Romanian Neurosurgery <p>Call for Papers - Vol. XXXV, No. 2 (June 2021)<br />Submission Deadline: May 1, 2021</p> London Academic Publishing en-US Romanian Neurosurgery 1220-8841 Active hydrocephalus with aqueduct stenosis to an old woman <p><strong>Introduction</strong>: Aqueduct stenosis (AS) in old people is a rare pathological entity. I report a case of a 66 years old woman with severe ataxia, cognitive deterioration, loss of sphincters control (gatism). Clinical, neuro-radiologic and therapeutic considerations are discussed.</p> <p><strong>Case presentation</strong>: A 66 years old woman with a 6 months history of mild cerebral trauma by car accident without losing consciousness, present 2 months before hospitalization severe ataxia, cognitive disorders, gatism. At the time of trauma, brain scanner performed in another institution showed minimal fronto-basal cerebral contusions and blood collection around the brain stem. One month after a new unenhanced brain scan all previous lesions are gone. At admission, an abnormal enlargement of lateral and third ventricles are remarked both on unenhanced CT and MRI scan of the brain explained by cerebral aqueductal stenosis. Ventricular open pressure was 350 mm H<sub>2</sub>O. A ventriculoperitoneal shunt with a variable pressure valve was installed. The surgery went uneventful and the patient recovered as expected. 6-month follow-up visit the patient was symptom-free, with a fine intellectual recovery.</p> G. Iacob Copyright (c) 2021 2021-10-07 2021-10-07 251 256 Particular management strategy for intraprocedural coil migration during endovascular treatment of intracranial aneurysm <p><em>Migration of coils represents one of the most challenging complications of endovascular management of cerebral aneurysms with a potentially catastrophic result. In this article, we present the successful management of a coil migration during the endovascular occlusion of an anterior communicating artery aneurysm. A stent fixation technique was used with good vascular repermeabilisation. The reported frequency, risk factors and management strategies are also discussed. </em></p> A. Chiriac N. Dobrin Georgiana Ion Z. Faiyad I. Poeata Copyright (c) 2021 2021-10-07 2021-10-07 257 261 Talk and Die Syndrome <p>The "Talk and Die" Syndrome is described as the clinical deterioration following a mild to moderate traumatic brain injury. In the face of this event, individuals are able to articulate recognizable words and then deteriorate within 48 hours of the injury. This syndrome represents a major public health challenge due to its high morbidity and mortality rate; it develops from an intracranial haemorrhage causing an increase in intracranial pressure and leading the person to a neurological crisis with focal signs, coma and later death.</p> I.D. Lozada-Martínez A. Galeano-Buelvas A.C. Pearson-Arrieta O.J. Diaz-Castillo M.G. Ortega-Sierra J.S. Robledo-Arias Juan Santiago Serna-Trejos Julio César Mantilla-Pardo D.A. Betancourt-Cundar Randy Eliecer Frias-Bechara Harold Yesid Mendez-Martinez Luis Rafael Moscote-Salazar Copyright (c) 2021 2021-10-07 2021-10-07 262 269 Essentials of nimodipine in neurocritical care patients <p>Nimodipine is a drug belonging to the group of calcium channel blockers, very well tolerated, widely recognized for its central action as a vasodilator preventing vasospasm secondary to aneurysmal subarachnoid haemorrhage. It is currently approved as a drug used in the treatment of this type of haemorrhage, mainly because it is effective in reducing neurological deficits due to delayed cerebral ischemia. In addition, due to its relaxing action on the cerebral vascular musculature and its facility to cross the blood-brain barrier, it has multiple functions in other types of cerebral vascular lesions such as ischemic stroke and other neurological conditions involving stress or cell death. Its role as a prophylactic agent in the treatment of migraine and its effect as a neuroprotective agent have also been evaluated.</p> Sandra Marcela Mass-Ramirez Carmen Sofia Sierra-Ochoa Ivan David Lozada Marintez Brayan Stiven Aristizabal-Carmona Juan Esteban Suárez-Muñoz Lina Marcela Ortiz-Roncallo Jose David Rubiano-Buitrago Bryan Hernández-Nieto Sergio Antonio Barahona-Botache Julián Eduardo Cárdenas-Mayorga Luis Rafael Moscote-Salazar Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 270 276 Multiple intracranial aneurysms in subarachnoid haemorrhage. Which one has bled? <p>This paper is intended as an illustrative teaching case. It gives a porotype case of a patient with subarachnoid haemorrhage and multiple intracranial aneurysms, where the CT data is non-conclusive as to the source of haemorrhage. The paper then discusses the diagnostic challenges and management pearls, pertaining to such scenarios. The paper concludes with a few “take-home points” that summarise the criteria to be applied in such cases.</p> Zahraa F. Al-Sharshahi Samer S. Hoz Mustafa M. Altaweel Altaweel Copyright (c) 2021 2021-10-07 2021-10-07 277 280 Intracranial myopericitoma <p>Myopericytoma is a benign, soft tissue tumor probably derived from perivascular myoid cells. They are usually found in subcutaneous tissues in the extremities. Intracranial localization of myopericitoma is exceedingly uncommon. We report a 43 years old male patient with incidentally found myopericitoma of the posterior fossa. Patient was operated and tumor was completely removed. Patient was subsequently diagnosed with acquired immunodeficiency syndrome due to human immunodeficiency virus infection. One year after operation tumor showed no signs of recurrence, but patient developed progressive symptoms of AIDS and started highly active antiretroviral therapy (HAART). Connection of intracranial myopericitoma appearance and HIV/AIDS has been reported before, but clear connection is yet to be elucidated.</p> Branko Đurović Danilo Radulović Miloš Joković Irena Cvrkota Marko Đurović Nemanja Jovanović Vuk Aleksić Copyright (c) 2021 2021-10-07 2021-10-07 281 284 Analysis of functional outcome of single and double level lumbar discectomy <p><strong>Introduction: </strong> Functional improvement in lumbar PIVD patients can be assessed either objectively like improvement in SLRT, relief in pain, etc or subjectively using different types of scales. In our study, we have used Revised Oswestry Disability Index (RODI) score, Ronald–Morris disability questionnaire (RDQ), The Back Bournemouth Questionnaire (BQ) to analyse functional outcome in single and double level lumbar PIVD patients pre-operatively and post-operatively.</p> <p><strong>Method: </strong>It is a prospective study including 80 patients of lumbar PIVD who failed to respond to conservative treatment. Patients were clinically evaluated and disability scales viz- RODI, RDQ &amp; BQ were recorded. After lumber discectomy, patients were again assessed and scored as per disability scales at 1 month, 6 months and 1 year postoperatively.</p> <p><strong>Result:</strong> RODI, RDQ and BQ scores were calculated at pre-operatively and post-operatively 1, 6 and 12 months and statistically analysed. The mean RODI scores at pre-operative and postoperative 1, 6, and 12 months were 72, 18, 10, and 6 respectively. The mean RDQ scores at pre-operative and postoperative 1, 6, and 12 months were 15, 5, 3, and 2 respectively. Similarly, the mean BQ scores at pre-operative and postoperative 1, 6, and 12 months were 51, 12, 8, and 4 respectively. Statistically, significant improvement was seen in mean scores of all 3 functional scales and maximum changes were observed after 1 month. Statistically, significant improvements were observed in 54 out of 62 patients (87%). Three questions of BQ related to the patient social and family activities, anxiety and depression were separately compared pre and post-operatively and they showed a statistically significant improvement.</p> <p><strong>Conclusion: </strong>Overall 87% of patients had a significant improvement in functional assessment using RODI, RDQ and BQ scales. On comparing single and double level discectomy patients, the functional improvement was similar in follow up of one year. Social and family activities (SFA), depression and anxiety of the patients improved significantly over 1 year.</p> Surendra Gupta Deepak Kumar Singh Anuj Chhabra Mohd Kaif Kuldeep Yadav Rakesh Kumar Singh Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 285 293 Possible predictive markers in surgical decision making in patients with degenerative or isthmic lumbar spondylolisthesis <p><strong>Background:</strong> Although age, comorbidity, duration and severity of symptoms, slippage degree, and flexion-extension slipping stability during X-ray imaging are effective in making a surgical decision in patients with spondylolisthesis, these factors are rarely based on definitive evidence. The aim of this study was to determine the efficacy of clinical, radiological and biochemical findings in surgical decision making in these patients.</p> <p><strong>Materials and Methods:</strong> Patients’ data including age, gender, degree and type (i.e. degenerative or isthmic) of the spondylolisthesis, urinary incontinence, neurogenic claudication were recorded. Radiological imaging studies (lumbar dynamic X-ray, computed tomography, magnetic resonance imaging), serum glucose, C-reactive protein and erythrocyte sedimentation rate values of the patients obtained during hospital admissions were evaluated.</p> <p><strong>Results:</strong> Forty patients were followed conservatively and 12 patients were treated surgically. Degenerative spondylolisthesis was seen in 22 patients. Nine patients had neurogenic urinary incontinence and 19 patients had neurogenic claudication. When the patients were divided into two groups with and without surgical treatment, the presence of the pars defect, slipping distance in a neutral position and slipping distance in flexion position was significantly different between groups. A positive correlation was found between pars defect and surgical treatment. <em>Likelihood ratio</em> test results revealed that the presence of pars defect, neurogenic claudication and neurogenic urinary incontinence could be the best parameters in decision making the surgical treatment.</p> <p><strong>Conclusion:</strong> The presence of pars defect, neurogenic claudication and urinary incontinence could be the best parameters that may help the surgeon to make the surgical treatment decision.</p> Ulaş Yüksel Mustafa Ogden Mustafa Ilker Karagedik Turgut Kultur Bulent Bakar Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 294 303 Surgical site infections in neurosurgery <p><strong>Background: </strong>Surgical site infections in neurosurgery are serious due to their proximity to the central nervous system and their management is a challenge. The aim of our work is to report surgical site infections (SSI) in patients who underwent brain or spinal surgery and to describe their characteristics.</p> <p><strong>Materials and method: </strong>We conducted a retrospective study involving patients who underwent surgery in our facility's neurosurgical emergency department over 5 years from January 2015 to December 2019. The data were collected from medical hospital and follow-up records.</p> <p><strong>Results: </strong>Fifty-eight cases of SSI were identified out of 2889 operations in total, for a frequency of 2%. The series consisted of 36 men (62.07%) and 22 women (37.93%). The average age was 43.9 years (19-72 years). 46 patients (79.31%) had undergone urgent surgery and 12 patients (20.69%) for delayed surgery. 40 patients (68.97%) had undergone cranial intervention and 18 patients (31.03%) underwent spinal surgery. The identified germ was Staphylococcus aureus in 13 cases (76.48%). Mortality was 13.8% (8 out of 58 cases).</p> <p><strong>Conclusion: </strong>The majority of microorganisms that cause the infections contaminate the surgical site intraoperatively. Preventive measures can reduce the rate of surgical site infections.</p> Albéric Bocco Lievin Panu Abdelmajid Chellaoui Abdelhakim Lakhdar Abdessamad Naja Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 304 308 Awake focussed craniotomy for oedematous/large brain lesions <p><strong>Aim</strong>: Awake craniotomy has been proven to be safe and effective. It has generally been used for non-edematous conditions. If done in edematous states, large craniotomies are advised. Here, we report the combined use of techniques of awake anaesthesia and focussed craniotomy for dealing with large/edematous brain lesions.</p> <p><strong>Materials and Methods</strong>: This was a prospective single-centre study from May to October 2019. Included were adult cooperative patients presenting with edematous brain lesions. A completely awake cycle was used using ring scalp block, Dexmedetomidine loading, and maintenance infusion, and use of Midazolam and Fentanyl. The dural flap was lifted limited to the lesion, and sometimes in stages to tackle the bulging brain. Data was collected for resection volume, pain scores using visual analogue scale (VAS) during the surgery, seizures, complications, new deficits, blood loss, duration of surgery, ICU, and postoperative hospital stay.</p> <p><strong>Results</strong>: Fifteen patients underwent the procedure. Pathologies were high-grade gliomas (7), low-grade gliomas (3), tuberculoma (2), metastasis (1), ependymoma (1), and meningioma (1). Fourteen patients underwent total, and one underwent subtotal excision. Brain bulge could be handled with the staged opening of the dura and intratumoral decompression. No patient required postoperative ventilatory support. Intraoperative pain scores ranged from 2-3. The duration of surgery ranged from 60-280min. Blood loss ranged from 75-300ml. Postoperative stay varied from 3-20 days. There were two intraoperative seizures (managed), two CSF leaks, and two infections. Two patients developed transitory motor deficits.</p> <p><strong>Conclusion:</strong> Awake focussed craniotomy was found safe and effective for large/edematous brain lesions in appropriately selected patients.</p> Jitin Bajaj Sharad N. Sharma Gopal Maravi Aamir Iqbal Yadram Yadav Ankur Shrivastava Ketan Hedaoo Ambuj Kumar Mallika Sinha Shailendra Ratre Vijay Parihar Narayan M. Swamy Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 309 315 Essentials of cerebral fat embolism syndrome <p>Fat embolism syndrome typically appears after an asymptomatic period of 24 to 72 hours and is typically manifested by the clinical triad of respiratory failure, neurological manifestations and petechiae, together with analytical alterations such as anaemia and thrombopenia. Respiratory distress is the most common symptom. Cerebral fat embolism is an incomplete form of fat embolism, which does not meet all the diagnostic criteria; in fact, it may appear without the presence of respiratory failure; Therefore, its early diagnosis is a challenge in the trauma patient</p> Ivan David Lozada Marintez Michael Gregorio Ortega-Sierra Maria Daniela Del Pilar Zambrano-Arenas Natalia Páez-Escallón Darwin Gabriel Perea-Martinez Yuly Sofia Caldera-Arrautt Kevin Solis-Bazza Duvan Alexander Betancourt-Cundar Hernando Jose Gonzalez-Garces Andrés Mauricio Manríque-Gualdron Feraz Fady Zaghab-Zgieb Luis Rafael Moscote-Salazar Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 316 320 Spinal conditions in geriatric patients in developing countries <p><strong>Background: </strong>The spinal injury in an elderly patient is associated with higher mortality and an increased frequency of life-threatening complications and specifically spinal cord injuries. The aim of this study is to study the prevalence of geriatric spinal neurosurgical conditions in the Neurosurgical Department at Khoula Hospital, Muscat, Sultanate of Oman.</p> <p><strong>Results:</strong> 171 patients were admitted due to spinal pathologies, which will be the main focus of the present study with an average age of 70.7 years. The male-to-female ratio was (1.5:1). Degenerative conditions were the most common spinal diagnosis (90.6%) followed by traumatic accidents (2.9%). Most of the patients underwent surgical intervention (78.9%). The majority of the patients (91.2%) of the patients stayed in the hospital for less than 15 days. There was a significant difference between the age of patients above and below 75 years the gender (p=0.003) and between the length of stay and type of intervention (P&lt;0.005).</p> <p><strong>Conclusion: </strong>Spinal cord-related pathologies are a growing cause of mortality and morbidity worldwide, because of the increasing number of elderly people due to an increasingly rising life span worldwide. In the present study, degenerative conditions were the most common spinal diagnosis followed by traumatic accidents.</p> Abdulrahman Al-Mirza Omar Al-Taei Tariq Al-Saadi Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 321 326 Fibrous dysplasia of sphenoid bone presenting as a case of loss of vision <p><strong>Background:</strong> Fibrous dysplasia is a fibro-osseous lesion of unclear aetiology wherein normal bone is replaced by abnormal fibrous tissue and immature bone. Fibrous dysplasia is associated with a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone &amp; is well documented to affect craniofacial structures.</p> <p><strong>Case description: </strong>A case of the lesser sphenoid wing fibrous dysplasia is described which presented with symptoms of pressure effects on the optic nerve, managed subsequently with microsurgical decompression of the nerve.</p> <p><strong>Conclusion: </strong>Craniofacial fibrous dysplasia is an uncommon entity which can present with loss of vision, wherein the visual prognosis depends upon timed &amp; adequate surgical intervention.</p> Abhishek Katyal Daljit Singh Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 327 329 The impact of lockdown on incidence of neurosurgery trauma patients in India <p><strong>Objective</strong>: Covid19 pandemic challenged the global healthcare system and both developed and developing countries responded with their might to fight this global pandemic. Road traffic accidents are a major cause of morbidity and mortality in India and we studied the impact of lockdown on neurosurgery trauma patients in a tertiary care centre in India.</p> <p><strong>Methods</strong>: Indian government announced complete lockdown on 25<sup>th</sup> march 2020 and India remained in complete lockdown till 31<sup>st</sup> May 2020. We included the patients admitted from 1<sup>st</sup> January 2020 to 24<sup>th</sup> March 2020 in pre lockdown period and25th march to In this cross-sectional study we divided the patients into two groups of pre lockdown and lockdown period and incidence of neurosurgery trauma patients was assessed for Road Traffic Accident, assault, hit by animal and fall from height.</p> <p><strong>Result</strong>: In our study 491 patients were admitted in pre lockdown and 369 patients were admitted in lockdown period. Road traffic accident patients were more in pre lockdown 39.5% (n=194) as compared to lockdown period 31.2% (n=115). However, cases of assaults were more in the lockdown period (14.6%, n=54) as compared to pre lockdown (3.9%, n=19). The death rate in neurosurgery trauma patients reduced significantly in lockdown (7.3%, n=27) as compared to pre lockdown (21.8%, n=107).</p> <p><strong>Conclusion</strong>: The COVID19 pandemic induced lockdown resulted in a decrease in motor vehicle movements which further decreased the incidence of RTA and related trauma however incidence of assault-related trauma and cases increased significantly in this period. The overall outcome of such patients improved probably due to better utilization of available health care facilities.</p> Ashutosh Roy Somil Jaiswal B.K. Ojha Chittij Srivastava Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 330 333 Non-invasive brain stimulation in Parkinson disease rehabilitation <p>Patients diagnosed with Parkinson’s disease suffer from various symptoms affecting motor and non-motor functions having adverse effects on their quality of life. Hence various evolving treatment methods are employed and researched for further benefits apart from the conventional pharmacological, surgical and rehabilitative treatment adjuncts. In this review article, we have summarized the therapeutic effects of noninvasive brain stimulation on various symptoms in Parkinson disease as it is the recent emerging tool and various researchers are working on application of this technique in Parkinson disease. It has been found that both transcranial direct current, as well as transcranial magnetic stimulation, is able to produce considerable effects in Parkinson patient.</p> Minakshi Gupta Sneha Chakraverty Ruchi Basista Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 334 338 Indirect revascularization in an Iraqi child with Moyamoya Disease <p><strong>Background</strong>: Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by bilateral stenosis starting at the supraclinoid internal carotid artery (ICA), with the development of a collateral network of vessels. It is an established cause of stroke in the pediatric age group. Despite its increasing prevalence in various parts of the world, it remains largely underrecognized in the Middle East, particularly in Iraq. This is the first case of MMD in an Iraqi patient undergoing surgery.</p> <p><strong>Case description</strong>: A 12-year-old boy presents with a 3-months history of progressive behavioural changes. MRI revealed diffuse infarcts of different ages. MRA and CT angiography revealed extensive asymmetrical steno-occlusive changes of the supraclinoid ICAs extending into the anterior and middle cerebral arteries, with the development of a collateral network in the basal ganglia. Indirect revascularization of the right side by encephaloduroarteriomyosynangiosis (EDAMS) was performed. The clinical status of the patient improved during the follow-up and the MRA showed a re-establishment of the blood flow to the MCA.</p> <p><strong>Conclusion</strong>: MMD should be recognized as a cause of stroke or recurrent TIAs in the Iraqi population, particularly in pediatric patients. EDAMS is an effective revascularization procedure with good results in pediatric patients.</p> Samer S. Hoz Aktham O. Al-Khafaji Zahraa F. Al-Sharshahi Mohammed A. Alrawi Copyright (c) 2021 2021-10-07 2021-10-07 339 344 Gastroparesis as a complication in the patient with traumatic brain injury <p>Patients with acute neurological diseases (traumatic brain injury, hemorrhagic or ischemic stroke, spinal cord injury or tumour) may present with various systemic alterations such as changes in cardiovascular and respiratory response, gastrointestinal function disorders, metabolic and endocrinological abnormalities, coagulopathies, among others. Head injury increases the risk of malnutrition due to multiple factors related to nutrient intake, abnormalities in energy expenditure, eating behaviour disorders, gastrointestinal changes, and medication side effects. Gastrointestinal conditions include gastroparesis, which is defined as a delay in gastric emptying in the absence of mechanical obstruction. These patients often report nausea, vomiting, pain, postprandial fullness and abdominal swelling. Although the exact mechanism by which it occurs in traumatic brain injury is not known, it is related to complications such as intracranial hypertension, so it is most often seen in cases of severe trauma. Therefore, the objective of this review is to expose basic and practical concepts about gastroparesis and its approach.</p> Sandra Marcela Mass-Ramirez Ivan David Lozada Marintez José Bohorquez-Rivero Ezequiel Garcia-Ballestas Diego Bustos Ingrith Tatiana Poveda-Castillo Raúl David Delgado-Marrugo Víctor Julián Daza-Martínez Andrés David Sastre-Martínez Michael Gregorio Ortega-Sierra Tariq Janjua María Paz Bolaño-Romero Luis Rafael Moscote-Salazar Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 345 351 A reverse brain herniation (RBH) after ventriculoperitoneal shunt (VP) in posterior fossa tumour with obstructive hydrocephalus <p>The risk of hydrocephalus in posterior fossa tumour is quite high (71- 90%), cerebrospinal fluid (CSF) diversion procedures like ventriculoperitoneal (VP) shunt, Endoscopic third ventriculostomy (ETV) and external ventricular drainage (EVD) are emergency procedures and may improve symptoms like headache and vomiting. However, post-operative deterioration after CSF diversion should alert the clinician to the possibility of RBH which is rare (3%) and has a high mortality. We report a case of a 12-year female child with a left cerebellar lesion with hydrocephalus. VP shunt was done and her pupils revert back to normal size, two hours post-surgery her pupils become dilated and not reacting to light, an urgent CT was done which showed reverse brain herniation. Reverse brain herniation is a very rare complication after the CSF diversion procedure with a poor prognosis.</p> Lamkordor Tyngkan Avatar Singh Abdul Rashid Bhat Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 352 354 A rare occurrence of primary basal ganglia germinoma in an adult patient <p><strong>Background</strong>: Basal ganglia germinomas (BGGs) represent a diagnostic and management neurosurgical dilemma. Because of the rarity of these tumors in adults, the management strategies are not well defined. </p> <p><strong>Case description</strong>: A 24-year-old man was presented with progressive left-sided hemiparesis. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a heterogeneous lesion with few microcystic nodules, seen involving the right basal ganglia with calcification. A stereotactic brain biopsy (SBB) was obtained. Histopathology revealed BGG. The patient received whole-brain radiation therapy (WBRT) and reported marked improvement in symptoms with no recurrence during a follow-up period of four years.</p> <p><strong>Conclusion</strong>: BGG should be considered a part of the differential diagnosis in young adults presented with hemiparesis and a heterogeneous lesion in the basal ganglia. Standard recommendations for the management of such rare lesions in adults are needed.</p> Ebtesam Abdulla Harleen Luther Tejal Shah Nisha Chandran Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 355 360 A case of sellar epidermoid tumour with haemorrhage <p><strong>Introduction</strong>: Intracranial epidermoid cysts are congenital inclusion tumours. Cerebellopontine angle and parasellar locations are the common locations. This is a report of an intrasellar epidermoid cyst with haemorrhage, which is rare.</p> <p><strong>Case report</strong>: A 70-year-old female presented with bifrontal headache, vertigo, and nasal discharge. Contrast-enhanced Magnetic resonance imaging[MRI] showed heterogeneously enhancing lesion in sella turcica. Internal hemorrhagic foci were seen. Computed tomography[CT] scan showed a slightly hyperdense tumour of sella. Transnasal transsphenoidal excision was done. Hemorrhagic and colloid material came out. Histopathological examination showed cyst lined by stratified squamous epithelium with keratohyalin granules and keratin flakes, suggestive of an epidermoid cyst.</p> <p><strong>Discussion</strong>: Usually epidermoid cyst is hypodense in CT scan. But hyperdensity can occur due to calcification of keratinized debris, increased protein content, and recurrent haemorrhage. Enhancement with gadolinium in MRI is mild and in cyst wall. Haemorrhage and enhancement are probably due to foreign body granulation tissue developing from leakage.</p> Ajaya Kumar A. Geetha Gopal K. Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 361 364 Hyperbaric oxygen therapy <p>The extent and progression of neurological impairment in traumatic brain injury depend significantly on the area of perilesional gloom, where neuronal apoptosis occurs. Inhibition of apoptosis becomes a therapeutic strategy to preserve brain tissue and promote functional recovery. Hyperbaric oxygen therapy is a treatment by which 100% oxygen is administered, with the aim of achieving a higher pressure than atmospheric pressure at sea level, to decrease ischemia and intensity of inflammatory processes triggered, compromising the viability of the tissues. For mild traumatic brain injury, studies indicate that hyperbaric oxygen therapy is no better than sham treatment. For acute treatment of moderate to severe traumatic brain injury, although the methodology is questionable in certain studies due to the complexity of the brain injury, hyperbaric oxygen therapy has been shown to be beneficial as a relatively safe adjunctive therapy. The objective of this review is to discuss aspects related to the pathophysiology of traumatic brain injury, the mechanism of action of hyperbaric oxygen therapy, and correlate these results with the use of this therapy in the prevention of neuronal injury, supported by original studies reported in the scientific literature</p> Ivan David Lozada Marintez Oscar Javier Diaz-Castillo Michael Gregorio Ortega-Sierra Jhon Jairo González-Monterroza Teddy Javier Padilla-Durán Harold Sebastián Castillo-Pastuzan Jhoan Sebastián Robledo-Arias Maria Paz Bolaño-Romero Alfonso Pacheco-Hernández Luis Rafael Moscote-Salazar Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 365 369 Epidemiological, demographic and clinical profile of traumatic brain injury patients <p><strong>Context: </strong>Traumatic brain injury is a major public health problem worldwide with increasing incidence and severity in developing countries<strong>. </strong>In India, it becomes a huge burden on society with a lack of proper preventive measures, public awareness, traffic sense and pre-hospital care. Therefore we studied the epidemiological profile and factors predicting outcome.</p> <p><strong>Aims:</strong> To study the epidemiological, demographic profile of TBI patients to help to improve the healthcare facilities.</p> <p><strong>Setting and design</strong>: It is an observational prospective study.</p> <p><strong>Methods and materials: </strong>Overall 2134 patients with TBI were enrolled. The data was collected according to the predesigned proforma. The demographic, epidemiological, clinical variables were analysed to determine the current trends and outcomes.</p> <p><strong>Result: </strong>The male: female ratio was 2.21:1 with most cases from the age group of 21-30 years ( 29.42%). RTA was the mode of injury in 64.48% of cases. Overall mortality was 10.91%. Overall descriptive data was suggestive of poor outcome in old patients, referred cases, acute SDH and brainstem lesions, hypoxic and hypotensive patients, associated injuries, pre-existing disease and with higher Rotterdam and ISS scores.</p> <p><strong>Conclusion:</strong> The outcome is dependent on factors like geographical, demographic, pre-hospital, and patient-related. With knowledge about the causes, patterns, and distribution the prognosis of TBI patients can be improved.</p> Abhijeet Singh Sachan Prakrati Sachan Sateesh Chandra Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 370 375 Letter to the editor. Face-off between glioma and meningioma <p>Gliomas are malignant, and intrinsic cerebral tumours may cause tumour-infiltrative oedema. Meningiomas are mostly benign, extrinsic cerebral tumours that do not infiltrate the surrounding parenchyma. Meningiomas may give rise to vasogenic oedema in the peritumoral tissue.[1] The radiological diagnosis of cerebral tumours may be non-conclusive on conventional MRI in few cases, and diagnosis must rely on histopathological analysis. [2] We report a case that has an atypical clinical presentation with nonconclusive MRI brain, and finally, histopathology confirmed the diagnosis.</p> Dinesh Chouksey Nitisha Goyal Rishu Garg Ajoy K. Sodani Copyright (c) 2021 Romanian Neurosurgery 2021-09-15 2021-09-15 376 377