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Meningiomas developing in the anterior and middle fossa can compress the optic nerve (ON) and cause secondary visual disturbances. The aim of this study was to evaluate the clinical, pathological, and surgical characteristics of atypical meningiomas (WHO grade II) compressing the ON and located in the anterior and middle fossa of the skull base. Materials and Methods: We retrospectively studied the data of 5 patients with atypical meningiomas compressing the ON, diagnosed at the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital in Iași, from 2010 to 2019. Results: Out of 5 patients, 4 presented with intracranial hypertension syndrome at admission, and 2 with motor deficits. Most patients (4 out of 5) had reduced visual acuity (VA) at admission, and 3 of them had partial or total ON atrophy. The preferred surgical approach was the pterional approach for sellar and parasellar meningiomas (2 cases), and the frontotemporal approach for large meningiomas with extension (3 cases). Conclusion: Although most patients had reduced VA at the time of admission, they presented to the hospital with other neurological symptoms. This suggests that the slow growth of intracranial meningiomas and the gradual compression of the ON may delay early diagnosis and, more importantly, effective treatment in these patients. We recommend regular evaluation of VA, as early detection of a slow-growing intracranial tumor, such as a meningioma, can help prevent vision loss.

Objectives We present the case of a 37-year-old female who underwent partial resection in 2018 for a diffuse fibrillary astrocytoma (WHO II) that invaded almost the entire right cerebral hemisphere. The patient followed conventional radiotherapy and chemotherapy. She presents after 6 years of regularly follow-ups with left hemiparesis, intracranial hypertension syndrome and tumor recurrence on MRI. The patient underwent another surgical intervention and the new histopathological diagnosis was diffuse astrocytoma grade IV. Therapeutic options for these patients are limited considering the fact that a gross total resection or a conventional re-irradiation could impact the quality of life. Therefore, exploring new therapeutic methods, such as targeted molecular therapy like EGFR antagonists or proteasome inhibitors, or proton therapy, should be considered. Material and Methods We conducted extensive research in two public medical databases for information related to the molecular pathways and management of primary and recurrent malignant astrocytoma and relevant articles were selected. Subsequently, we correlated this information with our direct experience in our case and discussed the observed results. Results Treatment modalities for these patients include reintervention, re-irradiation and second line chemotherapeutics. In relapsing cases the goal of reintervention is both to alleviate symptoms and obtain tumoral tissue for immunohistochemical analysis for identification of the new mutations. Conventional re-irradiation for large lesions carries high risks of producing both short-term and long-term side effects, impacting the quality of life. Alternatively, proton therapy minimizes the risk of adverse events due to Bragg peak reducing the irradiation of the surrounding tissue. Conclusions Genetic characterization of these lesions can facilitate targeted molecular therapy and help in establishing the prognosis. Re-irradiation of malignant astrocytomas with proton therapy is an effective treatment measure allowing for comparable tumor control to conventional radiotherapy.

Background/Objectives: Ongoing challenges in epilepsy therapy warrant research on alternative treatments that offer improved efficacy and reduced side effects. Designed to enhance mitochondrial targeting and increase bioavailability, mitocurcumin (MitoCur) was evaluated for the first time as an antiepileptic agent, with curcumin (Cur) and sodium valproate (VPA), a standard antiepileptic drug, included for comparison. This study investigated the effects on seizure onset, severity, and progression in a zebrafish model of pentylenetetrazole (PTZ)-induced seizures and measured the concentrations of the compounds in brain tissue. Methods: Zebrafish were pre-treated with MitoCur and Cur (both at 0.25 and 0.5 µM doses) and VPA (0.25 and 0.5 mM) and observed for four minutes to establish baseline locomotor behavior. Subsequently, the animals were exposed to a 5 mM PTZ solution for 10 min, during which seizure progression was observed and scored as follows: 1—increased swimming; 2—burst swimming, left and right movements; 3—circular movements; 4—clonic seizure-like behavior; 5—loss of body posture. The studied compounds were quantified in brain tissue through HPLC and LC-MS. Results: Compared to the control group, all treatments reduced the distance moved and the average velocity, without significant differences between compounds or doses. During PTZ exposure, seizure latencies revealed that all treatments effectively delayed seizure onset up to score 4, demonstrating efficacy in managing moderate seizure activity. Notably, MitoCur also provided significant protection against the most severe seizure score (score 5). Brain tissue uptake analysis indicated that MitoCur achieved higher concentrations in the brain compared to Cur, at both doses. Conclusions: These results highlight the potential of MitoCur as a candidate for seizure management.

