Pub Date : 2023-03-15DOI: 10.33962/roneuro-2023-020
Ahtesham Khizar, Soha Zahid
Global neurosurgery is relatively a new sub-discipline of global surgery. It is an area of study, research, practice, and advocacy that focuses on enhancing health outcomes and promoting health equity for all individuals around the world who are afflicted by neurosurgical disorders or require neurosurgical care. Low- and middle-income countries (LMICs) around the world have not benefited from advances in neurosurgery; most have little or no neurosurgical capacity in their entire country. The need of the hour is that a global problem necessitates a global response with a common vision and objectives.
{"title":"Global neurosurgery: the need of the hour for developing countries","authors":"Ahtesham Khizar, Soha Zahid","doi":"10.33962/roneuro-2023-020","DOIUrl":"https://doi.org/10.33962/roneuro-2023-020","url":null,"abstract":"Global neurosurgery is relatively a new sub-discipline of global surgery. It is an area of study, research, practice, and advocacy that focuses on enhancing health outcomes and promoting health equity for all individuals around the world who are afflicted by neurosurgical disorders or require neurosurgical care. Low- and middle-income countries (LMICs) around the world have not benefited from advances in neurosurgery; most have little or no neurosurgical capacity in their entire country. The need of the hour is that a global problem necessitates a global response with a common vision and objectives.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135748423","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}
Objectives. To determine the efficacy of endoscopic endonasal dura repair versus transcranial dura repair for post-traumatic CSF rhinorrhoea in terms of CSF rhinorrhea recurrence and other complications. Materials and methods. A total of 92 patients (age 15-50 years, both genders) with an established diagnosis of CSF rhinorrhea following traumatic brain injury were enrolled in this prospective cohort study. Group A and Group B were formed from the patients. Group A received endoscopic endonasal duraplasty, while Group B received transcranial duraplasty. Recurrence of CSF rhinorrhea, as well as any other complications (meningitis, anosmia, hydrocephalus, and abscess), were noted and compared between the two groups one week, two weeks, and four weeks after the procedure. Results. In Group A, the mean age was 28.6 ± 9.9 SD years and in Group B it was 29.9 ± 8.6 SD years. In group A, there were 63% (n=29/46) patients who had age between 15-30 years and 37% (n=17/46) had age between 31-50 years. In group B, 52.2% (n=24/46) patients had age between 15-30 years and 47.8% (n=22/46) had age between 31-50 years. In group A, there were 82.6% (n=38/46) males and 17.4% (n=8/46) were females and in group B there were 87% (n=40/46) males and 13% (n=6/46) females. At one month follow-up, overall recurrence of rhinorrhea was observed in 17.4% (n=8/46) patients in Group A, while it was 41.3% (n=19/46) patients in Group B (P=0.012). On the other hand, overall complications were 8.7% (n=21/46) in Group A patients, while they were 45.7% (n=21/46) in Group B patients (P=0.001). Conclusions. During a one-month follow-up, patients who received endoscopic repair experienced fewer recurrences and other complications overall than patients who underwent transcranial duraplasty, and the difference was statistically significant. We advise conducting studies with a larger sample size and longer follow-up periods.
