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Background/Objectives: Superior cerebellar artery (SCA) aneurysms are exceedingly rare, posing unique diagnostic and management challenges due to their complex anatomical location within the posterior circulation. The proximity of the SCA to vital structures, such as the brainstem and cerebellum, along with the significant role of poorly controlled hypertension in aneurysm formation, further complicates treatment. This case aims to highlight the surgical approach and management strategies employed in treating a rare SCA aneurysm in a patient with longstanding hypertension. Methods: A 68-year-old female presented with an acute onset of severe headache, nausea, and vomiting, later confirmed to be due to a ruptured SCA aneurysm. The patient's history of poorly controlled hypertension was identified as a major contributing factor to the aneurysm's development and rupture. Due to the aneurysm's wide-neck morphology and irregular shape, microsurgical clipping was selected as the treatment method. The occipito-parietal far-lateral approach was employed to gain optimal access to the aneurysm, minimizing the risk to adjacent neurovascular structures. Results: Microsurgical clipping successfully excluded the aneurysm while preserving the parent artery. The surgical approach enabled precise aneurysm isolation and ensured no postoperative neurological deficits. The patient recovered well, with no significant complications, and hypertension management was emphasized as a vital element of the patient's long-term care. Conclusions: The surgical technique effectively achieved complete aneurysm exclusion with preservation of the parent artery and no associated neurological deficits. The patient's recovery was uneventful, highlighting the efficacy of the approach. Long-term management of hypertension remains a critical component to prevent recurrence and ensure sustained outcomes. [ABSTRACT FROM AUTHOR]

Background: This case report highlights a rare presentation of a giant convexity en plaque anaplastic meningioma, located in the left frontoparietal parasagittal region, infiltrating the superior sagittal sinus, and associated with Gerstmann syndrome. This study aims to explore the clinical challenges, surgical management, and potential reversibility of neurological deficits induced by the tumor, including those characteristic of Gerstmann syndrome. Methods: A 76-year-old male patient presented with a history of worsening expressive aphasia and cognitive impairments, culminating in a generalized seizure. Preoperative imaging confirmed a 4 × 6 cm highly vascularized tumor with significant peritumoral edema. The patient underwent near-total resection of the tumor, aiming for a Simpson grade 2 resection, while managing hypervascularity and brain edema. Histological analysis confirmed the diagnosis of anaplastic meningioma (WHO Grade III), showing features such as necrosis, brain invasion, and high mitotic activity. Results: Post-surgical follow-up demonstrated significant improvement in the patient's neurological deficits, particularly in expressive language and cognitive function, suggesting a potential reversal of Gerstmann syndrome. Postoperative imaging revealed a moderate degree of cerebral collapse and absence of contrast leakage. Two-month follow-up confirmed no recurrence of neurological deficits. Conclusions: This case emphasizes the complexity of managing giant convexity en plaque anaplastic meningiomas, particularly when associated with Gerstmann syndrome. Surgical resection, despite the challenges posed by tumor size, hypervascularity, and peritumoral edema, can lead to significant neurological recovery, highlighting the potential reversibility of tumor-induced Gerstmann syndrome. [ABSTRACT FROM AUTHOR]

Background: Brain arteriovenous malformations (AVMs) are challenging vascular lesions. Extensive follow-up studies are necessary to refine the therapeutic algorithm, and to improve long-term survival in these patients. The aim of the study was to assess surgical outcomes, and to evaluate overall long-term mortality in patients treated for brain AVMs. Methods: This retrospective single-center study included 191 patients with brain AVMs, admitted between 2012 and 2022. Clinical and angiographical particularities have been analyzed, to identify factors that might influence early outcome and overall long-term mortality. Results: Out of 79 patients undergoing surgery, 51 had ruptured AVMs with total resection achieved in 68 cases (86.1%). Deep venous drainage was associated with incomplete resection. Female sex, admission modified Rankin Scale (mRS) > 2, and eloquent location were independent predictors of poor outcomes. Multiple venous drainage was associated with a higher risk of worsened early outcome. Eloquent brain region involvement, conservative treatment, increasing age, admission mRS > 2, and comorbidities significantly decrease survival in brain AVM patients. Patients treated with interventional treatments had significantly better survival than the conservatively managed ones, when adjusting for age and admission mRS. Conclusion: The study identified female sex, poor neurologic status on admission and eloquence as independent prognostic factors for a negative outcome after surgery. Patients who received interventional treatment had significantly better survival than patients managed conservatively. We recommend employing tailored, proactive management strategies as they significantly enhance longterm survival in brain AVM patients. [ABSTRACT FROM AUTHOR]

