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Esposito F.,Messina University | Di Rocco F.,University of Paris Descartes | Zada G.,University of Southern California | Cinalli G.,Santobono Pausilipon Childrens Hospital | And 5 more authors.
World Neurosurgery | Year: 2013

Background During the past decade, endoscopic intraventricular and skull base operations have become widely used for a variety of evolving indications. A global survey of practicing endoscopic neurosurgeons was performed to characterize patterns of usage regarding endoscopy equipment, instrumentation, and the indications for using image-guided surgery systems (IGSs). Methods An online survey consisting of 8 questions was completed by 235 neurosurgeons with endoscopic surgical experience. Responses were entered into a database and subsequently analyzed. Results The median number of operations performed per year by intraventricular and skull base endoscopic surgeons was 27 and 25, respectively. Data regarding endoscopic equipment brand, diameter, and length are presented. The most commonly reported indications for IGSs during intraventricular endoscopic surgery were tumor biopsy/resection, intraventricular cyst fenestration, septostomy/pellucidotomy, endoscopic third ventriculostomy, and aqueductal stent placement. Intraventricular surgeons reported using IGSs for all cases in 16.6% and never in 24.4%. Overall, endoscopic skull base surgeons reported using IGSs for all cases in 23.9% and never in 18.9%. The most commonly reported indications for IGSs during endoscopic skull base operations were complex sinus/skull base anatomy, extended approaches, and reoperation. Conclusions Many variations and permutations for performing intraventricular and skull base endoscopic surgery exist worldwide. Much can be learned by studying the patterns and indications for using various types of equipment and operative adjuncts such as IGSs. © 2013 Elsevier Inc. All rights reserved. Source

Rosa M.,University of Naples Federico II | Pascarella A.,University of Naples Federico II | Parenti G.,University of Naples Federico II | Buono S.,Santobono Pausilipon Childrens Hospital | And 6 more authors.
European Journal of Paediatric Neurology | Year: 2012

Purpose: evaluate the psychomotor evolution of a child with Multiple acyl-CoA dehydrogenase deficiency after treatment with L-carnitine, ubiquinone and riboflavin. Methods: an assessment of psychomotor development was performed before the start of farmacological treatment using the Assessment Scale of Mental Development Griffiths (GMDS-R, 0-2 years). The same assessment was performed after a month and after six months of treatment to evaluate the possible benefits of treatment. Results: we noticed a quick and dramatic improvement in muscular tone and motor performances after pharmacological treatment. We also observed a substantial improvement in the personal/social and hearing/language areas, suggesting the presence of intellectual/cognitive improvement. The clinical improvement correlated with the biochemical response. Conclusion: In our patient early therapy resulted in a optimal response in psychomotor development, motor function and muscole hypotonia. Evaluation with GMDS-R, a simple, non-invasive and multidimensional tool, represents a useful instrument to monitor the clinical response to treatment. © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. Source

D'Ascanio L.,Citta di Castello Civil Hospital | D'Ascanio L.,University of Rome La Sapienza | Lancione C.,Citta di Castello Civil Hospital | Pompa G.,University of Rome La Sapienza | And 3 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2010

Objective: Nasal-breathing impairment has been described as a possible determinant of maxillofacial development in children with adenoids/tonsils hypertrophy. However little is known about the possible influence of nasal septum deviation on craniofacial growth in childhood. We conducted a multicenter cephalometric study to compare skeletal and dental features in children with chronic nasal-breathing obstruction secondary to nasal septum deviation and nose-breathing controls. Methods: Ninety-eight children (59M, 39F; mean age 8.8 years; age range 7-12 years) with obligate mouth-breathing secondary to nasal septum deviation (group 1) and 98 age- and sex-matched nasal-breathing controls (group 2) were evaluated. Nasal-breathing function was assessed in all patients with clinical history, ENT instrumental examination and anterior active rhinomanometry. Cephalometric parameters were recorded in all subjects. Results: Patients of group 1 showed a statistically significant increase of upper anterior facial height (N-palatal plane) and total anterior facial height (N-Me) with regards to group 2. The angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in group 1 in comparison to controls. The gonial angle (Ar-Go-Me), palatal height and overjet were significantly higher in the mouth-breathing group. A significantly retrognatic position of the maxilla and mandible was recorded in group 1 in comparison to group 2. Most mouth-breathing children showed class II malocclusion, while the majority of control subjects presented normal occlusion. The prevalence of cross-bite was higher in group 1 with respect to controls (p= 0.02). Conclusion: Children with obligate mouth-breathing due to nasal septum deviations show facial and dental anomalies in comparison to nose-breathing controls. Possible physiologic explanations of our findings are reported. © 2010 Elsevier Ireland Ltd. Source

