Romanian Neurosurgery https://www.journals.lapub.co.uk/index.php/roneurosurgery <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 Subarachnoid haemorrhage. A critical neurosurgical emergency https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1935 <p>Subarachnoid haemorrhage (SAH) accounts for 3% of all strokes and is the cause of 5% of stroke mortality. SAH by rupture of cerebral aneurysm or arterial-venous malformation (AVM) remains the most devastating cerebrovascular disease. During admission for SAH, about 30-70% of patients suffer a rebleed, and from all rebleeds, about 90% lead to death no matter the treatment. Available current scales help predict the prognosis and guide the therapy. Considering that the lifestyle risk factors for SAH are of increasing prevalence, it is expected that it will affect even more people in the future. SAH should not be regarded as a disease but rather a set of events with devastating complications requiring adequate management from debut extending long after patient discharge.</p> Alexandra Bibiriță Daniel Teleanu Alexandru Vlad Ciurea Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 129 134 Meningioma in shape https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1936 <p><strong>Objective:</strong> The aim of this study was to evaluate the possible relationship between the appearance of tumour margins of atypical meningiomas and the risk of tumour recurrence, as well as progression-free survival. We also evaluated the correlations between the tumour margins and the neuroimaging characteristics (e.g. brain oedema and contrast enhancement) along with pathological features (e.g. brain invasion and mean value of Ki-67 LI).</p> <p><strong>Material and methods</strong>: In our study, we included 81 patients diagnosed with atypical meningioma (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. We followed the MRI imaging characteristics (e.g. tumour margins patterns, contrast enhancement, oedema grading and tumour volume), but also the pathological characteristics such as brain invasion and the mean value of the Ki-67 labelling index. The assessment of tumour recurrence was made using MRI imaging (T1+ contrast), over a follow-up period of 5 years after the surgery.</p> <p><strong>Results: </strong>In our study, we observed that 59.3% (<em>n=48</em>) of meningiomas had an irregular appearance. The irregular margins predominated in the male population (65.1%) and were statistically significantly correlated with brain oedema (<em>p</em>&lt;0.001), contrast enhancement (<em>p</em>&lt;0.01), anatomical location (<em>p</em>&lt;0.014) and the mean value of the Ki-67 labelling index (<em>p</em>&lt;0.01). The tumour margins were not correlated with brain invasion or volume of meningiomas.</p> <p><strong>Conclusion:</strong> In our series of patients we found that the irregular margin was not a prognostic factor for tumour recurrence over a period of 5 years or for progression-free survival.</p> A.I. Cucu Mihaela Cosman B. Dobrovat Cristina Dascalu Ioana Jitaru R.B. Sandu A. Tudor Claudia Costea Mihaela Turliuc Gabriela Dumitrescu Anca Sava I. Poeata Copyright (c) 2021 2021-06-18 2021-06-18 135 142 The role of MRI-guided focused ultrasound in neurosurgery https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1937 <p><strong>Introduction.&nbsp;</strong>MRgFUS is a novel technology, which can have profound implications in the current treatment of neurological disorders. Its applications range widely, from the alteration of the blood-brain barrier, ablation of tumours to the treatment of movement disorders.</p> <p><strong>Objective.&nbsp;</strong>To review, following thorough research of the literature, the principles of its use in the treatment of neurological diseases and the main reported evidence of its clinical implementation.</p> <p><strong>Material and method.&nbsp;</strong>Interrogation of the MEDLINE database, using the PubMed search engine, for the following &nbsp;MESH words: “MRgFUS”, “FUS” “BRAIN”, from 2000 to the current year.</p> <p><strong>Conclusion.&nbsp;</strong>MRgFUS can be safely used today for the treatment of Essential Tremor. New research is warranted for the evaluation of its safety and effectiveness in other neurological disorders.</p> Marius Gabriel Dabija Ioan Sebastian Nechifor Vlad Andrei Dabija Bogdan Costachescu Lucian Eva Copyright (c) 2021 2021-06-18 2021-06-18 143 147 The stent-assisted coil-jailing technique for very small intracranial aneurysm treatment https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1938 <p>The stent-assisted coil-jailing technique was initially introduced as an effective and secure method in the treatment of large wide-necked intracranial aneurysms. Later on, this technique has proved its efficiency in the safety and optimal treatment of very small aneurysms. In this article, we will present the successful treatment of a very small middle cerebral artery aneurysm using the stent-assisted coil-jailing technique and review the current trends in this type of treatment.