{"title":"The efficacy of endoscopic endonasal duraplasty compared to transcranial duraplasty for post-traumatic CSF rhinorrhea in terms of CSF rhinorrhea recurrence and other complications","authors":"Pranab Regmi, Ahtesham Khizar, Pradhumna Kumar Yadav","doi":"10.33962/roneuro-2023-014","DOIUrl":"https://doi.org/10.33962/roneuro-2023-014","url":null,"abstract":"Objectives. To determine the efficacy of endoscopic endonasal dura repair versus transcranial dura repair for post-traumatic CSF rhinorrhoea in terms of CSF rhinorrhea recurrence and other complications. Materials and methods. A total of 92 patients (age 15-50 years, both genders) with an established diagnosis of CSF rhinorrhea following traumatic brain injury were enrolled in this prospective cohort study. Group A and Group B were formed from the patients. Group A received endoscopic endonasal duraplasty, while Group B received transcranial duraplasty. Recurrence of CSF rhinorrhea, as well as any other complications (meningitis, anosmia, hydrocephalus, and abscess), were noted and compared between the two groups one week, two weeks, and four weeks after the procedure. Results. In Group A, the mean age was 28.6 ± 9.9 SD years and in Group B it was 29.9 ± 8.6 SD years. In group A, there were 63% (n=29/46) patients who had age between 15-30 years and 37% (n=17/46) had age between 31-50 years. In group B, 52.2% (n=24/46) patients had age between 15-30 years and 47.8% (n=22/46) had age between 31-50 years. In group A, there were 82.6% (n=38/46) males and 17.4% (n=8/46) were females and in group B there were 87% (n=40/46) males and 13% (n=6/46) females. At one month follow-up, overall recurrence of rhinorrhea was observed in 17.4% (n=8/46) patients in Group A, while it was 41.3% (n=19/46) patients in Group B (P=0.012). On the other hand, overall complications were 8.7% (n=21/46) in Group A patients, while they were 45.7% (n=21/46) in Group B patients (P=0.001). Conclusions. During a one-month follow-up, patients who received endoscopic repair experienced fewer recurrences and other complications overall than patients who underwent transcranial duraplasty, and the difference was statistically significant. We advise conducting studies with a larger sample size and longer follow-up periods.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135748419","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}
Secondary visual impairment induced by sinusitis is a rare condition that cannot be recognized in all cases. A steady decline in visual acuity and visual field together or alone is the main symptom patients may complain of on admission. This might be hard for general practitioners in Uzbekistan, as possible causes are either intracranial or ophthalmic abnormalities. Hence, it is frequently misdiagnosed or leads to late diagnosis once visual impairment becomes severe. In this paper, we discuss the case of a 9-year-old boy with impaired vision on the left side that was detected almost too late and could have led to complete vision loss. Ineffective conservative therapy was provided for four months. CT and MRI confirmed a lesion in the left sphenoethmoidal sinus. The patient then underwent endoscopic sphenoiethmodotomy with drainage of the left sphenoethmoidal sinus. In the early postoperative phase, as early as the next day after the surgical procedure, the patient experienced visual improvement. Forty days following surgery, in combination with postoperative conservative care in an eye hospital, there was a noticeable improvement in vision. In conclusion, it is crucial for ophthalmologists, neurologists, and ENT surgeons to focus on inflammation in the sphenoethmoidal sinus in children even with mild vision impairment.
{"title":"Secondary optic neuropathy due to sphenoid-ethmoidal sinus mucocele","authors":"Khabibullo Khasanov, Gulnarakhon Alikhodjayeva, Jakhongir Yakubov, Ilkhom Khujanazarov","doi":"10.33962/roneuro-2023-013","DOIUrl":"https://doi.org/10.33962/roneuro-2023-013","url":null,"abstract":"Secondary visual impairment induced by sinusitis is a rare condition that cannot be recognized in all cases. A steady decline in visual acuity and visual field together or alone is the main symptom patients may complain of on admission. This might be hard for general practitioners in Uzbekistan, as possible causes are either intracranial or ophthalmic abnormalities. Hence, it is frequently misdiagnosed or leads to late diagnosis once visual impairment becomes severe. In this paper, we discuss the case of a 9-year-old boy with impaired vision on the left side that was detected almost too late and could have led to complete vision loss. Ineffective conservative therapy was provided for four months. CT and MRI confirmed a lesion in the left sphenoethmoidal sinus. The patient then underwent endoscopic sphenoiethmodotomy with drainage of the left sphenoethmoidal sinus. In the early postoperative phase, as early as the next day after the surgical procedure, the patient experienced visual improvement. Forty days following surgery, in combination with postoperative conservative care in an eye hospital, there was a noticeable improvement in vision. In conclusion, it is crucial for ophthalmologists, neurologists, and ENT surgeons to focus on inflammation in the sphenoethmoidal sinus in children even with mild vision impairment.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135748421","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 : 2023-03-15DOI: 10.33962/roneuro-2023-004
