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Videoangiography using indocyanine green (ICG) has been used in the ophthalmologic field for a long time. It was introduced to the neurosurgical field several years ago but has been limited to vascular surgeries. We applied ICG... more
Videoangiography using indocyanine green (ICG) has been used in the ophthalmologic field for a long time. It was introduced to the neurosurgical field several years ago but has been limited to vascular surgeries. We applied ICG videoangiography to brain tumor surgery and evaluated the usefulness. Twenty-three patients with a brain tumor who underwent microsurgical resection were analyzed. The pathological diagnosis was meningioma in 15 patients, metastasis in three, glioma in three, and hemangioblastoma in two. A microscope with a special filter and infrared excitation light to illuminate the operating field was used in this study. The intravascular fluorescence was imaged with a video camera attached to the microscope. ICG was injected intravenously with the dose of 5-25 mg, and overall, ICG was injected intraoperatively 32 times. ICG videoangiography allowed for an excellent evaluation of blood flow in the tumoral and peri-tumoral vessels both before and after the resection in all cases. ICG videoangiography is a useful method for monitoring blood flow in the exposed vessels during microsurgery for a brain tumor. This noninvasive method is simple, safe, cost-effective, and easily repeatable. Before resection, it provides information on the tumoral and peri-tumoral circulation including sequential visualization of vessels or direction of the blood flow. After resection, it checks the patency of the peri-tumoral vessels and is especially useful for the vein. This ICG videoangiography can be an alternative tool to intraoperative angiography or Doppler ultrasonography in selective cases.
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Research Interests: Deep Brain Stimulation, Quality of life, Treatment Outcome, Subthalamic Nucleus, Brain, and 13 moreHumans, Female, Male, Follow-up studies, Clinical Sciences, Aged, Middle Aged, Globus Pallidus, Neurosciences, Nervous System Diseases, Parkinson Disease, Neurological Sciences, and Severity of Illness Index
BACKGROUND Accurate electrode position is important for the efficacy of deep brain stimulation (DBS). Several reports revealed errors during stereotactic surgery due to cerebrospinal fluid (CSF) loss and subdural air invasion. Because... more
BACKGROUND Accurate electrode position is important for the efficacy of deep brain stimulation (DBS). Several reports revealed errors during stereotactic surgery due to cerebrospinal fluid (CSF) loss and subdural air invasion. Because subdural air resolves in the weeks after surgery and the brain returns to its original position, DBS electrodes may become displaced postoperatively. OBJECTIVE To quantitatively assess postoperative DBS electrode displacement in relation to subdural air invasion. METHODS We retrospectively analyzed 14 patients with advanced Parkinson disease and subthalamic nucleus DBS electrodes that underwent immediate postoperative frame-based stereotactic computer tomography (CT) and repeated CT after longer follow-up. We performed volumetric measurements of postoperative subdural air collections on both sides of the brain and determined stereotactic coordinates of the deepest DBS contact on the direct postoperative and follow-up CT. RESULTS Subdural air collection...
Research Interests: Mathematics, Neurosurgery, Computed Tomography, Deep Brain Stimulation, Medicine, and 14 moreSubthalamic Nucleus, Cerebrospinal Fluid, Humans, Female, Male, Frontal Cortex, Clinical Sciences, Middle Aged, Adult, Retrospective Studies, Stimulation, Neurosciences, Parkinson Disease, and Postoperative Complications
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An application of computer graphics technology to functional stereotactic neurosurgery is presented. Neuroanatomical images derived from a stereotactic atlas and information retrieved from a neurophysiological data base are drawn on a... more
An application of computer graphics technology to functional stereotactic neurosurgery is presented. Neuroanatomical images derived from a stereotactic atlas and information retrieved from a neurophysiological data base are drawn on a graphic monitor. The pictures are oriented and scaled according to appropriate landmarks. The aim of this work is to add confidence in the surgeon's selection of the probe trajectory and to improve the knowledge of sensory and motor organization within the thalamus.
