Publications by authors named "Raffaele De Marco"

Arginine-Vasopressine deficiency (AVP-D), formerly known as Central Diabetes Insipidus, is a well-known complication in surgery for sellar/parasellar masses. Although less frequent in endoscopic series than transcranial and microscopic transsphenoidal ones, AVP-D has been variably related to different factors. Focusing the work on pituitary Neuroendocrine Tumors (PitNET), all patients who were treated endoscopically at a single centre were retrospectively reviewed to analyze the occurrence of this complication.

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Objective: To evaluate the applicability and performance of predictive scoring systems for outcome prediction in a real-world cohort of patients with aneurysmatic Subarachnoid Hemorrhage (aSAH), trying to avoid overtreatment and reducing their impact on Intensive Care Unit (ICU) overcrowding.

Methods: All adult patients diagnosed with aSAH from January 2018 to December 2023 were retrospectively collected in a single centre. Predictive scores such as SAFIRE, HATCH, HAIR, and Nutshell were calculated, and their performance was analyzed using receiver operating characteristic (ROC) analysis.

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Objective: The use of the endoscope has brought major changes in skull base surgery in the last decades. In the cerebellopontine angle (CPA), it has shown few advantages over microscopic surgery alone, evolving towards a full-endoscopic surgery for neurovascular conflicts and tumors. This review aims to systematically analyze the literature about the use of the endoscope in the cerebellopontine angle tumors.

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Objective: Extradural spinal nerve sheath tumors with foraminal involvement are rare, and the gold standard for surgical resection is not established yet. Traditionally, lumbar intra-extraforaminal schwannomas have been resected through a posterior midline or paraspinal open approach. The lateral transpsoas approach represents a suitable, minimally invasive approach which can provide direct access to the extraforaminal and lumbar plexus region avoiding bone removal, hence the necessity of lumbar fusion.

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: In pituitary adenomas, examinations of surgical specimens have shown that dural invasion occurs in 42-85% of cases. No studies about dura mater invasion have been conducted specifically in acromegaly patients. The aim of the present study was to evaluate the relationship between histologically dural invasion and the main features of GH-secreting adenomas.

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Purpose: To evaluate the correlation between the degrees of circumferential decompression of the optic canal (OC) and the improvement of visual acuity in patients with parasellar meningiomas (PMs) with optic canal invasion.

Methods: This is a monocentric retrospective study conducted at author's institution. The visual acuity was evaluated preoperative and at 3-months after surgery with Snellen acuity test.

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Article Synopsis
  • - The endoscopic endonasal corridor (EEO) is an effective surgical route for treating craniovertebral junction (CVJ) issues, particularly beneficial for elderly patients with health complications who may not tolerate more invasive procedures.
  • - In a specific case study of an 80-year-old man, EEO was successfully used to address ventral compression caused by degenerative changes, while preserving the C1 anterior arch.
  • - The surgery demonstrated positive outcomes without the need for posterior instrumentation, highlighting the technique's effectiveness and the importance of thorough preoperative planning.
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High-grade gliomas are the most prevalent neurooncological desease in adults, their incidence increases with age, peaking in the seventh decade. This paper aims to address how to select patients for surgical resection by identifying pre-surgical predictors of 12-month mortality in newly diagnosed HGG patients aged ≥ 75 years. A prognostic score will be proposed to guide surgical decisions based on expected survival.

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Article Synopsis
  • - The text discusses two cases of lumbosacral dura mater expansion that compressed nerves, treated with lumboperitoneal shunts (LPS) after reviewing cases from existing literature on symptomatic dural ectasia (DE).
  • - A comprehensive search evaluated surgical management approaches for DE, including treatments for both children and adults, while excluding cases with cerebrospinal fluid leaks and considering severe forms like meningoceles.
  • - The conclusion highlights that DE is rare and mainly linked to connective tissue disorders, suggesting treatment strategies should be tailored based on the specific symptoms and etiologies, as the condition can lead to ongoing complications.
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Background: In surgical practice during endoscopic endonasal approach, growth hormone-secreting pituitary neuroendocrine tumor (GH-secreting PitNET) patients show morphologic differences in the nasal cavities and sinuses, leading to a narrower surgical field and a carotid prominence and potentially increasing the complexity of the surgical and the risk of complications. The aim of the study is to evaluate the anatomical differences of the sphenoid sinus between patients with GH-secreting PitNETs and patients with nonfunctioning pituitary neuroendocrine tumor (NF-PitNET) who underwent endoscopic endonasal approach.

Methods: This is a monocentric retrospective study conducted at the author's institution.

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Article Synopsis
  • Copeptin has the potential to predict central diabetes insipidus (CDI) post-neurosurgery, particularly in acromegaly patients, but its role in monitoring fluid balance is still unclear.
  • A study analyzed 15 acromegaly patients undergoing surgery, examining their fluid balance and levels of copeptin and growth hormone (GH) before and after the procedure.
  • Results showed that high copeptin levels were linked to increased risk of polyuria post-surgery, while GH levels had a notable connection to negative fluid balance, indicating that copeptin could be useful for early risk assessment in these patients.
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Purpose: This retropective multicentric study aims to investigate the clinical applicability of the NSE score in the elderly, to verify the role of this tool as an easy help for decision making also for this class of patients.

