Search

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.

Management of intracranial aneurysms is still a therapeutic challenge, especially in cases of complex lesions. Thus, the improvement of the study and intervention planning possibilities correlated with the access to continuous professional training based on simulation and clinical diversity represent optimal conditions for the efficient solution of this pathology. The development of three-dimensional printing technology offers a new opportunity in the modern treatment of intracranial aneurysms. The aim of this study is to present some aspects related to the materials and methods of manufacturing simulation models of individual 3D printed aneurysms and their influence in the optimal management of these lesions.

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.

Schwannomatosis is a rare tumor syndrome characterized by the presence of multiple benign non-vestibular, non-intradermal schwannomas and by the absence of neurofibromatosis type 1 or 2 syndromes. Multiple schwannomas are clinically and genetically distinct from neurofibromatosis, and the main treatment in case of symptomatic lesions is represented by surgical resection. In case of asymptomatic lesions, the indicated treatment is neuroimaging follow-up (MRI). We are presenting the case of a patient with three schwannomas of the cauda equina, as well as the treatment strategy in the case of this rare pathology.

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.

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.

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.

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.

Having a recent history, the neurological condition called myasthenia gravis has raised dilemmas and questions among doctors since it was first discovered in the 16th century and it has not ceased to be a challenge. Nowadays, neuroscience researchers from around the world have been striving to perfect a modern treatment of this condition. Our paper is an incursion into the past, more precisely into the history of the treatment of this disease, from its origin to date, when immunological therapy has progressed.

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.

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.