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. Santa Maria della Misericordia | D'Agostini S.,Unita Operativa di Neuroradiologia | And 4 more authors.
Cortex | Year: 2015

Neuropsychological data about acquired impairments in reading and writing provide a strong basis for the theoretical framework of the dual-route models. The present study explored the functional neuroanatomy of the reading and spelling processing system. We describe the reading and writing performance of patient CF, an Italian native speaker who developed an extremely selective reading and spelling deficit (his spontaneous speech, oral comprehension, repetition and oral picture naming were almost unimpaired) in processing double letters associated with surface dyslexia and dysgraphia, following a tumor in the left temporal lobe. In particular, the majority of CF's errors in spelling were phonologically plausible substitutions, errors concerning letter numerosity of consonants, and syllabic phoneme-to-grapheme conversion (PGC) errors. A similar pattern of impairment also emerged in his reading behavior, with a majority of lexical stress errors (the only possible type of surface reading errors in the Italian language, due the extreme regularity of print-to-sound correspondence). CF's neuropsychological profile was combined with structural neuroimaging data, fiber tracking, and functional maps and compared to that of healthy control participants. We related CF's deficit to a dissociation between impaired ventral/lexical route (as evidenced by a fractional anisotropy - FA decrease along the inferior fronto-occipital fasciculus - IFOF) and relatively preserved dorsal/phonological route (as evidenced by a rather full integrity of the superior longitudinal fasciculus - SLF). In terms of functional processing, the lexical-semantic ventral route network was more activated in controls than in CF, while the network supporting the dorsal route was shared by CF and the control participants. Our results are discussed within the theoretical framework of dual-route models of reading and spelling, emphasize the importance of the IFOF both in lexical reading and spelling, and offer a better comprehension of the neurological and functional substrates involved in written language and, in particular, in surface dyslexia and dysgraphia and in doubling/de-doubling consonant sounds and letters. © 2015 Elsevier Ltd.


Tomasino B.,IRCCS E. Medea | Marin D.,IRCCS E. Medea | Canderan C.,IRCCS E. Medea | Maieron M.,Fisica medica A.O.S. Maria della Misericordia | And 2 more authors.
AIMS Neuroscience | Year: 2014

In the present study we investigated the effects of lesions affecting mainly the anterior insula in a series of 22 patients with lesions in the left hemisphere (LH), and 18 patients with lesions involving the right hemisphere (RH). The site of the lesion was established by performing an overlap of the probabilistic cytoarchitectonic maps of the posterior insula. Here we report the patients' neuropsychological profile and an analysis of their pre-surgical symptoms. We found that pre-operatory symptoms significantly differed in patients depending on whether the lesion affected the right or left insula and a strict parallelism between the patterns emerged in the pre-surgery symptoms analysis, and the patients' cognitive profile. In particular, we found that LH patients showed cognitive deficits. By contrast, the RH patients, with the exception of one case showing an impaired performance at the visuo-spatial planning test were within the normal range in performing all the tests. In addition, a sub-group of patients underwent to the post-surgery follow-up examination.


Tomasino B.,IRCCS E. Medea | Ceschia M.,University of Udine | Fabbro F.,IRCCS E. Medea | Skrap M.,Unita Operativa di Neurochirurgia
Journal of Cognitive Neuroscience | Year: 2012

The role that human motor areas play in linguistic processing is the subject of a stimulating debate. Data from nine neuro-surgical patients with selective lesions of the precentral and postcentral sulcus could provide a direct answer as to whether motor area activation is necessary for action word processing. Action-related verbs (face-, hand-, and feet-related verbs plus neutral verbs) silently read were processed for (i) motor imagery by vividness ratings and (ii) frequency ratings. Although no stimulus- or task-dependent modulation was found in the RTs of healthy controls, patients showed a task × stimulus interaction resulting in a stimulus-dependent somatotopic pattern of RTs for the imagery task. A lesion affecting a part of the cortex that represents a body part also led to slower RTs during the creation of mental images for verbs describing actions involving that same body part. By contrast, no category-related differences were seen in the frequency judgment task. This task-related dissociation suggests that the sensorimotor area is critically involved in processing action verbs only when subjects are simulating the corresponding movement. These findings have important implications for the ongoing discussion regarding the involvement of the sensorimotor cortex in linguistic processing. © 2012 Massachusetts Institute of Technology.


Giannicola G.,Centro Clinico per la Neurostimolazione | Rosa M.,Centro Clinico per la Neurostimolazione | Servello D.,Neurochirurgia Funzionale e Centro Tourette | Menghetti C.,Neurochirurgia Funzionale e Centro Tourette | And 10 more authors.
Experimental Neurology | Year: 2012

Studies describing subthalamic (STN) local field potentials (LFPs) recorded during deep brain stimulation (DBS) in patients with Parkinson's disease (PD), within the first month after DBS electrode implant, show that DBS modulates specific STN oscillations: whereas low-frequency (LF) oscillations (2-7. Hz) increase, beta oscillations (8-30. Hz) variably decrease. No data show whether LFPs remain stable for longer than one month after DBS surgery. Having long-term information is essential especially for use as a long-term feedback control signal for adaptive DBS systems. To evaluate how STN activity behaves years after prolonged chronic stimulation in PD we studied STN LFPs at rest without DBS and during ongoing DBS, in 11 parkinsonian patients 7 years (7.54 ± 1.04) after STN electrode implantation for DBS (hyperchronic group) and in 16 patients 3 days after STN electrode implantation (acute group). STN LF and beta-band LFPs recorded at rest at 7 years contained almost the same information as those recorded at 3 days. STN recordings showed similar LFP responses to DBS in the acute and hyperchronic stages: whereas during ongoing DBS the LF power band increased for the whole population, beta activity decreased only in nuclei with significant beta activity at baseline. The LF/beta power ratio in all nuclei changed in both study groups, suggesting that this variable might be an even more informative marker of PD than the single LF and beta bands. Because STN LFP activity patterns and STN LFP responses to DBS stay almost unchanged for years after DBS electrode implantation they should provide a consistent feedback control signal for adaptive DBS. © 2012 Elsevier Inc.


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.


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.


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.


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.


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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