Gerardo Iacopino | Università degli Studi di Palermo (original) (raw)

Papers by Gerardo Iacopino

Scientific Reports, 2021

The prevalence and impact of imaging findings detected during screening procedures in patients un... more The prevalence and impact of imaging findings detected during screening procedures in patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy for functional neurological disorders has not been assessed yet. This study included 90 patients who fully completed clinical and neuroradiological screenings for tcMRgFUS in a single-center. The presence and location of preoperative imaging findings that could impact the treatment were recorded and classified in three different groups according to their relevance for the eligibility and treatment planning. Furthermore, tcMRgFUS treatments were reviewed to evaluate the number of transducer elements turned off after marking as no pass regions the depicted imaging finding. A total of 146 preoperative imaging findings in 79 (87.8%) patients were detected in the screening population, with a significant correlation with patients’ age (rho = 483, p

Operative Neurosurgery, 2019

INTRODUCTION In recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (... more INTRODUCTION In recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. OBJECTIVE To present the case of a patient affected by tremor combined with Parkinsonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremor after a few months from the first tcMRgFUS treatment. METHODS A 72-yr-old, right-handed man, came to our observation because of a disabling tremor affecting his upper limbs, refusing any invasive surgical procedure and already treated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration, as a progressive recurrence of tremor on the right upper limb was observed after a few months from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUS procedure 6 mo after the former treatment. RESULTS After the second procedure, an immediate and complete relief from tremo...

Journal of Diabetes & Metabolism, 2015

Diabetes and ischemic stroke are common diseases that frequently occurring together. Among patien... more Diabetes and ischemic stroke are common diseases that frequently occurring together. Among patients with diabetes mellitus several factors contribute in varying degrees to the overall cerebrovascular risk including hyperglycemia, vascular risk factors such as hypertension and dyslipidemia and also genetic, demographic, and lifestyle factors and several studies have shown that people with diabetes have approximately twice the risk of ischemic stroke compared with those without diabetes. The association between ischemic stroke and diabetes is bidirectional and it is not limited to acute ischemic stroke since diabetes may contribute to a more insidious brain damage represented by lacunar infarcts increasing the risk of dementia and leading to a steeper decline in cognitive function. The higher cerebrovascular risk profile of subjects with diabetes mellitus emphasizes the importance of secondary prevention strategies with the aim to prevent a substantial number of these disabling strokes among patients with diabetes. In this review, we describe the relationship between glucose metabolism and acute ischemic stroke and focus on the analysis of diabetes-related risk factor for stroke and on specific patterns of stroke type associated with diabetes.

Acta Neurochirurgica Supplement, 2017

A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ)... more A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ). These include congenital disorders, chronic inflammation, neoplasms, infections, and posttraumatic conditions that could all result in CVJ compression and myelopathy Endoscopic-assisted procedures have been further developed for CVJ decompression and they have now become conventional approaches. The aims of the present study were:(1) to compare "radiological" and "surgical" nasoaxial lines (NAxLs); (2) to introduce an analogous radiological line as a predictor of the superior extension of the transoral approach (palatine inferior dental arch line (PIA); (3) to compare the "radiological" nasopalatine line (NPL) with the "surgical" NPL (SNPL) and surgical PIA (SPIA); (4) to compare "our" SNPL with the NAxL; and (5) to find possible radiological reference points to predict, preoperatively, the maximal extent of superior dissection for the transoral approach (SPIA).

Frontiers in Oncology

Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery... more Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery. We present data from our case series of brain tumor surgery performed with the aid of IOUS in order to identify IOUS advantages and crucial aspects that may improve the management of neurosurgical procedures for brain tumors. From January 2021 to September 2021, 17 patients with different brain tumors underwent brain tumor surgery aided by the use of IOUS. During surgery, the procedure was supported by the use of multiples ultrasonographic modalities in addition to standard B-mode: Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS). In selected cases, the use of IOUS during surgical procedure was combined with neuronavigation and the use of intraoperative fluorescence by the use of 5-aminolevulinic acid (5-ALA). In one patient, a preoperative ultrasound evaluation was performed through a former iatrogenic skull defect. This study confirms t...

Frontiers in Surgery

Introduction: In this microneurosurgical and anatomical study, we characterized the superficial a... more Introduction: In this microneurosurgical and anatomical study, we characterized the superficial anastomosing veins of the human brain cortex in human specimens.Material and Methods: We used 21 brain preparations fixed in formalin (5%) that showed no pathological changes and came from the autopsy sections. The superficial veins were dissected out of the arachnoid with the aid of a surgical microscope.Results: We dissected nine female and 12 male brain specimens, with an average age of 71 ± 11 years (range 51–88 years). We classified the superficial veins in five types: (I) the vein of Trolard as the dominat vein; (II) the vein of Labbé as the dominant vein; (III) a dominant sylvian vein group, and the veins of Trolard and Labbé nonexistent or only rudimentary present without contact to the Sylvian vein group; (IV) very weak sylvian veins with the veins of Trolard and Labbé codominant; and V) direct connection of Trolard and Labbé bypassing the Sylvian vein group. The vein of Trolard ...

