Papers by Giuseppe La Rocca
Clinical Neurology and Neurosurgery, Nov 1, 2020
Journal of Neurosurgical Sciences, Oct 1, 2022
BACKGROUND Trans-sphenoidal endoscopic surgery has drawn huge benefits from advances in surgical ... more BACKGROUND Trans-sphenoidal endoscopic surgery has drawn huge benefits from advances in surgical visualization. The Ultra-HD "4K" endoscope has improved 4-fold image resolution compared with HD, but its actual advantages are unclear. Aim of the present study was to assess its usefulness in the early outcome of trans-sphenoidal surgery. METHODS We analyzed a series of 199 trans-sphenoidal pituitary adenoma procedures performed by an experienced team using alternatively HD (n=102) or 4K (n=97) endoscopes. We evaluated extent of resection both subjectively, based on intraoperative surgeon's impression, and objectively based on post-operative MR scan. RESULTS Baseline patients' characteristics were balanced. Objective near-total and total resection rates were comparable between 4K and HD groups (91.5% vs 86.3% and 64.9% vs 56.9%, respectively). 4K endoscope slightly improved resection rate in recurrent adenoma. At multivariate analysis, the only independent prognosticator of total resection was cavernous sinus invasion. Importantly, 4K endoscope enhanced the reliability of intraoperative judgement on extent of resection, significantly reducing unexpected residuals (12.8% vs 33.3% for HD). Operative features and clinical outcomes were similar. CONCLUSIONS The HD endoscope remains the standard-of-care for pituitary surgery. The 4K enhanced, "immersive" visualization significantly improved the reliability of surgeon's judgment on resection and might be useful in surgically difficult cases.
Clinical Neurology and Neurosurgery, 2020
Contrast-enhanced ultrasound (CEUS) is a real-time, feasible technique. Both intraoperatively and... more Contrast-enhanced ultrasound (CEUS) is a real-time, feasible technique. Both intraoperatively and bedside, it satisfies the need for serial assessment and easy performability. Initially employed in neuro-oncology, it has recently overcome this first application. We aimed to evaluate the literature and give a comprehensive view of its use in the fields listed below. A systematic review of all pertinent literature was performed via PubMed access according PRISMA P guidelines. Studies not involving human adults and not reporting original data were excluded. Cross-check of references of selected articles was performed to complete bibliographical research. 67 articles were then grouped by field of application: Oncology (26 articles) further subdivided in a) cranial tumors (23 articles) and b) spinal tumors (3 articles); Vascular (31 articles), divided in three sections: a) aneurysms, AVMs and AVFs surgery (6 articles), b) cerebral perfusion assessment and acute stroke patients management (15 articles), c) carotid plaques treatment (10 articles); TBI (2 articles); Pediatrics (4 articles); Peripheral nerve surgery (2 articles) and others (2 articles). CEUS versatility across the aforementioned areas was analyzed, underlining its complementarity to other well-settled imaging techniques. This review is focused on reporting CEUS advantages and disadvantages, suggesting a further broadening of the already numerous applications. Neurosurgery is experiencing the rediscovery of intraoperative ultrasound (ioUS). In particular, growing enthusiasm was shown after the introduction of contrast-enhanced ultrasound (CEUS) in the field neurooncology, following the leads of other surgeries such as thyroid and hepatic surgery. Those experiences in literature proved the integration of ioUS and
World Neurosurgery, 2019
BACKGROUND: Neurosurgical diseases have a devastating impact on society. It is estimated that app... more BACKGROUND: Neurosurgical diseases have a devastating impact on society. It is estimated that approximately 14 million essential neurosurgical cases develop worldwide annually, of which more than 80% arise in low-and middle-income countries. Neurosurgical cadaveric dissection remains largely unexploited as a learning tool for the training of surgeons in developing countries, often because of the assumed high costs. -METHODS: The minimum requirements to establish a neurosurgical cadaver laboratory are the availability of minimally equipped environment to perform dissection, respecting safety requirements, fitting surgical instruments, anatomic samples, and materials to be used for preservation and preparation of anatomical specimens. Moving from these basic foundations, we established our
Acta neurochirurgica, 2018
Intra-operative ultrasound (ioUS), and the recently introduced contrast-enhanced ultrasound (CEUS... more Intra-operative ultrasound (ioUS), and the recently introduced contrast-enhanced ultrasound (CEUS) demonstrated to be an extremely valuable tool in oncological cerebral neurosurgery. The authors applied ioUS/CEUS techniques to spinal oncological surgery as showed in the illustrative case of a dorsal hemangiopericytoma. ioUS and CEUS provide real-time information that proved useful in identifying both vascular and parenchymatous tumoral patterns, anatomical relations with nervous structure, plan surgical strategy, and identify residuals. It allows to visualize unexposed anatomical and pathological structures within the parenchyma and is a valuable guide during resection.
