Dott. Giannantonio Spena
Director of Neurosurgery Unit
Fondazione IRCCS Policlinico San Matteo
Pavia, Italy
Fondazione IRCCS Policlinico San Matteo
Pad. Nuovo Ospedale "DEA"
Piano +7 - Corpo A
Secretary + 39 382 502780
For Private Outpatient Appointment
Policlinico San Matteo: you can book an appointment by calling +39 382 501788 or by filling out the online form.
- Poliambulatorio Akesis viale Libertà 4, Pavia
+39 382 302996
PATHOLOGIES TREATED
Dr. Spena has performed more than 2,870 surgical procedures, 2,300 of which as first operator.
His main fields of interest and surgical practice are:
- brain gliomas with extensive experience in awake surgery with intraoperative mapping
- many years of experience in the use of intraoperative electrophysiological monitoring for cerebral and spinal cord pathology
- Specialist in awake brain mapping for the removal of tumors in critical and highly functional areas
- posterior fossa tumors (routine collaboration with the ENT team for lateral approaches to the base of the skull)
- intracranial and spinal vascular pathology (aneurysms, AVMs, AVDFs, cavernomas)
- Chiari I Disease, Syringomyelia, and Cranio-Occipital Hinge Pathologies
- Instrumented spinal surgery
Una delle nostre sale operatorie
Minimally invasive approaches to intracranial pathology
A minimally invasive approach refers to a surgical approach that manipulates the surrounding structures as little as possible. In other words, an approach that is small enough to manage the pathology and the surgical area of interest while avoiding exposing and manipulating the surrounding areas.
The concept of minimally invasiveness applies to various areas of both cranial and spinal neurosurgery.
Below are images of some of these approaches.
Minicraniotomy for lateral subfrontal approach
Using this approach, it is possible to dominate all the structures of the anterior cranial fossa and much of the middle cranial fossa.
Here on the left is an intraoperative photograph during endoscope-assisted resection of anterior clinoid meningioma.
Removal of a posterior clinoid meningioma through a mini supraorbital craniotomy
Retrosigmoid minicraniotomy
Using this approach it is possible to dominate all the structures of the cerebellopontine angle belonging to the posterior cranial fossa.
Below is a series of intraoperative photographs during resection of tumors of the cerebellopontine angle and foramen magnum using retrosigmoid and far lateral approaches with endoscope assistance.
Further information:
the tools of neurosurgery
Operating microscope
It allows for dozens of magnifications of the surgical view, highlighting submillimeter details and permitting dissection of infinitesimal structures. In the photo below, you can see how a deep-seated artery no more than 2 mm in diameter is magnified, allowing for manipulation.
Intraoperative videoangiography
This method allows, after intravenous infusion of indocyanine green, to visualize the arterial and venous vessels of the brain, confirming their patency and normal blood flow within them.
Use of Fluorescein for Brain Tumors
This technique, after an intravenous infusion of sodium fluorescein, allows for amplified vision of the portions of the brain infiltrated by a tumor. This allows the surgeon to better target the removal.
Intraoperative ultrasound
Ultrasound is a technique that uses sound waves to visualize even deep-seated organs in the human body. In the operating room, it can be used on the brain to determine the extent and extent of a tumor infiltrating the brain and to determine any residual tumor after surgical removal.
Endoscope
Over the past two decades, the endoscope has become part of the neurosurgical arsenal. It allows for a clear and precise view, especially in very deep and narrow structures. Below is an image of endoventricular endoscopy.
Use of ultrasoun aspirator for the endoscopic resection of a tumor located in the acqueduct of Sylvius.
Quadrigeminal plate meningioma
Meningiomas are benign tumors and surgery ensures cure in most cases.
Sometimes meningiomas are located in deep and very complex locations. In the case reported below, the meningioma had grown to the posterior portion of the midbrain (the quadrigeminal lamina). The patient was operated on in the sitting position, and the removal was complete without causing neurological deficits.
