Romanian Neurosurgery 2020-01-21T19:01:33+00:00 Dr Stefan Mircea Iencean Open Journal Systems <p>Call for Papers -&nbsp;Vol. XXXIV, No. 1 (March 2020)<br>Submission Deadline: February 1, 2020</p> A neurosurgical challenge: awake mapping in „critical” language area tumours 2020-01-20T09:09:37+00:00 Mihaela Cosman Ionut Mihail Pantiru Bogdan Florin Iliescu Nina Straticiuc Iulia Aldea Vlad Buraga Gabriela Florenta Dumitrecu Ion Poeata <p><strong>Introduction</strong>. 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.</p> <p><strong>Materials and methods</strong>. 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.</p> <p><strong>Results</strong>. 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.</p> <p><strong>Conclusion</strong>. 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&nbsp;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.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Cardiac dysfunction evoked by ECG and echocardiography changes and release of cardiac biomarkers in patients with aneurysmal subarachnoid haemorrhage. 2020-01-20T09:09:37+00:00 Raluca Ungureanu Mihai Dumitru Gabriel Iacob <p>The invisible brain-heart link has been observed and described for centuries now, although a greater interest in the matter has been manifested over the past several decades, especially in patients with aneurysmal subarachnoid haemorrhage (aSAH). We present the case of a patient with aSAH and signs of cardiac injury evoked by ECG changes and elevated cardiac enzymes. Furthermore, we reviewed current medical literature by searching the international database PubMed for recent articles on the subject of cardiac biomarkers, ECG and echocardiography changes in the setting of SAH. Our analysis of the selected articles, published between 2012 and 2018, revealed that 22 are patient population studies, 16 are case studies and 6 are reviews of the literature. The most common ECG changes were prolonged QTc andnonspecific ST/T-wave changes. Echocardiography changes included regional wall-motion abnormalities, typically involving the base of the heart (neurogenic stunned myocardium), yet there was also the scenario of Takotsubo cardiomyopathy (stress cardiomyopathy), which affects the apex of the heart. There is a significant statistical association of elevated levels of troponin and NT-proBNP with a bad outcome after SAH, and we should always keep in mind the dramatic scenario of misdiagnosing the cerebral haemorrhage and treating for a coronary syndrome instead. Therefore, the management of aSAH requires a close cooperation between neurosurgeons, intensivists, cardiologists and radiologists in high volume centres.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Finite element method to study cervical postoperative stability 2020-01-20T09:09:36+00:00 Andrei St. Iencean Stefan C. Castravete Ion Poeata <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Extradural autologous temporal muscle graft mimicking a meningioma 2020-01-20T09:09:36+00:00 Mihaela Dana Turliuc Claudia Florida Costea Irina Elena Balan B. Costachescu B. Dobrovat S. Turliuc Cristina Mihaela Ghiciuc R. Arbore-Sorete V. Hartie F. Sima A. I. Cucu <p>Meningiomas are the most common dural tumour, but there are also many other dural masses which mimic their appearances, such as neoplastic and non-neoplastic lesions. In this paper we report another mass which may mimic a dural lesion, namely a muscle graft harvested from the temporal site and left in situ, used to achieve haemostasis in a posttraumatic temporal extradural hematoma in a young male patient. Solid knowledge of differentiating neuroimaging characteristics of dural masses, as well as its corroboration with the patient’s medical history are extremely helpful in establishing an accurate diagnostic.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Secondary giant cell glioblastoma in a multiple drug abuser - simple association or ethiopathogenic correlation? 2020-01-20T09:09:35+00:00 L. Eva M. S. Ples M. R. Munteanu Gabriela Florenta Dumitrescu Nicoleta Dumitrescu Horia Ples <p>Experimental investigations have shown that drug abuse initiates a cascade of pathophysiological events including toxic and hypoxic-ischemic injury on neurons, microglia and astrocytes, which finally lead to widespread disturbances in the brain. There are many reports about the psychiatric and neurologic effects of multiple drug abuse, but only a few clinical studies reporting possible correlation between recreational illicit drugs and gliomas.