21SelectedAbstracts


 

 

 

 

 
504          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

SELECTED ABSTRACTS 

of the 40th Congress of the Romanian Society of Neurosurgery with 

International Participation, September 18th - 21th 2013 

 
MICROSURGERY OF VENTRICULAR 

LESIONS: AN EXPERIENCE WITH 309 

PATIENTS  

Prof. Basant Kumar Misra,  

Chairman, Department of Neurosurgery and 

Gamma Knife Radiosurgery,  

P. D. Hinduja National Hospital & Medical 

Research Centre, Mumbai, India  

President Elect, World Federation of Skull Base 

Societies Secretary, WFNS  

Chairman, Education Committee, Asian Australian 

Society of Neurological Surgeons  

Past President, Skull Base Surgery Society of India 

  

INTRODUCTION: Microsurgical 

experience with the management of lateral and 

anterior third ventricular tumors is presented. 

The surgical approach to the lesions at 

posterior third ventricle and suprasellar 

tumors like craniopharyngioma is not 

included here.  

MATERIAL AND METHOD: Three 

hundred nine ventricular lesions, 214 anterior 

third ventricular and 95 lateral ventricular, 

were operated by the first author from 1987 till 

2014 June. These were mostly primary 

intraventricular lesions. 90% of the third 

ventricle lesions were benign as was most of 

the lateral ventricular lesions. Colloid cyst (153 

cases) was the commonest 3rd ventricular 

lesion and neurocytoma (25 Cases) the 

commonest lateral ventricular tumor.  

RESULTS: While the majority of the third 

ventricular tumors were operated by the 

transcallosal route, the transcortical was the 

preferred route for the lateral ventricular 

tumor. Following transcallosal 

transventricular entry there were four options 

of entering the third ventricle, the 

transforaminal, interforniceal, subchoroidal 

and subforniceal suprachoroidal. Our 

preferred route is the transforaminal followed 

by subforniceal suprachoroidal; the later was 

first time developed and reported in the 

literature by the author in 1994. The 

approaches to the lateral ventricle are more 

varied and was dependent on the location of 

the lesion in the ventricle: lateral temporo 

parietal, middle temporal gyrus, anterior 

temporal lobectomy, occipital incision, 

superior parietal, middle frontal gyrus, and 

transcallosal. 

 

CHANGING TRENDS IN THE 

MANAGEMENT OF PETROCLIVAL 

MENINGIOMA 

Prof. Basant Kumar Misra, 

Chairman, Department of Neurosurgery and 

Gamma Knife Radiosurgery, 

P. D. Hinduja National Hospital & Medical 

Research Centre, Mumbai, India 

President Elect, World Federation of Skull Base 

Societies Secretary, WFNS 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         505 

 

 

 

 

 

 

 

Chairman, Education Committee, Asian Australian 

Society of Neurological Surgeons 

Past President, Skull Base Surgery Society of India 

 

The initial enthusiasm of achieving 

eradication of a seemingly ‘inoperable’ 

meningioma by novel skull base approaches 

led many neurosurgeons to employ radical 

surgery. 

The accompanying high morbidity was 

accepted as inevitable. Over the years, 

however, many started questioning this 

philosophy and the last decade saw the 

pendulum swing to the other extreme with the 

popularity of endoscopic surgery and 

radiosurgery. 

Thus, minimally invasive neurosurgery 

became the fashion. However, it is important 

to remember “the pearl” that inadequate 

treatment through a less invasive approach is 

maximally invasive. Realization has now 

dawned that endoscopic surgery and 

radiosurgery cannot replace microsurgery for 

meningioma. A judicious use of various 

microsurgical techniques, including skull base 

approaches, with appropriate adjuncts like 

neuroendoscope and image guidance is the 

best way forward in dealing various 

meningioma. Measures preventing 

neurovascular damage during surgery, 

adequate closure to prevent CSF leaks, the 

bugbear of skull base surgery, and quick 

remedial measures to treat CSF leaks will go a 

long way to achieve acceptable results. Radical 

but safe excision in skull base tumors followed 

by adjunct radiosurgery, if necessary, will 

result in long-term control. Examples of 

meningioma at various sites managed will be 

demonstrated on video. Our philosophy is that 

of Optimally Invasive Neurosurgery, 

individualizing the approach to suit the given 

patient with a goal to achieve maximal result 

with minimal damage to the patient. 

Neuroendoscope, image guidance and 

radiosurgery are all utilized as pillars on the 

foundation of microsurgery! We will try to 

answer some of the following decision 

dilemmas in this lecture: 

(1) to treat or not, 

(2) microsurgery or radiosurgery, 

(3) which surgical approach and 

(4) total or subtotal excision 

 

“RADIATING” MULTIPLE SUBPIAL 

TRANSECTION FOR REFRACTORY 

EPILEPSY REDUCES RATE OF 

COMPLICATIONS 

Christian Raftopoulos 

 

BACKGROUND: Multiple subpial 

transection (MST) is a potential surgical 

treatment for patients with epileptogenic foci 

located in cortical areas with higher functions. 

As neurosurgical teams have become more 

experienced with MST, the original technique 

has adapted. 

OBJECTIVE: To report our 6-year 

experience with a modified MST technique. 

METHODS: The population included 62 

consecutive patients with medically refractory 

epilepsy treated by MST, with a follow-up 

period ranging from 2 to 9 years. MST was 

performed on gyri under neuronavigation and 

guided by intraoperative electrocorticography. 

We performed radiating MST from a single 

cortical entry point. The MST technique was 



 

 

 

 

 
506          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

described according to the number of 

transections performed and the Brodmann 

areas (BAs) involved. Any MST-related 

complications were registered and followed 

up. Clinical outcome was described in terms of 

seizure suppression or reduction according to 

the Engel modified classification. 

RESULTS: Twelve patients underwent 

MST alone (MSTa), and 50 had MST with 

another procedure. The main MST sites were 

BA 4 (61%) and 3, 1, 2 (58%); in 22% of cases, 

MST was performed in BA 44, 22, 39, and 40. 

Permanent neurological deficits were 

observed in 4 (6.4%) patients; 2 minor deficits 

were MST related (3.2%). A reduction in the 

seizure rate of at least 50% was seen in 79% of 

patients (MSTa group, 75%), and 42% became 

seizure free (MSTa group, 33%). 

CONCLUSION: This study demonstrates 

the efficacy and low morbidity of radiating 

MST performed under neuronavigation 

and intraoperative electrocorticography. 

 

PRESERVATION OF FUNCTION IN 

ACOUSTIC NEUROMA SURGERY 

Prof. Basant Kumar Misra, 

Chairman, Department of Neurosurgery and 

Gamma Knife Radiosurgery, 

P. D. Hinduja National Hospital & Medical 

Research Centre, Mumbai, India 

President Elect, World Federation of Skull Base 

Societies Secretary, WFNS 

Chairman, Education Committee, Asian Australian 

Society of Neurological Surgeons 

Past President, Skull Base Surgery Society of India 

 

INTRODUCTION: An attempt is made to 

present the management protocol in Acoustic 

Neuroma (AN) patients and outline the steps 

for preservation of cranial nerve function 

during acoustic neuroma surgery. 

MATERIAL & METHOD: A detailed 

analysis of 1454 cases of cerebellopontine 

angle lesions operated by the first author 

between 1987 and 2014 June yielded 913 cases 

of AN. Microsurgery was the primary option 

in 634 and Gammaknife Radiosurgery was 

done in 296, of which 66 were previously 

operated by the author. A detailed analysis of 

microsurgically managed patients in two 

different periods (100 consecutive patients 

each before 1993 and 2008) were compared to 

see the changing trend and document current 

results. In the initial experience (1990s), the 

emphasis in microsurgery was preserving life, 

total excision of tumor and preservation of 

function in that order. In the 21st century, the 

emphasis in microsurgery has been all about 

functional preservation. In 100 consecutive 

cases of VS (excluding neurofibromatosis-2) 

that were treated microsurgically between 

2005-08, there were four small tumors (<2 

cm), 14 medium – sized tumors (2-3 cm) and 

82 large tumors (≥ 3 cm). 

The total excision rates was 83%. The facial 

nerve anatomical preservation rate was 96% 

and function was Grade III House-Brackmann 

(HB) or better in 87%. Both the total excision 

rate and facial function of Grade II HB or 

better were 100% in cases with tumor size less 

than three cm. Functional hearing 

preservation was achieved in ten cases. There 

was no operative mortality. The risk of injury 

to cranial nerves 7th and 8th can be: (i) just 

medial to IAM, (ii) at the brain stem and (iii) 

inside IAM. The causes of injury just medial to 

IAM is because of mechanical injury while 



 

 

 

 

 
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dissecting because of well-known maximal 

adherence between tumor and the nerve and 

the sharp angle the nerves make between the 

IAM and cisternal component. At the 

brainstem, the risk of injury is because of 

venous injury and subsequent loss of 

anatomical definition. Inside the IAM, the 

main causes of injury to VII and VIII are 

vascular jeopardy, thermal injury by drilling or 

coagulation and injury to labyrynth causing 

deafness. Recognizing the risk factors is the 

first step towards prevention of injury to 7th 

and 8th cranial nerves. 

