Outcome of lumbar intervertebral foraminal stenosis surgery and depression.

A total of 58 patients consecutively underwent surgical treatment for lumbar intervertebral foraminal stenosis. We performed a microsurgical combined transarticular lateral and medial procedure with partial facetectomy in all patients to decompress the affected nerve root. All patients underwent assessment of depressive symptoms by means of the Zung Self Depression Scale (SDS).

Trigeminal neuralgia and persistent trigeminal artery.

We report a case of trigeminal neuralgia caused by persistent trigeminal artery (PTA) associated with asymptomatic left temporal cavernoma. Our patient presented unstable blood hypertension and the pain of typical trigeminal neuralgia over the second and third divisions of the nerve in the right side of the face. The attacks were often precipitated during physical exertion.

Intrathecal baclofen therapy for severe spasticity: analysis on a series of 112 consecutive patients and future prospectives.

Objective: Intrathecal baclofen therapy (ITB) is a well-known treatment for spasticity. Despite this fact, several topics have to be still discussed: new indications and screening tools, appropriate surgical timing and complicance avoidance.

Methods: A total of 112 consecutive patients all with a severe, progressive and refractory to medical therapy spasticity from different causes were treated using ITB, after a bolus test.

Use of a collagen biomatrix (TissuDura) for dura repair: a long-term neuroradiological and neuropathological evaluation.

Purpose: The aim of this study was to evaluate the clinical, neuroradiological, and neuropathological outcomes of patients treated with equine collagen foil (TissuDura) as a dura mater substitute during cranial and spinal neurosurgical procedures.

Materials And Methods: All patients treated at the Department of Neurosurgery of the Second University of Naples with TissuDura between 2005 and 2009 were included. Dural reconstruction was performed using TissuDura, overlaid 1 cm over the dural defect with additional fixation using fibrin glue.

Cranial reconstruction using bioabsorbable calcified triglyceride bone cement.

Background: We report our experience on 6 cases of cranial reconstruction using bioabsorbable calcified triglyceride KRYPTONITE Bone Cement (Doctors Research Group).

Methods: Six patients underwent cranial reconstruction during the surgical removal of a supratentorial tumor between September 2008 and November 2009 at our department. In 5 patients, we performed the cranial reconstruction using KRYPTONITE Bone Cement and cranial fixations; in the remaining patient, we avoided cranial fixation systems or other bone sutures to obtain good aesthetic results in the frontal supraorbital region.

Spontaneous intraparenchymal tension pneumocephalus triggered by compulsive forceful nose blowing.

The case is described of a 50-year-old man, treated for 10 years in an outpatient psychiatric clinic for an obsessive compulsive disorder, who presented with acute loss of consciousness after forceful nose blowing. A CT scan revealed an intraparenchymal air collection with tension signs in the left frontal lobe and a bone defect in the roof of the ethmoid sinus. After emergency left frontal craniotomy and dura opening, the gaseous collection was evacuated by a ventricular catheter inserted into the brain and the bone defect was repaired with pericranium flap and muscle.

Surgery, radiotherapy and temozolomide in treating high-grade gliomas.

Temozolomide (TMZ) a recent, oral, second generation alkylating agent is a chemotherapeutic with demonstrated efficacy for the treatment of high-grade gliomas. The efficacy of TMZ has been demonstrated in both pre-clinical and phase I and II studies. The goal of this study is to determine the activity and safety of temozolomide in improving overall survival (OS), progression-free survival (PFS) and health-related quality of life (HQL) in patient with malignant gliomas treated by surgery, radiotherapy and temozolomide.

Prognostic role of depression after lumbar disc surgery.

A total of 73 patients underwent microdiscectomy for lumbar disc herniation between September 2001 and May 2002 at the Department of Neurosurgery of the Second University of Naples. Preoperatively and 3 and 6 months after surgery, patients were assessed on the Zung Self-rating Depression Scale (SDS) and on a visual analogue scale (VAS) for the subjective perception of pain. At 3 and 12 months, we found that patients with lower SDS scores (n=41) had a better outcome regarding pain than patients with relevant depressive symptoms (n=32).