Journal of neurosurgical sciences, Jan 8, 2017
Acta neurochirurgica. Supplement, 2017
Chronic diseases of consciousness (CDC) can still be considered a challenging frontier for modern... more Chronic diseases of consciousness (CDC) can still be considered a challenging frontier for modern medicine, probably because of their not completely understood physiopathological mechanisms. Following encouraging evidence on cerebral hemodynamics, some authors have hypothesized a role for neuromodulation in the treatment of CDC patients. In the past 40 years, spinal cord stimulation (SCS) and deep brain stimulation (DBS) have been used experimentally for the treatment of patients in a severe altered state of consciousness, with some interesting but not conclusive results. The present review summarizes the data currently available in the literature on this particular and debated topic. On these grounds, further clinical studies are needed to better understand the altered dynamics of neuronal network circuits in CDC patients as a step towards novel therapeutic strategies.
Acta neurochirurgica. Supplement, 2017
Giant aneurysms of the basilar artery are rare and are frequently associated with obstructive hyd... more Giant aneurysms of the basilar artery are rare and are frequently associated with obstructive hydrocephalus and brainstem compression. Treatment still remains a challenge both for neurosurgeons and for interventional neuroradiologists. Cases reported in the literature are anecdotal and, overall, their outcomes are poor. We present the case of a patient with a giant aneurysm of the basilar artery tip, involving the origin of both the posterior cerebral and superior cerebellar arteries, who underwent coiling and ventriculoperitoneal shunting for associated obstructive hydrocephalus. A pCONus ® stent (Phenox; Bochum, Germany) was detached with its petals opened over the ostia of the parent vessels, with the aim being to reconstruct the neck of the aneurysm and to preserve the flow in the parent vessel. Moreover, the presence of the stent was useful to maintain the coils within the dome of the aneurysm. The pCONus is a new neurovascular device that is also useful for treating cases of c...
Acta Neurochirurgica Supplement, 2017
A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ)... more A variety of pathological conditions may affect the clivus and the craniovertebral junction (CVJ). These include congenital disorders, chronic inflammation, neoplasms, infections, and posttraumatic conditions that could all result in CVJ compression and myelopathy Endoscopic-assisted procedures have been further developed for CVJ decompression and they have now become conventional approaches. The aims of the present study were:(1) to compare "radiological" and "surgical" nasoaxial lines (NAxLs); (2) to introduce an analogous radiological line as a predictor of the superior extension of the transoral approach (palatine inferior dental arch line (PIA); (3) to compare the "radiological" nasopalatine line (NPL) with the "surgical" NPL (SNPL) and surgical PIA (SPIA); (4) to compare "our" SNPL with the NAxL; and (5) to find possible radiological reference points to predict, preoperatively, the maximal extent of superior dissection for the transoral approach (SPIA).
Journal of neurosurgery, Aug 4, 2015
OBJECT Only a few published studies of the surgical treatment of benign peripheral nerve sheath t... more OBJECT Only a few published studies of the surgical treatment of benign peripheral nerve sheath tumors (BPNSTs), malignant peripheral nerve sheath tumors (MPNSTs), and peripheral non-neural sheath tumors (PNNSTs) have analyzed the results and possible prognostic factors using multivariate analysis. The authors report on their surgical series of cases of BPNSTs, MPNSTs, and PNNSTs with long-term follow-up and analyze the role of selected factors with respect to the prognosis and risk of recurrence of these tumors using multivariate analysis. They also review the pertinent literature and discuss their results in its context. METHODS The authors retrospectively reviewed data from cases involving patients who underwent resection of a peripheral nerve tumor between January 1983 and December 2013 at their institution. Of a total of 200 patients, 150 patients (with 173 surgically treated tumors) had adequate follow-up data available for analysis. Pain was assessed using a visual analog sca...
Neurosurgical review, Jan 7, 2018
Residual and recurrent intracranial aneurysms after surgical clipping present a persistent risk o... more Residual and recurrent intracranial aneurysms after surgical clipping present a persistent risk of bleeding. Secondary coiling after incomplete clipping represents a strategy to occlude the residual sac: feasibility, bleeding risk and outcome were evaluated through a systematic review of literature along with the series of two tertiary referral neurovascular centres. Demographics, ruptured status, aneurysm morphology, topography, exclusion at surgery, timing of secondary coiling, complications, occlusion rate and outcome were analysed. Percentage of incidence and 95% CI were calculated for all variables. T test was used for continue variables, whereas Fisher's test (two-sided) is for categorical ones. Overall, 102 patients (92 cases from literature and 10 cases from institutional series) were included. Mean age at diagnosis was 52.94 ± 12.17 years, and male/female ratio 0.5; 3/4 of aneurysms involved the anterior circulation, whereas ¼ the posterior circulation. An aneurysmal ne...
World Neurosurgery
INTRODUCTION "Diffuse midline glioma H3K27M-mutant" (a mutation genes encoding H3 histo... more INTRODUCTION "Diffuse midline glioma H3K27M-mutant" (a mutation genes encoding H3 histone variants) represents a defined pathologic entity since 2016 WHO CNS classifications and include midline structures, namely thalamus, brainstem and spinal cord. H3K27M mutant glioma responds more poorly and is associated with worse clinical outcome. Mutation detection is now diagnostic for 'diffused midline gliomas' We report on a case arising in an atypical non midline localization with an exceedingly adverse course.The present case arises the question of the possible meaning of the H3K27M-mutation also in high grade gliomas (HGG) arising from the cerebral hemispheres, and its implications from a prognostic and therapeutic view. CLINICAL PRESENTATION A 48-year-old woman was admitted with a mass arising from the splenium of the corpus callosum with bilateral hemispheric extension, displaying MRI characteristics typical of a HGG.Needle biopsy confirmed the diagnosis of "diffuse astrocytic neoplasm, WHO grade IV". Immunostaining of the tumor revealed the H3K27M-mutant nuclear expression. The patient was referred to adjuvant therapy and died 3 months after biopsy. CONCLUSIONS This experience highlights the possible negative prognostic impact of H3K27M-m and the possibility that the H3K27M-m could be a reliable prognostic indicator to be considered not only in diffuse midline gliomas but also in gliomas form the cerebral hemispheres. Since the rarity and limited knowledge on this specific mutation this experience, reports should be encouraged.
European Journal of Gastroenterology Hepatology, Jan 31, 2001
To establish whether tailoring the dosage of interferon (IFN)-alpha2b in non-cirrhotic naive pati... more To establish whether tailoring the dosage of interferon (IFN)-alpha2b in non-cirrhotic naive patients with chronic hepatitis C according to hepatitis C virus (HCV) genotype and viraemic level improves the rate of sustained response (normal alanine aminotransferase values and HCV-RNA negativity 6 months after the end of therapy). A total of 538 consecutively collected HCV-positive patients with non-cirrhotic chronic hepatitis who had not been previously treated. Quantitative viraemia and genotype were determined in each patient by a core laboratory. The patients were randomized to: Group 1, 86 patients with genotype non-1 and viraemia < 1,000,000 HCV genome equivalents/ml (GenEq/ml) treated with 3 Million Units (MU) IFN three times weekly (t.i.w.) for 1 year; Group 2, 42 patients with genotype 1 and viraemia < 1,000,000 GenEq/ ml treated with 3 MU IFN t.i.w. for 1 year; Group 3, 46 patients with genotype 1 and viraemia < 1,000,000 GenEq/ ml treated with 5 MU IFN t.i.w. for 1 year; Group 4, 85 patients with genotype non-1 and viraemia > 1,000,000 GenEq/ml treated with 3 MU IFN t.i.w. for 1 year; Group 5, 88 patients with genotype non-1 and viraemia > 1,000,000 GenEq/ml treated with 5 MU IFN t.i.w. for 1 year; Group 6, 94 patients with genotype 1 and viraemia > 1,000,000 GenEq/ml treated with 3 MU IFN t.i.w. for 1 year; Group 7, 97 patients with genotype 1 and viraemia > 1,000,000 GenEq/ml treated with 5 MU IFN daily for 2 months followed by 5 MU t.i.w. for a further 10 months. According to an intention-to-treat analysis, a sustained virological response (negative HCV-RNA by polymerase chain reaction 6 months after the end of therapy) was observed in 42% of Group 1 patients, in 21% of Group 2 patients versus 24% of Group 3 patients [P = not significant (NS)], in 28% of Group 4 patients versus 35% of Group 5 patients (P = NS), and in 8.5% of Group 6 patients versus 12% of Group 7 patients (P = NS). Even though a trend towards a therapeutic improvement is observed, the adoption of more aggressive IFN protocols, such as induction therapy, does not appear to significantly improve the rate of sustained response in patients with chronic hepatitis C associated with HCV genotype 1 and highly viraemic levels compared with standard therapy. Moreover, patients with only one unfavourable predictive factor (genotype 1 or high viraemia) do not gain major therapeutic benefits when treated with high doses of IFN.