</p> A. Chiriac N. Dobrin Georgiana Ion Z. Faiyad I. Poeata Copyright (c) 2021 2021-06-18 2021-06-18 148 151 Endovascular treatment options for carotid-cavernous fistulae https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1939 <p>A carotid-cavernous fistula is a pathological shunt between the internal or external carotid arteries and the cavernous sinus (CS). The arteriovenous shunt can be direct, between the internal carotid artery and the CS, or indirect, between meningeal branches from the carotid arteries and the dural coverings of the CS. Direct fistulas occur most commonly after craniofacial trauma, while indirect shunts result from various chronic diseases. Signs and symptoms depend on the venous drainage routes. Exophthalmos, chemosis, and diplopia are caused by venous drainage through the superior and inferior ophthalmic veins. If venous egress is mainly through the inferior petrosal sinus, patients complain of pulsatile tinnitus. Cortical venous drainage is the most dangerous route because it can lead to focal neurological deficits and intracerebral haemorrhage. Treatment of carotid-cavernous fistulae can be achieved through different endovascular techniques, using detachable balloons, coils, liquid embolic agents, covered stents, and flow-diverters. This paper aims to report three cases with carotid-cavernous fistulae, which were successfully cured using different transarterial and transvenous modalities.</p> Roxana Codreanu Rares Cristian Filep Lucian Marginean Copyright (c) 2021 2021-06-18 2021-06-18 152 158 Deep cerebral vein thrombosis due to anaemia in a child https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1942 <p>An eighteen-month-old child presented with vomiting, fever and altered sensorium of two days duration. He had anaemia and computed tomography of head revealed hyper-dense internal cerebral veins, vein of Galen and inferior sagittal sinus and bilateral thalamic hypo-density. The child improved with anti-coagulants and packed cell transfusion.</p> Rajneesh Misra Sushil Kumar Sandeep Sharma Copyright (c) 2021 2021-06-18 2021-06-18 159 161 Long term clinical outcome following decompressive surgery for Cauda Equina Syndrome https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1943 <p><strong>Study design</strong>: Retrospective study with prospective long-term clinical follow-up.</p> <p><strong>Background</strong>: Cauda equina syndrome (CES) is a neurosurgical emergency, mostly caused by herniated lumbar disc for which urgent surgical decompression is indicated. Data on long-term clinical outcome of bladder, bowel &amp; sexual function following decompression are elusive.</p> <p><strong>Aim</strong>: To evaluate the effectiveness of surgical decompression on recovery of CES symptoms at long-term follow-up &amp; role of timing of surgery on the outcome.</p> <p><strong> Methods</strong>: Records of 35 CES patients who underwent surgical decompression for herniated lumbar disc during a five years period retrospectively analysed &amp; patients called for follow-up visits. Outcome measures comprised of history &amp; clinical examination pertinent to bladder, bowel &amp; sexual function.</p> <p><strong>Results</strong>: Twenty-four patients (68.5%) were included for final evaluation who attended follow-up visits, with a minimum follow-up period of one year. Most common complaint at presentation was bladder dysfunction (100%) with urinary retention in 16 patients (66.6%), faecal incontinence in 11 (45.8%), saddle anaesthesia in 22 (91.6%) &amp; erectile dysfunction in 6 patients (out of 15 males). Only four patients underwent surgery within 48 hours of CES symptom onset, rest cases after 48 hours duration. At follow-up, bladder dysfunction present in 33.3% with urinary retention in 16.6%. Faecal incontinence persisted in 4 patients (16.6%) &amp; saddle anaesthesia in 7 (29.1%). Sexual dysfunction was the most persistent complaint.</p> <p><strong>Conclusion</strong>: Long-term follow-up shows significant recovery of sphincteric function in CES patients after surgical decompression. Urinary &amp; bowel dysfunction improve significantly. Timing to surgery didn’t affect the long-term outcome.</p> Lohar Vishnu Kumar Jaiswal Gaurav Gupta Tarun Kumar Jain Sachin Kumar Lodha Krishna Govind Yadav Kaushal Copyright (c) 2021 2021-06-18 2021-06-18 162 173 Visual outcome analysis in patients with posterior fossa tumours undergoing surgical treatment https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1719 <p><strong>Background: </strong>In the past, there were studies done to assess visual outcomes like visual acuity, fundoscopic findings and visual field mainly in pediatric patients with posterior fossa tumours (PFT). We assessed the above parameters pre- and post-operatively in all age group patients including both extra and intra-axial PFT. We also assessed visual outcome in patients with or without hydrocephalus.</p> <p><strong>Objectives: </strong>To analyze “visual outcomes in patients with posterior fossa tumours undergoing surgical treatment”. The effect of hydrocephalus on the visual outcome was also analyzed.</p> <p><strong>Materials and Methods: </strong>This prospective study including 107 patients with PFT undergoing definitive surgery was conducted in the Department of Neurosurgery at Dr Rmlims, Lucknow. Pre-op and post-op (six weeks after tumour resection) visual examinations were done and compared.</p> <p><strong>Results:</strong> A shifting trend towards normalization of visual acuity (VA) was seen post-surgery in all age groups. Overall improvement was seen in the majority of cases having pupil normal size sluggish reactive (NSSR) after surgery. Papilledema improved in the majority of patients in all age groups and patients having hydrocephalus. Colour vision and night vision also improved in the majority. The field of vision cut was not improved postoperatively in the majority.</p> <p><strong>Conclusion:</strong> Visual parameters like visual acuity, pupil size and reactivity to light; colour vision and night vision were improved significantly after surgery whereas cut field of vision did not improve. All fundoscopic findings like papilledema, retinal venous dilation and retinal splinters haemorrhage disappeared in a significant number of patients post-operatively. In cases with obstructive hydrocephalus, these parameters also improved significantly after Ventriculo-peritoneal shunt/ ETV or definitive surgery.</p> Deepak Kumar Singh Vrihaspati Kumar Agrahari Mohd. Kaif Rakesh Kumar Kuldeep Yadav Copyright (c) 2021 Romanian Neurosurgery 2021-06-18 2021-06-18 174 179 Single versus double burr holes evacuation in the treatment of chronic subdural hematoma https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1727 <p><strong>Background: </strong>Chronic subdural hematoma (CSDH) is a well-known entity and common surgical disorder managed by the neurosurgeon and, if not recognized and treated timely, may prove fatal. It can be non-traumatic or post-traumatic and all of them need urgent attention irrespective of aetiology. It manifests with a progressive neurologic deficit that occurs &gt;3 weeks following head injury. The principal techniques used in the treatment of CSDHs presently are burr hole, twist drill craniostomy, craniectomy and craniotomy.</p> <p><strong>Objective: </strong>The aim of this study was to assess clinical outcome in unilateral chronic subdural hematoma patients treated by single or double burr-hole drainage. This prospective study was carried out at the Department of Neurosurgery, IMS, BHU, Varanasi from September 2016 to August 2018. A total of 60 patients with their age ranged from 22to 88 years with GCS 6 to 15 &amp; hematoma thickness 10mmc were included in this study and randomly divided into two groups using random allocation software. In group A, patients with chronic subdural hematoma (CSDH) were managed with single burr-hole drainage. In group B, patients were managed with double burr-hole drainage. Clinical outcome was measured on the1st postoperative day, 3rd postoperative day and 7th postoperative day by GCS and at 1month follow-up by measuring the Glasgow outcome scale (GOS).</p> <p><strong>Result:</strong> In this study double burr-hole drainage and single burr-hole drainage surgery shows equal success in the management of CSDHs with single burr hole taking less operative time.</p> Shrish Nalin Anurag Sahu Kanika Gupta Kulwant Singh Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 180 188 Upper cervical spine tuberculosis https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1839 <p>Tuberculosis is an infection caused by Mycobacterium tuberculosis; mainly affects the lungs; spinal tuberculosis presents 6 % of the extrapulmonary locations; Upper cervical spine tuberculosis is a rare condition and counts only 0.3 to 1 % of all spinal tuberculosis; that makes it a rare condition studied by few case reports. We report a case of upper cervical spine tuberculosis of the atlantoaxial facet joint. </p> Adel Khelifa Lakhdar Berchiche Walid Bennabi Muneer Al Zekri Abdelhalim Morsli Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 189 191 The use of corticosteroids in autoimmune encephalitis https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1834 <p>Autoimmune encephalitis (AE) is a brain inflammation caused by autoantibodies that target proteins, intracellular and extracellular antigens, triggering damage in the CNS; AE is classified in various syndromes caused by various antibodies, It is a diagnosis of exclusion. Therefore, it has to be differentiated from multiple causes that could unleash encephalitis. However, its treatment is based primarily on immunotherapy, where corticosteroids as immunosuppressive agents, play a key role in the treatment along with other agents.</p> Ivan David Lozada Marintez Bryan Lester Nahar-González Yandris Arevalo-Martínez Loraine Quintana-Pajaro Silvia Prada-Soto Teresa Pacheco-Hernandez William Florez-Perdomo Yelson Alejandro Picón-Jaimes Luis Rafael Moscote-Salazar Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 192 198 Paediatric brain abscesses in tribal region of India https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1826 <p><strong>Introduction:</strong> Brain parenchymal abscesses are relatively infrequent but potentially serious infections in the paediatric population. Surgical intervention in addition to a prolonged administration of antibiotics is generally appropriate management.</p> <p><strong>Aims and objective:</strong> We performed this study to assess the clinical profile, aetiology and outcome of paediatric brain abscess which are treated surgically only by aspiration in the tribal region of Rajasthan.</p> <p><strong>Material and method: </strong>A single-centre retrospective study was conducted over a 5 year period (2014–2019) in the department of neurosurgery in RNT medical college, Udaipur, Rajasthan. We treated approx 60 patients of which 25 patients treated conservatively and 5 patient treated by craniotomy and abscess excision. So only 30 patient included in our study in which abscess treated by aspiration only. Patients&lt;18 years of age with a confirmed intra-parenchymal abscess were included. Patient records were reviewed for abscess location, microbiology results, Clinical features, Surgical intervention, and outcome using the Glasgow Outcome Score at 3 months.</p> <p><strong>Result:</strong> 11 patients had an abscess in the temporal lobe and Streptococcus was the most common causative micro-organism (n¼15). 25 patients (80%) had an identifiable source which included: ENT infections, congenital cardiac malformations, recent dental surgery and meningitis. The most common symptom is fever f/b headache, seizure and vomiting. But despite previous studies seizure (10/30) presentation is comparatively more. All 30 patients underwent aspiration.</p> <p><strong>Conclusion:</strong> In tribal regions of India ENT infections are a more common source of brain abscess because of poor hygiene and illiteracy and their ignorance of ENT infections and also not taking seriously to fever, headache and other health issues. But at present, there are also decreasing trends of brain abscess by ENT infections and rising trends by congenital heart disease which is a good sign that the health and educational infrastructure is strengthening in the tribal region also.</p> Sachin Kumar Jain Gaurav Jaiswal Tarun Kumar Gupta Krishna Govind Lodha Vishnu Kumar Lohar Kaushal Yadav Copyright (c) 2021 Romanian Neurosurgery 2021-06-18 2021-06-18 199 203 Lateral orbitotomy in the management of an intra-orbital lipoma https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1811 <p><strong>Introduction: </strong>Lipomas are benign subcutaneous mass, but the intra-orbital location is rarely reported in the literature and it can resemble a variety of other orbital lesions.</p> <p><strong>Case report: </strong>We describe a 15-year-old girl who presented with left exophthalmia. Orbital magnetic resonance imaging showed an encapsulated intra-conal mass displacing the optic nerve medially, the external right muscle laterally and the globe anteriorly. Excisional biopsy of the mass by lateral orbitotomy approach resolved the exophthalmia, and histology revealed a primary orbital lipoma.</p> <p><strong>Conclusion: </strong>The diagnosis of an intra-orbital lipoma is not easy and the surgical approach represents a challenge to achieve a total excision while avoiding complications.</p> Mandour Cherkaoui Ait Lhaj El Houssaine Khouya Ali Adil Gazzaz Miloudi E.L. Mostarchid Brahim Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 204 206 Primary calvarial cavernous haemangioma in a child https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1808 <p>A wide variety of bone lesions is encountered on the skull and usually with poor clinical presentations and non-specific radiological features. Primary cavernous hemangioma is one of these rare calvarial lesions that the symptoms are limited to a simple subcutaneous mass frequently neglected by the patient. Although seen in all ages from neonate to elderly; few cases were reported in the literature of patients in the first decade of life. We report a case of four years old boy with primary calvarial cavernous hemangioma in order to help to understand this pathology and to urge physicians to explore any chronic subcutaneous mass at any age. </p> Khelifa Adel Walid Bennabi Lakhdar Berchiche Abdelhalim Morsli Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 207 209 A solitary case of gliosarcoma an indication for TP53 mutation analysis: a non-concordant finding https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1753 <p><strong>Background: </strong>Li-Fraumeni syndrome (LFS) is a hereditary, autosomal dominant malignancy predisposition induced by a mutant TP53. Here, we describe a gliosarcoma (GS) case with a clinical family history impressive for an LFS case in the absence of inherited germline TP53 mutations. </p> <p><strong>Case description: </strong>We present a 44-year-old female with a right high parietal mass. The mass proved pathologically to be GS with an isocitrate dehydrogenase-1 (IDH1) mutation. Pedigree analysis identified five first-degree and second-degree relatives with LFS spectrum malignancies. The patient tested positive for TP53 mutation; however, her family tested negative.</p> <p><strong>Conclusion: </strong>Of all the tumours, GSs are the least described entity with LFS. We are highlighting the need to do a genetic survey in family members of the patient who has been diagnosed to have gliosarcoma and other tumours consistent with LFS.</p> Ebtesam Abdulla Nabeel Hameed Roopa Arora Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 210 214 C7 contribution to the ulnar nerve https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1734 <p><strong>Introduction</strong>. Classic anatomical literature frequently describes C7 contribution to ulnar nerve (UN) formation as a casual event. However, surgical practice and dissections frequently reveal a recurrent presence of a lateral cord component of the UN. This study aimed to seek through literature to establish the frequency and degree of this contribution.</p> <p><strong>Methodology</strong>. We ran a literature review searching on Pubmed, MEDLINE, Embase and Web of Science databases for ulnar nerve anatomy and described discursively the results.</p> <p><strong>Results and discussion</strong>. We found 9 articles that described quantitatively and qualitatively the contribution of C7 on the formation of the UN. The prevalence described ranged from 2 to 100%, depending on the methodology used and population characteristics. When present, studies described a contribution from 9,9% to 30,4%, sending even more fibres than T1 root on average.</p> <p><strong>Conclusion</strong>. The C7 root can be considered a frequent and important component of the ulnar nerve, explaining UN territory repercussions on C7 radiculopathies. This knowledge is important on surgical approaches, maybe avoiding iatrogenic lesions and negative outcomes.</p> Lívio Pereira de Macêdo Arlindo Ugulino Netto Kauê Franke Pierre Vansant Oliveira Eugenio Lucas Ribeiro de Moraes Freitas Fábio Antônio Serra de Lima Júnior João Vitor Romeiro de Paula Silvya Nery Bernardino Fernando Henrique Morais de Souza Nivaldo S. Almeida Hildo Rocha Cirne Azevedo-Filho Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 215 218 Burr-hole craniostomy versus mini-craniotomy in the treatment of chronic subdural hematomas https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1946 <p>Although cases of spontaneous recovery or under medical treatment have been reported, the treatment of chronic subdural hematoma is mainly surgical. The optimal surgical technique for the treatment of chronic subdural hematomas is still open to debate. The purpose of this study was to compare the clinical outcomes between burr-hole craniostomy and craniotomy in patients with chronic subdural hematoma. Materials and methods: we have performed a retrospective study in patients operated for chronic subdural hematoma in the neurosurgery department of the teaching hospital of Bouaké between July 1, 2016, and June 30, 2020. We compared the data of patients operated by a single burr-hole craniostomy (group A) and those operated by minicraniotomy (group B). Demographic parameters, clinical signs, complications and neurological findings were analyzed. Fisher’s exact test, Chi-squared, and student’s t-test were performed. Results: group A included 46 patients and group B 55 patients. There was no significant difference between the two groups about age (59.5 years vs 59.8 years p = 0.89), sex (man: 74% vs 78.2%, P = 0.645), comorbidities, clinical signs on admission and location of the hematoma. There was also no significant difference between recurrence rates (4.3% vs 3.6% p = 0.55), postoperative complications (15.21% vs 7.27% p = 0.172) and neurological findings between the two groups. Conclusion: patient outcomes are similar in the treatment of chronic subdural hematomas by craniostomy and minicraniotomy.