A Case Series of Surgical Resection of Anterior and Posterior Butterfly Glioma Grade 4 via a Minimally Invasive Keyhole Approach

Surgical resection of infiltrating glial neoplasms has proven to improve quality of life and confer a significant survival benefit. As accumulating evidence cements the role of surgery in grade 4 gliomas, there is a general trend to transition away from traditional large craniotomies to smaller 'keyhole' approaches, which aim to reduce the trauma and complication profiles associated with large exposures. A keyhole approach uses a small craniotomy positioned perfectly to reach at least all the target structures that a conventional approach would reach. We present a case series of operated butterfly gliomas grade 4 patients through keyhole approaches. All three operated patients have better survival than the literature biopsy groups. The resection of butterfly gliomas should be considered in selected cases. For some patients, it is feasible with the technology used nowadays, with improved quality of life and better survival prognosis.

T- configuration stent assisted coiling treatment of a complex wide-necked basilar tip aneurysm

The advancement of intracranial stent technology and techniques has extended the applications of endovascular coiling methods for complex intracranial aneurysms. Coiling of wide-necked and complex bifurcation aneurysms usually requires double stent implantation. Different configurations for double stent-assisted coil embolization have been described. The T-configuration stent-assisted coiling procedure was recently described as a feasible, effective, and relatively safe endovascular technique used to treat wide-necked complex bifurcation aneurysms. In this article, we present the successful management of a complex wide-neck basilar tip aneurysm using a slightly modified T-configuration stent-assisted coiling technique.

Particular management strategy for intraprocedural coil migration during endovascular treatment of intracranial aneurysm

Migration of coils represents one of the most challenging complications of endovascular management of cerebral aneurysms with a potentially catastrophic result. In this article, we present the successful management of a coil migration during the endovascular occlusion of an anterior communicating artery aneurysm. A stent fixation technique was used with good vascular repermeabilisation. The reported frequency, risk factors and management strategies are also discussed.

Meningioma in shape

Objective: The aim of this study was to evaluate the possible relationship between the appearance of tumour margins of atypical meningiomas and the risk of tumour recurrence, as well as progression-free survival. We also evaluated the correlations between the tumour margins and the neuroimaging characteristics (e.g. brain oedema and contrast enhancement) along with pathological features (e.g. brain invasion and mean value of Ki-67 LI). Material and methods: In our study, we included 81 patients diagnosed with atypical meningioma (grade II meningioma), who have undergone surgery at the "Prof. Dr N. Oblu" Emergency Clinical Hospital Iasi, between January 1, 2010, and December 31, 2019. We followed the MRI imaging characteristics (e.g. tumour margins patterns, contrast enhancement, oedema grading and tumour volume), but also the pathological characteristics such as brain invasion and the mean value of the Ki-67 labelling index. The assessment of tumour recurrence was made using MRI imaging (T1+ contrast), over a follow-up period of 5 years after the surgery. Results: In our study, we observed that 59.3% (n=48) of meningiomas had an irregular appearance. The irregular margins predominated in the male population (65.1%) and were statistically significantly correlated with brain oedema (p<0.001), contrast enhancement (p<0.01), anatomical location (p<0.014) and the mean value of the Ki-67 labelling index (p<0.01). The tumour margins were not correlated with brain invasion or volume of meningiomas. Conclusion: In our series of patients we found that the irregular margin was not a prognostic factor for tumour recurrence over a period of 5 years or for progression-free survival.

The stent-assisted coil-jailing technique for very small intracranial aneurysm treatment

The stent-assisted coil-jailing technique was initially introduced as an effective and secure method in the treatment of large wide-necked intracranial aneurysms. Later on, this technique has proved its efficiency in the safety and optimal treatment of very small aneurysms. In this article, we will present the successful treatment of a very small middle cerebral artery aneurysm using the stent-assisted coil-jailing technique and review the current trends in this type of treatment.

Management of a double basilar tip aneurysm

Complex basilar tip aneurysms are still challenging to secure with coils or stent-assisted coiling. Double aneurysms at the basilar bifurcation and the basilar artery-superior cerebellar artery are a rare particular situation that usually requires more appropriate treatment. This case reports details of our experience with a double basilar tip aneurysm treated in two steps by coiling repair and stent-assisted coiling.