Patients suffering from allergic conditions often also complain of ophthalmological symptoms. There are many anatomic connections between allergic conjunctivitis and allergic rhinitis. In addition to the physical connections existing within the nasolacrimal duct, the most important systems involved in pathological processes are innervation, circulation, and the lymphatic and neurogenic systems. A significant number of neurogenic compounds have been identified in the respiratory tract, nasal mucosa and ocular surface. The thorough understanding of the connection between nasal mucosa and ocular surface may influence the therapeutic approach and may improve the patients’ quality of life.

Primary open-angle glaucoma (POAG) is a progressive optic nerve disease characterized by neurodegeneration of retinal ganglionic cells and their axons. Local inflammatory responses are implicated in the pathology of glaucoma. Despite the large number of studies conducted to identify non-genetic risk factors, only race, age, intraocular pressure, and corneal thickness were consistently identified. Of these, only intraocular pressure is a modifiable factor and also the only means we have at our fingertips to influence the development of glaucomatous disease. Tooth loss or periodontal disease is associated with systemic endothelial dysfunction, which has been implicated in primary open-angle glaucoma. The main hypothesis behind this correlation is that infectious and inflammatory processes located in the teeth can produce factors that will be released into systemic blood circulation. At the eye level, these factors are responsible for triggering the inflammatory response, neurodegeneration and, in some cases, open-angle glaucoma. Mounting evidence suggests that neuroinflammation is a key process in glaucoma, while the precise roles are yet to be discovered. In this article we reviewed the literature on neuroinflammation in glaucoma triggered by oral cavity microbiota and infiltration of peripheral immune cells. In conclusion, if an association between dental health, the oral microbiome and POAG were established, this would have potentially significant implications for the understanding and management of glaucoma and possibly other neurodegenerative diseases and we will be able to work together in order to prevent both glaucoma and dental diseases.

Low-grade glioma is characterized by slow growth, infiltrative pattern through white matter tracts and progression to a malignant tumour type. The traditional classification is newly replaced by molecular stratification. This reorganisation gathers glioma with similar prognosis and treatment protocols. The preferential location of that tumour in eloquent areas constituted, over time, a real challenge regarding the best surgical approach. Because of the high risk of postoperative neurological deficits initially a more conservative management was adopted. Once with the development of preoperative and intraoperative functional assessment techniques, a higher degree of resection was possible in the limits of cortico-subcortical eloquence, being well known that this is a statistically significant factor for survival. We present in this paper the natural evolution of low-grade glioma, their new molecular classification, prognostic factors and the various approach proposed for eloquent ones.

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.

Extradural vertebral artery dissection is a condition with a generally good prognosis if it is promptly recognized and treated. Diagnosis and consequently therapy delay may cause extensive ischemia with catastrophic consequences, due to embolism from the thrombus in the vessel wall or its extension. Considering these aspects and also its low incidence, the identification and treatment of this condition must be immediate, all the more, so as its onset is deceitful by occipital headache and neck pain. The association between vertebral artery dissection and dental procedures has been previously noticed. This paper aims to describe the etiopathogenesis and clinical recognition of dental chair vertebral artery dissection for a prompt neurosurgical intervention, in order to have a good prognosis.

Intraoral local anesthesia is a common dental procedure. It may often be accompanied by general complications, some of which may be ophthalmological, like: diplopia, ptosis, mydriasis, amaurosis, strabismus [1]. We report the case of a 67-year-old female patient who suffered an extraction of the left maxillary second molar and after intraoral local anesthesia administration she noticed the onset of diplopia, due to left lateral rectus muscle palsy. Ocular complications may occurs during intraoral local anesthesia, which are most of the times remitted and leave no visual sequelae.

Most posttraumatic cerebrospinal fluid fistulas are accompanied by rhinorrhea and the physician can easily diagnose a fistula (leakage) in case of a traumatic event. Nevertheless, cases of fistulas occurring many years after the head injury have been reported in literature. We report the rare case of a 19-year-old female patient with a penetrating head injury and 3 years long-term posttraumatic cerebrospinal fluid fistula complicated with recurrent meningitis.

