The Geneva and Lausanne (French-speaking Switzerland) experience: in favor of the transsphenoidal approach when feasible

Background: The authors present their current attitude towards management of craniopharyngiomas in children. Radical surgery cannot be performed when one is not sure about its potential danger to the visual pathways and the hypothalamus. Methods: Most of the surgeries that have been performed in our institution via an intracranial approach were incomplete and followed by radiotherapy, in the last 10 years with stereotactic conformational radiotherapy. Discussion: Considering our past and present experience concerning the transphenoidal approach for treatment of craniopharyngiomas, we make a plea for the consideration of this approach in children whenever feasible (around 25% of the cases in children older than 5 years). Craniopharyngiomas that can be removed by this approach represent a milder form of the disease and the results concerning the visual, hypothalamic functions and quality of life are significantly better than that obtained via an intracranial approach. When the craniopharyngioma cannot be removed by this approach because of tight hypothalamic adherences, the technique of cystosphenoidostomy with a custom-made shunt plus adjuvant stereotactic conformational radiotherapy is an alternative for its total remova

Metodi per la valorizzazione del patrimonio geologico, dal rilevamento geomorfologico all’itinerario geoturistico. Applicazioni in ambiente urbano e naturale

This research develops within the framework of a recent, widespread, need to give space to the popularization of Earth Sciences and to highlight the scientific work in these disciplines. The geological heritage is an essential part of the cultural heritage of a territory and it needs land planning, conservation, valorisation and dissemination. In the context of sustainable development, different forms of "thematic" tourism have grown in recent years, including the geotourism. The scientific community is increasingly involved in the economic development of the territory, through the research on geological heritage too. Different aspects are being studied: -the analysis of the territory for the recognition of geological aspects of scientific interest; -their evaluation; -the analysis of the risks to which they are subject and the conservation strategies; -the strategies for the use of the sites, the understanding of scientific aspects by users and tools for the mediation of knowledges. Aim of the research Through the scientific literature and the direct knowledge of an area it is possible to understand the geological heritage value, depending on its conservation and enhancement. For this reason institutions, public and private structures involved in land management often address to the universities and to the research to develop territories potential through the use of geo-environmental information, education, dissemination and sustainable management of the landscape. The aim of this thesis was to prepare a methodological procedure for the geoheritage enhancement, that defines the steps for the analysis of an area, beginning from the geomorphological survey to the creation and dissemination of instruments to popularize the geological heritage. The procedure has been developed starting from pure research, but aimed to its direct application as a guideline for the institutions and structures mentioned above. Study areas The development of the methodological procedure is supported by verifying its functionality through the application on two areas. A natural area, the mountain range of Monti Ernici (Southern Lazio) of known geomorphological interest and of interesting cultural aspects related to karst phenomenon; and an urbanized area, the city of Rome, characterized by the enormous knowledge accumulated in bibliography and the great potential of its geological and cultural heritage. The application of the method involved the geomorphological survey of the areas and the production of thematic cartography. Were inventoried and evaluated the geosites and geomorphosites characterizing the two territories and their data were organized in a relational database, functional to the processing for the automathic choice of geotourist trails. For each area was developed an enhancement proposal. This PhD thesis presents the research work describing it in three parts and an appendix. Part I The first part develops in three chapters introducing the context in which the work fits in. In Chapter 1, summarizing the remarkable bibliography consulted, are introduced the terms of geological heritage and the definitions adopted among the various developed in the history of this kind of studies. In particular geological goods are described as part of the cultural heritage and the definition of geosite is explained through its historical evolution (Strasser et al., 1995; Grandgirard, 1997, 1999; Wimbledon et al., 1999), its increasing specificity depending on the fields of application (Panizza & Piacente, 1999, 2003; Panizza, 2001) and through the definition of descriptive attributes of the quality of a geological site (Reynard, 2004, 2005). Some important concept are introduced such as geodiversity and geoconservation, and the application concepts of “geodiffusione” (spreading geological knowledges, Piacente, 2003) and geotourism (Hose, 1995, 2000; Newsome & Dowling, 2010; Gray, 2011; Arouca Declaration, 2011). The Chapter 2 is a retrospective of the projects, the research and the legislation about geological heritage, starting from the understanding of the need to safeguard geodiversity such as biodiversity. This excursus is a pan of the national and international initiatives. It is highlight the importance of Geoparks initiative, under the auspices of UNESCO, and the Italian Geological Service's role in launching the national-level projects. Particular attention was paid to the state of the art in the Latium region, to mark the starting point of the work on the study areas. The Latium regional geosites inventory was arranged by the Regional Park Agency-ARP (Cresta et al., 2005), in the context of initiatives undertaken by the Geological Survey, in collaboration with it and with the Latium Region. The ARP provided the geosites evaluation too, developing an evaluation model that indexes the Intrinsic Value of Sites of Geological Interest (VISIG). This index allows to give a priority order to the protection and preservation of geosites. The Regional Park Agency also contributed to the promulgation of regional laws for the geosites protection (D.G.R. Lazio 859/09). In the Chapter 3 are described the interventions of the research on geological heritage, in particular the axis on which the studies develop (evaluation, protection, popularization) and the problems they face. The first paragraph introduce the results of international and national research on the evaluation models of geological heritage goods. There are different models depending on the purpose of the evaluations, which can be summed up in three kinds: awareness and conservation of geosites (Panizza & Piacente, 1993; Serrano & Gonzales Trueba, 2005; Pereira et al., 2007; Fattori & Mancinella, 2010; Coratza et al., 2012), environmental impact assessments (Rivas et al., 1997; Coratza & Giusti, 2005; Bruschi & Cendrero, 2005), education and/or local development through thematic tourism (Reynard, 2007; Bollati, 2012). The same type of description is made of the tools developed for the protection, legislation and management of geosites, which concerns the administration of the territory. Management is also the issue of the vulnerability of the sites, exposed to flows of visitors, but also the vulnerability of the visitors in the presence of active geosites and, in particular, active geomorphosites (Reynard, 2004). Finally, are described the geo-heritage enhancement strategies on which the majority of studies concentrate: geotourist trails planning (Coratza et al., 2004; The Via Geoalpina VVAA, 2010; Del Monte et al., 2013; Magagna et al., 2013) virtual and non-virtual ones, static mapping (Carton et al., 2005; Castaldini, 2005; Coratza & Regolini-Bissig, 2009; Regolini-Bissig & Reynard, 2010 and bibliography inside; Regolini, 2012 ) and dynamic (Ghiraldi et al., 2009, 2010), the preparation of informational supports, panels, guides and smartphones applications (Small, 2005; Qiu & Hubble, 2012 e bibliography inside; Magagna et al., 2010; divulgando.eu), methods for the scientific information interpretation (Cayla, 2009; Dowling, 2010; Calonge, 2010; Cardozo Moreira, 2012) and in conclusion the evaluation of the efficacy of these products (Sellier, 2009; Martin et al., 2010). The chapter closes by raising issues like the need for a uniform methodology of analysis, the disclosure of evaluations and the need to use the environmental interpretation, particularly in the geotourist cartography. Part II In this part of the thesis are shown the purpose of the work, the methods chosen to built the enhancement procedure and the integrations improved on the methods, to optimize the purposes. The Part II develops in two chapters in which it deals with the revision of several existing methods for the inventory, evaluation and enhancement of the geological heritage (methods chapter). The other chapter (materials chapter) describes the instruments chosen for enhancement and summarize the work in the proposal for a methodology that allows to start from the territory to get to its usability in geotourist terms. The chapter 4 refers to methods consulted for each step of the analysis and geotourist enhancement of an area, then arousing the interest on the integretions. Bibliographic consultation, for example, based on scientific publications, is complemented by tourist and popularization ones, such as data about the historical-archaeological heritage. This informations are needed for the enhancement of cultural landscapes in which the geosites are inserted. Among the methods for the analysis and the representation of the areas there are the geomorphological survey and mapping. In the paragraph related to the materials of enhancement the geotourist mapping methods are described and the proposal of a model for geotourist map legend. The selection and integrations of the inventory and evaluation methods constitute the fundamental element of the chapter. The methods have been analyzed and dismantled in their parts to build a new inventory and evaluation card: it contains informations open to every kind of reader and it shows the significance of a site for geotourism. The card is based on two models: the geosite inventory card by ISPRA (Italian insitute for Environmental Protection and Research, isprambiente.it) and the geosite evaluation model proposed by the ARP (Latium Regional Park Agency; Fattori & Mancinella, 2010). The integrations to this methods are described below. Geosite inventory card: • the information given is useful and essential (the document is simple, easy to read and it uses a non-specialist language); • the iconographic and representative aspects of the geological site are widely highlighted (images, maps, explanatory schemes of genetic processes); • the scientific description is in non-specialist terms and it is based on the interpretation of scientific language (Ham, 1984); • in the card are described scientific interests of the site and additional (contextual) too; • the informations given are useful for the approach to the site (land use, conservation status, guidance on usability and accessibility). Geosite evaluation card: The use of a site of geological interest for economic development through geotourism need to evaluate different aspect of a geosite. Among the several attributes which could be quantified, can't miss the attributes summarized in the new index proposed in this thesis, the Value of a Site for Geotourism (VSG) index: VSG= RP+RR+SCE+SAC+AC the attributes are representativeness (RP), rarity (RR), scenic value (SCE), historical-cultural-archeological value (SAC) and accessibility (AC). The card allows to confer a value to each attribute identifing the characteristics of the geosite and recognizing them in the descriptions in the card. Each description try to remove the subjectivity of the selection and confers a value to the analysis of the geosite characteristics. The integrations to the base model lie in: • some aspects included in representativeness (RP) evaluation has been redefined; the relationship between frequency of a geological aspect and the geographical setting of analysis is a new proposal for rarity (RR) evaluation; sub-attributes describing the scenic value (SCE) of a site are integrated from other models (Reynard et al, 2007; Ghiraldi, 2011) and “peculiarity of the forms” has been introduced as a new characteristic ; the evaluation of historical, archaeological and cultural value (SAC) of the site has been included in the geosite evaluetion; the difficulty to reach a site and the presence of nearby services are the sub-attributes for the accessibility (AC); • the card has been reviewed in order to make possible to understand the evaluation of a geological good to "non-specialists" users. • finally, when compared to other evaluation models, the Value of a Site for Geoturism doesn’t present weights of the attributes. Infact, scientific attributes of the geosite are as important as additional ones, as the definition of geotourism wants (Arouca Declaration, 2011). The chapter 5 describes the materials of this research, consisting of geoturist enhancement tools. Chief among these a relational database in G.I.S. environment, for storage, management and analysis of all data (results of the survey, the geosite inventory and evaluation, network of touristic attractors of the analyzed areas, etc.). The geographical characterization of geomorphosites (forms present in geographic space, which are mapped and spatially georeferenced), linked to a number of attributes, makes them ideal objects to be managed by G.I.S systems . The database consists of 3 types of data: raster files, vector files, tables. The tables are structured on the basis of the assessment model of the VSG. Using the potential of relational database (connections between tables with one-to-one relationships and many to one and/or query formulation) it is possible to get the selection of geosites that respond to specific needs (Gregori & Melelli, 2005). The geographic properties of the data (georeferencing) also allows to create connection paths between sites, which take into account additional features such as usability or accessibility (geotourist itineraries). This is the procedure used to develop geoturist itineraries, described in the paragraph dedicated to enhancement tools. It is shown how to set a query, from the choice of a set of specific requirments for the itinerary: -choosing data from query -joining tables -queries of type ‘select by attributes ... ' and ' select by location ... '. Geosites with requested attributes and the closest traces (paths or roads) are selected in this way and joined to build the itinerary. The popularization of the geotourist itinerary consists in the description by stops, which is combined to the geoturist map. The problems of geoturist mapping (Regolini, 2012) are analyzed in this chapter to propose simplifications, changes and integrations of a geomorphologic map used to develop a the geoturist one. In particular, integrations include: the theme of the map, the base, the scale, the legend and the geo-morphological symbology. Each map product in this thesis is the synthesis of digital georeferenced data, which constitute the G.I.S environment relational database. The data stored in the database will appear as a paper geoturist map or as digital frame, via a web-gis that works on computerized platforms with a user-friendly interface. At the moment, the work still lack of the web-GIS implementation and interface. The last paragraph of chapter 5 summarizes in a flowchart the procedure proposed for the geoturist enhancement of an area, which may have application as a guideline for the institutions and public and private structures involved in the management and development of the territory. Part III The last part of the thesis is divided into three chapters, focusing on the areas of application of the methodology proposed. The chapter 6 briefly describes the landscapes of the Lazio region and places Rome and the Ernici Mountains within their variety, reflecting the distribution of the litostructural units and hence the regional geo-diversity. It also mentions the tourism dynamics in Lazio and the fusion of natural and cultural aspects of the territories represented in the selected areas. It gives an added value for Lazio classic tourism. The chapter 7 introduce the geographical and geological framework of Rome, followed by a description of the geomorphologic detection. Rome has been the subject of numerous studies, some of which about geomorphological setting (Bellotti et al., 1997, Della Seta & Del Monte, 2006; Ascani et al., 2008; Del Monte et al., 2013). Data avalaible in bibliography are not homogeneous, beacause of the different subjects and objectives of the studies. The analysis of different aspects did’nt include the geomorphological survey and the description of results, traditionally structured in the genetic classification of forms and data representation on a geomorphological map. For this reason, the geomorphological survey was conducted, at 1: 10,000 scale and produced the geomorphologic map of Rome. The geosite inventory was supported by this analysis and the geomorphological map is the basis for the geoturist map. The geosites inventory allowed to add two new geosites (geomorphosites) to the regional inventory: the Tiberina Island, a fluvial bar arosed where the Velabrum Maius merge into the Tevere counter flow and with an almost flat confluence angle; and the Testaccio Mount, an example of human morphogenesis, with its 48 m s.l.m. consisting of testae, broken Roman amphoras. The VSG (Value of a Site for Geotourism) of these geomorphosites, and the geosite reported by ARP (Regional Park Agency), has been evaluated. The results data, stored in ESRI ArcMap ® (ArcGIS software), were interrogated through specific queries, selecting the geosites of " mid-high VSG, linked to historical and archaeological aspects of high importance and quoting Roman legends or traditions, with high scenic value (SCE attribute) due to grandeur and presence of naturality colors ". Queries are the translation of this sentence. The enhancement proposal of the area consists of a geotourist itinerary, developed linking the selected geosites. The geotourist map includes the itinerary description with suggested stops of natural and cultural interests. Text and diagrams allow the scientific explanation of geological and geomorphological aspects and refer to historical-archeological ones (Coarelli, 2001; Insolera, 2001; Puliga & Panichi, 2009; Touring Club Italiano, 1999). The structure of chapter 8 is the same of the previous one: Ernici Mountains geographical and geological framework, geomorphological survey, geosites inventory and evaluation, enhancement. The literature about geomorphological setting of this area is very lacking. The mountain chain extension is about 550km2, this wide area demanded the choice of two sub-areas representative of the morphological aspects, on which concentrate the 1: 10,000 scale geomorphologic survey. An area includes Lazio and Abruzzi slopes of Viglio Mount and the ridges towards Campo Catino, including the homonimous hollow; the second sub-area insists on the Fiume river valley, Trisulti of Collepardo, including the foothills of the Rotonaria and Monna Mountains. The geosites inventory for these areas has identified three new geomorphosites unreported in regional inventory: the Viglio Mount wreck glacial cirque, fine example of the last glacial maximum glacialism forms on the Lazio-Abruzzi Apennines; the Madonna delle Cese (Our Lady of Meadows) Cave, a karst open cave that now houses a chapel; and the Arch in the rock of Trisulti, the wreck of a pressured karstic pipe of an ancient karstic underground grid. The superficial streaming reached and intruded by erosion the underground one, so nowadays the Fiume river flows thorugh the ancient pipe track. The VSG (Value of a Site for Geotourism) of these geomorphosites, and the geosite reported by ARP (Regional Park Agency), has been evaluated. The procedure of automatic selection of sites to develop the geotourist itinerary was not applied, because of the geographical separation of the two sub-areas and the related difficulty to develop an itinerary connecting them. The enhancement proposal of the Ernici Mounts consits of the geoturist map (paper)of the Rotonaria Mount-Trisulti of Collepardo sub-area, which includes a geoturist itinerary described by stops, schematic scientific aspects explanation and images. The itinerary tells about the cultural landscape (Sauer, 1925; Andreotti, 1998, 2008; Unesco, 2005) of the area, through Karst, hermitages and spirituality. Appendix Appendix is about the formative experience at the Adamello Brenta Nature Park, Geopark of the European UNESCO Network. The experience was a curricular internship, based on an agreement between La Sapienza University and Adamello Brenta Natural GeoPark. The internship objectives and subjects were the experience with geological heritage enhancement and dissemination tools and related practical activities; geological heritage mapping; geomorphological hazards analysis along geoturist itinerariess. The result of the internship is a partnership with the Geopark, that allowed the application of the enhancement methodology developed during this doctorate on the geopark area of UNESCO Dolomites

Urban Geomorphological Heritage. An Overview

Urbanization is a global phenomenon and currently more than half of the world's population lives in urban areas. Studies on geomorphological heritage and the development of specific methods of investigation (assessment, inventories, cartography) are, however, relatively rare and limited. This paper first describes the relationships between urbanization and geomorphology. Secondly, it presents an overview of the main works on the urban geomorphological heritage. Then, the main methods of investigation are presented. Finally, we discuss the challenging issues concerning the protection and the promotion of the urban geomorphological heritage

Contribution for an urban geomorphoheritage assessment method. Proposal from three geomorphosites in Rome (Italy)

Urban geomorphology has important implications in spatial planning of human activities, and it also has a geotouristic potential due to the relationship between cultural and geomorphological heritage. Despite the introduction of the term Anthropocene to describe the deep influence that human activities have had in recent times on Earth evolution, urban geomorphological heritage studies are relatively rare and limited and urban geotourism development is recent. The analysis of the complex urban landscape often need the integration of multidisciplinary data. This study aims to propose the first urban geomorphoheritage assessment method, which originates after long-lasting previous geomorphological and geotouristic studies on Rome city centre, it depict rare examples of the geomorphological mapping of a metropolis and, at the same time, of an inventory of urban geomorphosites. The proposal is applied to geomorphosites in the Esquilino neighbourhood of Rome, whose analysis confirm the need for an ad hoc method for assessing urban geomorphosites, as already highlighted in the most recent literature on the topic. The urban geomorphoheritage assessment method is based on: (i) the urban geomorphological analysis by means of multitemporal and multidisciplinary data; (ii) the geomorphosite inventory; and (iii) the geomorphoheritage assessment and enhancement. One challenge is to assess invisible geomorphosites that are widespread in urban context. To this aim, we reworked the attributes describing the Value of a site for Geotourism in order to build up a specific methodology for the analysis of the urban geomorphological heritage

Urban geomorphological heritage. An overview

Urbanization is a global phenomenon and currently more than half of the world’s population lives in urban areas. Studies on geomorphological heritage and the development of specific methods of investigation (assessment, inventories, cartography) are, however, relatively rare and limited. This paper first describes the relationships between urbanization and geomorphology. Secondly, it presents an overview of the main works on the urban geomorphological heritage. Then, the main methods of investigation are presented. Finally, we discuss the challenging issues concerning the protection and the promotion of the urban geomorphological heritage

Geomorphological classification of urban landscapes. The case study of Rome (Italy)

The results of a long-lasting geomorphological survey carried out in Rome are summarized. A method aimed at integrating survey data, historical maps, aerial photographs and archaeological and geomorphological literature produced a geomorphological map of the present-day historical centre. The geomorphology of Rome is related to the paleogeographical conditions prior to the founding of the City; they allow us to recognize the stages of landscape evolution of the ancient Caput Mundi (Capital of the World). The study area has been affected by continuous man-made changes to the drainage network and to the topographic surface over the last 3000 years. It has forced the authors to develop innovative solutions to undertake effective analysis of the urban environment and the legend of the geomorphological map in this peculiar context. The resulting map is useful for urban planning and archaeological research

Geomorphology of the historic centre of the Urbs (Rome, Italy)

Based on long-lasting multidisciplinary and multitemporal investigations, in 2016 the first geomorphological map of the central area of Rome was presented. It introduced innovative solutions for cartographic restitution of urban landforms. Under this work, the urban geomorphological analysis delved deeper, because the study focused on the smaller area of the Urbs, the ancient city centre that has been modified by human activities over millennia. The main goal of the new study was to verify if the 1:5000 scale survey could allow to improve the legend symbols, in order to better represent landforms from natural and anthropogenic processes in urban environment. Since the map scale was doubled compared with the previous and consequently the map area available was four times bigger, we were able to provide much more details. Moreover, results better highlighted the applicative significance of urban geomorphological maps as complementary tool for the assessment of natural hazards and risks

Clinical Outcome After Pencil Beam Scanning Proton Therapy of Patients With Non-Metastatic Malignant and Benign Peripheral Nerve Sheath Tumors.

Objective Peripheral nerve sheath tumors (PNSTs) commonly arise from peripheral nerve roots and grow locally invasive. Malignant PNSTs (mPNSTs) represent aggressive sarcomas of neural origin that can originate from PNSTs. Radiation therapy is commonly used as part of the required multimodal treatment. However, both entities tend to occur early in life and are associated with the genetic disorder neurofibromatosis type 1 (NF-1), which is known to cause increased radiosensitivity. Pencil beam scanning proton therapy (PBSPT) allows for a minimization of the dose delivered to organs at risk and the integral dose and, thus, potentially also a reduction of radiation-induced adverse events. We report the clinical outcome and toxicity rates of patients with (m)PNSTs treated with PBSPT. Methods We retrospectively reviewed 36 patients who received PBSPT (median dose, 64 GyRBE) with curative intent for (m)PNSTs between 1999 and 2020 at our institute. Twenty-eight (78%) and 8 (22%) patients were treated at diagnosis and for tumor recurrence/progression, respectively. The median age was 32 years (range, 3-75), and 25 (69%) patients were male. mPNST and PNST were diagnosed in 31 (86%) and 5 (14%) patients, respectively. Underlying NF-1 disease was found in 8 (22%) patients. Acute and late toxicities were recorded according to Common Terminology Criteria for Adverse Events, version 4.1 (CTCAE v4.1). Overall survival (OS), local control (LC), and distant control (DC) were estimated using the Kaplan-Meier method. Results With a median follow-up time of 31 months (range, 4-194), 13 (36%) patients died from a progressive disease, 8 (22%) experienced local failure, and 14 (39%) experienced distant failure after PBSPT. Estimated 2-year OS, LC, and DC were 75.5%, 73.5%, and 61.2%, respectively. Acute grade 3 toxicity (dermatitis, mucositis, and pain) was observed in 5 (14%) patients. Late grade 3 cataract and osteonecrosis were both observed in 1 (3%) patient at 34 and 194 months after PBSPT, respectively. There was no late grade >3 toxicity or radiation-induced secondary cancer. Conclusion To our knowledge, this is the first study to analyze the outcome of (m)PNSTs treated with proton therapy using a PBS delivery paradigm. In our cohort, consisting mainly of patients with mPNSTs, we report reasonable oncological outcomes and low toxicity rates after PBSPT