</p> <p>In this paper we present the case of a 40 years-old male patient, with a long history (almost ten years) of multiple drug abuse, including cocaine, heroin, marijuana, ethnobotanical drugs and nicotine, who was diagnosed and surgically treated for a supratentorial secondary giant cell glioblastoma (sgcGB) developed in a diffuse astrocytoma NOS. Depending on the type of the illicit drug used by the patient and the moment of life he used them, the morphological features identified in the histological samples of our patient confirmed the gliomagenesis effect of chronic multiple drug abuse, but also its inhibitory effects on tumour cells growth. This was due to the fact that although the tumour was large in size and caused brain sub-falcine herniation, the patient reported the onset of seizures only late in the evolution.</p> <p>In conclusion, the diagnosis of a brain tumour should take into consideration not only patient's clinical and imaging data, but also his lifestyle, especially his addiction to recreational drugs.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Pitfalls and problems encountered in rat model sciatic nerve surgery 2020-01-20T09:09:34+00:00 Marin Andrei Mihai Ruxandra Ioana Marin Georgiana Gabriela <p>When learning the basics of microsurgery, a trainee must be equipped with patience and perseverance in order to evolve. One must have the ground knowledge when it comes to peripheral nerve injury and nerve regeneration process in order to fully understand that the technique is vital for the outcome and final results. Furthermore, a trainee must practice on non-living tissue before performing successful in vivo operations and even in this case, one may be confronted with problems regarding the surgical technique. [1] The following article aims to reveal the main problems/mistakes when performing sciatic nerve surgery in an in vivo experimental model and the solutions for these problems.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Gamma Knife radiosurgery: effect on corticotropin-secreting pituitary adenoma 2020-01-20T09:09:34+00:00 Dan Nicolae Paduraru Raluca Ciunt Andra Morar Laura Maria Dragomir Carla Scânteie Alexandra Bolocan Octavian Andronic Cristina Ghervan Bogdan Socea Mara Carsote Ana Valea <p><strong>Introduction: </strong>Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures.</p> <p><strong>Case presentation: </strong>A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant.</p> <p><strong>Conclusions: </strong>Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Preliminary study of thrombogenicity induced by the nanoparticle surface coating of intracranial stents 2020-01-20T09:09:23+00:00 A. Chiriac Georgiana Ion G. Stan T. Popescu Mihaela Sofronie I. Poeata <p>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).</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Nonsteroidal anti-inflammatory drugs-induced hypersensitivity reactions 2020-01-20T09:09:33+00:00 Andrei Gheorghe Vicovan Liliana Veres Andrei Cucu Dana Turliuc Cristina Mihaela Ghiciuc <p>The role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in neurosurgical practice is a secondary one, however they are still constantly involved in perioperative management of pain or in nonoperative management of acute radiculopathy. Beside the well-known adverse reactions (ADRs), the neurosurgeon practitioner should also take in account the drug hypersensitivity reactions (DHRs) of NSAIDs and be able to deal with it. The aim of this paper was to review the diagnostic and management steps for NSAIDs-induced Hypersensitivity Reactions. The actual stratification of NSAIDs-induced Hypersensitivity Reactions is based on understanding of the heterogeneity of immunological/non-immunological mechanisms of reactions and complexity of clinical manifestations. Practically, this stratification allows the physician to assess suspicion of DHR, based on anamnesis and clinical analysis, and to consider further practical steps to manage and eventually confirm the diagnosis. Drug allergies are considered only the DHRs for which a definite immunological mechanism (either drug-specific antibody or T cell) is demonstrated. In conclusion, clinical analysis and anamnesis of patient with NSAIDs-induced Hypersensitivity Reactions can be realized by any physician and could be enough to diagnose, but it is not sufficient to confirm the diagnosis. In vitro tests and oral provocation challenges may be necessary to be undertaken by an allergy specialist.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Current applications of 3d printing in neurosurgery 2020-01-20T09:09:22+00:00 A. Chiriac A. Iencean Georgiana Ion G. Stan S. Munteanu I. Poeata <p>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.