 

MICROSURGERY OF GIANT 

INTRACRANIAL ANEURYSMS 

Prof. Basant Kumar Misra, 

Chairman, Department of Neurosurgery and 

Gamma Knife Radiosurgery, 

P. D. Hinduja National Hospital & Medical 

Research Centre, Mumbai, India 

President Elect, World Federation of Skull Base 

Societies 

Secretary, WFNS 

Chairman, Education Committee, Asian Australian 

Society of Neurological Surgeons 

Past President, Skull Base Surgery Society of India 

 

INTRODUCTION: Giant intracranial 

aneurysms (GIA) are treacherous lesions with 

significant risks in management. In spite of the 

great advances in endovascular therapy the 

results of EVT in giant aneurysms has been 

suboptimal. A retrospective analysis of our 

strategy and results with microsurgery of GIA 

in the 21st century is presented. 

MATERIAL AND METHOD: The author 

has operated on 123 GIA microsurgically till 

June 2013, 99 since 2000 and the material of 

this presentation. Age ranged from 2 to 73 

years and the female to male ratio was 2:1. 80% 

were in the anterior circulation and 20% in the 

posterior circulation. Intra operative 

neuroprotection measures included mild 

hypothermia, propofol induced burst 

suppression and hypertensive anesthesia 

during temporary arterial occlusion. 

Peroperative parent artery/bypass patency was 

checked by Microvascular Doppler, catheter 

angiography / ICG dye angiography. 

Postoperative check angiogram was 

routinely performed. 

RESULTS: Exclusion of the aneurysm from 

the circulation by direct repair (clipping, 

aneurysmorrhaphy, excision & suture) was 

done in 60. Flow diversion and ECIC bypass 

was done in 29, high flow bypass in 27 and 

STMC in 2. Trapping was done in 10. 

Temporary ECIC protective bypass was done 

in 3. Hypothermic cardiac arrest was used in 3 

cases of giant basilar artery aneurysm with 

femoro-femoral bypass for direct repair. 

Dedicated skull base approach and lumbar 

drainage helped in avoiding brain retraction. 

Postoperative outcome was good in 79%, poor 

in 16% and 5 patients died. 

CONCLUSIONS: Judicious surgical 

strategy and appropriate technology can result 

in good outcome in more than 80% of cases of 

GIA. Majority of the GIA can be treated 

microsurgically, the preferred modality today. 

 

  



 

 

 

 

 
508          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

FOURTH VENTRICLE TUMORS 

I.S. Florian1,2, M. Balaci2, S.I. Fofana2, C. Kakucs1,2 
1University of Medicine and Pharmacy “Iuliu 

Hatieganu” Cluj-Napoca, Department of 

Neurosurgery 
2Cluj County Emergency Hospital, Department of 

Neurosurgery 

 

INTRODUCTION: Fourth ventricle 

tumors are rare and challenging lesions with 

nonspecific clinical manifestations, with a 

native CT scan usually irrelevant in the early 

stages and with common rapid neurological 

deterioration due to brainstem compression or 

hydrocephalus. 

The purpose of this study is to present our 

surgical experience in the management of 

fourth ventricle lesions. 

MATERIAL METHODS: We 

retrospectively evaluated the epidemiological 

aspects, indications, approaches, the 

histopathological findings, clinical outcomes 

and other specific characteristics of 102 

patients diagnosed with fourth ventricle tumor 

that were operated in our service in a 15 year 

period between January 1999 and December 

2013, representing 51% of all intraventricular 

operated tumors and 2,8% of 3609 operated 

intracranial tumors by the main author in this 

period. 

RESULTS: The gender distribution in this 

study was 45% females and 55% males. Over 

50% of the tumors were found in the 4-18 years 

aged group population. Regarding the 

pathological findings there was a high variety 

with the predominance of medulloblastomas 

(35%), followed by ependymomas (28%), 

pilocytic astrocytomas (17%), other tumors 

being more rare. While medulloblastomas 

represented 50% of fourth ventricle tumors in 

pediatric patients, for the adult population in 

our experience ependymomas represent 41%, 

astrocytoma 18% and medulloblastomas 7%. 

All the cases were operated in the sitting 

position with no significant air-embolism 

complications related to the position. There 

was a slight predominance in favor of 

transvermian approach, compared with 

telovellar approach. Complete removal was 

achieved in large majority of the cases, except 

the exophytic from the brain stem. The main 

complication was pneumocephalus, but only 

in 3% of cases was noted a tension 

pneumocephalus. 

Another complications were persistent 

hydrocephalus (requiring definitive VPS) and 

CSF leakage, but only 1% developed 

meningitis. Cerebellar mutism, PRES were 

uncommon in our experience, and the 

mortality was 2% in our experience, higher 

than in supratentorial procedures. 

CONCLUSIONS: The surgical results are 

directly correlated with the surgical expertise, 

the proper selection of the cases and of the 

approach. Sitting position is, in our opinion, 

the proper position for posterior fossa surgery. 

Cerebellar mutism is more related to 

retraction forces that can be encountered in 

both of the main approaches for fourth 

ventricle tumors: transvermian or telovellar 

approach. Despite of their frightening aura, 

majority of fourth ventricle tumors can be 

totally removed, offering the cure in benign 

lesions. 

The amount of tumor removal is directly 

correlated with survival in malignant tumors. 



 

 

 

 

 
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KEY WORDS: intraventricular tumors, 

telovelar approach, transvermian approach, 

hydrocephalus, sitting position. 

 

SURGICAL MANAGEMENT AND 

OUTCOME OF MCA BIFURCATION 

ANEURYSMS 

R.M. Gorgan2, Narcisa Bucur1, Angela Neacsu1, 

Aurelia Mihaela Sandu1, V.M. Pruna1,  

F. M. Brehar2, A. Giovani1 
1Clinical Hospital “Bagdasar-Arseni”, Bucharest 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: A shift in paradigm in 

the treatment of MCA bifurcation aneurysms 

was encountered in recent years since the 

pipeline embolisation device became available. 

The objective is to evaluate the role of surgical 

clipping for the MCA bifurcation aneurysms 

in this changing era. 

PATIENT AND METHODS: This study 

analyzes the 5 years results on MCA 

bifurcation aneurysms in 4th neurosurgical 

department with a mean follow up of 28 

months, dedicated especially to surgical 

treatment 

RESULTS/RESULT: Between January 2009 

and December 2013, 59 MCA bifurcation 

artery aneurysms were treated by surgical 

clipping and 2 by endovascular embolisation 

in our department. 

The incidence was twice in women than in 

men, 35% of the aneurysms were ruptured; the 

postoperative mortality was 10%: 1 death out 

of 39 in the SAH group and 7 out of 20 in the 

hematoma group, 4 patients died before 

surgery. 63,7% of the aneurysms were located 

on the right side. The average dimensions were 

3,99 neck and 7.68 for dome with increased 

dimensions in the hematoma group. In the 

SAH group 4 patients developed new 

neurological deficits postoperative. Most of 

the patients who died presented in WFNS 5. 

Most of the patients in the SAH group 

presenting in 

WFNS 3 grade recovered the neurological 

deficit postoperative. The postop Rankin scale 

averaged to 1 in the SAH group. 

CONCLUSIONS: Surgical clipping 

remains the only curative treatment especially 

in acute cases of ruptured aneurysms or in 

cases where the broad neck prevents 

embolisation or where the aneurysm is 

thrombosed and acts by mass effect. 

KEY WORDS: MCA bifurcation; clipping; 

hematoma 

 

POSTERIOR FOSSA MENINGIOMAS – AN 

OVERVIEW 

St. Florian1,2, B. Pintea1,2, A. Kiss1, I. Irimescu2, 

Andrasoni Zorinela2 
1University of Medicine and Pharmacy “Iuliu 

Hatieganu” Cluj-Napoca, Discipline of 

Neurosurgery 
2Cluj County Emergency Hospital, Department of 

Neurosurgery 

 

INTRODUCTION: Posterior fossa 

meningiomas have a frightening aura mostly 

because of the high vascularizationand 

intimate relation with numerous neuro-

vascular structures in a quite small space. 

From a surgical point of view the most difficult 

locations are clival meningiomas, those 



 

 

 

 

 
510          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

situated medial to the acoustic meatusand the 

tentorial notch. 

