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Intracranial pressure monitoring seems to be an indispensable stage in management of severe traumatic brain injured patient. Since 2009, this technique completes our trauma protocol. The study has been carried out from 2011 to 2013 in Prof. Dr. N. Oblu hospital in Iasi. There have been included in the study patients with severe craniocerebral trauma, who had traumatic brain lesions CT detected and Glasgow score between 3 and 8. The age ranged from 16 to 60, an average of 35.5 years old. 50% of the studied cases had a favorable outcome. Diagrams associated to this category of patients showed increases in intracranial pressure above normal values but without repeated values above 50 mm Hg. Most of those patients had a good evolution under medical treatment. Monitoring intracranial pressure is an extremely useful stage in treating intracranial high pressure in traumatology and it should be included in the equipment of any intensive therapy section caring traumatic patients.

Traumatic intracranial aneurysms are rare conditions that can be a result of vast head trauma. Different aspects as history, etiology, histopathology, clinical manifestations, diagnosis and treatment options are discussed regarding the literature. A particular case of a pericalosal aneurysm is presented to highlight the importance of keeping in mind that this location can be a site of such aneurysms.

Intracranial dural arteriovenous fistulae (DAVF) with retrograde cortical venous drainage are uncommon lesions frequently associated with a poor prognosis if left untreated. The treatment of DAVFs with cortical venous drainage by endovascular occlusion of the entire arterial supply or the venous drainage is considered curative. We present our first endovascular experience with use of Onyx via the arterial route in these aggressive fistulas.

Particular anatomical situation like wide-neck aneurysms or a large neck/fundus ratio, located on an arterial bifurcation or a small artery, are still a challenge for endovascular coil occlusion. These are due to the risk of coil migration or coil protrusion into the parent vessels. In our study we describe the balloon assisted coiling technique regarding the efficacy and safety of its practice and the problems that could appear.

Orbital tumors are complex lesions representing a great challenge for the neurosurgeons and ophthalmologist. Methods: We analyse the database for 57 patients who underwent surgery for the treatment of orbital tumors at our institution between 2001 and 2010. Data from clinical notes, surgical reports, and radiological findings were extracted for the statistical analysis. Results: Predominant symptoms were exophthalmos (68%), visual disturbance (42%) and ocular mobility limitation (37%). The most used surgical approache was superior orbitotomy. Orbital tumors histopathological results showed that hemangiomas were the most common tumors type (35%). Malignant tumors accounted for 23% of cases. Total resection of tumors was achieved in 78% of patients. Conclusion: Surgical treatment could be considered an optimal treatment option for most of the orbital tumor. A better imaging anatomy analysis of the orbit correlated with good surgical skills is needed to overcome the pitfalls of intraorbital surgery.

Ventriculo-peritoneal (VP) shunt placement represents the most widely accepted form of treatment for most patients with hydrocephalus. Despite significant improvements in VP shunt procedures, various complications remain a common situation. The diagnosis of shunt failure can be confounded by a variety of factors, mechanical failure being the most common cause of multiple shunt revisions in a lifetime. A better understanding of mechanisms of shunt failure will cause an improvement in the management of this neurosurgical procedure.

Volume measurement techniques of intracranial aneurysms from 3D rotational angiography vary on different factor settings and, therefore, are operator-dependent. The purpose of this study was to evaluate the application and the precision of ellipsoidal approximation (mathematics and computer technique) and software methods to measure intracranial aneurysms volume starting from planar (DR and SD) and 3-dimensional (3D) angiographic images. The reliability of the methods was statistically compared in a clinical setting of 42 angiograms and 100 measurements performed by the same users. This study suggests that both techniques could be used for clinical applications with similar efficiency results. The 3D rotational angiography is an increasingly used method for cerebral aneurysms treatment planning. This complex imagistic method permits a better evaluation of cerebral aneurysms anatomy by an improved delimitation of vessels and aneurysms contours. Moreover, the 3D dataset can be used to calculate aneurysm volume. It is known the important role of aneurysm volume calculation in coil embolization treatment. To assess an optimal degree of coils aneurysm packing, it has become imperative to determine preoperatively the volume of the aneurysm to be embolized.

Authors describe a giant intradiploic epidermoid cyst of the cranial vault with massive intra- and extracranial extension and analyze the clinicopathological, imaging features and treatment of these lesions in the light of the most important published data. A 38-years old male patient with a history of chronic headache reported a painless subcutaneous swelling 4 months ago on the right frontoparietal scalp. CT and MRI evaluation revealed a large well-defined extracerebral mass in the frontoparietal scalp with destruction of both the inner and outer tables of the bone. The patient underwent a total microsurgical resection of the tumor and the cranial defect produced by the resection of the space-occupaying lesion was repaired with titanium wire mesh and methyl methacrylate cranioplasty. The histological examination has shown a cystic structure lined by squamous epithelium and containing laminated keratin material, aspects that are suggesting a epidermoid cyst. The patient post-operative course was uneventful, without any neurological deficit and was discharged after 48 hours of hospitalisation in a good medical condition. The review of the literature shows that the parietal bone location for intradiploic epidermoid tumors in rare. Complete surgical resection represent the gold standard of treatment, and no adjuvant therapy is needed. Recent advances in diagnostic imaging and treatment of these lesions are reviewed.

