Objective: Though vagus nerve stimulation (VNS) is an important option in pharmacoresistant epilepsy, its mechanism of action remains unclear. The observation that VNS desynchronised the EEG activity in animals suggested that this mechanism could be involved in VNS antiepileptic effects in humans. Indeed VNS decreases spiking bursts, whereas its effects on the EEG background remain uncertain. The objective of the present study is to investigate how VNS affects local and inter regional syncronization in different frequencies in pharmacoresistent partial epilepsy. Methods: Digital recordings acquired in 11 epileptic subjects 1 year and 1 week before VNS surgery were compared with that obtained 1 month and 1 year after VNS activation. Power spectrum and synchronization were then analyzed and compared with an epileptic group of 10 patients treated with AEDs only and with 9 non-epileptic patients. Results: VNS decreases the synchronization of theta frequencies (P!0.01), whereas it increases gamma power spectrum and synchronization (!0.001 and 0.01, respectively). Conclusions: The reduction of theta frequencies and the increase in power spectrum and synchronization of gamma bands can be related to VNS anticonvulsant mechanism. In addition, gamma modulation could also play a seizure-independent role in improving attentional performances. Significance: These results suggest that some antiepileptic mechanisms affected by VNS can be modulated by or be the reflection of EEG changes. q

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Transient bone marrow oedema syndrome of the proximal femur is characterized by acute, progressive pain in the hip that is increased by weight-bearing. Treatment includes restricted weight-bearing and analgesic medication. A prospective, randomized study was performed to compare two groups of patients affected by bone marrow oedema syndrome of the femoral head. 20 patients received pharmacological and hyperbaric oxygen therapy, and a control group of 21 patients received pharmacological therapy alone. The overall average WOMAC score at 3 months was significantly higher (p<0.001) for the hyperbaric oxygen group (70.8 points) compared with the control group (56.4 points). Magnetic Resonance Imaging at 3 months showed resolution of bone marrow oedema in 55.0% of the patients treated with hyperbaric oxygen compared with 28% in the control group. Hyperbaric oxygen therapy appears to be effective in treating transient bone marrow oedema syndrome, resulting in an accelerated recovery of hip function compared to pharmacological therapy alone.

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Symptomatic lumbar synovial cysts (LSCs) are a rare cause of degenerative narrowing of the spinal canal, with thecal sac or nerve root compression. True synovial cysts have a thick wall lined by synovial cells, containing granulation tissue, numerous histiocytes, and giant cells. In contrast, pseudo-cysts lack specialized epithelium, have a collagenous capsule filled with myxoid material, and may be classified into ganglion cysts, originating from periarticular fibrous tissues, and ligamentous cysts, arising from the ligamentum flavum or even from the posterior longitudinal ligament. Here we present the surgical series of the Chair of Neurosurgery at the University of Cagliari (Italy) including a total of 17 LSCs. Surgical technique consisted of facet sparing excision of LSC, achieved by simple hemilaminectomy/laminectomy, and diagnosis was always confirmed by histological specimen examination, which detected the typical synovial epithelium, the intracystic presence of hemosiderin, histiocytes, and calcifications. Further immunohistochemical investigation revealed positive staining for cytokeratin: CK5, CK6, and AE1/AE3. Clinically, our cohort experienced rapid and complete resolution of symptoms, without perioperative complications, or recurrence of cysts or vertebral instability at a median follow up of 28 months, when the MacNab score was generally excellent. A review of the literature, retrieving articles published from 1973, collected a total of 101 articles concerning all the cases of LSC scientifically described to date. Both clinical and histological findings described in our study support the theory of degenerative microtraumatic pathogenesis of synovial cysts.