Romanian Neurosurgery 2020-04-05T10:21:21+00:00 Dr Stefan Mircea Iencean Open Journal Systems <p>Call for Papers -&nbsp;Vol. XXXIV, No. 2 (June 2020)<br>Submission Deadline: May 1, 2020</p> Overview of patients with vascular pathology and cost analysis of medical care – research market for an entrepreneurial project 2020-03-17T08:23:51+00:00 Aurelia Mihaela Sandu Adrian Mircea Fürtös Radu Mircea Gorgan <p><strong>Introduction</strong>: Brain vascular pathology, aneurysms, arteriovenous malformations (AVMs), cavernomas, dural arteriovenous fistulas (DAVF), venous angiomas and capillary telangiectasia, represents a serious health problem worldwide.</p> <p><strong>Aim</strong>: The aim of this article is to perform an analysis of patients with brain vascular pathology and to analyze costs of health services, a research market for an entrepreneurial project, in order to design guidelines for patients’ selection and treatment.</p> <p><strong>Material and methods</strong>: We performed an observational, descriptive study of patients with vascular pathology, from 2018 to 2019.</p> <p><strong>Results</strong>: A total of 153 patients with brain vascular pathology were admitted in our department. Mean age was 49.53 ± 13.997 years. Sex ratio was 0.86. Mean hospital stay was 11.33 ± 13.724 days. Seventy-four patients (48.37%) underwent surgery. Seventy-eight patients (50.98%) had cerebral aneurysms. Complications were seen in 24 patients (30.77%) and vasospasm in 32 cases (41.03%). Thirty-six patients underwent surgery. Outcome was favorable, according to mRS(p=0.001) and Karnofsky score(p=0.006).Thirty-three patients (21.57%) had brain AVMs. Twenty patients underwent surgery. Complications were seen in 4 cases (12.12%). The outcome was favourable, according to mRS(p=0.001) and Karnofsky score (p=0.002). Thirty-nine patients (25.49%) had cavernomas. Surgery was performed in 18 cases. The outcome was favourable, according to Engel Epilepsy Surgery Outcome Scale, mRS (p=0.000) and Karnofsky score (p =0.000). Costs of health services were correlated with longer hospitalization, higher mRS, lower Karnosfsky score, presence of complications and presence of vasospasm.</p> <p><strong>Conclusions</strong>: Proper treatment of brain vascular pathology ensures a favourable outcome. Adequate patients’ selection and choosing the best treatment can reduce costs. Surgery is the treatment of choice in ruptured aneurysms, AVMs and cavernomas. Early surgery, with specific treatment of the vascular lesion and removal of intracranial blood ensures a better outcome, with lower medical costs. Prevention of complications, aggressive treatment of vasospasm reduces medical costs.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Management of a patient with acute internal hydrocephalus, ventriculitis and bronchopneumonia 2020-03-17T08:23:51+00:00 Balasa Daniel Tunas Alexandru <p>A 69-year-old patient, with a long history of lung tuberculosis, with&nbsp;lymphopenia was emergently admitted in our hospital for bronchopneumonia, ventriculitis, acute internal&nbsp;hydrocephalic. He was aggressively treated with iv Meropenem and Vancomycin, intraventricular high doses of Vancomycin, aerosols, Dexametazone with healing of internal hydrocephalus, ventriculitis and improvement of bronchopneumonia.</p> <p><br> </p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Accuracy of 2D Fluoroscopy with Preoperative CT Fused Neuronavigation in Thoracic and Lumbar Pedicle Screw Insertion 2020-03-17T08:23:50+00:00 Adrian Bălașa Corina-Ionela Hurghiș Flaviu Tămaș Ioan-Alexandru Florian Levente Peter Rareș Chinezu <p><strong>Aim:&nbsp;</strong>Pedicle screw fixation is an established technique in the lumbar and thoracic area. Fluoroscopy-guided screw placement and subsequently navigation have decreased the rate of misplaced screws, but no technique has wholly eliminated this risk. This paper aims to study the difference between the accuracy of the fluoroscopic guided screw placement to that of the 2D fluoroscopy- preop CT fused neuronavigation guided technique, a lesser-used navigation technique.&nbsp;</p> <p><strong>Material and Methods:</strong> This retrospective study reflects our results using both techniques between March 2018 and March 2019 in both degenerative or traumatic spinal pathology for thoracic and lumbar regions. The accuracy of the screw placement was measured using Mirza grading system on postoperative CT images.</p> <p><strong>Results</strong>: A total number of 56 patients underwent spinal instrumentation surgery. A total of 274 screws were placed with a mean number of 4.89 screws per patient; 199 screws were implanted using neuronavigation and 75 using the freehand-2D fluoroscopy-guided technique.