Papers by Giannantonio Spena
Evaluation of endocrinological sequelae following particle therapy performed on anterior skull base lesions in the adult population
Surgical Neurology International
Background: Radiotherapy has increasingly assumed a central role in the multidisciplinary treatme... more Background: Radiotherapy has increasingly assumed a central role in the multidisciplinary treatment of skull base lesions. Unfortunately, it is often burdened by relevant radio-induced damage to the pituitary function and the surrounding structures and systems. Patients who were treated with radiotherapy around the sellar region especially have a high risk of developing radio-induced hypopituitarism. Particle therapy has the potential advantage of delivering a higher radiation dose to the target while potentially sparing the sellar region and pituitary function. The aim of this study is to evaluate the pituitary function in adult patients who have undergone hadron therapy for anterior skull base lesions involving or surrounding the pituitary gland. Methods: This is a retrospective, observational, and noncontrolled study. We evaluated pituitary and peripheral hormone levels in all patients referring to National Center for Oncological Hadrontherapy, Pavia, Italy for anterior skull bas...
Journal of Neuro-Oncology
Purpose The extent of resection (EOR) is an independent prognostic factor for overall survival (O... more Purpose The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. Methods A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. Results A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early ...
Commentary: “Sagittal Crest”: Definition, Stepwise Dissection, and Clinical Implication From a Transorbital Perspective
Operative Neurosurgery, 2022
Digital Technology in Neurosurgery: A Successful Entrepreneurship Story
Neurosurgery and Global Health, 2022
Cerebral cavernous malformations: surgical or conservative management?
Objective: Microsurgical excision of cerebral cavernous malformations (CCM) is often routinely pe... more Objective: Microsurgical excision of cerebral cavernous malformations (CCM) is often routinely performed in patients with related epilepsy or even in asymptomatic cases to prevent hemorrhage. Few prospective studies have reliably demonstrated that surgery can statistically and clinically improve the[for full text, please go to the a.m. URL]
Minimally Invasive Subfrontal Approach: How to Make it Safe and Effective from the Olfactory Groove to the Mesial Temporal Lobe
Journal of Neurological Surgery Part A: Central European Neurosurgery, 2021
Background Different surgical approaches have been developed to manage lesions of the anterior an... more Background Different surgical approaches have been developed to manage lesions of the anterior and middle skull base areas. Frontal, pterional, bifrontal, and fronto-orbito-zygomatic approaches are traditionally used to reach these regions. With advancements in the neurosurgical field, skull opening should be simple and as minimally invasive as possible, tailored on the surgical corridor to the target. The supraorbital approach and the “keyhole” concept have been introduced and popularized by Axel Perneczky starting from 1998 and are now considered a part of everyday practice. The extended possibilities of this surgical route, considering the reachable targets and surgical limits, are described and systematically analyzed, including a description of the salient surgical anatomy, presenting different illustrative cases. Methods and Results Different illustrative cases are presented and discussed to underline the potentials and limits of the minimally invasive subfrontal approach (MIS...
Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas
Neurosurgery, 2019
BACKGROUND The postoperative outcomes and the predictors of seizure control are poorly studied fo... more BACKGROUND The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. METHODS Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas. RESULTS A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P = .013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P = .042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P
Surgery of Cerebral Ischemia: State of the Art for the Supratentorial Region
Current Innovations in Medicine and Medical Science Vol. 4
Endoscopic endonasal approach for infradiaphragmatic craniopharyngiomas: a multicentric Italian study
Journal of Neurosurgery
OBJECTIVE Infradiaphragmatic craniopharyngiomas (ICs) represent a distinct subtype, harboring a s... more OBJECTIVE Infradiaphragmatic craniopharyngiomas (ICs) represent a distinct subtype, harboring a sellar-suprasellar origin and generally growing in the extra-arachnoidal space contained by the diaphragma sellae. They have been considered ideal for surgical removal through the transsphenoidal approach since the 1960s. The authors present a multicentric national study, intending to selectively analyze IC behavior and the impact of the transsphenoidal endoscopic endonasal approach (EEA) on surgical outcomes. METHODS Craniopharyngiomas that were intraoperatively recognized as infradiaphragmatic and removed with standard EEA between 2000 and 2021 at 6 Italian neurosurgical departments were included in the study. Clinical, radiological, and surgical findings and outcomes were evaluated and reviewed. RESULTS In total, 84 patients were included, with 45.23% identified as pediatric cases and 39.28% as having recurrent tumors. The most common presenting symptoms were endocrine (75%), visual (5...
Neuro-Oncology Practice
Background People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncologi... more Background People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients’ well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results Thirty-eight European centers completed the survey. Thirty of them offered at least one postsurgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at...
Surgical Management of Brain Cavernous Malformations
Methods in Molecular Biology, 2020
Surgical removal of accessible lesions is the only direct therapeutic approach for cerebral caver... more Surgical removal of accessible lesions is the only direct therapeutic approach for cerebral cavernous malformations (CCMs). The approach should be carefully evaluated according to clinical, anatomical, and neuroradiological assessment in order to both select the patient and avoid complications. In selected cases, a quantitative anatomical study with a preoperative simulation of surgery could be used to plan the operation. Neuronavigation, ultrasound, and neurophysiologic monitoring are generally required respectively to locate the CCMs and to avoid critical areas. The chapter describes all the possible surgical approaches for supratentorial, infratentorial, deep seated and brain stem CCMs. In any case before performing surgery, the physicians should always consider the benign nature of the lesions and the absolute necessity to avoid not only neurological deficits, but also a neuropsychological impairment that could affect the quality of life of the patients.
Management of Chiari Malformation
Understanding of the Chiari malformation type I (CMI) has evolved over time thanks to accumulated... more Understanding of the Chiari malformation type I (CMI) has evolved over time thanks to accumulated surgical experiences, neuroradiological refinements, and better comprehension of pathophysiology. CMI is defined as a descent of the cerebellar tonsils into the cervical canal due to a volumetric disproportion between the posterior fossa and cerebellar volumes. In more than one-third of cases, CMI is associated with syringomyelia, a cystic dilation of the spinal cord which leads to debilitating myelopathy. It has been demonstrated that both these conditions are associated with the obstruction of the cerebrospinal fluid flow at the level of the foramen magnum caused by the low-lying tonsils.
Surgical Neurology International, 2021
Background: Fixation of bone flaps after craniotomy is a routine part of every neurosurgical proc... more Background: Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure. The ideal fixation device should be safe, reliable, biologically inert, easy to use, and inexpensive and should not produce artifacts on neuroimaging. The authors describe a new device that meets these criteria. Methods: This is an observational, multicentric, and case series study of 56 patients who underwent a craniotomy and were subject to cranial bone flap fixation with the NT cranial small fixation system. A case–control group in whom titanium miniplates and screws were implanted was collected. All patients underwent CT scans of the head with 3D reconstruction at day 1 and day 90 postoperatively to evaluate bone flap position and fusion. Results: A total of 140 NT cranial small were implanted in 56 patients (mean age 44.2, range 22–63 years). The new device has shown stronger fixation qualities with optimal bone flap fusion and good cosmetic features. No surgical or relevant ...
Surgical Neurology International, 2021
Background: Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, ... more Background: Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, are rare. The authors reported a complex case of intradiploic intraosseous metaplastic meningioma of the left medial wall and orbital roof with the left frontal sinus invasion and left ethmoidal body bone substitution. The authors also conducted a systematic review concerning diagnosis and management of patients affected by purely calvarial intradiploic meningiomas along with a focus on fronto-orbito-ethmoidal ones. Methods: A literature search was conducted using PubMed and Scopus databases according to preferred reporting items for systematic reviews and meta-analysis statement and with the following Mesh terms: Intradiploic, intraosseous, calvarial, and meningioma. Eligibility criteria were limited by the nature of existing literature on intradiploic meningiomas, consisting of only case series, and case reports. Results: A total of 128 published studies were identified through our sea...
When a benign disease turns into disaster: a unique case of a surgically treated hemorrhagic sylvian fissure meningioma
Journal of Neurosurgical Sciences, 2020
Annals of Medicine and Surgery, 2020
Introduction: Diffuse idiopathic skeletal hyperostosis of cervical spine can lead to dysphagia. P... more Introduction: Diffuse idiopathic skeletal hyperostosis of cervical spine can lead to dysphagia. Presentation of case: A 73-year-old male weighing 110 kg and diagnosed with diffuse idiopathic skeletal hyperostosis in cervical spine with dysphagia. Patient manifested local pain of neck, a gradual limitation of spinal mobility. The surgery decision was based on swallowing problems, not pain in the spine. Before surgery radiographs, magnetic resonance images, computed tomography of the cervical spine and gastroscopy were obtained. Osteophytes were removed from the anterior approach with present otolaryngologist by surgery. Discussion: In this case used gastroscopy, CT and MRI for diagnostics. During the procedure we had support otolaryngologist. The patient has not been found a stenosis spinal canal and neurological symptoms. We were removed the ostheophytes. Interbody implants have not been applied. Conclusion: Disc degeneration disease itself can be asymptomatic or not a dominant problem for the DISH patients. Clinical signs may pharyngoesophageal and tracheal compression, causing dysphagia, shortness of breath and stridor. In this case, the cervical spine was stability and not demonstrated a stenosis in the spinal canal. Isolate removing of the osteophytes without implants in DISH of cervical spine can be enough solution.
Neurosurgical Review, 2019
Awake surgery is a well-defined procedure with a very low morbidity. In particular, stimulation-r... more Awake surgery is a well-defined procedure with a very low morbidity. In particular, stimulation-related intraoperative seizure (IOS) is a commonly discussed and serious complication associated with awake surgery. Here, we reviewed the literature on awake surgery and IOS and sought to obtain evidences on the predictive factors of IOS and on the effect of IOS on postoperative outcomes. We conducted a comprehensive search of the Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases to identify potentially relevant articles from 2000 to 2019. We used combinations of the following search terms: "intraoperative seizure awake craniotomy," "awake surgery seizures," and pertinent associations; the search was restricted to publications in English and only to papers published in the last 20 years. The search returned 141 articles, including 39 papers that reported the IOS rate during awake craniotomy. The reported IOS rates ranged between 0 and 24% (mean, 7.7%). Only few studies have assessed the relationships between awake surgery and IOS, and hence, drawing clear conclusions is difficult. Nevertheless, IOS does not cause permanent and severe postoperative deficits, but can affect the patient's status perioperatively and the hospitalization duration. Anterior tumor location is an important perioperative factor associated with high IOS risk, whereas having seizures at tumor diagnosis does not seem to influence. However, the role of antiepileptic drug administration and prophylaxis remains unclear. In conclusion, given the difficulty in identifying predictors of IOS, we believe that prompt action at onset and awareness of appropriate management methods are vital.
Acta Neurochirurgica, 2020
Background Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is di... more Background Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is divided in three main phases: opening, tumor resectionduring which the patient needs to be fully awakeand closure. The anesthetic management of awake neurosurgery is a challenge, and there are currently no guidelines. Objective The objective of the survey was to explore differences and commonalities regarding the anesthetic management of awake DLGG surgery within the European Low-Grade Glioma Network (ELGGN) centers. Methods A form that contained 14 questions about the anesthetic management was sent to 28 centers in May 2015. Results Twenty centers responded. During the opening and closing non-awake periods, 56% of teams chose general anesthesia with mechanical ventilation for at least one period (asleep-awake-asleep, SAS protocol), and 44% monitored anesthesia care including sedation without mechanical ventilation (MAC protocol). In case of SAS, all the teams chose intravenous anesthesia, 82% used laryngeal mask instead of endotracheal intubation during the opening sequence, and 71% during closure. Local and regional anesthesia was practiced by all the teams. The most frequently reported cause of pain was dural and cerebral vessels manipulation (77%). Pain management was mostly based on paracetamol (70%) and remifentanil (55%). Conclusion Our survey showed that there was an equivalent proportion of centers using SAS or MAC protocols in the anesthetic management of awake surgery in ELGGN centers. The advantages and disadvantages of each anesthesia protocol were reviewed.
World Neurosurgery, 2019
To evaluate the feasibility of transcranial sonography in patients harboring polymethylmethacryla... more To evaluate the feasibility of transcranial sonography in patients harboring polymethylmethacrylate cranioplasties (PMMA-CP) and explore whether this material is a valid sonic window to explore intracerebral structures.
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Papers by Giannantonio Spena