Comparative study of microsurgery and Gamma-Knife surgery in patients with vestibular schwannoma

Introduction: Vestibular schwannomas (VSs) are benign neoplasms of Schwann cell origin. Although benign in nature, the treatment of vestibular schwannoma remains a challenge for modern neurosurgery. Patients with vestibular schwannomas have several management options including observation, surgical resection, stereotactic radiosurgery, fractionated radiation therapy, or combinations of these. Material and methods: We study two patient groups that have been treated using either GammaKnife radiosurgery or microneurosurgery. We analyze the criteria for primary referral to one of the thera­peutic procedures and look at their results in terms of tumor control and facial nerve function preservation. The surgical group consisted mostly of patients with equal or bigger than 3 cm (80,95%) tumors out of which 80,95% showed imagistic or clinical signs of brainstem compression. The radiosurgery group consisted exclusively of tumors smaller than 3 cm. Facial nerve function preservation results were unsatisfactory in the surgical group but were good for the patients referred to radiosurgery. Results: Our results show that tumor size is a major factor in facial nerve function preservation. However for large tumors surgery is the only possible therapeutic method. Conclusions: For those patients with smaller tumors and very good preoperative neurological function radiosurgery should be the therapy of choice, keeping in mind that in 12% of the cases in our series there has been an enlargement in tumor volume that could raise the indication for microneurosurgery

Use of high performance technologies in the treatment of chronic neuropathic pain

Spinal cord neurostimulation is a minimally invasive treatment method for chronic neuropathic pain that is refractory to treatment, and is part of top technology in field. Relatively recent introduction of this method in the Neurosurgery Clinic "Prof. Dr. N. Oblu "of Iasi has aligned the clinic's therapeutic arsenal to world standards. This has made it possible to treat in Romania a category of patients who would be treated abroad until now. Our clinic has entered the "National Program for diagnostic and treatment using high performance equipment "- Subprogram of treatment of neuropathic pain by implant of a spinal cord neurostimulator and is currently the only one in Romania where this treatment can be done. This represents a new step in the transformation process of the Clinical Hospital Emergency "Prof. Dr. N. Oblu" Iasi in a real Center of Excellence in the field Neurosurgery. The team dealing with the implant consists of 3 neurosurgeons, a neurologist, pa sychologist and an anesthetist, trained in a specialized foreign center

The role of MR tractography in pre-surgical planning - personal series of 25 cases and a review of the literature

Introduction: Diffusion tensor imaging (DTI) contains a wealth of information on molecular diffusion in biological tissues. Knowledge of the topography, integrity, and involvement by the pathological process of the white matter tracts is an important factor in pre-surgical planning for patients with brain lesions. We have evaluated the clinical utility of a magnetic resonance tractography technique based on DTI Materials and methods: We studied, in a prospective manner, 25 cases with lesions involving salient intracerebral and medullary tumors (22 and 3 cases respectively). All cases followed a preoperative imaging protocol that included DTI on top of the usual MR imaging protocol. We analyzed the DTI findings preoperatively and looked at the significant information that influences the surgical plan: position of the significant white matter tracts, the degree of their involvement in the pathological process and anatomical integrity, relationships with important anatomical landmarks and with the major surgical approach paths. We present the postoperative results and some of the most illustrative cases in the series and compare our results with the similar studies in the literature. Results: Pathological examination of the resection specimens documented glioblastoma in twelve cases, grade one astrocytomas in five cases and grade two in one case, meningioma in five cases, mature teratoma and AVM in one case respectively. We managed to identify the degree of involvement of white matter tracts in all cases using DT imaging 2D maps and 3D reconstructions. Normal white matter tracts were highlighted in the controlateral hemisphere in all patients. Changes in tracts’ structure and position were characterized for each patient. Conclusion: Our experience, based on the results of the present study strongly suggests that in depth knowledge of the white matter tracts involvement in an intracerebral or intramedullary pathological process improves significantly the surgical planning in terms of surgical procedure safety and functional outcome