Publications by authors named "Gianluigi Zona"

Background: High-grade glioma (HGG) patients post-radiotherapy often face challenges distinguishing true tumor progression (TTP) from pseudoprogression (PsP). This study evaluates the effectiveness of systemic inflammatory markers and volume of enhancing tissue on post-contrast T1 weighted (T1WCE) MRI images for this differentiation within the first six months after treatment.

Material And Methods: We conducted a retrospective analysis on a cohort of HGG patients from 2015 to 2021, categorized per WHO 2016 and 2021 criteria.

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  • Trauma, particularly traumatic brain injury (TBI), is a significant cause of maternal mortality during pregnancy, yet there is a lack of guidelines for managing these cases.
  • An international survey with 122 physicians from 110 centers revealed that many do not have specific protocols for TBI in pregnant patients and highlighted a preference for using MRI and varying practices regarding transfusions and treatment methods.
  • The findings indicate substantial inconsistency in how severe TBI is managed in pregnant individuals, suggesting a need for more research and education to standardize care.
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Introduction: Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance.

Research Question: This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems.

Methods: After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method.

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Introduction: Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients.

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Background: Acute brain injured (ABI) patients are at high risk of developing ventilator-associated pneumonia (VAP). However, incidence, risk factors and effects on outcome of VAP are not completely elucidated in this population. The primary aim of this study was to determine the incidence of VAP in a cohort of ABI patients.

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  • Meningiomas are primarily benign brain tumors, but 20% can be aggressive and recur; this study explores the connection between cancer stem cells and the aggressive nature of these tumors, focusing on the CXCL12-CXCR4/CXCR7 pathway.* -
  • Researchers isolated and characterized meningioma stem cells from patient samples, finding that these cells showed higher rates of proliferation, migration, and tumor formation compared to non-stem cells and were significantly influenced by the CXCR4/CXCR7 system.* -
  • The findings suggest that the CXCL12 and CXCL11 chemokines play a role in the malignancy of meningioma stem-like cells, indicating that targeting CXCR4/C
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Background: All available recommendations about the management of antithrombotic therapies (ATs) in patients who experienced traumatic brain injury (TBI) are mainly based on expert opinion because of the lack of strength in the available evidence-based medicine. Currently, the withdrawal and the resumption of AT in these patients is empirical, widely variable, and based on the individual assessment of the attending physician. The main difficulty is to balance the thrombotic and hemorrhagic risks to improve patient outcome.

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Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in which an alternating current is delivered to the tumor lesion producing local heating and consequent necrosis. However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability, and indeed the aim of the present study is to investigate the effects of RFA on spine stability.

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  • The study looked at two types of brain bleeding: one from problems with blood vessels (aSAH) and one that wasn't, called spontaneous non-aneurysmal subarachnoid hemorrhage (smSAH), to see how they affect inflammation in the body.
  • Researchers observed 48 patients and collected blood samples over several days to learn about their immune responses.
  • The results showed important differences in inflammation markers on the first day, suggesting that understanding these immune reactions might help in treating patients better in the future.
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Background: Questions remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance regarding this topic. Specifically, in this manuscript (part 2), we aim to provide a list of experts' recommendations regarding the management of SAH patients in a center with neurosurgical/neuroendovascular facilities after aneurysm treatment.

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Background: Several cases of adverse reactions following vaccination for coronavirus disease 2019 (COVID-19) with adenoviral vector vaccines or mRNA-based vaccines have been reported to date. The underlying syndrome has been named "vaccine-induced immune thrombotic thrombocytopenia" (VITT) or "thrombosis with thrombocytopenia syndrome (TTS)" with different clinical manifestations.

Methods: We report the clinical course of five patients who had severe adverse reactions to COVID-19 vaccines, either with VITT/TTS, abdominal or pulmonary thrombosis after adenoviral vaccines, or Stevens' Johnson syndrome because of mRNA vaccination, all of whom required admission to the intensive care unit (ICU).

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Background: Issues remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI). In this manuscript, we aim to provide a list of experts' recommendations regarding the early management of SAH patients from hospital admission, in a center with neurosurgical/neuro-endovascular facilities, until securing of the bleeding aneurysm.

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Objective: Surgical indications for cerebral cavernous malformations (CCMs) remain significantly center- and surgeon-dependent; available grading systems are potentially limited, as they do not include epileptologic and radiologic data. Several experienced authors proposed a new grading system for CCM and the first group of patients capable of providing its statistical validation was analyzed.

Methods: A retrospective series of 289 CCMs diagnosed between 2008 and 2021 was collected in a shared anonymous database among 9 centers.

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Background: Cerebral intraparenchymal masses represent usually a neoplastic, or infectious differential diagnostic workup in neurology or infectious disease units.

Case Presentation: Our patient was an 82-year-old male presenting with seizures, cerebral masses and a history of past treated pulmonary tuberculosis. Initial workup included a differential diagnosis of an infectious mass/multiple abscess.

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Background: Chloride intracellular channel-1 (CLIC1) activity controls glioblastoma proliferation. Metformin exerts antitumor effects in glioblastoma stem cells (GSCs) inhibiting CLIC1 activity, but its low potency hampers its translation in clinical settings.

Methods: We synthesized a small library of novel biguanide-based compounds that were tested as antiproliferative agents for GSCs derived from human glioblastomas, in vitro using 2D and 3D cultures and in vivo in the zebrafish model.

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Background: The effects of positive end-expiratory pressure (PEEP) on lung ultrasound (LUS) patterns, and their relationship with intracranial pressure (ICP) in brain injured patients have not been completely clarified. The primary aim of this study was to assess the effect of two levels of PEEP (5 and 15 cmHO) on global (LUStot) and regional (anterior, lateral, and posterior areas) LUS scores and their correlation with changes of invasive ICP. Secondary aims included: the evaluation of the effect of PEEP on respiratory mechanics, arterial partial pressure of carbon dioxide (PaCO) and hemodynamics; the correlation between changes in ICP and LUS as well as respiratory parameters; the identification of factors at baseline as potential predictors of ICP response to higher PEEP.

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Introduction: Anticoagulation management in high-grade gliomas is a widely studied but still debated topic, since the increased thrombotic risk is accompanied by the high background rate of intralesional bleeding. Currently, the main challenge when prescribing anticoagulants to HGG patients is to balance the risk between ICH and VTE both in the perioperative period and in the postoperative follow-up during adjuvant chemo- and radiotherapic treatment.

Evidence Acquisition: A systematic review according to PRISMA-P Guidelines was performed: 12 observational studies were selected, eight retrospective and four prospective.

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Purpose: Acromegaly is a severe chronic endocrine disease. Achieving biochemical control often needs a multimodal treatment approach, including prolonged medical treatment. Aim of the study is to evaluate the burden of treatment direct costs with respect to the different therapeutic strategies, disease control, and follow-up length.

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  • - The endoscopic endonasal approach (EESBS) for treating tumors in the sellar and parasellar regions is commonly used in neurosurgery, but there’s no unanimous agreement on the use of anterior nasal packing due to its varied applications.
  • - A survey of 39 Italian neurosurgical centers revealed that 84% of participants find anterior nasal packing useful mainly for preventing nosebleeds, though it can lead to nasal discomfort.
  • - The study suggests that the decision to use anterior nasal packing should depend on specific surgical conditions, as it helps reduce postoperative complications after intricate nasal surgeries.
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