Observations in 124 Cases
Bernardo Fraioli and Beniamino Guidetti
✓ Twenty-six patients were operated on using a technical modification of Förster's method of treating spasticity, which consists of a partial section of the rootlets constituting the posterior roots. Many patients had mild cerebral spastic quadriplegia or spastic diplegia: several of them were nearly independent when standing or walking, and two of them completely independent. The spastic disorders that were not made worse by voluntary movements were reduced or abolished in all but one patient, in whom rootlet section was insufficient. The spastic disorders that were made worse by voluntary movements were only partially reduced; after operation they were scarcely evident or absent in a static position, but evident during voluntary movements. No improvement was observed in one patient who suffered from spastic disorders that were evident only during voluntary movements, or in one patient suffering from dystonia. The procedure caused no sensory disorders. The operation was especially useful in patients who were acquiring or had already acquired independence when standing or walking.
Beniamino Guidetti and Emanuele La Torre
✓ The authors present 26 cases of carotid-ophthalmic aneurysms that were surgically treated. Contrary to the opinion that these aneurysms, which often are of giant size, must be treated conservatively or by common carotid ligation, the authors favor radical surgery, believing that carotid ligation does not provide assurance against the risk of rebleeding, and frequently is associated with failure to restore useful vision. Often these aneurysms have a neck more suitable for ligation than shown by angiography, since a giant aneurysm may overlap the carotid artery in the angiogram. Preoperative criteria and some details of radical treatment are discussed.
Surgical experience with 51 cases and long-term results
Lucio Palma and Beniamino Guidetti
✓ This study concerns 51 cases of cystic pilocytic astrocytoma of the cerebral hemispheres. At operation these tumors closely resembled cerebellar astrocytomas, presenting as a big cyst contiguous with the lateral ventricle and containing a small mural nodule. The nodule was in a deep location in 26 cases, and always showed marked contrast enhancement on computerized tomography scans. The most frequent presenting symptom was epilepsy (68%), and the most common sign was papilledema (85%). The major goal of surgery was extirpation of the nodule. The follow-up period of the 34 cases available for long-term review ranged from 6 to 31 years (mean 17 years). Of these, 28 patients (82%) had a good outcome; four (12%) had a fair result, and two (6%) had a poor response. An analysis of these results shows that total extirpation of the mural tumor was associated with the best outcome, whether or not the cyst wall was completely removed. Radiation therapy was irrelevant to the prognosis for these patients. On the other hand, partial excision of the nodule, correlated with the deep location of the tumor, was the cause of the two poor results in this series and resulted in multiple operations for recurrences in two other patients. Nevertheless, two of these patients are still alive and well many years after incomplete surgical treatment. On the basis of this study, the importance of recognizing the occurrence of this “benign” tumor of the cerebral hemispheres is stressed, and the hypothesis of a common origin from subependymal glia of all pilocytic astrocytomas is supported.
Clinical evaluation and late surgical results
Beniamino Guidetti and Franco M. Gagliardi
✓ The authors report on the clinical data, operating technique, postoperative complications, and late results in a series of 31 epidermoid and 21 dermoid cysts of the central nervous system.
Report of Six Cases
Beniamino Guidetti and Aldo Fortuna
Conservative and surgical treatment
Beniamino Guidetti and Alberto Delitala
✓ The authors present a consecutive series of 145 patients admitted to the Institute of Neurosurgery of Rome University with an intracranial arteriovenous malformation (AVM). Of these, 95 received surgical care, and 50 were treated conservatively. Total removal of the AVM was performed in all but three of the patients treated surgically, and all underwent postoperative angiography. The postoperative mortality was 6.3%. A long-term follow-up study showed a mortality rate of 20% in the group of patients receiving conservative treatment, while no recurrence of bleeding was observed in the surgical group. The choice of treatment of these malformations is still an open question. The authors' contribution to the discussion is based on the late results of both surgical and conservative treatment.