Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: Anatomic considerations - Part I

INTRODUCTION: Interest in using the extended endonasal transsphenoidal approach for management of suprasellar lesions, with either a microscopic or endoscopic technique, has increased in recent years. The most relevant benefit is that this median approach permits the exposure and removal of suprasellar lesions without the need for brain retraction. MATERIALS AND METHODS: Fifteen human cadaver heads were dissected to evaluate the surgical key steps and the advantages and limitations of the extended endoscopic endonasal transplanum sphenoidale approach. We compared this with the transcranial microsurgical view of the suprasellar area as explored using the bilateral subfrontal microsurgical approach, and with the anatomy of the same region as obtained through the endoscopic endonasal route. RESULTS: Some anatomic conditions can prevent or hinder use of the extended endonasal approach. These include a low level of sphenoid sinus pneumatization, a small sella size with small distance between the internal carotid arteries, a wide intercavernous sinus, and a thick tuberculum sellae. Compared with the subfrontal transcranial approach, the endoscopic endonasal approach offers advantages to visualizing the subchiasmatic, retrosellar, and third ventricle areas. CONCLUSION: The endoscopic endonasal transplanum sphenoidale technique is a straight, median approach to the midline areas around the sella that provides a multiangled, close-up view of all relevant neurovascular structures. Although a lack of adequate instrumentation makes it impossible to manage all structures that are visible with the endoscope, in selected cases, the extended endoscopic endonasal approach can be considered part of the armamentarium for surgical treatment of the suprasellar area

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

A NEW LOOK TO PROLAGUS (OCHOTONIDAE, LAGOMORPHA) FROM THE LATE MESSINIAN OF CIABÒT CAGNA (PIEDMONT, NW ITALY)

Ciabòt Cagna (Piedmont, NW Italy) is a post-evaporitic Messinian fossiliferous locality. According to the literature, in Ciabòt Cagna was recorded the ochotonid Prolagus michauxi, but the present revision led to: 1) ascribe it to Prolagus sorbinii, a species present since the beginning of Messinian in continental Italy; 2) exclude a W Europe immigration source of ochotonids into continental Italy during Messinian; 3) and modify the geographical range of P. sorbinii and P. michauxi, which boundary should be W Alps.

Stress and anxiety for the university students.

The scientific literature has highlighted how the incoming and outgoing transitions through the university represent stressful moments for students. Generally, an adaptation of one’s self it’s needed [1-5] with the effects that the student must necessarily reorganize its time, its method of study, its interpersonal relationships, as well as the separation from home and the redefinition of its training and employment project. This “change” activates some adaptation strategies that may be functional or dysfunctional to the realized path, also generating manifestations of psychological distress. The DSM-5 [6] introduced the cluster of “exam anxiety”, assimilated within the more general anxiety disorder and characterized by concern and lack of adaptation response to the stressor “university examination”. Furthermore some factors have also been identified (personality traits, low self-esteem and social support) that would represent an obstacle for adaptive functions in the integration process related to the university experience [7,8]. Students may experience different forms of discomfort: disorientation, psychological deadlock, blocking their studies, anxiety by exam, difficulty in concentrating, difficulty in adapting and affective / relational issues [9]. The results of the SCL-90R Test [10], that measure 9 primary symptom dimensions and that we used with students of Psychological Counseling Center ‘M. Cesaro’ of the University of Salerno (Italy), show that the university students have clinical disorders almost severe in Anxiety (standard deviation 11) and Global Severity index with standard deviation [10]