</p> André Tokpa Moussa Diallo Louis Kéabléon Derou Yves Soress Dongo Bernard Fionko Adéréhime Haïdara Copyright (c) 2021 2021-06-18 2021-06-18 219 224 Shunt in scrotum: unusual shunt complication in an operated case of post TBM hydrocephalus https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1947 <p>The role of shunt placement is to divert cerebrospinal fluid (CSF) from within the ventricles to an alternative location most commonly peritoneal space. Ventriculo Peritoneal Shunt (VPS) is associated with many complications viz over drainage, valve failure, breaking of catheter, catheter obstruction, coiling of catheter, spontaneous knot formation, infection and migration of distal catheter and all of them finally leading to obstructive hydrocephalus. One such complication is distal catheter migration to a rare but possible site i.e. scrotum. We reported a case of scrotal migration of shunt as a late complication of VPS insertion.</p> Manoj Agarwal Sharad Pandey Pankaj Kumar L.N. Gupta Copyright (c) 2021 2021-06-18 2021-06-18 225 227 Spectrum of non-traumatic craniovertebral junction disorders https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1949 <p><strong>Introduction: </strong>Craniovertebral junction is the “zone of transition” between the skull and cervical spine so its detailed discussion is lacking in so many standard textbooks addressing these regions. These anomalies are especially common in the Indian subcontinent. Accurate diagnosis, probable aetiology and pre-treatment evaluation considerably affect the prognosis of patients.&nbsp;The aim of this study was to classify various Craniovertebral junction disorders according to their aetiology and to correlate the imaging findings with the clinical profile of the patients and histopathology whenever possible.</p> <p><strong>Methods: </strong>This prospective observational study was done in our department over the period of one year from August 2016 to July 2017. 57 North Indian patients from all age groups and both sex, who had imaging features suggesting craniovertebral junction pathology were selected for the study.</p> <p><strong>Results:</strong> Our study group comprised 34 males and 23 females with a male to female ratio of 1.47: 1. The most common age group was 11-20 years and the most common aetiology being developmental followed by infective, autoimmune and inflammatory disorders.</p> <p><strong>Conclusions:</strong> CVJ abnormalities are a group of treatable neurological disorders, and are approached with much caution by clinicians. Thus, it is crucial that radiologists should be able to make a precise diagnosis, categorize them into etiological groups, and give precise anatomical information on MDCT and/or MRI, as this information ultimately helps determine the management of such abnormalities and their prognosis.</p> Neha Singh Deepak Kumar Singh Copyright (c) 2021 2021-06-18 2021-06-18 228 233 Possibilities of endoscopic endonasal transsphenoidal surgery in treatment of growth-hormone pituitary adenomas https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1950 <p>Pituitary adenomas are one of the most common primary central nervous system tumours and have an estimated prevalence of 17%.&nbsp; Management of hormone-secreting pituitary adenomas involves a multidisciplinary approach that can incorporate surgical, medical, and/or radiation therapies. Acromegaly is a rare, chronic disorder that mostly results from growth hormone (GH)-secreting pituitary adenoma. We analyzed the outcomes of surgical treatment for growth hormone (GH) pituitary adenomas based on 28 cases and determine factors that lead to biochemical remission.</p> Ruslan V. Aksyonov Orest I. Palamar Andriy P. Huk Dmytro S. Teslenko Dmytro I. Okonskyi Copyright (c) 2021 2021-06-18 2021-06-18 234 238 Letter to the editor https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1731 <p>Endovascular treatment of intracranial aneurysms has become one of the most important preclinical research arenas. This influential progress is due to the incredible development of new devices and catheters technologies. One of the main outcomes for intraluminal devices used for treatment is the rate of occlusion of the aneurysm.</p> Amit Agrawal Luis Rafael Moscote-Salazar Tariq Janjua Copyright (c) 2021 Romanian Neurosurgery 2021-06-15 2021-06-15 239 240