Unita Operativa di Neurochirurgia

Santa Maria della Versa, Italy

Unita Operativa di Neurochirurgia

Santa Maria della Versa, Italy

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Tomasino B.,IRCCS E. Medea | Marin D.,IRCCS E. Medea | Maieron M.,Fisica Medica A.O.S. Maria della Misericordia | Ius T.,Unita Operativa di Neurochirurgia | And 4 more authors.
Cortex | Year: 2013

The present study explored the functional neuroanatomy of Foreign Accent Syndrome (FAS) in an Italian native speaker who developed an altered speech rhythm and melody following a circumscribed tumour to the left precentral gyrus. Structural, functional, fibre tracking and intraoperative findings were combined. No signs of dysarthria, apraxia of speech, or aphasia nor other cognitive deficits were detected, except for the fact that the patient was perceived as a non-native speaker. The patient fMRI maps were compared with a control group of 12 healthy controls. During counting, sentences and pseudoword pronunciation the patient showed an additional increased sparse activation in areas around the pre/postcentral gyrus corresponding to those involved in phonation (i.e., larynx motor area). The intraoperative cortical stimulation mapping evidenced a mouth motor representation close to the tumour, a motor type of speech arrest site just below it, and anteriorly a proper speech arrest site. Our results are discussed within the current neurolinguistic models of speech production, and emphasize the importance of the primary motor cortex. We argue that this FAS case should be thought of as a disorder of the feedforward control commands, in particular of the articulator velocity and position maps which are hypothesized to lie along the caudoventral portion of the precentral gyrus. © 2011 Elsevier Ltd.


PubMed | University of Udine, IRCCS E. Medea, Unita Operativa di Neurochirurgia and Unita Operativa di Neurologia
Type: | Journal: Brain research | Year: 2014

We explored implicit motor simulation processes in Parkinsons Disease (PD) patients with ON-OFF subthalamic deep brain stimulation (DBS) of the sub-thalamic nucleus (STN). Participants made lexical decisions about hand action-related verbs, abstract verbs, and pseudowords presented either within a positive (e.g., Do ) or a negative (e.g., Dont ) sentence context. Healthy controls showed significantly slower responses for hand-action verbs (vs. abstract verbs) in the negative (vs. positive) context, which suggests that negative contexts may suppress motor simulation or preparation processes. The STN-DBS improves cortical motor functions, thus patients are expected to perform at the same level as unimpaired subjects in the ON condition. By contrast, the 50% reduced DBS is expected to result in a reduced activation for motor information, which in turn might cause a reduced, if not absent, context modulation. PD patients exhibited the same pattern as controls when their DBS was at 100% ON; however, reducing the DBS to 50% had a deleterious outcome on the positive faster than negative context effect, suggesting that the altered inhibition mechanism in PD could be responsible for the missed effect. In addition, our results confirm the view that implicit motor simulation mechanisms behind action-related verb processing are flexible and context-dependent.


Fabbri A.,Presidio | Servadei F.,Unita Operativa di Neurochirurgia | Marchesini G.,University of Bologna | Stein S.C.,University of Pennsylvania | Vandelli A.,Presidio
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2010

Background: The effect of pre-injury antiplatelet treatment in the risk of intracranial lesions in subjects after mild head injury (Glasgow Coma Scale (GCS) 14-15) is uncertain. Methods: The potential risk was determined, considering its increasing use in guidelines on cardiovascular disease prevention, and ageing of the trauma population in Europe. Patients: The interaction of antiplatelet therapy with the prediction variables of main decision aids was analysed in 14 288 consecutive adolescent and adult subjects with mild head injury. Measurements: Any intracranial lesion at CT scan was selected as an outcome measure in a multivariable logistic regression analysis. Results: Intracranial lesions were demonstrated in 880 cases (6.2%), with an unfavourable outcome at 6 months in 86 (0.6%). Antiplatelet drugs were recorded in 10% of the entire cohort (24.7% in the group over 65 years). They increased the risk of intracranial lesions in the univariate analysis (OR 2.6; 95% CI 2.2 to 3.1), interacting with age in the multivariate analysis (antiplatelet OR 2.7 (1.9 to 3.7); age ≥75 years 1.4 (1.0 to 1.9)). The inclusion of these two variables with those included in previous decision aids for CT scanning (GCS, neurodeficit, post-traumatic seizures, suspected skull fracture, vomiting, loss of consciousness, coagulopathy) predicted intracranial lesions with a sensitivity of 99.7% (95% CI 98.9 to 99.8) and a specificity of 54.0% (95% CI 53.1 to 54.8), with a CT ordering rate of 49.3% (undetermined events 0.2:1000). Interpretation: Antiplatelet drugs need to be considered in future prediction models on mild head injury, considering their increasing use and progressive ageing of the trauma population.