AIM: The purpose of this retrospective 

study is to present our strategies in the 

management of these difficult tumors and to 

deliniatethe technique’s advantages and ait in 

achieving an improved extent of tumor 

resectionand enhancing the patient’s outcome. 

MATERIALS AND METHODS: From a 

total of 765 locations of intracranial 

meningiomas operated by the main author 

between 2001 – June 2014, 118 were located in 

the posterior fossa. All patients were evaluated 

by MRI and CT scans before surgery, and 

tumor location, size and relation to 

neighbouring anatomical structures were 

determined. We discussed the tumor’s 

characteristics that could influence treatment 

decisionand the choice of the most reliable 

approach. 

RESULTS: 118 posterior fossa 

meningiomas represent 15% of all new cases of 

intracranial meningiomas operated by the 

main author. The specific locations were: 

Cerebello pontine angle: 40 cases; Tentorial - 

23 cases; Tentorial notch: 3 cases; Petro-clival: 

20 cases; Foramen magnum: 13 cases; 

Convexity: 19 cases. All cases were operated in 

semi-sitting position. Simpson’s grade I 

resection was not a goal, but grade II was 

achieved in most of the cases. The most 

frequent complication related to semi-sitting 

position was pneumocephalus. Local 

postoperative complications were pseudo-

meningocelle, hematomas (5%) and CSF 

fistulas (4%). Postoperative mortality was 2%. 

CONCLUSIONS: Despite their scary 

appearance, most of the posterior fossa 

meningiomas can be safely resected without 

major complications. Avoiding is a matter of 

adherence to the general principles of 

meningioma surgery: Early devascularization, 

preservation of arachnoidal layer, internal 

debulking, circumferential dissection and 

preservation of all normal vasculature and 

nervous structures. All these objectives could 

be achieved with microsurgical techniques in 

semi-sitting position. 

KEY WORDS: posterior fossa, 

meningiomas, semi-sitting, tentorial notch, 

retrosigmoid approach, gross total removal. 

 

POSTERIOR FOSSA CAVERNOUS 

MALFORMATIONS – CLINICAL 

CHARACTERISTICS, MANAGEMENT 

AND PROGNOSTIC FACTORS 

Ligia Tataranu¹˒², V. Ciubotaru¹, M. Chelsoi¹, 

Adriana Solomon¹˒², D. Paunescu¹˒² 

¹Neurosurgical Clinic, “Bagdasar – Arseni” 

Emergency Clinical Hospital, Bucharest, Romania 

²“Carol Davila” University of Medicine and 

Pharmacy, Bucharest, Romania 

 

INTRODUCTION: Cavernous 

malformations represent clusters of abnormal, 

dilated sinusoidal channels with a single layer 

of endothelium. 

MATERIAL AND METHODS: Between 

July 2004 and July 2014, 38 patients were 

diagnosed with posterior fossa cavernous 

malformations and treated in our 

neurosurgical department from “Bagdasar – 

Arseni” Emergency Clinical Hospital, 

Bucharest, Romania. There were 25 women 

(65.8%) and 13 men (34.2%) with age between 



 

 

 

 

 
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28 and 69 years old. The mean age at 

admission was 49.8 years. 

RESULTS: There were 38 patients with 48 

posterior fossa cavernous malformations 

(CM), 7 patients had multiple cavernous 

malformations (18.4%), 3 patients with both 

supra and infratentorial lesions and 4 with 

cavernous malformations located exclusively 

in the posterior fossa. 3 patients (7.9%) had 

associated developmental venous anomalies. 

From 48 posterior fossa cavernous 

malformations, 22 were located in the 

cerebellar hemispheres, 3 in vermis, 10 in 

pons, 6 in midbrain, 1 in medulla and 6 in 

cerebellar peduncles. The most common signs 

and symptoms at presentation were headache 

35 patients (92.1%), cerebellar symptoms 

(ataxia, dysarthria, vertigo) 25 patients 

(65.7%), motor weakness 10 patients (26.3%), 

paresthesia 8 patients (21%), and cranial nerve 

dysfunction 15 patients (39.5%). 37 

cavernomas were approached microsurgically. 

Removal of the lesion was attempted in all 

patients. Some degree of transient 

neurological deterioration was detected in 10 

patients (27%). A significant permanent 

neurological deterioration from surgery was 

detected in 6 patients (16,2%): two patients 

had third nerve palsy following resection of a 

midbrain cavernoma, one experienced 

unilateral hearing loss after surgical resection 

of a pontine cavernoma, two patients retained 

minor sensitive symptoms, and one patients 

had postoperative pulmonary 

thromboembolism and died. Overall, 

preoperative symptoms improved in a large 

number of patients: cerebellar symptoms 

improved in 20 patients (52,6%), motor 

weakness in 5 patients (13.2%), paresthesia in 

1 patient (2,6%), cranial nerve palsy in 3 

patients (7.9%), and headache in 33 patients 

(86.8%). The histopathological examination 

confirmed the diagnosis of cavernous 

malformations in all 37 operated patients, one 

patients refused the surgical treatment. From 

48 posterior fossa cavernous malformations, 

36 had at least one hemorrhagic episode prior 

to hospital admission. 

CONCLUSIONS: Cavernous 

malformations are more frequent present in 

the younger population. Individualized 

surgical strategies ensure decreased 

postoperative hemorrhage rates and favorable 

long-term outcomes. 

KEY WORDS: cavernous malformations, 

posterior fossa 

 

THE PREFERENCE FOR 

TRANSCALLOSAL OR TRANSCORTICAL 

APPROACH IN SURGERY OF LATERAL 

VENTRICLE TUMORS 

M. Radoi2, Ram Vakilnejad1, Lidia Gheorghitescu1, 

F. Stefanescu1, C. Popescu1, L. Danaila2 
1National Institute of Neurology and Neurovascular 

Diseases - Bucharest, Neurosurgery, Romania 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Tumors of the lateral 

ventricle are rare and could originate in the 

ventricular wall or arising and expanding 

within the lateral ventricle from the 

surrounding neural structures. 

Based on a 10 years retrospective study, we 

analyze postoperative results and factors that 



 

 

 

 

 
512          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

affected the preference for transcallosal or 

transcortical approach. 

PATIENT AND METHODS: We 

performed a retrospective study, lasted 

between January 2004 - June 2014, that 

comprised 29 consecutive patients who 

underwent operation for lateral ventricle 

tumors. 

The main clinical symptoms and signs 

were associated with the localization and size 

of the tumors. The transcortical approach was 

used in 18 patients and the transcallosal 

approach was used in 11 patients. 

RESULTS/RESULT: Total tumor resection 

was achieved in 21 patients (72.5%). In cases 

with subtotal resection, transcortical approach 

was used in 6 cases (20.5%) and transcallosal 

approach in 2 cases (7.5%). Most frequent 

histological tumor’s type was glioblastoma, 

choroid plexus papilloma, ependymoma and 

meningioma. One patient died because of 

postoperative intraventricular hemorrhage. 

Additional neurological deficits were seen in 4 

patients and postoperative seizure occurred in 

five patients. Two patients with preoperative 

hydrocephalus required ventriculo-peritoneal 

shunting after tumor’s resection. 

Two patients developed postoperative 

epidural hematoma and one required 

reoperation. 

The mean duration of postoperative 

evaluation was 26,45 months (range 4-96). 

CONCLUSIONS: The nature, size, 

location and vascularization of 

intraventricular tumors are the most 

important elements influencing the choice of 

surgical approach. Surgeons must evaluate all 

these factors and prefer the short and safe way 

to remove the tumor. 

KEY WORDS: lateral ventricle tumors, 

transcallosal approach, transcortical approach. 

 

 

DISCUSSING POST-OP COMPLICATIONS: 

CEREBELLAR MUTISM AND 

POSTOPERATIVE VISUAL LOSS AFTER 

POSTERIOR FOSSA SURGERY, A CASE 

REPORT 

A. Budu1, B. Iliescu1, D. Rotariu2, B. Chirita2,  

C. Apetrei2, I. Poeata1 
1“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 
2“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 

 

Cerebellar mutism has been associated 

with injury to midline cerebellar structures 

secondary to degenerative disease, tumors, 

hemorrhage, or surgery. This syndrome 

typically arises 48 hours after the initiating 

event and resolves approximately 7 to 8 weeks 

later. Another rare post-op complication that 

can appear after posterior fossa surgery is the 

postoperative visual loss syndrome which has 

a very low incidence (∼1/60 000–1/125 000 

cases) and usually occurs after long prone 

patient positioned surgery. We present the 

case of a 10 year old child that presented to our 

hospital with signs of ICP due to a large 4th 

ventricle ependymoma. After endoscopic 

third ventriculostomy and surgery he 

developed cerebellar mutism and post-op 

visual loss syndrome. The possible etiology of 

this complications along with an in depth look 



 

 

 

 

 
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about the pathophysiology of such post-op 

complications is discussed. 