European Journal of Gastroenterology Hepatology, 2001
2010 International Conference on E Business, 2010
The COMETA e-Infrastructure running in Sicily is compliant with the EGEE middleware and specifica... more The COMETA e-Infrastructure running in Sicily is compliant with the EGEE middleware and specifications offering a great computing power and huge storage capacity. Since its beginning one of the main goals has been to extend the adoption of Grid paradigm from the academic to business world. Several software and hardware extensions have been implemented in order to enhance the infrastructure performances; they include a new low-latency net layer reserved to heavy parallel applications; some modifications to the parallel job submission and execution procedures for a better support of MPI-based applications; new tools for job monitoring and file catalogue interaction; a scheduling policy tailored on the requirements of a complex environment hosting heterogeneous jobs; the GridLM license server able to grant access to commercial software only to authorised users; finally, the Secure Storage Service defends from insider abuse and completes a very high security level environment. The proposed business model includes a wide range of services collectively defined as Infrastructure-as-a-Service. All the above components result in a powerful and flexible platform, easy to use for any applications and open to further developments.
Nowadays, global Grid infrastructures offer production quality services to a large number of Virt... more Nowadays, global Grid infrastructures offer production quality services to a large number of Virtual Research Communities (VRCs) and several scientific and industrial applications produce, after long runs, complex output patterns that can be collected and encoded as a unique video which can be easily shown to a wide audience and monitored with the strong impact of multimedia communication. In this contribution we describe the design and prototypal implementation of a new Grid service: the Visualization Element which has been first tested on the Sicilia Grid of COMETA and allows non-expert users to control and show their jobs" evolution using a simple and intuitive web-based interface.
Nowadays, global Grid infrastructures offer production quality services to a large number of Virt... more Nowadays, global Grid infrastructures offer production quality services to a large number of Virtual Research Communities (VRCs) and several scientific and industrial applications produce, after long runs, complex output patterns that can be collected and encoded as a unique video which can be easily shown to a wide audience and monitored with the strong impact of multimedia communication. In this contribution we describe the design and prototypal implementation of a new Grid service: the Visualization Element which has been first tested on the Sicilia Grid of COMETA and allows non-expert users to control and show their jobs" evolution using a simple and intuitive web-based interface.
Proceedings of the 2010 American Control Conference, 2010
The problem of deriving efficient automatic gear shifting policies in cars equipped with AMT (Aut... more The problem of deriving efficient automatic gear shifting policies in cars equipped with AMT (Automated Manual Transmission) is investigated in this paper with the aim at minimizing fuel consumption. Two different online gear shifting strategies have been fully analyzed and are here described: (1) E.G.A. (Efficient Gear Actuator), based on the choice at each time instant of the most efficient
First International Conference on Testbeds and Research Infrastructures for the DEvelopment of NeTworks and COMmunities, 2005
The elements of the GILDA dissemination grid developed within the context of Italian INFN Grid Pr... more The elements of the GILDA dissemination grid developed within the context of Italian INFN Grid Project and the European EGEE Project are presented and described.
Key Engineering Materials, 1998
Impact Response and Dynamic Failure of Composites and Laminate Materials aluminium layers. To det... more Impact Response and Dynamic Failure of Composites and Laminate Materials aluminium layers. To determine the resistance to the third damage mode in aircraft structures - impact damage - an extensive test programme was carried out. This paper describes a part of the impact ...
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Papers by Giuseppe La Rocca