Romanian Neurosurgery <p>Call for Papers -&nbsp;Vol. XXXIII, No. 2 (June 2019)<br>Submission Deadline: May 1, 2019&nbsp;</p> London Academic Publishing en-US Romanian Neurosurgery 2344-4959 Endovascular management of recurrent anterior communicating aneurysm previously embolized. Case presentation <p>Although endovascular coiling treatment has been widely accepted as the method of choice for intracranial aneurysms, concerns about its durability are still discussed. Attention was largely focused on aneurysm recurrence after coil occlusion with possible unfavourable evolution to a new bleeding episode. We present our experience of a patient with a ruptured anterior communicating artery aneurysm previously treated by endovascular coil embolization that presented over a 4-year period for aneurysm recurrence.</p> A. Chiriac Georgiana Ion Z. Faiyad I. Poeata ##submission.copyrightStatement## 2019-03-20 2019-03-20 7 11 10.33962/roneuro-2019-001 Pathways of metastatic spread in meningiomas <p>Meningioma is a common intracranial neoplasm derived from meningothelial cells, and it is generally associated with a benign clinical course. In spite of this, the malignant behaviour of these tumours as the occurrence of extracranial meningioma metastases in different organs is described in the literature: lung and pleura, spine and other bones, abdominal organs, lymph nodes or even skin. The aim of this review is to analyse the pathways of metastatic spread of the intracranial meningioma tumour cells towards different organs.</p> A. I. Cucu Dana Mihaela Turliuc Claudia Florida Costea B. Costachescu Andreea Eliza Malaimare L. A. Blaj Violeta Trandafir Cristina Danca I. Poeata ##submission.copyrightStatement## 2019-03-20 2019-03-20 12 16 10.33962/roneuro-2019-002 Underlying histopathology of peripheral nerve injury and the classical nerve repair techniques <p>A much-debated subject in the last 20 years, the recovery after peripheral nerve injury still remains one of the most researched themes of our days. Although the central nervous system has not exhibited any ground-breaking discoveries in matters of healing through surgical procedures, this is not the case for the peripheral nervous system (PNS). The PNS recovery after injury has improved over the years so we now speak of time and percentage of rehabilitation. The increased interest for this subject is a result in the development of the medical technique, that allowed the creation of new molecules capable to improve the regeneration rate. Furthermore, the evolution in diagnostic parameters, as well as the possibility of a thorough follow-up, contributed to the ascending research of this field.&nbsp; One must not forget that all experimental studies have as endpoint obtaining safe and reproducible solutions which can be applied in treating patients with peripheral nerve injury. We will briefly present the microscopic events that occur following a peripheral nerve injury, the key factors which influence their regeneration as well as the classical techniques used to repair them. However, the most intriguing topic in nerve regeneration is not related to the surgical procedure (considered to be the Gold Standard in whole nerve injury), but rather the helping substances that facilitate a faster and better recovery.</p> Marin Andrei Mihai Ruxandra Ioana Enescu Dan Mircea ##submission.copyrightStatement## 2019-03-20 2019-03-20 17 22 10.33962/roneuro-2019-003 Surgical management of middle cerebral artery aneurysms <p><strong>Background</strong>. The middle cerebral artery (MCA) harbors approximately 14% to 30% of all ruptured cerebral aneurysms. They can occur at multiple sites throughout the course of the middle cerebral artery, but most often are found at the bifurcation of the first segment (M1).</p> <p><strong>Methods</strong>. A retrospective review of 116 consecutive patients with an MCA aneurysm treated by surgical clipping, by two senior neurosurgeons, was performed. The data of all our consecutive patients were searched to obtain patient characteristics, details of the aneurysm size and orientation, treatment details, complications and follow up. At admission, the clinical condition of all patients was classified according to the Hunt and Hess scale. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 2 to 72 months (mean 30 months).