Highly experienced neurosurgeon with a high-level scientific background, interest and reasonably good H-indexWorked in several different Countries (Italy, UK, USA, USSR and Russian Federation now, Cuba and Albania), speaks 5 languages.Still practicing soccer and tennis, believes in the latin mainstream "mens sana in corpore sano". Divorced and remarried, has 4 children
Background: Intracranial dermoid cysts (DCs) represent an infrequent subset of congenital ectoder... more Background: Intracranial dermoid cysts (DCs) represent an infrequent subset of congenital ectodermal inclusion cysts predominantly observed near the midline structures. In spite of their benign nature, they can cause clinical manifestations, necessitating surgical removal as the main therapeutic measure. Case report: We present here an extremely rare case characterized by a radiologically atypical dermoid cyst located within the corpus callosum, an extremely rare location for such tumors. Successful surgical excision resulted in good clinical outcomes. Conclusions: This paper underscores the importance of a timely, proper radiological diagnostic process, which sees magnetic resonance imaging (MRI) as the main step, as well as the fact that interpretation of MRI data can sometimes be challenging, as it was in the patient of this report.
BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor... more BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis. OBJECTIVE To prospectively evaluate the efficacy of V to VII anastomosis after FP. METHODS In a prospective study, we included 30 consecutive patients with FP (20 women and 10 men) whose mean age was 48.8 yr (32-76 yr). In almost all cases, FP developed after cerebellopontine angle tumor surgery (29 patients), whereas in one case, FP occurred after skull base trauma. Pre- and postoperative evaluation of facial nerve function was performed using the House-Brackmann (HB) scale and the Sokolovsky scale, as well as by electromyography. Follow-up ranged from 11 to 51 mo and averaged 22 mo. RESULTS All patients achieved functional recovery of the facial nerve from VI to either III or IV HB degree. Patients with short time FP showed significantly better postoperative recovery. CONCLUSION The results of the V to VII anastomosis demonstrate a significant improvement of facial nerve function and virtually no complications.
✓ Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgi... more ✓ Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision. Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.
The author has reviewed the problem of conservative care of subarachnoid hemorrhage (SAH) due to ... more The author has reviewed the problem of conservative care of subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms. A retrospective study was performed, comparing two different antifibrinolytic therapeutic modalities, in order to investigate whether one of the two would have led to lower complications rate. 131 patients with recently ruptured intracranial aneurysms were treated according to two different methodics: AMCA, 3 gm/day, combined with Aprotinine, 3-400,000 K.I.U./day; and AMCA, 6 gm/day. Patients of both differently treated groups showed similar rate of rebleeding and of thromboembolic complications, while those treated with the modality 'B' showed a higher rate of ischemic complications and of post-SAH hydrocephalus. The fact that this study is retrospective leads to consider carefully the above results. Nevertheless, there are reasonable preliminaries in order to support a larger use of this modality 'A'. The question of surgical timing is also briefly discussed. In the last years most surgeons were used to operate not less than 8-10 days after SAH. However, recently several authors have supported early surgery, mainly on the basis of pathophysiological considerations. A New Multicenter International Cooperative Study has been organized in order to correlate the results of surgical management of intracranial aneurysms to the interval SAH-operation. This would possible give an important contribution to the clarification of this debated problem.
31 cases of petroclival meningioma have been operated on during a 4-year period using two differe... more 31 cases of petroclival meningioma have been operated on during a 4-year period using two different philosophies as far as the approach. Group A patients ( 13 cases) have been operated on using mostly either a subtemporal transtentorial or a retrosigmoid approach. Group B patients (18 cases) have been managed using a lateral skull base approach, either the anterior transpetrosal or the presigmoid approach. Translabyrintine/transcochlear were used more frequently, but not exclusively, in more recent cases. Tumor dissection and removal appeared to be easier in skull-base operated patients. However operations take longer time and surgical complications such as CSF leak and hearing loss were increased. Radical tumor removed could be achieved in an equal percentage of cases of both groups (77% vs 83%). Early postoperative course was more favourable in group B patients. Skull base approaches facilitate tumor dissection and removal at the expenses of increased surgical complications. However the widened surgical field and increased angle of approach that the techniques of skull base surgery may offer can play a significant role in the removal of sizeable, infiltrative and/or recurrent petroclival meningiomas.
Occlusion of the internal carotid artery by an intracranial tumor occurs only rarely. Three such ... more Occlusion of the internal carotid artery by an intracranial tumor occurs only rarely. Three such cases are reported here. All were parasellar tumors, 2 meningiomas and 1 pituitary adenoma. The occlusion was demonstrated by carotid angiography in all cases. The location of the tumor was demonstrated by a computerized tomographic (CT) scan in 1 case. These 3 cases were encountered in a neurosurgical series of over 4,500 brain tumors and 10,000 angiographic examinations during the period 1952 to 1979.
Three cases with germinoma in the region of the pineal body diagnosed by means of computer tomogr... more Three cases with germinoma in the region of the pineal body diagnosed by means of computer tomography are described. The diagnosis was verified in all of them during operation. Computer tomography demonstrated three-dimensional structures with irregular contours in the posterior parts of the third ventricle which was seen more clearly after injection of the contrast medium. Petrifaction was found in the center of the pathological structure in all cases. The diagnostic value of computer tomography from the standpoint of the localization of the tumor is emphasized.
Background: Intracranial dermoid cysts (DCs) represent an infrequent subset of congenital ectoder... more Background: Intracranial dermoid cysts (DCs) represent an infrequent subset of congenital ectodermal inclusion cysts predominantly observed near the midline structures. In spite of their benign nature, they can cause clinical manifestations, necessitating surgical removal as the main therapeutic measure. Case report: We present here an extremely rare case characterized by a radiologically atypical dermoid cyst located within the corpus callosum, an extremely rare location for such tumors. Successful surgical excision resulted in good clinical outcomes. Conclusions: This paper underscores the importance of a timely, proper radiological diagnostic process, which sees magnetic resonance imaging (MRI) as the main step, as well as the fact that interpretation of MRI data can sometimes be challenging, as it was in the patient of this report.
BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor... more BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis. OBJECTIVE To prospectively evaluate the efficacy of V to VII anastomosis after FP. METHODS In a prospective study, we included 30 consecutive patients with FP (20 women and 10 men) whose mean age was 48.8 yr (32-76 yr). In almost all cases, FP developed after cerebellopontine angle tumor surgery (29 patients), whereas in one case, FP occurred after skull base trauma. Pre- and postoperative evaluation of facial nerve function was performed using the House-Brackmann (HB) scale and the Sokolovsky scale, as well as by electromyography. Follow-up ranged from 11 to 51 mo and averaged 22 mo. RESULTS All patients achieved functional recovery of the facial nerve from VI to either III or IV HB degree. Patients with short time FP showed significantly better postoperative recovery. CONCLUSION The results of the V to VII anastomosis demonstrate a significant improvement of facial nerve function and virtually no complications.
✓ Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgi... more ✓ Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision. Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.
The author has reviewed the problem of conservative care of subarachnoid hemorrhage (SAH) due to ... more The author has reviewed the problem of conservative care of subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms. A retrospective study was performed, comparing two different antifibrinolytic therapeutic modalities, in order to investigate whether one of the two would have led to lower complications rate. 131 patients with recently ruptured intracranial aneurysms were treated according to two different methodics: AMCA, 3 gm/day, combined with Aprotinine, 3-400,000 K.I.U./day; and AMCA, 6 gm/day. Patients of both differently treated groups showed similar rate of rebleeding and of thromboembolic complications, while those treated with the modality 'B' showed a higher rate of ischemic complications and of post-SAH hydrocephalus. The fact that this study is retrospective leads to consider carefully the above results. Nevertheless, there are reasonable preliminaries in order to support a larger use of this modality 'A'. The question of surgical timing is also briefly discussed. In the last years most surgeons were used to operate not less than 8-10 days after SAH. However, recently several authors have supported early surgery, mainly on the basis of pathophysiological considerations. A New Multicenter International Cooperative Study has been organized in order to correlate the results of surgical management of intracranial aneurysms to the interval SAH-operation. This would possible give an important contribution to the clarification of this debated problem.
31 cases of petroclival meningioma have been operated on during a 4-year period using two differe... more 31 cases of petroclival meningioma have been operated on during a 4-year period using two different philosophies as far as the approach. Group A patients ( 13 cases) have been operated on using mostly either a subtemporal transtentorial or a retrosigmoid approach. Group B patients (18 cases) have been managed using a lateral skull base approach, either the anterior transpetrosal or the presigmoid approach. Translabyrintine/transcochlear were used more frequently, but not exclusively, in more recent cases. Tumor dissection and removal appeared to be easier in skull-base operated patients. However operations take longer time and surgical complications such as CSF leak and hearing loss were increased. Radical tumor removed could be achieved in an equal percentage of cases of both groups (77% vs 83%). Early postoperative course was more favourable in group B patients. Skull base approaches facilitate tumor dissection and removal at the expenses of increased surgical complications. However the widened surgical field and increased angle of approach that the techniques of skull base surgery may offer can play a significant role in the removal of sizeable, infiltrative and/or recurrent petroclival meningiomas.
Occlusion of the internal carotid artery by an intracranial tumor occurs only rarely. Three such ... more Occlusion of the internal carotid artery by an intracranial tumor occurs only rarely. Three such cases are reported here. All were parasellar tumors, 2 meningiomas and 1 pituitary adenoma. The occlusion was demonstrated by carotid angiography in all cases. The location of the tumor was demonstrated by a computerized tomographic (CT) scan in 1 case. These 3 cases were encountered in a neurosurgical series of over 4,500 brain tumors and 10,000 angiographic examinations during the period 1952 to 1979.
Three cases with germinoma in the region of the pineal body diagnosed by means of computer tomogr... more Three cases with germinoma in the region of the pineal body diagnosed by means of computer tomography are described. The diagnosis was verified in all of them during operation. Computer tomography demonstrated three-dimensional structures with irregular contours in the posterior parts of the third ventricle which was seen more clearly after injection of the contrast medium. Petrifaction was found in the center of the pathological structure in all cases. The diagnostic value of computer tomography from the standpoint of the localization of the tumor is emphasized.
Uploads
Papers by Aldo Spallone