Mahamadou Dama, Oumar Diallo, Oumar Coulibaly, Daouda Sissoko, Theodore Maxim Coulibaly, Kalba Tembine, Thomas Coulibaly, Fengqiang Liu, Cisse El Hassimi Mohamed, Drissa Kanikomo
Introduction: Spontaneous intracerebral haemorrhage (ICH) is a rupture of blood vessels in the brain parenchyma, in the absence of any underlying structural vascular lesion. It’s destructive and associated with a high mortality rate. There is a specific threshold of hematoma evacuation to impact mortality or functional outcome in ICH even the curative effect of minimally invasive hematoma removal for cerebral haemorrhage has not been fully recognized worldwide. We aim to evaluate surgical performance on hematoma volume and functional outcomes of patients. Methods: This study is a retrospective and observational clinical study. A total of 30 ICH patients were treated in the Department of neurosurgery at the Hospital of Mali from December 2019 to November 2020. Minimal invasive puncture hematoma removal was performed in all the patients. The modified Rankin scale (mRS) was used to assess functional outcomes at 6 months and one year of surgery. Was considered poor functional outcome mRS >3. The percentages (%) of the count data were assessed by Fisher’s exact test by SPSS 23.0 software was used. Results: A total of 23 ICH patients met the inclusion criteria, the mean was 47,78 years. Among the risk factors, the HTA is present in 91,3% of patients. The evacuation was satisfactory in 91.30% of cases. Conclusion: This first study of minimally invasive stereotaxic for ICH evacuation must be followed up and encouraged. Even if the results are satisfactory, a double-blind study is required in the largest sample.
{"title":"Preliminary results of minimally invasive stereotaxic surgery of intraparenchymal hematomas at the Hospital of Mali (23 cases)","authors":"Mahamadou Dama, Oumar Diallo, Oumar Coulibaly, Daouda Sissoko, Theodore Maxim Coulibaly, Kalba Tembine, Thomas Coulibaly, Fengqiang Liu, Cisse El Hassimi Mohamed, Drissa Kanikomo","doi":"10.33962/roneuro-2023-004","DOIUrl":"https://doi.org/10.33962/roneuro-2023-004","url":null,"abstract":"Introduction: Spontaneous intracerebral haemorrhage (ICH) is a rupture of blood vessels in the brain parenchyma, in the absence of any underlying structural vascular lesion. It’s destructive and associated with a high mortality rate. There is a specific threshold of hematoma evacuation to impact mortality or functional outcome in ICH even the curative effect of minimally invasive hematoma removal for cerebral haemorrhage has not been fully recognized worldwide. We aim to evaluate surgical performance on hematoma volume and functional outcomes of patients. Methods: This study is a retrospective and observational clinical study. A total of 30 ICH patients were treated in the Department of neurosurgery at the Hospital of Mali from December 2019 to November 2020. Minimal invasive puncture hematoma removal was performed in all the patients. The modified Rankin scale (mRS) was used to assess functional outcomes at 6 months and one year of surgery. Was considered poor functional outcome mRS >3. The percentages (%) of the count data were assessed by Fisher’s exact test by SPSS 23.0 software was used. Results: A total of 23 ICH patients met the inclusion criteria, the mean was 47,78 years. Among the risk factors, the HTA is present in 91,3% of patients. The evacuation was satisfactory in 91.30% of cases. Conclusion: This first study of minimally invasive stereotaxic for ICH evacuation must be followed up and encouraged. Even if the results are satisfactory, a double-blind study is required in the largest sample.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135747673","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 : 2023-03-15DOI: 10.33962/roneuro-2023-008
Amjed Hassan Saheb, Rania H. Al-Taie, Ibrahim A. Farooq, Abbas Musaab Taha, Hawraa Sadeq Naser, Zahraa Mohammed Yaseen, Mustafa Ismail, Samer S. Hoz
Background. The high mortality rate of a cranial bullet injury, the catastrophic damage of vital tissue, and the frequency of gunshot accidents made managing such cases highly effortful in neurosurgical trauma centres. One category of these injuries is the gravitational bullet injury, in which the bullet's movement depends on gravity after losing its kinetic energy. This paper aims to describe the conservative treatment plan we applied for a patient who suffered an intracranial gravitational bullet injury. Case description. The patient presented with a cranial bullet injury that migrated caudally to his lateral ventricle. This unapproachable location of the bullet made the surgical intervention undoable. Therefore, after the implication of resuscitative management, the patient went under heavy observation with a suitable follow-up plan. The patient's short-term outcome was excellent, and his Glasgow coma scale was 15 at the discharge. Conclusion. Conservative management in a gravitational bullet is one of the possible methods to reach the best outcome in non-operable patients. Such measures are highlighted in this case, even when a complication like a bullet migration may occur.
