The Circolo Hospital of Varese is one of the highly specialized regional reference centers for neuroemergencies. To enable this role, a team of professionals who belong to the various structures involved in the front line management of these time-dependent pathologieswhich involve a very high risk for survival and quality of life and a management characterized by extreme complexity: Neuroradiology, directed by Dr. Andrea Giorgianni, Neurosurgery, directed by Prof. Davide Locatelli, Neuroanimation, directed by Prof. Luca Cabrini, and Neurology, directed by Dr. Simone Vidale.
Every year, cases of neurological interest are treated in an emergency and urgent manner at the Circolo Hospital in Varese there are more than 600but this calculation does not take into account the fact that the same patient is treated simultaneously by different specialists, often requiring multiple treatments, pharmacological, endovascular and surgical, in addition to the assiduous care of neuroresuscitators.
Stroke, in fact, whether ischemic or haemorrhagic, as well as head trauma, is a complex pathology which strikes suddenly, in relation to which two factors are fundamental: the time and type of treatment.
“Each stroke can have different causes and consequences, for which different responses must be guaranteed – explains Dr. Giorgianni – Thanks to the development of technologies and skills in the endovascular field, today the majority of strokes find the answer in interventional neuroradiology procedures more effective. At the Circolo Hospital we have an angiographic area made up of 4 rooms, all of which are being renovated, just as the entire fleet of large radiological equipment is being renovated. Thanks to the collaboration with the Cardiologists and Radiologists, with whom we share the angiographic area, we are therefore able to guarantee a response to multiple emergencies simultaneously.”
In 2023, the Neuroradiology team performed 381 vascular procedures, both angiographic and interventional, for the diagnosis and therapy of ischemic and hemorrhagic stroke. To these patients, we must add those who require a neurosurgical approach, which in 2023 numbered 196, including head and spinal cord trauma, cerebral hemorrhages from ruptured aneurysms or other vascular alterations.
“As for the synergy with colleagues in the management of cerebral hemorrhages due to ruptured aneurysms – adds Prof. Locatelli, who is also a professor at the University of Insubria – each case is always evaluated with Neuroradiologists in order to guarantee the best therapeutic choice for the patient, surgical or endovascular. It is then essential to follow patients even after the emergency. We do this through the multidisciplinary neurosurgical-neuroradiological vascular clinic, active since March 2015. From then until 2023 we have evaluated 1029 cases, while from the beginning of 2023 to today we have already seen 86 patients, both in follow up and as first visits ”.
Some patients, around forty per year, are treated with pharmacological and perfusion therapies by Neurology. “In this regard – explains Dr. Vidale – we are very attentive to the ongoing evolution and we are acquiring new therapies that have proven particularly effective in the treatment of stroke as an alternative or in combination with surgery or endovascular interventions”. Of the approximately 1200 patients who were admitted to the intensive care unit directed by Prof. Cabrini in 2023, a significant proportion had stroke or head trauma.
“Among the patients treated by Neuroradiologists and Neurosurgeons, over 300 were admitted to our department and all were guaranteed support as anesthesiologists during the procedures – specifies Prof. Cabrini, who is also a professor at the University of Insubria – On average, we participate in an urgent neuroradiological or neurosurgical procedure every 28 hours, in addition to the neurological and neurosurgical cases that we admit but which do not require an immediate procedure.”
The professionals involved in the management of neuroemergencies have come together in a conference on Thursday 23 May, underlining once again the need to work together in close synergy to continue to improve the level achieved. In particular, there are three lines of action: continuous updating, with particular attention to the issues of trauma and acute neurological pathologies, the extension of the collection and analysis of data, compared to Italian data, to better understand the points that require targeted interventions, and the promotion of the humanization of care, with specific attention to how it can improve long-term physical, cognitive and emotional outcomes.