 

SURGERY OF PETROCLIVAL 

MENINGIOMAS. RECENT SURGICAL 

RESULTS AND OUTCOMES 

M. Radoi2, Ram Vakilnejad1, Lidia Gheorghitescu1, 

F. Stefanescu1 
1National Institute of Neurology and Neurovascular 

Diseases - Bucharest, Neurosurgery, Romania 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Petroclival 

meningiomas represent only 10% of all 

meningiomas located in the posterior fossa, 

but are some of the most formidable 

challenges in skull base surgery. We described 

our recent experience (2000-2014) regarding 

the surgery of these tumors. 

PATIENT AND METHODS: We 

retrospectively analyzed surgical results and 

outcome in 11 cases of petroclival 

meningiomas. Most common symptoms in 

our series were headache and gait disturbance, 

while cranial nerves palsies represented the 

most common presenting signs. 

There were 8 females and 3 males, and the 

mean age was 52 years. Surgical approaches 

chosen for petroclival meningiomas in our 

series were retrosigmoid (9 patients) and 

subtemporal transtentorial (2 patients). 

RESULTS/RESULT: We achieved total 

tumor resection in 5 cases (45%) and subtotal 

resection in 6 cases (55%). Overall outcome 

(total/subtotal resection) was good in 6 cases, 

fair in 3 cases and poor in one case. One 

postoperative death occurred due to 

hemorrhagic midbrain infarction (9%). 

Complications were usually related to cranial 

nerve deficits: loss of hearing (2 patients), 

paresis of trochlear nerve (1 patient), 

trigeminal nerve (3 patients) and facial nerve 

(1 patient). In 4 patients these cranial nerves 

deficits were transient. In one case, a patient 

developed postoperative hydrocephalus and 

needed shunt placement. 

CONCLUSIONS: Despite the fact that 

complications can be disastrous, we 

considered that an appropriate approach, 

combined with microsurgical techniques and 

a better understanding of the anatomy, greatly 

decrease the incidence and severity of 

complications and make feasible a total tumor 

resection. 

KEY WORDS: petroclival meningiomas, 

surgery, retrosigmoid approach, subtemporal 

transtentorial approach. 

 

DECOMPRESSIVE CRANIECTOMY IN 

SEVERE BRAIN INJURY GUIDED BY 

INTRACRANIAL PRESSURE 

MONITORING. N. OBLU EMERGENCY 

HOSPITAL EXPERIENCE 

C. Apetrei1, A. Iordache1, B. Chirita2, A. Budu2,  

M. Cosman2, I. Poeata1 
1“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 
2“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 

 

Severe brain injury is a devastating entity 

for the patient. It often leads to neurological 

and anatomical troubles with severe and 

permanent deficiency that affects the patient’s 

quality of life on long term or can even cause 



 

 

 

 

 
514          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

death. Intracranial pressure monitoring seems 

to be an indispensable stage in management of 

severe traumatic brain injured patients. Our 

days this technique completes trauma protocol 

in our center. We compared two groups of 

patients with severe traumatic brain injury 

who received a decompressive craniectomy: in 

the first group the surgical decision was made 

on clinical signs and imaging, in the second 

group of patients decompressive craniectomy 

was performed after invasive monitoring of 

intracranial pressure. The first group studied 

includes a total of 77 patients. In this group, 

mortality was very high, namely 75%. In the 

last two years in 20 patients with severe brain 

injury we monitored intracranial pressure 

with Camino systems. 

In this group the overall mortality was 45%. 

Among the 20 patients monitorred in 8 

patients we had performed a decompressive 

craniectomy. In this second group of 8 patients 

we found a mortality of 62%. (lower then those 

in the first group). The main complication was 

bronchopneumonia occurred in both groups 

studied. In conclusion, monitoring of 

intracranial pressure seems to be 

indispensable in the management of severe 

brain injuries as guides for an aggressive 

treatment including the decompressive 

craniectomy. 

 

MILD HEAD INJURY: EPIDEMIOLOGY, 

MANAGEMENT, OUTCOME, COSTS 

D. Adam 

“Carol Davila” University of Medicine and 

Pharmacy Neurosurgery, Bucharest, Romania 

 

INTRODUCTION: Mild traumatic brain 

injuries represent 80% of the total traumatic 

brain injuries. Their management is 

conducted as recommended by EBIC 

(European Brain Injury Consortium) or 

WFNS (World Federation of Neurosurgical 

Societies). The aim of the study is to analyze 

the management of patients with mild 

traumatic brain injuries who present at the 

Emergency Department (ED), of the admitted 

ones, the paraclinical investigations used and 

the cerebral lesions which these identify. 

PATIENT AND METHODS: During a 3 

months period, 533 patients with mild 

traumatic brain injuries presented at the ED. 

We have followed these patients regarding the 

demographic data, the causes that led to the 

mild traumatc brain injuries and the 

paraclinical investigations used. 

Regarding the admitted patients, we have 

taken into consideration risk factors, 

neurological symptoms, the need to repeat a 

paraclinical investigation, their management 

and outcome. 

RESULTS/RESULT: Out of the 533 

patients who presented at the ED, 248 (65%) 

were adults and 158 (29.64%) were third age 

patients. The remaining 27 (5%) were aged 

between 0-18 years old. Male patients (359; 

67%) were more frequently affected than 

female patients (174; 32.6%). The top three 

causes were aggressions (57%), car accidents 

(27%) and same level falls (6.3%). The patients 

were investgated by skull X-rays (47.8%) and 

head computed tomography (CT) scans 

(52.35%). Out of the total number of patients, 

198 were admitted; these had the following 

risk factors: age > 65 years old (31%), alcohol 

use (18.6%), seizures (7.57%) and the 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         515 

 

 

 

 

 

 

 

following clinical symptoms: headaches 

(71%), vomiting (9.6%), dizziness (36.8%), loss 

of consciousness (31.8%). Out of the admitted 

patients, only 12 presented cerebral lesions: 

hemorrhagic brain contusions (n=5), small 

subdural blood collections (n=3), traumatic 

subarachnoid hemorrhages (n=2), acute 

subdural hematoma (n=1) and 

intraventricular hemorrhage (n=1). The 

patient with acute subdural hematoma was 

operated on and had a favorable outcome. 

The patient with intraventricular 

hemorrhage, who was 90 years old and 

presented with coagulopathy, has deceased. 

All the other patients were discharged after a 

mean hospitalization period of 3 days. 

CONCLUSIONS: Out of the patients with 

mild traumatic brain injuries, only a small 

number present cerebral lesions. For their 

diagnosis, expensive paraclinical 

investigations are used in both the ED and the 

neurosurgical department. Careful 

monitoring of the evolution of the 

neurological status and performing a head CT 

scan only in case of neurological deterioration 

would save resources that could be targeted for 

the therapeutic stage. 

KEY WORDS: mild head injury, head CT scan. 

 

RECCURENCE OF CHRONIC SUBDURAL 

HEMATOMAS: THE IMPORTANCE OF 

THE SURGICAL TECHNIQUE 

T. Papacocea 

Emergency Clinical “St. Pantelimon” Hospital, 

Neurosurgery, Bucharest, Romania 

 

INTRODUCTION: In this study we are 

trying to establish a correlation between the 

surgical technique used for the treatment of 

chronic subdural hematomas and the risk of 

reccurence. 

PATIENT AND METHODS: Between 

01.04.2008 and 30.06.2014, 138 patients were 

operated on and followed-up for chronic 

subdural hematomas. Among them, 18 

patients (13%) had one or several reccurencies. 

Factors related to the patients (gendre, 

age,location of the hematoma) are analysed as 

possible predictors of reccurence. 

RESULTS/RESULT: Several surgical 

techniques were used in the treatment of 

chronic subdural hematomas. 

Each of them is analysed to find possibly 

connections with the reccurence risk of the 

size of the approach, the reposition of the bone 

flap, the suture of the dura and other aspects 

CONCLUSIONS: There are obvious, 

statistically significant, correlations between 

the risk of reccurence and some elements of 

the used surgical technique. 

KEY WORDS: chronic subdural 

hematomas, reccurence, surgery. 

 

TRAUMATIC INJURIES OF THE SPINE IN 

PAEDRIATIC POPULATION 

A. Tascu2, F. Exergian1, D. Serban1, A. Iliescu1,  

C. Pascal1, G Popescu1 
11-st Neurosurgery Clinic- Pediatric Department, 

Emergency Hospital “Bagdasar-Arseni”, Bucharest, 

Romania, Av Berceni 10-12, Sector 4, Cod 041915 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Traumatic pediatric 

spine injuries represents a subject poorly 

debated in the literature. 



 

 

 

 

 
516          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

The authors aim is to realize an extended 

study addressing this theme. 

PATIENT AND METHODS: Authors 

present a retrospective study including 434 

pediatric patients admitted with traumatic 

spine injuries in the First and Second 

Neurosurgical Clinics in "Bagdasar-Arseni" 

Clinical Hospital, from 2003 to 2013 (11 

years). The diagnosis was established 

throughout clinical examination and radio-

imagistic investigations. The study group was 

divided in 4 age-related categories (0-3y, 4-

7y,8-14y and 15-18y) taking into 

consideration specific age related risk factors. 

Out of the 434 admitted patients, 172 had no 

proven osseous or disc lesions, 149 had spinal 

fractures with or without spinal cord 

involvement, 51 had spinal luxations and 24 

had other spinal pathologies. 

Neurological diagnosis was establish using 

Frankel Classification grading system. Also the 

etiology and the localization of the spinal level 

where included in the study. 68,5% of the 

patients were treated conservative, while 

31,5% needed surgery. 

RESULTS/RESULT: Based on the 

information noted in the medical records, a 

distinct injury profile, explained by anatomical 

and biomechanical features, differentiates the 

young patient with an immature spine from 

the older adolescent with a more mature, adult 

like spine. 

CONCLUSIONS: Traumatic spine injuries 

in pediatric patients have a low incidence, 

mainly due to a more flexible spine. 

Anatomical particularities in children spine 

allows a better applicability of conservative 

treatment. The prognosis depends on the 

severity of spinal cord injuries, with neuro-

functional recovery noticeably increased in 

pediatric population compared to adult 

population. 

KEY WORDS: spine trauma, children, 

outcome. 

 

BRACHIAL PLEXUS SURGERY - LONG 

AND A HARD TASK 

Rasulic Lukas, Samardzic Miroslav, Bascarevic 

Vladimir, Micovic Mirko, Cvrkota Irena, Savic 

Andrija, Zivkovic Bojana 

Corresponding author: 

Associated Professor Lukas Rasulic 

Clinic of Neurosurgery, Clinical Centre of Serbia, 

Koste Todorovica 4, 11000 Belgrade, SERBIA 

E-mail: lukas.rasulic@kcs.ac.rs 

 

Surgery of the brachial plexus is 

demanding field of surgery. In recent years, 

development of microsurgery - improvements 

in optics, electrodiagnostic, equipment, 

magnetic resonance imaging, surgical 

instruments, and new suture material evolved 

surgery of brachial plexus. 

The most common condition in this 

section of neurosurgical expertise that requires 

surgical treatment is brachial plexus injury. In 

90% of cases cause of brachial plexus injury is 

vehicular accident. This said, it is obvious that 

this type of injury usually occurs in previously 

healthy and relatively young population. The 

fact that untreated brachial plexus injury may 

cause permanent disability of these previously 

healthy young people, demands development 

of even better treatment plans and new 

surgical techniques. 

Timing of the surgical treatment is of the 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         517 

 

 

 

 

 

 

 

outmost importance. Most experts in this field 

of surgery recommend conservative treatment 

for patients who have showed spontaneous 

recovery within the first few week after the 

trauma. Surgical treatment is indicated for 

patients who have an associated vascular 

lesion and for sharp wounds, in which a nerve 

lesion can be expected, exploration and repair 

of the divided neural elements should be 

undertaken as soon as the patient’s condition 

permits. The patient with a root avulsion 

injury should undergo surgery within the first 

few months after the injury. A closed injury 

without evidence of root avulsion should be 

treated by surgery, if there is no sign of 

recovery within 6 months. In cases of brachial 

plexus traction injuries only possibility is 

neurotization (nerve transfer). 

If indicated, surgical treatment consists of 

neurolysis, nerve grafting, nerve transfer and 

combination of these procedures. Goal of the 

treatment is achieving good shoulder and 

elbow control, than elbow, wrist and finger 

extension, and finally sensibility of the hand 

and the forearm. 

Combined use of donor nerves in 

reinnevation of the musculocutaneus or 

axillary nerves results with high rate and better 

quality of recovery when compared to the 

other modalities of nerve transfer. The use of 

intraplexal and contralateral plexal 

neurotization along with a better 

understanding of central-peripheral function 

integration may provide improved results and 

purposeful hand function for our patients in 

the future. 

The other, much rarer pathology are 

tumors of brachial plexus. They pose a great 

challenge to the neurosurgeon. Radical to 

complete excision of the tumor with 

preservation of neurological function of the 

involved nerve is an ideal surgical treatment 

option with brachial plexus tumor surgery. 

KEY WORDS: nerve transfer, nerve 

transplantation, peripheral nerve surgery, 

brachial plexus tumors. 

 

SURGERY OF THE PERIPHERAL NERVES 

IN CHILDREN 

Rasulic Lukas, Samardzic Miroslav, Bascarevic 

Vladimir, Micovic Mirko, Cvrkota Irena, Savic 

Andrija, Zivkovic Bojana 

Corresponding author: 

Associated Professor Lukas Rasulic 

Clinic of Neurosurgery, Clinical Centre of Serbia, 

Koste Todorovica 4, 11000 Belgrade, SERBIA 

E-mail: lukas.rasulic@kcs.ac.rs 

 

Modern surgical treatment of peripheral 

nerves begins with introduction of operative 

microscope in 1964 (Curtze). Pathology of 

peripheral nerves is a complex field of 

neurosurgery, and includes injuries, tumors 

and compressive neuropathies. 

NERVE INJURIES: In neonatal period the 

most frequent type of injury is obstetric 

brachial plexus injury. 

After this period and until 3rd year of age 

child is prone to falls and cuts, while still 

insecure on his feet. From age 3 to 8, frequent 

type of injury are secondary peripheral nerve 

injuries after fracture (compression of radial 

nerve after humerus fracture, ulnar and 

median nerve after supracondylar fracture, 

and injuries of the knee that affect peroneal 

nerve). From age 9 to 15 the most frequent 



 

 

 

 

 
518          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

mechanisms are motorcycle accidents, cuts, 

missile injuries and stab wounds. 

Indications for operative treatment are 

open injuries with undoubtable nerve injury 

and neurological deficit, closed injuries that 

show no sign of recovery even three months 

after injury, and pain that is resistant to 

therapy. 

Good preoperative evaluation and 

multidisciplinary approach is an imperative. 

In our Clinic, many different procedures 

are done: neurolysis, direct suture, nerve 

transplantation, nerve transfer. Treatment of 

choice is different for every patient and it is 

individually selected. After surgery, of 

outmost importance for neurological recovery 

is physical rehabilitation. 

In children, greater regeneration ability 

contributes to better treatment results 

(especially in children less than 10 years old). 

Poorer results are when mixed nerves are 

involved, traction injuries and higher lesions. 

Best results are accomplished when defect is 

less than 5cm. Also, better recovery is noticed 

in early surgical treatment, however delay no 

longer than 6 months doesn’t affect outcome 

significantly. 

OBSTETRIC BRACHIAL PLEXUS 

INJURY: Specific type of peripheral nerve 

injury in children is obstetric brachial plexus 

injury. 

Risk factors are: shoulder dystocia, 

macrosomia (over 4kg), small 

stature/cephalopelvic disproportion, breech 

presentation). The generally accepted 

mechanism of this injury is traction to the neck 

during delivery, where the neck on the side of 

the anterior shoulder is stretched and this 

stretch causes a “strain” on the brachial plexus 

on that side, causing a varying degree of injury. 

Initial treatment consists of detailed 

clinical examination, including a check for 

associated injuries. Electrophysiological 

diagnostic is recommended at 4 weeks initially 

to confirm the diagnosis and get a baseline 

reading. Repeat examinations are carried out 

every 4–6 weeks until 3 months. 

Surgery should be performed when there 

are no clinical signs of recovery three months 

after surgery; partial lesions of brachial plexus 

are usually treated conservatively. 

In majority of cases, 70-80% of children 

spontaneous recovery is expected. Early 

recovery, during first two weeks is good 

prognostic sign. If treated surgically after 9 

months of injury outcome is significantly 

poorer. 

After surgery, physical rehabilitation is 

conducted. Functional usage of injured arm 

and child feeding itself are the most important 

recovery criteria. 

PERIPHERAL NERVE TUMORS IN 

CHILDREN: Tumors of peripheral nerves are 

rare lesions, and even rarer in children. 

However, around 14% of all soft-tissue tumors 

in children arise from peripheral nerve system. 

They are even more frequent in 

phakomatoses. 