{"title":"Conservative management of intraventricular migrating intracranial bullet","authors":"Amjed Hassan Saheb, Rania H. Al-Taie, Ibrahim A. Farooq, Abbas Musaab Taha, Hawraa Sadeq Naser, Zahraa Mohammed Yaseen, Mustafa Ismail, Samer S. Hoz","doi":"10.33962/roneuro-2023-008","DOIUrl":"https://doi.org/10.33962/roneuro-2023-008","url":null,"abstract":"Background. The high mortality rate of a cranial bullet injury, the catastrophic damage of vital tissue, and the frequency of gunshot accidents made managing such cases highly effortful in neurosurgical trauma centres. One category of these injuries is the gravitational bullet injury, in which the bullet's movement depends on gravity after losing its kinetic energy. This paper aims to describe the conservative treatment plan we applied for a patient who suffered an intracranial gravitational bullet injury. Case description. The patient presented with a cranial bullet injury that migrated caudally to his lateral ventricle. This unapproachable location of the bullet made the surgical intervention undoable. Therefore, after the implication of resuscitative management, the patient went under heavy observation with a suitable follow-up plan. The patient's short-term outcome was excellent, and his Glasgow coma scale was 15 at the discharge. Conclusion. Conservative management in a gravitational bullet is one of the possible methods to reach the best outcome in non-operable patients. Such measures are highlighted in this case, even when a complication like a bullet migration may occur.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135747676","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 : 2023-03-15DOI: 10.33962/roneuro-2023-003
Arif Zafar, Samantha Strickland, Shailendra Achawal
Background. Cranioplasty has been described in history as far back as the 16th century. The use of autologous cranioplasty has been published since 1821 and is still under practice today worldwide. Recent evidence however has suggested increased complication and revision rates with the use of autologous bone. We compared our results of autologous cranioplasty versus synthetic material. Methods. A retrospective study was carried out of cranioplasty procedures at our unit between August 2009 and March 2018. Bone flaps were placed in a sterile sealed plastic container and stored at -81 degrees. Swabs and bone chips were used for cultures and bone flap disposed if positive. On re-implantation, the bone was thawed at room temperature and soaked in gentamicin. Synthetic cranioplasties were constructed using thin-slice CT to design a custom flap for each patient. Results. 144 cranioplasties were studied. 51 own bone and 93 synthetic. The average delay in cranioplasty was 286 days (Range 16 – 1264 days). The overall complication rate for all 144 cranioplasties was 20.8%; Autologous 31.4% and synthetic 15.1%; p 0.031. Bone flap infection rate overall for all 144 cases was 9.7% - Autologous 11.8% and Synthetic 8.6%; p 0.565. The revision rate was found to be 13.2% overall; 23.5% for autologous and 7.5% for synthetic. The difference in revision rate was found to be statistically significant (p 0.01). Conclusion. Revision rate and overall complication rate were higher in the own bone group with P<0.05. There was no difference in infection. Our results mirror recent publications and should be considered when undertaking a cranioplasty.
{"title":"Autologous versus synthetic cranioplasty","authors":"Arif Zafar, Samantha Strickland, Shailendra Achawal","doi":"10.33962/roneuro-2023-003","DOIUrl":"https://doi.org/10.33962/roneuro-2023-003","url":null,"abstract":"Background. Cranioplasty has been described in history as far back as the 16th century. The use of autologous cranioplasty has been published since 1821 and is still under practice today worldwide. Recent evidence however has suggested increased complication and revision rates with the use of autologous bone. We compared our results of autologous cranioplasty versus synthetic material. Methods. A retrospective study was carried out of cranioplasty procedures at our unit between August 2009 and March 2018. Bone flaps were placed in a sterile sealed plastic container and stored at -81 degrees. Swabs and bone chips were used for cultures and bone flap disposed if positive. On re-implantation, the bone was thawed at room temperature and soaked in gentamicin. Synthetic cranioplasties were constructed using thin-slice CT to design a custom flap for each patient. Results. 144 cranioplasties were studied. 51 own bone and 93 synthetic. The average delay in cranioplasty was 286 days (Range 16 – 1264 days). The overall complication rate for all 144 cranioplasties was 20.8%; Autologous 31.4% and synthetic 15.1%; p 0.031. Bone flap infection rate overall for all 144 cases was 9.7% - Autologous 11.8% and Synthetic 8.6%; p 0.565. The revision rate was found to be 13.2% overall; 23.5% for autologous and 7.5% for synthetic. The difference in revision rate was found to be statistically significant (p 0.01). Conclusion. Revision rate and overall complication rate were higher in the own bone group with P<0.05. There was no difference in infection. Our results mirror recent publications and should be considered when undertaking a cranioplasty.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135747677","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}
Introduction: Vestibular schwannomas are benign neoplasms of the nerve seath, and they represent the third most common endocranial tumour, following the meningioma and the pituitary adenomas. The primary symptoms of vestibular schwannomas are hearing loss, tinnitus as well as a balance disorder. The therapy of vestibular schwannoma consists of observation, surgery and radiosurgery. The majority of patients who are good candidates for surgery are already affected by significant hearing impairment, thus one of the primary goals of the surgery is the preservation of facial nerve function. Aim: To analyze the outcome of facial nerve function one-year post-surgery using clinical and neuropsychological parameters. Material and methods: This study analyzed the patient's clinical status on admission along with the neuroradiological characteristics of tumours and the neurophysiological intraoperative parameters and their effect on the facial nerve function in the early postoperative period as well as one year after the surgery using the House–Brackmann scale. Results: A total of 30 patients who underwent surgery from January 1st 2015 to December 31st 2018 at the Clinical Centre of Serbia, Neurosurgery Clinic for vestibular schwannomas were examined. The median age of the patients was 51 years. Hearing loss was present in all patients. Sensitivity drop in the innervation region of n. trigeminus was present in 7 (23.3%) patients, as was tinnitus. Cerebellar symptomatology (76%) was present in the highest percentage of patients. Conclusion: We can conclude that the most important aspects of the facial nerve function are the preoperative state of the facial nerve and the electrophysiological parameters. Although the radical procedure of surgery led to an immediate postoperative outcome, it was not significant for the ultimate outcome of treatment. Thus, radical surgery may be considered to carry the same risk of definitive impairment of the facial nerve function, just like a combination treatment with subtotal resection and stereotaxic radiosurgery.
{"title":"Influence of clinical and neurophysiological parameters on the function outcome of the facial nerve after vestibular schwannoma surgery","authors":"Dražen Radanović, Rosanda Ilić, Ivan Bogdanović, Bojana Živković, Srbislav Pajić, Magdalena Nikolić, Đurđina Bogosavljević","doi":"10.33962/roneuro-2023-006","DOIUrl":"https://doi.org/10.33962/roneuro-2023-006","url":null,"abstract":"Introduction: Vestibular schwannomas are benign neoplasms of the nerve seath, and they represent the third most common endocranial tumour, following the meningioma and the pituitary adenomas. The primary symptoms of vestibular schwannomas are hearing loss, tinnitus as well as a balance disorder. The therapy of vestibular schwannoma consists of observation, surgery and radiosurgery. The majority of patients who are good candidates for surgery are already affected by significant hearing impairment, thus one of the primary goals of the surgery is the preservation of facial nerve function. Aim: To analyze the outcome of facial nerve function one-year post-surgery using clinical and neuropsychological parameters. Material and methods: This study analyzed the patient's clinical status on admission along with the neuroradiological characteristics of tumours and the neurophysiological intraoperative parameters and their effect on the facial nerve function in the early postoperative period as well as one year after the surgery using the House–Brackmann scale. Results: A total of 30 patients who underwent surgery from January 1st 2015 to December 31st 2018 at the Clinical Centre of Serbia, Neurosurgery Clinic for vestibular schwannomas were examined. The median age of the patients was 51 years. Hearing loss was present in all patients. Sensitivity drop in the innervation region of n. trigeminus was present in 7 (23.3%) patients, as was tinnitus. Cerebellar symptomatology (76%) was present in the highest percentage of patients. Conclusion: We can conclude that the most important aspects of the facial nerve function are the preoperative state of the facial nerve and the electrophysiological parameters. Although the radical procedure of surgery led to an immediate postoperative outcome, it was not significant for the ultimate outcome of treatment. Thus, radical surgery may be considered to carry the same risk of definitive impairment of the facial nerve function, just like a combination treatment with subtotal resection and stereotaxic radiosurgery.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135748416","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 : 2023-03-15DOI: 10.33962/roneuro-2023-016
Sura H. Talib, Mayur Sharma, Vishan P. Ramanathan, Yara Alfawares, Muntadher H. Almufadhal, Mustafa Ismail, Samer S. Hoz
Background. Cavernous carotid aneurysms (CCA) are rare aneurysms with a relatively benign natural history. The association between CCA aneurysm and ipsilateral Internal carotid artery (ICA) thrombosis or occlusion has not been described previously. The management of patients with these dual lesions is a challenging problem. Case description. In this report, we describe an 18-year-old man who presented with left abducent nerve palsy of 3 weeks duration, and imaging revealed left CCA with left ICA occlusion. The patient was managed conservatively with clinical and imaging follow-up. The patient recovered well with complete resolution of clinical symptoms and disappearance of left CCA. Conclusions. The association of giant CCA and ICA occlusion on the same side is a rare phenomenon with no current consensus on the appropriate follow-up and management strategy. In this report, we described the first case of spontaneous complete disappearance of a giant CCA in the setting of ipsilateral ICA occlusion with complete resolution of symptoms at nine months of follow-up.
{"title":"Spontaneous complete resolution of a giant cavernous carotid aneurysm in the setting of ipsilateral ICA occlusion","authors":"Sura H. Talib, Mayur Sharma, Vishan P. Ramanathan, Yara Alfawares, Muntadher H. Almufadhal, Mustafa Ismail, Samer S. Hoz","doi":"10.33962/roneuro-2023-016","DOIUrl":"https://doi.org/10.33962/roneuro-2023-016","url":null,"abstract":"Background. Cavernous carotid aneurysms (CCA) are rare aneurysms with a relatively benign natural history. The association between CCA aneurysm and ipsilateral Internal carotid artery (ICA) thrombosis or occlusion has not been described previously. The management of patients with these dual lesions is a challenging problem. Case description. In this report, we describe an 18-year-old man who presented with left abducent nerve palsy of 3 weeks duration, and imaging revealed left CCA with left ICA occlusion. The patient was managed conservatively with clinical and imaging follow-up. The patient recovered well with complete resolution of clinical symptoms and disappearance of left CCA. Conclusions. The association of giant CCA and ICA occlusion on the same side is a rare phenomenon with no current consensus on the appropriate follow-up and management strategy. In this report, we described the first case of spontaneous complete disappearance of a giant CCA in the setting of ipsilateral ICA occlusion with complete resolution of symptoms at nine months of follow-up.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"112 Pt 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135747671","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 : 2023-03-15DOI: 10.33962/roneuro-2023-015
Mohd Kaif, Kuldeep Yadav, Amit Upadhyay, Deepak Kumar Singh, Rakesh Kumar Singh, Ashish Chandra Agarwal, Kshitij Sinha
Objective. To obtain evidence that the use of endoscopy along with a microscope in the surgical management of pituitary tumours improves intraoperative visualization and significantly impacts operative outcomes in the trans-nasal approach. Material and methods. Each patient underwent endonasal transsphenoidal microscopic tumour resection. The procedure was modified by the use of intrasellar endoscopy as an adjunctive imaging modality. Following complete microscopic resection of tumour, rigid 0° and 30° 4.0-mm endoscopes were used to conduct a final survey of the sellar and parasellar spaces. Residual tumour fragments identified during this endoscopic examination were removed. Results. In 50 patients with pituitary macroadenomas, the rigid 30 ° angled rigid endoscope was found to be highly beneficial. Hidden areas could be visualized and tumour residues were detected. In the majority of the patients with detected tumour residues, adenomatous remnants were safely removed by meticulous endoscopic dissection under optimum visual control after the main part of the tumour had been removed with the operating microscope. Conclusions. Endoscopy provides distinct advantages over microscopy in imaging intrasellar and parasellar structures during pituitary tumour resection which are often missed by microscopy alone.
{"title":"Combined endoscopic-microscopic trans-nasal trans-sphenoidal approach for pituitary adenomas","authors":"Mohd Kaif, Kuldeep Yadav, Amit Upadhyay, Deepak Kumar Singh, Rakesh Kumar Singh, Ashish Chandra Agarwal, Kshitij Sinha","doi":"10.33962/roneuro-2023-015","DOIUrl":"https://doi.org/10.33962/roneuro-2023-015","url":null,"abstract":"Objective. To obtain evidence that the use of endoscopy along with a microscope in the surgical management of pituitary tumours improves intraoperative visualization and significantly impacts operative outcomes in the trans-nasal approach. Material and methods. Each patient underwent endonasal transsphenoidal microscopic tumour resection. The procedure was modified by the use of intrasellar endoscopy as an adjunctive imaging modality. Following complete microscopic resection of tumour, rigid 0° and 30° 4.0-mm endoscopes were used to conduct a final survey of the sellar and parasellar spaces. Residual tumour fragments identified during this endoscopic examination were removed. Results. In 50 patients with pituitary macroadenomas, the rigid 30 ° angled rigid endoscope was found to be highly beneficial. Hidden areas could be visualized and tumour residues were detected. In the majority of the patients with detected tumour residues, adenomatous remnants were safely removed by meticulous endoscopic dissection under optimum visual control after the main part of the tumour had been removed with the operating microscope. Conclusions. Endoscopy provides distinct advantages over microscopy in imaging intrasellar and parasellar structures during pituitary tumour resection which are often missed by microscopy alone.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135747672","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 : 2023-01-05DOI: 10.33962/roneuro-2022-075
George Popescu, Marius C. Zaharia, Andrei Giovani, Ioana Miron, Cezar Vîjlănescu, Radu M. Gorgan
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.
{"title":"Surgical management of spinal cord hemangioblastoma","authors":"George Popescu, Marius C. Zaharia, Andrei Giovani, Ioana Miron, Cezar Vîjlănescu, Radu M. Gorgan","doi":"10.33962/roneuro-2022-075","DOIUrl":"https://doi.org/10.33962/roneuro-2022-075","url":null,"abstract":"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.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135405114","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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