</p> <p><strong>Results</strong>. Surgical clipping was performed for 113 ruptured MCA aneurysms; only in 3 cases the aneurysm was unruptured. Fourteen patients presented with significant hematoma which required the evacuation of the clot. Post-operative control angiography was performed in 32 patients (27.5%), from which we reported a full occlusion of the aneurysm in 32 patients (93.75%). Perioperative mortality was 5.2% (6 patients), due to neurological (4 patients) or systemic causes (2 patients).&nbsp; The outcome was graded mRankin 0–2 in 72.5% of the cases (84 patients) at the end of the first postoperative months, and 78.5% (91 patients) at six months follow-up. The most important improvement was recorded for patients graded mRankin 1-2 at the first month follow-up. All 3 patients with a surgically treated asymptomatic MCA aneurysm had an excellent outcome (mRS 0) at both follow-up, 1 months and respectively 6 months.</p> <p><strong>Conclusions</strong>. For the experienced neurovascular team, MCA aneurysms currently make microsurgical treatment the preferred treatment modality for most MCA aneurysms.</p> Mugurel Radoi Florin Stefanescu Ram Vakilnejad ##submission.copyrightStatement## 2019-03-20 2019-03-20 23 30 10.33962/roneuro-2019-004 Neuromodulation devices nowadays <p><strong>Introduction</strong>. Neuromodulation devices have known a great progress in the past years being used in treatment of drug resistant neurological diseases such as epilepsies and migraines. A neuromodulation device can stimulate profound or superficial neural pathways in order to balance chronic drug-resistant disorders that involve disturbances of cellular electrical potentials.</p> <p><strong>Material</strong>. Cranial neuromodulation devices implants used until now usually determined skull irregularities, implant site infection, resorption of the bone flap or osteomyelitis. In order to solve these problems, it was needed a customized cranial implant that integrates the neuromodulation device. We report the first description of a fully integrated neuromodulation device within a customized cranial implant, publicised in 2018 by Gordon et al., that demonstrates the utility of a computerized neurostimulation device combined with clear custom-designed cranial implant.</p> <p><strong>Conclusion</strong>.&nbsp;The new approach of neurotechnology confines a better solution for neuroimplants devices with less follow-up complications and great patient’s satisfaction.</p> R. E. Rizea Karina Lidia Gheorghita Gh. David A. V. Ciurea ##submission.copyrightStatement## 2019-03-20 2019-03-20 31 33 10.33962/roneuro-2019-005 New technics for removal of intradural spinal tumours <p><strong>Introduction</strong>. Neuronavigation is a computer-assisted technology based on pre- and intraoperative images that permit neurosurgeons to have a better approach of the brain and intradural spinal tumors. The neuronavigation systems have been a significant progress in neurosurgery. These systems allow neurosurgeons to evaluate surgical risks, select the best interventional method, localize better the tumors in order to improve the accuracy of the resection and decide on the optimal trajectory for the surgical procedure, resulting in decreased patient morbidity and mortality.</p> <p><strong>Material</strong>: Spinal cord tumors are rare and uncommon lesions. Their growth result in compression of the spinal cord, which can cause severe neurologic deficits such as limb dysfunction, motor and sensation loss with the possibility of leading to death. We present o short report of a study publicated by Stefini et al. in 2018 regarding the use of neuronavigation for removal of intradural spinal tumors.</p> <p><strong>Conclusion</strong>: The benefits of using neuronavigation in resection of the intradural spinal tumors include decreased risk of bad localization of the tumor, minimal invasive surgery technique and reduction of bone removal.</p> R. E. Rizea Karina Lidia Gheorghita M. V. Salaceanu A. V. Ciurea ##submission.copyrightStatement## 2019-03-20 2019-03-20 34 36 10.33962/roneuro-2019-006 The surgical procedure of syringomyelie with Chiari I in adults regarding the intrapial aspiration of cerebellar tonsils: does this procedure improve symptoms with less complication? <p><strong>Introduction</strong>. Cranio-vertebral decompression remains the common denominator for the treatment of syringomyelia associated with Chiari I. On the other hand, the details of the procedure, remains controversial. The success of the surgery is to restore the circulation of cerebro-spinal fluid at the level of the foramen magnum. How is this circulation restored to the level of foramen is the question? We offer our attitude towards the treatment of syringomyelia with Chiari I.