Papers by Roberto Gazzeri
Neurosurgical review, Jan 20, 2017
Chronic subdural hematoma (CSDH) with brain herniation signs is rarely seen in the emergent depar... more Chronic subdural hematoma (CSDH) with brain herniation signs is rarely seen in the emergent department. As such, there are few cumulative data to analyze such cases. In this study, we evaluated the clinical features, risk factors, and rates of completion with impending brain herniation on arrival in a cohort study. We analyzed 492 consecutive patients with CSDH between January 2010 and October 2015. First, we analyzed the clinical factors and compared them between patients with or without brain herniation signs on admission. Second, we compared clinical factors between patients with or without completion of brain herniation after operation among patients who had brain herniation signs on arrival. Eleven (2.2%) patients showed brain herniation signs on arrival, and six patients (1.2%) progressed to complete brain herniation. Patients with brain herniation signs on arrival were significantly older (P = 0.03) and more frequently hospitalized with a concomitant illness (P < 0.0001). ...
Journal of neurosurgery, Nov 1, 2016
O steOpOrOsis is a major global health problem, with more than 10 million people currently diagno... more O steOpOrOsis is a major global health problem, with more than 10 million people currently diagnosed with this ailment. 2,14 Although 80% of patients with osteoporosis are women, a considerable number of men are also affected. Due to increasing life expectancy, the number of elderly patients with osteoporosis affected by spinal diseases will continue to grow. Osteoporosis reduces bone quality through negative bone remodeling, predisposing patients to spinal fracture, deformity, and stenosis; thus, surgical correction of these problems in such patients is difficult. Although pedicle screws are the most commonly used device to achieve posterior fixation in the thoracic and lumbar spine, their use is relatively contrain-dicated in patients with osteoporosis because of the risk of failure at the bone-screw interface, leading to screw pullout, loosening, and migration. 11,19,23 Major complications include pseudarthrosis, and hardware failure secondary to poor fixation in osteoporotic bone. Obtaining adequate screw purchase remains a challenge in poor bone quality. As a result, a variety of methods have been developed to improve pedicle screw fixation in the osteoporotic spine. These include the use of bigger and longer screws, optimizing the pedicle fit of the screw, undertapping the screw trajectory, and selecting the optimal screw trajectory. 1,30 Nevertheless, implant failure still occurs with increasing frequency. To enforce the construct anchorage in weak abbreviationS BMD = bone mineral density; CaP = calcium phosphate; DEXA = dual-energy x-ray absorptiometry; ODI = Oswestry Disability Index; PMMA = polymethylmethacrylate; VAS = visual analog scale.
PubMed, Apr 1, 2016
The need for spinal fixation in patients who cannot tolerate classical open surgery has led in re... more The need for spinal fixation in patients who cannot tolerate classical open surgery has led in recent years to the development of minimally invasive approaches. The use of percutaneous pedicle screw fixation offers several advantages, such as less blood loss and postoperative pain due to blunt separation of the muscles with reduction of soft tissue dissection. Medical records and demographic information, diagnosis, and preoperative pain levels of 63 patients who underwent percutaneous minimally invasive thoracolumbar spine stabilization using the Illico® Fixation System (Alphatec Spine, Carlsbad, California) were analysed: a total of 344 screws were implanted. Preoperative and postoperative clinical assessment of the patients were based on a visual analogue scale. Because percutaneous techniques do not allow gross visualization of the vertebra and erroneous placement of the screw may be high in the initial cases, we discuss the techniques for a safe implantation of pedicle screws using a single or double intraoperative fluoroscopy. We report tips and tricks for technical challenges including fixation in osteoporotic patients, percutaneous insertion of long rods, compression/distraction using multiaxial screws turning into monoaxial, and use of minimally invasive retractror for interbody fusion. Recently, indications for minimally invasive percutaneous fixation have expanded and my results support that it may be considered a safe and effective option for the treatment of degenerative and traumatic thoracolumbar spinal diseases.
PubMed, Mar 1, 2001
Diaphragma sellae meningiomas are very rare and often manifest themselves with aspecific symptoms... more Diaphragma sellae meningiomas are very rare and often manifest themselves with aspecific symptoms. Before the advent of MR, the diagnosis was very difficult or even impossible. For this reason they were often included in the broader category of suprasellar meningiomas. We describe two cases of diaphragma sellae meningiomas anterior to the pituitary stalk, manifesting with visual disturbances. We present the clinic and diagnostic data and we compare our experience with that reported in the literature. The tumor were removed by pterional (case 1) and subfrontal approach (case 2) with a recover of vision. Our experience support a clear demarcation of the diaphragma sellae meningioma among the wither group of suprasellar meningiomas. It is mandatory to define its position relative to the pituitary stalk and to the diaphragma sellae to chose the best surgical approach.
PubMed, May 1, 1999
Subdural hematomas may affect 0.4-5 p. 100 of patients with cancer, because of predisposing risk ... more Subdural hematomas may affect 0.4-5 p. 100 of patients with cancer, because of predisposing risk factors or because of the cancer itself. The most likely association is with hematological cancer with coagulative disorders. An association with pachymeningitis carcinomatosa is less likely. In this instance the subdural hematoma is due to a neoplastic obstruction of dural vein with subdural engorgement and hemorrhage or subdural effusion. We report a case in which an acute neurological deterioration due to a subdural hematoma disclosed a dural metastasis from a breast cancer operated four years earlier and present a literature review.
PubMed, Dec 1, 2012
Osteoporosis is a major global health problem, with over 10 million people currently diagnosed wi... more Osteoporosis is a major global health problem, with over 10 million people currently diagnosed with the disease. Although 80% of osteoporotic patients are women, a considerable number of men are also affected. Also, due to increasing life expectancy, the number of elderly patients with osteoporosis affected by degenerative and traumatic spinal diseases will increase further. Osteoporosis reduces bone quality through negative bone remodelling. Low bone quality can reduce the pull-out strength of pedicle screw, and negative bone remodelling can cause delayed bone fusion. However, pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pull-out, and fixation failure. Our preliminary study aims to investigate the efficiency of expandable pedicle screws (OsseoScrew-Spinal Fixation System, Alphatec Spine Inc., Carlsbad, CA) in osteoporotic spinal patients. All osteoporotic patients with degenerative and traumatic spinal diseases admitted in our department underwent a pre-operative spinal x-Ray and MRI or CT. Pre-operative clinical assesment of patients was based on the visual analog scale (VAS) and Owestry Disability (ODI) questionnaire-a disease-specific outcome measure. Ten osteoporotic patients were treated with expandable pedicle screws (OsseoScrew). Post-operative clinical assessment of patients was based on the VAS and ODI questionnaire at 3 months and 1 year of follow-up. Post-operative radiologic follow-up was performed after 3 days (CT, x-ray); 3 months (x-ray); 6 months (spinal CT); and 1 year (spinal CT). Expandable pedicle screws improved pull-out strength as compared to standard pedicle screws in osteoporotic patients with degenerative and traumatic spinal diseases.
Clinical Neurology and Neurosurgery, Aug 1, 2014
The role of surgical management in the setting of multiple brain metastases is controversial. Alt... more The role of surgical management in the setting of multiple brain metastases is controversial. Although the role of surgical resection in single brain metastases is well stated, in multiple brain metastases whole brain radiation therapy remains a mainstay of treatment. In this series, the authors evaluate the efficacy of minimally invasive neurosurgical techniques in the resection of brain metastases with a particular focus on multiple metastases. 57 patients who underwent surgical resection of brain metastases with a key-hole approach, were analyzed for surgical success, complications, neurological deficits, functional outcome and overall survival. 187 brain metastases were detected. The majority of patients improved in KPS postoperatively at 6 weeks (80.6%) and 3 months follow up (62.5%). Mean overall survival was 14.2 months with a 1 year survival rate of 44%. According to univariate analysis, poor systemic control of cancer, tumor extending to both lobar and deep brain, lower extent of resection and symptomatic tumor resection were found to be associated with poorer survival. With the use of minimally invasive neurosurgery, aggressive management of multiple metastases leads to minimal postoperative stay, improvement in quality of life and overall survival. Patient overall survival is dependent on recursive partitioning analysis (RPA) class, and should be used to guide management.
Journal of Neurosurgical Sciences, Mar 1, 2017
Infections of the spine have been a constant throughout history. At present there are infections ... more Infections of the spine have been a constant throughout history. At present there are infections in the spine fostered in part by the same advances in medicine: there are a lot of immunocompromised patients, the life expectancy of patients with chronic diseases is augmented and the increasing number of complex spinal surgeries can result in secondary infection. In this review the main types of infection of the spine and its treatment highlighting techniques in minimally invasive surgery are discussed. Spontaneous pyogenic and nonpyogenic spine infections as well as iatrogenic infections can be treated in a different manner depending on its extension, location and microorganism involved. We will review the use and the indication of percutaneous image-guided techniques, endoscopic and microsurgical techniques with or without use of tubular retractors. We conclude that techniques in minimally invasive surgery in spine infections are safe, effective and have benefits in morbidity of the approach and subsequent patient recovery.
Spine, Apr 1, 2008
Study Design. Case report and clinical discussion. Objective. To describe a rare case of spinal c... more Study Design. Case report and clinical discussion. Objective. To describe a rare case of spinal cervical screw migration into the gastrointestinal tract 11 years after surgery. Summary of Background Data. Anterior cervical spine fusion and stabilization with plating is a well-established procedure for cervical myelopathy, cervical spinal trauma, and spinal infectious disease. Esophageal injury has been related to screw or plate extrusion. Methods. We present a 45-year-old white man suffering from severe quadriparesis and neck pain. Cervical spine magnetic resonance images showed spondylodiscitis and spinal fracture of C4 and C5 vertebral bodies. He underwent anterior surgical decompression consisting of C4 and C5 corpectomies and fusion with fibular allograft fixated with a cervical plate. The patient's neurologic examination gradually improved during his follow-up. Results. The patient returned 11 years after cervical spine graft and plating, complaining of severe dysphagia and high fever. Radiographs of the cervical spine showed a screw back-out. Three days later, a new radiograph of the cervical spine revealed a progression of the screw's extrusion. In a new cervical spine radiograph, obtained immediately before surgical intervention, the displaced screw was no more visible. Abdominal radiograph showed the missed screw in the right lower abdominal quadrant. Barium meal swallowing test showed no leakage on the cervical area. At 6 months follow-up, the patient is in good condition and symptom free. Conclusion. In this case, the delayed esophageal perforation occurred 11 years after initial surgery: the rapid progression of the screw extrusion after initial pull-out (6 days) was documented by several radiographs and spontaneous closure of the fistula was achieved.
Minimally Invasive Neurosurgery, Aug 1, 2011
The retrosigmoid approach is often used for posterior fossa pathology. Many variations of positio... more The retrosigmoid approach is often used for posterior fossa pathology. Many variations of positioning exist. Here, we report a simple, safe, and quick positioning technique which maximizes patient safety, surgeon comfort, and intraoperative view. We reviewed the senior author&#39;s prospective surgical database for retrosigmoid approaches to the posterior fossa and noted any complications or difficult exposures. Over 970 retrosigmoid operations were performed over the course of 19 years. There were no positioning-related complications and no aborted surgeries due to inadequate exposure. No normal cerebellum was ever resected to increase exposure and no retractor was ever used in the posterior fossa. Supine positioning for the retrosigmoid approach is an excellent and safe positioning alternative.
The Spine Journal, Oct 1, 2017
Acta neurochirurgica, Feb 20, 2009
Zentralblatt für Neurochirurgie, Jul 29, 2008
Spinal dumbbell tumors originate from nerve roots, usually growing within the spinal canal, the n... more Spinal dumbbell tumors originate from nerve roots, usually growing within the spinal canal, the neural foramen and the extraforaminal compartment in the paraspinal region. We report a case of a 20-year-old man who presented with back pain radiating to his left lower limb mostly when in a supine position. Magnetic resonance imaging of the lumbar spine showed a dumbbell lesion at the L5-S1 neural foramen, with enlargement of the foramen and extension into the left paraspinal compartment. Although MR imaging studies were strongly suggestive of a dumbbell radicular schwannoma, the histological diagnosis was an osteoblastoma of the lumbar spine originating from the left L5 pedicle with intracanalicular, intraforaminal and extracanalicular extension. The presentation, imaging studies, intervention, pathology and differential diagnosis are described.
