Publications by authors named "Garbossa D"

Background: Post-traumatic pseudomeningoceles are common findings after a brachial or lumbar plexus trauma, in particular after nerve root avulsion. Unlike meningoceles, pseudomeningoceles are CSF full-filled cysts confined by the paraspinous soft tissue, along the normal nerve course, in communication with the spinal subarachnoid spaces. Normally no more than a radiological finding at MRI, in rare instances they might be symptomatic due to their size or might constitute an obstacle during a reconstructive surgery.

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Purpose: To evaluate the correlation between the degrees of circumferential decompression of the optic canal (OC) and the improvement of visual acuity in patients with parasellar meningiomas (PMs) with optic canal invasion.

Methods: This is a monocentric retrospective study conducted at author's institution. The visual acuity was evaluated preoperative and at 3-months after surgery with Snellen acuity test.

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Background: Non-meningothelial intracranial mesenchymal tumors are a heterogeneous group of central nervous system neoplasms endowed with great variability clinically and histologically. For this precise reason, significant difficulties exist in specifically cataloguing tumor entities with such distant characteristics and such uncertain clinical course.

Case Description: In an attempt to increase the knowledge inherent in this type of central nervous system lesions we report a case of a rare and unusual myxoid mesenchymal tumor of difficult anatomopathological classification characterized by rapid progression and optimal therapeutic response after combined surgical and radiotherapy treatment, with histo-molecular definition and DNA methylation profile.

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Background Context: Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate.

Purpose: This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis.

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Article Synopsis
  • - The research aimed to create a deep learning model for accurately assessing the extent of resection (EOR) in glioblastoma patients using postoperative MRI scans, addressing limitations of existing algorithms that only focus on preoperative images.
  • - Utilizing data from multiple sources, the model was trained to segment tumor features like contrast-enhancing tumor, edema, and surgical cavity, and was compared with other segmentation models, showing high performance in classifying resection categories.
  • - The study found that the nnU-Net framework outperformed other algorithms, achieving high accuracy in both segmentation (with median Dice scores up to 0.81) and EOR classification (96% accuracy in comparisons), making it a valuable tool for clinical use.
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The role of brain metastases (BM) surgery is of paramount importance for patients' progression-free and overall survival. "En-bloc" and "piecemeal" resection represent the main surgical techniques. Although en-bloc resection remains the best surgical option, it is not widely adopted or feasible as the first choice.

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  • - The endoscopic endonasal corridor (EEO) is an effective surgical route for treating craniovertebral junction (CVJ) issues, particularly beneficial for elderly patients with health complications who may not tolerate more invasive procedures.
  • - In a specific case study of an 80-year-old man, EEO was successfully used to address ventral compression caused by degenerative changes, while preserving the C1 anterior arch.
  • - The surgery demonstrated positive outcomes without the need for posterior instrumentation, highlighting the technique's effectiveness and the importance of thorough preoperative planning.
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  • This study examines how the different presentations of posterior fossa arachnoid cysts (PFACs) affect surgical decisions and patient outcomes in children.
  • A "wait and see" approach is recommended for asymptomatic patients, leading to better outcomes at one year; surgery types like fenestration or shunting show no significant difference in outcomes, but cyst location does matter.
  • Factors such as patient age, presence of hydrocephalus, and cyst location are crucial in determining the best treatment to reduce complications and improve results after surgery.
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High-grade gliomas are the most prevalent neurooncological desease in adults, their incidence increases with age, peaking in the seventh decade. This paper aims to address how to select patients for surgical resection by identifying pre-surgical predictors of 12-month mortality in newly diagnosed HGG patients aged ≥ 75 years. A prognostic score will be proposed to guide surgical decisions based on expected survival.

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  • The study focuses on improving glioma surgery outcomes by utilizing diffusion tensor imaging (DTI) to analyze the brain's white matter near tumors, specifically in the adjacent tumor area (BAT).
  • It involves an observational study of 118 glioma patients, measuring DTI parameters like Fractional Anisotropy (FA), Mean Diffusivity (MD), and Tract Irregularity (TI), to assess their relationship with tumor grades and surgical outcomes.
  • Results indicate a significant inverse relationship between FA and tumor grading, along with direct relationships for MD and TI values, highlighting their potential as predictive tools for safe tumor resection.
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Background And Objectives: Choosing the correct site for a nerve biopsy remains a challenge due to nerve sacrifice and major donor site complications, such as neuroma, as seen in sural nerve biopsy. Selecting a deeper donor nerve can help in burying nerve stumps in deep soft tissues, preventing neuroma. Moreover, using an expendable, deeply situated motor nerve can aid indiagnosis when a motor neuropathy is suspected.

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Deep learning (DL) has been applied to glioblastoma (GBM) magnetic resonance imaging (MRI) assessment for tumor segmentation and inference of molecular, diagnostic, and prognostic information. We comprehensively overviewed the currently available DL applications, critically examining the limitations that hinder their broader adoption in clinical practice and molecular research. Technical limitations to the routine application of DL include the qualitative heterogeneity of MRI, related to different machinery and protocols, and the absence of informative sequences, possibly compensated by artificial image synthesis.