The impact and causes of negative cortical mapping in primary motor area tumours

Introduction: Intraoperative neurophysiological monitoring is the golden standard for lesions located in eloquent areas of the brain. On the one hand, positive mapping offers a view of the relationship between the anatomo-functional cortical organisation of the patient and the lesion, facilitating the choice of the cerebrotomy entry point and the resection until the functional borders are found. On the other hand, negative mapping does not offer certainty that the absence of the motor response, from the operative field, is the real feedback or is the result of the false-negative response. In such a situation, a differentiation between those two must be done. Materials and methods: We evaluated the results of direct cortical stimulation of lesion located in or near the primary motor area, which were diagnosticated with contrast-enhancement head MRI and admitted to the Third Department of Neurosurgery, "Prof. Dr N. Oblu” Emergency Clinical Hospital, Iasi, Romania, between January 2014 and July 2018. Special attention was given especially to the negative mapping cases, regarding the histological type, imagistic localisation, symptoms and neurological outcome immediate postoperative, at 6 months and one-year follow-up. Results: From all 66 patients meeting the inclusion and exclusion criteria in 9,09% (6 cases) we did not obtain any motor response after direct cortical stimulation. The imagistic localisations of those cases were: 3 – Rolandic, 2 – pre-Rolandic and one retro-Rolandic. Tumors histological types were: glioblastoma, anaplastic astrocytoma, oligoastrocytoma and oligodendroglioma each one case and two cases of fibrillary astrocytoma. The intensity range was between 6 – 18mA, the mode – 12mA and the median – 10mA. Postoperatively the neurological condition of 3 patients worsened (4,54% from all the cases), while 3 had a favourable evolution with symptom remission. At 6monts and one-year follow-up in one case (1,51%), we observed no improvement in contrast with the other two, where dysfunction remission was highlighted. Conclusion: The possible technical, surgical and anesthesiologic causes of false-negative motor response must be eliminated to be able to differentiate from the real absence of the functional area from the operative field. In the first scenario, the resection may be associated with permanent postoperative neurologic deficit and major life quality alteration while in the second one the patient presents no motor dysfunction after surgery and the resection may be extensive with multiple oncological benefits.

The 3D printed models technology for the management of intracranial aneurysms

Management of intracranial aneurysms is still a therapeutic challenge, especially in cases of complex lesions. Thus, the improvement of the study and intervention planning possibilities correlated with the access to continuous professional training based on simulation and clinical diversity represent optimal conditions for the efficient solution of this pathology. The development of three-dimensional printing technology offers a new opportunity in the modern treatment of intracranial aneurysms. The aim of this study is to present some aspects related to the materials and methods of manufacturing simulation models of individual 3D printed aneurysms and their influence in the optimal management of these lesions.

The tumour volume influence on tumour recurrence and progression-free survival in the case of atypical meningiomas

Objective: The objective of our study was to evaluate a possible relation between the volume of atypical meningiomas (AMs) and the risk of tumour recurrence, as well as progression-free survival (PFS). Material and methods: We evaluated 81 patients diagnosed with AMs (WHO grade II meningioma) who have undergone surgery at the "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi between January 1, 2010, and December 31, 2019. The recorded data were demographic and imagistic (MRI, contrast-enhanced T1WI). We calculated the tumour volume prior to the surgery and evaluated the tumour recurrence using MRI at 12, 24, 36, 48 and 60 months after the surgery. Results: 50.6% of patients had meningioma volume < 26.4 cm3. Women had larger tumour volumes than men (52.6%). Patients of age ? 60 years old, had tumour volumes ? 26.4 cm3 in 58.5% of cases and meningiomas with volumes ? 26.4 cm3 recurred earlier (p=0.010). Also, patients who had tumour volumes ? 26.4 cm3, had a shorter PFS (40.976 months), compared to patients with tumour volumes < 26.4 cm3, who had better PFS (53.4 months). Conclusions: the tumour volume of AMs ? 26.4 cm3 represents a negative prognostic factor for both early tumour recurrence and reduced PFS.

Mechanical thrombectomy techniques for acute ischemic stroke

Mechanical thrombectomy technique was introduced as an effective and secure method in acute ischemic stroke patients suffering from intracranial large vessel occlusion (LVO). In this article, we will review the main mechanical thrombectomy techniques and current trends in this type of treatment for acute ischemic stroke.

A neurosurgical challenge: awake mapping in „critical” language area tumours

Introduction. Despite the technological development lesion located in or near language area still represent a challenge for every neurosurgeon. Awake craniotomy and intraoperative neurophysiological monitoring come to our help. Different techniques variation exists among specialized centres. We present our experience and the set up for this procedure. Materials and methods. We conducted a retrospective analysis of collected data from 10 patients with brain tumours located in or near language area to which we performed awake craniotomy and intraoperative neurophysiological monitoring. They were admitted in Third Department of Neurosurgery,” Prof. Dr. N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results. Presenting symptoms had a duration more than a month in 60 % of patients. In 80% of them were represented by epileptic seizures and the rest of 20 % had transient aphasia elements. The median age of presentation was 28 years old with a male dominance. The histological reports indicated: fibrillary astrocytoma – 40%, anaplastic astrocytoma – 30%, oligodendroglioma – 20% and metastases – 10%. Gross total resection was performed in half of the cases and subtotal in just one case, in which the spontaneous speech and object naming showed repeated impairment in time of tumour debulking. The surgical intervention was well tolerated by all the patients. The intensity of cortical stimulation used was between 4 – 10 mA. Postoperatively two patients had neurological aggravation, with full recovery at 3 months follow up period, two were stationary and six had symptoms remission. Conclusion. A young age of presentation, a paucity of symptoms, the chance for an increase in overall survival and progression free survival impose the need for direct communication and feedback with the patient in time of tumour resection. Thus, awake craniotomy and intraoperative neurophysiological monitoring is the golden standard for selected cases of language area tumours.

Current applications of 3d printing in neurosurgery

Medical implications of 3-dimensional (3D) printing technology have progressed with increasingly used especially in surgical fields. 3D printing techniques are practical and anatomically accurate methods of producing patient specific models for medical education, surgical planning, training and simulation, and implants production for the assessment and treatment of neurosurgical diseases. This article presents the main directions of 3D printing models application in neurosurgery.

Preliminary study of thrombogenicity induced by the nanoparticle surface coating of intracranial stents

Endovascular treatment of intracranial aneurysms with intracranial stents was proven to be clinically safe and effective, but is still associated with a risk of thromboembolic complications. Stent thrombosis could be a sever complication associated with specific stent surface coatings and designs. Standardized in vitro tests for investigation of thrombogenicity induced by different nanomaterials were used as the basic method in carrying out the present study. Therefore, the aim of this study was to evaluate the thrombogenicity of three different nanomaterials (ZnO, TiO2 si Fe3O4) possible used as surface coating for intracranial stents. This study is based on a procedure for in vitro analyses of plasma coagulation time. To measure the plasma coagulation time, platelet-poor plasma from human whole blood was in vitro exposed to nanoparticles and analysed in prothrombin (PT) and activated partial thromboplastin (APTT).

Finite element method to study cervical postoperative stability

A cervical spine model built by means of the finite element method was used to determine the risk of postoperative cervical instability in relation to the type of discectomy, in cervical disc herniation. Furthermore, this model was employed to check whether, at the adjacent levels of the fusion discectomy, the intervertebral translation during cervical movements will maintain the normal amplitude [normal ROM] or its amplitude will decrease. The intervertebral displacement and the tension arising from motion and weight in the cervical vertebral structure were thus determined through computer modelling using the above-mentioned method and the software Abaqus. It resulted in a cervical spine model consisting of 739666 finite elements interacting through 210530 nodes, with biomechanical properties following the vertebral anatomical structures modelled. Two movement situations were studied to determine the behaviour of this model. Firstly, the moment of force for flexion and extension of 1 Nm. Secondly, we aimed to establish the maximum flexion and extension for a normal cervical spine model in order to determine the momentum value of moving forces for each of them. It was showed that both anterior cervical microdiscectomy without fusion and cervical discectomy with cage fusion (used for the surgical treatment of cervical disc herniation at one level), ensure postoperative vertebral stability when performed properly. Both types of surgery reduce the mobility of the cervical spine, although more in the case of fusion discectomy. The intradiscal tension increases in movement in both models, with a higher intensification in the fusion discectomy model. The practical conclusion is that microdiscectomy without fusion is preferable in the case of a single-level cervical disc herniation occurred to a cervical spine without instability.