Symptoms and signs of peripheral nerve 

tumors are caused by direct nerve invasion, 

involvement of surrounding tissues, or mass 

effect. The duration and progression of 

symptoms or signs is important as most 

benign tumors have a longer duration and a 

slow rate of progression, while malignant 

tumors tend to progress rapidly in size, 



 

 

 

 

 
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amount of pain, and neurologic deficit. A 

careful family history is important in the 

assessment of an underlying neurogenetic 

disorder, such as neurofibromatosis. 

Peripheral primitive neuroectodermal 

tumors (pPNETs) account for 4-17% of all 

pediatric soft tissue tumors and often exhibit 

aggressive clinical behavior. In several large 

series, the rates of metastases range from 20-

31%, with long-term survival rates (< 25%). 

Obtaining a complete resection of tumor with 

negative margins is paramount in surgically 

treating primitive neuroectodermal tumors. 

KEY WORDS: pediatric peripheral nerve 

surgery, peripheral nerves, pediatric 

peripheral nerve tumors. 

 

MINIMAL INVASIVE SPINE SURGERY 

WITH ROBOTIC INTRAOPERATIVE 2/3D 

FLUOROSCOPY AND COMPUTER 

ASSISTED NAVIGATION 

Christian Raftopoulos (Belgium) 

 

Many surgical treatments for chronic low 

back pain that is refractory to medical 

treatments focus on spine stabilization. One of 

the main surgical procedures consists of 

placing an interbody cage with bone grafts 

associated with pedicle screws. 

This technique can be performed using 

different approaches: a large open posterior 

approach, tubular approaches (minimal open) 

or percutaneously (minimally invasive 

percutaneous or MIP). 

One of the main difficulties is to precisely 

locate the screws into the pedicle avoiding 

especially infero-medial pedicle breaches. This 

difficulty is even greater when working 

percutaneously. 

This lecture focuses on percutaneously 

placed pedicle screws (PPS), reports the use of 

a robotic multi-axis 2D/3D fluoroscopy and 

neuronavigation to enhance the accuracy of 

pedicle screw placement and reviews other 

strategies and results reported in the literature. 

 

WRONG SITE SURGERY IN THE REALM 

OF NEUROSURGERY 

Y. Enchev, T. Kondev, B. Iliev, D. Handjiev,  

T. Avramov, P. Trendafilov 

Department of Neurosurgery, Medical University of 

Varna, University Hospital “St. Marina, Varna, 

Bulgaria 

 

Recently there is a surge in patient safety 

awareness, nevertheless preventable harm to 

neurosurgical patients remains problematic. 

Wrong site surgery with its subtypes 

permanently exists in the realm of 

neurosurgery, however it is often 

underreported or underestimated due to the 

associated legal claims. Wrong-patient, 

wrong-side, wrong-level and wrong-

procedure surgeries could be catastrophic to 

patients, healthcare professionals and 

institutions. These sentinel events are 

generally preventable according to the 

literature. Different approaches are developed 

in an attempt to solve this problem. One of the 

most promising tool is the neurosurgical safety 

checklist. It represents low-cost, time-saving, 

cost-effective and easy to apply and to modify 

solution. 



 

 

 

 

 
520          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

The multicentric critical analysis of the 

long-term experience with such checklists will 

be fateful for their future. 

 

MICROSURGERY OF POSTERIOR 

CRANIAL FOSSA MENINGIOMAS 

M.R. Gorgan1,2, Narcisa Bucur1, Angela Neacsu1, 

F.M. Brehar1,2, V.M. Pruna1, Aura Sandu1, 

Catioara Cristescu1 
1“Bagdasar-Arseni” Emergency Clinical Hospital, 

Bucharest 
2Clinic of Neurosurgery - “Carol Davila” University 

of Medicine and Pharmacy, Bucharest 

 

INTRODUCTION: The authors of this 

study presents a retrospective study based on 

48 case series of posterior fossa meningiomas 

operated in the fourth department of 

neurosurgery of “Bagdasar-Arseni” Clinic 

Emergency Hospital between June 2009 and 

June 2014. 

MATERIAL AND METHODS: Data was 

collected and analyzed from electronic data 

base and hospital registry. There were 17 man 

and 31 women with a median age of 54.8 years 

old. All patients underwent open tumor 

resection. 12 patients benefited from a 

ventriculoperitoneal shunt, 4 in an acute 

phase. 

RESULTS: Tumor size was between 3-5 cm 

in 29 cases, and over 5 cm in 19 cases. 

2 of this category of patients supported 2 

and respectively 3 stages of resection. 

According to Simpson Scale, grade I resection 

was achieved in 20,8%, grade II in 34.6 %, 

grade III in 35.4 %, and grade IV in 9.2%. The 

most frequent location was cerebellar 

convexity (37.5%) followed by pontocerebellar 

angle (27.1%) and petroclival area (24.1%). 

Most frequent pathological samples showed 

transitional meningioma (33.9%) followed by 

meningothelial (25.2%) and fibrous type 

(22.5%). They were 6 cases with atypical and 

anaplastic meningiomas (12,5%). In 94.6 % of 

cased the postoperative neurological status 

remained the same or improved. 3 cases (5.6%) 

presented neurological deterioration, 2 

reversed on the follow-up period, and 1 

remained permanent. One case with a giant 

hemifossa tumor deceased by complications 

related to brain stem decompression. They 

were 2 CSF postoperative fistulas, one 

postoperative wound infection, one 

postoperative cerebellar hematomas, and 3 

patients presented decompensations of 

previous illnesses (heart and lung). They were 

recorded 4 tumor re-growth in malignant 

meningiomas, and 2 in the non-malignant 

group. All cases benefited of treatment: 4 

cases- gamma-knife and 2 cases-open surgery. 

Mean general follow up period was 34 months. 

CONCLUSION: General results of the 

treatment of posterior fossa meningioma are 

very good in our clinic, due to homogenous 

neurosurgical attitude, experienced teams and 

adequate perioperative treatment. The rate of 

total resection is significant decreased by 

lesions over 5 cm diameter and lesions located 

in petroclival area. 

 

  



 

 

 

 

 
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THE INTERHEMISPHERIC 

TRANSCALLOSAL APPROACH FOR 

VENTRICULAR TUMORS. PERSONAL 

CONSIDERATIONS 

I. Poeata1,2, Z. Faiyad2, A. Chiriac1, B. Iliescu1,  

D. Rotariui2, A. Budu2 
1“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 
2“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 

 

The optimal approach for lateral and third 

ventricular mass lesions depends on many 

considerations, among which: location, size, 

aim of surgery, neurosurgeon’s experience and 

preferences. Maximal safe resection is 

generally the goal together with a minimally 

invasive surgical corridor. 

In this presentation we review our last 

series of 34 supratentorial ventricular tumors 

operated on during a 5 years period (9 

glioblastomas, 8 low grade gliomas, 6 coloid 

cysts, 3 metastasis, 2 meningiomas, 2 

neurocytomas,1 cavernoma, 1 

subependimoma, 1 choroid plexus tumor, 1 

pineocytoma). 21 of these were approached 

through an interhemispheric transcalosal 

route. We present videos with our techniques 

for nervous tissue (i.e. fornicis) and vessel 

preservation (collateral of the sagittal sinus, 

pericallosal and calosomarginal arteries, 

thalamostriate veins, posterior choroidal 

arteries) tumor dissection, intra and 

extracapsular debulking, and removal together 

with pre/post op imaging. 

 

 

DIFFUSION TENSOR IMAGING: 

IMPLICATIONS FOR TARGET VOLUME 

DELINEATION IN HIGH GRADE GLIOMA 

RADIOTHERAPY AND FOLLOW UP 

I.C. Chiricuta1, M. Medrea2, C. Popa3 
1AMETHYST Radiotherapy Center, Otopeni 
2Centrul de Diagnostic Romano-German 

MEDINST, Bucuresti 
3INNBN, Clinica de Neurologie, Bucuresti 

 

AIMS: Radiotherapy treatment planning 

for high-grade gliomas (HGG) is hampered by 

the inability to visualize peritumoral white 

matter infiltration and to individualize 

radiotherapy target volumes. Diffusion tensor 

imaging (DTI) is able to show white-matter 

abnormalities resulting from tumor 

infiltration not visualized by conventional 

imaging methods as CT and MRI. The gross 

tumor volume (GTV) and the subclinical 

disease volume considered as the clinical target 

volume (CTV) should include the 

macroscopic and the peritumoral white-

matter infiltration. 

METHODS: In ten patients with biopsy-

proven HGG who were refered and treated by 

high dose radiotherapy at our center were 

retrospectively analysed regarding the 

information obtained by DTI tractography. 

Using a Siemens MR facility a DTI 

tractography was obtained before and after 

high dose radiotherapy. The follow up DTI 

were performed in 4 patients. 

RESULTS: a comparison of the GTV and 

CTV delineation based only on the 

conventional methods used for imaging of 

high grade gliomas for external beam 

radiotherapy and the additional information 



 

 

 

 

 
522          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

obtained on white matter peritumoral 

infiltration provided by the DTI tractography 

was performed. Postradiotherapy changes in 

tract configuration were analysed. 

CONCLUSION: DTI tractography can be 

used to individualise radiotherapy target 

volumes. Changes in the shape of the 

radiotherapy used target volumes make the 

individualization of treatment possible. 

 

AGRESSIVE OR CONSERVATIVE 

MANAGEMENT IN EXTRADURAL 

HEMATOMAS IN CHILDREN 0-3 YO – A 

CHALLENGING NEUROSURGICAL 

CHOICE 

A. Tascu2, R.E. Rizea2, A. Iliescu1, C. Pascal1,  

Iulia Vapor1, P. Petrescu1, Catalina Lipan1, Simona 

Mihaela Florea1 
11-st Neurosurgery Clinic-Pediatric Department, 

Emergency Hospital „Bagdasar-Arseni”, Bucharest, 

Romania, Av Berceni 10-12, Sector 4, Cod 041915 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Epidural hematomas 

(EDH) in children appear as a consequence of 

head trauma. Although emergency surgical 

intervention was the classical neurosurgical 

treatment for EDH, lately there has been 

observed a tendency to replace operation by 

conservative management, whenever the 

neurological status and imaging appearance 

allows it. The aim of this article is to present 

our experience in treating EDH in children 0-

3 years old and to establish a management 

protocol for EDH in infants, by evaluating the 

clinical and neuroimaging status, of both 

surgically and conservatively treated patients, 

from hospital admission to discharge. 

PATIENT AND METHODS: 

Retrospective study that includes 52 patients 

diagnosed with an extradural hematoma, 

admitted in the First Neurosurgical Clinic, 

Clinical Hospital ‘Bagdasar-Arseni’ in 

Bucharest, from January 2004 to December 

2013. The patients were identified by diagnosis 

from the clinic’s database; clinical and imaging 

data was extracted from the patient’s 

individual records and crosschecked with the 

operating protocols. Cerebral CT scan was the 

preferred imaging investigation for diagnosis. 

RESULTS/RESULT: our study includes 52 

patients (26 boys and 26 girls), with a mean age 

of 14.5 months (range 6 weeks – 3 years old). 

25 patients were surgically treated, while the 

other 27 received symptomatic medication 

and were monitored clinically and by imaging 

exams. The most frequent clinical 

manifestations were intracranial hypertension 

(21 patients) and psychomotor agitation (19 

patients). The traumatic mechanisms were: 

accidental falling (38 patients), blunt head 

trauma (3 patients), road accident (2 patients), 

unspecified (8 patients) other causes (1 

patient). Based on the Glasgow Coma Scale 

classification of TBI, 39 patients suffered a 

mild TBI, 7 a moderate TBI and 6 patients 

suffered a severe TBI. Most of the patients had 

a good recovery; there was a total of two 

deaths. The most common location for the 

EDHs was parietal (20 pa tients) and temporal-

parietal (11 patients). 

CONCLUSIONS: Both surgical treatment 

and conservative management of EDH have a 

good clinical outcome. Clinical and 

neuroimaging evaluation at admission and 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         523 

 

 

 

 

 

 

 

dynamic imaging surveillence plays an 

imperative role in deciding the appropriate 

therapeutic attitude for each patient. 

KEY WORDS: extradural hematoma, 

children, head trauma. 

 

COMPLEX SURGERY IN CERVICAL SPINE 

TRAUMA 

T. Maior 

Department of Neurosurgery, Cluj County 

Emergency Hospital 

 

This paper aims to present the surgical 

protocol of the traumatic spine injuries, of the 

injuries belonging to the occipital cervical 

junction area as well of those in subaxial and 

transition cervical dorsal area. 

The advantages and disadvantaged, 

indications and contraindications, tips and 

tricks of the different types of approach are 

comparatively presented, by showing several 

cases from the personal database of the author. 

KEY WORDS: odontoid surgery, anterior 

fusion, posterior – transarticular fusion, 

combined approaches. 

 

THORACIC SPINE TYPE C INJURIES 

ACCORDING TO AO CLASSIFICATION: 

INJURY PROFILE, MANAGEMENT AND 

OUTCOME 

C. Filip, D. Serban, N. Calina, G. Checiu, M. Podea, 

C. Zamfir, F. Exergian 

Emergency Hospital “Bagdasar–Arseni”, 

Department of Neurosurgery, Bucharest, Romania 

 

INTRODUCTION: In the last years we 

observed an increased number of patient with 

multiple lesions after high energy accidents. 

Type C injuries of the thoracic spine are the 

most severe lesions, with the worse prognosis. 

PATIENT AND METHODS: This study 

analises the injury profile, management and 

outcome of all pacients with thoracic spine, 

from T1 to T10, type C injuries treated in the 

Spinal Surgery Department of "Bagdasar-

Arseni" Emergency Hospital, in the last 5 

years. 

RESULTS/RESULT: There were 26 patiens 

admitted, mostly male = 77%, mean age 33.8 

years. All of them were victims of high energy 

accidents. All the 26 patients presented had 

spine injury associated with multiple lesions 

(head, thoracic, abdominal and limbs). We 

have chosen a posterior approach in all cases, 

with laminectomy or hemilamnectomy, 

permitting us to resolve all the major 

objectives of the surgery with the advantage of 

lower blood loss and a smaller operating time. 

The purpose of surgery was to achieve 

decompression of the spinal cord and the 

stability of the thoracic spine. We treated 

surgically 19 patients and conservative 4 

patients. 

CONCLUSIONS: Thoracic spine type C 

fractures remain a challenge for the spinal 

surgeon. These lesions require a 

multidisciplinary team approach for the 

treatment of the associated lesions. The main 

goal of the surgery is to achieve stability of the 

fractured segments. 

The timming for surgery is indicated 

mainly by the associated respiratory problems. 

KEY WORDS: thoracic spine, type C 

injuries. 

 



 

 

 

 

 
524          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

PERCUTANEOUS TRANSPEDICULAR 

STABILIZATION IN THORACO-LUMBAR 

FRACTURES PATIENTS 

G. Zapuhlih 

Institute of Neurology&Neurosurgery Department 

of Neurosurgery, Chisinau, Moldova 

 

INTRODUCTION: We present our 

preliminary results of using percutaneous 

transpedicular stabilization in thoraco-lumbar 

fractures patients. 

PATIENT AND METHODS: Four patients 

with spinal fractures in thoraco-lombar 

region, were operated on using stabilizing 

procedures in our institution during the 

period of time since February 2013 till August 

2014. 

RESULTS/RESULT: In all 4 cases we 

obtained good stabilization using monoaxial 

screws , and no mobility limitations 

CONCLUSIONS: Percutaneous 4 screws 

fixation time in thoraco-lumbar region is 

faster and the intraoperative bleeding is less in 

comparison with open surgery , with average 

operative time of 45-60 minutes, and 

bloodshed of about 200 ml, instead 135 

minutes and 1 liter. 

KEY WORDS: Percutaneous, 

transpedicular, thoraco-lumbar fractures 

 

IMMUNOHISTOCHEMICAL EXPRESSION 

OF GFAP-Δ AND NESTIN IN CEREBRAL 

ASTROCYTOMAS CORRELATES WITH 

TUMOR INVASIVENESS 

Felix Brehar1, Mircea Gorgan1, Dorel Arsene2, 

Lacramioara Brinduse3 
1Clinic of Neurosurgery - “Carol Davila” University 

of Medicine and Pharmacy, Bucharest 

2Victor Babes” National Institute of Pathology, 

Splaiul Independenţei 99 – 101, Bucharest 
3Public Health and Management, “Carol Davila” 

University of Medicine and Pharmacy, Bucharest 

 

INTRODUCTION: GFAP-δ, the delta 

isoform of glial fibrilary acid protein (GFAP), 

is particularly expressed in the subventricular 

zone (SVZ) of the brain. GFAP-δ positive cells 

in the SVZ co-express the neural stem cells 

(NSCs) marker nestin. According to the theory 

of glioma oncogenesis transformation of a cell 

population with stem features which resides in 

the SVZ could be the origin of astrocytomas. 

The working hypothesis of this paper is that 

cerebral astrocytomas retain the molecular 

signature of precursor cells and express the 

GFAP-δ and nestin. 

MATERIAL AND METHODS: We 

investigated the immunostaining of GFAP-δ 

and nestin in cerebral astrocytomas and 

evaluated the correlation between the positive 

cell ratio of these markers and the 

neuroimaging features associated with tumor 

invasion in forty-four cases of grade II, III and 

IV cerebral astrocytomas (World Health 

Organization's classification). Tissue samples 

were obtained by stereotactic biopsies in all 

cases. GFAP-δ and nestin immunostaining 

were graded in a semi-quantitative manner 

taking into account the ratio of positive cells. 

According to the neuroimaging criteria, 

tumors were categorized in highly-invasive 

and low-invasive. 

RESULTS: There were thirty-seven high-

grade astrocytomas (thirty-five glioblastomas 

and two anaplastic astrocytomas) and seven 

low-grade (diffuse) astrocytomas included in 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         525 

 

 

 

 

 

 

 

this study. Most of the low-grade and high-

grade astrocytomas express GFAP-δ and 

nestin. 

There is a statistically significant 

correlation between the neuroimaging 

invasiveness of cerebral astrocytomas and 

GFAP-δ immunostaining grade (rho=0,484, 

N=44, p=0,001) and nestin immunostaining 

grade (rho=0,362, N=44, p=0,012). 

CONCLUSIONS: Our results show that 

GFAP-δ and nestin positive cell ratio in biopsy 

samples of cerebral astrocytomas correlates 

with tumour invasiveness assessed by 

preoperative neuroimaging investigations. 

Therefore, we suggest that GFAP-δ and nestin 

could have potential clinical implications as 

markers associated with tumor invasiveness in 

cerebral astrocytomas. 

KEY WORDS: cerebral astrocytomas, 

GFAP-δ, nestin, immunostaining. 

Acknowledgments: This work was 

supported by grant no.28487/30.10.2012 of 

University of Medicine and Pharmacy “Carol 

Davila”, Bucharest, Romania. 

 

PRESERVATION OF PASSING-THROUGH 

VESSELS DURING BRAIN TUMOR 

RESEMOVAL 

I. Poeata1,2, Z. Faiyad2, A. Chiriac1, B. Iliescu1,  

C. Apetrei2, A. Iencean2 
1“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 
2“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 

Cranial base meningiomas and high grade 

gliomas are the most frequent tumors that can 

incorporate brain vessels into the tumor mass. 

Sometimes tumors lobs just cover the vessels 

with or without vessel wall infiltration, other 

times the vessel trunk (i.e. carotid artery, 

pericallosal artery, sylvian artery, rolandic 

artery or important venous trunks) cross the 

tumor mass giving vascular supply for the 

tumor or collaterals traversing the tumor with 

brain destination to more or less important 

areas. For the big trunks preop images, 

neuronavigation and intraop echodopler can 

give indications about the position but not 

about the cleavage plane between the vessel 

wall and the tumor tissue. For perforators and 

other small branches careful dissection can 

provide identification and preservation. For 

big vessels reconstruction is sometimes 

possible with suture or tangential clips. At the 

end the balance between the decision to 

maximize the tumor resection continuing 

dissection or to live bigger or smaller part of 

the tumor for avoiding vessels potential 

damage remains a challenge in all this cases. 

We present videos from our surgeries to 

document our attitude concerning this topic. 

 

OUR EXPERIENCE IN A SERIES OF 277 

BRAIN AVMS, MICROSURGICAL 

TREATMENT AND OUTCOME 

M.R. Gorgan2, V.Gh. Ciubotaru1, Ligia Gabriela 

Tataranu2, Al. Tascu2, A. Iliescu1, Narcisa Bucur1, 

Angela Neacsu1, F.M. Brehar2,  

Aurelia Mihaela Sandu1 
1Clinic of Neurosurgery, Emergency Clinical 

Hospital Bagdasar-Arseni, Bucharest, Romania 
2University of Medicine and Pharmacy “Carol 

Davila” Bucharest, Romania 

 

INTRODUCTION: Brain arteriovenous 

malformations (AVMs) are congenital tangle 



 

 

 

 

 
526          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

of dysplastic vessels. 

METHOD: We reviewed medical records 

of patients with brain AVMs operated from 

1999 to June 2014, in Clinic of Neurosurgery, 

Emergency Clinical Hospital Bagdasar-Arseni. 

RESULTS: 277 patients with brain AVMs 

underwent surgery. Mean age was 29.82 years. 

Fourty five patients (16.25%) had grade I 

Spetzler-Martin AVMs, 100 patients (36.10%) 

grade II, 81 patients (29.24) grade III, 39 

patients (14.08%) grade IV and 12 patients 

(4.33%) grade V. In 250 patients (90.25%) 

AVMs were supratentorial and in 27 cases 

(9.75%) were infratentorial. 195 patients had 

ruptured AVMs, 86 presented seizures and 

111 cases had motor deficits. We performed 

total resection of AVMs in 228 cases (82.31%). 

Following surgery modified Rankin Score 

improved in 202 patients (73%), remained 

unchanged in 41 (15%) and deteriorated in 34 

patients (12%) (Wilcoxon test p=0.000, Z=-

9.248). Short term morbidity rate was 37%. 

Long term follow-up revealed favorable 

outcome in 241 patients (86.7%). Mortality 

was 6.1%. 

CONCLUSIONS: Microsurgery is the 

treatment of choice in AVMs. In the majority 

of cases the outcome was favorable. Surgical 

results were good, with low morbidity and 

mortality. Patients with poor results belonged 

to the group admitted with severe altered state 

of consciousness, massive hematomas and 

acute brainstem dysfunction. 

Acknowledgement: This paper was co-

financed from the European Social Fund, 

through the Sectorial Operational Programme 

Human Resources Development 2007-2013, 

project number POSDRU/159/1.5/S/138907 

“Excellence in scientific interdisciplinary 

research, doctoral and postdoctoral, in the 

economic, social and medical fields - 

EXCELIS”, coordinator The Bucharest 

University of Economic Studies. 

 

PHOSPHORYLATED NEUROFILAMENT 

SUBUNIT NF-H IN CSF IS BIOMARKER IN 

ACUTE TRAUMATIC SPINAL CORD 

INJURIES 

St.M. Iencean1, A. Tascu2, A.St. Iencean3,  

I. Poeata1, R.M. Gorgan2 
1Gr.T. Popa University of Medicine and Pharmacy, 

Iasi, Neurosurgery, Iasi, Romania 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 
3Emergency Prof. Dr. N. Oblu Hospital, 

Neurosurgery III, Iasi, Romania 

 

INTRODUCTION: The objective of this 

study was to measure the phosphorylated 

neurofilament subunit NF-H (pNF-H) in 

cerebro-spinal fluid of patients with spinal 

cord injury and to determine the correlation 

between the pNF-H levels and the severity of 

the injury. 

PATIENT AND METHODS: The study 

included 15 subjects with acute traumatic 

spinal cord injury: eight patients with 

complete spinal cord injury (SCI) and seven 

patients with incomplete SCI. All patients were 

classified according to the American Spinal 

Injury Association impairment scale (ASIA) 

and all patients underwent surgery during the 

first 24 hours (decompression, stabilization). 

We measured daily the heavy phosphorylated 

neurofilament subunit (pNF-H) 

concentration by sandwich ELISA test in CSF 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         527 

 

 

 

 

 

 

 

in all patients and and we correlated the values 

of pNF-H with the clinical evolution. 

RESULTS/RESULT: For all patients with 

SCI pNF-H was detectable in CSF samples and 

the values were different in the cases of 

complete SCI toward the cases of incomplete 

SCI and the cerebro-spinal pNF-H level was 

more elevated in cases of complete SCI. The 

level of CSF pNF-H was of ten till hundred 

times higher in complete SCI than the level of 

CSF pNF-H in cases with incomplete SCI, 

where the level of this biomarker was close to 

normal. The patients with a favorable 

neurological evolution after treatment had a 

specific pattern of daily values of NFP-H: a 

sudden increase up to a maximum value then 

a progressive decrease until normal. The 

maximum values were different in each case, 

from 10 times up to 170 times higher than the 

normal. 

CONCLUSIONS: The phosphorylated 

form of the high-molecular-weight 

neurofilament subunit NF-H (pNF-H) in 

cerebro-spinal fluid can be a specific 

biomarker for spinal cord injury and it can 

distinguish the severity of SCI. pNF-H is a 

predictive biomarker because of its values 

pattern can show the reducing or stopping of 

the secondary lesion and the favorable result. 

KEY WORDS: biomarker, cerebro-spinal 

fluid, phosphorylated neurofilament subunit 

NF-H, spinal cord injury 

 

 

 

 

 

SPINAL INTRAMEDULLARY 

CAVERNOMAS. PERSONAL EXPERIENCE 

REFFERING TO SIX CASES 

G. Iacob 

University Emergency Hospital, