Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-040
Ahtesham Khizar, Syed Aamir Shah, Soha Zahid, Jayant Kumar Yadav
Background. The ventriculoperitoneal shunt is a common treatment for hydrocephalus. There are several complications associated with it. Shunt failure is one of the most frequent complications, but total intracranial shunt migration is quite uncommon. The exact cause of shunt migration is unknown, but several factors are thought to play a role. Case presentation. A 10-month-old boy was diagnosed with total intracranial migration of a ventriculoperitoneal shunt (Chhabra type). We used neuroendoscopy to remove this intracranially migrated shunt and implanted a new ventriculoperitoneal shunt (Medtronic type) on the opposite side. He had a favourable clinical outcome. Conclusion. Total intracranial shunt migration is an uncommon complication which is most likely caused by increased intraperitoneal pressure, strong head movements, and insufficient shunt fixation. Better patient handling combined with appropriate operative technique would be the best way to prevent shunt migration.
{"title":"Total intracranial migration of ventriculoperitoneal shunt","authors":"Ahtesham Khizar, Syed Aamir Shah, Soha Zahid, Jayant Kumar Yadav","doi":"10.33962/roneuro-2023-040","DOIUrl":"https://doi.org/10.33962/roneuro-2023-040","url":null,"abstract":"Background. The ventriculoperitoneal shunt is a common treatment for hydrocephalus. There are several complications associated with it. Shunt failure is one of the most frequent complications, but total intracranial shunt migration is quite uncommon. The exact cause of shunt migration is unknown, but several factors are thought to play a role. Case presentation. A 10-month-old boy was diagnosed with total intracranial migration of a ventriculoperitoneal shunt (Chhabra type). We used neuroendoscopy to remove this intracranially migrated shunt and implanted a new ventriculoperitoneal shunt (Medtronic type) on the opposite side. He had a favourable clinical outcome. Conclusion. Total intracranial shunt migration is an uncommon complication which is most likely caused by increased intraperitoneal pressure, strong head movements, and insufficient shunt fixation. Better patient handling combined with appropriate operative technique would be the best way to prevent shunt migration.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Glioblastoma Multiforme (GBM) is the most prevalent form of brain cancer. The effect of Extent of Resection (EOR) on GBM survival is controversial. EOR degree, pre- and postoperative tumour volume estimation, and significance to residual tumour volume are still challenged. GBM has a 14-month Overall Survival (OS) rate. There is no evidence of a link between EOR and OS survival. We wish to determine whether GBM tumour removal increases survival. Methods. At the Regional Center for Neurosurgery and Neurology in Uzhhorod, Ukraine, we conducted a retrospective evaluation of 86 consecutive patients diagnosed with glioblastoma who underwent surgery between January 1, 2010, and December 31, 2020, and who are being followed until January 1, 2022. Patients were selected if they met the following criteria: they were at least 18 years old, they had a diagnosis of glioblastoma (primary, secondary, or recurrent), they were either IDH mutants or wild types, they had an MRI within 2 weeks before surgery, and they had another MRI within 72 hours after surgery. Before and after surgery, we did a volumetric analysis of gadolinium-enhanced T1 MRI scans of the tumour to figure out EOR. Partial resection (PR) is <70%, sub-total resection (STR) is 70-90%, near-total resection (NTR) is 91-99%, and gross total resection (GTR) is >99%. By comparing pre- and post-operative volumes with the EOR, the Kaplan-Meier survival curve and Cox's regression analysis determined the impact of the EOR on survival rates. Many researchers considered a p value of 0.05 or below to be significant. Results. A total of 86 patients were included in the analysis after being subjected to the criteria used to narrow the pool of potential participants. The average length of time people lived was 15 months. For PR patients, the median survival time was 3 months, for STR patients it was 10 months, and for NTR patients it was 16 months. Patients receiving GTR, on the other hand, had a considerably better outcome, with a median survival time of 36 months. This data demonstrate a direct correlation between EOR and survival rates. It was discovered that EOR improvement affected post-op survival. High EOR patients have a better prognosis for survival. Adjuvant therapy, pre- and post-operative KPS score, pre- and post-operative tumour volume, and gender also contributed significantly to enhanced survival. Conclusion. Patients with glioblastoma appear to benefit from a more aggressive treatment strategy that combines maximal safe resection with the use of salvage adjuvant therapy. There was a correlation between complete resection (gross total resection) of intracranial GBM and improved survival. Whenever feasible, complete surgical removal of the tumour is recommended.
{"title":"Role of extent of resection on the survival of glioblastoma multiforme","authors":"Dipak Chaulagain, Volodymyr Smolanka, Andriy Smolanka, Taras Havryliv","doi":"10.33962/roneuro-2023-034","DOIUrl":"https://doi.org/10.33962/roneuro-2023-034","url":null,"abstract":"Background. Glioblastoma Multiforme (GBM) is the most prevalent form of brain cancer. The effect of Extent of Resection (EOR) on GBM survival is controversial. EOR degree, pre- and postoperative tumour volume estimation, and significance to residual tumour volume are still challenged. GBM has a 14-month Overall Survival (OS) rate. There is no evidence of a link between EOR and OS survival. We wish to determine whether GBM tumour removal increases survival. Methods. At the Regional Center for Neurosurgery and Neurology in Uzhhorod, Ukraine, we conducted a retrospective evaluation of 86 consecutive patients diagnosed with glioblastoma who underwent surgery between January 1, 2010, and December 31, 2020, and who are being followed until January 1, 2022. Patients were selected if they met the following criteria: they were at least 18 years old, they had a diagnosis of glioblastoma (primary, secondary, or recurrent), they were either IDH mutants or wild types, they had an MRI within 2 weeks before surgery, and they had another MRI within 72 hours after surgery. Before and after surgery, we did a volumetric analysis of gadolinium-enhanced T1 MRI scans of the tumour to figure out EOR. Partial resection (PR) is <70%, sub-total resection (STR) is 70-90%, near-total resection (NTR) is 91-99%, and gross total resection (GTR) is >99%. By comparing pre- and post-operative volumes with the EOR, the Kaplan-Meier survival curve and Cox's regression analysis determined the impact of the EOR on survival rates. Many researchers considered a p value of 0.05 or below to be significant. Results. A total of 86 patients were included in the analysis after being subjected to the criteria used to narrow the pool of potential participants. The average length of time people lived was 15 months. For PR patients, the median survival time was 3 months, for STR patients it was 10 months, and for NTR patients it was 16 months. Patients receiving GTR, on the other hand, had a considerably better outcome, with a median survival time of 36 months. This data demonstrate a direct correlation between EOR and survival rates. It was discovered that EOR improvement affected post-op survival. High EOR patients have a better prognosis for survival. Adjuvant therapy, pre- and post-operative KPS score, pre- and post-operative tumour volume, and gender also contributed significantly to enhanced survival. Conclusion. Patients with glioblastoma appear to benefit from a more aggressive treatment strategy that combines maximal safe resection with the use of salvage adjuvant therapy. There was a correlation between complete resection (gross total resection) of intracranial GBM and improved survival. Whenever feasible, complete surgical removal of the tumour is recommended.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"323 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-037
Samer S. Hoz, Hosam AL-Jehani, Waeel O. Hamouda, Mahmood F. Al-Zaidy, Mustafa Ismail, Aktham O. Al-Khafaji
Background. In cases of spontaneous subarachnoid haemorrhage (SAH) with multiple intracranial aneurysms (MIAs) detected on angiography, some radiological clues assist in determining the site of a ruptured aneurysm which is bleeding is quite beneficial for the selection of the best treatment strategy. Case description. We report a case of a 60 years old patient who presented with spontaneous SAH, sellar hematoma, and three different aneurysms detected in angiography. Although the right Posterior communicating artery (PcomA) aneurysms showed Murphy’s teat on angiography intraoperatively, we discovered that the right superior hypophyseal aneurysm (SHA) was the source of the index bleeding. Both aneurysms were clipped successfully. Conclusion. From the preoperative radiological and intraoperative surgical findings, we propose that sellar hematoma on a non-contrast CT scan is a new potential sign to be correlated with superior hypophyseal artery aneurysm rupture.
{"title":"Sellar hematoma as a new potential radiological clue for superior hypophyseal artery aneurysm rupture","authors":"Samer S. Hoz, Hosam AL-Jehani, Waeel O. Hamouda, Mahmood F. Al-Zaidy, Mustafa Ismail, Aktham O. Al-Khafaji","doi":"10.33962/roneuro-2023-037","DOIUrl":"https://doi.org/10.33962/roneuro-2023-037","url":null,"abstract":"Background. In cases of spontaneous subarachnoid haemorrhage (SAH) with multiple intracranial aneurysms (MIAs) detected on angiography, some radiological clues assist in determining the site of a ruptured aneurysm which is bleeding is quite beneficial for the selection of the best treatment strategy. Case description. We report a case of a 60 years old patient who presented with spontaneous SAH, sellar hematoma, and three different aneurysms detected in angiography. Although the right Posterior communicating artery (PcomA) aneurysms showed Murphy’s teat on angiography intraoperatively, we discovered that the right superior hypophyseal aneurysm (SHA) was the source of the index bleeding. Both aneurysms were clipped successfully. Conclusion. From the preoperative radiological and intraoperative surgical findings, we propose that sellar hematoma on a non-contrast CT scan is a new potential sign to be correlated with superior hypophyseal artery aneurysm rupture.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-038
Toyin Oyemolade, James Balogun
Intracranial lipomas are rare, frequently asymptomatic, congenital malformations. They are most commonly located in the pericallosal region and are often detected incidentally during neuroimaging studies or postmortem examinations. While other associated brain malformations, most notably callosal agenesis, are frequently reported, association with a subcutaneous scalp lipoma is extremely rare. We present a case of pericallosal lipoma associated with callosal agenesis and subcutaneous lipoma over the anterior fontanelle in a 6-month-old female infant who had excision of only the extracranial mass and has remained asymptomatic from the intracranial mass for the 3 years of follow up.
{"title":"Intracranial lipoma associated with a subcutaneous lipoma","authors":"Toyin Oyemolade, James Balogun","doi":"10.33962/roneuro-2023-038","DOIUrl":"https://doi.org/10.33962/roneuro-2023-038","url":null,"abstract":"Intracranial lipomas are rare, frequently asymptomatic, congenital malformations. They are most commonly located in the pericallosal region and are often detected incidentally during neuroimaging studies or postmortem examinations. While other associated brain malformations, most notably callosal agenesis, are frequently reported, association with a subcutaneous scalp lipoma is extremely rare. We present a case of pericallosal lipoma associated with callosal agenesis and subcutaneous lipoma over the anterior fontanelle in a 6-month-old female infant who had excision of only the extracranial mass and has remained asymptomatic from the intracranial mass for the 3 years of follow up.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Object. Our aim is to demonstrate the various aspects of clinical-Radiological presentation and surgical Outcome with association to the tumour size concerning cerebellopontine angle (CPA) tumours.
Materials and method. This is a prospective study of 40 patients at the Department of Neurosurgery, Jayarogya Group of Hospitals, GRMC Gwalior, M.P. India. All of the patients were pre-operatively evaluated with either non-enhanced and enhanced computerized tomography (CT) or Magnetic-resonance (MR) imaging or both.CPA tumours (predominantly acoustic neuroma) that underwent surgical removal using a suboccipital retro sigmoid approach over a 2-year period (June 2019 to May 2021).
Results. There was a female preponderance. The most common presentation was Sensorineural hearing loss (90%) followed by Headache (67.5%). The majority of cases of Vestibular Schwannoma have heterogenous enhancement with cystic component.65% of patients have large (26-40mm) size tumours and facial nerve preservation is 86.4% in medium size tumours (10-25 mm).and Incidence of post-postoperative of facial nerve palsy is more in Giant size tumour (> 40mm) so Positive association between size of lesion and Incidence of Post-operative facial nerve palsy. CSF leak occurs in 6 patients and postoperative Hydrocephalus occur in 2 patients and Mortality occurs in 3 patients.
Conclusion. CP angle Tumor was common in middle age group, with the incidence in females slightly more than in males. The majority of lesions were of large size (26-40mm). Most of the patients on admission had a non-serviceable hearing. Heterogeneous enhancement with cystic components was found in most of the lesions. Gross-total excision was one in the majority of cases and vestibular schwannoma was the most common histopathological lesion obtained. Facial nerve palsy was the most complication and as the size of the lesion increased, the possibility of facial nerve palsy also increased post-operatively. Overall mortality is 7.5%.
{"title":"Cerebellopontine angle tumours: clinico-radiological features and surgical outcome","authors":"Vivek Kumar Kankane, Ketan Gujral, Avinash Sharma, Aditya Shrivastava","doi":"10.33962/roneuro-2023-042","DOIUrl":"https://doi.org/10.33962/roneuro-2023-042","url":null,"abstract":"Object. Our aim is to demonstrate the various aspects of clinical-Radiological presentation and surgical Outcome with association to the tumour size concerning cerebellopontine angle (CPA) tumours.
 Materials and method. This is a prospective study of 40 patients at the Department of Neurosurgery, Jayarogya Group of Hospitals, GRMC Gwalior, M.P. India. All of the patients were pre-operatively evaluated with either non-enhanced and enhanced computerized tomography (CT) or Magnetic-resonance (MR) imaging or both.CPA tumours (predominantly acoustic neuroma) that underwent surgical removal using a suboccipital retro sigmoid approach over a 2-year period (June 2019 to May 2021).
 Results. There was a female preponderance. The most common presentation was Sensorineural hearing loss (90%) followed by Headache (67.5%). The majority of cases of Vestibular Schwannoma have heterogenous enhancement with cystic component.65% of patients have large (26-40mm) size tumours and facial nerve preservation is 86.4% in medium size tumours (10-25 mm).and Incidence of post-postoperative of facial nerve palsy is more in Giant size tumour (> 40mm) so Positive association between size of lesion and Incidence of Post-operative facial nerve palsy. CSF leak occurs in 6 patients and postoperative Hydrocephalus occur in 2 patients and Mortality occurs in 3 patients.
 Conclusion. CP angle Tumor was common in middle age group, with the incidence in females slightly more than in males. The majority of lesions were of large size (26-40mm). Most of the patients on admission had a non-serviceable hearing. Heterogeneous enhancement with cystic components was found in most of the lesions. Gross-total excision was one in the majority of cases and vestibular schwannoma was the most common histopathological lesion obtained. Facial nerve palsy was the most complication and as the size of the lesion increased, the possibility of facial nerve palsy also increased post-operatively. Overall mortality is 7.5%.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136016502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-14DOI: 10.33962/roneuro-2023-036
Tareq Abdul Ghani Hamid, Abdul Wahab Mahmoud Ibrahim, Ibrahim Ali Awad, Talal Ahmed Youssef Amer, Wael K. Zakaria
Background. High-grade glioma is the commonest primary malignant brain tumour in adults. Intra-arterially selectively infused chemotherapeutic agents into the tumour bulk is being widely trialled recently with promising results.
Methods. This is a prospective study designed between November 2015 and November 2019. Thirty patients were diagnosed with recurrent histo-pathologically proven GBM after one surgery at least and followed by standard radiotherapy and temodal. Patients aged between 37-76 years, 18 males and 12 females were subdivided into group A of 21 patients who underwent intra-arterial delivery of carboplatinand group B of 9 patients who underwent re-surgical resection and local application of carboplatin.
Results. The mean age of the included cases was 55.4 years (range, 37-76 years). Selective intra-arterial injection was performed in 21 cases (70%), while the remaining 9 cases (30%) had local application of carboplatin in the tumour bed. Post-treatment vomiting was reported in 7 cases (23.3%). Significant and partial responses were achieved in 2 cases for each (6.7%). Time to tumour progression had a mean of 19.03 weeks (range, 3 – 30 weeks). After receiving carboplatin, the study cases had a mean survival of 26.5 weeks (range, 6 – 70 weeks). Intra-arterial injection had significantly better results compared to local tumour bed infiltration (p = 0.01).
Conclusion. Although recurrent glioblastoma multiformis has poor survival, intra-arterial delivery of carboplatin may have a slight positive impact on patient survival. The procedure however is relatively safe with manageable complications.
{"title":"Prospective study of selective intra-arterial cerebral infusion and intra-operative local application of carboplatin for recurrent glioblastoma multiformis","authors":"Tareq Abdul Ghani Hamid, Abdul Wahab Mahmoud Ibrahim, Ibrahim Ali Awad, Talal Ahmed Youssef Amer, Wael K. Zakaria","doi":"10.33962/roneuro-2023-036","DOIUrl":"https://doi.org/10.33962/roneuro-2023-036","url":null,"abstract":"Background. High-grade glioma is the commonest primary malignant brain tumour in adults. Intra-arterially selectively infused chemotherapeutic agents into the tumour bulk is being widely trialled recently with promising results.
 Methods. This is a prospective study designed between November 2015 and November 2019. Thirty patients were diagnosed with recurrent histo-pathologically proven GBM after one surgery at least and followed by standard radiotherapy and temodal. Patients aged between 37-76 years, 18 males and 12 females were subdivided into group A of 21 patients who underwent intra-arterial delivery of carboplatinand group B of 9 patients who underwent re-surgical resection and local application of carboplatin.
 Results. The mean age of the included cases was 55.4 years (range, 37-76 years). Selective intra-arterial injection was performed in 21 cases (70%), while the remaining 9 cases (30%) had local application of carboplatin in the tumour bed. Post-treatment vomiting was reported in 7 cases (23.3%). Significant and partial responses were achieved in 2 cases for each (6.7%). Time to tumour progression had a mean of 19.03 weeks (range, 3 – 30 weeks). After receiving carboplatin, the study cases had a mean survival of 26.5 weeks (range, 6 – 70 weeks). Intra-arterial injection had significantly better results compared to local tumour bed infiltration (p = 0.01).
 Conclusion. Although recurrent glioblastoma multiformis has poor survival, intra-arterial delivery of carboplatin may have a slight positive impact on patient survival. The procedure however is relatively safe with manageable complications.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136016500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-14DOI: 10.33962/roneuro-2023-025
Iulia Miculescu, Daniela L. Ivan, Aurelia Dabu, Daniel Teleanu, A. V. Ciurea
Background. The T2-FLAIR (fluid-attenuated inversion recovery) mismatch sign has been defined over the last few years as an important novel radiogenomic marker highly suggestive of isocitrate dehydrogenase mutated (IDH-mut) 1p19q non-codeleted gliomas (astrocytomas). Existing studies have demonstrated that this has good specificity but limited sensitivity for IDH-mut astrocytomas. Thenew 2021 WHO Classification of Tumors of the Central Nervous System (WHO CNS5) has introduced a layered grading system in which all IDH mutant diffuse astrocytic tumours are considered a single type (Astrocytoma, IDH-mutant) and are graded as CNS WHO grade 2, 3, or 4. Because of the growing importance of molecular information in CNS tumour classification, diagnoses and diagnostic reports need to combine different data types into a single diagnosis. Whether the T2FLAIR mismatch sign is of clinical relevance for the management of low-grade gliomas still needs to be further determined.Methods. We included histologically verified supratentorial low-grade gliomas (LGG) WHO grade 2-3 retrospectively during the period 2013–2018 (n=18). For the period 2019–2023 (n=27), patients with a radiological presumptive diagnosis of low-grade glioma were prospectively included, and we took into consideration the fact that in this group we could encounter other diagnoses than glioma.Clinical, radiological and histology data were collected. We aimed to examine the association of the T2-FLAIR mismatch sign (where identified) with clinical factors and outcomes. We evaluated the diagnostic reliability of the mismatch sign and its relation to the definitive histological diagnosis, the co-existence of an MR spectroscopy signature; we have also tried to determine whether the identification of the radiogenomic marker had any impact on the clinical outcome through the decision-making in neurosurgical management.Results. Out of 45 patients with radiological suspected glioma, 30 had a definitive diagnosis of diffuse astrocytoma grade 2 and 3 (Astrocytoma, IDH-mutant according to WHOCNS5). 6 patients had a diagnosis of glioblastoma (Glioblastoma, IDH-wildtype according to WHOCNS5). 8 patients have been diagnosed with oligodendroglioma (Oligodendroglioma, IDH-mutant, and 1p/19q-codeleted according to WHOCNS5) and 1 case had a definitive histology of cerebral abscess. Out of the 30 patients with IDH-mut astrocytoma, 6 (20.0%) showed a mismatch sign. The sensitivity and specificity of the mismatch sign for IDH-mut astrocytoma detection were 20% and98.6%, respectively. There were no differences between patients with an IDH-mut astrocytoma with or without T2FLAIR mismatch sign when grouped according to this with related to baseline characteristics, clinical outcome and presenting symptoms. MR spectroscopy sequences were analyzed where available for the retrospective and prospective cohort. There were 7 cases where MR spectroscopy was performed and, for the IDH-mut astrocytoma cases (n=4) it showed a per
背景。在过去的几年中，T2-FLAIR(液体衰减反转恢复)错配标志被定义为一种重要的新型放射基因组标记物，高度提示异柠檬酸脱氢酶突变(IDH-mut) 1p19q非编码胶质瘤(星形细胞瘤)。现有研究表明，这对IDH-mut星形细胞瘤具有良好的特异性，但敏感性有限。新的2021世卫组织中枢神经系统肿瘤分类(WHO CNS5)引入了分层分级系统，其中所有IDH突变的弥漫性星形细胞肿瘤被视为单一类型(星形细胞瘤，IDH突变)，并被评为CNS WHO 2级，3级或4级。由于分子信息在中枢神经系统肿瘤分类中的重要性日益增加，诊断和诊断报告需要将不同的数据类型合并为一个单一的诊断。T2FLAIR错配征象对低级别胶质瘤的治疗是否具有临床意义还有待进一步研究。我们回顾性纳入了2013-2018年期间经组织学验证的幕上低级别胶质瘤(LGG)， WHO分级2-3级(n=18)。在2019-2023年期间(n=27)，前瞻性纳入影像学推定诊断为低级别胶质瘤的患者，我们考虑到在这一组中我们可能会遇到胶质瘤以外的其他诊断。收集临床、放射学和组织学资料。我们的目的是检查T2-FLAIR不匹配征象与临床因素和结果的关系。我们评估了错配标志的诊断可靠性及其与明确组织学诊断的关系，共存的磁共振光谱特征;我们也试图通过神经外科治疗的决策来确定放射基因组标记物的识别是否对临床结果有任何影响。在45例放射学怀疑为胶质瘤的患者中，30例明确诊断为2级和3级弥漫性星形细胞瘤(星形细胞瘤，根据WHOCNS5的idh突变)。6例患者被诊断为胶质母细胞瘤(胶质母细胞瘤，根据WHOCNS5的IDH-wildtype)。8例患者被诊断为少突胶质细胞瘤(根据WHOCNS5，少突胶质细胞瘤，idh突变，1p/19q编码)，1例有明确的脑脓肿组织学。在30例IDH-mut星形细胞瘤患者中，6例(20.0%)出现错配征象。错配征象检测IDH-mut星形细胞瘤的敏感性和特异性分别为20%和98.6%。IDH-mut星形细胞瘤患者有或没有T2FLAIR不匹配征象的分组与基线特征、临床结局和表现症状没有差异。在回顾性和前瞻性队列可用的情况下，对磁共振光谱序列进行分析。有7例进行了磁共振成像，在IDH-mut星形细胞瘤病例中(n=4)， Cho/NAA比率持续高，在有无T2FLAIR错配标志的患者中没有任何差异。在我们相对较小的回顾性和前瞻性队列中，发现的T2-FLAIR不匹配征象与临床表现、预后或结果无关。直到最近，中枢神经系统肿瘤的分级主要集中在组织学特征上，但是特定的分子标记现在可以用于有价值的预后信息。因此，分子特异性信息已被作为分级的基本特征，被认为对进一步估计不同肿瘤类型的预后非常有用。我们不能确定具有错配征象的IDH-mut星形细胞瘤是否代表一个特定亚群。我们的研究证实T2-FLAIR不匹配标志是IDH-mut星形细胞瘤的可靠特异性标志物。
{"title":"The T2FLAIR mismatch novel radiogenomic marker in the newly suspected low-grade gliomas","authors":"Iulia Miculescu, Daniela L. Ivan, Aurelia Dabu, Daniel Teleanu, A. V. Ciurea","doi":"10.33962/roneuro-2023-025","DOIUrl":"https://doi.org/10.33962/roneuro-2023-025","url":null,"abstract":"Background. The T2-FLAIR (fluid-attenuated inversion recovery) mismatch sign has been defined over the last few years as an important novel radiogenomic marker highly suggestive of isocitrate dehydrogenase mutated (IDH-mut) 1p19q non-codeleted gliomas (astrocytomas). Existing studies have demonstrated that this has good specificity but limited sensitivity for IDH-mut astrocytomas. Thenew 2021 WHO Classification of Tumors of the Central Nervous System (WHO CNS5) has introduced a layered grading system in which all IDH mutant diffuse astrocytic tumours are considered a single type (Astrocytoma, IDH-mutant) and are graded as CNS WHO grade 2, 3, or 4. Because of the growing importance of molecular information in CNS tumour classification, diagnoses and diagnostic reports need to combine different data types into a single diagnosis. Whether the T2FLAIR mismatch sign is of clinical relevance for the management of low-grade gliomas still needs to be further determined.Methods. We included histologically verified supratentorial low-grade gliomas (LGG) WHO grade 2-3 retrospectively during the period 2013–2018 (n=18). For the period 2019–2023 (n=27), patients with a radiological presumptive diagnosis of low-grade glioma were prospectively included, and we took into consideration the fact that in this group we could encounter other diagnoses than glioma.Clinical, radiological and histology data were collected. We aimed to examine the association of the T2-FLAIR mismatch sign (where identified) with clinical factors and outcomes. We evaluated the diagnostic reliability of the mismatch sign and its relation to the definitive histological diagnosis, the co-existence of an MR spectroscopy signature; we have also tried to determine whether the identification of the radiogenomic marker had any impact on the clinical outcome through the decision-making in neurosurgical management.Results. Out of 45 patients with radiological suspected glioma, 30 had a definitive diagnosis of diffuse astrocytoma grade 2 and 3 (Astrocytoma, IDH-mutant according to WHOCNS5). 6 patients had a diagnosis of glioblastoma (Glioblastoma, IDH-wildtype according to WHOCNS5). 8 patients have been diagnosed with oligodendroglioma (Oligodendroglioma, IDH-mutant, and 1p/19q-codeleted according to WHOCNS5) and 1 case had a definitive histology of cerebral abscess. Out of the 30 patients with IDH-mut astrocytoma, 6 (20.0%) showed a mismatch sign. The sensitivity and specificity of the mismatch sign for IDH-mut astrocytoma detection were 20% and98.6%, respectively. There were no differences between patients with an IDH-mut astrocytoma with or without T2FLAIR mismatch sign when grouped according to this with related to baseline characteristics, clinical outcome and presenting symptoms. MR spectroscopy sequences were analyzed where available for the retrospective and prospective cohort. There were 7 cases where MR spectroscopy was performed and, for the IDH-mut astrocytoma cases (n=4) it showed a per","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136016501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-14DOI: 10.33962/roneuro-2023-028
Yakouba Haro, Sylvain D. Zabsonre, Abdoulaye Sanou, Inoussa Zoungrana, Joseph Biogo, Abel Kabre
Introduction. Bobble head doll syndrome is a neurological syndrome characterized by abnormal involuntary movements of the head combining repetitive or episodic movements of 2 to 3 Hz back and forth in the anterior-posterior direction that can be assimilated to approval movements (yes-yes) and occasionally lateral rotations that can be assimilated to disapproval signs (no-no). It is a rare entity first described by Benton[1]. We describe three cases managed at the Yalgado Ouédraogo University Hospital in Burkina Faso.
Observations. Three children, one girl and two boys, aged respectively 5, 9 and 14 years were seen for involuntary abnormal head movements associating lateral rotations assimilated to signs of disapproval (no-no) in two cases, and back and forth movements of the head in one case. In the 14-year-old adolescent, there was also a picture of intracranial hypertension. Clinical examination revealed ataxia and macrocrania in both cases and a syndrome in 1 case. Imaging revealed triventricular hydrocephalus on aqueductal stenosis in all cases with an associated supra sellar cyst in 2 cases. The treatment consisted of endoscopic treatment in 2 cases and ventriculoperitoneal shunt in 1 case. Surgery allowed a considerable regression of involuntary movements of the head in the immediate postoperative period and a complete recovery in the long term.
Conclusion. The bobble head doll syndrome is a rare entity related to the consequences of chronic hydrocephalus responsible for abnormal movements whose management done well and early leads to favourable results.
{"title":"Bobble Head Doll Syndrome","authors":"Yakouba Haro, Sylvain D. Zabsonre, Abdoulaye Sanou, Inoussa Zoungrana, Joseph Biogo, Abel Kabre","doi":"10.33962/roneuro-2023-028","DOIUrl":"https://doi.org/10.33962/roneuro-2023-028","url":null,"abstract":"Introduction. Bobble head doll syndrome is a neurological syndrome characterized by abnormal involuntary movements of the head combining repetitive or episodic movements of 2 to 3 Hz back and forth in the anterior-posterior direction that can be assimilated to approval movements (yes-yes) and occasionally lateral rotations that can be assimilated to disapproval signs (no-no). It is a rare entity first described by Benton[1]. We describe three cases managed at the Yalgado Ouédraogo University Hospital in Burkina Faso.
 Observations. Three children, one girl and two boys, aged respectively 5, 9 and 14 years were seen for involuntary abnormal head movements associating lateral rotations assimilated to signs of disapproval (no-no) in two cases, and back and forth movements of the head in one case. In the 14-year-old adolescent, there was also a picture of intracranial hypertension. Clinical examination revealed ataxia and macrocrania in both cases and a syndrome in 1 case. Imaging revealed triventricular hydrocephalus on aqueductal stenosis in all cases with an associated supra sellar cyst in 2 cases. The treatment consisted of endoscopic treatment in 2 cases and ventriculoperitoneal shunt in 1 case. Surgery allowed a considerable regression of involuntary movements of the head in the immediate postoperative period and a complete recovery in the long term.
 Conclusion. The bobble head doll syndrome is a rare entity related to the consequences of chronic hydrocephalus responsible for abnormal movements whose management done well and early leads to favourable results.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"272 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136016503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-16DOI: 10.33962/roneuro-2023-019
Goran Tasić, Igor Nikolić, Lukas Rasulić, Aleksandar Janićijević, Vuk Aleksić
Anaplastic astrocytoma WHO (World Health Organization) grade 3 represents about 7% of all primary brain tumours in the adult population. The standard treatment protocol involves safe surgical resection, chemotherapy and radiotherapy. Advances in therapeutic protocols have been noted over the past few decades, but the prognoses are still poor with a median survival of 31 months.
We present a case of a male patient who is alive 25 years after the initial diagnosis and treatment of anaplastic astrocytoma WHO grade 3. The patient was operated and reoperated two times due to local tumour recurrence in the first two years after the initial diagnosis. After the last operation, the patient abandoned medical therapy and started praying. The patient is still alive without any clinical or radiological signs of tumour recurrence.
{"title":"The curious case of commitment to religion and prayer in extreme long term survival anaplastic astrocytoma patient","authors":"Goran Tasić, Igor Nikolić, Lukas Rasulić, Aleksandar Janićijević, Vuk Aleksić","doi":"10.33962/roneuro-2023-019","DOIUrl":"https://doi.org/10.33962/roneuro-2023-019","url":null,"abstract":"Anaplastic astrocytoma WHO (World Health Organization) grade 3 represents about 7% of all primary brain tumours in the adult population. The standard treatment protocol involves safe surgical resection, chemotherapy and radiotherapy. Advances in therapeutic protocols have been noted over the past few decades, but the prognoses are still poor with a median survival of 31 months.
 We present a case of a male patient who is alive 25 years after the initial diagnosis and treatment of anaplastic astrocytoma WHO grade 3. The patient was operated and reoperated two times due to local tumour recurrence in the first two years after the initial diagnosis. After the last operation, the patient abandoned medical therapy and started praying. The patient is still alive without any clinical or radiological signs of tumour recurrence.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135553984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-16DOI: 10.33962/roneuro-2023-007
Tommy Alfandy Nazwar, Farhad Balafif, Donny Wisnu Wardhana, Muhammad Annas, Agus Chairul Anab, M. Istiadjid E.S.
Background. Apoptosis is one of the indicators to check for following brain damage. Along with this trend, treatment in the form of herbal and phytopharmaca therapy is required more frequently to treat brain injury complications. Black cumin possesses a function that opposes the apoptotic mechanism.
Objectives. This study sought to determine the effect of black seed on an animal model of brain damage using apoptotic measures.
Methods. Four treatment groups were created from the experimental animals as follows: Group BC1: For 7 days following the brain contusion, they were given [0.3 gram] g/kg bw of black cumin extract daily. Group BC2: For 7 days following the brain contusion, they were given [0.4 gram] g/kg bw of black cumin extract daily. Following the brain contusion, Group K received 3 ml of Nacl 0.9% daily for 7 days. The TUNEL DNA fragmentation method was used to count the amount of apoptotic cells and analysis was conducted using ANOVA with F-test and Tukey HSD.
Results. The control group had the greatest amount of apoptosis at 30.4. Apoptosis averages for BC1 (0.3 g), and BC2 (0.4 g) groups of rats were 25.0, and 18.8, respectively. Black cumin anova test with apoptosis was present while a higher dose of black cumin will minimize the amount of apoptosis.
Conclusions. Injecting black cumin extracts into rats with head injuries reduced apoptosis, albeit not significantly. In rats with experimental head injuries, black cumin extract induces a connection through the apoptosis mechanism.
{"title":"Black cumin 0.3 gram and 0.4 gram on apoptotic levels in Cerebral Contusions Rattus Norvegicus Wistar","authors":"Tommy Alfandy Nazwar, Farhad Balafif, Donny Wisnu Wardhana, Muhammad Annas, Agus Chairul Anab, M. Istiadjid E.S.","doi":"10.33962/roneuro-2023-007","DOIUrl":"https://doi.org/10.33962/roneuro-2023-007","url":null,"abstract":"Background. Apoptosis is one of the indicators to check for following brain damage. Along with this trend, treatment in the form of herbal and phytopharmaca therapy is required more frequently to treat brain injury complications. Black cumin possesses a function that opposes the apoptotic mechanism.
 Objectives. This study sought to determine the effect of black seed on an animal model of brain damage using apoptotic measures.
 Methods. Four treatment groups were created from the experimental animals as follows: Group BC1: For 7 days following the brain contusion, they were given [0.3 gram] g/kg bw of black cumin extract daily. Group BC2: For 7 days following the brain contusion, they were given [0.4 gram] g/kg bw of black cumin extract daily. Following the brain contusion, Group K received 3 ml of Nacl 0.9% daily for 7 days. The TUNEL DNA fragmentation method was used to count the amount of apoptotic cells and analysis was conducted using ANOVA with F-test and Tukey HSD.
 Results. The control group had the greatest amount of apoptosis at 30.4. Apoptosis averages for BC1 (0.3 g), and BC2 (0.4 g) groups of rats were 25.0, and 18.8, respectively. Black cumin anova test with apoptosis was present while a higher dose of black cumin will minimize the amount of apoptosis.
 Conclusions. Injecting black cumin extracts into rats with head injuries reduced apoptosis, albeit not significantly. In rats with experimental head injuries, black cumin extract induces a connection through the apoptosis mechanism.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135553985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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