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Objectives/hypothesis Maxillary cancers are rare and aggressive tumors, which can spread beyond the sinus bony walls. Preoperative assessment of infiltration of maxillary sinus floor (MSF) is paramount for surgical planning, as palatomaxillary demolition significantly impacts patients' quality of life. This study investigates the challenges involved in the preoperative and intraoperative evaluation of MSF infiltration and analyzes its prognostic relevance. Study design Retrospective case series. Methods A retrospective review of patients treated for sinonasal malignancies at a single Institution was performed. Patients receiving surgical-based treatment with curative intent for primary maxillary sinus cancers, between January 2000 and November 2019, were included. Results A cohort of 118 patients was analyzed. By comparing intraoperative findings (endoscopic assessment and frozen sections) with preoperative radiological assessment, diagnostic changes with regard to MSF infiltration were found in 27.1% (32/118 cases). MSF infiltration negatively affected the prognosis in both univariate and multivariate analyses in the overall population. In the subgroup of pT1-T3 tumors, MSF infiltration was significantly associated with reduced overall (P = .012), disease-free (P = .011), and distant recurrence-free (P = .002) survival rates. Conversely, pT classification was not able to stratify patients according to prognosis, mainly because early-staged cancers (pT1-T2) with MSF infiltration showed reduced survival rates, similar to those observed in pT3 cancers. Conclusions Preoperative imaging should be integrated with intraoperative findings based on endoscopic inspection and frozen sections. Future studies are required to investigate the opportunity to incorporate MSF infiltration in the TNM staging system, considering its crucial role in defining the extent of surgery and its potential as prognosticator. Level of evidence 4 Laryngoscope, 2021.

Background The primary aim of this study was to provide additional data of neuroimaging features of coronavirus disease 2019 (COVID-19) in a large-scale population admitted in several northern Italy institutions. The secondary aim was to analyze acute cerebrovascular disease (CVD) prevalence in COVID-19. Methods A database of confirmed COVID-19 hospitalized patients who developed acute neurological symptoms and underwent any neuroimaging was retrospectively gathered from twelve institutions based in Lombardy from February 21st to July 10th. To assess the prevalence of CVD we conducted a scoping review following the PRISMA extension guidelines for scoping reviews. We searched PubMed/Medline, SCOPUS and EMBASE databases for peer-reviewed in-press or published studies from December to January 2021 reporting CVD in COVID-19 patients. Results Out of 90 COVID-19 patients who were referred to neuroimaging, 78 (87%) showed CVD, in particular 65 had acute ischemic strokes (AIS), 8 had intracerebral hemorrhages, 2 subarachnoid hemorrhages (SAH) and 3 showed clinical and imaging findings in keeping with posterior reversible encephalopathy syndrome (PRES); 6 patients (7%) showed clinical and imaging findings highly suggestive of encephalitis; 3 patients (3%) showed demyelinating diseases: 1 case of MS progression, 1 case of newly diagnosed MS and 1 case of acute disseminated encephalomyelitis (ADEM); 2 cases (2%) acuity of chronic subdural hematoma (cSDH); 1 patient (1%) with Guillain Barré syndrome. In addiction two patients with CVD developed cauda polyradiculitis and tetraparesis. In our scoping review out of 3275 studies, 24 satisfied the inclusion criteria: in a pooled total population of 136198 patients, the pooled prevalence of CVD was 0.9%. In particular 0.8% of AIS and 0.1% of ICH and 0.003% of PRES. Conclusions Our study shows a high prevalence of CVD among patients who developed acute neurological symptoms, which is in line with papers reporting data comparable to ours. The heterogeneity of clinical reports, however, constitutes a limitation when comparing our findings with those of the clinical papers. Nonetheless, CVD could be a frightening association with COVID-19, particularly in critically ill patients. Healthcare policymakers and clinicians should be prepared to a likely increase in workload and to rearrange the strategy of healthcare delivery.

Journal of Neuroradiology - Sous presse. Manuscrit accepte. Disponible en ligne depuis le vendredi 15 mai 2020

Background The purpose of this study was to report our experience with the endoscopic management of sinonasal schwannomas, analyzing the advantages, limitations, and outcomes of the technique. Methods A retrospective analysis was carried out on 11 patients treated endoscopically between 2000 and 2014 at a single institution. Results Eight patients underwent an exclusive endoscopic endonasal approach, whereas, in 3 patients, an osteoplastic flap was combined because of massive or lateral frontal sinus involvement. The tumor extended into the orbit in 5 cases, and involved the skull base in 5 patients who required a concomitant endoscopic duraplasty. No evidence of disease was observed in 10 patients after a mean follow-up of 90.1 months (range, 14–189 months). One patient was alive with persistence of disease, although asymptomatic. Conclusion The endoscopic endonasal approach is a valid alternative for the vast majority of sinonasal schwannomas with minimal morbidity for the patient. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2074–E2082, 2016

This paper is a case report of a young patient after a major head trauma causing multiple skull base fractures. The trauma occasioned pseudoaneurysm (PSA) from intracavernous C4 segment of left internal carotid artery (ICA) protruding in the sphenoidal sinus. After two months, two episodes of massive epistaxis occurred. Consequently, the post-traumatic PSA was treated, after carotid occlusion test, with flow-diverter stent positioning. A computed tomography angiography study performed in the following days showed complete resolution of the post-traumatic PSA lesion and ICA patency.

The use of flow-diverter (FD) stents in recent years has positively changed the therapeutic approach to some vascular diseases, especially of certain types of aneurysms. This paper describes the case of a young patient after a major head trauma causing multiple skull fractures. The trauma occasioned two pseudoaneurysms from the A1 segment of the right anterior cerebral artery and from the A2 segment of the left anterior cerebral artery. Both lesions were treated with two Pipeline devices (ev3, Irvine, CA, USA) in two different sessions. The CT study and angiographic investigations performed in the following month showed a complete resolution of the post-traumatic pseudoaneurysmal lesions. Although the use of FD stents is described in the literature, particularly in the treatment of selected aneurysms, this paper shows good technical results in the use of these stents in cases of intracranial post-traumatic pseudoaneurysms with clinical improvement.

Lhermitte-Duclos disease is a rare pathologic condition consisting of a dysplastic gangliocytoma of the cerebellum. Its association with phacomatosis and an autosomal dominant neoplastic syndrome, Cowden's syndrome is also known. Modern neuroimaging contributes to a correct diagnosis and pre- and postoperative evaluation. Here we describe the morphologic and metabolic aspects of the disease as shown by conventional MRI, diffusion imaging and spectroscopy in a 31-year-old woman. In addition, the specific neuroradiologic characteristics are presented and discussed in the light of the main pathologic and clinical features, such as hypertrophy of the cerebellar folia associated with white matter atrophy.

The aim of this study is to explore the possibility of endovascular treatment of internal carotid artery pseudoaneurysm (PSA). These lesions are difficult to treat with a surgical approach, especially if they are located extracranially and close to the skull base. Endovascular stent placement in symptomatic and unstable extracranial internal carotid PSA was found to be safe and effective. Depending on hemodynamic aspects, complete local exclusion of aneurysmal formation is achieved in few months. We present three patients with carotid dissection and PSA formation that have been successfully treated by stent placement.

International audience; Lake Ohrid (Balkan peninsula) is the oldest European extant lake and one of the deepest and largest. Such a unique, terrestrial natural archive is especially relevant for both paleoenvironmental and paleoclimatic reconstructions but also for genetic studies. In the frame of the International Continental Scientific Drilling Program (ICDP), a deep drilling campaign was carried out within the scope of the Scientific Collaboration on Past Speciation Conditions in Lake Ohrid (SCOPSCO) project in 2013. Here, we present the summary of palynological analyses carried out in the upper 200 m of the overall 569 m long DEEP site sediment succession from the central part of the lake. These studies, performed by an international palynological team, document the main floristic, vegetation and climate changes during the last ca 500 kyr, at a millennial-scale resolution (~1.6 kyr). The continuous sediment infill permitted to trace multiple non-forested/ forested phases as a response to Glacial/Interglacial cycles as well as to sub-Milankovitch climate changes. The pollen record, corresponding with marine isotope stages MIS 13 to MIS 1, points to a progressive change from cooler and wetter to warmer and drier interglacials. New palynological studies are underway to reconstruct vegetational and climatic conditions over older intervals as well as to obtain high resolution data for some key intervals such as MIS 5-6, MIS 11-12, MIS 35-42. The complete record of changes in flora composition and vegetation during both glacials and interglacials will furnish indispensable insights for understanding the role of refugia, ecosystem resilience and maintenance of terrestrial biodiversity in the Mediterranean area.

Vengono presentati quattro casi di paralisi isolata del nervo ipoglosso giunti recentemente alla nostra osservazione. In tre casi la sintomatologia clinica era conseguente ad una compressione del tronco nervoso a livello del canale osseo proprio (due da secondarismo di carcinoma mammario, il terzo da dissezione della carotide interna a livello del bulbo della giugulare). Nel quarto caso il deficit neurologico era in relazione con una poussée di sclerosi multipla. Una paralisi isolata del XII è sintomo relativamente raro, spesso misconosciuto o sottovalutato. Al contrario la nostra esperienza e un'attenta analisi della letteratura mostrano come esso possa essere espressione di patologie a eziopatogenesi estremamente polimorfa, anche gravi e potenzialmente curabili. Il suo rilievo deve quindi indurre il neuroradiologo ad uno studio mirato di tutta la regione, il cui presupposto è rappresentato da una conoscenza approfondita anatomo-clinica, al fine di un corretto utilizzo delle specifiche metodiche diagnostiche.

Dal giugno 1991 all'agosto 1994 abbiamo sottoposto a biopsia vertebrale TC-guidata 24 pazienti, portatori di alterazioni litiche vertebrali o disco-vertebrali di natura non sicuramente determinabile in base ai dati morfologici lesionali ed al contesto clinico-diagnostico. Due tipi prelievo sono possibili, citologico ed istologico, con tecnica differente, in particolare per quanto riguarda lo strumentario utilizzato. In 15 pazienti abbiamo avuto un reperto di tipo neoplastico, in 10 secondario ed in 5 primitivo. In 5 il reperto è stato di tipo infettivo-infiammatorio. In 4 pazienti infine prelievi ripetuti non hanno fornito materiale sufficiente ad una corretta diagnosi. Nella nostra serie l'attendibilità diagnostica è stata quindi dell'83%. Nei 24 casi da noi trattati non lamentiamo alcuna complicanza. L'unica controindicazione assoluta alla metodica è la presenza di una grave coagulopatia. In conclusione la metodica, grazie all'impiego della TC, risulta semplice, rapida e sicura; elevata è nella nostra esperienza l'efficacia a fini diagnostico-terapeutici.

Le spondilodisciti rappresentano una patologia di sempre più frequente osservazione, sia per l'incremento in anni recenti di condizioni favorenti (quali la tossicodipendenza, l'AIDS o l'immunodepressione terapeutica), sia per la maggiore sensibilità delle indagini diagnostiche, in particolare della risonanza magnetica, sia infine per l'aumentata invasività diagnostica e terapeutica a carico dei dischi intervertebrali (chirurgia spinale, discografie, trattamenti percutanei per ernie discali).Essa rimane tuttavia una causa non comune di rachialgia, la cui eziologia, per quanto spesso attribuibile con certezza ad un preciso agente patogeno, non è ancora chiarita con certezza in tutti i suoi aspetti.In letteratura le segnalazioni riguardanti localizzazioni discitiche multiple sono in generale scarse. Recentemente sono giunti alla nostra osservazione tre casi di spondilodiscite lombare multipla, meritevoli di descrizione sia per la loro rarità, sia per alcune peculiarity morfologiche e conseguentemente radiologiche.Esse ci consentono inoltre considerazioni di ordine eziopatogenetico generale, anche riguardo la ben più frequente localizzazione singola. La concentrazione nei tempo delle nostre osservazioni ci fa ritenere probabile che anche le localizzazioni multiple siano di fatto più frequenti di quanto usualmente ritenuto e segnalato.

L'eclampsia gravidica costituisce una infrequente ma grave complicanza in corso di sindrome gestosica ed è caratterizzata da episodi di convulsioni generalizzate seguiti da coma che generalmente recede in un breve lasso di tempo. A questi tipici sintomi principali si associano altri segni di interessamento del sistema nervoso centrale, spesso di natura focale, che in passato sono stati descritti come a rapida risoluzione (2–3 giorni) senza reliquati sia dal punto di vista clinico che radiologico, ove si escludano gli infrequenti casi (5%) in cui si osserva l'instaurarsi di una grave emorragia cerebrale capace di condurre al decesso la paziente. Vengono descritti due casi che si discostano in parte da quanto finora segnalato in letteratura poiché, dopo il superamento da parte delle pazienti dell'episodio eclamptico acuto, si è osservato in entrambe il persistere di segni neurologici per la durata di mesi. In base a tali rilievi viene ipotizzato che l'evoluzione dei sintomi neurologici post-eclampsia sia più variabile nell'entità e nella durata di quanto finora dimostrato, evidenziandosi in tal modo un possibile inquadramento di tali rilievi in gradi progressivi di gravità legati al tipo (edema, sofferenza ischemica, emorragia) ed all'entità del danno instauratosi a carico del sistema nervoso centrale.