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Giant intracranial aneurysms may not be amenable to direct surgical clipping or endovascular coiling because of three critical factors: 1) lack of clear aneurysmal neck; 2) giant size; 3) involvement with critical perforating or branch... more
Giant intracranial aneurysms may not be amenable to direct surgical clipping or endovascular coiling because of three critical factors: 1) lack of clear aneurysmal neck; 2) giant size; 3) involvement with critical perforating or branch vessels. Techniques of flow redirection, however, may offer an alternative treatment strategy for these difficult lesions. In this paper, we report on the use of this alternative strategy in the successful treatment of a left giant fusiform carotid terminus-M1 aneurysm in a 16 year-old boy suffering from Ehler-Danlos disease. This patient was admitted to our Institution because his aneurysm was continuing to be increasing in size, despite a previous ligation of his left cervical ICA which was performed at another institution 2 years earlier after the patient had experienced a hemorrhagic stroke. Upon admission, a neurological examination revealed a slight motor aphasia with mild right hemiparesis, remnant of the ancient stroke. Because of its size and...
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The use of local anaesthesia has been advocated by most pediatric surgeons in order to cut down hospitalization costs as well as to avoid general anaesthesia. In 1992, 26 patients aged 4 to 14 years (avg. 8 years) underwent small surgical... more
The use of local anaesthesia has been advocated by most pediatric surgeons in order to cut down hospitalization costs as well as to avoid general anaesthesia. In 1992, 26 patients aged 4 to 14 years (avg. 8 years) underwent small surgical procedures with local anesthesia, obtained by the application of EMLA cream 60 to 120 minutes prior to the procedure. EMLA cream is aneutectic mixture of lidocaine and prilocaine with a meeting point at a lesser temperature than the two compounds separately. In this way, concentration of anaesthetics increases up to 80% in the emulsion droplets. This preparation enables small operations to be performed under local anesthesia even in small children who can be safely treated as outpatients. Disadvantages due to the long time necessary for optimal action can be overcome by application of the cream at home by the parents themselves.
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Primary central nervous system lymphomas are a large group of neoplasms thought to account for about 1 % of primary brain tumors. Their incidence has increased rapidly in recent years notably in patients with acquired immunodeficiency... more
Primary central nervous system lymphomas are a large group of neoplasms thought to account for about 1 % of primary brain tumors. Their incidence has increased rapidly in recent years notably in patients with acquired immunodeficiency syndrome (AIDS) and in immunocompetent and immunosuppressed subjects [1, 2]. Radiation therapy has mainly been applied to treat CNS-NHL, but low cure rate and lack of enduring response has stimulated the search for alternatives [3].
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During the past decades, medical applications of virtual reality technology have been developing rapidly, ranging from a research curiosity to a commercially and clinically important area of medical informatics and technology. With the... more
During the past decades, medical applications of virtual reality technology have been developing rapidly, ranging from a research curiosity to a commercially and clinically important area of medical informatics and technology. With the aid of new technologies, the user is able to process large amounts of data sets to create accurate and almost realistic reconstructions of anatomic structures and related pathologies. As a result, a 3-diensional (3-D) representation is obtained, and surgeons can explore the brain for planning or training. Further improvement such as a feedback system increases the interaction between users and models by creating a virtual environment. Its use for advanced 3-D planning in neurosurgery is described. Different systems of medical image volume rendering have been used and analyzed for advanced 3-D planning: 1 is a commercial “ready-to-go” system (Dextroscope, Bracco, Volume Interaction, Singapore), whereas the others are open-source-based software (3-D Sli...
