Frequency and outcome of olfactory impairment and sinonasal involvement in hospitalized patients with COVID-19

Background: Olfactory dysfunction has shown to accompany COVID-19. There are varying data regarding the exact frequency in the various study population. The outcome of the olfactory impairment is also not clearly defined. Objective: To find the frequency of olfactory impairment and its outcome in hospitalized patients with positive swab test for COVID-19. Methods: This is a prospective descriptive study of 100 hospitalized COVID-19 patients, randomly sampled, from February to March 2020. Demographics, comorbidities, and laboratory findings were analyzed according to the olfactory loss or sinonasal symptoms. The olfactory impairment and sinonasal symptoms were evaluated by 9 Likert scale questions asked from the patients. Results: Ninety-two patients completed the follow-up (means 20.1 (± 7.42) days). Twenty-two (23.91) patients complained of olfactory loss and in 6 (6.52) patients olfactory loss was the first symptom of the disease. The olfactory loss was reported to be completely resolved in all but one patient. Thirty-nine (42.39) patients had notable sinonasal symptoms while rhinorrhea was the first symptom in 3 (3.26). Fifteen patients (16.3) had a taste impairment. Patients with sinonasal symptoms had a lower age (p = 0.01). There was no significant relation between olfactory loss and sinonasal symptoms (p = 0.07). Conclusions: Sudden olfactory dysfunction and sinonasal symptoms have a considerable prevalence in patients with COVID-19. No significant association was noted between the sinonasal symptoms and the olfactory loss, which may suggest that other mechanisms beyond upper respiratory tract involvement are responsible for the olfactory loss. © 2020, Fondazione Società Italiana di Neurologia

NAVIGATION-ASSISTED MICROSCOPIC REMOVAL OF HYPOPHYSEAL ADENOMA:A RETROSPECTIVE STUDY

Neuronavigation is a commonly used technology that provides continuous, three-dimensional information for the precise localization of and surgical trajectory to brain lesions. This study was performed to evaluate the role that navigation can play in assisting microsurgical trans-sphenoidal surgery for precise localization and removal of pituitary tumours while simultaneously preserving pituitary gland function. Six patients (3 males and 33 females) with ypophyseal adenomas were treated with neuronavigation-assisted removal. Surgery was performed via endonasal trans-sphenoidal approach. Three patients had residual adenomas and two of the relapsed. There was one post operative rhinoliquorrea. In two cases the visual deficit did not significantly improved after operation. No statistical significance was detected among tumor dimensions with residual tumor, surgical complication (i.e. rhinoliquorrea), persisting visual deficit and used of abdominal fat for closing the sphenoidal field, respectively. Microneurosurgical trans-sphenoidal techniques combined with neuronavigation systems can precisely define the localization and removal of lesions in the sella region with respect to the margins of important anatomical structures in the neighbourhood and the endocrinological functionality of the pituitary gland. Neuronavigation can be easy applied during endonasal trans-sphenoidal microscopic surgery and requires a minimal amount of time. It makes operation easier, faster, and probably safe

Minicraniotomy Under Local Anesthesia and Monitored Sedation for the Operative Treatment of Uncomplicated Traumatic Acute Extradural Hematoma

Background: Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. Methods: We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. Results: The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4\u201315). The median trauma to surgery time was 25 hours (range, 13\u2013192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. Conclusions: Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma

Gliomi cerebrali: considerazioni sui protocolli terapeutici e sulla sopravvivenza.

none5Studio sugli oncotipi cerebrali e sui protocolli terapeutici più adeguati.noneR.Ghadirpour; G.Trapella; M.Yusuf; M.Migliore; PL ApiR., Ghadirpour; Trapella, Giorgio; M., Yusuf; M., Migliore; Pl, Ap

Idiopathic dissection of vertebral artery

No abstract availabl

Primary pituitary neuroendocrine tumor: Case report and literature review

Background: Neuroendocrine tumors (NET) originate from the diffuse neuroendocrine system. These can arise in almost every organ of the body, although they are most commonly found in the gastrointestinal tract and respiratory system. The skull base and sellar region are extremely rare sites for neuroendocrine carcinoma. Consequently, in this case, both diagnosis and definition of surgical goals, as well as further treatment strategies were challenging. Case Description: A 65-year-old woman was admitted to our Neurosurgery Department with a rapidly progressive visus reduction, drowsiness, polyuria, and polydipsia. Neuroimaging showed a sellar/suprasellar mass (diameter of 2 cm) with a heterogeneous signal compressing the optic chiasm and extending laterally toward the cavernous sinus. Differential diagnosis based on imaging included pituitary macroadenoma or metastasis. The patient underwent endoscopic endonasal transsphenoidal surgery. A total resection of the mass was impossible because of the infiltration of the optic chiasm and the intraoperative histological diagnosis of malignant epithelial neoplasm. Further histological evaluation revealed that the lesion was a NET with no other primary or metastatic sites detectable. Subsequently, the patient was successfully treated with fractioned stereotactic radiotherapy and polychemotherapy. Four years after the surgery, follow-up magnetic resonance imaging showed stability of the residual disease. Neurologic examination revealed a complete visual recovery. Conclusions: Primary pituitary NET, though rare, should be included in the differential diagnosis of sellar lesions. A multimodality treatment approach is needed. Finally, the present case highlights, that in the case of a pituitary lesion infiltrating the optic chiasm, including NET, the endoscopic endonasal transsphenoidal subtotal resection followed by fractioned stereotactic radiotherapy and chemotherapy may represent an effective and safe choice of treatment

Entrapment of temporal horn: First case of bilateral occurrence and review of literature.

The entrapped temporal horn is a rare entity, caused by an obstruction of the trigone of the lateral ventricle which seals off the temporal horn from the rest of the ventricular system. This form of focal hydrocephalus has been described in a variety of diseases including central nervous system infections, hemor- rhages, trauma, extra-axial or intra-axial tumors, postoperative scarring within the trigone, neurosarcoidosis and xanthogranu- lomatosis. Clinical presentation is often with headache, seizures, hemiparesis, and visual field deficits [9]. Within the trapped temporal horn, the choroid plexus continues to produce cerebro spinal fluid (CSF), resulting in progressive dilation; the dilated temporal horn then behaves as a mass lesion. Since 1947, thirty-six cases have been reported (Table 1). To the best of our knowledge this is the first case of bilateral entrapped temporal horn