Positioning on surgical table.

Positioning on the surgical table is one of the most important steps in any spinal surgical procedure. The "prone position" has traditionally been and remains the most common position used to access the dorsolumbar-sacral spine. Over the years, several authors have focused their attention on the anatomy and pathophysiology of both the vascular system and ventilation in order to reduce the amount of venous bleeding, as well as to prevent other complications and facilitate safe posterior approaches.

The use of local agents: bone wax, gelatin, collagen, oxidized cellulose.

The use of local agents to achieve hemostasis is an old and complex subject in surgery. Their use is almost mandatory in spinal surgery. The development of new materials in chemical hemostasis is a continuous process that may potentially lead the surgeon to confusion.

Management of benign craniovertebral junction tumors.

Background: We report our surgical experience in the treatment of fifteen consecutive patients with benign craniovertebral junction tumors, observed from 1993 to 2000 at our department.

Method: We treated 7 meningiomas, 3 epidermoids, 3 C1 neurinomas and 2 neurinomas of the lower cranial nerves. Clinical results were evaluated by Karnofsky Performance Scale and all patients underwent preoperative neuroradiological evaluation with CT, MRI and MRA; angiography was not routinely performed and was considered for each individual case.

Lumbosacral dural ectasia in type 1 neurofibromatosis. Report of two cases.

Dural ectasia denotes circumferential expansion or dilatation of the dural sac, and has been frequently reported in association with type 1 neurofibromatosis (NF1). The pathogenesis has not been defined, but its correlation with NF1 infers a congenital malformative hypothesis. The neural elements in the dilated sleeve typically are not enlarged or abnormal, nevertheless the enlarged area contain an increased amount of cerebrospinal fluid.

Traumatic subependymal hematoma during endoscopic third ventriculostomy in a patient with a third ventricle tumor: case report.

Endoscopic third ventriculostomy has become a routine intervention for the treatment of non-communicating hydrocephalus. This technique is largely considered safe and a very low incidence of complications is reported. However, hemorrhage in the course of neuroendoscopy is still a problem difficult to manage.

Spontaneous resolution of chronic subdural hematoma.

Background: Spontaneous resolution of chronic subdural hematoma has rarely been reported in the literature, and its mechanism has not been fully investigated. Response to surgery has been very satisfactory; in fact, this is generally considered the treatment of choice.

Methods: From a series of 24 cases of chronic subdural hematomas, we observed five patients between 1996 to 1998.

[Urapidil: hypotension induced in neuroanesthesia].

The authors report their experience on the use of urapidil in 31 patients, submitted to neurosurgical procedures. Urapidil, administered both in the inductive (0.7-1 mg/kg) and in preoperative phases (0.

[Total intravenous anesthesia in neurosurgical patients].

The authors present an anesthesiologic technique, consisting of the use of propofol + fentanyl + O2. The main advantages, described in 82 neurosurgically treated patients, are the following: moderate decrease both of ICP and MAP, absence of frequency, modifications rapid recovery both of consciousness and of motility, which allows a preliminary valuation of neurological status.

Trigeminal neuralgia treated by percutaneous thermocoagulation. Comparative analysis of percutaneous thermocoagulation and other surgical procedures.

The authors analyze the results they obtained by percutaneous radiofrequency technique for trigeminal neuralgia. The clinical material consists of 605 cases observed from 1977 to 1986 at their Institute. There was a female preponderance (62%) and an average age of 65 years.

Microsurgical management of suprasellar and intraventricular meningiomas.

A series of 78 intracranial meningiomas (68 suprasellar, 10 intraventricular) were operated on in our Institute after the advent of the operating microscope. In our review, we discuss the microsurgical technical problems related to the preservation of vascular and brain structures in the removal of intraventricular and parasellar meningiomas. Basic diagnostic criteria to plan correctly the surgical approach will be emphasized.