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Valentini L.G.,Fondazione Istituto Neurologico Carlo Besta
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology | Year: 2011

The surgical results of this series of occult spina bifida seem better than the natural history registered in the long pre-operative period in terms of neurological deterioration. The major contribution to this result is attributed to neurophysiological monitoring that lowers the risks of permanent damage and increases the percentage of effective detethering. The present series of TCS, due to conus and filar lipoma, documents that CM1 is a really rare association occurring in less than 6% of the patients, despite the low position of conus. The detethering procedure did not influence the tonsillar position, thus excluding the correlation between the tethering and the tonsillar descent. The genetic alteration documented in a girl reinforces the hypothesis of a rare complex polymaformative picture deserving multiple procedures according to the prevailing clinical symptoms.

Boncoraglio G.B.,Fondazione Istituto Neurologico Carlo Besta
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Studies in animal models of ischemic stroke have shown that stem cells transplanted into the brain can lead to functional improvement. However, to date, evidence for the benefits of stem cell transplantation in ischemic stroke patients is lacking. OBJECTIVES: To assess the efficacy and safety of stem cell transplantation compared with conventional treatments in patients with ischemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched February 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (1966 to August 2008), EMBASE (1980 to August 2008), Science Citation Index (1900 to August 2008), and BIOSIS (1926 to August 2008). We handsearched potentially relevant conference proceedings, screened reference lists, and searched ongoing trials and research registers (last searched November 2008). We also contacted individuals active in the field and stem cell manufacturers (last contacted December 2008). SELECTION CRITERIA: We included randomized controlled trials (RCTs) recruiting patients with ischemic stroke, in any phase of the disease, and an ischemic lesion confirmed by computerized tomography or magnetic resonance imaging scan. We included all types of stem cell transplantation regardless of cell source (autograft, allograft, or xenograft; embryonic, fetal, or adult; from brain or other tissues), route of cell administration (systemic or local), and dosage. The primary outcome was efficacy (assessed as combined functional outcome or disability and dependency) at longer follow-up (minimum six months). Secondary outcomes included post-procedure safety outcomes (death, worsening of neurological deficit, infections and neoplastic transformation). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We contacted study authors for additional information. MAIN RESULTS: We identified three very small RCTs. Two are still awaiting classification because only subgroups of patients could be included in this meta-analysis and additional unpublished data are needed. The third trial randomized 30 patients to intravenous transplantation of autologous mesenchymal stem cell (10 participants) or reference group (20 participants) (five participants, initially randomized to the intervention group, refused the treatment and were allocated to the reference group) and found a statistically non-significant functional improvement in treated patients at longer follow-up. No adverse cell-related events were reported. AUTHORS' CONCLUSIONS: No large trials of stem cell transplantation have been performed in ischemic stroke patients and it is too early to know whether this intervention can improve functional outcome. Large, well-designed trials are needed.

Aronica E.,University of Amsterdam | Aronica E.,SEin Epilepsy Institute in the Netherlands Foundation | Becker A.J.,University of Bonn | Spreafico R.,Fondazione Istituto Neurologico Carlo Besta
Brain Pathology | Year: 2012

Structural abnormalities of the brain are increasingly recognized in patients that suffer from pharmacoresistant focal epilepsies by applying high-resolution imaging techniques. In many of these patients, epilepsy surgery results in control of seizures. Neuropathologically, a broad spectrum of malformations of cortical development (MCD) is observed in respective surgical brain samples. These samples provide a unique basis to further understand underlying pathomechanisms by molecular approaches and develop improved diagnostics and entirely new therapeutic perspectives. Here we provide a comprehensive description of neuropathological findings, available classification systems as well as molecular mechanisms of MCDs. We emphasize the recently published ILEA classification system for focal cortical dysplasias (FCDs), which are now histopathologically distinguished as types I to III. However, this revised classification system represents a major challenge for molecular neuropathologists, as the underlying pathomechanisms in virtually all FCD entities will need to be specified in detail. The fact that only recently, the mammalian target of rapamycin (mTOR)-antagonist Everolimus has been introduced as a treatment of epilepsies in the context of tuberous sclerosis-associated brain lesions is a striking example of a successful translational "bedside to bench and back" approach. Hopefully, the exciting clinicopathological developments in the field of MCDs will in short term foster further therapeutic breakthroughs for the frequently associated medically refractory epilepsies. © 2012 The Authors; © 2012 International Society of Neuropathology.

Ferroli P.,Fondazione Istituto Neurologico Carlo Besta
Acta neurochirurgica. Supplement | Year: 2011

To investigate the application of indocyanine green (ICG) videoangiography during microsurgery for central nervous system (CNS) tumors. One hundred patients with CNS tumors who underwent microsurgical resection from December 2006 to December 2008 were retrospectively analyzed. The diagnosis was high grade glioma in 54 cases, low grade in 17 cases, meningioma in 14 cases, metastasis in 12 cases and hemangioblastoma in 3 cases. Overall, ICG was injected intraoperatively 194 times. The standard dose of 25mg of dye was injected intravenously and intravascular fluorescence from within the blood vessels was imaged through an ad hoc microscope with dedicated software (Pentero, Carl Zeiss Co., Oberkochen, Germany). Pre-resection and post-resection arterial, capillary and venous ICG videoangiographic phases were intraoperatively observed and recorded. ICG videangiography allowed for a good evaluation of blood flow in the tumoral and peritumoral exposed vessels in all cases. No side effects due to ICG were observed. ICG video-angiography is a significant method for monitoring blood flow in the exposed vessels during microsurgical removal of CNS tumors. Pre-resection videoangiography provides useful information on the tumoral circulation and the pathology-induced alteration in surrounding brain circulation. Post-resection examination allows for an immediate check of patency of those vessels that are closely related to the tumor mass and that the surgeon does not want to damage.

Filippini G.,Fondazione Istituto Neurologico Carlo Besta
Handbook of Clinical Neurology | Year: 2012

The descriptive epidemiology of primary central nervous system (CNS) tumors is based on population-based cancer registries that include tumors of the brain, cranial nerves, cerebral meninges, spinal cord, and spinal meninges. Malignant CNS tumors in adults account for 1.7% of new cancers and 2.1% of cancer deaths. In Europe, Australia/New Zealand, and North America there are 7.5-14 new cases per 100. 000 population per year in males, and 4-11 new cases in females. Incidence rates of benign and borderline CNS tumors are available from the Surveillance, Epidemiology, and End Results (SEER) Program for the time period 1975-2004: incidence was 8.1 new cases per 100. 000 population per year in males, and 12.1 in females. Incidence and mortality significantly increased in white males and females from 1975-1991; subsequently, the incidence remained steady, and mortality decreased significantly from 1992-2004. In population-based studies less than 5% of glioma risk is hereditary. Well-identified genetic syndromes that include primary brain tumors (PBTs) are most often autosomal dominant, and have variable penetrance. The most common syndrome is neurofibromatosis type 1. Ionizing radiation has a proven etiological role in experimental studies in monkeys and primates and, as a late complication of therapeutic X-irradiation, in humans. Extensive epidemiological research conducted during the past 20 years on occupational electromagnetic field exposure did not indicate strong or consistent associations with adult PBTs. The WHO/IARC has classified RF electromagnetic fields as possibly carcinogenic to humans (Group 2B) based on an increased risk for glioma associated with wireless phone use. Additional research needs to be conducted into the long-term use of mobile phones. © 2012 Elsevier B.V.

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