&nbsp; The accuracy rate of pedicle screw placement in the freehand technique guided by 2D fluoroscopy was 88,00%. With the use of neuronavigation, the accuracy increased to 89,96%.</p> <p><strong>Conclusion:</strong>&nbsp; Pedicle screw placement accuracy is higher when guided by CT-fluoro matching neuronavigation compared to freehand fluoroscopy-guided technique and can be used in departments where there is no intraoperative O-arm or 3D fluoroscopy available.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## A rare case of pituitary macroadenoma with synchronous suprasellar meningioma. 2020-03-17T08:23:50+00:00 Bogdan Ionut David Ligia Gabriela Tataranu Vasile Gheorghe Ciubotaru Aurelia Mihaela Sandu Radu Mircea Gorgan <p>Synchronous tumours can be found all along the entire neuraxis, however, some lesions are far less likely to coexist. One of these extremely rare associations is between GH-pituitary adenomas and suprasellar meningiomas. A wide spectrum of transcranial and transsphenoidal approaches were described in the literature for either sellar, suprasellar and parasellar lesions, but no agreement has been reached for the cases of simultaneous occurring lesions.</p> <p>We present a rare case of a woman with GH-secreting pituitary adenoma and concomitant suprasellar meningioma. The strategy chosen was sequential transsphenoidal surgeries. However, after the first surgery, the remaining tumour mass did not mobilize as expected due to gravity, hence we decided to perform a transcranial subfrontal unilateral approach. Surprisingly, the second surgery revealed a different histopathological result.</p> <p>Association of a GH-pituitary adenoma and suprasellar meningioma is very rare, only 17 cases being reported in the relevant literature so far.&nbsp; Different authors prefer different strategies, ranging from only transsphenoidal to simultaneous transsphenoidal and transcranial approaches, but no general consensus was established.</p> <p>In conclusion, the existence of synchronous tumours of the sellar region should be taken into account when imaging studies reveal an intracranial mass developing both sellar and suprasellar. The surgical strategy should be tailored to every specific patient and experience of the neurosurgeon.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Microsurgical clipping of paraclinoid aneurysms 2020-03-17T08:23:49+00:00 Mugurel Radoi Ram Vakilnejad Suditu Stefan Florin Stefanescu <p><strong>Background</strong>. Paraclinoid aneurysm is a nonspecific term that includes ophthalmic segment aneurysms and distal cavernous internal carotid artery (ICA) aneurysms. The literature mostly described the frequency to be in the range of 1.3-5%. and a high incidence of being multiple or having a large size.</p> <p><strong>Methods</strong><em>.</em> A retrospective review of 18 consecutive patients surgically treated for paraclinoid aneurysm was performed. The data of all our consecutive patients were searched to obtain patient and aneurysm characteristics, treatment details, complications and follow up. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 3 to 62 months (mean 26 months).</p> <p><strong>Results</strong><em>.</em> Surgical clipping was performed for 15 ruptured paraclinoid aneurysms; only in 3 cases the aneurysm was unruptured. Post-operative control angiography was performed in 10 patients (55.56%), from which we reported a full occlusion of the aneurysm in 9 patients (90%). Best results were obtained in patients who preoperatively were included in 1<sup>st</sup> and 2<sup>nd</sup> grade of Hunt &amp; Hess scale. Two months postoperative follow-up was complete for all but one patient who died 12 days after surgery, from cerebral ischemia resulting from severe cerebral vasospasm. There were excellent and good results (mRS 0–2) in 88% of the cases (15 out of 17 patients) at two months follow-up, and 94% (16 out of 17 patients) at six months follow-up. Three patients with slight disabilities, ranked mRS 1-2 at two months follow-up, improved to mRS 0, with no symptoms at all, at 6 months postoperative control. All 3 patients with a surgically treated non-ruptured paraclinoid aneurysm had an excellent outcome (mRS 0).</p> <p><strong>Conclusions</strong>. Most appropriate treatment is to occlude aneurysms without compromising patency of the parent artery. Anterior clinoidectomy and microsurgical clipping can still be a standard treatment despite of recent development of endovascular coiling procedures.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Management of facial paralysis following treatment of neurosurgical tumours 2020-03-17T08:23:52+00:00 Costan V. V. Ciofu M. L. Sava F. Boisteanu O. Dabija M. <p>The purpose of this study is to present our experience on improving the quality of life of patients with facial paralysis due to an operated intracranial tumour, by performing minimally invasive static reanimation procedures. We reviewed the clinical information pertaining to neurosurgical patients with facial paralysis that underwent static reanimation. The study included 11 patients with complete facial nerve paralysis of all nerve branches, that reported different primary complaints upon presentation. The performed procedures consisted of gold plate insertion into the superior eyelid, inferior eyelid ectropion correction or suture suspension. The functional results were favourable in all cases and the resulting appearance was acceptable. The choice of the different techniques used is discussed. Good outcomes are possible using static reanimation with an adequate adaptation of the techniques to the main patient complaint.</p> 2019-12-16T00:00:00+00:00 ##submission.copyrightStatement## Mechanical thrombectomy techniques for acute ischemic stroke 2020-03-17T08:23:49+00:00 A. Chiriac Georgiana Ion N. Dobrin Dana Turliuc I. Poeata <p>Mechanical thrombectomy technique was introduced as an effective and secure method in acute ischemic stroke patients suffering from intracranial large vessel occlusion (LVO). In this article, we will review the main mechanical thrombectomy techniques and current trends in this type of treatment for acute ischemic stroke.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## The tumour volume influence on tumour recurrence and progression-free survival in the case of atypical meningiomas 2020-03-18T08:23:57+00:00 A. I. Cucu Claudia Florida Costea Mihaela Dana Turliuc Cristina Gena Dascalu Ioana Jitaru R. Dinu Gabriela Dumitrescu Anca Sava B. Dobrovat Camelia Bogdanici T. Andrei I. Stirban I. Poeata <p><strong>Objective: </strong>The objective of our study was to evaluate a possible relation between the volume of atypical meningiomas (AMs) and the risk of tumour recurrence, as well as progression-free survival (PFS).</p> <p><strong>Material and methods</strong>: We evaluated 81 patients diagnosed with AMs (WHO grade II meningioma) who have undergone surgery at the "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi between January 1, 2010, and December 31, 2019. The recorded data were demographic and imagistic (MRI, contrast-enhanced T1WI). We calculated the tumour volume prior to the surgery and evaluated the tumour recurrence using MRI at 12, 24, 36, 48 and 60 months after the surgery.</p> <p><strong>Results</strong>: 50.6% of patients had meningioma volume &lt; 26.4 cm<sup>3</sup>. Women had larger tumour volumes than men (52.6%). Patients of age ≤ 60 years old, had tumour volumes ˃ 26.4 cm<sup>3 </sup>in 58.5% of cases and meningiomas with volumes ˃ 26.4 cm<sup>3</sup> recurred earlier (<em>p=0.010</em>). Also, patients who had tumour volumes ˃ 26.4 cm<sup>3</sup>, had a shorter PFS (40.976 months), compared to patients with tumour volumes &lt; 26.4 cm<sup>3</sup>, who had better PFS (53.4 months).</p> <p><strong>Conclusions</strong>: the tumour volume of AMs ˃ 26.4 cm<sup>3</sup> represents a negative prognostic factor for both early tumour recurrence and reduced PFS.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Puncture site bleeding complications in patients with Clopidogrel hyper-response 2020-03-17T08:23:48+00:00 Nedeljković Žarko Vukasinović Ivan Majstorović Branisalva Milosević Medenica Svetlana Milićević Mihailo Ilić Rosanda Aleksić Vuk Paunović Aleksandra Stanimirovic Aleksandar Scepanović Vuk Milić Marina Todorović Marko Milisavljević Filip Grujičić Danica <p>Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations 2020-03-17T08:23:48+00:00 Bindu A. V. Orlov M. Yu. Litvak S. O. M. V. Yeleynik <p><strong>Objective.</strong>&nbsp;to assess the frequency, risk factors and clinical and neurological consequences of intraoperative rupture of arterial aneurysm (AA) of the brain (B) in clipping operations of the B AA .</p> <p><strong>Materials and approaches</strong>. A retrospective analysis of microsurgical operations clipping of cerebral aneurysms in 1449 (100%) patients for the period from 2011 to 2018 was performed, of which 141 (9.73%) cases had intraoperative rupture of the aneurysm (IORA). Preoperative examination: clinical and neurological examination, CT of the brain, cerebral angiography( CAG), duplex scanning of the main vessels of the head and neck. The analyzed criteria are risk factors of IORA: AA size, localization, shape, duration of surgery after the primary rupture of AA, the presence of hypertension and the patient's condition before surgery.</p> <p><strong>Results</strong>. The frequency of IORA in clipping operations of B AA was 9.73% (141 patients) in a series of observations 1441 (100%). Most often IORA-141 (100%) was registered in clipping operations of AA of complex ACA-AcomA (86 (61%) cases out of 141 (100%)). IORA is possible at all stages of the operation with the maximum frequency of contact breaks – 135 (95.74%); the rarest-6 ( 4.26%)&nbsp; -&nbsp; non - contact IORA (at the stage of craniotomy)&nbsp; was recorded. At the preoperative stage, the vast majority of patients with subsequent IORA were diagnosed with cerebral edema, AA of large size, atherosclerotic changes in the aneurysm-affected segment of the artery and cervical areas of the aneurysm, high blood pressure during surgery, adhesive arachnoid changes. At the time of discharge from the hospital, according to the Glasgow results scale: 69 (48.94%) full or partial restoration of labor activity, 18 (12.77%) had limited daily activities without the need for outside assistance, 37 (26 24%) deep disability ) Deaths were in the group of "contact" IORA -&nbsp; 17 (12.06%). At 6 ( 4.26%) of "non-contact" IORA,&nbsp; a deepening of initial neurological symptoms was recorded with a suppression of the level of consciousness, the addition of pyramidal insufficiency, speech impairment and psycho-organic syndrome, and a deepening of the phenomena of initial cerebral arterial vasospasm.</p> <p><strong>Conclusions<u>.</u></strong>&nbsp;IORA is predominantly in contact with a frequency of occurrence-9.73 %. The most common risk factors for IORA were: cerebral edema, large AA, atherosclerotic changes in the aneurysm-affected artery segment and cervical aneurysm sites, high blood pressure during surgery, adhesions arachnoid changes. IORA leads to deepening of initial neurological symptoms, phenomena of initial vasospasm of cerebral arteries with the level of total mortality-17 (12.06%).</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Surgical challenges and outcome of endoscopic endonasal approaches in the management of recurrent pituitary adenomas 2020-03-17T08:23:47+00:00 Ahmed Nageeb Mohamed Taha Hosam Shata Mohamed Mahmoud Saad Mohamed <p><strong>Background</strong>: Various surgical approaches for the management of midline anterior skull base meningiomas exist in the literature. The main surgeon target is proper selection the appropriate approach that achieves total removal of the lesion without causing morbidity or mortality and facilitates safe effective removal of the tumor.</p> <p><strong>Objectives<em>:</em></strong> To evaluate the role of the extended pterional approach for excision of midline anterior skull base meningiomas as regard the effectiveness, extent of resection and surgical outcome.</p> <p><strong>Patients and methods: </strong>This retrospective study involved 23 cases with midline anterior skull base meningiomas resected through the extended pterional approach. Patients' clinical data, operative notes, imaging studies and clinical follow-up data were analyzed and evaluated.</p> <p><strong>Results:</strong> Tumors studied were 9 olfactory groove meningiomas, 8 tuberculum Sellae meningiomas, 4 planum sphenoidale meningiomas and 2 diaphragma sellae meningiomas. Gross total resection tumor excision in 15 cases (64.5%), subtotal excision in 5 cases (21.5%) and partial excision in 3 cases (14%). Complications were diabetes insipidus (2 cases 8.6%), CSF rhinorrhea (3 cases 12.9%) and visual deterioration (3 cases 12.9%). We had two cases of mortality.</p> <p><strong>Conclusion: </strong>The extended pterional approach allows safe and effective removal of midline anterior skull base meningiomas. It expands the exposure offered by the classic pterional approach and minimizing the necessity for applying fixed brain retraction with good cosmetic outcome and less approach related morbidities in comparison with the extensive skull base approaches.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## A lateral meningocele in a 48 years lady revealed by a CSF fistula 2020-04-05T10:21:21+00:00 Ibrahim Assoumane Nadhim Benmedakhene Adakal Ousseini Bachir Sabrina Nadia Lagha Sidi Said Abderahmanne Abdelhalim Morsli <p><strong>Background</strong>: Lateral meningocele is defined by the presence of protrusions of the arachnoid and the dura matter extending laterally through inter- or intravertebral foramina. It is an extremely rare condition; to the best of our knowledge, only a few cases are reported in the literature and most of them in childhood.</p> <p><strong>Case presentation: </strong>Authors reported a case of a 48 years old lady who consulted for a lombo-sacral mass right-sided with a CSF fistula. The Spinal MRI objectified a meningocele lateralized in the right side associated with multiples malformations. The patient underwent surgery and the meningocele was closed after excision of the associated subcutaneous lipoma.&nbsp;The long term outcome was favourable and the follow up was assured by clinical examination monthly in the first year.</p> <p><strong>Conclusion: </strong>Lateral meningocele is very rarely reported, it is usually associated with multiples malformations. Surgical treatment is a good option for treatment for avoiding complications. The prognostic depends on the preoperative status and the associated malformations.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Spinal intramedullary cysticercosis mimicking spinal tumour 2020-03-17T08:23:47+00:00 Ahmed Ansari Sheshank Agrawal Sadaf Riyaz <p>Neurocysticercosis is a relatively uncommon entity with even more rare spinal intramedullary variety. We present a case of cervico- dorsal intramedullary NCC mimicking spinal tumour with per operative finding mimicking abscess.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## The extended pterional approach for midline anterior skull base meningiomas 2020-03-17T08:23:40+00:00 Ahmed Nageeb Mohamed Taha Hosam Shata Mohamed Mahmoud Saad Mohamed <p><strong>Background</strong>: Various surgical approaches for the management of midline anterior skull base meningiomas exist in the literature. The main surgeon target is proper selection the appropriate approach that achieves total removal of the lesion without causing morbidity or mortality and facilitates safe effective removal of the tumour.</p> <p><strong>Objectives:&nbsp;</strong>To evaluate the role of the extended pterional approach for excision of midline anterior skull base meningiomas as regarding the effectiveness, extent of resection and surgical outcome.</p> <p><strong>Patients and methods: </strong>This retrospective study involved 23 cases with midline anterior skull base meningiomas resected through the extended pterional approach. Patients' clinical data, operative notes, imaging studies and clinical follow-up data were analyzed and evaluated.</p> <p><strong>Results:</strong> Tumors studied were 9 olfactory groove meningiomas, 8 tuberculum Sellae meningiomas, 4 planum sphenoidale meningiomas and 2 diaphragma sellae meningiomas. Gross total resection tumour excision in 15 cases (64.5%), subtotal excision in 5 cases (21.5%) and partial excision in 3 cases (14%). Complications were diabetes insipidus (2 cases 8.6%), CSF rhinorrhea (3 cases 12.9%) and visual deterioration (3 cases 12.9%). We had two cases of mortality.</p> <p><strong>Conclusion: </strong>The extended pterional approach allows safe and effective removal of midline anterior skull base meningiomas. It expands the exposure offered by the classic pterional approach and minimizing the necessity for applying fixed brain retraction with good cosmetic outcome and less approach-related morbidities in comparison with the extensive skull base approaches.</p> 2020-03-16T00:00:00+00:00 ##submission.copyrightStatement## Computed tomography-based morphometric measurements of the atlas (C1) posterior arc 2020-03-17T08:23:46+00:00 Yasar Karatas Bulent Kaya Mehmet Fatih Erdi Fatih Keskin Densel Arac Emir Kaan Izci Mehmet Uyar Ali Sami Kıvrak Erdal Kalkan <p><strong>Study design: </strong>Single-center retrospective study</p> <p><strong>Objectives:</strong> This study is performed to determine the anatomic feasibility of the C1 posterior arc screw and help select an optimal screw trajectory in treating patients with craniovertebral junction pathologies.</p> <p><strong>Material and Methods: </strong>We reported a single-centre retrospective study. Forty patients (20 male and 20 female) who underwent cervical computed tomography (CT) were chosen from the hospital records. Based on CT images, we measured left laminar length (LLL)<strong>, </strong>right laminar length (RLL), left laminar angle (LLA), right laminar angle (RLA), left laminar axial thickness (LLAT), right laminar axial thickness (RLAT), left laminar coronal thickness (LLCT), right laminar coronal thickness (RLCT), and craniocaudal angle (CCA) of the C1 posterior arc.</p> <p><strong>Results:</strong> The mean values and standard deviations (SD) for nine parameters at the C1 posterior arc were determined. LLL, RLL, LLCT, and RLCT were statistically longer in men than women. RLAT was bigger in men but there was no statistical difference. RLA was statistically wider in women than men. LLA and CCA were wider in women but there was no statistical difference, LLAT was bigger in women but there was no statistical difference. There was no statistical difference in measurements by age.</p> <p><strong>Conclusion:</strong> &nbsp;The results of this study are important to avoid neurovascular injury and pedicle breakage because of choosing large screw while performing C1 laminar screw fixation.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Intraventricular arachnoid cyst of lateral ventricle in an elderly patient 2020-03-17T08:23:46+00:00 Rajneesh Misra Sushil Kumar Sandeep Sharma Pankaj Bharadva <p>Arachnoid cysts are usually located in relation to the arachnoid cisterns. Intra-ventricular location is rare and its embryological emergence in this site is controversial. We report a large intra-ventricular cyst in a 61-year-old female who presented with decreased vision, headache and right hemiparesis. MRI was suggestive of cystic lesion in the lateral ventricle and was excised completely through a craniotomy.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Intraneural synovial sarcoma of median nerve 2020-03-17T08:23:45+00:00 Sandeep Bhardwaj Anil Kansal Rohit Bansal Rakesh Sharma 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. &nbsp;Although originally believed to arise from synovium, these tumours have been found to occur anywhere in body<sup>1,2</sup>. 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> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Microbiota Gut-Brain Axis and Neurodegenerative Disease 2020-03-17T08:23:45+00:00 Poluyi Edward Oluwatobi Imaguezegie Grace Ese Poluyi Abigail Oluwatumininu Morgan Eghosa <p>This review highlights the microbiota gut-brain axis and neurodegenerative diseases excluding studies on animal models. Gut microbiota is capable of modulating some brain activities via the microbiota gut-brain axis. A bidirectional communication exists between the gastrointestinal (GI) tract and the central nervous system (CNS) in the microbiota gut-brain axis. Gut dysbiosis has been linked to neurodegenerative diseases as a result of the imbalance in the composition of its microbiota, which has a damaging effect on the host’s health<strong>. </strong>The association between the role and mechanism of CNS disease and gut microbial is yet to be fully explored. Although some studies have shown a positive relationship between a rich diverse microbial community and the brain of the host, and a negative relationship between microbial dysbiosis, intestinal infection and human brain health, our knowledge, however, is limited due to the inability to identify the major players in this heterogeneous microbial community.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Association of platelet count and platelet indices with cranial meningioma 2020-03-17T08:23:44+00:00 Yasar Karatas Fatih Keskin Mehmet Fatih Erdi Bulent Kaya Densel Arac Emir Kaan Izci Erdal Kalkan <p><strong>Introduction and Objectives:</strong> In this study, we aimed to investigate whether platelet count (PLT) and platelet indices included mean platelet volume (MPV), platecrit (PCT), platelet distribution width&nbsp; (PDW) values can be used as diagnostic markers in cranial meningiomas.</p> <p><strong>Materials and Methods:</strong> The study included results of 29 patient and 47 healthy contributors. Based on pathologies, the patients were divided into two groups. The first group included meningioma patients and the second one included healthy individuals. Healthy contributors named control group. Platelet count and platelet indices were determined using Sysmex XN 550 haematology analyzer. The preoperative platelet count (PLT) and platelet indices included mean platelet volume (MPV), platecrit (PCT), platelet distribution width&nbsp; (PDW) values were recorded from the routine laboratory tests.</p> <p><strong>Results:</strong> There was no statistically significant difference in PLT between the meningioma and healthy groups (p = 0.217)<strong>.</strong> There was a statistically significant difference in PCT between the meningioma group and the healthy group (p = 0.002). There was a statistically significant difference in PDW between meningioma group and healthy group (p = 0.001). In terms of MPV, there was a statistically significant difference between meningioma group and the healthy group (p = 0.001)</p> <p><strong>Conclusion:</strong> Platelet count and indices are easily available in the routine blood tests. Despite the retrospective design and small sample size, our findings suggest that altered MPV, PDW and PCT levels might serve as potential biomarkers for the diagnosis of meningiomas.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Fast growing recurrent grade I meningioma 2020-03-17T08:23:44+00:00 Prashank Goel Daljit Singh <p>Meningiomas are mostly regarded as benign tumours, accounting for 13% to 26% of all primary intracranial tumors<sup>1</sup>. According to 2016 World Health Organization (WHO) classification, meningiomas are classified into grade I (benign), II (atypical), and III (anaplastic).<sup>2</sup> Meningioma&nbsp;are neoplasms derived from arachnoidal (meningothelial) cells. These lesions can occur in people of any age but commonly present in middle age. Women are more likely to develop a meningioma, with a female/male ratio of approximately 2:1 intracranially and 10:1 in the spine.<sup>3</sup> Even after complete removal, meningiomas have been estimated to recur in 10 to 32% of the cases within 10 years. However, recurrences in grade 1 meningiomas are rare and occur after long duration.<sup>4</sup> We herein report a case of grade 1 meningioma that recurs very fast, within the duration of 1 yr and the recurrent size of the tumor was approx three times the size of the primary one. To our knowledge, very few cases in the literature have been reported with such a fast-growing grade 1 meningioma.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## A giant occipital encephalocele 2020-03-17T08:23:43+00:00 M. Al-Zekri F. Aichaoui A. Khelifa A. Morsli <p>Occipital encephalocele is a rare congenital anomaly that is characterized by herniation of brain tissue through a defect in the skull. Because of their enormous size, they pose a surgical challenge. Occipital encephalocele is the commonest of all encephalocele; the management of encephalocele defects requires immediate surgical closure. The author reports a case of a five months old female baby who presented a progressively increasing swelling over the occipital region. This swelling was present since birth. Surgery was planned to reduce the size of the swelling as well as its contents. The sac was excised and reduced sufficiently enough to accommodate the healthy-looking brain tissue. This infant did well postoperatively.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Early diagnosis and management of traumatic dura tear with brachial plexus injury without spinal lesions in childhood 2020-03-17T08:23:43+00:00 A. Khelifa L. Berchiche I. Assoumane M. Al-Zekri B. Yakoubi A. Morsli <p>Although the dura is a thick membrane, it could be severed in spine surgery and less frequently by a traumatism (7,8,10); in this case, it is usually accompanied with bone or ligamentous injury (2). Rare cases are reported of a traumatic dura tear without spinal lesion and would suspect in the first place a brachial plexus injury (2,8). Dura tears are rarely seen in childhood (3). We report a case of early diagnosis of dura tear in brachial plexus injury without bone or <em>ligamentous</em> lesions on a child of 4 years old and we discuss the diagnostic and treatment modalities.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Lumbar unilateral laminotomy for bilateral decompression in lumbar spinal stenosis 2020-03-17T08:23:42+00:00 Amin Sabry Wael Zakarya Amr Farid Khalil <p><strong>Background:</strong> Multiple surgical approaches are existing for the management of lumbar canal stenosis.</p> <p><strong>Objective:</strong> This study was conducted to assess the outcomes of unilateral laminotomy with bilateral decompression in such cases.</p> <p><strong>Patients and methods:</strong> This prospective study was conducted at Mansoura University Hospitals, and we included a total of 12 cases with lumbar canal stenosis. All cases underwent unilateral laminotomy with bilateral canal decompression during the period between July 2017 and July 2018. Post-operative outcomes included ODI, and VAS score for both leg and back pain.</p> <p><strong>Results:</strong> The age of the cases ranged between 38 and 62 years. We included 7 males and 5 females. ODI, lower extremity, and back pain showed a significant decrease after the operation (p &lt; 0.05).</p> <p><strong>Conclusion:</strong> &nbsp;&nbsp; Unilateral laminotomy with bilateral canal decompression is a safe and feasible approach to managing LSS. Excellent outcomes are expected regarding leg pain and quality of life, while slight improvement is anticipated regarding low back pain.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Glioblastoma of septum pellucidum 2020-03-17T08:23:42+00:00 Rajneesh Misra Sushil Kumar Kundan Kumar <p>A rare case of glioblastoma multiforme (GBM) of septum pellucidum is being reported. There were symptoms of altered behaviour, memory and changes in sensorium. The MRI was suggestive of a tumour arising from the septum pellucidum. Glioblastomas arising from septum pellucidum are rare. While even a partial endoscopic excision of the more common pathology viz. colloid cyst is acceptable, only, a safe maximal excision of a highly malignant pathology like glioblastoma is an acceptable goal in order to give any benefit of surgical exploration to the patient.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Efficacy of c-arm scopy-guided erector spinae plane block (ESPB) in postoperative pain control and reduction of opioid side effects in spinal instrumentation surgery 2020-03-17T08:23:41+00:00 Yasar Karatas Fatih Keskin Mehmet Fatih Erdi Bulent Kaya Ibrahim Kosemen Mehmet Kenan Erdal Kalkan1 <p><strong>Background: </strong>Spinal instrumentation surgery causes significant pain in patients. As a result, patients are exposed to excessive opioid use and the associated side effects, as well as prolonged hospital stay, resulting in economic burden. Local anaesthetics can help both reduce postoperative pain and minimize the side effects associated with systemically administered opioid analgesics.</p> <p><strong>Objective: </strong>The aim of this retrospective study was to investigate the effect of erector spinae plane block on analgesia in spinal instrumentation surgery and to reduce the side effects of excessive opioid use.</p> <p><strong>Materials and Methods:</strong> We reported a retrospective study. Thirty patients, who underwent spinal instrumentation surgery from 2017 to 2018, were chosen from the hospital records. We performed spinal instrumentation and decompression by laminectomy to all patients under general anaesthesia. While 15 of these patients underwent erector spinae plane block, these patients received patient-controlled analgesia postoperative period. The other 15 patients received only patient-controlled analgesia postoperative period. We analyzed patients' data for differences in preoperative and postoperative visual analogue scores, nausea vomiting scores, constipation life quality scale, patient-controlled analgesia shot count and mean opioid consumption of patients.</p> <p><strong>Results: </strong>The data of 30 patients undergoing lumbar spinal instrumentation surgery were retrospectively analyzed. There was no significant difference in the age, preoperative VAS, preoperative ODI and sex between the two groups (p˃0,05). In addition, there were statistically significant differences in postoperative VAS, postoperative ODI, Nausea Vomiting Score, Constipation Life Quality Score (CLQS), petidin consumption and PCA shot count (p &lt;0.05). In all variables with significant differences, the values ​​in the block group were lower than the non-block group.</p> <p><strong>Conclusion: </strong>ESPB provides effective analgesia and reduces side effects due to excessive opioid usage.</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## The role of strict patient-positioning during nursing in the management of intracerebral migration of gravitational bullet injury 2020-03-17T08:23:41+00:00 Samir H. Aldelfi Salima B. Alsaadi Mohammed Maan AbdulAzeez Mukarram N. Musarhad Mohammed D. Khudhair Samer S. Hoz <p>The intracranial migration of bullet was described in literature since Cushing time and the First World War [1]. The literature is still away from delivering a clear guideline and constitutes more of case reports rather than comprehensive well-designed studies [2-13], this mostly due to the variability and diversity in the presentation and management of such cases. The migration of bullet can be a sequel of any type of penetrating injury to the skull [14]. Intracranial migration after gravitational (falling) bullet injury is a unique type of injury that constitutes of significant human and material losses with differences in biomechanics and structural brain changes after the insult especially regarding the velocity of impact and the degree of yaw for the intracranially settled bullet [15]. The gravitational bullets injuries are considered by the international disease classification system as celebratory firing, that is quite common and is part of the traditional happy (marriage) or funeral event in the middle east in general and in rural areas of Iraq in particular, and also reported in some areas around the world (South America, North Africa, and middle of Asia) [15,16].</p> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Clinical spectrum of paediatric head injury. A prospective study from tribal region 2020-03-17T08:23:40+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 the paediatric population with special concern to tribal regions of developing countries like India where aetiology of traumatic brain injury in the paediatric population fall from height dominant over the road traffic accident as a major.</p> <p><strong>Aim &amp; 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> 2020-03-15T00:00:00+00:00 ##submission.copyrightStatement## Resection of giant invasive thoracic schwannoma 2020-03-17T08:23:52+00:00 A. Khelifa F. Aichaoui I. Assoumane M. Al-Zekri T. Bennafaa A. Morsli <p>Even though spinal nerve sheath tumours, presented especially by schwannomas, are considered to be mostly benign; they can gain a huge size and have an invasive behaviour, causing spinal cord compression, bone destruction, and make the total removal of the tumour a real challenge for the surgeon. This type of tumours is recently described as giant invasive spinal schwannoma (GISS), this type rarely reported in the thoracic region; deserve a special studying vis-a-vis the diagnosis and the management of both the tumour and the bone destruction. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> 2020-01-15T00:00:00+00:00 ##submission.copyrightStatement##