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## The supraorbital keyhole approach for clipping of anterior circulation ruptured aneurysms 2020-01-20T09:09:33+00:00 Mostafa M. Nabeeh Ashraf A. Ezz-El Din <p><strong>Introduction</strong>. The supraorbital approach has been demonstrated to be useful, particularly in minimization of brain retraction and exposure to air, decreases blood loss, surgical trauma, operative time and infection rates. While its shortcomings include&nbsp;&nbsp; difficult control of frontal air sinus, narrower surgical view and limited exposure of sylvian fissure.</p> <p><strong>Patients and methods</strong>. We retrospectively reviewed the files of patients who underwent clipping of anterior circulation aneurysms through the supraorbital keyhole approach at Neurosurgery Department, Mansoura University between Jan 2014 and May 2016.</p> <p><strong>Results</strong>. Twenty-five consecutive patients harbouring aneurysm at anterior circulation underwent clipping through the supraorbital keyhole approach, sixteen A-com artery aneurysms and nine cases of ICA aneurysms Table 1 show the location of aneurysms. Eleven patients were males, and 14 were females. The ages ranged from 44 to 69 with a mean age of 61.9 years. All patients were presented with subarachnoid haemorrhage due to rupture of aneurysms in anterior circulation The Hunt and Hess grade was (1.50 ± 0.65) and Fisher grade was (1.67 ± 0.45). The average operative time was 3.32 ± 1.14 hours. Follow-up ranged from 1 to 16 months with a mean of 7 months</p> <p><strong>Conclusion</strong>. Surgical clipping of some selected aneurysms of anterior circulation can be operated through minimally invasive supraorbital approach which minimize the dissection and retraction of the brain, reduce operative time and blood loss with small incision and good cosmetic results.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Adeloye-Odeku Disease in Irrua, South-South Nigeria 2020-01-20T09:09:32+00:00 E. Morgan C. O. Okwumezie G. C. Akasike E A. Morgan <p>First described in a publication by two Nigerian Neurosurgeons, Adeloye A and Odeku EL, in 1971, Adeloye-Odeku disease is a solitary congenital subgaleal inclusion dermoid cyst of the anterior fontanelle. This rare lesion, which makes up about 0.1-0.5% of all cranial tumours and 0.2% of all inclusion cysts, was initially thought to be found only in Africans. However, further reports have shown it to have a universal occurrence, as it has been reported in Caucasians, Chinese, Indians, and other part of the world. This lesion is also known as Congenital inclusion dermoid cyst (CIDS), is a benign slow-growing lesion, and if untreated, may persist to adult life.</p> <p>This article gives a highlight of the disease and its management and goes further to report 3 cases of this rare benign lesion seen in Irrua, South-South Nigeria, a rural, low-resource tertiary health institution.</p> <p>Incidentally and interestingly, all three cases presented within three consecutive months (January-March, 2019) at the neurosurgery outpatient clinic. Being uncomplicated cases, private and group counselling was done. The parents of the patients were much more reassured and relieved from their anxieties seeing others with similar problem. They were all worked up for surgery at different dates, had excision of the cysts with no complication and are currently being followed at the outpatient clinic.&nbsp;</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Extremely rare complication of granulomatosis with polyangiitis 2020-01-20T09:09:31+00:00 Oguz Baran Selçuk Ozdogan Nail Demirel Sevket Evran Hanife Gulden Duzkalir Ayhan Kocak <p>The systemic vasculitis of the small-medium arteries, arterioles, venules and rarely large arteries that involves respiratory system and kidneys was defined as Granulomatosis with Polyangiitis (GPA) disease by Wegener in 1936. Intracranial aneurysms and subarachnoid haemorrhage (SAH) are extremely rare complications of GPA and our case will be the 2nd case treated with clipping aneurysm and the 11th case with subarachnoid haemorrhage in the literature.</p> <p>A 43-year-old man presented to the emergency room with a severe headache and was admitted for further evaluation. He had GPA diagnosis 14 years ago with cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA) and PR3-ANCA positive laboratory tests and kidney biopsy. SAH was seen on cranial computed tomography (CT) images. Then cerebral digital substraction angiography (DSA) performed and right middle cerebral artery aneurysm exposed. Aneurysm was clipped without any complication.</p> <p>Intracranial aneurysms and SAH are extremely rare complications of GPA. GPA related aneurysmal SAH is an exceptional condition in neurovascular pathology. Monitoring patients with GPA for SAH must be remembered and kept in mind as a diagnosis.