Provinciali L.,Marche Polytechnic University | Lattanzi S.,Marche Polytechnic University | Chiarlone R.,S.S. di Brachiterapia Presso Science di Radioterapia Ospedale S. Paolo | Fogliardi A.,Unita Operativa di Terapia del Dolore e Cure Palliative | And 6 more authors.
Minerva Medica | Year: 2014

The treatment of neuropathic pain is a medical challenge. The responsiveness to the different classes of drugs is often unsatisfactory and frequently associated to a wide range of side effects. International guidelines suggest for the "localized" neuropathic pain the topical treatment with 5% lidocaine medicated plaster, alone or associated to systemic drugs, as the first choice since its favorable efficacy and tolerability profile. Many clinical experiences support the rationale for using 5% lidocaine medicated plaster in different kinds of localized neuropathic pain, such as postherpetic and trigeminal neuralgia, compressive syndromes, painful diabetic polyneuropathy and pain secondary to trauma or surgical interventions. This paper reports a series of clinical cases whose heterogeneity suggests the wide burden of applicability of the topical 5% lidocaine, either alone and associated to systemic drugs. All the described conditions were characterized by a highly intense pain, not adequately controlled by actual medications, which improved after the use of topical lidocaine. The good response to lidocaine allowed the reduction, of even the withdrawal, of concurrent drugs and improved the patients' quality of life.


Tomasino B.,University of Udine | Fregona S.,University of Trieste | Skrap M.,Unita Operativa di Neurochirurgia | Fabbro F.,University of Udine
Frontiers in Human Neuroscience | Year: 2013

The brain network governing meditation has been studied using a variety of meditation practices and techniques practices eliciting different cognitive processes (e.g., silence, attention to own body, sense of joy, mantras, etc.). It is very possible that different practices of meditation are subserved by largely, if not entirely, disparate brain networks. This assumption was tested by conducting an activation likelihood estimation (ALE) meta-analysis of meditation neuroimaging studies, which assessed 150 activation foci from 24 experiments. Different ALE meta-analyses were carried out. One involved the subsets of studies involving meditation induced through exercising focused attention (FA). The network included clusters bilaterally in the medial gyrus, the left superior parietal lobe, the left insula and the right supramarginal gyrus (SMG). A second analysis addressed the studies involving meditation states induced by chanting or by repetition of words or phrases, known as "mantra." This type of practice elicited a cluster of activity in the right SMG, the SMA bilaterally and the left postcentral gyrus. Furthermore, the last analyses addressed the effect of meditation experience (i.e., short- vs. long-term meditators). We found that frontal activation was present for short-term, as compared with long-term experience meditators, confirming that experts are better enabled to sustain attentional focus, rather recruiting the right SMG and concentrating on aspects involving disembodiment. © 2013 Tomasino, Fregona, Skrap and Fabbro.


PubMed | Instituto Of Ricovero E Cura A Carattere Scientifico E Medea, Unita Operativa di Neuroradiologia, Fisica Medica A.O.S. Maria della Misericordia Udine and Unita Operativa di Neurochirurgia
Type: | Journal: Frontiers in human neuroscience | Year: 2015

Our environment is full of auditory events such as warnings or hazards, and their correct recognition is essential. We explored environmental sounds (ES) recognition in a series of studies. In study 1 we performed an Activation Likelihood Estimation (ALE) meta-analysis of neuroimaging experiments addressing ES processing to delineate the network of areas consistently involved in ES processing. Areas consistently activated in the ALE meta-analysis were the STG/MTG, insula/rolandic operculum, parahippocampal gyrus and inferior frontal gyrus bilaterally. Some of these areas truly reflect ES processing, whereas others are related to design choices, e.g., type of task, type of control condition, type of stimulus. In study 2 we report on 7 neurosurgical patients with lesions involving the areas which were found to be activated by the ALE meta-analysis. We tested their ES recognition abilities and found an impairment of ES recognition. These results indicate that deficits of ES recognition do not exclusively reflect lesions to the right or to the left hemisphere but both hemispheres are involved. The most frequently lesioned area is the hippocampus/insula/STG. We made sure that any impairment in ES recognition would not be related to language problems, but reflect impaired ES processing. In study 3 we carried out an fMRI study on patients (vs. healthy controls) to investigate how the areas involved in ES might be functionally deregulated because of a lesion. The fMRI evidenced that controls activated the right IFG, the STG bilaterally and the left insula. We applied a multimodal mapping approach and found that, although the meta-analysis showed that part of the left and right STG/MTG activation during ES processing might in part be related to design choices, this area was one of the most frequently lesioned areas in our patients, thus highlighting its causal role in ES processing. We found that the ROIs we drew on the two clusters of activation found in the left and in the right STG overlapped with the lesions of at least 4 out of the 7 patients lesions, indicating that the lack of STG activation found for patients is related to brain damage and is crucial for explaining the ES deficit.


Maieron M.,Fisica Medica | Marin D.,IRCCS E. Medea | Fabbro F.,IRCCS E. Medea | Fabbro F.,University of Udine | Skrap M.,Unita Operativa di Neurochirurgia
Frontiers in Human Neuroscience | Year: 2013

The relation between the sensorimotor cortex and the language network has been widely discussed but still remains controversial. Two independent theories compete to explain how this area is involved during action-related verbs processing. The embodied view assumes that action word representations activate sensorimotor representations which are accessed when an action word is processed or when an action is observed. The abstract hypothesis states that the mental representations of words are abstract and independent of the objects, sensorimotor properties they refer to. We combined neuropsychological and fMRI-PPI connectivity data, to address action- related verbs processing in neurosurgical patients with lesions involving (N=5) or sparing (N=5) the primary motor cortex and healthy controls (N=12). A lack of significant changes in the functional coupling between the left M1 cortex and functional nodes of the linguistic network during the verb generation task was found for all the groups. In addition, we found that the ability to perform an action verb naming task was not related to a damaged M1. These data showed that there was not a task-specific functional interaction active between M1 and the inferior frontal gyrus. We will discuss how these findings indicate that action words do not automatically activate the M1 cortex; we suggest rather that its enrolment could be related to other not strictly linguistic processing. © 2013 Maieron, Marin, Fabbro and Skrap.


PubMed | IRCCS E. Medea and Unita Operativa di Neurochirurgia
Type: Journal Article | Journal: Journal of neurosurgery | Year: 2016

OBJECTIVE Awake surgery and mapping are performed in patients with low-grade tumors infiltrating functional brain areas for which the greater the resection, the longer the patient survival. However, the extent of resection is subject to preservation of cognitive functions, and in the absence of proper feedback during mapping, the surgeon may be less prone to perform an extensive resection. The object of this study was to perform real-time continuous assessment of cognitive function during the resection of tumor tissue that could infiltrate eloquent tissue. METHODS The authors evaluated the use of new, complex real-time neuropsychological testing (RTNT) in a series of 92 patients. They reported normal scoring and decrements in patient performance as well as reversible intraoperative neuropsychological dysfunctions in tasks (for example, naming) associated with different cognitive abilities. RESULTS RTNT allowed one to obtain a more defined neuropsychological picture of the impact of surgery. The influence of this monitoring on surgical strategy was expressed as the mean extent of resection: 95% (range 73%-100%). At 1 week postsurgery, the neuropsychological scores were very similar to those detected with RTNT, revealing the validity of the RTNT technique as a predictive tool. At the follow-up, the majority of neuropsychological scores were still > 70%, indicating a decrease of < 30%. CONCLUSIONS RTNT enables continuous enriched intraoperative feedback, allowing the surgeon to increase the extent of resection. In sharp contrast to classic mapping techniques, RTNT allows testing of several cognitive functions for one brain area under surgery.