Envy and jealousy are emotions or feelings that are found in all cultures of the world in all historical periods. Envy is a negative emotion which occurs when a person lacks another’s possession, or the egotistical ill-feeling caused by another’s achievement or superior quality or welfare. Envy is found in all professions, yet more frequently among doctors, especially among surgeons. It may be classified in surgical envy, hierarchical envy and patient-related envy. Professional envy in doctors makes socializing and interrelating difficult, as the peers are always seen as competitors and socializing with them is competition and not a collective effort directed to help the patient and to do good. The remedy for professional envy is self-discipline and devotion to the profession and to the patient, the pursuance of a higher life ideal, the aw

Trigeminal neuralgia is a common condition in elderly patients. In this group of patients, trigeminal neuralgia mainly occurs due to a neurovascular conflict. However, the primary or secondary tumour lesions located at the level of the trigeminal nerve (in Meckel's cave) are rare. The authors are presenting the case of a 70 year old patient who was hospitalized for right trigeminal neuralgia, whose subsequent imaging explorations and anatomopathological examination revealed a metastatic adenocarcinoma of the colon, which is a rare etiology of trigeminal neuralgia

Eye globe rupture is an ophthalmologic emergency which needs surgery in order to preserve globe integrity and visual acuity. In certain cases of severe physical trauma, partial or total extrusion of the ocular contents leads the surgeon to the decision to eviscerate the eye globe. The aim of this article is to highlight the psychological impact in a clinical case with forensic implications of a 39-year old patient with eye globe rupture. He underwent severe physical aggression, as he was hit with a metallic blunt object in the face, which led to losing one eye and permanent mutilation. In eye globe rupture generating the loss of the eye, as it is in our case, patient undergoes concomitant mental disability, needing after operation psychological counseling in order to accept his present status. It is also essential for the ophthalmologist to make a correct and well-documented assessment of the patient, to complete a full forensic report and to establish accurately under which provisions of the Romanian Criminal Code the offence is falling.

Neurosurgery is a rewarding career choice in which there are many challenges and stress factors that can lower the level of satisfaction and also increase the levels of burnout. The identification and management of common work-related stressors is important for improving the performance of health-care specialists and also for providing high-quality patient care.

Most traumatic brain injuries with occipital impact cause frontal and temporal contre-coup lesions, while patients with coagulopathies are more susceptible to such lesions. We present the case of a chronic ethylic patient with thrombocytopenia, who was treated for ethanol withdrawal syndrome at a psychiatric service. The head CT scan revealed an occipital contusion with atypical localization and the absence of fronto-temporal contre-coup lesions. In conclusion, it is recommended a head CT scan to chronic alcoholic patients with psychiatric manifestations, especially in the context of systemic coagulopathies related to excessive alcohol consumption. In the case of chronic ethylic patients that frequently display systemic coagulation disorders, the head CT scan is necessary at the first psychiatric manifestations.

Orbitocranial penetrating injuries (OPI) represent a rare type of head injuries encountered in clinical practice. These appear after falls or motor vehicle accidents and are more frequent among children. We present the case of a male patient with OPI, associated with large frontal hemorrhagic contusion, with minimal periorbital trauma findings related to brain injury. Knowing and understanding the clinical anatomy of the orbit and the patterns of injuries in OPI are mandatory, since failure in detecting intracranial complications may lead to the increase of the neurological morbidity, visual loss and death.

Atypical meningioma represent an intermediary group between the benign meningioma (grade I) and anaplastic meningioma (grade III), and are known for high recurrence rate and short life expectancy. After modification of the classification World Health Organization in 2007, subsequent studies have tried to find prognostic factors for recurrence and survival, which are inconstant from author to author. This paper aims to present a short review of the most important prognostic factors in atypical meningioma.

The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach.

The Holy Bible includes descriptions of the spine with both neurosurgical and neurological implications and most spinal disorders presented have been briefly described and display a mystical nature. The Holy Bible is a book full of sacred precepts and not a medical encyclopedia as it was written in the context of that age, and in a language that had to be understood by people of that era. This paper aims to give a short presentation of several diseases of the spine mentioned in the Holy Scripture in order to identify the most common disease among the Jews during biblical times and attempts to provide their diagnosis.

Background: The involvement of falx cerebri in tuberculosis is extremely rare, with only three cases reported so far in the literature. The diagnosis is most often difficult to establish, given the location of the lesion, making surgical intervention necessary for a definite histopathologic diagnosis. Methods: We present the case of a 49-year old female patient who was admitted for a right jacksonian seizure, followed by a right crural monoparesis, without a history of tuberculosis. The lesion mimicked a falx cerebri en plaque meningioma in the imaging tests. Results: A complete surgical excision was performed through a left fronto-parietal parasagittal approach. The histopathological examination revealed a case of cerebral tuberculosis. The surgical treatment was complemented postoperatively with antituberculous therapy. Conclusion: In this article, we emphasize the rarity of the lesion at this level and also presenting similar cases from the literature. Moreover, we also discuss epidemiological, clinical, imaging, therapeutic as well as pathological aspects of en-plaque dural tuberculoma.

Rightfully regarded as the father of German neurosurgery, Fedor Krause made a major contribution not only in world neurosurgery, but also in medicine. The aim of this paper is to highlight once more the significance and importance of Fedor Krause’s work and exceptional human quality.

The arachnoid cyst is a lesion commonly encountered in neurosurgery, especially in pediatric pathology. We are presenting the case of an adult patient with a suprasellar arachnoid cyst with giant perimesencephalic and mesial temporal extension discovered incidentally, where there is a discrepancy between the spectacular neuroimaging and the non-specific symptomatology. Some of the physiopathological mechanisms which led to the evolution of the cyst will also be presented.

Myasthenia gravis is one of the neurological diseases with a relatively recent history, full of mistakes, in which the British and German neurology schools have attempted to find answers when confronted with the unknown. The paper aims at making a historical account of the disease from its discovery in the 16th century, when the first case of myasthenia gravis was medically diagnosed, to the beginning of the 20th century, when the dawn of modern therapy started to show.

Severe head trauma remains an important public health issue and the intracranial pressure monitoring is useful in indicating the patients prognosis, variation especially elevated intracranial pressure were associated with a poor prognosis. We illustrate some cases where we insert the monitoring system (intraparenchymal or intraventricular) and the neurological evolution.

AIM: to compare the AgNOR's mean number with the histological type and grade of cerebral astrocytic tumors. MATERIALS AND METHOD: 16 primary cerebral astrocytic tumors (4 diffuse astrocytomas, 4 anaplastic astrocytomas and 8 glioblastomas) stereotactic biopsied in the Department of Neurosurgery, Clinical Hospital „Prof. Dr. N. Oblu” Iaşi, and histopathologically conventional diagnosed in Department of Neuropathology of the same hospital, were retrospectively identified. Tumor specimens were submitted to a combined staining technique: one – step silver nitrate method for AgNOR protein sites (modified after Ploton et al, 1986) counterstained with periodic acid-Schiff staining for basement membrane of vascular components. The mean AgNOR values (mAgNOR) for tumoral and vascular nuclei were determined. RESULTS: The average values of mean AgNORs/nucleus (mAgNOR/nucleus) presented a linear increase with increasing grade of malignancy from 1.96 for diffuse astrocytoma (GII), 2.34 for anaplastic astrocytoma (GIII), to 3.18 for glioblastoma multiforme (GIV). mAgNOR/tumoral nucleus also showed a linear correlation with the histological tumor grade: 2.27 for diffuse astrocytomas, 2.78 for anaplastic astrocytomas, and 3.35 for glioblastomas multiforme. A distinct difference between the mean values of AgNORs/vascular nucleus was expressed: 1.52 for diffuse astrocytoma (GII), 1.90 for anaplastic astrocytoma (GIII), and 3.18 for glioblastoma multiforme (GIV). There were some overlaps between GIII and GIV astrocytic tumors regarding the mAgNOR/tumoral nucleus: maximum value in anaplastic astrocytomas (GIII) was 2.91 and minimum value in small cells glioblastomas (GIV) was 2.47. Differentiation could be achieved with mAgNORs/vascular nucleus as no extreme value overlapped: maximum value in anaplastic astrocytomas (GIII) was 1.99 and minimum value in small cells glioblastomas (GIV) was 2.54. CONCLUSION: The malignancy grade of an astrocytic tumor can accurately be establish both on histological features of the conventional stained sample and on the average number, the shape and the distribution of AgNORs within tumoral and vascular nuclei, as AgNORs determinations supplement the histological information in small biopsies.