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Editorial. The role of telemedicine in countries with limited facilities: which peculiarities?

Franco Servadei and Ismail Zaed

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Editorial. Perceive the differences, differentiate the perceptions: why should we be interested in TBI management in Tanzania?

Franco Servadei, Riccardo Spaggiari, and Maria Pia Tropeano

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Effect of common carotid ligation on giant aneurysms of the internal carotid artery

Computerized tomography study

Eugenio Pozzati, Leo Fagioli, Franco Servadei, and Giulio Gaist

✓ The effects of common carotid artery ligation on five giant aneurysms (greater than 2.5 cm in diameter) of the internal carotid artery were studied by computerized tomography (CT). Four aneurysms thrombosed completely and one partially. The CT image of the thrombosed part in giant aneurysms is protean, varying from hyperdensity in the immediate postoperative period to isodensity and finally to inhomogeneously increased or decreased density, the attenuation values depending on the different stages of organization of the thrombus and on calcium deposition.

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Pudendal neuralgia due to solitary neurofibroma

Case report

Francesco Tognetti, Massimo Poppi, Giulio Gaist, and Franco Servadei

✓ An unusual case of pudendal neuralgia due to a solitary neurofibroma of the perineal region is described. The authors outline the long clinical history. There was complete pain relief after removal of the lesion.

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Traumatic aneurysms of the supraclinoid internal carotid artery

Report of two cases

Eugenio Pozzati, Giulio Gaist, and Franco Servadei

✓ This paper describes two patients with traumatic aneurysms of the supraclinoid internal carotid artery, which occurred after a closed-head injury and without demonstrable basal skull fracture. In the first case, the traumatic origin of the aneurysm was demonstrated by repeat angiograms. The second case documents the formation of a giant, traumatic, true aneurysm of the supraclinoid carotid artery over a period of less than 2 months; there was an associated traumatic partial occlusion of the vessel proximal to the aneurysm. The mechanisms of injury of the supraclinoid carotid artery are discussed.

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Introduction. Best practices in telemedicine for optimizing patient care

Franco Servadei, Katharine J. Drummond, Ann Stroink, and Jamie J. Van Gompel

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Introduction. Traumatic brain injury

Alex B. Valadka, Andrew I. R. Maas, and Franco Servadei

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Editorial. Neurosurgery in the storm of COVID-19: suggestions from the Lombardy region, Italy (ex malo bonum)

Marco Cenzato, Francesco DiMeco, Marco Fontanella, Davide Locatelli, and Franco Servadei

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Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience

Reza Ghadirpour, Davide Nasi, Corrado Iaccarino, Antonio Romano, Luisa Motti, Rossella Sabadini, Franco Valzania, and Franco Servadei


The purpose of this study was to evaluate the technical feasibility, accuracy, and relevance on surgical outcome of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during resection of intradural extramedullary (IDEM) spinal tumors.


Clinical and intraoperative neurophysiological monitoring (IONM) data obtained in 108 consecutive patients who underwent surgery for IDEM tumors at the Institute for Scientific and Care Research “ASMN” of Reggio Emilia, Italy, were prospectively entered into a database and retrospectively analyzed. The IONM included SSEPs, MEPs, and—whenever possible—D-waves. All patients were evaluated using the modified McCormick Scale at admission and at 3, 6, and 12 months of follow-up .


A total of 108 patients were included in this study. A monitorable D-wave was achieved in 71 of the 77 patients harboring cervical and thoracic IDEM tumors (92.2%). Recording of D-waves in IDEM tumors was significantly associated only with a preoperative deeply compromised neurological status evaluated using the modified McCormick Scale (p = 0.04). Overall, significant IONM changes were registered in 14 (12.96%) of 108 patients and 9 of these patients (8.33%) had permanent loss of at least one of the 3 evoked potentials. In 7 patients (6.48%), the presence of an s18278 caudal D-wave was predictive of a favorable long-term motor outcome even when the MEPs and/or SSEPs were lost during IDEM tumor resection. However, in 2 cases (1.85%) the D-wave permanently decreased by approximately 50%, and surgery was definitively abandoned to prevent permanent paraplegia. Cumulatively, SSEP, MEP, and D-wave monitoring significantly predicted postoperative deficits (p = 0.0001; AUC = 0.905), with a sensitivity of 85.7% and a specificity of 97%. Comparing the area under the receiver operating characteristic curves of these tests, D-waves appeared to have a significantly greater predictive value than MEPs and especially SSEPs alone (0.992 vs 0.798 vs 0.653; p = 0.023 and p < 0.001, respectively). On multiple logistic regression, the independent risk factors associated with significant IONM changes in the entire population were age older than 65 years and an anterolateral location of the tumor (p < 0.0001).


D-wave monitoring was feasible in all patients without severe preoperative motor deficits. D-waves demonstrated a statistically significant higher ability to predict postoperative deficits compared with SSEPs and MEPs alone and allowed us to proceed with IDEM tumor resection, even in cases of SSEP and/or MEP loss. Patients older than 65 years and with anterolateral IDEM tumors can benefit most from the use of IONM.

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Neurosurgical digital teaching in low-middle income countries: beyond the frontiers of traditional education

Federico Nicolosi, Zefferino Rossini, Ismail Zaed, Angelos G. Kolias, Maurizio Fornari, and Franco Servadei


Neurosurgical training is usually based on traditional sources of education, such as papers, books, direct surgical experience, and cadaveric hands-on courses. In low-middle income countries, standard education programs are often unavailable, mainly owing to the lack of human and economic resources. Introducing digital platforms in these settings could be an alternative solution for bridging the gap between Western and poor countries in neurosurgical knowledge.


The authors identified from the Internet the main digital platforms that could easily be adopted in low-middle income countries. They selected free/low-cost mobile content with high educational impact.


The platforms that were identified as fulfilling the characteristics described above are WFNS Young Neurosurgeons Forum Stream, Brainbook, NeuroMind, UpSurgeOn, The Neurosurgical Atlas, Touch surgery, The 100 UCLA Subjects in Neurosurgery, Neurosurgery Survival Guide, EANS (European Association of Neurosurgical Societies) Academy, Neurosurgical.TV, 3D Neuroanatomy, The Rhoton Collection, and Hinari. These platforms consist of webinars, 3D interactive neuroanatomy and neurosurgery content, videos, and e-learning programs supported by neurosurgical associations or journals.


Digital education is an emerging tool for contributing to the spread of information in the neurosurgical community. The continuous improvement in the quality of content will rapidly increase the scientific validity of digital programs. In conclusion, the fast and easy access to digital resources could contribute to promote neurosurgical education in countries with limited facilities.