</p> <p><strong>Material and method</strong>. Consecutive series of 32/121 patients benefiting from cranio-vertebral decompression associated with intrapial aspiration of cerebellar tonsils treated for syringomyelia with a Chiari I malformation in adults.</p> <p><strong>Result</strong>. Motor deficits were present in 20 / 22 patients, representing 90% of the entire patient group. these motor deficits are improved in 16 out of 22 cases, and remained unchanged in 06cas. no motor aggravation occurred. in our study, bone decompression and intra pial aspiration of cerebellar tonsils (sub arachnoids manipulation) were found to be associated with favourable results on clinical signs and symptoms. However, sub arachnoids manipulation and intra pial aspiration of cerebellar tonsils showed a little more complication compared with bone decompression with dural plasty.</p> <p><strong>Conclusion</strong>. The bone decompression with dural graft and intradural dissection of adhesions and reduction by intra pial aspiration or resection of the tonsils is indicated on the MRI aspect of cerebellar tonsils of considerable size totally obstructing the foramen Magnum, the intraoperative finding, through the arachnoid, of the absence of passage of the cerebro-spinal fluid because of the bulging of the cerebellar tonsils.</p> Ait Bachir Mustapha T. Benbouzid ##submission.copyrightStatement## 2019-03-20 2019-03-20 37 48 10.33962/roneuro-2019-007 Primary cerebellopontine angle glioblastoma in a child. A rare entity <p>Cerebellopontine angle extraaxial glioblastoma (GBM) is extremely rare at any age but especially in children. We reported a case of 14-year-old girl, who presented with nausea, vomiting and ataxia. She was evaluated with computed tomography (CT) and magnetic resonance imaging (MRI). Imaging demonstrated irregular ring enhancing right CP angle mass. The atypical findings of irregular ring enhancement, CP angle location and presentation in childhood, combine to make the prospective diagnosis of GBM a difficult one. This combination of findings has been reported very rarely.</p> Kaviraj Kaushik Sharad Pandey ##submission.copyrightStatement## 2019-03-20 2019-03-20 49 51 10.33962/roneuro-2019-008 Ossification of the yellow ligament in thoracic spine: a case report <p>Ossifications of the yellow ligament (OYL) and calcification of yellow ligament are relatively rare clinical entities, and can make sever morbidity surgical evaluation can relived the sign and symptom and improve life quality we present a patient with ossification of the yellow ligament in level of T9 and T10 of thoracic spin.</p> Aydin Kazempour Azar Javad Aghazadeh Firouz Salehpoor Amir Rezakhah Amir Kamalifar Saber Ramezanpour Samar Kamalifar ##submission.copyrightStatement## 2019-03-20 2019-03-20 52 54 10.33962/roneuro-2019-009 Comparison of the predictive strength of total white blood cell count within 24 hours on the outcome of traumatic brain injury with cranial computed tomography scan in a resource-limited tertiary health centre in sub-Saharan Africa <p><strong>Background</strong>: The enormous disease burden of patients with traumatic brain injury (TBI) remains a huge source of concern to the patient and caregivers. Computed tomography (CCT) scan is a valuable investigative tool in patients with traumatic brain injury which can be used to predict the outcome of TBI. The use of total white blood cell as a predictive parameter in patients with TBI is still at a primordial stage. This study aimed to compare the predictive strength of total WBC count within 24 hours of TBI with cranial computed tomography scan.</p> <p><strong>Methods</strong>: This research was done over one-year period at the Lagos University Teaching Hospital, Lagos. One hundred and fifty-eight patient who met the inclusion criteria were studied and the male to female ratio of 3.6:1.</p> <p><strong>Results</strong>: The mean total WBC count was 14,279.94 and the area under the curve of total WBC count and CCT scan was 0.633 and 0.855 respectively.</p> <p><strong>Conclusion</strong>: Our conclusion was that despite both parameters been a predictor of the outcome of TBI, the total white blood cell is a weaker predictor of outcome compared to cranial computerize tomography scan.</p> Eghosa Morgan Olufemi Bankole Okezie Kanu Omotayo Ojo Edward Poluyi ##submission.copyrightStatement## 2019-03-20 2019-03-20 55 59 10.33962/roneuro-2019-010 Isolated fourth ventricle haemorrhage: “think beyond intracranial source’’ unusual presentation of lumbosacral spine arteriovenous malformation presentation <p>Spinal arteriovenous malformations (SAVMs) are rare vascular lesions and account for about 4% of primary intraspinal masses. Since SAVMs can involve any location along the spinal column and produce a host of different problems, the symptoms are extremely variable. There are few reports of simultaneous cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM (SAVMs). Herein, we present a rare case of Lumbo Sacral spine arteriovenous malformation, which clinically manifests as sudden onset of severe headache and vomiting due to isolated fourth ventricle Hemorrhage (IVH) without cerebral subarachnoid hemorrhage.</p> Naresh Panwar Manish Agrawal Ghanshyam Agrawal V. D. Sinha ##submission.copyrightStatement## 2019-03-20 2019-03-20 59 62 10.33962/roneuro-2019-011 First report of two synchronous but separately placed intramedullary angiolipomas located in the dorsal spine causing progressive compressive myelopathy: management strategies and outcome review <p>Spinal angiolipoma is a benign lesion and presents with compressive myelopathy. Typically, it is located in epidural compartment. However, intramedullary angiolipoma is extremely uncommon, and till date only eight cases are reported in the literature and all reported cases had isolated solitary lesion. Authors report an interesting case of intramedullary spinal angiolipoma (ISAL) in a - 48- years male, presented with compressive myelopathy, magnetic resonance imaging study revealed presence of two separate angiolipomas, which were located at D8-D9 and D10-D12 vertebral levels respectively, underwent successful near total surgical resection with good neurological outcome. Current case represents first of its kind in the western literature. Management of such rare pathology along with pertinent literature is briefly discussed.</p> Guru Dutta Satyarthee Mehar Tej Burgula ##submission.copyrightStatement## 2019-03-20 2019-03-20 63 66 10.33962/roneuro-2019-012 Cystotoperitoneal shunt surgery during infancy in porencepahalic cyst located in frontal region led to regaining of developmental milestone <p>Porencepahalic cyst is considered as an extremely uncommon developmental disorder of the central nervous system, being characterized by the presence of a fluid-filled cysts or cavities located within the cerebral hemispheres. It can be associated with varied aetiology and can present with a spectrum of clinical presentation varying from asymptomatic to grossly spastic limbs, mental retardation, cognitive impairment and intractable seizure. Extensive Pubmed and Medline search did not yield any result when searched for term “infancy, porencepahalic cyst, cystoperitonreal shunt.” However, clear guideline for management is still lacking. Authors report an interesting case of giant porencepahalic cyst located in the right frontal region in infancy and underwent cystoperitonreal shunt surgery, which lead to good outcome with remarkable recovery of delayed milestones with adequate scholastic performances along with marked diminution in the size of porencepahalic cyst.</p> Guru Dutta Satyarthee Luis Rafael Moscote-Salazar Amit Agrawal ##submission.copyrightStatement## 2019-03-20 2019-03-20 67 70 10.33962/roneuro-2019-013 Tibial nerve schwanoma: short review of surgical management <p>Schwannoma is a benign, solitary nerve sheath tumour and accounting for about 5% of soft tissue tumours. It can occur along the peripheral nervous system in any part of body. It presents as a painless, swelling. We report an adult male presented with tibial nerve schwanoma underwent successful surgical excision. However, differentiation with neurofibroma is very important as surgical planning and prognosis is quite different. In lower limb usually incidence of neurofibroma is higher in contrast of upper limb. Pertinent literature and management are briefly discussed.</p> Guru Dutta Satyarthee Luis Rafael Moscote-Salazar Sanjeev Lalwani ##submission.copyrightStatement## 2019-03-20 2019-03-20 71 73 10.33962/roneuro-2019-014 Toddler with repeated fall frequently visiting hospital presented with acute subdural hematoma on readmission with ultra-rapid evolution: surgical management strategy <p>Repetitive fall producing head injury in children may lead to development of intracranial hematoma. The course of evolution may be rapid in case of repeated fall due to induction of sub-clinical coagulopathy caused by repetitive cranial injury. The awareness of such possibility is highly desired among the pediatrician and neurosurgeon and emergency team and quick diagnosis and pertinent imaging study is of immense value and appropriate surgical management for prompt and expediting the evacuation of intracranial hematoma evacuation should be attempted to preserve good neurological outcome. Authors reports a case, who had rapid neurological worsening, managed surgically with good neurological outcome, further various surgical management options along with pertinent literature are briefly reviewed.</p> Guru Dutta Satyarthee ##submission.copyrightStatement## 2019-03-20 2019-03-20 74 76 10.33962/roneuro-2019-015 Middle cerebral artery stroke following massive hornet sting: a case report <p>Hornet stings are frequently encountered in practice in Nepal. Majority of patients sustain minor illness. However, complications like anaphylactic shock and the rare acute kidney injury, multiple organ dysfunction and acute myocardial infarction have been reported. Ischemic stroke following hornet stings has been reported infrequently in scientific publications. We report a case of fatal&nbsp;&nbsp; right Middle Cerebral artery territory ischemic stroke and acute kidney injury in a 40-year farmer.</p> Gopal Sedain Gentle Sunder Shrestha ##submission.copyrightStatement## 2019-03-20 2019-03-20 77 79 10.33962/roneuro-2019-016 Epidemiological study of intracranial meningiomas in a tertiary care hospital <p>Meningiomas are tumours that arise from the meningothelial cells. Most of these tumours are intracranial; some are intraspinal and few extra cranial. There are many histological variants classified into three grades depending on clinical behaviour. Classification is important for determining the modality of treatment. Objectives: To study the incidence, location, sex and age predilection, histological variants and grading of meningiomas based on WHO 2007 classification and recurrence if present. Materials and methods: All 200 cases of meningiomas. Based on Histological features, typing and grading of meningiomas was done as per the WHO 2007 classification of Meningiomas. Age, Sex incidence, Location of meningiomas were studied. Results: Meningiomas comprised 26.17% of all CNS tumours during the study period. Of 764 CNS tumours, 200 were meningiomas. Most of them were intracranial, predominantly involving the convexities of brain, females and the 41 – 50 age group. Of these, 180 were benign grade I tumours, 12 were grade II and 8 were grade III. The most common histological variant was fibroblastic and meningothelial. Grade II and Grade III tumours commonly recurred. Conclusion: Meningiomas are slow-growing tumours arising from the meningothelial cells accounting for 26.17% of all CNS neoplasms showing a variety of histological patterns, more common in women, predominantly Grade I tumours. Recurrence of tumours depends on histological grade and extent of surgery.</p> Avdhesh Shukla Asheesh Kumar Gupta Anand Sharma S. N. Iyengar ##submission.copyrightStatement## 2019-03-20 2019-03-20 80 86 10.33962/roneuro-2019-017 Introduction of triage. An experience of a triage nurse in a tertiary centre in Japan <p>Emergency medical treatment in Japan is subject to jurisdiction by the Fire Department. Triage, by definition, is a dynamic process, as the patient's status can change rapidly. Triage is very important for Japan, where emergency patients are on the rise. The role of triage nurse is also important. That will improve the life-saving rate of emergency patients and improve the reversion to society.</p> Shinobu Tsuge Takahiro Shinagawa Kumi Hara Akio Aihara ##submission.copyrightStatement## 2019-03-20 2019-03-20 87 89 10.33962/roneuro-2019-018 Surgeon specialist branding or what do surgeon specialists need to know about their brand <p>As the world has widely adapted the principle of searching for relevant information online, many practicing physicians, especially those who are involved in specialty - must pay a close attention to their brand and their reputation on the World Wide Web. There are numerous web pages available to the general public about particular physician and where he/she practices. Most of those pages are either managed by a third-party company or created for promotional use. Some physicians are not even aware of this and are found by surprise when their patients bring up the information, they found on them online. Physician’s name is a brand that he or she carries throughout entire medical career, and it might make or break the legacy of academic or private physician on the long run.</p> Emil Zhalmukhamedov ##submission.copyrightStatement## 2019-03-20 2019-03-20 90 93 10.33962/roneuro-2019-019