This article discusses the use of endoscopic spine surgery (ESS) as a minimally invasive alternative to traditional surgery for lumbar disc herniation. The article presents six successful cases using the interlaminar approach, with favorable postoperative outcomes. However, the article also highlights potential complications and the need for caution during the procedure. The document provides a detailed description of the technique, which involves specialized instruments and a 4K camera system. It emphasizes the importance of proper patient selection and surgeon skill for successful outcomes. [Extracted from the article]

INTRODUCTION: Intraoperative ultrasound (IOUS) is a non-invasive technique that is increasingly used in neurosurgery, especially in oncological pathology. The main advantage consists of offering a real time image and can help localize the lesion and guide the extent of resection. MATERIAL AND METHODS: We describe our experience at Bagdasar-Arseni Clinical Emergency Hospital from a prospectively maintained database of malignant CNS tumors where IOUS was used over the past three years. RESULTS: Intraoperative ultrasound (IOUS) was routinely employed in the resection of brain tumors, proving helpful not only in localizing the lesion but also in determining the extent of resection. This was particularly useful for diffuse infiltrative lesions such as gliomas. Moreover, in patients with multiple metastases, where the neuronavigation system was limited due to brain shift following the resection of one lesion, IOUS was very efficient in determining the location. CONCLUSION: Intraoperative ultrasound is a widely adopted technique in neurosurgery, aiding neurosurgeons achieve maximal safe resection of brain and spinal tumors. Its main advantages include quick, real-time image acquisition, compensation for brain shift, and integration with neuronavigation systems. The most significant limitation, however, is the relatively long learning curve associated with mastering the technique. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Navigated transcranial magnetic stimulation (nTMS) is a noninvasive preoperative mapping technique used to identify eloquent cortical areas. Malignant brain tumors often have an infiltrative growth pattern, making complete resection difficult, especially when these tumors are situated in eloquent regions. In this paper, we present our experience with nTMS cortical mapping for malignant brain tumors located in eloquent areas. MATERIAL AND METHODS: Patients with malignant brain tumors located in motor or language eloquent areas who underwent nTMS mapping followed by surgery at our institution were included in the study. Patients were excluded if they presented TMS or MRI contraindications. RESULTS: Patients with gliomas and metastases located in motor or language eloquent areas were included in the study. The results of the nTMS brain mapping were integrated into the intraoperative neuronavigation system and used to guide surgical planning. nTMS was useful in determining the eloquent areas, especially for motor cortex. No patients suffered new-onset or worsening of the preexistent neurological deficits following surgery. CONCLUSIONS: nTMS preoperative cortical mapping combined with intraoperative neuronavigation is a valuable tool for the resection of malignant brain tumors. It offers guidance for avoiding eloquent areas, thereby improving the functional outcomes for patients. [ABSTRACT FROM AUTHOR]

Background. Hemangioblastomas are considered rare tumours that are located, in most cases, in the posterior cranial fossa. In most of cases, spinal hemangioblastomas are identified on the thoracic and cervical levels and can be associated in one-third of cases with von Hippel Lindau Syndrome. Material and methods. In this paper, we are presenting our clinic's experience with spinal hemangioblastomas and the follow-up of the patients in the last 10 years. Results. In our study, we included six men and three women with a mean age of 45 years, ranging between 36 to 61 years. The mean hospitalization days was 17 days. Among nine patients, there were identified 12 tumors. Six patients presented cervical spine hemangioblastomas, two of them had thoracic spine lesions and in one case, the tumour was identified at the lumbar level. Furthermore, two patients presented multiple lesions. Two patients had been associated with von Hippel Lindau Syndrome. In all cases, surgery was the therapeutic approach. Discussions. Despite the rapid advance of technology and the new alternatives for the treatment of these lesions, surgical resection of hemangioblastomas remains the gold standard treatment. Conclusions. Hemangiolbastomas are benign tumours that can be associated with von Hippel Lindau. A whole-body scan is required to confirm or exclude this syndrome. Even though the surgical treatment for asymptomatic patients remains debatable, surgical intervention is the only treatment that can lead to the total removal of the tumour. [ABSTRACT FROM AUTHOR]