Methods: All elderly patients (> 65 years) suffering from spinal metastases undergoing surgical or non-surgical treatment at the authors' Institutions between 2015 and 2022 were recruited. An agreement group (AG) and non-agreement group (NAG) were identified accordingly to the agreement between the NSE score indication and the performed treatment.

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Article Synopsis
  • The study evaluated the impact of opening the lateral ventricle during surgery on post-surgical complications in patients with high-grade gliomas (HGG), comparing outcomes of those who had the ventricle opened versus those who did not.
  • A total of 380 patients were studied, with a median overall survival (OS) of 16.6 months and progression-free survival (PFS) of 10.9 months, revealing some complications but not directly linked to the ventricle opening.
  • The findings suggest that opening the lateral ventricles does not significantly increase the risk of complications such as dissemination or hydrocephalus, and it may be necessary for achieving better surgical removal of the tumor.
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Objective: Extraparenchymal localization of neurocysticercosis (NCC) is rare in non-endemic areas. A case of mixed (intraventricular, IV, and subarachnoid basal, SAB) NCC was surgically treated using the neuroendoscope and a systematic review of the literature was performed with the aim to analyze the use of this instrument in the management of the extraparenchymal forms of the parasitic disease.

Materials And Methods: Medline and Embase databases were searched for studies where the neuroendoscope was used for the management of IV/SAB NCC cysts, either for the cerebrospinal fluid diversion or cyst removal.

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Objectives: To describe surgical treatment of 3 cases of severe and progressive thoracolumbar kyphosis in myelomeningocele and provide a systematic review of the available literature on the topic.

Methods: Medical records and pre- and post-operative imaging of 3 patients with thoracolumbar kyphosis and myelomeningocele were reviewed. A database search was performed for all manuscripts published on kyphectomy and/or surgical treatment of kyphosis in myelomeningocele.

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Objective: The use of endoscopic assistance in retrosigmoid approach for tumors of the cerebellopontine angle brought undoubted technological advantages in skull base surgery. Nonetheless, the use of the endoscope is not as widespread as it could be. The aim of the study is to analyze the impressions of neurosurgeons and otologists with different experience in vestibular schwannoma surgery, experiencing the introduction of the endoscope in surgical daily practice.

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Purpose: Endoscopic endonasal approach (EEA) is the safest and most effective technique for odontoidectomy. Nevertheless, this kind of approach is yet not largely widespread. The aim of this study is to share with the scientific community some tips and tricks with our ten-year-old learned experience in endoscopic endonasal odontoidectomy (EEO), which remains a challenging surgical approach.

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Article Synopsis
  • - The study focuses on using Artificial Intelligence (AI) to improve the evaluation of glioblastoma (a type of brain tumor) through MRI imaging, which is crucial for clinical decisions and surgical planning.
  • - Researchers trained a segmentation algorithm on a dataset of 237 MRIs (71 preoperative and 166 postoperative) from patients with Grade IV Glioma to enhance the accuracy of tumor assessment before and after surgery.
  • - Results indicate that while the algorithm performed well in preoperative evaluation (DICE score of 91.09), its performance was lower in postoperative assessments (DICE score of 72.31), suggesting that AI can help mitigate issues related to low-quality MRI images.
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Introduction: Patients' quality of life (QoL), facial nerve (FN), and cochlear nerve (CN) (if conserved) functions should be pursued as final outcomes of vestibular schwannoma (VS) surgery. In regard to FN function, different morphologic and neurophysiological factors have been related to postoperative outcomes. The aim of the current retrospective study was to investigate the impact of these factors on the short- and long-term FN function after VS resection.

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Background: Peripheral nerve injuries (PNIs) include several conditions in which one or more peripheral nerves are damaged. Trauma is one of the most common causes of PNIs and young people are particularly affected. They have a significant impact on patients' quality of life and on the healthcare system, while timing and type of surgical treatment are of the utmost importance to guarantee the most favorable functional recovery.

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Amino acid PET imaging has been used for a few years in the clinical and surgical management of gliomas with satisfactory results in diagnosis and grading for surgical and radiotherapy planning and to differentiate recurrences. Biological tumor volume (BTV) provides more meaningful information than standard MR imaging alone and often exceeds the boundary of the contrast-enhanced nodule seen in MRI. Since a gross total resection reflects the resection of the contrast-enhanced nodule and the majority of recurrences are at a tumor's margins, an integration of PET imaging during resection could increase PFS and OS.

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Introduction: For spine surgeons, dealing with unstable cervical spine has been usually challenging, and this becomes more difficult when facing a primary craniovertebral junction tumor. Primary spine tumor surgery should always include column reconstruction in order to guarantee biomechanical stability of the spine, but surgeons should always be aware that instrumentations could create interferences with postoperative radiations. However, although carbon fiber instrumentations have started to be used in thoracolumbar oncology for few years, these options are still not available for cervical spine.

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