Romanian Neurosurgery 2019-10-20T08:01:32+00:00 Dr Stefan Mircea Iencean Open Journal Systems <p>Call for Papers -&nbsp;Vol. XXXIII, No. 4 (December 2019)<br>Submission Deadline: November 1, 2019&nbsp;</p> 150 years since the birth of Harvey Williams Cushing 2019-10-20T08:01:32+00:00 H. Ples H. Berceanu <p>&nbsp; &nbsp;</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Anatomical localization of intracranial grade II meningiomas in North-Eastern Romania 2019-10-20T08:01:31+00:00 A. I. Cucu Claudia Florida Costea Mihaela Dana Turliuc Cristina Mihaela Ghiciuc B. Costachescu Roxana Popescu Gabriela Florenta Dumitrescu Anca Sava Daniela Maria Tanase R. Arbore-Sorete I. Poeata <p><strong>Objective</strong>.&nbsp;Our research aims to assess a possible connection between tumour localization and histological subtypes of grade II meningiomas.</p> <p><strong>Material and methods</strong>. 143 patients with grade II WHO meningiomas underwent surgical resection in "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iași between 1990 and 2015. The collected data included: patient age, gender, tumour localization and histopathological diagnosis (atypical, clear cells and chordoid meningioma).</p> <p><strong>Results</strong>. 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.</p> <p><strong>Conclusions</strong>. 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.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Syringobulbia and syringomyelia in a case with Chiari 0 malformation successfully treated by posterior fossa reconstruction 2019-10-20T08:01:31+00:00 R. B. Sandu M. I. Pantiru M. Cosman I. Poeata <p>“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.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Learning curve in rat dissection for experimental sciatic nerve repair 2019-10-20T08:01:30+00:00 Marin Andrei Marin Georgiana Gabriela Dobrete Nicoleta Amalia Enescu Dan Mircea <p>The baseline for any key research in nerve regeneration is an experimental model and the sciatic nerve in the rat model is the workhorse in this field. Although physically resistant to external traumas, a surgical intervention constitutes a major distress even for a rat. In the following presentation, we will analyse the learning curves for different stages in the rat sciatic nerve surgery as well as possible factors which influence these times.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Neurosurgery in the elderly patient 2019-10-20T08:01:30+00:00 Gabriel Iacob <p><strong>Objective</strong>.&nbsp;For government officials and health providers, elderly population - aged 65 and over, especially neurosurgical patient, represent a larger concern, an increasing problem not only for socio-economic reasons related to the medical act, but also for additional care requirements which should be done by the family and society, including rehabilitation facilities, occupational &amp; physical therapy, speech therapists, visiting nurses, to insure an effective recuperation after hospital discharge. A retrospective study with 325 "elderly" patients cohort, aged 65 and over, admitted in the Neurosurgery Department undergoing common neurosurgical procedures, in the last five years offer an evaluation for neurosurgical procedures, outcomes, comorbidities, anaesthetic and analgesic requirements, outcome.</p> <p><strong>Material and method</strong>. This study was performed on patients aged 65 years or older, with neurosurgical diseases, admitted to the Neurosurgery or the Intensive Care Unit of our hospital, between 2014-2019. An analysis was made on variables such as age, pathology, comorbidities, length of hospital stay especially in the ICU unit, type of cranio-cerebral or spinal procedures performed, anaesthesia protocols, complications, performance status, re-admissions and mortality.</p> <p><strong>Results</strong>. Patients age were divided into three categories: between 65-70 years old there were 152 patients (46,76%), between 70-85 years old 93 patients (28.61%) and over 85 years old 80 patients (24,61%). 173 patients were females (53,23%), 152 were males (46.76 %). The admission Glasgow Coma Scale (GCS) score to those over 85 years old was between 3-12 in 29 cases (8.02%) with early death in 13 patients. Several comorbidities were noticed in 294 patients (90.15%): cardiac, pulmonary, hematologic especially coumarinic overdose, hepatic and renal failures, psychiatric illnesses, concomitant systemic disease or immunosuppressed patients by decompensated diabetes, primitive cancers affecting various organs, infectious diseases, also severe osteoporosis, chronic ethylic intoxication, limiting surgical attitude, also obtaining the informed consent for surgery. There were 154 (47,38%) patients with cerebral pathology and 171 (52,61%) patients with spinal pathology. Most common surgical procedures performed were: craniotomies for tumours and hematoma removal, minimal invasive procedures for spine, endovascular and vertebroplasty. The median length of stay for emergency patients was significantly longer than that of elective patients (13 vs. 8 days). For 215 (66.15%) patients general anaesthesia was performed, local anaesthesia in 97 (29.84%) patients, 13 patients (4%) were not operated. Good quality of life results appreciated by patients and relatives were recorded in 236 cases (72.61%) in the first and second category; less better results to those over 85 years old; same symptoms especially pain 63 patients (19.38%), complications to 47 patients (14,46%) especially cardiac, renal and&nbsp;respiratory failures, also motor deficits, seizures, CSF fistula, mortality in 26 cases (8%), re-admissions in 45 cases (13.84%) less than 1 month after discharge.</p> <p><strong>Conclusions</strong>. Old prejudices that old age is a contraindication for surgery have to be removed. Clinical and surgical decisions for neurosurgical procedures in the elderly are decisive for limiting reported morbidity and mortality rates. For life quality, realistic family and society expectations, several aspects should be considered for safe and effective results: careful patient selection on patient status, comorbidities and physiological reserve; neurosurgical pathology, urgency of the surgical procedure, the strategy of neurosurgical management based on advances in imaging and interventional radiology, minimal invasive neurosurgical procedures with significant preoperative and postoperative care. Good results could be obtained even in elderly people for chronic subdural hematoma, simple brain or spinal tumour, good grade aneurysm, trigeminal pain, vertebroplasty in spinal vertebral fractures, etc.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## “The Silk Road” via subarachnoid cisterns 2019-10-20T08:01:29+00:00 A. I. Cucu Mihaela Dana Turliuc Claudia Florida Costea B. Costăchescu Cristina Mihaela Ghiciuc B. Dobrovăț Camelia Margareta Bogdănici Daniela Maria Tănase Gabriela Florența Dumitrescu Anca Sava I. Poeată <p>Meningiomas are generally slow-growing extra-axial benign tumours and in rare cases they can metastasize both neural and extra-neural. Intracranial meningiomas with leptomeningeal dissemination are extremely rare and the exact pathogenesis still remains unknown. The aim of this review is to analyse the pathways of intracranial and spinal metastatic spread of intracranial meningiomas and to discuss their particular clinical and pathological features. We highlight the fact that there is a possibility of leptomeningeal dissemination, even if cerebrospinal fluid cytology is negative, in patients with a medical history of a resected meningioma. We identified three possible ways of dissemination: haematogenous, through the CSF, or during surgery. From a histopathological point of view, the more malignant the meningioma, the more likely its leptomeningeal dissemination.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## A rare case of metastatic esthesioneuroblastoma 2019-10-20T08:01:28+00:00 Emilia Marciuc M. Barcan S. Popa B. I. Dobrovăț R. M. Popescu R. Buga D. Haba <p>Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a rare malignant tumour of the basal layer of the olfactory epithelium, which originally develops unilaterally, accounting for 3-6% of all intranasal tumours. We present the case of a patient with a voluminous ethmoidal lesion that invaded the left basal frontal lobe and left orbit. The biopsy revealed a stage C KADISH, grade III neuroblastoma. The patient followed a multimodal treatment with chemotherapy and radiation therapy to which he responded partially, then returned after 11 months for sphincter disorder and bilateral sciatic type pain. An MRI showed metastasis of the filum terminale, the anatomopathological exam identifying also neuroblastoma. CT and MRI imaging are required for a correct assessment of the regional extension of olfactory neuroblastoma, response to oncological treatment but also for the detection of secondary lesions found in a small number of cases.