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Paediatric traumatic brain injury 2020-01-20T09:09:31+00:00 Vibhushankar Parashar Vivek Kumar Kankane Gaurav Jaiswal Tarun Kumar Gupta <p><strong>Introduction</strong>. Traumatic brain injury is a leading cause of death and disability among children, adolescents. Therefore, analysing outcome predictors and initiating preventive policies may contribute to decreased incidence and better prognosis.</p> <p><strong>Aim</strong>. Aim to describe the epidemiologic characteristics, mechanism of injury, radiological findings and also to analyse the determinants of outcome that could help to provide better critical care and also to establish effective preventive policies.</p> <p><strong>Material and Methods.</strong> We conducted a prospective study including patients ≤18 years admitted to our Neuro-intensive care unit at R.N.T. Medical College ,Udaipur, Rajasthan, India from September 2016 to June 2018.Factors including age, gender ,mode of injury, Glasgow coma score(GCS) at admission ,pupillary size-reaction, radiological findings and their relation to outcome was assessed .Patients were divided into mild, moderate and severe head injury according to GCS. Outcome of patients was assessed by Glasgow outcome scale. For statical Analysis used Chisquare test. Statistical Analysis was carried out using Stata 11.0(College station, Texas, USA)</p> <p><strong>Results</strong>. The study comprised of 84 paediatric patients. 44.4%of patients were within 1–5-year age group. The most common cause for trauma was falls and traffic accidents. Patients with mild, moderate and severe head injury were 38.1%, 47.6%and 14.3% respectively. Poor outcome predictors included severity of head injury, pupil size and reaction, midline shift on CT.</p> <p><strong>Conclusion</strong>. This study emphasizes increased burden of paediatric brain injury with assessment of predicting factors for more effective critical care of patients and emerging need for effective fall and traffic accidents prevention strategies.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Burden of traumatic brain injury in refugee population: unmet need of care and gaps in knowledge 2020-01-20T09:09:30+00:00 Harsh Deora Amit Agrawal Ranabir Pal Luis Rafael Moscote-Salazar Muhammad Hussam Alothman Guru Dutta Satyarthee <p><strong>Background and objectives</strong>. Due to marked increase in violence, the world is facing problem of refugee population either as a source of refugee population or shelter provider. These refugee population is exposed to prolonged physical and emotional distress over years, may result into spectrum of neuropsychiatric disease conditions including traumatic brain injury (TBI). Although trauma is one of the major events faced by refugee population, the exact details of the injuries still not documented and there is paucity of published literature; further these injuries may be recorded as unspecified.</p> <p><strong>Methods</strong>. The present article is intended to provide a theoretical overview of existing knowledge and gaps on trauma and injuries in the refugee population. Authors analysed all relevant articles available on PubMed and Medline using the keywords: “Refugee”, “Traumatic Brian Injury”, “Head Injury”.</p> <p><strong>Results</strong>.&nbsp;There is a gap in knowledge for this particular demographic population. They suffer a wide range of physical and emotional to social traumatic events. The most common cause of head injury was assault; however, motor vehicle accidents were less prevalent, and there is an ongoing struggle for resources to fulfil basic needs&nbsp;leading to health care taking a backseat. There is high prevalence of post-traumatic stress disorder. Many of the refugees are settled in relative economically poorer countries which further add to the burden of a nation already besotted with internal requirements. There is a need for international collaboration to tackle unique problem.</p> <p><strong>Conclusion</strong>. Authors recommend urgent need to handle the root causes responsible for the generation of refugee population and at the same time it is necessary to identify the epidemiology, patterns, management challenges and consequences of injuries and barriers to seek and provide care in refugee population.