for patients with recurrent Glioblastoma (rGBM); chemotherapy, additional surgery and Stereotactic irradiation can be used but haven't an established role. The significance of a second resection and systemic therapy in rGBM is still unclear.

Journal of neurosurgical sciences

We propose an easy-to-construct digital video editing system ideal to produce video documentation... more We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high...

BioMed Research International, 2015

Neurosurgery, 2005

We report an extremely rare case of a primary orbital germinoma in a previously healthy 56-year-o... more We report an extremely rare case of a primary orbital germinoma in a previously healthy 56-year-old man. The patient had a 3-month history of progressive left proptosis and visual deterioration. A magnetic resonance imaging scan revealed an intraconal enhancing mass superomedially displacing the optic nerve and abutting the ocular globe. The patient underwent a lateral orbitotomy with en bloc tumor resection. Histologically, the tumor was found to be a germinoma. The patient's postoperative course was uneventful, and no adjuvant therapy was performed. Periodic imaging study results of the testes, mediastinum, and the whole body were negative for tumors. At the last follow-up, 24 months after surgery, proptosis had resolved, visual acuity in the left eye had improved, and magnetic resonance images confirmed complete tumor removal. To our knowledge, this is the first report of a primary germinoma of the orbit. Although highly unusual, orbital germinomas widen the spectrum of descr...

Neurosurgery, 2010

Niels Stensen (1638-1686) was a prominent Danish scientist who laid the foundations of paleontolo... more Niels Stensen (1638-1686) was a prominent Danish scientist who laid the foundations of paleontology, geology, and crystallography. He undertook a personal search for the truth, rejecting many assumptions of his time, and he struggled to acquire a firm foundation of knowledge based on close observation and rigorous experimentation. Niels Stensen is known eponymously for the discovery of the duct of the parotid gland (ductus stenonianus) but most clinicians are not familiar with his contributions to anatomy beyond his studies on the glands. In 1665, he delivered a lecture in Paris on the anatomy of the brain, the Discours sur l'anatomie du cerveau ("A Dissertation on the Anatomy of the Brain"), which is a seminal investigation on methods in neuroscience. His scientific letter on a hydrocephalic calf represents an early pathophysiological investigation on hydrocephalus. In 1667 Stensen converted to Catholicism and in 1677 he was consecrated titular bishop of Titiopolis. He spent the last years of his life in poverty and traveled continuously trying to bring back northern Europe to Catholicism. This essay highlights the life and the scientific contributions of Niels Stensen, with emphasis on his contributions to neuroscience.

Case Reports in Neurological Medicine, 2012

Primary spinal non-Hodgkin's lymphoma is extremely rare, and the occurrence of spinal dumbbell-sh... more Primary spinal non-Hodgkin's lymphoma is extremely rare, and the occurrence of spinal dumbbell-shaped lymphoma is exceptional. We present a case of primary spinal dumbbell-shaped lymphoma to clarify the diagnosis and the management of these lesions. A 45-year-old man presented with sensory symptoms for 8 months. Magnetic resonance imaging of the thoracic spine demonstrated a dumbbell-shaped lesion at the D4-D6 level with spinal cord compression and right foraminal extension at D4-D5 level. The patient underwent D4-D6 laminectomy, with a subtotal resection of the mass. Diffuse large B-cell lymphoma was diagnosed in the pathological examination. He underwent local spinal radiotherapy and chemotherapy. Follow-up evaluation at one year demonstrated no evidence of relapse. Although highly unusual, lymphoma should be included in the differential diagnosis for spinal dumbbell-shaped tumours. After surgery and adjuvant therapy a long-term clinical and neuroradiological followup is mandatory.

Neurosurgical Review, 2013

The microsurgical anatomy of cerebellar peduncles and their relationships with neighbouring fasci... more The microsurgical anatomy of cerebellar peduncles and their relationships with neighbouring fasciculi were investigated by using a fibre dissection technique. As the dissection progressed, photographs of each progressive layer were obtained and stereoscopic images were created using the 3D anaglyphic method. These findings provided the anatomical basis for a conceptual division of cerebellar peduncles into segments. The middle cerebellar peduncle (MCP) was divided into two segments: cisternal and intracerebellar segments. The inferior cerebellar peduncle (ICP) was divided into three segments: cisternal, ventricular and intracerebellar segments. The superior cerebellar peduncle (SCP) was divided into three segments: intracerebellar, intermediate and intrategmental segments. The fibre dissection technique disclosed a constant course of peduncular fibres inside the white core of the cerebellum. The pontocerebellar fibres of the MCP pass over and laterally to the bundles of the ICP and SCP. The centripetal fibres of the ICP wrap around the radiation of the SCP and the dentate nucleus, directed towards the cortex of the vermis. The centrifugal bundle of the SCP ascends towards the mesencephalon where it sinks passing below the fibres the lateral lemniscus. The knowledge gained by studying the intrinsic anatomy of the cerebellum is useful to accomplish appropriate surgical planning and, ultimately, to understand the repercussions of surgical procedures on the white matter tracts in this region.