Our experience with a single stage bilateral approach for treatment of bilateral middle cerebral artery aneurysms

Surgical management of bilateral middle cerebral artery (MCA) aneurysms is particular challenging clinical situation. For these patients various options of surgical treatment are available as unilateral approach, single stage bilateral craniotomy or two stage bilateral craniotomy. We report our experience with a case of bilateral MCA aneurysm which was managed by single stage bilateral pterional craniotomy.

Syringobulbia and syringomyelia in a case with Chiari 0 malformation successfully treated by posterior fossa reconstruction

“Chiari zero malformation” is a rare and a relatively new described condition which associates syringohydromyelia without caudal displacement of the cerebellar tonsils through the foramen magnum. We present a case of a 40 years old woman with Chiari zero malformation with both syringomyelia and syringobulbia and a good clinical and radiological outcome after posterior fossa decompression. The presence of associated syringomyelia and syringobulbia in this condition is less frequent and it usually occurs in younger patients. In our case we considered syringobulbia as being an extension of syringomyelia.

Anatomical localization of intracranial grade II meningiomas in North-Eastern Romania

Objective. Our research aims to assess a possible connection between tumour localization and histological subtypes of grade II meningiomas. Material and methods. 143 patients with grade II WHO meningiomas underwent surgical resection in "Prof. Dr. N. Oblu" Emergency Clinical Hospital Ia?i between 1990 and 2015. The collected data included: patient age, gender, tumour localization and histopathological diagnosis (atypical, clear cells and chordoid meningioma). Results. 135 (94.4%) of all 143 patients with grade II meningiomas were atypical meningiomas, 6 (4.2%) were cell clear meningiomas and only 2 (1.4%) were chordoid meningiomas. As concerns their distribution by gender, 79 (55.2%) were female and 64 (44.8%) were male. Grade II meningiomas were most commonly located at convexity 49.7% (n=71), followed by skull base in 30.8% (n=44) of the cases and parasagittal/falcine in 14.7% (n=21) of the patients. Conclusions. The most common localization of grade II meningiomas was convexity, followed by skull base, parasagittal/falcine and intraventricular areas. We have also noticed that convexity meningiomas are more frequent in women, unlike the other anatomical localizations in which the male-female ratio is almost equal. Therefore, further research is necessary to determine the role of embryological, anatomopathological and genetic factors in underlying the connection between meningioma grade and anatomical localization.

The History of Arachne Through Historic Descriptions of Meningiomas with Hyperostosis: From Prehistory to the Present

BACKGROUND

Intracranial meningiomas are brain tumors that have probably been known the longest, largely because of the occasional production of grotesque cranial deformities that have attracted the attention and interest of humankind. Because of the tendency of some intracranial meningiomas to cause skull deformation and thickening, these tumors have given rise to various speculations and theories related to their origin, starting in prehistoric times up to the present.

METHODS

From the Steinheim skull and "pharaonic meningiomas" to the first meningioma monograph and the first explanations of Harvey Cushing regarding the mechanism of hyperostosis, this review aims to weave again the story of Arachne. We identify the main contributors who have tried to understand and explain the tendency of some of these tumors to cause hyperostosis or other skull bone involvements.

CONCLUSIONS

The contribution of neurosurgeons or pathologists over the centuries is of undeniable importance and is the basis for understanding future molecular mechanisms.

Endovascular management of recurrent anterior communicating aneurysm previously embolized. Case presentation

Although endovascular coiling treatment has been widely accepted as the method of choice for intracranial aneurysms, concerns about its durability are still discussed. Attention was largely focused on aneurysm recurrence after coil occlusion with possible unfavourable evolution to a new bleeding episode. We present our experience of a patient with a ruptured anterior communicating artery aneurysm previously treated by endovascular coil embolization that presented over a 4-year period for aneurysm recurrence.

Pathways of metastatic spread in meningiomas

Meningioma is a common intracranial neoplasm derived from meningothelial cells, and it is generally associated with a benign clinical course. In spite of this, the malignant behaviour of these tumours as the occurrence of extracranial meningioma metastases in different organs is described in the literature: lung and pleura, spine and other bones, abdominal organs, lymph nodes or even skin. The aim of this review is to analyse the pathways of metastatic spread of the intracranial meningioma tumour cells towards different organs.

Chemical Aspects of Peritumoral Cerebral Edema in Atypical Meningiomas

Aim of this study was to perform a retrospective evaluation of the radiological, clinical and pathological features influencing the occurrence of peritumoral brain edema (PBE) and understanding the responsible chemical mediators involved. We have examined magnetic resonance imaging(MRI), symptoms and pathology for 25 patients with convexity atypical meningiomas (WHO grade II), who underwent surgery at Professor Dr. N. Oblu Emergency Clinical Hospital between 2010 and 2017. We evaluated the possible prognostic factors related to peritumoral edema including: demography (age, gender), pathology (anatomical localization of the tumor, tumor volume, brain invasion, shape of tumor margin), symptoms and neuroimaging characteristics such as high signal intensity of the tumor on T2-weighted images (T2WI), contrast enhancement and heterogeneity. Age, gender, anatomical location of the tumor and brain invasion were not correlated with peritumoral edema. Also, the neuroimaging characteristics (homogeneity, high signal intensity on T2WI, high contrast enhancement) or the presence of motor deficit were not statistically significant regarding the relationship with the edema. Peritumoral edema and irregular tumor margins were statistically significantly (p=0.03). Tumor volume was not associated with the peritumoral edema. We also found other significant statistical correlations of the radiological features, which are worth mentioning: high-contrast enhancement with the age of the patient (p=0.006), high signal intensity on T2WI with tumor volume (p=0.03) and tumor heterogeneity with irregular tumor margins (p=0.002). The results of this study demonstrate that an irregular tumor margin may be an important predictive factor that would influence the occurrence of peritumoral edema in atypical meningiomas.

Meningiomas Related to the Chernobyl Irradiation Disaster in North-Eastern Romania Between 1990 and 2015

Even if meningiomas are the most common radio-induced tumors that occur in the adult population, the epidemiology of these types of tumors after Chernobyl nuclear accident, is still unclear. This paper aims to determine the tumoral behavior of intracranial meningiomas in North-Eastern Romania, affected by the radioactive cloud from Chernobyl nuclear accident , over a period of 25 years, namely between 1990 and 2015. Our research consists of an analytical, observational, cohort-based and retrospective study, conducted in Prof. Dr. N. Oblu Clinical Emergency Hospital of Iasi, Romania, on a group of 1287 patients diagnosed with intracranial meningiomas and operated between 1990 and 2015. In these period there was an increased number of intracranial meningiomas, with first peak between 1993-1996 and the second peak between 2007-2015, corresponding to 7-10 years and 21-30 years, after the Chernobyl accident. Regarding the annual frequency of histopathologic grading, for grade I meningiomas there were no trend or cyclicity of the cases diagnosed each year, but for grade II and III meningiomas there were an ascending trend in the period 1996-2000, that corresponds to the 10-14 years from the Chernobyl accident.

The Role of OsiriX Based Virtual Endoscopy in Planning Endoscopic Transsphenoidal Surgery for Pituitary Adenoma

AIM

Virtual endoscopy (VE) is the navigation of a 3D model reconstructed from radiological image data. The aim of this paper is to evaluate the role and accuracy of the virtual endoscopy realized using commercially available software, OsiriX, as a method of planning of surgical interventions.

MATERIAL AND METHODS

The computed tomographies of 22 patients with pituitary adenomas proposed for endoscopic approach were reconstructed using OsiriX. VE was performed prior to surgery to assess the surgical corridor and particular anatomy. We evaluated the following landmarks: inferior and middle turbinate, sphenoid ostia (SO), choanal arch (Ch), sphenoethmoidal recess (SER), sphenoid septa, sella turcica, carotid prominences and opticocarotid recesses (OCR). The intraoperative endoscopic images were reviewed and compared with the virtual images.

RESULTS

The virtual images had a good resemblance with the actual surgical images. All the structures from the nasal cavity were identified and had a perfect matching except the SO which was identified in 8 cases in VE vs. 12 intraoperative. All the structures from the sphenoid sinus were identified with perfect matching except the ipsilateral carotid prominence (14 in VE vs. 10 intraoperative) and the contralateral carotid prominence (16 in VE vs. 18 intraoperative). The VE could not show the state of the sellar floor and did not offer any information about the sellar content.

CONCLUSION

VE realized in OsiriX represents an affordable alternative to the specially designed systems, offering reliable data and good quality images that are useful for the preoperative planning, but some limitations are present such as inability to obtain additional information in cases where the sphenoid sinus is fully occupied by tumor or not aerated, inability to clearly differentiate between structures at the level of the sella, and impossibility to simulate working instruments.

Unusual aggressive and rapidly growing glioblastoma multiforme – case presentation

Glioblastoma multiform is one of the most rapidly progressing cerebral tumors and the most aggressive one in our neurosurgical experience. We present the case of a 45 year old patient with very aggressive type of tumor who had come to our service for the following: intense headache, confusion, right hemiparesis installed approximately one month before. IRM scan shows up the presence of a large tumoral mass without a precise border in the left temporal-parietal region which had extended all the way down to the thalamus. The planned intervention used 5-aminolevulinic acid (5-ALA) for the precise removal of the tumor mass, suboptimal because of the risk of lesioning the motor tracts – indicated by the intraoperative electrophysiological monitoring. After surgery the outcome was good with the partial regression of the motor deficit, but only after 3 weeks due to the unexpected tumor growth the neurological status started to decay and even worsened. The patient underwent surgery again with the partial remission of the symptoms although following imagistic controls showed up fast tumor growth once more. He was recommended to oncology service for the beginning of radiotherapy. We consider the evolution and invasion of this tumor in only a 3 weeks period being impressive.

Associated intracranial lesions: meningioma and anterior communicating aneurysm

Asymptomatic associated intracranial lesions are more frequently diagnosed with the utilization of high-resolution imaging. The occurrence of brain tumors together with intracranial aneurysms are a very rare situation. This coexistence is still a diagnostic and therapeutic challenge as no consensus concerning imaging that may cover both type of intracranial lesion was established. We report a case of a 62 years old patient with a meningioma and aneurysm treated in one session with good outcome.

The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: our first experience

Complex cavernous sinus fistulae (CCF) are still a technical challenge to neurovascular team. The most commonly performed treatment consists in endovascular embolization of the lesion through an arterial or venous approach. Not always these conventional routes are feasible, requiring alternative routes. We report a case of a 44-year-old woman with a complex indirect (Barrow D) carotid cavernous sinus fistula treated by two interventional sessions that imposing a retrograde direct transvenous approach via the superior ophthalmic vein.

Our first experience with cervical expandable cage for vertebral body reconstruction

Vertebral body reconstruction after corpectomy using expandable cage has become a common surgical procedure especially at thoracic level. The recent published papers describe the successful use of expandable cages for cervical vertebral body reconstruction. In this paper we present our first experience with expandable cervical cage in the reconstruction of the cervical spine in a patient with cervical spondylotic myelopathy (CSM)

Extracranial internal carotid artery aneurysm treated by combined endovascular - microsurgical techniques

Extracranial internal carotid artery aneurysms are rare lesions that still represent a challenge from diagnosis and treatment point of view. Giant complex aneurysms of extracranial internal carotid artery are usually completely excluded by surgical approaches. We present a case of a patient with an extracranial internal carotid artery aneurysm treated by a combined treatment, along with a short review of this pathology.

Ruptured fusiform aneurysm of the proximal anterior cerebral artery in young patient - case report

A 16-year old male presented with a ruptured aneurysm of the proximal segment of the anterior cerebral artery, with symptoms like sudden headache. Paraclinical explorations revealed a fusiform aneurysm of the right A1 segment. The optimal treatment used was the microsurgical one via right pterional approach. The aneurysm was associated with a saccular pseudoneurysm at the proximal part. The saccular portion was clipped and the fusiform one was wrapped with muscle. The postoperative evolution was favorable, without neurological deficits.

Three-level cervical disc herniation

Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6) treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

Combined treatment for complex intracranial aneurysm

Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

Acute intracerebral haemorrhage complication after carotid artery stenting

Intracranial hemorrhage following carotid artery stenting is a recognized rare complication but with potentially devastating evolution. Reports of acute cerebral hemorrhage injury following internal carotid artery (ICA) angioplasty are few, and usually were discussed in correlation with hyperperfusion syndrome. In this article we present a patient who experienced a fatal ipsilateral basal ganglia hemorrhage within 10 minutes after carotid angioplasty and stent placement

Temporo-sylvian anastomosis and aneurysm clipping in a case of left M1 aneurysm with progressive evolution after initial embolization; Case report

A giant unrupted middle cerebral artery aneurysm partially thrombosed, previously endovascularly treated after a mild right hemiparesis remitted. After 12 months, in routine check we discovered a reperfusion of the aneurysm and decide ECIC bypass and clipping, with a good outcome

Cerebral venous etiology of intracranial hypertension and differentiation from idiopathic intracranial hypertension

This study presents the characteristics that distinguish between idiopathic intracranial hypertension (ICH) and ICH caused by intracranial vascular damage. Twenty-one patients with ICH were included in this study. The analysis of the symptomatology correlated with the values of intracranial pressure, and the imaging findings revealed significant differences between these two types of ICH. ICH caused by intracranial venous vascular damage is named vascular ICH. Vascular ICH has a known etiology, such as cerebral vascular illness, and a relatively rapid increase in intracranial pressure of approximately 21 cmH2O and imaging findings show characteristic images of thrombosis or stenosis of the intracranial venous system, while all brain images (computed tomography, magnetic resonance imaging, angio-magnetic resonance imaging) are normal in idiopathic ICH. The treatment of vascular ICH is etiologic, pathogenic, and symptomatic, but that of idiopathic ICH is only symptomatic.

One-step endovascular treatment of bilateral traumatic carotid-cavernous fistulae with atypical clinical course

Traumatic carotid-cavernous fistula (TCCF) is a rare neurovascular pathologic entity. The bilateral form occurs even rarer and given the potential risk for both optic tracts presents an urgent indication for quick and effective treatment. We present a patient with a bilateral Barrow type A TCCF with a fulminant development of symptoms, who was successfully treated with bilateral detachable balloons in a single session endovascular procedure. The patient experienced complete relief of symptoms, however the complete neurological deficit in the left optic nerve was persistent.

Glioamele căilor optice în neurofibromatoza de tip 1 la copil

Gliomul de căi optice are expresie clinică maximă în copilărie, în jurul vârstei de 5 ani, fiind a doua tumoră ca frecvenţă în neurofibromatoza tip 1. Topografic se descriu 3 tipuri de glioame de căi optice: tipul I – glioame retrobulbare prechiasmatice, tipul II – glioame de tract optic şi tipul III – glioame chiasmatice. Examenele neuroimagistice sunt esenţiale în stabilirea diagnosticului şi a indicaţiei neurochirurgicale. Managementul acestor tumori este dificil chiar dacă au caracteristici histopatologice benigne. Pacienţii cu glioame de nerv optic simptomatice şi progresie documentată neuroimagistic au indicaţie de rezecţie tumorală. Glioamele de nerv optic asociate neurofibromatozei tip 1 au în general o evoluţie bună, factorii de prognostic nefavorabil fiind reprezentaţi de debutul clinic precoce, sub vârsta de 6 ani şi de afectarea chiasmatică şi retrochiasmatică.

The optic pathways gliomas in children with neurofibromatosis 1

Optic pathways gliomas have the maximal clinical expression in childhood around the age of 5, being the second tumor in neurofibromatosis type 1 in frequency. Considering their location, it describes three types of optic pathways gliomas: type I - retrobulbar gliomas, type II - optic tracts gliomas and type III - chiasmatic gliomas. Neuroimaging exams are essential in diagnosis and selection surgical patients. Management of these tumors is often difficult even they exhibit histological benign features. Patients harboring optic nerve gliomas with symptomatic and documented neuroimaging progression have indication of tumor resection. Optic nerve gliomas associated with neurofibromatosis type 1 have generally a good prognosis. Unfavorable prognostic factors are represented by the early clinical onset under 6 years of age and chiasmatic and retrochiasmatic location.

Injectable iron-modified apatitic bone cement intended for kyphoplasty: cytocompatibility study

In this study, the cytocompatibility of human ephitelial (HEp-2) cells cultured on new injectable iron-modified calcium phosphate cements (IM-CPCs) has been investigated in terms of cell adhesion, cell proliferation, and morphology. Quantitative MTT-assay and scanning electron microscopy (SEM) showed that cell adhesion and viability were not affected with culturing time by iron concentration in a dose-dependent manner. SEM-cell morphology showed that HEp-2 cells, seeded on IM-CPCs, were able to adhere, spread, and attain normal morphology. These results showed that the new injectable IM-CPCs have cytocompatible features of interest to the intended kyphophasty application, for the treatment of osteoporotic vertebral compression fractures.