Romanian Neurosurgery <p>Call for Papers - Vol. XXXV, No. 1 (March 2021)<br />Submission Deadline: February 1, 2021</p> London Academic Publishing en-US Romanian Neurosurgery 1220-8841 Physiological alteration and anaesthetic drugs effects on intraoperative neurophysiological monitoring procedures Intraoperative neurophysiological monitoring (IOM) and especially motor evoked potentials represents an important tool in the evaluation of the nervous system integrity and particularly of the motor tracts. A real and correct registration of the potentials with a proper interpretation of the modification is mandatory for an optimal outcome in eloquent areas, tumours, brainstem and medullary lesions. For all this to happen a suitable anaesthetic protocol must be used. Even though there is a large spectrum of anaesthetic agents at our disposal it is imperative to know their effect on the IOM signals recordings and the fact that some of them are dose-dependent. Drugs effects and physiological changes produced intraoperatively must be corrected before a shift in the direction of the surgical lesion resection it is taken. We present an overview of the action of the anaesthetic agents, most used protocols and the physiological alteration encountered in the operative theatre. Mihaela Coșman Andreea Atomei Nina Straticiuc Alexandru Caragea Mihai Soare Alina Mihaela Neacșu Copyright (c) 2020 2020-12-16 2020-12-16 475 481 Complications after sciatic nerve defect repair in rats Experimental microsurgery is a provocative field with great rewards. Nerve microsurgery is particularly challenging because the results of the operation can only be tardily observed. During this time frame, multiple complications can appear to the laboratory rats, which can influence the final results. For this reason, when experimenting with Wistar rats, one must be familiarized with the possible complications in order to know the suitable solutions for all the issues. Lack of information and henceforth lack of action might result in compromising the final data. Andrei Marin Georgiana Gabriela Marin Carmen Giuglea Copyright (c) 2020 2020-12-16 2020-12-16 482 487 Surgical management of Rolandic area meningioma in the era of intraoperative neurophysiological monitoring Introduction: The advantages and the necessity of intraoperative neurophysiological monitoring (IOM) in the surgery of motor area infiltrative tumours is well known. The use of this technique for Rolandic meningioma is still debatable. The absence or the loss of the cleavage plan and an infiltrative border make the dissection exceedingly difficult and increase the risk of new postoperative motor disfunction. Materials and methods: We evaluated the impact of IOM, especially direct cortical stimulation on the degree of resection, new postoperative deficits, symptom remission and clinical-imagistic aspects at one-year follow up of 19 cases of Rolandic meningioma admitted in Third Department of Neurosurgery,” Prof. Dr N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results: More than half of the cases (57,88%) had epileptic manifestations as the main clinical symptom with the Jacksonian seizures being on the first place (31,57%), followed by progressive paresis (26,31%) and other nonspecific symptoms. Intraparenchymal preoperative oedema was observed in 36,84% of patients. The intensity of direct cortical stimulation was between 6-13 mA (median = 9mA; mode = 12mA). Simpson degree of resection was dominated by S3– 47,36% and S4 was obtained in 15,78% of cases. Postoperative the outcome was favourable for 73,68% patients with 5,26% motor aggravation and 10,52% new deficits. At one-year follow up no imagistic recurrence was observed and the permanent motor deficit was maintained in one of the three cases (5,26%). Conclusion: Even though meningiomas are extranevraxial lesions and those located on the convexity have a low risk of complication, the absence of a clear dissection plan between the tumour and the adjacent motor cortex is associated with a high risk for new postoperative neurological deficits. Therefore, it is important to perform cortical mapping for Rolandic meningioma, to determine the location of the primary motor area and to protect it from mechanical and vascular trauma, during tumour resection. Mihaela Coșman Ionuț Mihail Panțiru Andrei Ionuț Cucu Andreea Lenuța Atomei Gabriela Florența Dumitrecu Ion Poeată Copyright (c) 2020 2020-12-16 2020-12-16 488 494 Endodermal cyst of the cranio-cervical junction We report an extremely rare case of an endodermal cyst of the cranio-cervical junction located dorsally to the brainstem and upper cervical spine in a 27-year-old female presented with occipital headache, vertigo and pain in both shoulders. Neurological examination showed neck stiffness with bilateral XIth nerve palsy. Magnetic resonance imaging revealed a cystic lesion at the cranio-cervical junction and slight compression of the brain stem. The lesion was totally removed through the posterior approach. The histological diagnosis was endodermal cyst. To our knowledge, the only one such case has been reported in the literature. Bogdanović Ivan Ilić Rosanda Milićević Mihajlo Aleksić Vuk Milosavljević Filip Miljković Aleksandar Šćepanović Vuk Stanimirović Aleksandar Nedeljković Žarko Todorović Marko Joković Miloš Grujičić Danica Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 495 497 Dolichoectatic middle cerebral artery masquerading as cerebral cavernous malformation Background: Intracranial dolichoectasia (IADE) is a rare vascular disease characterized by distension, elongation and tortuosity of an artery. IADE rarely involves pediatric aged groups. It is either asymptomatic or manifests as ischemic or hemorrhagic attacks. Case description: A healthy, 30-year-old, female teacher presented with recurrent attacks of bi-frontal headaches associated with dizziness and dropping attacks of two-week duration. She was referred by her general physician to our institution of Neurosurgery Teaching Hospital in Baghdad, Iraq with a suspicion of medial temporal lesion on a cranial computed tomography (CT) scan. Magnetic resonance imaging study excluded the diagnosis suggesting a dolichoectatic middle cerebral artery that was confirmed by CT-angiography. Conclusion: Dolichoectasia of the middle cerebral artery is a rare and benign lesion. However, it can masquerade as cerebral cavernous malformation or intracranial arterial aneurysm. Thus, careful radiological evaluation with the suggested diagnostic criteria are of paramount importance to prevent its misdiagnosis. Zahraa F. Al-Sharshahi Saja A. Albanaa Ahmed M. Jawad Noor K. Al-Waely Noor A. Hummadi Samer S. Hoz Copyright (c) 2020 2020-12-16 2020-12-16 498 503 The two stages surgery in the management of central neurocytoma Central neurocytoma is an uncommon benign tumour of the central nervous system. The intraventricular location close to the Monro foramina and the attachment to septum pellucidum are characteristics for diagnosis. The encasement of vascular structures represents a surgical challenge. We report a series of 10 cases of central neurocytoma operated at our department 06 of those was operated in two stages intentionally in order to avoid post-operative complications and to obtain complete removal. W. Bennabi A. Khelifa Y. Felissi L. Houari A. Morsli Copyright (c) 2020 2020-12-16 2020-12-16 504 508 Multilocular hydrocephalus <p>Multilocular hydrocephalus is an entity that occurs relatively frequently in neurosurgical practice. We are present an editorial letter with a mini-review of the pathophysiology, surgical, and medical treatment.</p> Harold Vasquez Ezequiel García-Ballestas Luis Rafael Moscote-Salazar Sergio A Serrato William A. Florez Perdomo Amit Agrawal Copyright (c) 2020 Romanian Neurosurgery 2020-12-12 2020-12-12 509 511 Safety of metoclopramide in traumatic brain injury patients <p><strong>Background:</strong> One in every three related-injury deaths in United State are linked directly to traumatic brain injury (TBI), for which it is considered as a leading cause of death. Traumatic brain injury took place due to severe head assault to a hard object, with headache and vomiting being amongst the most common presenting symptoms. Metoclopramide is an old antiemetic agent that has been used widely for nausea and vomiting in TBI patients.</p> <p><strong>Aim:</strong> A systematic review of the literature to investigate the safety of metoclopramide in treating traumatic brain injury patients.</p> <p><strong>Methods:</strong> A literature review was conducted in 6 databases, we determine the pertinence of a study to the inclusion criteria by assessing the title, keywords, and abstracts. Five studies were found to be relevant. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed.</p> <p><strong>Results:</strong> The collective sample size was 93 patients with an average of age 38.5 years. 51.6 % were male and 48.6% were females. Most patients received 10 mg metoclopramide IV with a percentage of 77.4%. While only 22.5% received 20 mg IV metoclopramide. Seventy-one patients received metoclopramide alone and 22 received combination therapy. Headache was the most common reported side effect (46.2 %), followed by anxiety and drowsiness with (39.7%) and (27.9 %); respectively. Fatigue reported in (24.7%), while dystonia was the least common and developed only in 5.3%.</p> <p><strong>Conclusion: </strong>Metoclopramide is a common medication used to treat TBI patients in the emergency department. However, the review demonstrated that the central nervous system (CNS) side effect is excepted. Alternative options with lower CNS side effects may be better tried.</p> Said Al Jaadi Yahya Al Kindi Tariq Al-Saadi Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 512 517 Pre-hospital care: demography, current profile and future trends <p><strong>Introduction. </strong>Traumatic brain injury (TBI) is a major public health problem throughout the world. It is one of the leading causes of mortality and disability as a consequence results in a great financial burden on societies. Damage to the brain following trauma does not occur only at the moment of injury but also develops over a period of hours to days with the further secondary insult of the brain.</p> <p><strong>Methods.</strong> This was a prospective study done between April 2017 to March 2019. A total of 2134 patients were enrolled for this study with a collection of data in a formatted proforma. All the patients of trauma with clinical or radiological evidence of head injury coming to the trauma centre were included.</p> <p><strong>Results.</strong> In our study patient, mortality was 6.79% in patients receiving pre-hospital care compared to 12.03% in patients not receiving adequate pre-hospital care. 29.42% were in the age group of 21–30 years. RTA (overall 64.45%) was the most common mode of injury in the age group 21–30 years with 81.36% cases. Mortality in first emergency care provider by ambulance paramedics was 5.69% and member of the public was 10.10%. </p> <p><strong>Conclusion.</strong> It was observed that mortality was higher in patients not receiving adequate pre-hospital care. Early resuscitation facilities at the site of the accident have to be introduced and improved with the execution of rapid transportation to trauma care centres.</p> Sateesh Chandra Verma Abhijeet Singh Sachan Surjeet Singh Prakrati Sachan Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 518 523 The encephalitic syndrome revealing cerebral gliomatosis in an adolescent <p>Cerebral gliomatosis is a rare glial tumour which is defined by a diffuse and not very destructive infiltration of the encephalon by the glial neoplastic cells in the absence of individualizable tumour mass (Sanson et al., 2005).</p> <p>The clinical and radiological presentation is often misleading and not very specific, and the diagnosis is rarely mentioned. Histological diagnosis remains difficult. Finally, gliomatosis poses a specific therapeutic problem compared to other glial tumours due to the toxicity of panencephalic radiotherapy and the impossibility of achieving surgical reduction of the tumour (Sanson et al., 2005).</p> <p>Data from the literature show a median overall survival of 14.5 months, a higher frequency of oligodendroglial forms. The prognosis is linked to age, functional status, histological grade, oligodendroglial differentiation (Sanson et al., 2005).</p> <p>We report the observation of a gliomatosis occurring in a 14-year-old boy, having presented focal subintral epileptic attacks accompanied by hemiparesis. Flair sequence brain MRI showed a left fronto-temporo-insular hyper signal. The brain biopsy revealed gliomatosis. The evolution was favourable after radiotherapy. Gliomatosis is a diagnosis to be systematically evoked in the presence of a diffuse cerebral affection. Its etiopathogenic mechanism is unknown, and evolution is unpredictable (Millan. BS et al., 2010).</p> Hakim Si Ahmed Smail Daoudi Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 524 527 Brain radionecrosis after radiation therapy for atypical meningioma <p><strong>Introduction.