Vittorio Ricciuti

Background/Objectives: degenerative cervical myelopathy (DCM) is the leading cause of spinal cord impairment in adults, often resulting in disability and reduced quality of life (QoL). Surgery is recommended for moderate and severe cases, while its role in mild DCM remains debated. Emerging evidence suggests that early surgery may improve outcomes, particularly QoL. Methods: We conducted a retrospective, single-center observational study of a cohort of patients undergoing cervical spine surgery for DCM between January 2020 and August 2023 at a single institution (Policlinico di Monza, Italy). Demographic, clinical, radiological and surgical data, as well as complications and outcomes, were analyzed. Neurological status was assessed using the modified Japanese Orthopedic Association (mJOA) score and QoL was evaluated using the Short Form-36 (SF-36) questionnaire preoperatively, at discharge, and at follow-up. Results: 51 patients were included (mean age 58.1 years; 41% female), with anterior surgery performed in 67%. Mild preoperative mJOA score was observed in 74% of patients. At follow-up, 65% achieved complete recovery, 29% improved, and 6% remained stable. No neurological deterioration was recorded. Univariate analysis identified age, anterior cervical discectomy and fusion (ACDF), and mild preoperative mJOA score as significant predictors of recovery. Multivariate logistic regression analysis identified mild preoperative mJOA score as a strong independent predictor of complete clinical recovery (OR = 240.64, 95% CI: 6.82–8496.22, p = 0.002). SF-36 showed significant improvements in emotional well-being, social functioning, pain, and general health, particularly in mild cases. Complications were low (5.8%) and limited to transient dysphagia. Conclusions: early surgical treatment in selected patients with mild DCM may be associated with favorable neurological and quality-of-life outcomes, although larger prospective studies are needed.

Endoscopic transorbital approaches (ETOAs) are finding wide application for skull base lesions, particularly for spheno-orbital meningiomas (SOMs). These tumors have high recurrence rates, and second surgery can often represent a challenge. In this study we analyze our experience of management of recurrent SOMs through a slightly modified eyelid crease approach. Between May 2016 and September 2023, in the Department of Neurosurgery of Fondazione IRCCS Policlinico San Matteo (Pavia, Italy), five consecutive recurrent SOMs have been treated using an endoscopic transorbital approach. Demographic data, preoperatory deficits, lesions characteristics, histology, grade of resection, eventual adjuvant treatments, complications, outcome in terms of symptoms improvement and cosmesis, and hospitalization are described. One patient maintained a right lateral rectus muscle palsy that was already present in the preoperatory, no cerebrospinal fluid (CSF) leaks were reported. All patients had postoperative periorbital edema, but no other systemic complication was found. All patients had proptosis improvement, two had visual acuity improvement, and best cosmetic outcome was obtained in all cases. Hospitalization varied between 4 and 6 days. ETOAs in the management of recurrent SOMs are safe and have good outcome. Right selection of patients is mandatory, but when feasible, endoscopic surgery can allow a virgin route to a previously operated tumor, guaranteeing a good strategic option.

Background: This work aims to review the current literature and our experience on vascular Eagle syndrome (ES) that can present misleading clinical presentations and better understand the possible therapeutic strategies.Methods: We reviewed the existing literature on PubMed from January 1, 2017, to December 31, 2022, including the sequential keywords “vascularANDEagle syndrome,” “vascularANDstyloid syndrome,” “vascularANDelongated styloid process,” “vascularANDstylocarotid syndrome,” and “Eagle syndromeANDcarotid artery dissection.”Results: 38 vascular ES cases, including our experience, were analyzed. The most frequent clinical onset was hemiparesis (n21, 57%), but other regular clinical presentations were aphasia, loss of consciousness, amaurosis, headache, or a combination of the latter. Massive oral bleeding was reported only once in the literature before our case. Twelve patients were treated with only antiplatelet therapy, either single or double. Nine patients were treated with anticoagulation therapy only. In 14 patients, a carotid artery stent was used, associated with anticoagulation or antiplatelet therapy. In 17 cases, a styloid process (SP) resection was performed.Conclusion: ES has many clinical presentations, and carotid artery dissection resulting in oral bleeding seems rare. Literature results and our experience make us believe that when dealing with vascular ES, the best treatment strategy is endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated SP to prevent stent fracture.