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Improved pain and quality of life outcomes after percutaneous vertebroplasty for thoraco-lumbar non-osteoprotic compression fractures 2020-01-20T09:09:30+00:00 Mostafa M. Nabeeh Hanee A. Awad Nabil M. Ali <p><strong>Introduction</strong>: Vertebroplasty is a minimally invasive technique in which percutaneous injection of bone cement under fluoroscopic guidance Percutaneous vertebroplasty (PVP) has been widely and successfully accepted in the treatment of osteoporotic and neoplastic vertebral compression fractures to control pain refractory to medical treatment. However, using of vertebroplasty as primary line treatment for traumatic, non-osteoporotic compression fractures still not widely accepted and considered a debatable issue.</p> <p><strong>Patients and methods:</strong> This prospective comparative study was conducted at Neurosurgery department, Mansoura university hospital and Mansoura emergency hospital through the period between January 2015 and March 2016. 20 patients complaining of back pain due to single level thoracolumbar vertebral compression non-osteoprotic fractures were admitted to the study. Patients were divided into two groups 10 patients each, PVP group and conservative group. Outcome were assessed as regard pain improvement using Visual analogue scale VAS and quality of life using short form 36 scale (SF36).</p> <p><strong>Results</strong>: Ten patients in the PVP group received Vertebroplasty, eight males (80%) and two females (20%) the age ranged from 29 to 62 years with mean age of 44.2+8.3 (mean+SD) years. The conservative group included ten patients seven males (70%) and three females (30%) the age ranged from 31 to 64 years with mean age of 45.1+9.2 (mean+SD) years. The level of injury ranged from D6 to L4. VAS and SF36 results showed significant improvement in post injection results compared to preinjection and to the conservative group</p> <p><strong>Conclusion</strong>: Percutaneous vertebroplasty is safe and effective procedure to improve pain and quality of life in non osteoprotic patients complaining of traumatic compression fractures of thoraco-lumar region it decreases pain, and provide early ambulation of patients which improve their quality of life without significant morbidity.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Rapid spontaneous resolution of traumatic acute subdural hematoma 2020-01-20T09:09:29+00:00 Gautam Sachidanand Shringi Prashant <p>Introduction: Acute subdural hematoma (ASDH) is the most common type of traumatic intra -cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The mortality rates are seen to be ranging from 40% to 90%, diagnosed on computed tomography (CT) as extra axial, hyperdense, crescent lesion between the Dura and brain parenchyma1. Acute SDH is an acute space occupying lesion to increase intracranial pressure (ICP), and is often complicated by co-existing intracranial lesions, including a variety of diffuse injuries, contusional hematomas, and edema. Acute subdural post-traumatic hematoma’s (SDH) continue to have a distressingly high morbidity and mortality.2 Clinical factors like presenting GCS, Pupils, time to operative interval, Hemodynamics and co-morbidities, plays a critical role in overall outcome from acute subdural hematoma.3Careful monitoring of the neurological status is mandatory even for selected acute SDH patients with intact consciousness and no brain shift because of the possibility of the unexpected worsening. Spontaneous resolution of an acute SDH has been reported in rare cases. We report a case series of spontaneous rapid reduction of acute SDH, also we discuss the prognosis of each patient according to a Clinicoradiological Prognostic Score developed by Gautam and Sharma3 as well as mechanisms related to the rapid resolution of acute SDH.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Induced epidural haematoma 2020-01-20T09:09:28+00:00 Sherief Ahmed El Anany Abd Elghany Elshamy <p><strong>Background</strong>: A novel case of epidural haematoma caused by general surgery</p> <p><strong>Case presentation: </strong>Fifty-four years male patient was admitted at Mansoura Emergency Hospital with Glasgow coma scale 4 on ventilator. rapid evacuation of EDH was done and the GCS became 9</p> <p><strong>Conclusion</strong>: rapid accumulation of epidural haematoma is fatal and may lead to death.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Quality and reliability of the information on YouTube Videos about Botox injection on spasticity 2020-01-20T09:09:28+00:00 Aysel Gürcan Atci <p><strong>Background</strong>: This study analyzes the botox injection on spastisite 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, “botox injection on spastisite” was written to the standard YouTube search bar, and the videos with the highest views were ranked using advanced search preferences. The 69 most widely viewed videos were watched and scored by one physician.</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> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Skull metastasis of hepatocellular carcinoma in normal liver 2020-01-20T09:09:27+00:00 A. Khelifa I. Assoumane Bachir S. L. Berchiche T. Bennafaa A. Morsli <p><strong>Background</strong>: So far hepatocellular carcinoma (HCC) is the most common liver malignant tumour; it is rarely encountered on a healthy liver (9). The metastasis from HCC cancer are seen in lymph nodes (16%–40%) and lungs (34%–70%), (1,3,4,5,7,8), bone metastasis is unusual and some locations stay rare among them the skull (2,4,5). We report here a case of a patient operated in our department for skull metastasis. That patient was followed for hepatocellular carcinoma in digestive surgery department.</p> <p><strong>Case presentation</strong>: The patient is a 57 years old male presenting HCC on healthy liver, the patient was referred to our department by digestive surgery colleagues to manage a parietal subcutaneous mass; brain CT scans were performed objectified a calvarial osteolytic process. We remove the tumour and we put a cranioplasty using surgical cement, later the histological studies were in favour of secondary location of hepatocellular carcinoma.</p> <p><strong>Conclusion</strong>: Skull metastasis from hepatocellular carcinoma is rare, reporting such cases strengthen the idea of evoking HCC metastasis in the differential diagnosis of cranial subcutaneous mass.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Surgical consideration in posterior C1-2 instrumentation in case of vertebral artery anomaly 2020-01-20T09:09:27+00:00 Harshad Patil Nitin Garg <p>Anatomical variations in the course of the vertebral artery have been previously described in the literature. Generally, these predictable patterns of variations commonly observed in lower cervical vertebral artery anatomy and less commonly described for upper cervical vertebral artery anatomy. Due to presence of these variations, treatment options for upper cervical spine pathology may be influenced and sometimes prevent commonly performed stabilization procedures.&nbsp; Herein author presented a case of vertebral artery anatomic variation at the craniovertebral junction and management option for such variations.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Management of spinal dural arterio venous fistula with peri-medullar drainage 2020-01-20T09:09:26+00:00 Assoumane Ibrahim Loucif Houari Sanoussi Samuila Sidi Said Abderahmane Abdelhalim Morsli <p><strong>Introduction</strong>: Spinal Dural Arterio Venous Fistula (SDAVF) is an arteriovenous communication on the spinal dura with peri-medullar venous drainage. It is a curable cause of myelopathy and the most common form of spinal arterio venous malformation (AVM). The average age of revelation is the fifth decade; it is a diagnostic and therapeutic emergency.</p> <p><strong>Materials and methods</strong>: This is a retrospective study conducted in the neuro surgical department of CHU Bab El Oued in Algiers during a five years time from November 2013 to September 2018. We assessed the clinical status of patients according to the Aminoff-Logue disability score before and after surgery. All patients did a total spine MRI followed by a Medullar angiography which facilitated the pin-pointing of the exact location of the dural fistula. The mean follow-up is 30 months.</p> <p><strong>Results</strong>: There were five males and two females, all of them older than 45 years of age. At the admission, patients presented with signs of neurological deficits. After the diagnosis of SDAVF the surgical intervention consisted of a disconnection of the arteriovenous communication by coagulation and section of the fistula at the foot of the vein after a laminectomy. Functional rehabilitation was prescribed for all patients and they were regularly followed-up.</p> <p><strong>Conclusion</strong>: Treatment of AVF is surgical or endovascular. Results depend largely on preoperative neurological status.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Transzygomatic anterior infratemporal fossa approach and high cervical approach for resection of infra temporal fossa and parapharyngeal space solitary fibrous tumours 2020-01-20T09:09:26+00:00 Kazumi Ohmori Shiduka Kamiyoshi Taku Takeuchi Takanori Fukushima Takashi Tsuduki Toshika Arita <p>The infratemporal fossa (ITF) is the region under the floor of the middle fossa giving passage to most major cerebral vessels and cranial nerves.(1) It is closely related to important adjacent regions such as the middle fossa, pterygopalatine fossa, orbit, and nasopharynx.