Surgery, General Neuroscience, Neurology (clinical)
48
Scopus Publications
Scopus Publications
Artificial neural networks can be effectively used to model changes of intracranial pressure (ICP) during spinal surgery using different noninvasive ICP surrogate estimators Abdulla WATAD, Nicola L. BRAGAZZI, Susanna BACIGALUPPI, Howard AMITAL, Samaa WATAD, Kassem SHARIF, Bishara BISHARAT, Anna SIRI, Ala MAHAMID, Hakim ABU RAS, Ahmed NASR, Federico BILOTTA, Chiara ROBBA, Mohammad ADAWI Journal of Neurosurgical Sciences, 2023 BACKGROUND Artificial Intelligence (AI) techniques play a major role in anesthesiology, even though their importance is often overlooked. In the extant literature, AI approaches, such as Artificial Neural Networks (ANNs), have been underutilized, mainly being used to model patient's consciousness state, to predict the precise amount of anesthetic gases, the level of analgesia, or the need of anesthesiological blocks, among others. In the field of neurosurgery, ANNs have been effectively applied to the diagnosis and prognosis of cerebral tumors, seizures, low back pain, and also to the monitoring of intracranial pressure (ICP). METHODS A MultiLayer Perceptron (MLP), which is a feedforward ANN, with hyperbolic tangent as activation function in the input/hidden layers, softmax as activation function in the output layer, and cross-entropy as error function, was used to model the impact of prone versus supine position and the use of positive end expiratory pressure (PEEP) on ICP in a sample of 30 patients undergoing spinal surgery. Different non invasive surrogate estimations of ICP have been used and compared: namely, mean optic nerve sheath diameter (ONSD), non invasive estimated cerebral perfusion pressure (NCPP), pulsatility index (PI), ICP derived from PI (ICP-PI), and flow velocity diastolic formula (FVDICP). RESULTS ONSD proved to be a more robust surrogate estimation of ICP, with a predictive power of 75%, whilst the power of NCPP, ICP-PI, PI, and FVDICP were 60.5%, 54.8%, 53.1%, and 47.7%, respectively. CONCLUSIONS Our MLP analysis confirmed our findings previously obtained with regression, correlation, multivariate Receiving Operator Curve (multi-ROC) analyses. ANNs can be successfully used to predict the effects of prone versus supine position and PEEP on ICP in patients undergoing spinal surgery using different non invasive surrogate estimators of ICP.
Optimization of Vascular Supply in Free Flaps for Head and Neck Reconstruction: Analysis of a Young Team’s Experience Paolo Iacoviello, Susanna Bacigaluppi, Simone Callegari, Carlo Rossello, Andrea Antonini, Marco Gramegna, Mariano Da Rold, Giuseppe Signorini, Giuseppe Verrina Frontiers in Surgery, 2022 BackgroundFor head and neck reconstructive procedures, free flap survival depends on microsurgical and anatomical choices besides multimodal clinical management. The aim of the present study is to identify relevant variables for flap survival in our initial consecutive series.MethodsA single-center, novel reconstructive team consecutive surgical series was revised. The outcome was analyzed in terms of flap survival observing variables considered more relevant: flap type, recipient artery, vein(s), and graft interposition were discussed for facial thirds to be reconstructed. Statistical analysis was performed with Chi-square, Mann–Whitney, and Odds ratio.ResultsA total of 118 free flaps were performed in 115 microsurgical procedures (93.9% for malignancies) on 109 patients, with a flap survival rate of 91.5%. For reconstruction of the middle and lower third of the face, the facial artery was privileged, because it was already transected during lymph node dissection in order to save the superior thyroid artery for further microsurgical needs. Flap failure was 50% venous. Double vein anastomosis was not related to flap survival. Deep venous drainage (as the internal jugular vein system) required fewer revisions. Half of the re-explorations saved the flap. Grafts were a risk for flap survival. Bony flaps were more critical.ConclusionAt comparable reconstructive quality, flap choice should avoid a vascular graft. The facial artery is a preferable recipient vessel, since it saves other arteries both in the case of an arterial revision and in the case of recurrence, for further free flap reconstruction. For venous anastomosis, a deep venous recipient is safer, since it offers the possibility to choose the level of anastomosis optimizing the vascular pedicle geometry. A close postsurgical flap monitoring is advisable up to 7 days postoperatively to allow for timely flap salvage.
Systemic Inflammatory Response in Spontaneous Subarachnoid Hemorrhage from Aneurysmal Rupture versus Subarachnoid Hemorrhage of Unknown Origin Susanna Bacigaluppi, Nicola L Bragazzi, Federico Ivaldi, Federica Benvenuto, Antonio Uccelli, Gianluigi Zona Journal of Inflammation Research, 2022 Objective It is well known that spontaneous non-aneurysmal subarachnoid hemorrhage (SAH), also known as sine materia SAH (smSAH), has usually a better course and prognosis than its aneurysmal counterpart (aSAH). This might depend on different inflammatory mechanisms initiated by bleeding events of different origins. The aim of the present study was to explore the systemic inflammatory response in spontaneous SAH, comparing aSAH and smSAH. Methods We performed a prospective observational study over a consecutive series of patients with SAH. For these patients, we collected all clinical data and, furthermore, performed venous blood sampling over six time points to analyze blood cells. We further performed the analysis of lymphocytes and monocytes by means of flow cytometry to quantify common subtypes. Statistical analysis included a t-student test, Chi-square test, multivariate logistic regression, and ROC analysis. Results 48 patients were included: six (12.5%) with a diagnosis of spontaneous smSAH, and forty-two patients (87.5%) with aSAH. Significant differences on Day 0 were found for neutrophils and a systemic neuro-inflammatory index, namely, systemic inflammatory response index (SIRI). At the ROC analysis, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and SIRI exhibited satisfactory predictive power on day 0. At the multivariable logistic regression analysis, the combined index (NLR, LMR, SIRI at day 0) yielded an OR of 0.59 (95% CI 0.29–1.21]). LMR at day 0 yielded an OR of 1.25 ([95% CI 0.94–1.68]), NLR at day 0 exhibited an OR of 0.68 ([95% CI 0.42–1.09]), and SIRI at day 0 displayed an OR of 0.31 ([95% CI 0.06–1.49]). Conclusion This preliminary study indicated a possible role of some inflammatory indices that point out the importance of innate and adaptive immunity in the etiopathogenetic mechanisms. Drugs modulating these responses could eventually counteract or, at least, reduce secondary damage associated with SAH.
Microsurgical Three-Dimensional Reconstruction of Complex Nasal and Midfacial Defect: Multistep Procedure Respecting Aesthetic Unit Criteria Paolo Iacoviello, Susanna Bacigaluppi, Marco Gramegna, Simone Callegari, Giuseppe Signorini, Giuseppe Verrina Journal of Craniofacial Surgery, 2021 Extended tumor resection in the middle third of the face leads to complex defects: wide, 3-dimensional, and multitissutal. Appropriate reconstruction is challenging but mandatory to obtain a functional and aesthetic outcome for the preservation of an acceptable quality of life. Three-dimensional combined flaps and multistep procedures concur to reach this scope. This is exemplified on the treatment of an invasive recurrent skin malignancy involving the cheek and maxillary bone in association with a full-thickness nasal defect. Reconstruction was performed with 3-dimensional multifolded anterolateral tigh chimeric flap, followed by multistep procedure respecting the aesthetic nasal reconstruction guidelines. Reconstructive surgery had the following targets: targets: rebuilding the oral and nasal lining, filling the paranasal cavities, covering the facial skin defect respecting the aesthetic unit concept and providing a proper support to the facial structures. The aesthetic unit concept has to be respected throughout all steps, from tumor debulking, to reconstruction and even for the management of complications.
An international call for a new grading system for cerebral and cerebellar cavernomas Marco M. FONTANELLA, Susanna BACIGALUPPI, Francesco DOGLIETTO, Luca ZANIN, Edoardo AGOSTI, Pierpaolo PANCIANI, Francesco BELOTTI, Giorgio SARACENO, Giannantonio SPENA, Riccardo DRAGHI, Alessandro FIORINDI, Claudio CORNALI, Antonio BIROLI, Juri KIVELEV, Massimo CHIESA, Saverio F. RETTA, Roberto GASPAROTTI, Yoko KATO, Juha HERNESNIEMI, Daniele RIGAMONTI Journal of Neurosurgical Sciences, 2021 Surgical indications for cerebral cavernous malformations remain significantly center- and surgeon-dependent. Available grading systems are potentially limited, as they do not include epileptological and radiological data. A novel grading system is proposed for supratentorial and cerebellar cavernomas: it considers neuroradiological features (bleeding, increase in size), neurological status (focal deficits and seizures), location of the lesion and age of the patient. The score ranges from -1 to 10; furthermore, surgery should be considered when a score of 4 or higher is present. Based on neuroradiological characteristics, 0 points are assigned if the CCM is stable in size at different neuroradiological controls, 1 point if there is an increase in volume during follow-up, 2 points if intra- or extra-lesional bleeding <1 cm is present and 3 points if the CCM produced a hematoma >1 cm. Regarding focal neurological deficits, 0 points are assigned if absent and 2 points if present. For seizures, 0 points are assigned if absent, 1 point if present, but controlled by medications, and 2 points if drug resistant. We considered the site of the CCM, and in case of deep-seated lesions in a critical area (basal ganglia, thalamus) 1 point (-1) is subtracted, while for subcortical or deep cerebellar lesions 0 points are assigned, for CCMs in a cortical critical area 1 point is assigned and in case of lesions in cortical not in critical area or superficial cerebellar area, 2 points are assigned. As far as age is concerned, 0 points are assigned for patients older than 50 years and 1 point for patients younger than 50. In conclusion, a novel grading for surgical decision making in cerebral cavernomas, based on the experience of selected neurosurgeons, basic scientists, and patients, is suggested with the aim of further improving and standardizing the treatment of CCMs. The aim of this paper was also to call for both retrospective and prospective multicenter studies with the aim of testing the efficacy of the grading system in different centers.
Prognostic factors in chronic subdural hematoma: Results from a monocentric consecutive surgical series of 605 patients Susanna BACIGALUPPI, Fedra GUASTALLI, Nicola L. BRAGAZZI, Alberto BALESTRINO, Paolo BRUZZI, Gianluigi ZONA Journal of Neurosurgical Sciences, 2021 BACKGROUND The study of age-related diseases like chronic subdural hematoma (CSDH) is of high interest, considered the general ageing of the population. This investigation aimed to identify the main clinical characteristics of CSDH patients, to evaluate the impact of the disease on quality of life, its treatment and co-morbidities/complications and to compare our data with other surgical series published over the past 5 years. METHODS A retrospective cohort study including all consecutive patients operated for CSDH between January 1st 2006 and December 31st 2013 at the Unit of Neurosurgery of our hospital was carried out. RESULTS 605 patients were included in the study (66.0% male, mean age 77.5±10.5 years). History of brain trauma was reported in 65.6 %. Common co-morbidities were hypertension (59.0%), cardiopathies (36.0%), and previous stroke (23.6%). Clotting and coagulation alterations were present in 27.2% and 17.0%, respectively. In 24.0% of cases, the hematoma was bilateral. 17.3% had more than one surgery. Length of stay was of 14.8±10.1 days. Baseline KPS, pre-surgical KPS, and KPS at discharge were 87.7±14.9, 64.9 ±19.8 and 76.7±27.2, respectively. A complete recovery was observed in 62.9% of patients. Mortality rate during hospitalization was 7.4%. CONCLUSIONS The knowledge of clinical and surgical factors which might impact on the clinical outcomes could help to better manage patients with CSDH, which represents a surgically 'simple' but, indeed, not trivial disease.
An Early Increase of Blood Leukocyte Subsets in Aneurysmal Subarachnoid Hemorrhage Is Predictive of Vasospasm Susanna Bacigaluppi, Federico Ivaldi, Nicola L. Bragazzi, Federica Benvenuto, Fabio Gallo, Alessandro D'Andrea, Paolo Severi, Antonio Uccelli, Gianluigi Zona Frontiers in Neurology, 2020 Objective: Vasospasm is a severe complication in patients with aneurysmal subarachnoid hemorrhage (aSAH) and cannot be reliably predicted. Its pathophysiology remains elusive with the current body of evidence suggesting inflammation as one of the main driving forces. We here aimed to analyze circulating immune cell subsets over time in patients with aSAH with or without vasospasm.Methods: We performed a prospective observational study recruiting patients with spontaneous aSAH. Peripheral blood withdrawn at pre-specified time-points after aSAH, day 0, days 3–4, 6–8, 10–11, 13–15, and 18–21. Flow cytometry analysis, cell blood counts, and laboratory and diagnostic parameters were performed. Patients were monitored by transcranial Doppler for vasospasm as well as by advanced imaging and divided into a group with (VS) and without vasospasm VS (NVS).Results: We included 42 patients for study analysis, 21 VS and 21 NVS. An early significant increase at day 0 in platelet, leukocyte, neutrophil, lymphocyte, NK lymphocyte, monocyte, and CD 14++ CD16− DR+ monocyte counts was found in patients with later ensuing vasospasm. The early differences in platelets, leukocytes, lymphocytes, and NK lymphocytes remained significant on multivariate analysis.Conclusions: An early increase of immune cellular subsets in aSAH may contribute to predict VS.
Intraneural haemangioma of peripheral nerves Susanna Bacigaluppi, Pietro Fiaschi, Alessandro Prior, Nicola L. Bragazzi, Paolo Merciadri, Sergio Gennaro British Journal of Neurosurgery, 2020
Minimally invasive transforaminal interbody fusion: A single center experience Journal of Neurosurgical Sciences, 2014
Pre-symptomatic cervical myelopathy: Should we operate or should we observe? What is the chance of spinal cord injury from an accident? Journal of Neurosurgical Sciences, 2014
Schilder's disease: Non-invasive diagnosis? Susanna Bacigaluppi, Gabriele Polonara, Mario L. Zavanone, Rolando Campanella, Vincenzo Branca, Sergio M. Gaini, Giovanni Tredici, Antonella Costa Neurological Sciences, 2009