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Article Synopsis
  • Fluorescence-guided resection (FGR) using 5-ALA and sodium fluorescein (SF) is explored for maximizing glioblastoma removal, presenting concerns and methods from a specific medical center.
  • A study analyzed 100 patients with glioblastoma, using 5-ALA as the approved drug for FGR while also incorporating SF to enhance the surgical approach.
  • Results showed 96% achieved gross total resection, with the combined use of 5-ALA and SF improving surgical outcomes and potentially enhancing patient prognosis.
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Background: The relationship between meningiomas and gonadal steroid hormones has been the subject of debate, and there is limited understanding of the connection between patient, tumor characteristics, and progesterone receptor (PGR) status.

Methods: This retrospective observational study aims to explore the prognostic correlation between PGR+ and PGR-meningiomas in terms of various clinical, radiological, and surgical predictors. The analysis included 270 patients, divided into 2 groups: group A (PGR-, 194 patients), and group B (PGR+, 76 patients).

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  • Cranial CT scans are commonly used to detect brain injuries in children after trauma, but they pose risks due to radiation exposure, leading to a search for safer alternatives like serum biomarkers, specifically S100B.
  • A systematic review of pediatric studies found that S100B measurements combined with CT have a high sensitivity (98%) and a very high negative predictive value (99%), indicating that low-risk patients may avoid unnecessary CT scans.
  • Although S100B shows potential in managing mild traumatic brain injuries in emergency settings, high variability among studies suggests more research is needed before it can be consistently implemented in clinical practice.
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  • Hydrocephalus is a medical condition that requires surgical solutions to manage excess cerebrospinal fluid, with the ventriculoperitoneal shunt (VPS) being the most common method used today.
  • A systematic review and meta-analysis was conducted to compare the effectiveness and safety of VPS and ventriculoatrial shunt (VAS) techniques, analyzing data from nine studies involving 3,197 patients.
  • The analysis found that the VAS had a significantly lower risk of shunt dysfunction, while risks of infection, revision, and death were statistically similar between the two methods but showed high variability across studies.
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Background: In surgical practice during endoscopic endonasal approach, growth hormone-secreting pituitary neuroendocrine tumor (GH-secreting PitNET) patients show morphologic differences in the nasal cavities and sinuses, leading to a narrower surgical field and a carotid prominence and potentially increasing the complexity of the surgical and the risk of complications. The aim of the study is to evaluate the anatomical differences of the sphenoid sinus between patients with GH-secreting PitNETs and patients with nonfunctioning pituitary neuroendocrine tumor (NF-PitNET) who underwent endoscopic endonasal approach.

Methods: This is a monocentric retrospective study conducted at the author's institution.

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Background: Brain metastases (BMs) from colorectal cancer (CRC) are a small percentage of metastatic patients and surgery is considered the best choice to improve survival. While most research has focused on the risk of CRC spreading to the brain, no studies have examined the characteristics of BMs in relation to surgery and outcome. In this study, we evaluate the clinical and radiologic features of BMs from CRC patients who underwent surgery and analyze their outcomes.

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Background:  Rapid spread of the SARS-CoV-2 pandemic in 2020 led to an indirect effect on non-COVID patients. Since neuro-oncology cases are unique and brain tumors need a specific therapeutic protocol at proper doses and at the right times, the effects of the pandemic on health care services for patients with glioblastomas (GBs) and their impact on overall survival (OS) and quality of life are not yet known.

Methods:  We conducted a retrospective study of 142 GB patients who underwent surgery, radiation, and chemotherapy before and after the lockdown period, aiming to determine the differences in access to care, treatment modality, and adjuvant therapies, and how the lockdown changed the prognosis.

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Purpose: This retropective multicentric study aims to investigate the clinical applicability of the NSE score in the elderly, to verify the role of this tool as an easy help for decision making also for this class of patients.

Methods: All elderly patients (> 65 years) suffering from spinal metastases undergoing surgical or non-surgical treatment at the authors' Institutions between 2015 and 2022 were recruited. An agreement group (AG) and non-agreement group (NAG) were identified accordingly to the agreement between the NSE score indication and the performed treatment.

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Objective: The aim of this study is to investigate long-term prognostic factors and clinical outcomes in patients with idiopathic normal pressure hydrocephalus (iNPH) treated with ventriculo-peritoneal shunt (VPS).

Methods: This single-center retrospective observational study of prospectively collected data included patients with probable iNPH treated with VPS surgery. All patients underwent complete preoperative assessment, including past medical history and neurological examination, dynamic cerebrospinal fluid (CSF) flow brain magnetic resonance imaging (MRI), and preoperative CSF samplings.

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Background: Several risk stratification scores have been suggested to aid prognostication and guide treatment strategies for brain metastases (BMs). However, the current scores do not focus on the specific neurosurgical population, therefore not predicting short-term mortality and postoperative performance status.

Methods: This retrospective observational study of 362 consecutive patients treated with surgery for BMs aims to identify the factors associated with post-surgical outcomes and propose a surgery-specific prognostic score for patients with BMs candidate for open surgery.

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Purpose: Brain metastases (BMs) most frequently originate from the primary tumors of the lung and breast. Survival in patients with BM can improve if they are detected early. No studies attempt to consider all potential surgical predictive factors together by including clinical, radiological variables for their recognition.

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