(2) Due to the anatomical complexity in the ITF, surgical removal of the lesions in or around it is still challenging.(3) Since the 1960s, many surgeons have reported various surgical approaches. the preauricular transzygomatic approach via a transcranial route was reported to be used for exposure of the antero-superior portion of the ITF (2,3). Solitary fibrous tumours (SFTs) were first described by Klempere and Rabin in 1931 as spindle-cell tumours originating from the pleura.(4) With the exception of myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract showing myoid differentiation, all other HPC like lesions are best considered as subtypes of SFT.(5) Only a few cases of SFT have been described in the literature involving the skull base and parapharyngeal space.(6–8) The purpose of this article is to show anatomical dissections involving this surgical approach and to evaluate our surgical experience using it.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Radiological, biomechanical and histopathological characteristics of rat brain in Kaolin-induced hydrocephalus 2020-01-20T09:09:25+00:00 M. Yavuz Samanci Suat Erol Celik Zafer Unsal Coskun Deniz Ozcan <p><strong>Objective</strong>: A better understanding of the pathophysiology and underlying mechanisms of brain damage in hydrocephalus is vital in developing diagnostic, observational and treatment tools that will have an impact on hydrocephalus outcomes. In this study, we aimed to demonstrate the radiological, biomechanical and histopathological characteristics of rat brain tissue in an experimental hydrocephalus model.</p> <p><strong>Materials and Methods</strong>: Thirty-six male Sprague-Dawley rats (21 days old, weighing between 150 and 200 grams) were used in this study. Animals were randomly assigned to control (n = 6), 1-week hydrocephalus (n = 10), 2-week hydrocephalus (n = 10) and 3-week hydrocephalus (n = 10) groups. Hydrocephalus was induced with cisternal kaolin injection and controls received sham injection. Magnetic resonance imaging was used to measure ventricle size and cortical thickness. Vital signs, cerebral blood flow (CBF), mechanical tests and brain histology were assessed.</p> <p><strong>Results</strong>: Three rats in the hydrocephalus group died during the follow-up, yielding an overall mortality of 10% among animals from hydrocephalus groups. Ventricular width, cross-sectional area of the lateral ventricles, ventricular index and ventricle / brain area ratio progressively increased and cortical thickness progressively decreased following kaolin injection. CBF was significantly lower at baseline than at 1st, 2nd and 3rd week (p &lt; 0.05, for all). ICP was significantly elevated in all hydrocephalic groups in comparison with controls. EIT that was calculated from the first load-unload indentation test showed a significant increase at 2nd week post-injection (p=0.0001), indicating increased intracranial stiffness. However, this significant difference disappeared at 3rd week (p=0.956). Quantitative immunohistochemistry showed that hydrocephalic brains demonstrated significantly less NeuN-positive cells and significantly higher IBA-1-positive microglia and glial fibrillary acidic protein positive astrocytes cells in the cortex.</p> <p><strong>Discussion and Conclusion</strong>: Cisternal kaolin injection causes varying degrees of&nbsp;ventricular enlargement in a rat model and hydrocephalus might contribute to neuronal and axonal damage and alter brain stiffness through axonal stretching or local hypoperfusion progressively over a period of days to months. As shown in this study, irreversible changes in viscoelastic behaviour and cellular structure develop in the late stages of hydrocephalus, suggesting the importance of early intervention in the treatment of hydrocephalus.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Treatment of chronic pain by spinal cord stimulation 2020-01-21T18:52:37+00:00 F. Aichaoui A. Khelifa I. Assoumane M. Al-Zekri A. Morsli <p>Failed back surgery syndrome (FBSS) is often used to describe the condition of patients who have experienced continued pain after surgery. It is of multifactorial genesis and may be the consequence of various lumbar spinal diseases; lumbar disc herniation surgery or spinal canal stenosis laminectomy. The presented series included 13 patients affected with chronic pain related to FBSS who underwent implantation of spinal cord stimulation. The mean percentage of pain relief was 90 % for all patients. 60% of the patients were in a better psychological status and the intake of analgesic medications has been reduced of more than 70%. More than 50% of the patients could resume professional activities. Analysis of the risks and benefits comes in favour of spinal cord stimulation.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Microscopic trans-cerebellar approach for infratentorial cavernous malformation near the lateral recess associated with developmental venous anomaly 2020-01-21T11:55:34+00:00 Samer S. Hoz Awfa A. Aktham Hassan M. Bdaiwi Alyaa A. Khadim Zainab A. Jihan Mohammed Maan AbdulAzeez <p><strong>Background</strong>: Reports showed the intimate association of the developmental venous anomaly with infra-tentorial cavernous malformation. This association has several clinical and surgical implications, sometimes this association will be a surgical challenge and affect the selection of the safest approach to the lesion. Surgery for infratentorial cavernoma is indicated for accessible symptomatic lesion only.</p> <p><strong>Case scenario</strong>: we present a case of deep cerebello-pontine CM adjacent to the lateral recess, presented with acute clinical deterioration to the emergency department of the Neurosurgery Teaching Hospital in Baghdad, Iraq, with the only possible approach was Trans-cerebellar approach because of the medial location of the associated DVA.</p> <p><strong>Conclusion</strong>: The association of developmental venous anomaly with infratentorial cavernous malformation has a pivotal role in selection the most appropriate and safe surgical approach which should be based upon the individualized patient anatomy and the location of the target lesion.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Communicating spinal epidural thoracic arachnoid cyst en-bloc resection 2020-01-21T11:57:41+00:00 M. Al-Zekri F. Aichaoui I. Assoumane A. Khelifa W. Bennabi A. Morsli <p><strong>Background</strong>: Spinal extradural arachnoid cyst is an uncommon, expanding lesion which may communicate with the subarachnoid space, The etiology still remains unclear, but the most accepted explanation is the existence of areas of weakness in the spinal dura , Spinal arachnoid cysts are usually in the thoracic spine, and they may cause symptoms due to spinal cord compression.</p> <p><strong>Case Presentation</strong>: Patient is a 54-years-old female who presented with progressive back pain and motor deficit, Magnetic resonance imaging (MRI) study revealed an extradural cyst extending from T2 to T4 isointense with the cerebrospinal fluid (CSF) on all sequences and did not enhance on T1-weighted post-contrast MRI. Patient underwent T2-T4 laminectomy, en-bloc resection of the lesion was achieved and the histopathological examination objectified an arachnoid cyst.</p> <p><strong>Conclusion</strong>: Spinal extradural arachnoid cyst can cause neurologic deficit and the mainstay of treatment in patients with neurological symptoms is surgical removal of the cyst together with ligation of the communicating pedicle and closure of the dural defect.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Romanian neurosurgery at European standards 2020-01-21T11:59:22+00:00 Andreea Gavrilei Stefan Gradinaru Mihai-Stelian Moreanu Alexandru Vlad Ciurea <p>Sibiu, 2019</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## - 2020-01-21T19:01:33+00:00 - - <p>-</p> 2020-01-21T18:59:32+00:00 ##submission.copyrightStatement## Romanian Neurosurgery (2017) XXXI 4: 490 - 494 2020-01-21T12:00:19+00:00 RN . <p><strong>Corrigendum</strong></p> <p>"Long term prognosis of ventriculoatrial shunt for idiopathic normal pressure hydrocephalus in the elderly"&nbsp;</p> <p>Kiyoshi Takagi (1,2), Yoko Kato (2)&nbsp;</p> <ol> <li>Centre of Normal Pressure Hydrocephalus, Nagareyama Central Hospital, Japan.</li> <li>Fujita Health University Banbuntane Hotokukai Hospital, Japan.</li> </ol> <p>&nbsp;</p> <p>Romanian Neurosurgery (2017) <strong>XXXI 4</strong>: 490 - 494; doi: 10.1515/romneu-2017-0076</p> <p>&nbsp;<strong>Correction to</strong>:&nbsp; Romanian Neurosurgery (2017) <strong>XXXI 4</strong>: 490 - 494; doi: 10.1515/romneu-2017-0076; published 15 December 2017</p> <p>&nbsp;</p> <p>Since the publication of the article, the journal was notified that the authors were incorrectly presented.</p> <p>The authors are after correction:</p> <p>&nbsp;</p> <p>Long term prognosis of ventriculoatrial shunt for idiopathic normal pressure hydrocephalus in the elderly</p> <p>&nbsp;Kiyoshi Takagi (1,2), Yoko Kato (2)</p> <ol> <li>Centre of Normal Pressure Hydrocephalus, Nagareyama Central Hospital, Japan.</li> <li>Fujita Health University Banbuntane Hotokukai Hospital, Japan.</li> </ol> <p>&nbsp;</p> <p>&nbsp;The authors apologise for any inconvenience caused.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement##