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Magnetic resonance diffusion tensor imaging and fibertracking diffusion tensor tractography in the management of spinal astrocytomas

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World Journal of Clinical Cases 2016年第1期4卷 1-4页

作者： Alessandro Landi Valeria Palmarini Alessandro D'Elia nicola marotta Maurizio Salvati Antonio Santoro Roberto Delfini Department of Neurology and Psychiatry Division of NeurosurgeryUniversity of Rome "Sapienza"

Some specially imaging of magnetic resonance imaging,the diffusion-weighted imaging(DWI),the diffusion tensor imaging and fractional anisotropy(FA),are useful to described,detect,and map the extent of spinal cord *** measurements may are used to predicting the outcome of patients who have spinal cord *** tracking enable to visualizing the integrity of white matter tracts surrounding some lesions,and this information could be used to formulating a differential diagnosis and planning biopsies or *** this article,we will describe the current uses for DWI and fiber tracking and speculate on others in which we believe these techniques will be useful in the future.

关键词： Fiber tracking diffusion tensor imaging Surgery Magnetic resonance diffusion tensor imaging Intramedullary astrocytomas Spinal cord tumors Radiology

Giant xanthogranuloma of the pelvis with S1 origin: Complete removal with only posterior approach, technical note

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World Journal of Clinical Cases 2015年第1期3卷 77-80页

作者： nicola marotta Alessandro Landi Cristina Mancarella Pierluigi Rocco Andrea Pietrantonio Gaspare Galati Antonio Bolognese Roberto Delfini Department of Neurology and Psychiatry Division of NeurosurgeryPoliclinico Umberto I "La Sapienza" Università di Roma00161 Rome Italy Department of General Surgery "Pietro Valdoni" Policlinico Umberto I "La Sapienza" Università di Roma 00161 Rome Italy

Xanthogranulomas(XG) are benign proliferative disorder of histiocytes, a non-Langerhans cell histiocytosis. Whose etiology is unknown. The nature of these lesions is controversial and could be either reactive or neoplastic;the presence of monoclonal cells does, however, favor the second hypothesis. Xanthogranuloma is frequently found in young adults and children(under 20 years old), mainly in the skin. In about 5%-10% of all Juvenile XG(JXG) cases xanthogranuloma are extracutaneous. Within this group, the site most frequently involved is the eye. Other involved organs are heart, liver, adrenals, oropharynx, lung, spleen, central nervous system and subcutaneous tissue, although involvement of the spine is uncommon. Isolated lesions involving the sacral region are extremely rare. To date, this is the first reported case of a giant JXG arising from S1 with extension into the pelvic region in an adult spine.

关键词： Xanthogranulomas Non-Langerhans cell histiocytosis Touton giant cells Congenital xanthoma Neurofibromatosis

Algorhythm for Use of Percutaneous Short Fixation of Fractures Involving the Thoracolumbar Junction and Lumbar Spine

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International Journal of Clinical Medicine 2013年第7期4卷 18-23页

作者： nicola marotta Alessandro Landi Roberto Delfini Neurosurgery Department of University of Rome Sapienza Rome Italy.

Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.

关键词： Minimally Invasive Spine Surgery Percutaneous Short Fixation Thoraco-Lumbar Fractures

Trans-sacral screw fixation in the treatment of high dyplastic developmental spondylolisthesis

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World Journal of Clinical Cases 2013年第3期1卷 116-120页

作者： Alessandro Landi nicola marotta Cristina Mancarella Roberto Tarantino Roberto Delfini Department of Neurology and Psychiatry Division of NeurosurgeryUniversity of Rome"Sapienza"00165 RomeItaly

We describe the case of a 67-year-old woman with L5-S1 ontogenetic spondylolisthesis treated with pedicle fixation associated with interbody arthrodesis performed with S1-L5 trans-sacral screwing according to the technique of Bartolozzi. The procedure was followed by a wide decompressive laminectomy. The patient had a progressive improvement of the symptoms which gradually disappeared in 12 mo. The radiograph at 6 and 12 mo showed complete fusion system. The choice of treatment in L5-S1 ontogenetic spondylolithesis is related to a correct clinical and diagnostic planning(X-ray, computer tomography magnetic resonance imaging, Measurement). In particular, the severity index and the square of unstable zone, and the standard measurements already described in the literature, are important to understand and to plane the correct surgical strategy, that require, in most of the times, fusion and interbody artrodesis.

关键词： High-dysplastic developmental spondylolisthesis Spondylolisthesis Trans-sacral screw Pelvic balance Spinopelvic imbalance

Anterior Surgery in Multilevel Stenosis of the Lower Cervical Spine: Technical Indications and Personal Experience. 12 Years Follow-Up

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International Journal of Clinical Medicine 2014年第4期5卷 157-161页

作者： Alessandro Landi nicola marotta Cristina Mancarella Carlotta Morselli Roberto Tarantino Andrea Ruggeri Roberto Delfini Department of Neurology and Psychiatry Division of Neurosur-gery University of Rome “Sapienza” Roma Italy

Objective: cervical spondylotic myelopathy is a progressive degenerative cervical spine disease. During later stages of segmental degeneration, kyphosis of the cervical spine can occur and further compromise the spinal cord and nerve roots. Optimal surgical approach remains controversial. The choice to perform an anterior, posterior or combined approach depends on: sagittal alignment, number of involved levels, main compression localization, and clinical status. The anterior approach is recommended when compression involves primarily anterior horn of spinal cord. Methods: between January 2001 and December 2005, 121 patients (42 F, 79 M, mean age 62 years) were operated for cervical spondylosis (98 myelopathy, 23 radiculopathy). Anterior surgical approach was performed in 81 patients. 63 patients were operated performing multilevel discectomy and fusion (ACDF) and 18 patients performing corpectomy and fusion and anterior plating (ACCF). Preoperative documentation collected consisted of cervical X-ray (static-dynamic), cervical spine TC, cervical MRI. Clinical documentation permitted us to obtained clinical status of each patient based on JOA, NDI and VAS. A Clinical and radiological follow-up was performed at 1 month, 3 months, 1 year, 6 years, 12 years. Results: the fusion rate was calculated based on the static and dynamic X-ray (flexion and extension position), only a little percentage of patients underwent CT scan. There were no significant differences between ACDF and ACCF in clinical outcome at 6 years evaluated by VAS and NDI. The rate of fusion at 6 years for 2 levels ACCF (92%) was higher than that for 2 levels ACDF (86%) but is not statistically significative. Conclusion: classifying degenerative disease and biomechanics feature, preoperatively in necessary to guide the surgeon to choose the best anterior approach for cervical spondylosis.

关键词： Corpectomy Discectomy Multilevel Cervical Spine

Syringomyelia associated with cervical spondylosis: A rare condition

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World Journal of Clinical Cases 2013年第3期1卷 111-115页

作者： Alessandro Landi Lorenzo Nigro nicola marotta Cristina Mancarella Pasquale Donnarumma Roberto Delfini Division of Neurosurgery Department of Neurology and PsichiatryUniversity of Rome Sapienza00181 RomeItaly

Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finall

关键词： Syringomyelia Cervical spondylosis Syringomyelia surgery Syringomyelia etiology Syringomyelia physiopathology

First description of cervical intradural thymoma metastasis

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World Journal of Clinical Cases 2015年第11期3卷 946-950页

作者： nicola marotta Cristina Mancarella Davide Colistra Alessandro Landi Demo Eugenio Dugoni Roberto Delfini Department of Neurology and Psychiatry Division of Neurosurgery University of Rome "Sapienza"

Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic"(types A, AB, B1, B2, and B3) and "non-organotypic"(thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma.

关键词： Thymoma Metastasis Intradural lesion Spinal tumor Spinal surgery

360° fusion for realignment of high grade cervical kyphosis by one step surgery: Case report

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World Journal of Clinical Cases 2014年第7期2卷 289-292页

作者： Alessandro Landi nicola marotta Cristina Mancarella Demo Eugenio Dugoni Roberto Tarantino Roberto Delfini Department of Neurology and Psychiatry Division of NeurosurgeryUniversity of RomeSapienza00100 RomeItaly

Surgical treatment for cervical kyphotic deformity is still controversial. Circumferential approach has been well described in the literature but long terms outcomes are not well reported. Important to decide the correct treatment option is the preoperative radiological exams to value the type of deformity(flexible or fixed). We report the case of a 67-year-old woman affected by a severe cervical kyphotic deformity who underwent combined anterior/posterior surgical approach, getting a good reduction of the deformity and an optimal stability in a long term follow up.

关键词： Cervical deformity High grade kyphosis Circumferential fusion Surgical technique Degenerative cervical spine

Beneficial effect of refined red palm oil on lipid peroxidation and monocyte tissue factor in HCV-related liver disease： a randomized controlled study

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Hepatobiliary & Pancreatic Diseases International 2016年第2期15卷 165-172页

作者： Roberto Catanzaro nicola Zerbinati Umberto Solimene Massimiliano Marcellino Dheeraj Mohania Angelo Italia Antonio Ayala Francesco marotta Department of Clinical and Experimental Medicine Gastroenterology Section University of Catania Catania Italy CMP-Medical Center & Laboratories Pavia Italy WHO-center for Traditional Medicine & Biotechnology University of Milano Milano Italy ReGenera Research Group for Aging-Intervention Milano Italy Department of Research Sir Ganga Ram Hospital Rajinder Nagar New Delhi India Biochemistry and Molecular Biology Seville University Sevilla Spain

BACKGROUND： A large amount of endotoxin can be detected in the peripheral venous blood of patients with liver cirrhosis, contributing to the pathogenesis of hepatotoxicity because of its role in oxidative stress. The present study aimed to test the effect of the supplementation with red palm oil（RPO）, which is a natural oil obtained from oil palm fruit（Elaeis guineensis） rich in natural fat-soluble tocopherols, tocotrienols and carotenoids, on lipid peroxidation and endotoxemia with plasma endotoxin-inactivating capacity, proinflammatory cytokines profile, and monocyte tissue factor in patients with chronic liver disease. METHODS： The study group consisted of sixty patients（34 males and 26 females; mean age 62 years, range 54-75） with Child A/B, genotype 1 HCV-related cirrhosis without a history of ethanol consumption, randomly enrolled into an 8-week oral daily treatment with either vitamin E or RPO. All patients had undergone an upper gastrointestinal endoscopy 8 months before, and 13 out of them showed esophageal ***： Both treatments significantly decreased erythrocyte malondialdehyde and urinary isoprostane output, only RPO significantly affected macrophage-colony stimulating factor and monocyte tissue factor. Liver ultrasound imaging did not show any change. CONCLUSIONS： RPO beneficially modulates oxidative stress and, not least, downregulates macrophage/monocyte inflammatory parameters. RPO can be safely advised as a valuable nutritional implementation tool in the management of chronic liver diseases.

关键词： endotoxin isoprostane macrophage-colony stimulating factor monocyte tissue factor oxidative stress red palm oil