Background: Diffuse infiltrative low-grade gliomas (LGG) of the cerebral hemispheres in the adult are tumors with distinct clinical, histological and molecular characteristics. WHO (World Health Organization) classification recognizes grade II astrocytomas, oligodendrogliomas and oligoastrocytomas. Conventional MRI is used for differential diagnosis, guiding surgery, planning radiotherapy and monitoring treatment response. Advanced imaging techniques are increasing the diagnostic accuracy. Low-grade gliomas have been documented to undergo transformation into high-grade gliomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients diagnosed with low-grade gliomas. Methods: We have reviewed all adult patients operated on for hemispheric glioblastoma at N Oblu Hospital in Iasi between 2006 and 2009 and in particular those patients with secondary glioblastoma. Results: from the total 110 cases of glioblastoma, ten of them were secondary to malignant transformation of an previously operated low grade glioma. Of the 10 patients with secondary glioblastoma, the initial histology was: gr II astocytoma in 6 cases, oligoastocytoma in 2 cases and in oligodendroglioma in 2 cases. The mean patient age was 46.1± 0.9 years and the most frequent symptom was represented by seizures 70%, the mean time from the first symptom to diagnosis was 11,2 months. 40% of the cases had subtotal resection and 60% had total resection (defined by the surgeon at the time of operation). 5 patients received radiotherapy postoperatively, 2 received both radio and chemotherapy and 3 had no adjuvant treatment. In our series the median time to malignant transformation was 32,5 months. Conclusions: Younger age, normal neurological examination and oligodendroglial histology are favorable prognostic factors, total/near total resection can improve seizure control, progression-free and overall survival, mean while reducing the risk of malignant transformation. Early post-operative radiotherapy improves progression free but not overall survival. Chemotherapy can be useful both at recurrence after radiotherapy and as initial treatment after surgery to delay the risk of late neurotoxicity from large-field radiotherapy.

Resection of the maximum amount of tumoral tissue while preserving the function of the brain within or neighboring the tumor region established itself as a fundamental goal of modern oncologic neurosurgery. A major step in preoperative mapping of eloquent cerebral cortex was taken reliably through the use of functional magnetic resonance imaging. However it does not provide any information about the white matter tracts that may be affected by invasive, intrinsic brain tumors. The advances in diffusion-tensor (DT) imaging techniques have been used to map white matter tracts in the normal brain. The aim of this study was to demonstrate the role of DT imaging in preoperative mapping of white matter tracts in relation to cerebral neoplasms and the way it can influence the operative decision in our practice. Ten patients with brain malignancies within or neighboring eloquent cortical areas (nine glioblastoma and one grade two astrocytoma) underwent DT imaging examinations prior to tumor excision. Anatomical information about white matter tract location, orientation, and projections was obtained in every patient. Depending on the tumor type and location, evidence of white matter tract edema (one patient), infiltration (one patient), displacement (five patients), and disruption (three patients) could be assessed with the aid of DT imaging in each case. Diffusion-tensor imaging allowed for visualization of white matter tracts and was found to be beneficial in the surgical planning for patients with intrinsic brain tumors. The authors’ experience with DT imaging indicates that anatomically intact fibers may be present in abnormal-appearing areas of the brain. Whether resection of these involved fibers results in subtle postoperative neurological deficits requires further systematic study.

Achondroplasia is the most common form of human short-limbed dwarfism and is one of a spectrum of diseases caused by mutations in the FGFR3 gene. Achondroplasia is estimated to occur in 1 in 10,000–30,000 live births4,7. The disease is autosomal dominant, but 80% of patients have new mutations. It is commonly associated with several neurological conditions such as hydrocephalus, cervicomedullary compression, cervical or thoracic cord compression, and lumbar spinal compression due to bone stenosis along the neuraxis. We report a case with severe spinal stenosis at the lumbar and thoracic levels, with minimal involvement of the cervical spine with late neurological onset in an adult patient with achondroplasia. Neurological and radiological findings and surgical procedures are discussed. The patient was admitted with profound spastic lower paraparesis and urinary incontinence. In the first operation we performed lumbar decompression and the patient improved and on the fifth day she was able to take a short walk. 3 months after the first surgery we intervened on the thoracic spine with a multi-level decompression which allowed for further neurological improvement, continued in a specialized medical facility. The case stands out as the clinical picture was dominated by the lumbar stenosis (although both lumbar and thoracic stenosis were severe at the time of presentation) with a late onset and sparing of the cervical spine.

Most primary intracranial tumors occur as solitary lesions; multiple locations of one tumor, the occurrence of two different tumors or even collision tumors have been described only in a few patients. Multiple primary brain tumors rarely originate in different tissues. Cases not associated with von Recklinghausen's neurofibromatosis constitute only 0.3% of all primary brain tumors. The association of two primary intracranial tumors of different histogenesis in the same individual is rare, except in cases of phakomatosis or radiation-induced tumors. We present three cases with simultaneous occurrence of meningioma with glioblastoma, pituitary adenoma, and acoustic schwannoma respectively, as shown by MRI on admission. In two cases (meningioma/glioblastoma, and adenoma/meningioma associations) both tumors have been approached in one operation, both tumors being completely removed. In the meningioma/acoustic schwannoma association case only the schwannoma was approached surgically due to poor patient status and meningioma being completely clinically silent. Postoperative recovery was good for all three patients and the 1 year follow up showed no growth for the remnant meningioma. Although the particular tumors diagnosed in all three presented cases represent common primary intracranial tumors, the simultaneous occurrence of each two tumors is rare. Previous reported results failed to consistently show a common genetic mark that could explain the development of two different tumors. However, based on our cases and previous literature, we believe that increased research effort could provide significant insights in the appearance and development of multiple brain tumors.