Dottorato in NEUROSCIENZE CLINICO-SPERIMENTALI E PSICHIATRIA

Titolo della tesi: LESS INVASIVE MANAGEMENT IN NEUROSURGICAL DISEASES. MULTIDISCIPLINARY APPROACH AND LONG-TERM FOLLOW-UP

One of the main goals of Neuroscience is to understand how cognition, emotion and behavior can influence the personal perception of disability and thus functional outcomes. In recent years, the term “minimally invasive” has received great attention in several surgical fields, especially to promote the resolution of the many complex and vexing problems posed by the management of neurosurgical diseases. Less, or minimally invasive are not synonymous with absence of complications or drawbacks. Therefore, the goal of the modern approach to complex diseases is aimed to choose the less invasive treatment providing solutions for the drawbacks with quality of care over time. Among the minimally invasive approaches two main projects were described. The first one was focused on the functional outcome in degenerative diseases and spinal deformity and to the surgical removal of intramedullary spinal cord tumors. The results of the included studies showed how the impact on health-related quality of life in these patients can be compared with other chronic and severe conditions. The choice of a less invasive approaches results in earlier clinical benefit, lower blood loss and shorter surgical time and better recovery. The second project was focused on the role of Gamma Knife radiosurgery as a minimally invasive procedure in the management of vestibular schwannomas. The impact of hearing loss caused by natural history and treatment of vestibular schwannomas and the role of hearing rehabilitations were analyzed accordingly. The results of these studies underlined the benefits of a less invasive approach even in the management of skull base lesions. Hearing deteriorations, that occur mainly within 3 years after Gamma Knife, continues to deteriorate beyond the first 1-3 years. Beyond the first 3 years, hearing deterioration is mainly influenced by the effect of radiation toxicity. After more than 10 years from Gamma Knife the personal perception of hearing disability is influenced by emotion and behavior components. The impact of single side deafness on quality of life can be tolerated in absence of audiological decline of the controlateral ear. Hearing loss resulting from bilateral vestibular schwannomas, as in type 2 Neurofibromatosis, may conversely have a devastating impact. Terefore, hearing rehabilitation is indicated to restore, support communication, and improve the quality of life.