Operative Neurosurgery, Sep 1, 2013
BACKGROUND: The absence of ventriculomegaly has been considered an overt or relative contraindica... more BACKGROUND: The absence of ventriculomegaly has been considered an overt or relative contraindication to the endoscopic resection of colloid cysts. In the past, endoscopic removal of colloid cysts in the absence of ventriculomegaly has been considered ill advised. Reports of successful endoscopic surgery in small ventricles are surfacing. OBJECTIVE: We examined the combined experience of 2 high-volume endoscopic centers to characterize the outcomes of patients undergoing endoscopic removal of colloid cysts in small ventricles. METHODS: We retrospectively reviewed all endoscopic colloid cyst removal procedures by the 2 senior authors (P.N., C.T.) performed at the Barrow Neurological Institute over an 8-year period. Radiographic, clinical, and interview data were recorded and analyzed. The age-adjusted relative bicaudate index was used to define small ventricles. RESULTS: Sixteen patients (8 female) underwent attempted endoscopic removal of a colloid cyst in the absence of ventriculomegaly. Surgery was technically successful in 15 patients. The cyst was removed completely in 13 of patients. Short-term memory loss was initially present in 3 patients and completely resolved in all but 1 patient who had presented with short-term memory loss. Temporary complications occurred in 2 patients. CONCLUSION: Normal-size ventricles are not a contraindication to endoscopic removal of third ventricular colloid cysts. Complication rates are at least comparable to those of patients with ventriculomegaly or to those undergoing open microsurgical resection.
Neurosurgical Focus, Oct 1, 2014
World Neurosurgery, Nov 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Journal of neurological surgery, Feb 2, 2016
British Journal of Neurosurgery, 2020
Purpose: Decompressive craniectomy (DC) is widely used to treat raised intracranial pressure (ICP... more Purpose: Decompressive craniectomy (DC) is widely used to treat raised intracranial pressure (ICP) in cranial trauma and stroke. It is accompanied by numerous complications. The aim of our study is to assess the surgical treatment of infections related to the use of a dural substitute with concurrent CSF leakage performed at our institution. Material and methods: A retrospective analysis of a series of 72 patients who underwent DC between 2011 and 2017 was performed. Seven cases (9%) showed infection related to the use of xenograft (bovine pericardium) and coexisting CSF leakage. Epidural/subdural empyemas were observed in seven cases; three in conjunction with an intracerebral abscess. For reconstruction, free anterolateral thigh fascia lata flaps were used, based on the size of the defect. Results: After removal of the dural substitute and the implant of free fascia lata, infection and CSF leaks resolved in all. An anatomopathological examination of the implant at the later time of cranioplasty (CP) showed the tissue had become vascularized exhibiting integration with the native dura. No complications related to the harvesting of the fascia lata were observed. Conclusions: Fascia lata is a validated source of autologous grafts; it is cost-free and would appear to be the biological material most similar to the dura mater. The implanted material appears to maintain a lasting vitality when covered over with a well-vascularized scalp, even after a period of months, achieving a successful suppression of infection. Subsequent skull reconstruction is performed safely and easily using artificial bone.
Surgical Technology Online
Lumbar disc herniation is a common cause of back and radicular leg pain. A bulging annulus and co... more Lumbar disc herniation is a common cause of back and radicular leg pain. A bulging annulus and contained herniated disc can compress a nearby exiting root as it enters the neuroforamen and may cause pain and neurological symptoms. Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative to microdiscectomy for the treatment of contained lumbar disc herniations. However, there is no consensus regarding the type of laser to use, the ideal wavelength, or the energy applied. The ideal laser irradiation should have a high water absorption coefficient and low tissue pervasion, to limit thermal injury. The 1470 nm wavelength of the diode laser is absorbed by water 40 times more effectively than the 980 nm wavelength. We conducted this study to evaluate the efficacy and safety of PLDD using a 1470 nm diode laser. We retrospectively reviewed the clinical data of 27 patients with radicular pain who underwent PLDD for the treatment of contained lumbar disc hern...
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Papers by Roberto Gazzeri