A rare case of medulloblastoma with excessive nodularity: imagistic features

Medulloblastoma is the most common malignant tumor of childhood. Neuroimaging can play a role in the diagnosis of medulloblastoma, however atypical features do exist [2]. We report the case of a 1 year and 10- month-old infant diagnosed with a medulloblastoma with what we term “excessive” nodularity based on neuroimaging features and confirmed by neuropathology. CT-scan (CT) and magnetic resonance imaging (MRI) examination of the brain revealed a very large posterior fossa tumor attached to tentorium. On T2-weighted and post-gadolinium sequences, the tumor shows an extensive nodular grape-like appearance. Initial the patient was underwent a ventriculo-peritoneal shunt.The second operative procedure was tumour resection. Histology examen revealed a diagnosis of medulloblastoma desmoplastic with extensive nodularity. The neuroradiographic features of this medulloblastoma with what we describe as “excessive” nodularity are important to recognize as these children may be cured with chemotherapy alone

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

Professor Constantin Arseni between myth and reality

 

3D diffuse tensor imaging important acquisition in diagnostic and preoperative planning of intracranial lesions

Diffusion tensor imaging (DTI) is a MRI technique that enables the measurement of the diffusion of water in tissue in order to produce neural tract images. DTI allows clinicians to look at anisotropic diffusion in white-matter tracts, but it is limited in demonstrating spatial and directional anisotropy. Advanced methods such as color coding and tractography (fiber tracking) have been used to investigate the directionality. The localization of tumors in relation to the white matter tracts (infiltration, deflection), has been one the most important initial applications. Tractography potentially solves a problem for a neurosurgeon in terms of minimizing functional damage and determining the extent of diffuse infiltration of pathologic tissue to minimize residual tumor volume. In this way, tractography facilitates preoperative planning. Tractographic images may help to clarify whether a tumor is compressing, abutting, or infiltrating the contiguous white-matter tracts. DTI identify different tumor components, and to differentiate tumor invasion from normal brain tissue or edema. The recent development of DTI allows for direct examination of the brain microstructure, and DTI has become a useful tool for investigation of brain disorders such as stroke, epilepsy, MS, brain tumors, and demyelinating disorders

Neuromodulation devices nowadays

Introduction. Neuromodulation devices have known a great progress in the past years being used in treatment of drug resistant neurological diseases such as epilepsies and migraines. A neuromodulation device can stimulate profound or superficial neural pathways in order to balance chronic drug-resistant disorders that involve disturbances of cellular electrical potentials. Material. Cranial neuromodulation devices implants used until now usually determined skull irregularities, implant site infection, resorption of the bone flap or osteomyelitis. In order to solve these problems, it was needed a customized cranial implant that integrates the neuromodulation device. We report the first description of a fully integrated neuromodulation device within a customized cranial implant, publicised in 2018 by Gordon et al., that demonstrates the utility of a computerized neurostimulation device combined with clear custom-designed cranial implant. Conclusion. The new approach of neurotechnology confines a better solution for neuroimplants devices with less follow-up complications and great patient’s satisfaction

Adult quality of life in congenital hydrocephalus operated cases: A twenty years retrospective study

Congenital hydrocephalus is a health problem in many countries and in Romania the pediatric neurosurgical department of the Emergency Hospital “Bagdasar-Arseni” has a large number of such patients. This is a retrospective study and it includes the patients with congenital hydrocephalus operated between 1992 and 2012 in the pediatric neurosurgical department of the Emergency Hospital “Bagdasar-Arseni”. The functional outcome was assessed using Karnofsky Performance Scale, Hydrocephalus Outcome Questionnaire and Glasgow outcome scale. The total number of the patients was 372, with a predominance of boys (212 boys versus 160 girls) and at the time of our study 168 patients were over 16 years old. Functional outcome of the children over 16 years old assessed using Karnofsky Performance Scale, showed that 73 patients were above 80 and leading independent lives, and 95 were less than 80 points. The results would be better if all these patients would benefit from schooling for children with special needs

New technics for removal of intradural spinal tumours

Introduction. Neuronavigation is a computer-assisted technology based on pre- and intraoperative images that permit neurosurgeons to have a better approach of the brain and intradural spinal tumors. The neuronavigation systems have been a significant progress in neurosurgery. These systems allow neurosurgeons to evaluate surgical risks, select the best interventional method, localize better the tumors in order to improve the accuracy of the resection and decide on the optimal trajectory for the surgical procedure, resulting in decreased patient morbidity and mortality. Material: Spinal cord tumors are rare and uncommon lesions. Their growth result in compression of the spinal cord, which can cause severe neurologic deficits such as limb dysfunction, motor and sensation loss with the possibility of leading to death. We present o short report of a study publicated by Stefini et al. in 2018 regarding the use of neuronavigation for removal of intradural spinal tumors. Conclusion: The benefits of using neuronavigation in resection of the intradural spinal tumors include decreased risk of bad localization of the tumor, minimal invasive surgery technique and reduction of bone removal

Measures for Improving the Aquatic Biodiversity on the Lower Sector of Bega Veche River

For surface water bodies, the main environmental objectives set out in the Water Framework Directive are aimed at achieving the good ecological status, respectively the good potential for heavily modified and artificial water bodies. The Banat River Basin Management Plan 2016-2021 identified several significant pressures at watercourses level, such as Bega Veche, which lead to the failure to achieve these objectives. This paper presents the proposed green measures which have a beneficial role from a biological and ecological point of view, which involve natural water retention measures and renaturation of water streams banks, including measures to improve the retention capacity at catchment level