Terlizzi V.,University of Naples Federico II | Improta F.,University of Naples Federico II | Di Fraia T.,S. Maria Delle Grazie Pozzuoli Hospital | Sanguigno E.,S. Maria Delle Grazie Pozzuoli Hospital | And 4 more authors.
Journal of Clinical Neuroscience | Year: 2014

We describe, to our knowledge, the first case of arterial ischemic stroke after primary herpes simplex virus type 1 (HSV1) infection in a previously healthy child, without signs of encephalitis. A 10-year-old previously healthy girl was admitted to our hospital with acute left-sided hemiparesis which involved the lower half of her face. Submandibular lymphadenitis and oral vesicular lesions were present. MRI confirmed the suspicion of an acute ischemic stroke. Immunoglobulin M antibodies to HSV1 were detected. Cerebrospinal fluid polymerase chain reaction for herpes virus was negative. She was treated with aspirin (3 mg/kg) and intravenous acyclovir (10 mg/kg every 8 hours) for 21 days. Immunoglobulin G antibodies to HSV1 appeared 16 days after admission. Twelve months after her hospitalization the patient's examination was normal. Stroke should be considered a possible complication of HSV1 primary infection. Guidelines for the management of acute stroke in children are needed. © 2014 Elsevier Ltd. All rights reserved. Source

Roth J.,Tel Aviv University | Chaichana K.L.,Johns Hopkins Childrens Center | Jallo G.,Johns Hopkins Childrens Center | Mirone G.,Santobono Pausilipon Childrens Hospital | And 2 more authors.
Acta Neurochirurgica | Year: 2015

Background: Pure aqueductal tumors (ATs) differ from pineal region and tectal/tegmental tumors in that they are epicentered within the aqueduct. Nevertheless, these tumors are rarely described as a separate type of tumor, and are often grouped with other lesions located in the same vicinity. The present multicenter study focuses on our experience treating patients with pure ATs.Methods: Data from three large tertiary centers was collected retrospectively, including presenting symptoms, treatment paradigm, surgical approaches, pathology, and outcome.Results: Between 1999 and 2013, 16 patients with AT were diagnosed and treated at the three tertiary centers. Ages at presentation ranged from 5.5 to 57 years. Thirteen patients presented with hydrocephalus-related symptoms, and two were identified incidentally. Thirteen patients underwent an endoscopic third ventriculostomy, and two of these underwent a simultaneous endoscopic biopsy (one grade II ependymoma, one non-specified low-grade glioma). Two others underwent shunt placement. Three patients underwent resection due to tumor progression. Pathologies included glioblastoma multiforme, glioneural tumor, and ependymoma grade II. All non-resected tumors remained stable or grew only minimally.Conclusions: ATs are a rare entities that usually present with obstructive hydrocephalus. Treatment includes primarily cerebrospinal fluid drainage (preferably via an endoscopic third ventriculostomy). Simultaneous endoscopic biopsy may be done in selected cases. Tumor resection should be reserved for growing tumors; the trans-fourth ventricular or trans-choroidal approaches are probably safer than other approaches used to reach the tectal region. © 2014, Springer-Verlag Wien. Source

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