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

Surgical decompression of arachnoid cysts: A study on 44 pediatric patients

Background: There are yet to clarify some aspects regarding the surgical indications and surgical methods that are at choice for treating ACs. The purpose of the study is to contribute to the ongoing debate on the most appropriate treatment. Materials and methods: We included in the study 44 pediatric patients (aged < 18 years), operated for ACs in the Neurosurgery I Department, of the Emergency Clinical Hospital “Bagdasar-Arseni” in Bucharest, during the period January 2003 to December 2012. The surgical methods were either a craniotomy or cyst shunting. The information regarding these patients was retrospectively assessed based on their clinical and imaging records, and cross checked with the OR protocols. Treatment efficiency was evaluated considering postoperative clinical status, imaging appearance and postoperative complications. Results: 84.1% of the patients reported postoperative disappearance or reduction of symptoms, while 13.6 had the same complaints as prior surgery. Only one patient experienced worsening of symptoms. Follow-up imaging showed cyst disappearance in 29.5% patients and cyst reduction in 61.4% patients. 9.1% had no change in cyst volume. Craniotomy correlated with a better imaging appearance (p=0.02). There was no correlation between improved clinical status and cyst fluid reduction (p=0.6). 9 patients (20.4%), all with temporal cysts, experienced postoperative complications, and 7 of them (15, 9%) needed surgery. There was no severe or permanent dysfunction in any of the patients. 42.8% of the cyst shunting patients suffered postoperative complications, whereas only 10% of the craniotomy patients did. Conclusion: Cyst decompression results in significant clinical improvement and it can be performed with little risk for severe complications. Craniotomy seems to be a better surgical treatment option than cystoperitoneal shunt, with a better neuroimaging appearance and a lower complications rate

Subdural hematoma and arachnoid cyst: Case report

We present a case of a previously asymptomatic 15-year-old boy who was examined in the emergency services unit for syndrome of intracranial hypertension. He was addmited for headache, vertigo, vomiting and somnolence, GCS 14, and on local examination no traumatic signs. On admission, a CT-scan of his head revealed left fronto-temporo-parietal expansive process with important mass effect to the right. The patient underwent a left-sided craniotomy for evacuation of the subdural hematoma as well as the intracystic hematoma and cyst fenestration into the basal cisterns. The patient tolerated the procedure well and recovered completely. Intracranial arachnoid cysts are considered to be congenital malformations with a predilection for the temporal fossa. A review of clinical symptoms, etiology and mechanisms, diagnosis and treatment is made, followed by the necessary discussions. Taking into account the possible mechanisms of subdural hematomas in arachnoid cysts, in our opinion is logically to perform craniotomy with membranectomy, taking out the membrane from the vessels, in order to prevent another hemorrhage. Other authors propose subdural hematoma drainage without any specific treatment (shunt or fenestration) of the arachnoid cyst, for this category of patient. The diagnosis of a subdural hematoma superposed on a arachnoid cyst can be tricky for a doctor from other specialty or for a young neurosurgeon. It is important to identify and report such rare complications with intracranial arachnoid cyst, so that asymptomatic patients with an intracranial arachnoid cyst can be counseled about such possibilities following head trauma

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

New approach based on biomarkers in acute traumatic spinal cord injury

Spinal cord injury (SCI) is one of the most devastating traumas for an individual because the complete traumatic spinal cord injury leads to paraplegia or tetraplegia. The mechanical injuries directly cause axonal destruction in fiber tracts, destruction of the neurons and of the glial cells, and their destruction releases substances whose presence, quantity and dynamics can be lesional biomarkers. The reactions of partially injured cells simultaneously start and the occurring substances and their quantity may be reaction biomarkers. The lesional biomarkers appear immediately post-injury and after several hours there are both lesional biomarkers and reaction biomarkers. The most important lesional biomarkers are the phosphorylated neurofilament subunits resulting from the axonal neurofilament destruction. The heavy phosphorylated neurofilament subunit (pNF-H) is a predictive lesional biomarker because its values pattern can show the reducing or stopping of the secondary lesions and the favorable outcome. The complete SCI patients with a favorable development had a specific pattern of daily values of pNF-H: a sudden increase up to a maximum value then a progressive decrease to normal. The patients with unfavorable outcome or neurological stabilisation had two patterns: an increase to a plateau of pNF-H values or a progressive increase up to a peak followed by a progressive decrease to quasi-normal values

Pseudotumour cerebri: Idiopathic intracranial hypertension and vascular intracranial hyertension

From the first to use of “pseudotumor cerebri” by Nonne in 1904, the historic evolution of the knowledge on pseudotumor cerebri has been marked by several periods (the otologic stage, the neurosurgical stage, the neuro-ophthalmologic stage); today there are clear diagnosis criteria for the idiopathic intracranial hypertension, there is a clear differentiation between idiopathic intracranial hypertension and vascular intracranial hypertension, also the comprehension of the illness pathogeny is based on the dynamics of the intracranial fluids, which allows the auto-regulation of the cerebral circulation within quasi-normal limits, despite the very high intracranial pressure

Biomarkers in spinal cord compression: Ethics and perspectives

The phosphorylated form of the high-molecular-weight neurofilament subunit NF-H (pNF-H) in serum or in cerebro-spinal fluid (CSF) is a specific lesional biomarker for spinal cord injury. The lesional biomarkers and the reaction biomarkers are both presented after several hours post-injury. The specific predictive patterns of lesional biomarkers could be used to aid clinicians with making a diagnosis and establishing a prognosis, and evaluating therapeutic interventions. Diagnosis, prognosis, and treatment guidance based on biomarker used as a predictive indicator can determine ethical difficulties by differentiated therapies in patients with spinal cord compression. At this point based on studies until today we cannot take a decision based on biomarker limiting the treatment of neurological recovery in patients with complete spinal cord injury because we do not know the complexity of the biological response to spinal cord compression

Microsurgical Approach in a Thoracic Meningioma in Elderly: Case Report

Improved results in the treatment of intraspinal tumors have followed greater sophistication of diagnostic modalities and surgical techniques. Whereas originally tumors could be diagnosed radiologically only by bone erosion seen on radiographic films, now mielography, computed tomography (CT) and magnetic resonance imaging (MRI) provide precise localization. Indeed, MRI is a stand-alone diagnostic preoperative study for virtually all intradural tumors. With the advent of the operating microscope, microsurgical instruments, bipolar cautery and intraoperative ultrasonography, combined with ultrasoniccavitation devices and other techniques, surgeons can approach these tumors with greater ease