</strong> Atypical Meningioma (AM) is at high risk of local failure. The role of radiation therapy (XRT) as an adjuvant to surgical resection is incompletely defined. The most deleterious consequence of brain-directed XRT is radiation necrosis. Brain radionecrosis (BRN) after AM has been rarely reported. The relevant literature is reviewed, highlighting its diagnostic challenges.</p> <p><strong>Case Presentation.</strong> We report a 25-year-old male with a BRN after adjuvant XRT for AM, which has been misdiagnosed as a recurrent neoplastic lesion upon magnetic resonance spectroscopy (MRS) examination. Surgery and histopathological description were made and yielded a definitive diagnosis of BRN. The patient was treated by dexamethasone with concomitant hyperbaric oxygen therapy (HBO2). The patient showed a further progression of the disease. Therefore, he was elected to receive bevacizumab. However, the patient finally died for refractory brain edema.</p> <p><strong>Conclusion.</strong> BRN is a relatively rare instance after XRT for AM. There is no single modality that can reliably distinguish BRN from tumour recurrence. Therefore, reaching an early prompt treatment decision is challenging.</p> Ebtesam Abdulla Harleen Luther Tejal Shah Nisha Chandran Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 528 532 Traumatic isolated intracerebellar haematoma without any supratentorial lesion <p><strong>Purpose</strong>. Pure isolated cerebellar haematoma of traumatic aetiology, without associated posterior fossa sub- or epidural haematomas and without supratentorial bleed is a rare entity. We conducted this retrospective study to analyze the management strategy of isolated traumatic intracerebellar haematoma without supratentorial lesion in our institute.</p> <p><strong>Methods</strong>. We retrospectively reviewed records of more than 15000 head injury patients in our department of neurosurgery between January 2014 and November 2019. In this isolated intracerebellar hematoma patients are 60. Patients were divided into two groups assessed by the GCS score at the time of presentation – Group A (GCS&gt;13) Group B (GCS lesser than or equal to 13). Group A treated conservatively and B surgically. Group A subdivided according to the size of hematoma into1<sup>st</sup> (&gt;3cm ) and 2<sup>nd</sup> (&lt;3 cm ). Group B subdivided according to GCS into 1<sup>st</sup> ( &lt;8 ) and 2<sup>nd</sup> ( 8-13).</p> <p><strong>Results</strong>. Most Group B, subgroup 1<sup>st</sup> ( GCS&lt;8) patients found to be associated with poorer outcome ( 60 %) and subgroup 2<sup>nd</sup> ( GCS 8-13) had only 10 %. Group A subgroup 1<sup>st</sup> ( &gt; 3 cm hematoma) has associated with poor outcome ( 28.57%) and Subgroup 2<sup>nd</sup> ( &lt; 3 cm ) has 4.34% . GCS score at the time of admission, hematoma size, hematoma location, the timing of surgery were important factors for outcome.</p> <p><strong>Conclusion. </strong>We concluded that hematoma size is &gt; 3 cm and GCS &gt; 8 patient should operate within 12 hr. Patient of GCS &lt; 8 results of surgery are poor( 60%.) .If the size of hematoma &lt; 3 cm, lateral hematoma and GCS &gt;13 should be treated conservatively. The factors which may be associated with the poor outcome are Low GCS score at the time of admission(&lt;8), the large size of hematoma (&gt;3cm), median location and delay time of surgery(&gt;12hr).</p> Sachin Kumar Jain Pintu Kumar Gupta Tarun Gaurav Jaiswal Vishnu Kumar Lohar Prateek Patel Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 533 539 Dorsolumbar angiolipoma <p>A 55-year-old female was presented with complaints of tingling sensations of the bilateral lower limb with spastic paraplegia for last one year. Her pre-operative contrast MRI study of Dorsolumbar Spine was suggestive of extradural angiolipoma. She underwent D11, D12 and L1 Laminectomy and a mildly vascular yellowish globular extradural mass was found which was excised completely and dural decompression was achieved. Post-operatively, the patient’s neurologic symptoms improved.</p> <p><strong>Conclusion: </strong>Spinal angiolipoma is considered a rare benign entity which emulates malignancy. It should be included as a differential diagnosis of the spinal epidural tumour with fat component and a high degree of vascularisation. surgical removal of this epidural tumour through a proper and comprehensive approach provides complete and permanent recovery.</p> Surendra Kumar Gupta Anuj Chhabra Hanuman Kumar Prajapati Faran Ahmad Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 540 543 Comparative analysis of anterior third ventricle approaches <p><strong>Background. </strong>Third ventricle tumors are uncommon and account for only 0.6 - 0.9% of all the brain tumors<sup>7</sup>. In 1921, Dandy was the first neurosurgeon who successfully removed a colloid cyst from the third ventricle through a posterior transcallosal approach. Despite their unfavourable locations, these tumours can be removed successfully by proper knowledge of anatomical landmarks and by choosing the appropriate approach.</p> <p><strong>Methods.</strong> We performed a retrospective analysis of all patients (17 patients) who underwent surgery for anterior third ventricular masses between March 2018 to March 2020 in the Dr Ram Manohar Lohia Institute of Medical Science Lucknow, Uttar Pradesh.</p> <p><strong>Results</strong>: The most common symptom in our cases was headache, which was present in all (100%) patients, nausea/vomiting in 7 (41%), history of recurrent episodes of drop attacks in 4 (23%), h/o seizure in 2 (11.7%), visual disturbance in 1 (5.4%), memory disturbance in 1 (5.4%) and urinary incontinence in 1 (5.4%) patient. 6 patients were operated with transcallosal-transforaminal approach, 1 patient was operated with transcallosal interforniceal approach, 3 patients were operated with transcortical-transforaminal approach, 1 patient was operated with subfrontal translamina terminalis approach, 1 patient was operated with transcallosal-transchoroidal approach, 5 patients were operated with endoscopically. Gross total excision was achieved in 15 (88%) patients while in 2 (11.7%) patients subtotal resection was done due to their adherence to choroid plexus and optic chiasm. The most common post-operative complication was endocrine dysfunction in the form of diabetes insipidus.</p> <p><strong>Conclusions. </strong>Anterior Third ventricular tumours are mostly benign and best treatment modality is surgical resection. When we analyzed the results of various approaches, we found that despite their unfavourable location, the results were satisfactory for different tumours of different location in the anterior third ventricle, when treated with the carefully planned microsurgical or endoscopic approach with proper knowledge of anatomical landmarks.</p> Deepak Kumar Singh Kuldeep Yadav Rakesh Kumar Arun Kumar Singh Vipin Kumar Chand Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 544 549 Spontaneous spinal hematoma <p><strong>Background</strong>. Spontaneous spinal hematoma (SSH) is a rare condition that can result in severe functional disability and even death. But early detection and prompt intervention can substantially reduce the morbidity. We present a series of seven operated cases of SSH.</p> <p><strong>Methods</strong>. All operated cases of SSH between 2017 and 2019 were studied. The demographic and clinical features, risk factors and imaging features were analyzed. The functional outcome at discharge and 6 months were assessed.</p> <p><strong>Results</strong>. Seven operated cases of SSH with mean age 35(SD-20.9) were studied. Six cases were spontaneous spinal extradural hematomas (SSEDH) and one case was spontaneous spinal subdural hematoma (SSSDH). The most common site was cervicothoracic. Risk factors associated with SSH were thrombocytopenia, pregnancy, and necrotising pancreatitis. Two patients had preoperative Frankel’s grade A-B, three had grade C and two had D. The mean interval between the onset of symptoms and surgery was 4.7days.</p> <p>The functional outcome was dependent on the pre-operative functional status of the patient. Patients with SSEDH and thrombocytopenia had a poor outcome.</p> <p><strong>Conclusion.</strong> SSH even though spontaneous may be associated with risk factors. The presence of thrombocytopenia and preoperative functional status predicted outcome. This is the only single institution case series to report thrombocytopenia as a factor predicting poor outcome.</p> Rajeev Mandaka Parambil Premkumar Sasi Pavithran Vadakkam Muriyil Byjo Valiyaveetil Jose Akhil Mohan Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 550 556 Cervical extradural metastasis from follicular carcinoma thyroid after 14 years post-thyroidectomy with Elsberg phenomenon <p><strong><span data-preserver-spaces="true">Background</span></strong><span data-preserver-spaces="true">. Follicular carcinoma thyroid usually metastasises to bone. Common sites of bone metastasis include skull and spine. Spinal metastasis are more common in the cervical region followed by dorsolumbar spine. Cervical extradural lesions present with progressive quadriparesis, sensory loss, dysautonomia, and respiratory distress. Typical Elsberg phenomenon in a cervical extradural lesion is rare. Elsberg phenomenon involves the involvement of ipsilateral upper limb, ipsilateral lower limb followed by contralateral lower limb and contralateral upper limb.</span></p> <p><strong><span data-preserver-spaces="true">Case presentation</span></strong><span data-preserver-spaces="true">. We are reporting a case of 47-year-old lady presented with progressive quadriparesis of 1-month duration. Her weakness started in left upper limb followed by left lower limb, right lower limb and right upper limb weakness. She also had sensory loss below the level of C7. She had undergone near-total thyroidectomy for solitary thyroid nodule 14 years back and was on thyroid supplementation since then. Histopathology at that time was reported as follicular adenoma with Hashimoto thyroiditis. Her right upper limb power was grade 4- Left upper limb grade 1 right lower limb Grade 3, left lower limb grade 2 with hypertonia of both upper and lower limbs. She was evaluated with MRI Spine which showed a dumb bell-shaped extramedullary lesion involving the C5-C6 vertebra with significant cord compression and encasement of the left vertebral artery. USG neck showed left supraclavicular lymph node enlargement and small residual thyroid tissue in the left side of the thyroid. USG guided FNAC from the thyroid tissue and neck nodes were inconclusive. The patient underwent C4 and C5 laminectomy and subtotal excision from the cervical lesion. Histopathology was reported as metastasis from follicular carcinoma thyroid. Postoperatively patient limb power improved to grade 3 left upper and lower limbs and was discharged and later referred for radioiodine ablation</span></p> <p><strong><span data-preserver-spaces="true">Conclusion</span></strong><span data-preserver-spaces="true">. Cervical extradural metastasis from follicular carcinoma thyroid can present with Elsberg syndrome even without any neck swelling even after decades of post thyroidectomy status for a benign aetiology. Laminectomy and decompression may lead to clinical improvement.</span></p> Vijayan Pettakandy Shanavas Cholakkal Subrat Kumar Soren Harikrishnan S. Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 557 560 Surgical options for traumatic fractures of the thoracic and lumbar spine <p><strong><span data-preserver-spaces="true">Background context.</span></strong><span data-preserver-spaces="true"> Thoracolumbar fractures represent a large number of spine injuries in adults. Such fractures are a result of traumatic accidents with high-energy impacts, such as falls from height or following motor vehicle accidents, often resulting in some degree of neurological deficit.</span></p> <p><strong><span data-preserver-spaces="true">Purpose. </span></strong><span data-preserver-spaces="true">To report a total of 20 cases of thoracolumbar fractures in young adults with various neurological manifestations. The majority had indications for transpedicular fixation. </span></p> <p><strong><span data-preserver-spaces="true">Study Design.</span></strong><span data-preserver-spaces="true"> Series of 20 cases and review of the literature. </span></p> <p><strong><span data-preserver-spaces="true">Patient Sample.</span></strong><span data-preserver-spaces="true"> A series of 20 patients with a history of falling from a height or after motor vehicle accidents (RTA) with complicated fractures at the level of the thoracolumbar vertebrae which present with neurological deficits. </span></p> <p><strong><span data-preserver-spaces="true">Methods.</span></strong><span data-preserver-spaces="true"> We report here on a total of 20 patients with a history of falls from height or following RTA. Patients presented to the hospital complaining of back and abdominal pain. Fractures at the thoracolumbar vertebral level were confirmed with imaging studies revealing post-traumatic spinal deformities. All cases were initially considered for conservative medical treatment. However, unstable complicated cases with bone fragment migration as well as spinal canal compression were deemed candidates for surgical intervention via posterior spinal fusion with transpedicular screw fixation.</span></p> <p><span data-preserver-spaces="true">Written informed consent was gathered from all patients. Detailed history, clinical examination, as well as X-ray, computed tomography and magnetic resonance imaging of the dorsolumbar spine were obtained in all cases. Neurological status was assessed using the Frankel grading for spinal cord injury. </span></p> <p><strong><span data-preserver-spaces="true">Results.</span></strong><span data-preserver-spaces="true"> The patients tolerated the operations without complications and remained in stable postoperative condition. </span></p> <p><strong><span data-preserver-spaces="true">Conclusion.</span></strong><span data-preserver-spaces="true"> Surgical treatments via transpedicular fixation are extremely efficient for treating unstable and complicated thoracolumbar spinal fractures. Nevertheless, conservative medical treatment is still of high value and should be considered as the first treatment option, especially in stable cases. The patients who underwent surgery showed excellent outcomes and improvement of neurological deficits. The surgical procedure preferred in the present study was the posterior spinal fusion with pedicle screw fixation. </span></p> Elhawary E. Mohamed Ghaith S. Aljboor P. Armand Buzantian Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 561 569 Intradural migration of bullet in vertebra corpus after meningitis <p>In a gunshot injury, the spinal cord of the thoracic region is usually the most affected and damaged part of the body. In most cases, the bullet cannot be removed without causing more damage to the injury. Over time, the bullet tends to travel in different areas of the body. Moreover, cases on bullet movements in the spinal canal were reported in the literature. In this study, we reviewed the diagnosis and treatment of a 27-year-old male patient with a bullet detected in his vertebra corpus, which is caused by a gunshot injury. During the follow-up period, an intradural migration of the bullet from the vertebra corpus was observed. Furthermore, we performed surgery to prevent any future neural damage. In this study, we focused on a case with a gunshot injury, presenting an intradural migration of a bullet from the vertebra corpus after meningitis.</p> Halil İbrahim Gündüz Turan Kandemir Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 570 573 Global neurosurgery, Bangladesh and COVID-19 era <p><strong>Background.</strong> COVID-19 has become an alarming pandemic for our earth. It has created panic not only in China but also in developing countries like Bangladesh. Bangladesh has adequate confinements to constrain the spread of the infection and in this circumstance, overall healthcare workers including neurosurgeons are confronting a ton of difficulties. The purpose of this paper is to depict the proficiency of Global neurosurgery in this COVID-19 time.</p> <p><strong>Method.</strong> Global neurosurgery offers the chance of fusing the best proof-based guidelines of care. This paper demonstrated that, in low to middle-income countries, Global medical procedure has been received to address the issues of residents who lack critical surgical care.</p> <p><strong>Results.</strong> Inappropriate and insufficient asset allotment has been a significant obstacle for the health system for decently giving security to the patients. The fundamental training process has been genuinely hampered in the current circumstance. Worldwide health activities have set to an alternate centre and Global neurosurgery as an assurance is slowed down.</p> <p><strong>Conclusion. </strong>This paper recommended that Global neurosurgical activities need to come forward and increase the workforce to emphasize surgical service.</p> Robert Ahmed Khan Moshiur Rahman Amit Agrawal Ezequiel Garcia-Ballestas Luis Rafael Moscote-Salazar Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 574 576 Giant dorsal sacral meningocele in a child <p>Sacral meningoceles are uncommon congenital lesions, usually described in the anterior or lateral position, and they typically are asymptomatic [1,7]. A nine-years male child presented with a progressively increasing swelling over the lumbosacral region since birth.</p> Amit Agrawal Copyright (c) 2020 Romanian Neurosurgery 2020-12-16 2020-12-16 577 579