Research Interests: Neurosurgery, Diffusion Tensor Imaging, Medicine, Virtual Reality, Software, and 12 moreHumans, Computer Simulation, Trigeminal Neuralgia, Three Dimensional Imaging, Graduate medical education, Surgical Planning, Clinical Sciences, Computer User Interface Design, Cranial Nerves, Neurosciences, Brain Neoplasms, and cerebral arteries
The surgical approach to cerebral giant aneurysms is still a source of great concern. We describe our experience with giant aneurysms of the anterior circulation and discuss the different surgical techniques adopted. During the period... more
The surgical approach to cerebral giant aneurysms is still a source of great concern. We describe our experience with giant aneurysms of the anterior circulation and discuss the different surgical techniques adopted. During the period January 1972-December 1985, a total of 33 patients were operated upon at the Istituto Neurologico "C. Besta" of Milan for a giant aneurysm of the anterior circulation. Nineteen cases had suffered subarachnoid haemorrhage before admission; in 14 cases the hospitalization was due to evidence of mass effect on the surrounding neurovascular structures. All aneurysms were directly approached: in 24 cases the neck was occluded by a suitable clip, in 4 cases intramural thrombosis was attempted, in 3 cases the aneurysms were definitively trapped and in one case aneurysmorrhaphy was performed after resection of the sac. Operative mortality was 12%. Long-term follow-up shows good results whenever exclusion of the aneurysm from cerebral circulation had been achieved, either after removal of the sac or not; on the contrary, only fair or poor results were evident when other surgical techniques were adopted, either electively or out of necessity. The importance of intraoperative protection and monitoring of brain function is stressed.
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To extend the advantages of stereotactic localization to open procedures, a computational device with a graphic output is introduced. It is designed to be used in the operating room, where it processes neuroradiological information (CT,... more
To extend the advantages of stereotactic localization to open procedures, a computational device with a graphic output is introduced. It is designed to be used in the operating room, where it processes neuroradiological information (CT, MR, and angiography) acquired under stereotactic conditions. The surgeon can interact with neuroanatomical data, extracting borders of structures of surgical relevance. The resulting sets of outlines, shown tridimensionally within the reference of a stereotactic head holder, are presented with respect to the planned approaching trajectory. Color-coded high-resolution graphics show the relationship between lesions and normal brain structures and guide the surgeon's access to deep-seated lesions through small exposures.
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Cluster headache is the most severe among primary headaches. Positron emission tomography and functional MRI studies have demonstrated that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is... more
Cluster headache is the most severe among primary headaches. Positron emission tomography and functional MRI studies have demonstrated that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients thus indicating that cluster headache may originate at that level. These hypothalamic abnormalities in cluster headache led to the suggestion that deep brain stimulation of ipsilateral posterior inferior hypothalamus might produce clinical improvement in otherwise treatment refractory chronic cluster headache patients. In a patient with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side effects. So far other operations have been performed and the results are encouraging in terms of both pain relief and safety. The efficacy of hypothalamic electrical stimulation provides some hints into cluster headache pathophysiology.
Research Interests: Neurology, Neurosurgery, Deep Brain Stimulation, Magnetic Resonance Imaging, Functional MRI, and 15 morePositron Emission Tomography, Medicine, Humans, Neuroradiology, Hypothalamus, Female, Male, Clinical Sciences, Cluster Headache, Middle Aged, Adult, Neurosciences, Headaches, Neurological Sciences, and Electric stimulation
In an attempt to elucidate the mechanism(s) of action of thalidomide, a reportedly antiangiogenic molecule recently tested in the treatment of relapsing malignant gliomas, we performed an in vitro study on the following parameters: (a)... more
In an attempt to elucidate the mechanism(s) of action of thalidomide, a reportedly antiangiogenic molecule recently tested in the treatment of relapsing malignant gliomas, we performed an in vitro study on the following parameters: (a) effect of thalidomide on proliferation of endothelial cells; (b) effect of thalidomide on expression of avß3 integrin on the surface of endothelial cells; (c) effect
Research Interests: Cancer Research, Medicine, Angiogenesis, Cell Division, In Vitro, and 15 moreNeuro-Oncology, Humans, Vascular endothelium, Fibroblast Growth Factor, Endothelial cell, Tumor necrosis factor-alpha, Malignant Glioma, In Vitro Studies, Cell Proliferation, Neurosciences, Thalidomide, Matrix Metalloproteinase, Interleukin, Angiogenesis inhibitors, and Vascular endothelial growth factors
Research Interests: Deep Brain Stimulation, Medicine, Subthalamic Nucleus, High Frequency, Humans, and 14 moreDyskinesia, Levodopa, Clinical Sciences, Aged, Middle Aged, Motor Performance, Side Effect, Electrodes, Parkinson´s Disease, Neurosciences, Parkinson Disease, Severity of Illness Index, High Frequency Stimulation, and Electric stimulation
In vitro determination of 3H-thymidine labeling index (LI%) was carried out in craniopharyngiomas from 16 patients submitted to repeated surgical procedures. This study showed a poor correlation between LI% values and prognosis, but... more
In vitro determination of 3H-thymidine labeling index (LI%) was carried out in craniopharyngiomas from 16 patients submitted to repeated surgical procedures. This study showed a poor correlation between LI% values and prognosis, but allowed to detect a high LI% variation in the same tumor investigated in serial different times. The spatial distribution of S-phase proliferative cells in squamous epithelium of cystic components suggests a rationale for intracavitary treatment of cystic and mixed craniopharyngioma and may help explain its success.
Research Interests: Kinetics, Adolescent, Medicine, Cell Division, Humans, and 15 moreChild, Female, Male, Pediatric Neurosurgery, Spatial Distribution, Pituitary Gland, Middle Aged, Adult, Bleomycin, Neurosciences, Craniopharyngioma, Pituitary Neoplasms, Combined Modality Therapy, Child preschool, and Paediatrics and reproductive medicine
Since 1971, we have surgically treated spasticity in 109 cases of cerebral palsy with posterior rhizotomy. The best results have been obtained with functional posterior rhizotomy, an original modification of Foerster’s technique, in which... more
Since 1971, we have surgically treated spasticity in 109 cases of cerebral palsy with posterior rhizotomy. The best results have been obtained with functional posterior rhizotomy, an original modification of Foerster’s technique, in which the selection of the roots/rootlets to be sectioned is based on functional exploration of the spinal circuits involved in the maintenance of spasticity, using intra-operative electrostimulation on dorsal roots. This method makes selective sections possible, thereby saving a larger number of normal proprioceptive afferents, with consequent reduction in negative side effects. No recurrencies have been observed in our 3-year follow-up. The main indication is Little’s disease.
Research Interests: Cerebral Palsy, Medicine, Spasticity, Proprioception, Humans, and 15 moreChild, Pediatric Neurosurgery, Rhizotomy, Electromyography, Pediatric, Posture, Leg, Muscle contraction, Side Effect, Neurosciences, Surgical Treatment, Postoperative Complications, Muscle spasticity, Paediatrics and reproductive medicine, and Electric stimulation
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Q uando stat Colysaeum stat et Roma, quando cadet Colysaeum cadet et Roma, quando cadet et Roma cadet et mundus. (As long as the Colosseum lasts, Rome will last; when the Colosseum falls, Rome will fall; when Rome falls, the world will... more
Q uando stat Colysaeum stat et Roma, quando cadet Colysaeum cadet et Roma, quando cadet et Roma cadet et mundus. (As long as the Colosseum lasts, Rome will last; when the Colosseum falls, Rome will fall; when Rome falls, the world will fall.) (The Venerable Bede, AD 672–735) What is universally known as the Colosseum is, according to historical tradition, really the Flavian Theater, which takes its name from the dynasty of the Flavi (Vespasian, Titus, Domitian; AD 69–96), who promoted its construction between AD 70 and 80, the year of its resoundingly successful opening. The celebration of this great event was marked by 100 days of continuous gladiatorial exhibitions, games, and venationes (literally, “huntings”). These games, sponsored by the emperor Titus (AD 79–81), included fights between two persons or between groups of people; venationes of all kinds of animals (Fig. 1), including cranes and elephants, and during which 9000 beasts were killed (both carnivorous and herbivorous); other hunting rituals performed by women of very low social rank; a water show in the flooded amphitheater (which had a very effective hydraulic system), featuring bulls, horses, and other domesticated animals; punishment of the condemned to death ad bestias, as a part of mythological tableaux; and a series of other entertainments, among them a naumachia (“naval battle”), which were presented in other locations. Curiously and contrary to expectations, the name Colosseum does not derive from the extraordinary size of this great building (width, 156 m; length, 188 m; height, 52 m; average capacity, 50,000–58,000 persons, with a maximum of 73,000, according to the most reliable estimates), which, in any case, did not seem so exceptional to the Romans, but rather from its proximity to an enormous statue, the Colossus of Nero, from which the amphitheater took its name in the late Middle Ages. This unique public building of the empire’s capital was entirely surrounded by walls to enclose the fights between gladiators, the munera (originally, “manifestations,” in which the ancients believed they were fulfilling an obligation toward the dead by making human sacrifices to pacify the Manes, which passed from funerary and private rituals to great public performances), and the venationes. The Colosseum is the most complete and mature expression of Roman amphitheatric architecture, the apex of an articulated structural-constructive evolution, built from a variety of materials, ranging from stone (tufa and travertine) to brick and concrete.
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105 patients suffering from arteriosclerotic peripheral vascular disease (PVD) underwent epidural spinal stimulation in the last 10 years. Before 1986 the main indication was ischemic pain without any consideration of trophic lesions (19... more
105 patients suffering from arteriosclerotic peripheral vascular disease (PVD) underwent epidural spinal stimulation in the last 10 years. Before 1986 the main indication was ischemic pain without any consideration of trophic lesions (19 pts) while afterward the selection of the patients was more accurate in terms of disease's stage. The analysis of the data shows a more favourable results in the second group. Our experience suggest to use this technique in the treatment of patients in Fontaine's stage III and IV without necrosis and large trophic lesions.
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Research Interests: Chemotherapy, Drug delivery, Adolescent, Medicine, Humans, and 15 moreGlioma, Glioblastoma, Female, Male, Drug Delivery Systems, Clinical Sciences, Aged, Middle Aged, Doxorubicin, Adult, Combination drug therapy, Malignant Glioma, Convection Enhanced Delivery, Brain Neoplasms, and Neurological Sciences
Trigeminal neuralgia is a disorder characterized by paroxysmal pain arising in one or more trigeminal branches; it is commonly reported in multiple sclerosis. In multiple sclerosis patients the ophthalmic branch may be frequently involved... more
Trigeminal neuralgia is a disorder characterized by paroxysmal pain arising in one or more trigeminal branches; it is commonly reported in multiple sclerosis. In multiple sclerosis patients the ophthalmic branch may be frequently involved and the risks carried by neurosurgical ablative procedures are higher including major adverse effects such as corneal reflex impairment and keratitis. The objective of this works is to assess the role of posterior hypothalamus neuromodulation in the treatment of trigeminal neuralgia in multiple sclerosis patients. Five multiple sclerosis patients suffering from refractory recurrent trigeminal neuralgia involving all three trigeminal branches underwent deep brain stimulation of the posterior hypothalamus. The rationale of this intervention emerges from our earlier success in treating pain patients suffering from trigeminal autonomic cephalalgias. After follow-up periods that ranged from 1 to 4 years after treatment, the paroxysmal pain arising from ...
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The clinical course of 50 patients with low-grade glioma (31 male, 19 female) undergoing surgery at a single Institution from 1992 to 1996 was analyzed in relationship with known prognostic factors as far as time to tumor progression... more
The clinical course of 50 patients with low-grade glioma (31 male, 19 female) undergoing surgery at a single Institution from 1992 to 1996 was analyzed in relationship with known prognostic factors as far as time to tumor progression (TTP) and survival time (ST) are concerned. Moreover, microvessel density (MVD) and expression of the angiogenesis-related chemokine CXCL12 were investigated in surgical specimens. Age at diagnosis ranged from 1 to 68 years (median 30). Histology revealed 11 fibrillary, 6 protoplasmatic, 5 gemistocytic astrocytoma, 18 oligoastrocytoma and 10 oligodendroglioma. Mean follow-up was 86 months. Four patients were lost to follow-up. Of the remaining 46, twenty-four have shown disease progression and 14 have died. Median overall survival was not achieved; an estimated 75% percentage of survivors was found at 78 months. Complete gross tumor removal was associated to a longer TTP (P = 0.04 logrank). Of the investigated immunohistochemical parameters, while MVD was not predictive of subsequent TTP, expression of CXCL12 was associated with a significantly shorter TTP (P = 0.01 logrank): this predictive value remained significant (P = 0.02) at multivariate analysis. The data suggest the possible prognostic value for CXCL-12 (an angiogenesis- and tumor-growth-related chemokine) on TTP in low-grade gliomas.
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We read with great interest the article by Nakashima and coworkers, 1 who described in detail the clinical and laboratory features of 5 patients with multiple sclerosis (MS) whose magnetic resonance imaging (MRI) films showed linearly... more
We read with great interest the article by Nakashima and coworkers, 1 who described in detail the clinical and laboratory features of 5 patients with multiple sclerosis (MS) whose magnetic resonance imaging (MRI) films showed linearly shaped lesions along the intrapontine ...
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Research Interests: Neurosurgery, Medicine, Humans, Neuroradiology, Female, and 15 moreMale, Interventional Radiology, Follow-up studies, Ct Scan, Clinical Sciences, Middle Aged, Anti-Bacterial Agents, Time Factors, Lesion, Brain Abscess, X ray Computed Tomography, Neurosciences, Catheter, Brain stem, and Therapeutic Irrigation
Object The aim of this study was to review the indications for and results of deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) in the treatment of drug-refractory and severe painful syndromes of the face, disruptive and... more
Object The aim of this study was to review the indications for and results of deep brain stimulation (DBS) of the posterior hypothalamus (pHyp) in the treatment of drug-refractory and severe painful syndromes of the face, disruptive and aggressive behavior associated with epilepsy, and below-average intelligence. The preoperative clinical picture, functional imaging studies, and overall clinical results in the literature are discussed. Methods All patients underwent stereotactic implantation of deep-brain electrodes within the pHyp. Data from several authors have been collected and reported for each clinical entity, as have clinical results, adverse events, and neurophysiological characteristics of the pHyp. Results The percentage of patients with chronic cluster headache who responded to DBS was 50% in the overall reported series. The response rate was 100% for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing and for chronic paroxysmal ...
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THE INTRODUCTION OF thalamotomy in 1954 led naturally to exploration of the underlying subthalamic area, with the development of such procedures as campotomy and subthalamotomy in the posterior subthalamic area. The most popular of these... more
THE INTRODUCTION OF thalamotomy in 1954 led naturally to exploration of the underlying subthalamic area, with the development of such procedures as campotomy and subthalamotomy in the posterior subthalamic area. The most popular of these procedures was the subthalamotomy, which was performed in thousands of patients for various movement disorders. Today, in the deep brain stimulation (DBS) era, subthalamic nucleus DBS is the treatment of choice for Parkinson's disease, whereas thalamic and pallidal DBS are mainly used for nonparkinsonian tremor and dystonia, respectively. The interest in DBS in the posterior subthalamic area has been quite limited, however, with a total of 95 patients presented in 14 articles. During recent years, interest has increased, and promising results have been published concerning both…
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Research Interests: Medicine and Spinal Cord
In recent years, neuroimaging data have greatly improved the knowledge on trigeminal autonomic cephalalgias’ (TACs) central mechanisms. Positron emission tomography studies have shown that the posterior inferior hypothalamic grey matter... more
In recent years, neuroimaging data have greatly improved the knowledge on trigeminal autonomic cephalalgias’ (TACs) central mechanisms. Positron emission tomography studies have shown that the posterior inferior hypothalamic grey matter is activated during cluster headache attacks as well as in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Voxel-based morphometric MRI has also documented alteration in the
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The incidence of trigeminal neuralgia is about 5/10. Generally elderly people are affected by the so called "essential" form, although an early onset is not infrequent in secondary forms. The etiopathogenesis as well as the... more
The incidence of trigeminal neuralgia is about 5/10. Generally elderly people are affected by the so called "essential" form, although an early onset is not infrequent in secondary forms. The etiopathogenesis as well as the efficacy of different surgical treatments are still unclear because of the lack of animal sperimental models and of randomized controlled clinical studies. Nevertheless the hypothesis of a vascular conflict as the main etiologic factor is generally accepted. According both to our experience and to the literature data, microvascular decompression in the cerebello-pontine-angle appears to be the best clinical option presenting the most advantageous cost-benefit balance. The use of percutaneous lesive techniques, even if effective, should be limited in consideration of the risk of developing neuropathic disturbances, sometimes more difficult to treat than the original pain.
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In 1983, approximately 40 000 patients in France and 5 760 patients in Switzerland suffered from cerebral palsy, representing more than 0.1% of their respective populations. The functional disability of these patients is particularly... more
In 1983, approximately 40 000 patients in France and 5 760 patients in Switzerland suffered from cerebral palsy, representing more than 0.1% of their respective populations. The functional disability of these patients is particularly impressive and emphasizes the medical, social and economic importance of this problem. The term cerebral palsy is restricted to non-progressive disorders of motor function, already observed at an early age and due to cerebral lesions. These motor disorders can be of paretic, dystonic and dyskinetic nature. Their epidemiology, classification, etiology, pathology, early diagnosis and evolution are extensively reviewed by Th. Deonna. The difficulty in evaluation of treatment is the absence of a generally accepted rating scale. G. Broggi has proposed one on the basis of a large experience which could serve in the future for more objective evaluation. This monograph is devoted to the functional neurosurgical treatment of cerebral palsy. Physiotherapy and reh...
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A method is described, that enables the surgeon to appreciate the three-dimensional distribution of cerebral vessels within the stereotactic space.
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The potential of gene therapy strategies for malignant gliomas that are based on retroviral-mediated transfer of a "suicide gene" such as Herpes Simplex Virus-thymidine kinase HSV-tk and subsequent treatment by a prodrug... more
The potential of gene therapy strategies for malignant gliomas that are based on retroviral-mediated transfer of a "suicide gene" such as Herpes Simplex Virus-thymidine kinase HSV-tk and subsequent treatment by a prodrug (ganciclovir, for example), has been emphasized by the promising results obtained by several groups. However, further experimental data as well as preliminary clinical results indicate that the low efficiency of retroviral-mediated gene transfer in vivo as well as difficulties for the diffusion of the prodrug inside the tumour mass can limit the efficacy of this form of gene therapy. To achieve a more effective limitation of tumour growth other approaches may be combined with the "suicide gene" strategy and the enhancement of the immunological response to the tumour by cytokine gene transfer is prominent among these approaches. The authors' experiments in nude mice confirm the antineoplastic role of IL-4 and encourage testing the effects of t...
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The administration of baclofen, a GABAb agonist, by direct infusion into the CSF by means of a programmable device, may avoid the undesired side effects of the oral administration of both the same and other antispastic drugs while giving... more
The administration of baclofen, a GABAb agonist, by direct infusion into the CSF by means of a programmable device, may avoid the undesired side effects of the oral administration of both the same and other antispastic drugs while giving a marked reduction of spasticity. The preliminary results on 12 patients show the total efficacy of this procedure in reducing spasticity markedly.