Romanian Neurosurgery 2020-06-17T12:41:51+00:00 Editor Open Journal Systems <p>Call for Papers - Vol. XXXIV, No. 3 (September 2020)<br />Submission Deadline: August 1, 2020</p> Assessment of malpractice litigation following spine surgery 2020-06-15T10:32:57+00:00 Gabriel Iacob Alexandru Vlad Ciurea <p>Medical litigation in spine surgery is a serious concern today, with a high volume of clinical negligence claims, substantial financial cost and significant burden, who is threatening the future of this surgery.</p> <p>Classical spinal surgery should be performed with very well documented indication, in order to improve the expected results, with clear aims: decompression of the neural elements of the spine from tightness, stabilizing the spine to protect the nerves, eliminate the pain resulting from abnormal loading from the different movements.</p> <p>Spinal surgery today means a wide analysis, understanding and realization of spinal decompression, also osteosynthesis and fusions, using high-performance gestures, with increased addressability especially in the elderly, for a varied pathology, which involves anaesthetic-surgical risks, complications. In such a context, surgical damage does not necessarily result from an error or from surgical misconduct and the surgeon is not always responsible for the damage in the absence of a proven fault in the legal sense.</p> <p>The paper aims to briefly review the main problems, but also useful recommendations to meet various challenges, expectations, maintaining the quality of life of each patient, reducing risks of getting sued, also to increase the odds of a successful defence.</p> <p><strong>In conclusion</strong>: education, vigilance, improved patient-safety strategies, investigation, implementation and sharing of lessons learned from litigation claims remain important components of spinal surgeons training, to reduce future cases of negligence and improve patient care, quality of life, as many of the cases of successful litigation had a preventable cause.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Concomitant orbital and intracranial abscess 2020-06-15T12:14:44+00:00 Andreea Nae Stephen Farrell Kieron Sweeney Siobhan Hoare Michael Colreavy <p><strong>Background</strong>:&nbsp; Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae.</p> <p><strong>Case presentation</strong>: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic mini-craniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks.</p> <p><strong>Conclusion</strong>: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore prompt recognition and management are essential within a multidisciplinary team setting.</p> <p>We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Presentation, management and outcomes of pituitary adenomas 2020-06-15T13:08:54+00:00 Bogdan Ionut David Ligia Gabriela Tataranu Vasile Gheorghe Ciubotaru Aurelia Mihaela Sandu Radu Mircea Gorgan <p><strong>Introduction</strong>: One of the most frequently encountered intracranial tumours are the pituitary adenomas, these accounting for 5% to 20%. Therapeutic strategies vary largely, from medical therapy to complex neurosurgical procedures. The transsphenoidal approach can solve most of the lesions of the pituitary area, as long as the invasion of the adjacent structures is not significant. The transcranial approach is indicated in tumours with extensive invasion</p> <p><strong>Materials and methods</strong>: We performed a retrospective study in the Bagdasar-Arseni Emergency Hospital Neurosurgery that aimed to analyze the demographics, signs and symptoms, therapeutic strategy, surgical approach, complications, and histopathology, from 2010 to 2019.</p> <p><strong>Results</strong>: The total number of hospitalization records, including the follow-up hospitalization and/or second surgery hospitalization, was of 1107. Furthermore, there were 704 unique patients. The most common signs and symptoms encountered for the first admission were headache (245 – 34.56%), optic chiasm deficits (153 – 21.58%), acromegaly (85 – 11.99%). However, the majority of patients (507 – 71.51%) presented with some sort of hormonal imbalance or diabetes insipidus. On the one hand, a number of 325 (45.84%) patients had non-surgical treatment. On the other hand, a total of 384 (54.16%) surgeries for pituitary tumours were performed in this period.</p> <p><strong>Discussion</strong>: In our study, the patients who underwent surgery benefited from either microsurgical transsphenoidal or transcranial surgeries. Even if the transsphenoidal approach was used far more, there was a greater relapse proportion in these patients. Transcranial surgery, even if followed by a far less proportion of relapse surgery, carried with it the burden of more days spent in hospital (most of the time twice as much as for the transsphenoidal patients).</p> <p><strong>Conclusion</strong>: Both transsphenoidal and transcranial approaches have advantages and disadvantages, thus the best strategy would be to tailor each surgery to each patient, keeping an open mind to all available approaches.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 The impact of vertebral osteomyelitis on spinal stability and principles of surgical stabilization 2020-06-17T11:42:20+00:00 Vlad Catana Radu Mircea Gorgan <p>Vertebral osteomyelitis (VO) is a disease that responds well to conservative treatment and antibiotherapy if diagnosed in an early stage. Due to the prolonged onset of this pathology, many cases are diagnosed in mid or late stages and require surgery.</p> <p>The surgical treatment is not yet standardized and may only mean decompression of the infectious outbreak without stabilization, or surgical decompression associated with stabilization.</p> <p>Using only bone grafts for surgery or stabilizing the spine through segmental posterior and/or anterior instrumentation is accompanied by many controversies.</p> <p>In this review, we focus on demonstrating that combining a well-conducted antibiotherapy with thorough debridement of the necrotic areas and using metal implants for spinal stabilization lowers the infection rates, provides an early pain-free mobilization of the patient and reduces hospitalization costs.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Historical vignette 2020-06-15T14:15:31+00:00 Andreea-Anamaria Idu Aurel-George Mohan Mircea-Vicentiu Saceleanu Alexandru-Vlad Ciurea <p><strong>Introduction. </strong>Sofia Ionescu-Ogrezeanu (b. April 25, 1920, F?lticeni - d. March 21, 2008, Bucharest), also known as the Lady of Romanian Neurosurgery, became the first woman neurosurgeon in the world after performing a brain surgery during World War II, a fact recognized as a world premiere during the 13th World Congress of the World Federation of Neurosurgical Societies (WFNS) in Morocco, in 2005. [1]</p> <p><strong>Materials and methods. </strong>Sofia Ionescu is the first woman neurosurgeon. She was born on the fields of Bucovina, in F?lticeni, and became part of the "golden team" of the Romanian neurosurgery of the pioneering period. The decisive moment of her career took place in 1944, during the war when she was forced to perform an emergency operation on a child, a victim of the bombing.</p> <p>The article coagulates the reports regarding the description of the first brain surgery performed by the first woman neurosurgeon with the continuous activity integrated with the field of neurosurgery. Both specialized articles, biographical books, and television interviews were used as references.</p> <p><strong>Results. </strong>The operation performed in the fifth year of faculty was the first step of a journey of 47 years of neurosurgical career, practised with high morality and devotion. The sacrifice of the pioneer of the first woman neurosurgeon was recognized in the press in the country and abroad, as well as by the recognition of different titles and distinctions.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Incidence of vertebral osteomyelitis and benefits of spinal stabilization in infection 2020-06-17T12:41:51+00:00 Vlad Catana Radu Mircea Gorgan <p>In order to evaluate the etiology, characteristics and outcome of the surgical treatment of vertebral osteomyelitis cases in our hospital, patients with vertebral osteomyelitis between January 2014 and December 2018 were included in the study. Clinical and paraclinical data of the patients were collected from the medical records of the patients. Of the 164 patients diagnosed with vertebral osteomyelitis in our clinic 94 underwent surgery and only these last ones were included in the study. Of these 94 patients, 18 cases were diagnosed with tuberculous osteomyelitis and 76 with nontuberculous osteomyelitis. The age of the majority of patients ranged from 40 to 80 years with a peak of incidence between 61-70 years. All of the patients had back pain and regional tenderness of the affected area and many cases presented neurological deficits. The most common involved area affected in our cases was the thoracic spine. Magnetic resonance imaging is the examination that reveals the degree of involvement and excludes other pathologies from the differential diagnosis. The majority of patients had several comorbidities which we included in the study. From all the patients included 76 % underwent surgery with decompression and spinal stabilization using titanium instrumentation and 24 % underwent surgery with only spinal decompression. We also evaluated number hospitalization days of the operated cases. An early diagnosis seems crucial for a fast recovery, lowering the hospitalization costs of both the patient and the hospital and preventing sequelae development.&nbsp;</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Clinical spectrum of paediatric head injury 2020-06-15T14:51:42+00:00 Krishna Govind Lodha Tarun Kumar Gupta Gaurav Jaiswal Yogendra Singh <p><strong>Introduction</strong>: Traumatic Brain injury is considered as a major health problem which causes frequent deaths and disabilities in paediatric population with special concern to tribal regions of developing countries like India where etiology of traumatic brain injury in the paediatric population fall from height dominant over the road traffic accident as a major.</p> <p><strong>Aim and objective</strong>: The aim is to analyse the epidemiology, mechanism, clinical presentation, severity and outcome of paediatric head injury in the tribal region of northern India that could help to make preventive policies to improve their care.