Our policy in intraventricular colloid cysts. Experience of 31 operated cases.

The colloid cyst of the third ventricle is abenign tumor situated in the anterior partof the third ventricle. This lesion representsless than 1% of the primary brain tumorbeing more common in young adults.Because of its particular location, thecolloid cyst can obstruct the Monroforamen, producing intermittentintracranian hypertension with headache,vomiting and visual disturbances. Thirtyonecases of colloid cysts have beenoperated using the microsurgical approachin the First Neurosurgical Department ofEmergency Clinical Hospital “Bagdasar-Arseni” between January 1995 andDecember 2008. The age of the patientswas between 17 and 46 years, with amedium age of 31 years. The follow-upperiod was between 9 months and 7 years.In three cases TTA approach has beenperformed. One of the cases developed avenous cerebral infarct after this procedure,but the patient had finally a good outcome.For 28 patients the transcortical approachhas been performed. In all cases the totalresection of the colloid cyst has beenperformed. Of all 31 cases, one casepresented a transitory hemiparesis, twocases showed negativist behavior, and threecases had transitory memory disturbances.There was no intraventricular hemorrhageafter colloid cyst resection in our series. Inconclusion, according to our policy, themicrosurgical approach is the besttreatment for third ventricular colloid cystsbecause of its main advantages comparedwith the endoscopic approach: thepossibility of total resection of the cyst, thegood control of the bleeding source duringthe procedure, and a better exposure of theanatomical landmarks

Important controversies in lumbar spine surgery: which patients benefit from lumbar spinal fusion and who should be fused? : Literature review

Considering the rising tendency in the application of lumbar spine devices, a rigorous selection of candidates for lumbar spinal fusion must follow the benefit of the patient in terms of a better outcome than classical techniques or conservatory treatment. We pulled essential information from scientific sources regarding the clinical results of patients who underwent fusion surgery to sift patients who do better from fusion. We found out that imagistic proof of instability such as spondylolisthesis associated with lumbar spinal stenosis and refractory pain takes the most from spinal fusion procedures. Oswestry disability index improvement along with restoring the function and reduction of pain remained the postoperative desires of a successful fusion. Clinical amelioration with bracing test prior to intervention was a predictor of better results after fusion. Exclusion criteria like psychiatric disorders and prior lumbar spine surgery were highlighted since studies demonstrated that they are bad predictors of outcome in spinal fusion surgery. Laminectomy was nowhere implemented in the literature as to be urgently fused since only about 20% of patients manifest instability after this classical procedure. Iatrogenic segmental instability after laminectomy, radiologically proven should be a candidate for spinal fusion. These procedures have high costs and high rates of complications putting the patient’s functional status and quality of life at uncertainty since there is still a lot of debate in this area of spinal neurosurgery

HYDROCEPHALUS: OVERVIEW AND PERSPECTIVES

Cerebrospinal fl uid (CSF) is produced by choroid plexus, circulates in the subarachnoid space and the resorbtion occurs at the level of arachnoid granulation. Ventricular enlargement appears because of: 1exces of CSF production, 2. altered CSF fl ow or resorbtion, 3. secondary post-traumatic, and 4. post-aneurysmal SAH, with or without symptoms or neurologic impairment. Hydrocephalus (HY) (count in infants 3-5 / 1.000 new-born) represents the excess of CSF in ventricles or subarachnoidal space and is commonly associated with meningomyelocele (MMC) & acqueductal stenosis. The most often clinical syndrome which occurs in hydrocephalus is Intracranian Hypertension syndrome, which consists in headache, vomitting and papilary edema. The diagnostic protocol is represented by neurological examination, ophtalmological examination, CT scan and MRI. Purposes of surgical procedures are to decrease ICP, to re-expand the brain and to prevent neuronal destruction. The main surgical procedures are endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt and ventriculoatrial shunt

A rare case of Yhwag gene mutation causing developmental and epileptic encephalopathy

Background: epileptic encephalopathy 56 or DEE is a rare disease characterized by early-onset treatment-refractory epilepsy accompanied by global developmental regression that has been shown to be caused by various mutations of the YWHAG gene. Case presentation: We report a novel of a heterozygous mutation of YHWAG c.170G>A, p.(Arg57His), in a Caucasian male. Conclusions: Our report further confirms that mutation of YWHAG results in developmental and epileptic encephalopathy

A rare case of Yhwag gene mutation causing developmental and epileptic encephalopathy

Background: epileptic encephalopathy 56 or DEE is a rare disease characterized by early-onset treatment-refractory epilepsy accompanied by global developmental regression that has been shown to be caused by various mutations of the YWHAG gene. Case presentation: We report a novel of a heterozygous mutation of YHWAG c.170G>A, p.(Arg57His), in a Caucasian male. Conclusions: Our report further confirms that mutation of YWHAG results in developmental and epileptic encephalopathy

Surgical and functional outcome of olfactory groove meningiomas: Lessons from the past experience and strategy development

Object: Olfactory groove meningiomas (OGMs) constitute a unique subset of intracranial meningiomas, since they usually remain clinically silent for a long period of time, and they may be of large size upon their diagnosis. Their surgical management remains quite challenging. The surgical and the neuropsychological outcome of patients with OGM are presented in our current study, in order to establish a basis for developing efficacious surgical strategies for the management of this clinico-pathological entity. Methods: A retrospective study covering a 17-year period examined a total of 78 patients (31 males and 47 females) diagnosed with OGM, and surgically managed in the two participating institutions (Greece and Romania). The patients’ charts as well as their imaging studies (head CT, brain MRI/1HMRS, brain MRA/MRV, cerebral DSA), and their operative reports were carefully reviewed. All participants underwent pre- and post-operative neurocognitive evaluation with the Mini Mental Status Examination (MMSE), and the Frontal Assessment Battery (FAB). Microsurgical resection was performed by employing a bilateral subfrontal, a unilateral subfrontal, or a pterional approach. The Simpson scale was utilized for assessing the extent of resection. The histological type of the resected meningioma was identified. The follow up period ranged from 2 to 15 years (mean: 5.6). Results: Non-specific headache was the most common presenting symptom, followed by personality changes in our series. Grade 1 Simpson resection was accomplished in 19.2%, grade 2 in 46.2%, grade 3 in 17.9%, and grade 4 in 16.7%. The most common postoperative complication was anosmia (89.7%), followed by CSF leakage (21.8%). The observed 5-year recurrence rate was 11.8%. Analysis of our data demonstrated that patients with larger tumors presented with poorer neurocognitive status, and had also lower, compared with patients with smaller meningioma, postoperative neurocognitive outcome. Meningioma's histological type had no correlation with complication occurrence or tumor recurrence. Surgical resection significantly improved the preoperative MMSE scores of our patients, while the observed postoperative improvement of the FAB scores was not statistically significant. The bilateral subfrontal approach demonstrated higher complication rate than the other two approaches, in our series. Interestingly, bifrontal approach was associated with higher tumor recurrence rate. Tumor size, patient's age, and ethmoid bone infiltration seem to be predisposing factors for complication occurrence and tumor recurrence. Conclusion: Individualized surgical strategy is necessary for mitigating the postoperative complication rate, and the possibility of recurrence in the management of OGMs. The exact role of less invasive, endoscopic approaches in the management of these patients remains to be defined. © 201