Objective: Unusual clinical course Background: Trauma is the leading cause of death in people you... more Objective: Unusual clinical course Background: Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1 % of all patients with head injuries and fewer than 10 % of those who are comatose), they should always be considered in evalua-tion of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxi-al hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT find-ings) but also may depend on the judgement of the treating neurosurgeon. Case Report: A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed...

Life

In consideration of the increasing prevalence of COVID-19 cases in several countries and the resu... more In consideration of the increasing prevalence of COVID-19 cases in several countries and the resulting demand for unbiased sequencing approaches, we performed a direct RNA sequencing (direct RNA seq.) experiment using critical oropharyngeal swab samples collected from Italian patients infected with SARS-CoV-2 from the Palermo region in Sicily. Here, we identified the sequences SARS-CoV-2 directly in RNA extracted from critical samples using the Oxford Nanopore MinION technology without prior cDNA retrotranscription. Using an appropriate bioinformatics pipeline, we could identify mutations in the nucleocapsid (N) gene, which have been reported previously in studies conducted in other countries. In conclusion, to the best of our knowledge, the technique used in this study has not been used for SARS-CoV-2 detection previously owing to the difficulties in the extraction of RNA of sufficient quantity and quality from routine oropharyngeal swabs. Despite these limitations, this approach p...

Acta Neurochirurgica Supplement

The craniovertebral junction (CVJ) is a complex anatomical area upon which most of the motion of ... more The craniovertebral junction (CVJ) is a complex anatomical area upon which most of the motion of the upper cervical spine depends [1]. Because of its unique range of motion, the CVJ is subject to several types of traumatic injury; it has been shown that odontoid fractures are the most common ones in the general population and are the most common isolated spinal fractures [2]. Accounting for up to 18% of all cervical fractures, odontoid fractures are the most common ones in elderly patients [3], in whom they account for up to 60% of spinal cord injuries [4].

Journal of neurological surgery. Part A, Central European neurosurgery, 2021

BACKGROUND We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy ... more BACKGROUND We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy that optimizes dural opening and can be performed in elderly patients affected by acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants. METHODS We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5 years) treated in our institution, during a period of 10 years, with this novel diamond-shaped craniotomy. Seventeen patients were treated for intracerebral hemorrhage and 50 patients for acute subdural hematomas. All the patients were in therapy with antiplatelets or anticoagulants. RESULTS Approach-related complications were not detected. Ten of 67 patients (14.9%) presented temporal muscle atrophy; there was no scar deformity, paresthesia, hyperalgesia, or ramus frontalis palsy around the scalp incision. Thirty-day mortality was 22%. The mean follow-up was 1.3 years. One-month postoperative brain computed tomography scans s...

Current Pediatric Research, 2016

Background: Eosinophilic granuloma is the benign form of Langerhans cell histiocytosis, a rare pr... more Background: Eosinophilic granuloma is the benign form of Langerhans cell histiocytosis, a rare proliferative disorder. Skull osteolytic lesions are quite frequently encountered. Case report: We report the case of a 16 year old boy who was admitted to our Department with a painful swelling left frontal mass. A diagnosis of eosinophilic granuloma was presumed on the basis of the neuroradiological findings. Surgical removal of the lesion was achieved and the bone defect reconstructed by autologous fibrin glue and a titanium mesh. Histopathology confirmed the diagnosis. Conclusion: Although uncommon, eosinophilic granuloma should be considered in the differential diagnosis in case of an osteolytic calvarial lesion.

Background: Osteochondroma or osteocartolaginous exostosis is the most common benign tumor of bon... more Background: Osteochondroma or osteocartolaginous exostosis is the most common benign tumor of bone. They account for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumors. Usually these tumors are found in the appendicular skeleton, especially in the metadiaphyseal region of long bones. Spinal osteochondromas, however, are uncommon especially at cervical level. Clinical presentation: We report the case of a 16 year old boy presenting a hard, gradually progressing, large swelling mass, over the posterior part of the neck causing pain. Radiological images revealed a giant solitary osteochondroma arising from C3 to C6 laminae. The patient underwent complete surgical excision of the tumor. Postoperative outcome was good and recovery from the pain achieved. Conclusion: Solitary osteochondroma of the cervical spine is a rare manifestation of a common bony tumor. Patients affected may present with a multitude of symptoms and complications depending on the size and l...

Scientific Reports, 2021

The prevalence and impact of imaging findings detected during screening procedures in patients un... more The prevalence and impact of imaging findings detected during screening procedures in patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy for functional neurological disorders has not been assessed yet. This study included 90 patients who fully completed clinical and neuroradiological screenings for tcMRgFUS in a single-center. The presence and location of preoperative imaging findings that could impact the treatment were recorded and classified in three different groups according to their relevance for the eligibility and treatment planning. Furthermore, tcMRgFUS treatments were reviewed to evaluate the number of transducer elements turned off after marking as no pass regions the depicted imaging finding. A total of 146 preoperative imaging findings in 79 (87.8%) patients were detected in the screening population, with a significant correlation with patients’ age (rho = 483, p

Operative Neurosurgery, 2019

INTRODUCTION In recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (... more INTRODUCTION In recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. OBJECTIVE To present the case of a patient affected by tremor combined with Parkinsonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremor after a few months from the first tcMRgFUS treatment. METHODS A 72-yr-old, right-handed man, came to our observation because of a disabling tremor affecting his upper limbs, refusing any invasive surgical procedure and already treated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration, as a progressive recurrence of tremor on the right upper limb was observed after a few months from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUS procedure 6 mo after the former treatment. RESULTS After the second procedure, an immediate and complete relief from tremo...

Journal of Diabetes & Metabolism, 2015

Diabetes and ischemic stroke are common diseases that frequently occurring together. Among patien... more Diabetes and ischemic stroke are common diseases that frequently occurring together. Among patients with diabetes mellitus several factors contribute in varying degrees to the overall cerebrovascular risk including hyperglycemia, vascular risk factors such as hypertension and dyslipidemia and also genetic, demographic, and lifestyle factors and several studies have shown that people with diabetes have approximately twice the risk of ischemic stroke compared with those without diabetes. The association between ischemic stroke and diabetes is bidirectional and it is not limited to acute ischemic stroke since diabetes may contribute to a more insidious brain damage represented by lacunar infarcts increasing the risk of dementia and leading to a steeper decline in cognitive function. The higher cerebrovascular risk profile of subjects with diabetes mellitus emphasizes the importance of secondary prevention strategies with the aim to prevent a substantial number of these disabling strokes among patients with diabetes. In this review, we describe the relationship between glucose metabolism and acute ischemic stroke and focus on the analysis of diabetes-related risk factor for stroke and on specific patterns of stroke type associated with diabetes.

Acta Neurochirurgica Supplement, 2017

A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ)... more A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ). These include congenital disorders, chronic inflammation, neoplasms, infections, and posttraumatic conditions that could all result in CVJ compression and myelopathy Endoscopic-assisted procedures have been further developed for CVJ decompression and they have now become conventional approaches. The aims of the present study were:(1) to compare "radiological" and "surgical" nasoaxial lines (NAxLs); (2) to introduce an analogous radiological line as a predictor of the superior extension of the transoral approach (palatine inferior dental arch line (PIA); (3) to compare the "radiological" nasopalatine line (NPL) with the "surgical" NPL (SNPL) and surgical PIA (SPIA); (4) to compare "our" SNPL with the NAxL; and (5) to find possible radiological reference points to predict, preoperatively, the maximal extent of superior dissection for the transoral approach (SPIA).

Frontiers in Oncology

Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery... more Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery. We present data from our case series of brain tumor surgery performed with the aid of IOUS in order to identify IOUS advantages and crucial aspects that may improve the management of neurosurgical procedures for brain tumors. From January 2021 to September 2021, 17 patients with different brain tumors underwent brain tumor surgery aided by the use of IOUS. During surgery, the procedure was supported by the use of multiples ultrasonographic modalities in addition to standard B-mode: Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS). In selected cases, the use of IOUS during surgical procedure was combined with neuronavigation and the use of intraoperative fluorescence by the use of 5-aminolevulinic acid (5-ALA). In one patient, a preoperative ultrasound evaluation was performed through a former iatrogenic skull defect. This study confirms t...

Frontiers in Surgery

Introduction: In this microneurosurgical and anatomical study, we characterized the superficial a... more Introduction: In this microneurosurgical and anatomical study, we characterized the superficial anastomosing veins of the human brain cortex in human specimens.Material and Methods: We used 21 brain preparations fixed in formalin (5%) that showed no pathological changes and came from the autopsy sections. The superficial veins were dissected out of the arachnoid with the aid of a surgical microscope.Results: We dissected nine female and 12 male brain specimens, with an average age of 71 ± 11 years (range 51–88 years). We classified the superficial veins in five types: (I) the vein of Trolard as the dominat vein; (II) the vein of Labbé as the dominant vein; (III) a dominant sylvian vein group, and the veins of Trolard and Labbé nonexistent or only rudimentary present without contact to the Sylvian vein group; (IV) very weak sylvian veins with the veins of Trolard and Labbé codominant; and V) direct connection of Trolard and Labbé bypassing the Sylvian vein group. The vein of Trolard ...

Objective: Unusual clinical course Background: Trauma is the leading cause of death in people you... more Objective: Unusual clinical course Background: Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1 % of all patients with head injuries and fewer than 10 % of those who are comatose), they should always be considered in evalua-tion of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxi-al hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT find-ings) but also may depend on the judgement of the treating neurosurgeon. Case Report: A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed...

Life

In consideration of the increasing prevalence of COVID-19 cases in several countries and the resu... more In consideration of the increasing prevalence of COVID-19 cases in several countries and the resulting demand for unbiased sequencing approaches, we performed a direct RNA sequencing (direct RNA seq.) experiment using critical oropharyngeal swab samples collected from Italian patients infected with SARS-CoV-2 from the Palermo region in Sicily. Here, we identified the sequences SARS-CoV-2 directly in RNA extracted from critical samples using the Oxford Nanopore MinION technology without prior cDNA retrotranscription. Using an appropriate bioinformatics pipeline, we could identify mutations in the nucleocapsid (N) gene, which have been reported previously in studies conducted in other countries. In conclusion, to the best of our knowledge, the technique used in this study has not been used for SARS-CoV-2 detection previously owing to the difficulties in the extraction of RNA of sufficient quantity and quality from routine oropharyngeal swabs. Despite these limitations, this approach p...

Acta Neurochirurgica Supplement

The craniovertebral junction (CVJ) is a complex anatomical area upon which most of the motion of ... more The craniovertebral junction (CVJ) is a complex anatomical area upon which most of the motion of the upper cervical spine depends [1]. Because of its unique range of motion, the CVJ is subject to several types of traumatic injury; it has been shown that odontoid fractures are the most common ones in the general population and are the most common isolated spinal fractures [2]. Accounting for up to 18% of all cervical fractures, odontoid fractures are the most common ones in elderly patients [3], in whom they account for up to 60% of spinal cord injuries [4].

Journal of neurological surgery. Part A, Central European neurosurgery, 2021

BACKGROUND We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy ... more BACKGROUND We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy that optimizes dural opening and can be performed in elderly patients affected by acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants. METHODS We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5 years) treated in our institution, during a period of 10 years, with this novel diamond-shaped craniotomy. Seventeen patients were treated for intracerebral hemorrhage and 50 patients for acute subdural hematomas. All the patients were in therapy with antiplatelets or anticoagulants. RESULTS Approach-related complications were not detected. Ten of 67 patients (14.9%) presented temporal muscle atrophy; there was no scar deformity, paresthesia, hyperalgesia, or ramus frontalis palsy around the scalp incision. Thirty-day mortality was 22%. The mean follow-up was 1.3 years. One-month postoperative brain computed tomography scans s...

Current Pediatric Research, 2016

Background: Eosinophilic granuloma is the benign form of Langerhans cell histiocytosis, a rare pr... more Background: Eosinophilic granuloma is the benign form of Langerhans cell histiocytosis, a rare proliferative disorder. Skull osteolytic lesions are quite frequently encountered. Case report: We report the case of a 16 year old boy who was admitted to our Department with a painful swelling left frontal mass. A diagnosis of eosinophilic granuloma was presumed on the basis of the neuroradiological findings. Surgical removal of the lesion was achieved and the bone defect reconstructed by autologous fibrin glue and a titanium mesh. Histopathology confirmed the diagnosis. Conclusion: Although uncommon, eosinophilic granuloma should be considered in the differential diagnosis in case of an osteolytic calvarial lesion.

Background: Osteochondroma or osteocartolaginous exostosis is the most common benign tumor of bon... more Background: Osteochondroma or osteocartolaginous exostosis is the most common benign tumor of bone. They account for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumors. Usually these tumors are found in the appendicular skeleton, especially in the metadiaphyseal region of long bones. Spinal osteochondromas, however, are uncommon especially at cervical level. Clinical presentation: We report the case of a 16 year old boy presenting a hard, gradually progressing, large swelling mass, over the posterior part of the neck causing pain. Radiological images revealed a giant solitary osteochondroma arising from C3 to C6 laminae. The patient underwent complete surgical excision of the tumor. Postoperative outcome was good and recovery from the pain achieved. Conclusion: Solitary osteochondroma of the cervical spine is a rare manifestation of a common bony tumor. Patients affected may present with a multitude of symptoms and complications depending on the size and l...