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C. Kakucs and I. St. Florian

Abstract

This 41-years-old female presented with somnolence, confusion and nuchal rigidity. Preoperative angio-CT scan showed two aneurysm located on both internal carotid artery (ICA) at the site of posterior communicating artery (PComA). During surgery we discovered another dilatation on the origin of left ophtalmic artery that proves to be an infundibullum. We clipped the two communicating posterior aneurysm from the left side and the ophtalmic infundibullum was wrapped. Seven days after surgery the neurological status was improved and she was transferred to the Neurological department.

Open access

A. Oslobanu and St.I. Florian

Abstract

A biomarker is “a naturally occurring molecule, gene, or characteristic by which a particular pathological or physiological process, disease, etc. can be identified” and it could be used a measurable indicator for the presence or severity of disease state. YKL-40 is a secreted glycoprotein associated with extracellular matrix, a member of the mammalian chitinase-like proteins that is expressed in a several types of solid tumors. Although the implication of this biomarker in tissue remodeling processes or the role in cancer cell proliferation, invasiveness, angiogenesis, and remodeling of the extracellular matrix is going to be well recognized, the regulation and role in glioblastoma multiforme (GBM) progression remains unknown. Using the serum level of YKL-40 as a single screening test in cancer cannot be used, but in association with other tumoral biomarkers and imaging techniques can be a useful tool as a “prognosticator.” Moreover, elucidation of the YKL-40 functions could be an attractive target for antitumor therapy.

Open access

Adriana Baritchii, A. Gubian and St.I. Florian

Abstract

Malignant gliomas are aggressive brain cancers. After many decades of intensive research they represent a major cause of cancer related mortality and morbidity. Management of malignant gliomas is very difficult. None of the current treatments are curative. High grade gliomas are optimally treated with surgery followed by radiotherapy and chemotherapy. The impact of surgery on progression free survival and overall survival was a constant preoccupation and debate for decades among neurosurgeons. Different studies published in the last 25 years have provided evidence that the extent of resection of high grade gliomas can influence time to progression and median survival, although so far there is no class I prospective randomized trial to fully answer this question. Some of the most important studies are reviewed here. The modern neurosurgery relay on some tools that proved to be very helpful in guiding the surgeon to achieve the maximal tumoral cytoreduction with minimum impact on the brain’s eloquent areas. iMRI has been proved to be safe and became an important tool during tumor surgery, used alone or in conjuction with other important techniques: intraoperative neurophysiology, awake cortical mapping, 5-ALA fluorescence etc. Although so far the prognostic of high grade gliomas is still disappointing, further understanding of the biology of these tumors and a patient-tailored treatment could be the keys of finding a cure in the future.

Open access

Bianca St. Pintea, Zorinela Andrasoni and I.St. Florian

Abstract

Craniopharyngiomas are rare, highly complex tumors with bimodal incidence in the pediatric and adult age groups. In our opinion, depending on the means possible, total microscopic ablation offers the best chance of healing, or at least prolongs the time interval of recurrences.

Objective : The purpose of this paper is to add our surgical experience to in the last 11 years, in the context of the large debate from literature regarding the best therapeutically option concerning craniopharyngioma treatments.

Materials and Methods : We performed a retrospective analysis of 42 consecutive patients with craniopharyngioma who underwent surgical resection by one surgeon at the Neurosurgical Department of Cluj-Napoca County Emergency Hospital between January 2002 and December 2012. We perform a systematic review of the published review on goals and techniques associated with selected surgical strategies for the treatment of CPH.

Results : During this period a total of 42 patients with craniopharyngioma were treated in our institution by a single neurosurgeon, representing 12% from all cases of sellar and parasellar tumors respectively operated in last 11 years. There is a significant male preponderance. Nine patients were less than 18 years of age at admission. The patient age distribution showed a peak incidence between 10 and 15 years and another between 45 and 50 years. Considering the pediatric and adult populations together, the most common presenting symptom was visual disturbances with 60% of patients presenting in this manner, followed by severe headache in more than 50% of cases. Obstructive hydrocephalus occurred in 31% of cases. Calcifications were seen in 45% of cases, more frequently in children. All our cases underwent surgery by transcranial approach; extended frontotemporal, as the first choice, in 57% of cases. Gross total removal was achieved in over half of cases and near total resection was achieved in 40% of cases. The most frequent postoperative complications: diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion. No visual impairment was observed after surgery in the patients with normal visions at presentation. Only 3 of cases primarily operated by us recurred, in an interval of one to five years. The mortality rate in our cases treated by transcranial surgery was 2% in primary cases and 7% in cases of tumor recurrence.

Conclusions : Radical surgery offers the best chance for cure. Radical surgery is also associated with a higher risk of postoperative morbidity, being the reason for why many neurosurgeons recommend a subtotal resection followed by radiotherapy. In our opinion radical surgery is possible in large majority of the cases, fronto-temporal approach offering the most appropriate way to reach this objective. Every case must be judged with maximal attention based on preoperative neuroimagistic data but decisively, on intraoperative findings.

Open access

A. Oslobanu and St.I. Florian

Abstract

The treatment options and prognosis in gliomas could be determined by anatomic topographic location, beside different subtypes of glioma. The aim of this study is to find if any correlation between anatomical location of a glioma and the different subtypes of high grade glioma exist, and if this differences exists, does this influence the treatment options in terms of surgery. To do this, a representative group of 318 adults with high grade glioma was used. The most frequent subtypes of high grade glioma were glioblastoma (76,1%) followed by anaplastic astrocytomas (19,1%), anaplastic oligodendrogliomas (2,2), anaplastic ependymomas (1,2%), anaplastic oligoastrocytomas (0,9%), and anaplastic oligoastrocyomas (0,3%). The most frequent locations of gliomas were in the right frontal lobe in 11,95% of the cases, followed by left frontal in 9,12%, left temporal in 9,12%, right parietal in 8,18%, left parietal in 6,60%, right temporal in 5,66% for one lobe location. For multiple lobe locations the left fronto-parietal and left temporo-parietal (5,03%) were the most frequent locations. Deep-seated locations were present in 1,56% of the cases, and brain stem location was in 3,46%. No significant difference was observed between left or right predominence. Regarding the results among different subtypes of high grade glioma we noted that the anaplastic astrocytomas were more frequently located at the right frontal lobe in 18,03% compare to left frontal and left parietal lobe in 9,83%. In glioblastoma we found no significant differences in anatomical location as seen in anaplastic astrocytomas. These data results from our study could affect the therapeutic strategy regarding the extent of tumors resection.

Open access

H. Stan, P.A. Kiss, A. Stan and I.St. Florian

Abstract

Hydrocephalus represents one of the most frequent pathologic entities requiring neurosurgical intervention. Even in present times the treatment of hydrocephalus is a highly debated subject. Neuroendoscopy is one of the technique posibility. The present study includes patients with different types of hydrocephalus classified according to imagistic criteria (MRI). Neuroendoscopic therapeutic options are presented for different types of hydrocephalus and the postoperative results of these procedures are revealed by imaging. In conclusion, we consider neuroendoscopy useful in each type of hydrocephalus.

Open access

Bianca Pintea, Andreea Mogyoros, Zorinela Andrasoni and I.St. Florian

Abstract

Introduction: The fronto-temporal approach represent the shortest distance to the ipsilateral optic nerve and carotid artery, and allow the direct verification of the optical nerves, the carotid arteries, the pituitary stalk, the tumor and its relationship with the suprasellar structures.

Objective: The purpose of this study is to advocate an available cranial base technique for removing these tumors and to delineate the technique’s advantages that aid in achieving an improved extent of tumor resection and enhancing the patients’ overall outcome.

Materials and methods: We present a retrospective study of a single surgeon experience on 355 consecutive cases with sellar and parasellar tumors admitted and operated by transcranial approaches in our department between January 2000 and December 2012.

Results: Tumors in the sellar region represent 11, 8% of all tumors operated in our department. The most common type of tumor was pituitary adenomas, 165 of cases, followed by sellar and parasellar meningiomas, 128 of cases. Craniopharyngioma represent 12% of cases encountered in this region.

All our cases underwent surgery by transcranial approach, unilateral frontotemporal in 252 of cases (71%). In pituitary adenomas total and near total resection was achieved in 100% of patients operated by transcranial approaches. For resection of craniopharyngiomas we have frequently chosen the extended fronto-temporal approach.

The most common surgical related complications were: postoperative hematomas 9 of cases; wound infections, 6 of cases and CSF leakage, 12 of cases; transient visual alteration in 12 cases, transient third cranial nerve palsy in 6 of cases, transient motor deficit in 7 cases, hydrocephalus, 6 cases; transient diabetes insipidus in the large majority of pituitary adenomas and craniopharingiomas. Only 4 cases of pituitary adenomas and 6 of craniopharingiomas recurred after subtotal resection, requiring re-intervention. The mortality rate in our study was 2%.

Conclusions: Our experience demonstrated that the management of the large suprasellar tumors via fronto-temporal approach remains the main route for these tumors with significant extrasellar extension, fibrous tumors, cases with unrelated pathology that might complicate a transsphenoidal approach and recurrent tumors after previous transsphenoidal surgery. In our opinion there is no need for larger osteotomies or extensive drilling of cranial base. “Instead of bone, remove the tumor; it's easier even for the patient”.

Open access

C. Kakucs, C. Berce, A. Tamas-Szora, G. Ungureanu and I.St. Florian

Abstract

Aim: This study want to demonstrate the efficaciousness of drotaverinum as a replacer of papaverine in the prevention and treatment of vasospasm.

Material and method: In this study were used 20 albino Wistar male rats. Rats were divided in two groups and vasospasm was induced to the both femoral artery and after that irrigation of the femoral arteries with drotaverinum was performed to demonstrate the vasodilatation that can appear (group A). In the group B after the obtaining of vasospasm irrigation of the femoral arteries with saline solution was performed and this group was used as witness. The length of the vessels was measured when was achieved the vasospasm and also before and after the administration of the solutions. Pictures were taken at every step of dissection and solutions administration to can measure the length of arteries before and after the administration of drotaverinum and the saline solution.

Results: In all rats was obtained vasospasm at the femoral artery after clipping the artery and after we irrigate with adrenaline. In the group with drotaverinum we obtained the vasodilatation and in the witness group the caliber of the vessels remain the same. The statistical analysis of the data demonstrate a significant differences between the group were was used drotaverinum and the witness group were was used the saline solution (p<0,001).

Conclusions: Drotaverinum has a good vasodilatative effect on arteries and he can prevent the apparition of vasospasm and it can even treat vasospasm if occur by producing local vasodilatation and a good circulation in the area where is administrated. This study showed quantitatively that drotaverinum can treat the experimental peripheral vasospasm in rats.