Italy’s most fearsome Mafia boss, Salvatore ‘Toto’ Riina, could be released from prison on health grounds, according to a reported ruling by Italy’s top appeals court.

Riina was the former head of Sicily’s Cosa Nostra Mafia,

Riina, 86, whose brutality has earned him the nickname “The Beast,” was the mastermind behind several high profile Mafia murders of the 1980s and 1990s.

He was arrested in 1993 and is serving multiple sentences of life imprisonment in solitary confinement.

The Italian state should recognise the mobster’s “right to die in dignity,” the Court of Cassation said, striking down a ruling from a lower court that had refused a release request, the ANSA news agency said.

The judgment, which was not immediately available from the court, will not result in Riina’s immediate release, but clears the way for another lower court to authorize it, said ANSA. Its report was widely picked up by Italian media.

According to the cassation court, Riina suffers from severe kidney and brain problems, is at risk of “fatal and unpredictable” heart attacks and, while his criminal nature is undisputed, he can no longer be considered a menace to society.

Under Riina’s command, Cosa Nostra killed top anti-Mafia prosecutors Giovanni Falcone and Paolo Borsellino, and dozens of other well-known public figures, including Sicily governor Piersanti Mattarella, whose brother Sergio is now president of Italy.

The man who replaced Riina as Cosa Nostra’s leader, Bernardo “The Bulldozer” Provenzano, ended up behind bars in 2006, and fought unsuccessfully to be released on health grounds.

He died last year, aged 83.