Background. Even in the 21st century, infections of the central nervous system and their secondary damage still represents a high mortality condition. Furthermore, brain abscesses (BA) are huge public health issues due to their high mortality and morbidity with high financial implications for the health care system. Material and methods. In this article, we want to present our clinic's experience in the management of brain abscesses between 2012 and 2021. A 10 years retrospective study was performed in the 4th Neurosurgery Department of "Bagdasar-Arseni" Clinical Emergency Hospital in Bucharest Results. In the last 10 years, our clinic admitted 46 patients, 10 women and 36 men. The mean age was 47 years old. The most common symptom was headache (42 cases). In 39 cases, patients had solitary abscesses while seven patients presented multiple abscesses. The therapeutic approach was classic surgery in 37 cases. In four cases abscess drainage was performed and in five cases conservative treatment was used. At discharge, 31 patients were healed and seven patients died. Discussions. In BA management, antimicrobial therapy is crucial. Thus, identifying the pathogen is crucial for accurate antimicrobial treatment. Unfortunately, in too many cases, the agent remains unknown and empiric treatment is required. Aspiration of the abscesses proved to be safe and with similar results compared to classic surgery. Conclusions. Brain abscesses remain a high challenge to manage even in the 21st century. Broad-spectrum antibiotic treatment should be applied as soon as possible until the pathogen is identified and specific treatment will be used. [ABSTRACT FROM AUTHOR]

Background/Objectives: Approximately half of the patients harboring supratentorial brain arterio-venous malformations (stAVMs) present with hemorrhage, and another considerable proportion suffer from epileptic seizures. An important milestone in the management of this vascular pathology is acknowledging their natural history, especially across long periods of time. The aim of this study was to assess the predictive factors for hemorrhage and for epileptic seizures as presenting symptoms in stAVMs. Methods: We retrospectively analyzed patients with stAVMs admitted to our institution between 2012 and 2022 and evaluated predictive factors for hemorrhage and the risk factors associated with epileptic seizures. Results: The cohort included 169 patients, 78 of them (46.2%) presenting with intracerebral hemorrhage (ICH). Seventy-seven (45.5%) patients suffered from epileptic seizures. The annual hemorrhagic rate was 1.28%/year. Unruptured lesions ( p = 0.001, OR 3.1, 95% CI 1.6-6.2), superficial venous drainage ( p = 0.007, OR 2.7, 95% CI 1.3-5.7) and large nidus size ( p = 0.025, OR 4, 95% CI 1.2-13.5) were independently associated with seizures. Among unruptured lesions, superficial venous drainage (OR 2.6, p = 0.036, 95% CI 1.06-6.3) and frontal/temporal/parietal location (OR 2.7, p = 0.040, 95 CI% 1.04-6.9) significantly increased the risk of seizures as a presenting symptom in multivariate analysis. Patients younger than 18 ( p = 0.003, OR 4.5, 95% CI 1.6-12.2), those with AVMs < 3 cm ( p = 0.03, OR 2, 95% CI 1.07-3.9) or those with deep located AVMs ( p = 0.035, OR 2.3, 95% CI 1.06-5.1) presented statistically more often with ICH in multivariate regression. Small size (HR 1.8, 95% CI 1.09-3, p = 0.022) and exclusively deep venous drainage (HR 2.2, 95% CI 1.2-4, p = 0.009) were independent predictors for ICH, in time-dependent birth-to-diagnosis analysis. After shifting the birth-to-diagnosis curve by 10 years, unique arterial feeder demonstrated a positive correlation with ICH presentation as well. Conclusions: Small AVMs, those with exclusively deep venous drainage, unique arterial feeder or deep location may pose higher hemorrhagic risks for the patient, and therapeutic strategies should be tailored accordingly. When managing unruptured brain AVMs, it is important to consider the risk of developing seizures, in addition to the lifelong risk of hemorrhage, in determining the optimal treatment approach for each patient.

Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome.