Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd International Conference on Spine and Spinal Disorders Rome, Italy.

Day 1 :

Keynote Forum

Massimiliano Visocchi

Institute of Neurosurgery Catholic University of Rome, Italy

Keynote: Transoral vs transnasal approach for craniovertebral junction pathologies: Light and shadows

Time : 09:30-10:10

OMICS International Spine 2017 International Conference Keynote Speaker Massimiliano Visocchi photo
Biography:

Massimiliano Visocchi is Associate Professor in Neurosurgery at the Catholic University of Rome Italy and Visiting Professor at the Shanghai University (China) since 2012. Director of the Special Course and the Second degree level Master in Surgery of CranioVertebral Junction at the Catholic University of Rome Italy. Founder of the Research Center in Surgery of CranioVertebral Junction Catholic University of Rome Italy. President Elect  of the International Societies of Reconstructive Neurosurgery (ISRN), Member of the Board of the Neuroehabilitation Committe of the World Federation of Neurosurgical Societies (WFNS), Member of the Board of the Italian Society of Neurosurgery (SINCh), former President of 2 National Scientific Societies (SINSEC: Società Italiana di Neurosonologia ed Emodinamica Cerebrale- Gruppo di Studio di Emodinamica Cerebrale della Società Italiana di Neurochirurgia)

Abstract:

Background: Several pathologies affecting the craniovertebral junction (CVJ) can be approached by means of a microsurgical transoral approach (TOA) or with an endoscopic endonasal approach (EEA), potentially able to overcome some complications sometimes associated to the former approach. Herein, starting from the updated literature experience and adding our surgical experience, we critically analyze these procedures, trying to demonstrate that TOA still deserve a consideration and that, in some cases, it can be even considered superior to EEA. Methods: Our experience deals with 25 anterior procedures in 24 paediatric and adult patients (18 TOA and 7 EEA). The TOA group (13 male and 5 female, median age 33,1) encompasses 3 tumors, 3 Reumathoid arthritis, 1 condilus tertius, 3 Basilar invaginations, 4 Impressio basilaris, 1 developmental anomaly of C0-C1, 1 Os odontoideum, 1 post-traumatic C1-C2 compression, 1 C2 fracture. EEA Group (3 male and 4 female; median age 39,7 year-old) comprises 4 tumors, 2 Impressio basilaris and 1 Impressio basilaris with platybasia. Results: All the patients of TOA group but one were discharged after posterior procedures within two weeks and improved or remained unchanged after surgery and during the follow-up. No mayor complications occurred in TOA group. In EEA group two patients died for CSF infection, for disease progression and for heart attack. Conclusions: Our and other available data suggest that no clear superiority of EEA over endoscopic TOA can be assessed so far; on the other hand, EEA can produce complications similar to TOA in CVJ surgery.

OMICS International Spine 2017 International Conference Keynote Speaker Alfredo Pompili photo
Biography:

Alfredo Pompili completed his Graduation at Rome University La Sapienza in 1976. He is a Resident in Neurosurgery at University of Rome, Regina Elena National Cancer Institute in Rome, and Official Resident of French Government at Hopital Foch in Suresnes, France in 1980. He is an Assistant Neurosurgeon in Neurosurgical Department of Regina Elena National Cancer Institute in Rome from 1978; an Associate Professor from 1989; Head and Chairman from 2008 to 2015. He is an author of more than 110 indexed papers.
 

Abstract:

Background: The traditional uni-multilevel bilateral laminectomy/laminotomy has been the safest approach to the spinal canal for the removal of intramedullary and extramedullary-intradural tumors. Yasargyl suggested a more conservative unilateral approach. The unilateral approach for the removal of spinal schwannomas and meningiomas is at present a well known procedure. We and others had very good results, mainly on postoperative and late back  pain. Methods: 97 patients were operated upon between June 2000 and March 2014.There were  70 patients with schwannoma and 27 with meningioma.     Four had multiple tumors. The main symptom was pain. The evaluation according to the Dennis scale pain was extremely positive either at discharge or at one year follow up: p<0.0001 for schwannomas, p<0.001 for meningiomas. Neurological deficits, evaluated according to the modified McCormick scale, were recorded in 39 patients. Postoperative and late follow up improvement was significant either in schwannoma or in meningioma cases: p<0.0001 The quality of life evaluation, using the Karnofsky Performance Scale, improved greatly: p<0.0001. Late back pain at one year, that was recorded as a symptom by authors that used the bilateral approach, was neglectable in the present series Filum terminalis tumors are unfrequent. They are mainly ependymomas; incidence is 1/3 if compared with lumbar schwannomas. 19 patients with lumbar ependymoma and 3 with dermoid/teratoma were operated upon. Two had multiple tumors. There were 11 females and 11 males, mean age was 42 yrs (17-83). 20 patients were operated upon with unilateral laminectomy, in the prone position, with fluoroscopy, and neurophysiological monitoring. Two had bilateral laminectomy for (coexisting stenosis, intraoperative strategy change). After a midline incision, the muscles are detached only on the selected side. Under magnification, laminectomy is done with highspeed drill and bone forceps. Removal all the cranio-caudal ligamentum flavum is important, it must be removed also under the bottom of the spinous process. Results: Postoperatively, pain improved or disappeared in all patients (p<0.001). At one year 2 had some low back pain. The patient that was severely impaired did not recover, pain improved. The others were considered as grade I (McCormick scale). Excluding that patient, KPS improved to 95 points (p<0.001). Transient sphyncterial worsening occurred in 3 cases. None had external bracing. One had CSF collection, treated with bed rest. No recurrences at follow up (1-10 yrs), apart from the metastatic tumor that died at 3 years. Those two young ladies with multiple tumors did not recur and are in good conditions at 9 and 10 yrs.  This unilateral approach is suitable for filum ependymomas and dermoids and should be adopted in all high flow neurosurgical facilities.