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Idiopathic normal pressure hydrocephalus 2019-10-20T08:01:28+00:00 D. Adam D. Iftimie Cristiana Moisescu <p>Idiopathic normal pressure hydrocephalus (INPH) is a neurodegenerative disease which affects the elderly, with a significant prevalence in the general population (0,2% - 5,9%), thus a common pathology encountered by neurologists and neurosurgeons, alike. Although the widespread availability of modern imaging techniques has facilitated the diagnosis of this disorder, the clinical manifestations can often be misleading. Also, an overlap with other degenerative or psychiatric diseases can make the differential diagnosis even more challenging. Cerebrospinal fluid (CSF) diversion procedures are the first line of treatment for INPH. Nowadays, there are several shunting options available, including: ventriculoperitoneal (the most commonly used), ventriculoatrial, ventriculopleural, ventriculosternal, lumboperitoneal, endoscopic third ventriculostomy. Choosing a procedure tailored to the individual patient is essential for therapeutic success. Although they are generally straightforward surgical interventions, they associate a high rate of failure, regardless of procedure used, which emphasizes the need for regular clinical and imagistic follow-up. Thus, INPH remains a disease where there is significant room for improvement, both in diagnosis and treatment.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## 3D patient specific implants for cranioplasty 2019-10-20T08:01:27+00:00 A. Ladaru H. Moisa A. V. Ciurea <p>This article presents a multi-centre study cohort study on 50 patients with cranial defects of multiple etiologies (trauma, decompression, tumour surgery, etc.) operated in 10 hospitals. In all patients the neurosurgeon repaired the cranial defect using 3D printed and CNC milling and drilling grafts or Patient Specific Implants, from two world known manufacturers, custom made in accordance with the data obtained from the patient’s 3D CT reconstruction.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Our experience with a single stage bilateral approach for treatment of bilateral middle cerebral artery aneurysms 2019-10-20T08:01:27+00:00 A. Chiriac Georgiana Ion Z. Faiyad I. Poeata <p>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.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Primary central nervous system sarcomas 2019-10-20T08:01:26+00:00 Wael K. Zakaria Ahmed N. Taha Mohamed State <p><strong>Objective</strong>: Primary CNS sarcomas are very rare tumours with no defined standard of care.</p> <p><strong>Patients and methods</strong>: This study was a retrospective review of seven patients diagnosed with a primary CNS sarcoma at neurosurgery department, Mansoura university hospital between 2006 and 2018. We reviewed the clinical, radiological, and pathological data of these patients. There were 2 female (28.6%) and 5 male (71.4%) with age ranged from 8 years to 73 years (mean age 25.4 years). Three patients (42.9%) had an intracranial sarcoma, and four (57.1%) had intraspinal tumours. All intracranial tumours located in supratentorial region.</p> <p><strong>Results</strong>: we have characteristic imaging findings inform of osteolytic bony erosion in 3 patients and marked enhancement of the tumour in 5 (71.4%) patients. We operated upon all patients to remove the tumour surgically with our aim is gross tumour resection. Tumour was totally resected in 5 patients (71.4%) and subtotal in another 2 patients (28.6%). Tumour has dural attachment in 5 cases (71.4%) and brain invasion was present in all intracranial 3 patients (42.9%). Postoperative radiotherapy was used in 5 patients and postoperative chemotherapy was used in all patients. We used immunohistochemical studies for all patients with the most consistent finding being strong Desmin positivity. The mean length of patients survival was 4.6 years (range from 3 month to 8 years).</p> <p><strong>Conclusions</strong>: Primary CNS sarcomas are very rare CNS tumours, total surgical resection and post-operative radio and chemotherapy provided encouraging outcomes.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Tentorial dural arteriovenous fistulae presenting as transient ischemic attack 2019-10-20T08:01:25+00:00 Marco Zenteno Mohamed M. Arnaout Angel Lee Amit Agrawal Mohammed Maan AbdulAzeez Hayder Ali Al-Saadi Osama M. Al-Awadi Samer S. Hoz Luis Rafael Moscote-Salazar <p>Dural arteriovenous fistulae are vascular lesions of the dura mater, usually acquired, consisting of abnormal connections between the dural arteries with the venous sinuses or the cortical veins. A case report presents a case with an unusual form of presentation of the dural (tentorial) arterio-venous fistula simulating a transient ischemic attack in a 60-year-old male patient.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Quality and reliability of information available on YouTube videos pertaining to transforaminal lumbar epidural steroid injections 2019-10-20T08:01:25+00:00 Aysel Gürcan Atci Ibrahim Burak Atci <p><strong>Background</strong>. This study analyses the transforaminal lumbar steroid injection videos that have the highest views and likes on YouTube, and attempts to reveal the video qualities in order to contribute to the literature.</p> <p><strong>Methods</strong>. For review, “transforaminal lumbar steroid injection” was written to the standard YouTube search bar, and the videos with the highest views were ranked using advanced search preferences. The 50 most widely viewed videos were watched and scored by 2 physicians.</p> <p><strong>Results</strong>. The mean Modified DISCERN Score of the videos was 2,66+/-1,032 (the lowest: 1; the highest: 4) while the mean GQS score was 2,876+/-1,06 (the lowest: 1; the highest:4). In addition, the mean DISCERN score and the mean GQS value were 3,51 and 3,82, respectively, for the informational videos that were uploaded by health professionals but did not contain actual surgery.</p> <p><strong>Conclusion</strong>. We think that medical associations and state authorities in medicine should check the validity and accuracy of the information on the internet and should support the society in access to the most correct information.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Spontaneous cerebrospinal fluid rhinorrhea in a patient with Pallister–Hall syndrome 2019-10-20T08:01:24+00:00 Milicevic Mihajlo Aleksic Vuk Ilic Rosanda Scepanovic Vuk Stanimirovic Aleksandar Paunovic Aleksandra Milic Marina Nedeljkovic Zarko Matteo Sacco Grujicic Danica <p>Pallister-Hall syndrome (PHS) is extremely rare autosomal dominant disorder with typical clinical features such as presence of polydactyly, hypothalamic hamartoma, bifid epiglottis, anal, renal, genitourinary and pulmonary abnormalities, mainly located in the midline of the body. Spontaneous cerebrospinal fluid (CSF) rhinorrhea is also a rare condition, and it is used to describe nasal discharge of CSF unrelated to previous trauma, localized tumour, surgery, or previous radiation therapy. The exact cause is not yet fully understood.</p> <p>We report a case of adult female patient previously diagnosed with PHS and late onset of spontaneous nasal liquorrhea, due to defect in the anterior skull base. Although it can be incidental finding, we believe that described defect in the body midline can be another presentation of congenital craniofacial abnormality which are common in PHS.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Bilateral traumatic basal ganglia haemorrhage, a rare entity 2019-10-20T08:01:24+00:00 Vibhu Shankar Parashar Vivek Kumar Kankane Gaurav Jaiswal Tarun Kumar Gupta <p><strong>Aims</strong>. Traumatic basal ganglia haemorrhage is rare entity but post traumatic bilateral basal ganglia hematoma is even extremely rare and was earlier presented as case reports. Its incidence is about 3% after a closed head injury however, the incidence is higher in post mortem studies.</p> <p><strong>Material &amp; Methods</strong>. Out of 1485 head injury patients admitted to our institute from January 2012 to January 2019, there were 9 cases of traumatic bilateral basal ganglia haemorrhage. The incidence of traumatic bilateral basal ganglia Haemorrhage in our series is 0.61% which is very less compared to previous literature.</p> <p><strong>Results</strong>. There were 6 males and 3 females; age ranging from 19 to 50 years (average 32 years). Patients with hypertension, history of drugs abuse, history of coagulopathy, with doubtful history of trauma or unknown mode of injury were excluded from the study. The mode of injury in all the patients was road traffic accidents. Average follow up was 9.54 months. Outcome was assessed by Glasgow outcome Score. In 8 out of 9 patients, outcome was good. One patient died. All the nine cases were managed conservatively.</p> <p><strong>Conclusion</strong>. We report nine cases from a single institute which to the best of our knowledge is the largest series in world literature. Prognosis is variable and dependent on many factors. The prognosis of TBGH is favourable if not associated with other disorders like hypertension, diabetes mellitus, and coagulation disorders or diffuse axonal injury.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Risk factors for preoperative and postoperative late seizure in supratentorial meningiomas 2019-10-20T08:01:23+00:00 Rahsan Kemerdere Mehmet Yigit Akgun Orkhan Alizada Sureyya Toklu Burak Tahmazoglu Taner Tanriverdi <p><strong>Introduction</strong>. Seizure following meningioma surgery is common and management may be challenging. Identifying risk factors may help physicians to initiate optimal medical management. The aim of this study is to report seizure outcome and risk factors for perioperative seizure.</p> <p><strong>Materials and Methods</strong>.&nbsp;Sixty-three adult patients who underwent supratentorial meningioma resection were included, and perioperative data and long-term follow-up were provided in this retrospective study. Binary logistic regression analysis was used to identify the risk factors for perioperative seizure and postoperative late seizure.</p> <p><strong>Results</strong>.&nbsp;The results showed that 20 (37.1 %) patients had preoperative seizure and 10 (50 %) patients were seizure free at the long-term follow-up. Absence of headache was associated with preoperative seizure (p=0.002) while presence of early seizure was significant predictor for postoperative late seizure (p=0.03). Although not significant, occurrence of surgical complications (p=0.08) and non-skull base location (p=0.06) tended toward being a significant risk factor for postoperative late seizure.</p> <p><strong>Conclusion</strong>.&nbsp;Presence of early seizures, surgical complications and locations out of skull base may direct postoperative anti-epileptic treatment to decrease seizure incidence which, indeed, increases quality of life for patients with meningioma.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## A case report of retrograde suction decompression of a large paraclinoid aneurysm 2019-10-20T08:01:23+00:00 Ahmed Mohamed Khalil Yashuhiro Yamada Katsumi Takizawa Yoko Kato Ahmed Ansari <p>Surgical clipping of large Paraclinoidal IC (Internal carotid) aneurysm pose a great challenge as there are adhesions hindering exposure of aneurysm dome and parent artery . Obtaining adequate visualization of the aneurysm neck is very difficult in these aneurysms, also in the access of proximal control. There are many methods to obtain a proximal control in these aneurysms. Retrograde suction decompression provides adequate visualization of the aneurysm neck and its relation with the optic apparatus. Retrograde suction decompression can be done by many methods. The technique done via open catheterization of superior thyroid artery is readily accessible and provides adequate relaxation of the aneurysm dome enabling complete dissection of the aneurysm from the surrounding important neurovascular structures. In this report of a case of left Paraclinoidal ICA aneurysm which was clipped applying this method, we elaborate on the technique and discuss other methods available for proximal control in these difficult aneurysms.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Spinal epidural angiolipoma causing spinal cord compression 2019-10-20T08:01:22+00:00 A. Khelifa I. Assoumane S. Bachir L. Berchiche A. Morsli <p><strong>Background</strong>.&nbsp;Spinal angiolipoma (SAL) is a rare tumour with double component mature adipose tissue and proliferating abnormal blood vessels, which result in spinal cord compression requiring an urgent surgical removal. We report a case of woman with spinal angiolipoma.</p> <p><strong>Case presentation</strong>. The patient is a 26 years old woman with past medical history of a low grade urothelial bladder carcinoma removed 4 months before she consults at our department, 2 months later the patient presented a lower limbs weakness. The clinical exam at the admission found a patient with paraparesis, hypoesthesia at the level of Th4 and urinary urgency. The spinal MRI objectified a spinal cord compression by a lesion located at the epidural space from Th2 to Th4. The patient was operated and a fatty well vascularized tumour distinct from the epidural fat was removed through a Th2 to Th4 laminectomy. The pathology study was in favour of an angiolipoma. Days after the operation the patient recovered totally, the weakness and the urinary urgency disappeared. The patient is flowed since 24 months she got pregnant.</p> <p><strong>Conclusion</strong>. Spinal angiolipoma is a rare tumour with a clinic of spinal cord compression, MRI is the gold standard in diagnosis it shows a fatty lesion with a large enhancement, surgery is the perfect treatment with good outcome and exceptional recurrence.