Skrap M.,Unita Operativa di Neurochirurgia | Marin D.,IRCCS E. Medea | Ius T.,Unita Operativa di Neurochirurgia | Fabbro F.,IRCCS E. Medea | Tomasino B.,IRCCS E. Medea
Journal of Neurosurgery | Year: 2016

Objective: Awake surgery and mapping are performed in patients with low-grade tumors infiltrating functional brain areas for which the greater the resection, the longer the patient survival. However, the extent of resection is subject to preservation of cognitive functions, and in the absence of proper feedback during mapping, the surgeon may be less prone to perform an extensive resection. The object of this study was to perform real-time continuous assessment of cognitive function during the resection of tumor tissue that could infiltrate eloquent tissue. Methods: The authors evaluated the use of new, complex real-time neuropsychological testing (RTNT) in a series of 92 patients. They reported normal scoring and decrements in patient performance as well as reversible intraoperative neuropsychological dysfunctions in tasks (for example, naming) associated with different cognitive abilities. Results: RTNT allowed one to obtain a more defined neuropsychological picture of the impact of surgery. The influence of this monitoring on surgical strategy was expressed as the mean extent of resection: 95% (range 73%-100%). At 1 week postsurgery, the neuropsychological scores were very similar to those detected with RTNT, revealing the validity of the RTNT technique as a predictive tool. At the follow-up, the majority of neuropsychological scores were still > 70%, indicating a decrease of < 30%. Conclusions: RTNT enables continuous enriched intraoperative feedback, allowing the surgeon to increase the extent of resection. In sharp contrast to classic mapping techniques, RTNT allows testing of several cognitive functions for one brain area under surgery. © AANS, 2016.


Amato V.,Unita Operativa di Neurochirurgia | Giannachi L.,Unita Operativa di Neurochirurgia | Irace C.,Unita Operativa di Neurochirurgia | Corona C.,Unita Operativa di Neurochirurgia
Journal of Neurosurgery: Spine | Year: 2010

Object. The goal of this study was to determine the incidence of screw misplacement and complications in a group of 102 patients who underwent transpedicle screw fixation in the lumbosacral spine with conventional open technique and intraoperative fluoroscopy. The results are compared with published data. Methods. Cases involving 102 consecutive patients (424 inserted screws) were reviewed. Surgery was performed in all cases by the same surgeon's team, using the same implant, and all results were assessed by means of a specific CT protocol. The screw position was assessed by the authors and an independent observer. Screw position was classified as correct when the screw was completely surrounded by the pedicle cortex, as "cortical encroachment" (questionable violation) if the pedicle cortex could not be visualized, and as "frank penetration" when the screw was outside the pedicular boundaries. Frank penetration was further subdivided as minor (when the edge of the screw thread was up to 2.0 mm outside the pedicle cortex), moderate (2.1-4 mm), and severe (> 4 mm). The incidence of intra- and postoperative complications not related to screw position as well as hardware failures were also registered, with a minimum follow-up duration of 8 months. Results. The rate of frank pedicle screw misplacement was 5%. The rate of minimal or questionable pedicle wall violation was 2.8%. Among the frank misplacements, 6 were classified as minor, 12 as moderate, and 3 as severe penetration. Two patients (2%) had radicular pain and neurological deficits (inferomedial and inferolateral minor misplacement at L-4 and L-5, respectively), and 5 patients (4.9%) complained only of radicular pain. At the followup examination all patients had completely recovered their neurological function and radicular pain was resolved in all cases. The complications not related to screw malposition were 2 pedicle fractures (2% of patients), 1 nerve root injury (1%), and 1 dural laceration (1%). Five patients (4.8%) had postoperative anemia and required transfusions. Superficial or deep wound infection was noted in 3 patients (2.9%). Late hardware failure occurred in 2 patients (2%). One patient developed adjacent segmental instability and required additional surgery to extend the fusion. Conclusions. Our rates of screw misplacement and complications compare favorably with the lowest rates of the series in which conventional technique was used and are close to the rates reported for image-guided methods. The risk of malpositioning may be reduced with careful preoperative surgical planning, accurate knowledge of the spinal anatomy, surgical experience, and correct indication for conventional surgery. The conventional technique still remains a practical, safe, and effective surgical method for lumbosacral fixation.

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