</p> <p><strong>Material methods</strong>: It is a prospective observational study of 345 children of up to 18 years of age admitted under Department of Neurosurgery from October 2017 to April 2019.</p> <p><strong>Results</strong>: The study population comprised of 345 paediatric patients. Mean age was 9.25 years.36.81% patients were in 1-6-year age group and male to female ratio was 2.45. The most common cause for trauma was fall from height in 179(52%) cases followed by RTA in 141(41%) cases. The most common radiological finding was depressed skull fractures in 97(50%) cases. There was 35% mortality in severe head injury patients.</p> <p><strong>Conclusion</strong>: This study through some light on the different scenario of head injury in Tribal regions of Developing country and will help to formulate effective strategies for prevention and better care of the patients.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Coccydynia - a medical condition with multiple causes and different management strategies 2020-06-15T16:59:23+00:00 Amin Sabry Ashraf S. Zidan Mohemed Abdel Bari Hesham El Sobky <p><strong>Background: </strong>Coccydynia is a common complaint which is usually self-limited and tolerable. Although most of these patients respond dramatically to conservative measures, some patients need more complex plane of treatment. In these conditions, the cause of coccydynia can be complex and multifactorial.</p> <p><strong>Patients and methods</strong>: A total of 8 cases were included in the study. All cases received medical treatment for 9 months before surgery. Complete coccygectomy was performed for all cases. Post-operative outcomes were measured according to the degree of pain relief.</p> <p><strong>Results</strong>: The mean age of the included cases was 43.87 years (range, 39 – 52). A total of 5 females (62.5%) and 3 males (37.5%) were included. The mean preoperative VAS score was 9 (range, 8 – 10), while post-operatively, it decreased significantly down to 2 (range, 1 – 3). Excellent postoperative outcomes were achieved in 6 cases (75%) whereas good outcomes were obtained in the remaining 2 cases (25%).</p> <p><strong>Conclusion</strong>: Although conservative medical measures are effective for treating coccydynia, but surgical excision is still a valid treatment option in resistant cases.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Outcome analysis of upper and lower limb motor functions after anterior cervical discectomy and fusion for degenerative cervical disc disease 2020-06-15T17:41:21+00:00 Ninad N. Srikhande V.A. Kiran Kumar N.A. Sai Kiran Amrita Ghosh Ranabir Pal Luis Rafael Moscote-Salazar V. Anil Kumar Vishnu Vardhan Reddy Amit Agrawal <p><strong>Background<em>:</em></strong> Anterior cervical discectomy and fusion (ACDF) is the most commonly performed surgical procedure for symptomatic cervical disc disease. In this study, we analysed the upper and lower limb motor functions after ACDF for disc prolapse in patients with degenerative cervical disc disease.</p> <p><strong>Methods<em>:</em></strong> One hundred consecutive adult patients who underwent ACDF for single or two-level cervical disc prolapse during the study period (October 2015 to October 2017) were included in the study.</p> <p><strong>Results<em>:</em></strong> Preoperative motor deficits in limbs were noted in 73% (73/100) of the patients. Enhance recovery of motor deficits was noted in 72.6% (53/73) of these patients and persisting motor deficits in the remaining patients (20/73- 27.4%). Five patients (5/27- 18.5%) without any preoperative motor deficits developed motor deficits after ACDF. Detailed pre and postoperative (at the time of discharge) motor power (graded by MRC grade) in all 4 limbs (Shoulder abduction/adduction/flexion/extension, elbow flexion/extension, wrist flexion/extension, hip abduction/adduction/flexion/extension, knee flexion/extension, ankle flexion/extension) was recorded. Statistically significant improvement in motor power (as recorded at the time of discharge) was noted in all the tested muscle groups after ACDF.</p> <p><strong>Conclusion<em>:</em></strong> Early improvement in preoperative motor deficits can be expected in the majority of the patients with cervical PIVD following ACDF.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Prognostic factors of ruptured middle cerebral artery aneurysms treated with surgical clipping 2020-06-15T18:31:45+00:00 Samer S. Hoz Saja A. Albanaa Ali M. Neamah Farah W. Abdulmohsin Zahraa Al-Sharshahi <p><strong>Background</strong>: Spontaneous subarachnoid haemorrhage is an emergent condition that leads to profound morbidity and mortality. It is mainly caused by a ruptured intracranial aneurysm. Herein we described the relationship of different factors and their impact on the outcome of patients who underwent a surgical clipping exclusively to the ruptured middle cerebral artery aneurysm.</p> <p><strong>Methods</strong>: We retrospectively analyzed the medical records of patients admitted to the Neurosurgery Teaching Hospital (NTH) in Baghdad for the period between January 2017-April 2019 of patients who underwent microsurgical clipping for ruptured middle cerebral artery aneurysm. Demographic, clinical, radiological and surgical data were extracted. A univariate analysis was used to illustrate the relationship between the variables and outcome which was assessed using the five scores of the Glasgow Outcome Scale where patients were dichotomized into two groups; favourable (IV + V) and unfavourable (I, II, III).</p> <p><strong>Results</strong>: Within this cohort, a total of 50 patients were studied and the analysis revealed that 92% (N=46) had a favourable outcome and 8% (N=4) had an unfavourable outcome at discharge. The in-hospital mortality was 6%(N=3). Factors that were significantly associated with poor outcome were giant aneurysms, the presence of other unruptured aneurysms, post-operative clinical vasospasm, presence of contralateral weakness, lower pre/post-operative Glasgow coma scores, higher Hunt and Hess, World Federation of Neurosurgical Societies (WFNS) and modified-WFNS grades.</p> <p><strong>Conclusion</strong>:&nbsp; The factors with a significant impact on the outcome of patients with surgically clipped ruptured middle cerebral artery aneurysms were GCS, WFNS, m-WFNS, H&amp;H, contralateral muscle weakness, size of the aneurysm, presence of other unruptured aneurysms and clinical vasospasm.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 The efficacy of adalimumab on experimentally induced spinal cord ischemia-reperfusion injury 2020-06-17T11:26:59+00:00 Yasar Karatas Mehmet Fatih Erdi Bulent Kaya Fatih Keskin İbrahim Kılınç Mehmet Uyar Sabiha Serpil Kalkan Emir Kaan Izci Erdal Kalkan <p><strong>Objective:</strong>&nbsp;Paraplegia is a dangerous complication of thoracoabdominal aortic surgery. Various studies have been conducted on the prevention of this complication and some spinal cord protection methods have been proposed. However, there is not any modality that prevent the development of paraplegia certainly. In the I / R period, primary injury triggers secondary injury due to increased inflammation, apoptosis and free radical formation. In this study, we evaluated that the neuroprotective effect of adalimumab in spinal cord ischemia-reperfusion injury.&nbsp;</p> <p><strong>Materials and Methods:</strong>&nbsp;In total, 24 adult New Zealand rabbits were divided into three groups: Group 1, control; Group 2, ischemia-reperfusion by infrarenal aortic clamping; Group 3, adalimumab treated followed by ischemia. Tissue and plasma tumor necrosis factor alpha, interleukin 6, interleukin 10, thiobarbituric acid reactive substance, total oxidant status and total antioxidant status levels were analyzed as a marker of inflammation and oxidation. Histopathological evaluation of the tissues was performed, and apoptosis was evaluated by TUNNEL method.</p> <p><strong>Results:</strong>&nbsp;I/R injury significantly increases plasma and spinal cord tissue at TNF alpha, TOS, TBARS, IL6 levels and reduces plasma and spinal cord tissue to TAS and IL10 levels. Adalimumab treatment significantly reduces plasma and spinal cord tissue to TNF alpha, TOS, TBARS, IL6 and increases plasma and tissue to TAS and IL10 levels.</p> <p><strong>Conclusion:</strong>&nbsp;Adalimumab treatment significantly reduces the spinal cord neuronal damage score and the number of apoptotic cells. This paper aims to demonstrate the important neuroprotective effects of adalimumab on rabbit spinal cord I/R injury.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Experience, challenges and lessons learnt from microsurgical clipping of intracranial aneurysms at an emerging neurosurgical centre 2020-06-15T19:30:29+00:00 Varun Aggarwal Chandni Maheshwari Divya Kavita Amit Narang <p><strong>Objectives</strong>: To share our experience, challenges faced, lessons learnt and analyze the results of surgical management by microsurgical clipping of intracranial aneurysms at an emerging neurosurgical centre at Guru Gobind Singh medical college and hospital (GGSMC&amp;H) Faridkot, Punjab. India.</p> <p><strong>Material and</strong> <strong>Methods</strong>: This study includes all the patients who presented with the diagnosis of intracranial aneurysm on CT angiography and were treated with the microsurgical clipping,&nbsp; between March 2017 to April 2019.</p> <p><strong>Results</strong>: There was a total of 23 patients 11female and 12 male. Age range 32 to 85years. On admission 22 patients had SAH on CT scan and one was admitted after incidental detection of the aneurysm without SAH. The time interval between ictus and admission was 0-3 days in 13 patients, 3-14 days in 8 patients and more than 14 days in 1 patient. WFNS grade (gd) I-15 patients, gd II-2, gd III-2, gd IV-3 patients. Fisher gd I-nil, gd II-9, gd III-4, gd IV-9 patients. In 23 patients 27 Aneurysms were clipped. Distribution of location was Anterior Communicating-12, Distal Anterior Cerebral Artery- 4, Middle cerebral artery (MCA) Bifurcation-3, MCA trifurcation-1, Anterior Choroidal-1, Posterior Communicating (P-com) -1, Ophthalmic Internal Carotid Artery (OICA)-4 and three patients had associated multiple aneurysms. Size of aneurysms varied from &lt; 02mm diameter in 2 patients, 2-25mm - 23 and, more than 25mm-2 aneurysms. There was intra op rupture in 2 cases. Post-operatively 2 patients developed hemiparesis, which recovered, nine patients developed vasospasm. Two patients developed chest related complications. One patient developed renal failure.&nbsp; There were 8 deaths. Patients are on follow up since March 2017 till date.</p> <p><strong>Conclusions</strong>: Intracranial aneurysms are challenging to manage due to their proximity to vital intracranial structures, and difficulty in securing intracranial proximal control. Thorough knowledge of intracranial anatomy of adjacent relations, arachnoid planes and skilful dissection is a key element for a successful outcome. Data collected from GGSMC &amp; Hospital may not be representative of the entire state or country’s population. Therefore, a large-scale data collection is necessary to create our own database to ascertain the risk factors and preventive measures that are exclusive to our state and nation.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Endoscopic third ventriculostomy for obstructive hydrocephalus 2020-06-15T20:11:35+00:00 Hassan Z.A. Dixon Yasir M. Hamandi Ammar M.A. Mahmmoud Samer S. Hoz Zahraa F. Al-Sharshahi <p><strong>Introduction: </strong>Obstructive hydrocephalus has long been managed by valve-regulated shunts. These shunts are associated with a myriad of short and long-term complications. This has fueled interest in Endoscopic Third Ventriculostomy (ETV) which provides a more physiological pathway for cerebrospinal fluid (CSF) diversion while avoiding many shunt-related complications.</p> <p><strong>Aim:&nbsp;</strong>The objective of this study is to analyze the outcomes of ETV at our institution, focusing on the indications, success rates, and short-term complications.</p> <p><strong>Methods:&nbsp;</strong>Between July 2010 and September 2015, 47 patients with obstructive hydrocephalus underwent ETV at the Neurosurgery Teaching Hospital in Baghdad/ Iraq. We retrospectively analyzed the data of these patients using hospital health records. Simple statistics were performed using&nbsp; SPSS Version 20. A standardized surgical technique was employed in all cases.</p> <p><strong>Results:&nbsp;</strong>The mean age was 4.4 years (range 40 days - 38 years). The male: female ratio was 1.23:1 (55% males and 45% females). The most common cause of obstructive hydrocephalus in patients undergoing ETV was aqueductal stenosis (62%; N=29). The second most common cause was posterior fossa tumours (23%; N=11). The overall success rate for ETV was 68%. The net post-operative complication rate was 13% (N=6). CSF leak and seizures were the only two charted post-operative complications at the rates of 9%(N=4) and 4% (N=2), accordingly. No deaths were recorded.</p> <p><strong>Conclusion:&nbsp;</strong>ETV is a viable alternative to shunt insertion in a select group of patients with obstructive hydrocephalus, with acceptable success rate and safety profile.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Intraneural synovial sarcoma of median nerve 2020-02-25T08:00:44+00:00 Sandeep Bhardwaj Anil Kansal Rohit Bansil Rakesh Singh Akangsha Sharma <p>Synovial sarcomas are highly aggressive soft tissue tumour with a poor and dismal prognosis. These tumours have a high propensity for distant metastasis and local recurrence. Although originally believed to arise from synovium, these tumours have been found to occur anywhere in body [1],[2]. We report here, a case of median nerve sarcoma in a 15-year female. This is a rare tumour, which is diagnosed only after histopathological examination with only a few cases reported in the literature (Table 1). Although preoperatively tumour was thought to be a nerve sheath tumour, on histopathology analysis was found to be synovial sarcoma. Despite aggressive behaviour, wide local excision is recommended even in smaller lesions. So, the diagnosis should always be kept in differentials of nerve sheath tumour, as what may be a synovial sarcoma.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Romanian Neurosurgery Preoperative evaluation of superficial cortical venous drainage 2020-06-15T22:39:03+00:00 Surjeet Singh Stuti Kumari Abhijeet Sachan Shashi Kant Jain <p><strong>Objectives and methodology:&nbsp;</strong>The preoperative exact localization of superficial intracranial lesions and superficial cortical veins is often necessary for making craniotomy and evaluation of cortical veins. We developed a simple and cheap method for such localization using cod liver oil capsule during the preoperative MRI and MRV brain examination. With the help of MRV brain, 3DCEMRV and 2DTOF images were taken and superficial cortical veins studied in the marked area for comparison between both modalities of MRV and planning of surgery for avoiding venous injury.</p> <p><strong>Results:&nbsp;</strong>Most of the cases were in the age group 16-60 years (91.6%). The most common clinical manifestation was headache (85.4%) and meningioma (60.4%) was found to be the most common pathology. Clear visualization (Grade 3) of the individual superficial cortical vein was observed in 48 cases (100%) in 3DCEMRV as compared to 2DTOF 22 cases (45.8%) P &lt;0.001S. Clear visualization (Grade3) of superior sagittal sinus was observed in 48 cases (100%) in 3DCEMRV as compared to 2DTOF 33 cases (68.6%) P &lt;0.001S.&nbsp; In post-operative CT Head, we found 4 (8.3%) cases were having venous infarction.&nbsp; 5 patients (10.4%) developed motor weakness postoperatively. In 3 cases, postoperative MRV were done and found no venous injury.</p> <p><strong>Conclusion:&nbsp;</strong>This study showed that preoperative localization and evaluation of the tumoral area and cortical veins with the help of cod liver oil in MRI and MRV brain was very helpful in planning the surgery, making craniotomy and to avoid injury of the veins. This technique is easy to perform and the capsule is easily constructed and inexpensive. 3DCEMRV was found to be better modality than 2DTOF for delineation of veins. Final neurosurgical outcomes were better.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Long term study on the effects of microsurgical DREZotomy for chronic pain control 2020-03-27T12:25:14+00:00 Fayçal Aichaoui Khelifa Adel Muneer Al-Zekri Walid Bennabi Sid Abderahman Myara Abdelhalim Morsli <p>The DREZotomy (Dorsal Root Entry Zone tomy) is an analgesic procedure. The analgesic effect is evaluated on 30 patients with chronic pain resulting from respectively: brachial plexus avulsion (66.6%), postherpetic pain (10%), hyperspastic states (6.6%), phantom pain (6.6%), the pain in the stump (6.6%), and spinal cord injuries (3.3%). Pain intensity was evaluated using a visual analogue scale (VAS). At last evaluation, between 12 and 60 months, after DREZotomy, 93% had a good or excellent global pain relief after surgery. According to the component types of pain, 9.6% of patients had good or excellent control of the paroxysmal pain, and 84% of the continuous pain. Kaplan–Meier prediction of lasting global pain control at 60 months of follow-up was calculated at 75.5%. Comparison of the 2 corresponding Kaplan–Meier curves at long term, namely, pain control in 82.8% for the paroxysmal component and in 51.7% for the continuous component, showed a statistically significant difference (P &lt; 0.0001). Functional effects are improved by more than 70% according to patients.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Romanian Neurosurgery Post-traumatic arachnoid cyst without neurological sequels 2020-04-12T13:11:47+00:00 Raphael Oliveira Ramos Franco Netto João Italo Fortaleza de Melo Victor Augusto Ramos Fernandes Juliana de Almeida Rodrigues Franco Netto Leonardo Gattass Ferreira Luiz Dias Dutra <p>An eight-year-old male patient was admitted to the hospital with a history of left median paramedian frontal craniectomy due to car trauma at six months of age. Axial computed tomography of the skull with reconstruction in three dimensions revealed an arachnoid cyst with slight herniation of the brain in the frontal lobe, leading to protrusion against the skullcap, causing dilation of the ex-vacuum of the anterior extension of the homolateral lateral ventricle. He presented asymmetrical lateral ventricles, a reduced base cistern, and a slightly ectatic IV centred ventricle. After the physical examination, no neurological deficit was found, despite the changes identified in the images. It is believed that such conditions may progressively worsen with the development and maturation of nervous tissue over the age of the assessed child. To confirm this, specialized monitoring is of fundamental importance.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Romanian Neurosurgery Hypotension intracrânienne spontanée (HIS) 2020-06-16T00:54:11+00:00 Leklou H. Djellaoui M. <p>L’HIS est une céphalée chronique, liée à une fuite de LCR. Son diagnostic est facilité par l’IRM et sa prise est essentiellement médicale. Nous rapportons le cas d’une jeune femme ayant présenté un tableau clinique et signes IRM compatibles avec ce diagnostic et ayant bien évolué sous traitement.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Predictors of severe head injury in tertiary centre 2020-06-16T01:33:36+00:00 Rajendra Shrestha <p><strong>Introduction:&nbsp;</strong>Severe head injury (SHI) is associated with a high mortality and morbidity rate and is one of the leading causes of death in intensive care units. The aim of this study was to identify predictors of hospital outcome and mortality in ICU admitted SHI patients and to estimate their impact.</p> <p><strong>Methods:&nbsp;</strong>A retrospective analysis was carried on patients (n=321) with a severe head injury, defined as Glasgow Coma Scale (GCS) ? 8 who were admitted to the ICU neurosurgical department of National Trauma Center from 2017 to 2018. Both clinical and radiological predictors of hospitalized patients were identified.</p> <p><strong>Results: </strong>Total mortality rate was 5.9%. 243 (75.7%) of the patients were male and 78 (24.3%) were female. 55 % of cases were due to traffic accidents. Patients Middle Ages group was 60%. Coexisting injuries, found in 25% of the patients aggravated the prognosis. Blood grouping pattern in SHI were B+, A+ and O+ 36.1, 28 and 24.3% respectively.45% of the patients had Tattoo which was aggravating factors. The outcome is highly correlated with GCS’ values. CT scan findings revealed that patients with subdural hygroma after few days of admission CT scan which was very important prognostic factors in SHI.</p> <p><strong>Conclusions: </strong>SHI has high mortality and morbidity in today world as it has a high negative impact on young people, especially men with blood group B+. The age of the patient, presence of Tattoo, GCS at admission, the CT scanning at admission and CT scanning after a week of admission were significant predictors of outcome.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Cerebral revascularization by EC-IC bypass in ischemic conditions of different etiologies 2020-04-09T18:15:28+00:00 Forhad H Chowdhury Mohammod Raziul Haque Jalaluddin Muhammad Rumi Maliha Hakim Sharif Uddin Khan Mainul Haque Sarker <p><strong>Background</strong>: Even after the failure of EC-IC bypass trial, EC- IC bypass can help many patients in preventing future stroke. Here we present a case series of patients with cerebral ischemia from different etiological modes who underwent EC-IC bypass with positive end results.</p> <p><strong>Methods</strong>: Patients in these cases series with TIA/stroke/recurrent stroke were evaluated clinically for the history of TIA or recurrent/hemodynamic TIA (in rest or during work) or progressive hemiparesis/aphasia/visual disturbances or sudden hemiplegia/hemiparesis/aphasia with subsequent significant (days to a week) recovery. MRI of the brain was done in ischemic protocol in all cases. To see the arterial pathology dynamic CTA was also done in all cases except one case. DSA was done in 03 cases. When clinical features, cerebral ischemia on MRI and arterial stenosis/occlusion on angiogram were concordant with each other, only then cerebral revascularization was done. After bypass, all patients were followed up regularly. All recorded data were reviewed retrospectively.</p> <p><strong>Results</strong>: Total no. of cases were 08. The most common presentation was hemiparesis. Etiologies were infective thrombosis of ICA, orbital cellulitis, thrombosed giant ICA aneurysm, single &amp; multiple vessel occlusion and MCA stenosis. High flow EC-IC bypass was done in one case. STA- MCA bypass was done in rest of the cases. All patient were ambulant with static neuro-status without new stroke till last follow up. All bypasses were patent and functioning till last follow up (clinical, Doppler/Imaging).</p> <p><strong>Conclusion</strong>: In carefully selected cases cerebral revascularization in ischemic conditions can result positive outcome.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Romanian Neurosurgery A technical note 2020-06-16T11:49:44+00:00 Samer S. Hoz Zaid Aljuboori Zahraa F. Al-Sharshahi <p>The Liliequist membrane is a critical membrane located at the base of the brain separating the supratentorial from the infratentorial cisterns. The advantages of Liliequist membrane fenestration as a critical part of the pterional trans-Sylvian approach for ruptured anterior circulation aneurysm clipping is not well established. We demonstrated that the fundamental role of Liliequist membrane fenestration is brain relaxation through the egress of CSF that is not usually gained from other modalities (e.g., placement of a lumbar drain, fenestration of lamina terminalis) in this specific setting.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Intraventricular dissemination of the pilocytic astrocytomas in an adult 2020-06-16T12:30:26+00:00 Vijay P. Joshi Ashwin Valsangkar Satish Nivargi Anish Dekhne Amit Agrawal <p>Pilocytic astrocytoma (PA) is a subset of gliomas characterized by a benign course with an excellent prognosis and rarely metastasizing or spreading along the neuraxis. We report a case of a 56-year female with intraventricular dissemination of pilocytic astrocytoma in an adult and discuss the clinical significance diagnosis and management including the peculiar pattern of dissemination of the pilocytic astrocytoma. The course of the disseminated disease may not be as good as that of patients with localized recurrence or totally resected primary disease and can vary from rapid progression to prolonged stabilization.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Solitary plasmacytoma of occipital bone 2020-06-16T13:11:01+00:00 Rajneesh Misra Sushil Kumar Sandeep Sharma Rohan Sinha <p>We report a case of a 35-year-old male who presented with a pulsatile swelling in the posterior parieto-occipital area. CT and MRI revealed an extra-axial mass. Gross total resection was performed. Histologically it was found to be a plasmacytoma. No recurrence has been noted in the last 48 months of follow up.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Headache, seizures and loss of consciousness in an elderly male following groin hernia surgery 2020-06-16T13:49:09+00:00 Amit Agrawal <p>Headache after lumbar puncture is a common occurrence and have a benign course in the majority. In rare cases, it can be a mani­festation of rare but potentially life-threatening intracranial complications. We discuss a case of 65 years male patient who was operated for left inguinal hernia under spinal anaesthesia, had persistent headache partial response to conservative measures developed one episode of seizures and lapsed into altered sensorium. Imaging findings were suggestive of extensive left frontal-temporoparietal acute SDH with mass effect and midline shift. The hematoma was evacuated and the patient recovered well. Prolonged and persistent post-dural puncture headache complicated by atypical neurological deterioration following spinal anaesthesia should prompt the physician to consider the possibility of intracranial complications and to seek immediate radiological investigations.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Safety and efficacy of mini doppler in recurrent pituitary tumours 2020-06-16T14:09:31+00:00 Moshiur Rahman Ezequiel Garcia-Ballestas Luis Rafael Moscote-Salazar <p><strong>Background:</strong> Pituitary surgery is the most common surgery used to remove pituitary tumours. The use of mini doppler in surgical removal of an endonasal pituitary tumour has shown good short-term clinical outcomes and few complications in patients. Cavernous sinus invasion limits the surgical excision and still a challenge of gross total resection. &nbsp;</p> <p><strong>Objective:</strong> The main objective of this study is to evaluate the outcome of surgical removal of an endonasal pituitary tumour using mini doppler.&nbsp; &nbsp;</p> <p><strong>Method: </strong>A total of 12 patients were studied retrospectively from 2012 to 2018 in a single institution (Private hospital) in Dhaka, Bangladesh. The male and female ratio was 7:5.</p> <p><strong>Results: </strong>92% of cases of the total number of patients had satisfactory removal/ neurological improvement/hormonal improvement. Among 12 cases, 8 cases had transient diabetes insipidus and one patient had CSF leak.<strong>&nbsp; </strong>&nbsp;</p> <p><strong>Conclusion:</strong> The intraoperative Doppler is a useful tool to localize the carotids, which provides safer resection of endonasal pituitary tumours. Thus, it is very safe and effective for laterosellar resection of recurrent pituitary tumours and for cavernous sinus invasions.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Surgical management of intramedullary spinal cord metastasis 2020-06-16T15:02:57+00:00 A. Khelifa W. Bennabi L. Berchiche B. Yakoubi F. Aichaoui A. Morsli <p>Intramedullary spinal cord metastasis (IMSCM) is a rare complication of malignancies still studied by case reports; although surgery is related with the best results, the management is still debated considering the risks and the low life expectancy; in fact, many authors prefer conservative management (radiotherapy, chemotherapy), and so less than 200 cases reported in the literature with patients IMSCM were treated surgically; reporting such cases will help to understand the pathology and elaborate a clear management protocol. We report three cases of IMSCM operated at our department; in those patients, the intramedullary lesions revealed the primary tumours.&nbsp; &nbsp;&nbsp;</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Malfunction of a ventriculoperitoneal shunt during pregnancy 2020-06-16T15:36:04+00:00 A. Haidara Diallo O. A. Tokpa H.A. Nda K.S. Yao <p>Bringing a pregnancy to term is possible for a woman carrying a ventriculoperitoneal bypass valve, however, pregnancy can be a source of malfunction of the bypass system. We report two cases of malfunction of a VPS during the pregnancy's 3rd trimester in two patients aged 25 and 30 years respectively. The valve was examined in both cases and the persistence of the neurological signs required a cesarean section. The diagnostic aspects and management strategies were discussed as regards these two cases and throughout the literature review.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Cranium metastasis of HPV positive oropharyngeal squamous cell carcinoma 2020-06-16T16:18:48+00:00 Gokhan Canaz Huseyin Canaz Sabri Aydin <p>Head and neck squamous cell carcinomas rarely cause cranial metastases, but HPV related subgroup is known for unusual metastasis sites on the body. Despite the good overall treatment responses in this group, intracranial metastases are always accepted as a sign of rapid deterioration. We present a case of cranium metastasis of HPV related oropharyngeal squamous cell carcinoma, which had been very well responded to the treatment for years but deteriorates in a short period after the cranium metastasis.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020 Contribution of memory evaluation in temporal epilepsy surgery 2020-06-16T16:56:39+00:00 H. Lelklou M. Djellaoui H. Si Ahmed B. Yakoubi <p>Memory assessment is a crucial step in the pre-surgical assessment of temporal epilepsy. Indeed, it participates to a certain extent in the process of localization of the epileptogenic zone and also makes it possible to anticipate the possible risks of surgical treatment on the memory.<br>We propose to specify the contribution of memory evaluation in 60 patients’ candidates for temporal epilepsy surgery, in terms of localization of the “epileptogenic zone” and in the appreciation of the risk of postoperative memory decline.</p> 2020-06-15T00:00:00+00:00 Copyright (c) 2020