The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform
Pietro Fiaschi - One of the best experts on this subject based on the ideXlab platform.
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The role of external ventricular drainage for the management of posterior cranial fossa tumours: a systematic review
Neurosurgical Review, 2020Co-Authors: Pasquale Anania, Denise Battaglini, Alberto Balestrino, Alessandro D’andrea, Alessandro Prior, Marco Ceraudo, Diego Criminelli Rossi, Gianluigi Zona, Pietro FiaschiAbstract:Posterior cranial fossa tumours frequently develop hydrocephalus as first presentation in up to 80% of paediatric patients and 21.4% of adults, although it resolves after tumour Removal in 70–90% and 96%, respectively. New onset hydrocephalus is reported in about 2.1% of adult and 10–40% of paediatric patients after posterior fossa surgery. There is no consensus concerning prophylactic external ventricular drainage (EVD) placement that is frequently used before posterior fossa Lesion Removal, as well in those cases without clear evidence of hydrocephalus. The aim of the study was to define the most correct management for patients who undergo posterior fossa tumour surgery, thus identifying cohorts of patients who are at risk of persistent hydrocephalus prior to surgery. A systematic review of literature has been performed, following PRISMA guidelines. Most of the studies reported CSF shunt only in the presence of hydrocephalus, whereas only a few authors suggested its prophylactic use in the absence of signs of ventricular dilatation. Predictive factors for postoperative hydrocephalus has been identified, including young age ( 0.46 and Evans index > 0.4, pseudomeningocele, CSF leak and infection. The use of pre-resection CSF shunt in case of signs and symptoms of hydrocephalus is mandatory, although it resolves in the majority of cases. As reported by several studies included in the present review, we suggest CSF shunt also in case of asymptomatic hydrocephalus, whereas it is not indicated without evidence of ventricular dilatation.
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The role of external ventricular drainage for the management of posterior cranial fossa tumours: a systematic review
Neurosurgical Review, 2020Co-Authors: Pasquale Anania, Denise Battaglini, Alberto Balestrino, Alessandro D’andrea, Alessandro Prior, Marco Ceraudo, Diego Criminelli Rossi, Gianluigi Zona, Pietro FiaschiAbstract:Posterior cranial fossa tumours frequently develop hydrocephalus as first presentation in up to 80% of paediatric patients and 21.4% of adults, although it resolves after tumour Removal in 70–90% and 96%, respectively. New onset hydrocephalus is reported in about 2.1% of adult and 10–40% of paediatric patients after posterior fossa surgery. There is no consensus concerning prophylactic external ventricular drainage (EVD) placement that is frequently used before posterior fossa Lesion Removal, as well in those cases without clear evidence of hydrocephalus. The aim of the study was to define the most correct management for patients who undergo posterior fossa tumour surgery, thus identifying cohorts of patients who are at risk of persistent hydrocephalus prior to surgery. A systematic review of literature has been performed, following PRISMA guidelines. Most of the studies reported CSF shunt only in the presence of hydrocephalus, whereas only a few authors suggested its prophylactic use in the absence of signs of ventricular dilatation. Predictive factors for postoperative hydrocephalus has been identified, including young age ( 0.46 and Evans index > 0.4, pseudomeningocele, CSF leak and infection. The use of pre-resection CSF shunt in case of signs and symptoms of hydrocephalus is mandatory, although it resolves in the majority of cases. As reported by several studies included in the present review, we suggest CSF shunt also in case of asymptomatic hydrocephalus, whereas it is not indicated without evidence of ventricular dilatation.
Francesco Tomasello - One of the best experts on this subject based on the ideXlab platform.
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Cavernous malformation of the optic chiasm: An uncommon location.