Neurosurgical Review, 2008

The occurrence of subdural cerebrospinal fluid collections and ventricular dilatation (external h... more The occurrence of subdural cerebrospinal fluid collections and ventricular dilatation (external hydrocephalus) after foramen magnum decompression is extremely rare. The authors report on a 37-year-old man who developed symptomatic subdural fluid collections (SFC) after uncomplicated foramen magnum decompression for Chiari I-syringomyelia complex. Postoperative magnetic resonance imaging revealed a supratentorial SFC with prominent midline shift. In addition, bilateral infratentorial SFCs extending supratentorially through the tentorial notch, pseudomeningocele and initial shrinkage of the syrinx were observed. Few days after evacuation of supratentorial collection, the patient experienced increasing headache and a computerized tomography scan demonstrated a contralateral subdural collection as well as ventricular dilatation. A programmable ventriculoperitoneal shunt was placed with resolution of supratentorial collection and progressive improvement of infratentorial collections and pseudomeningocele. Although previous reports described the occurrence of extra-axial fluid collections and hydrocephalus after foramen magnum decompression for Chiari malformation, to our knowledge, this is the only report of acute external hydrocephalus after foramen magnum decompression requiring urgent evacuation of SFC in order to reduce the mass effect.

Neurosurgical FOCUS, 2006

NTRACRANIAL vascular malformations were originally classified by McCormick 31 into four types: di... more NTRACRANIAL vascular malformations were originally classified by McCormick 31 into four types: discrete venous, arteriovenous, capillary, and CMs, each with distinct pathological criteria for definition. The range of imaging characteristics and clinical manifestations that generally differentiate them have been characterized in several studies. Recently, mixed or transitional vascular malformations with pathological features of more than one type of malformation within the same lesion have been described. The detection of a wide spectrum of intermediate forms of McCormick's original categories suggests that these lesions might be a continuum of progression of a single pathological process. Investigators have described the simultaneous occurrence of venous malformations and CMs, arteriovenous and venous malformations, CMs with arteriovenous or capillary components, 25,34,47 and capillary telangiectasias associated with venous malformations. In addition, authors have described venous malformations associated with both a CM and a capillary telangiectasia. The coexistence of a CM and a DVA is the most common mixed vascular malformation. The natural history of this mixed phenotype is unclear, making it difficult to determine a long-term prognosis for symptomatic and asymptomatic patients. Moreover, much controversy exists about the biological behavior and the management of the DVAs associated with the CM. Even though most authors agree that microsurgical resection of the CM alone provides protection against future bleeding, 35-37,40 some reports raise the question whether the abnormal draining vein is the actual area of disease that induces the blood flow disturbances, which in turn result in the formation of a CM (de novo and recurrent). Developmental venous anomalies (DVAs) are often associated with intracranial cavernous malformations (CMs). The frequency of this association and the observation of de novo CMs located near a known, preexisting DVA raise speculations as to the possible etiopathogenetic relationship between the two. In this article, the authors review the recent literature dealing with the potential etiopathogenetic, prognostic, and therapeutic implications of the association between DVAs and CMs.

Neurosurgery, 2005

Endovascular techniques for the treatment of intracranial aneurysms are rapidly evolving. Modific... more Endovascular techniques for the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

Neurosurgery, 2013

1840-1898) was a prominent Italian anatomist, neuroscientist, and professor at the University of ... more 1840-1898) was a prominent Italian anatomist, neuroscientist, and professor at the University of Turin. Early in his career, he conducted clinical investigations with the physiologist Angelo Mosso that culminated in the first recording of brain pulsations in a human subject. Anatomic features named after him include the limbus Giacomini, Giacomini vertebrae, and the vein of Giacomini. Pushing anatomy research to reconsider anthropological studies of the late 19th century, Giacomini strongly refuted the theory connecting criminality to atavistic morphological characteristics. A tireless scientist, he was the first to describe the os odontoideum in 1886 and to suggest that the presence of an incompetent odontoid process may alter the motion of craniovertebral junction, anticipating the concept of spinal instability. In this essay, we highlight the life and scientific contributions of Carlo Giacomini, with emphasis on his contributions to neuroscience.

Neurosurgery, 2009

Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of ce... more Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of cerebrospinal fluid homeostasis. Direct intervention on the syrinx is a difficult choice and should be considered a rescue procedure. Data in the literature examining the various options are scanty, with generally unsatisfying results. We report our experience with shunting of the syrinx into the pleural space. Twenty patients with syringomyelia refractory to cerebrospinal fluid flow restoration underwent a procedure for placement of a syringopleural shunt between 1998 and 2008. Modified Japanese Orthopaedic Association Scale scores and magnetic resonance imaging were available for each patient preoperatively and at the latest follow-up evaluation. A 2-tailed Wilcoxon signed-rank test was used for statistical analysis. Complications related to the operative procedure and to hardware failure were noted. Nineteen patients were available for follow-up with a mean duration of 37.5 (standard deviation, 31.1) months. The condition of 1 patient deteriorated, 2 remained stable, and the remainder improved. The overall mean improvement on the Modified Japanese Orthopaedic Association Scale was 19.5% (95% confidence interval, 8.5-30.5). The median improvement was 4 points on the 17-point scale. Results were statistically significant (P < 0.001). Follow-up magnetic resonance imaging showed syrinx collapse in 17 cases and marked shrinkage in 2 cases. Except for 1 case of meningitis followed by fatal pulmonary embolism, no significant complications were noted. A syringopleural shunt should, in our view, be the syrinx diversion procedure of choice. More series of institutional experiences with a homogeneous approach would be helpful to verify this recommendation.