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Overview of neurosurgical capacity in St. Lucia 2019-10-20T08:01:21+00:00 Emil Zhalmukhamedov Christopher Magloire E. Maidyrov Aleric Soans Latisha Elijio Nikita Nossov Shameea Mahbub <p>When we talk about the most scenic Caribbean islands, St. Lucia is one of those islands that certainly come into our mind. It is a beautiful tourist destination and the place of post-volcanic paradise on earth. However, just like many remote Caribbean islands, St. Lucians (name for local population) used to have its own difficulties of obtaining on demand basic neurosurgical services in their homeland. This beautiful Caribbean island, socioeconomically falls in the same category as most low-and middle-income countries (LMICs) and unfortunately echoes the same unmet surgical and anaesthesia needs as the rest of them.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Ewing’s sarcoma of the mobile spine 2019-10-20T08:01:21+00:00 A. Khelifa I. Assoumane S. Bachir L. Berchiche N. Benmedakhene T. Bennafaa A. Morsli <p><strong>Background</strong>. Ewing’s sarcoma is a bony highly malignant tumour, it occurs most frequently in the second decade of life. Ewing’s sarcoma is a rare affection, located usually in the pelvis, the femur, the humerus, the ribs, the mandible and clavicle, other location are rare especially in the spine. We report three cases of spinal Ewing’s sarcoma, two primary spine locations and one on young adult with unusual clinical presentation.</p> <p><strong>Cases presentation</strong></p> <p><strong>Case 1</strong>. The first patient is a girl of 14 years old without past medical history. She presented initially two months before consultation a neck pain followed days after by a weakness of the left upper limb; the spine imaging performed objectified a destructive process of C2 with a spinal cord compression. The patient was operated beneficiating of a spinal cord decompression and a subtotal removal of the tumour. The pathologist’s results were in favour of Ewing’s sarcoma and the patient was oriented to oncology.</p> <p><strong>Case 2</strong>. The second patient is a man of 31 years old operated five years before he consulted for shoulder Ewing’s sarcoma followed by chemotherapy and radiotherapy, he presented two months before consultation a cauda equina syndrome. Spine MRI objectified a double location of an epidural tumour at T3-T4 and S1-S2 levels. The patient was operated beneficiating of subtotal removal of the tumour. The laboratory exam results were in favour of Ewing’s sarcoma and the patient was oriented to oncology.</p> <p><strong>Case 3</strong>. The third patient is a 6 years old boy who presented a 1 month history of low back pain followed by a rapidly deteriorating weakness of both lower limbs over a weak. On examination there was bilateral spastic paraplegia, hypoesthesia below the level of Th10 and a urinary retention. The MRI imaging revealed a lesion on the levels Th8, Th9 and Th10 vertebras involving the body, pedicle, lamina, and the transverse process on the left side with an epidural invasion compressing the spinal cord. The tumour was radically removed. Pathology report was in favour of Ewing’s sarcoma. Two weeks after surgery the patient was able to walk. He was referred for adjuvant systemic chemotherapy.</p> <p><strong>Conclusion</strong>. Ewing’s sarcoma is rare malignant tumour. The location in the spine exposes the patient to more complications because of the neurostructures compression. The surgical total removal followed by radio and chemotherapy is the only option with the best prognostic and guaranties an acceptable life quality.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement## Supratentorial hemangioblastoma without von Hippel-Lindau syndrome in an adult 2019-10-20T08:01:20+00:00 Oguz Baran Omur Kasimcan Aydin Sav Hakan Oruckaptan4 <p>Hemangioblastomas (HBLs) are highly vascular and cystic benign neoplasms. They form very small part of intracranial tumours and are often localized in the posterior fossa. Although most of them are sporadic, a significant group is accompanied with von Hippel-Lindau (VHL) syndrome.</p> <p>This case report presents a 57-year-old woman treated with total resection using micro-surgical technique and was diagnosed as HBL based on histopathologic findings. Contrast-enhanced cranial MRI of the patient with the complaints of spasms in the right side of body showed a right paracentral mass that caused midline shift.</p> <p>In literature, the previously reported cases of supratentorial HBL unaccompanied with VHL syndrome were searched in PUBMED, compiled and presented. It should be borne in mind that rare HBLs manifesting with various neurological symptoms may occur in the supratentorial region, and may not accompany with VHL syndrome.</p> 2019-09-02T00:00:00+00:00 ##submission.copyrightStatement##