Surgical neurology international, 2015Co-Authors: Concetta Alafaci, Giovanni Grasso, Francesca Granata, Mariano Cutugno, Daniele Marino, Francesco M. Salpietro, Francesco TomaselloAbstract:Cavernous malformations (CMs) of the optic chiasm are rare Lesions often presenting with acute chiasmal syndrome or a progressive visual loss. The case of a 48-year-old female with an intrachiasmatic CM is presented. The patient presented with an insidious history of progressive visual loss. Magnetic resonance imaging (MRI) showed a CM in the suprasellar region. The patient was operated via a right pterional approach with a complete Lesion Removal. The postoperative course was uneventful. Early postoperative ophthalmological examination revealed minimal improvement of the vision in the left eye. The clinical, neuroradiological, and intraoperative findings are presented, along with a review of the literature.
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cavernous malformation of the optic chiasm an uncommon location
Surgical Neurology International, 2015Co-Authors: Concetta Alafaci, Giovanni Grasso, Francesca Granata, Mariano Cutugno, Daniele Marino, Francesco M. Salpietro, Francesco TomaselloAbstract:BACKGROUND: Cavernous malformations (CMs) of the optic chiasm are rare Lesions often presenting with acute chiasmal syndrome or a progressive visual loss. The case of a 48-year-old female with an intrachiasmatic CM is presented. CASE DESCRIPTION: The patient presented with an insidious history of progressive visual loss. Magnetic resonance imaging (MRI) showed a CM in the suprasellar region. The patient was operated via a right pterional approach with a complete Lesion Removal. The postoperative course was uneventful. Early postoperative ophthalmological examination revealed minimal improvement of the vision in the left eye. CONCLUSION: The clinical, neuroradiological, and intraoperative findings are presented, along with a review of the literature.
Sergio Cavalheiro - One of the best experts on this subject based on the ideXlab platform.
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Hemorrhagic onset of spinal angiolipoma.
Journal of neurosurgery. Spine, 2014Co-Authors: Marcos Devanir Silva Da Costa, Daniel De Araujo Paz, Thiago Pereira Rodrigues, Ana Camila De Castro Gandolfi, Fabricio Correa Lamis, João Norberto Stávale, Italo Capraro Suriano, Luiz D. Cetl, Sergio CavalheiroAbstract:Spinal angiolipomas are rare benign tumors that generally induce slow progressive cord compression. Here, the authors describe a case of sudden-onset palsy of the lower extremities caused by hemorrhagic spinal angiolipoma. An emergent laminectomy was performed to achieve total Lesion Removal. Follow-up examinations indicated neurological improvement and the absence of recurrence.
Francesco Sardanelli - One of the best experts on this subject based on the ideXlab platform.
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An update on the management of breast atypical ductal hyperplasia
'British Institute of Radiology', 2020Co-Authors: Simone Schiaffino, Andrea Cozzi, Francesco SardanelliAbstract:Among Lesions with uncertain malignant potential found at percutaneous breast biopsy, atypical ductal hyperplasia (ADH) carries both the highest risk of underestimation and the closest and most pathologist-dependent differential diagnosis with ductal carcinoma in situ (DCIS), matching the latter's features save for size only. ADH is therefore routinely surgically excised, but single-centre studies with limited sample size found low rates of upgrade to invasive cancer or DCIS. This suggests the possibility of surveillance over surgery in selected subgroups, considering the 2% threshold allowing for follow-up according to the Breast Imaging Reporting and Data System. A recent meta-analysis on 6458 Lesions counters this approach, confirming that, surgically excised or managed with surveillance, ADH carries a 29% and 5% upgrade rate, respectively, invariably higher than 2% even in subgroups considering biopsy guidance and technique, needle calibre, apparent complete Lesion Removal. The high heterogeneity (I2 = 80%) found in this meta-analysis reaffirmed the need to synthesize evidence from systematic reviews to achieve generalizable results, fit for guidelines development. Limited tissue sampling at percutaneous biopsy intrinsically hampers the prediction of ADH-associated malignancy. This prediction could be improved by using contrast-enhanced breast imaging and applying artificial intelligence on both pathology and imaging results, allowing for overtreatment reduction
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upgrade rate of percutaneously diagnosed pure atypical ductal hyperplasia systematic review and meta analysis of 6458 Lesions
Radiology, 2020Co-Authors: Simone Schiaffino, Andrea Cozzi, Massimo Calabrese, E. Melani, Rubina Manuela Trimboli, Luca A. Carbonaro, Giovanni Di Leo, Francesco SardanelliAbstract:Background Management of percutaneously diagnosed pure atypical ductal hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I2 = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised Lesions and 5% (95% CI: 4%, 8%) for Lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised Lesions (I2 = 78%) rather than those managed with follow-up (I2 = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised Lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete Lesion Removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete Lesion Removal), atypical ductal hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Brem in this issue.
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Upgrade Rate of Percutaneously Diagnosed Pure Atypical Ductal Hyperplasia : Systematic Review and Meta-Analysis of 6458 Lesions
'Radiological Society of North America (RSNA)', 2019Co-Authors: Simone Schiaffino, Massimo Calabrese, E. Melani, Rubina Manuela Trimboli, Luca A. Carbonaro, Giovanni Di Leo, A. Cozzi, Francesco SardanelliAbstract:Background Management of percutaneously diagnosed pure atypical ductal hyperplasia (ADH) is an unresolved clinical issue. Purpose To calculate the pooled upgrade rate of percutaneously diagnosed pure ADH. Materials and Methods A search of MEDLINE and EMBASE databases was performed in October 2018. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines were followed. A fixed- or random-effects model was used, along with subgroup and meta-regression analyses. The Newcastle-Ottawa scale was used for study quality, and the Egger test was used for publication bias. Results Of 521 articles, 93 were analyzed, providing data for 6458 ADHs (5911 were managed with surgical excision and 547 with follow-up). Twenty-four studies used core-needle biopsy; 44, vacuum-assisted biopsy; 21, both core-needle and vacuum-assisted biopsy; and four, unspecified techniques. Biopsy was performed with stereotactic guidance in 29 studies; with US guidance in nine, with MRI guidance in nine, and with mixed guidance in eight. Overall heterogeneity was high (I2 = 80%). Subgroup analysis according to management yielded a pooled upgrade rate of 29% (95% confidence interval [CI]: 26%, 32%) for surgically excised Lesions and 5% (95% CI: 4%, 8%) for Lesions managed with follow-up (P < .001). Heterogeneity was entirely associated with surgically excised Lesions (I2 = 78%) rather than those managed with follow-up (I2 = 0%). Most variability was explained by guidance and needle caliper (P = .15). At subgroup analysis of surgically excised Lesions, the pooled upgrade rate was 42% (95% CI: 31%, 53%) for US guidance, 23% (95% CI: 19%, 27%) for stereotactic biopsy, and 32% (95% CI: 22%, 43%) for MRI guidance, with heterogeneity (52%, 63%, and 56%, respectively) still showing the effect of needle caliper. When the authors considered patients with apparent complete Lesion Removal after biopsy (subgroups in 14 studies), the pooled upgrade rate was 14% (95% CI: 8%, 23%). Study quality was low to medium; the risk of publication bias was low (P = .10). Conclusion Because of a pooled upgrade rate higher than 2% (independent of biopsy technique, needle size, imaging guidance, and apparent complete Lesion Removal), atypical ductal hyperplasia diagnosed with percutaneous needle biopsy should be managed with surgical excision
Marlon Maus - One of the best experts on this subject based on the ideXlab platform.
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Lasers in oculoplastic surgery.
Current opinion in ophthalmology, 1995Co-Authors: Marlon MausAbstract:Applications of laser-assisted surgery in oculoplastics are varied because the enormous scope of the specialty overlaps with ear, nose and throat, dermatology, plastic surgery, and ophthalmology, for example. All of these specialties have applications for lasers that in one fashion or another find their way into our armamentarium. In this article we present the last year's advances in laser applications in oculoplastics. By far, endonasal dacryocystorhinostomies are the most controversial and interest producing. Several articles address different approaches and conclusions. No final determination is available yet as to the effectiveness and ultimate success of this procedure. Dermatologic surgery for Lesion Removal and for cosmetic surgery also features in this year's review. The use of lasers for tattoo Removal was reported in detail in a superb article. Overall there were no major breakthroughs in laser surgery, however, several well-thought-out articles have added to our understanding of this surgical modality.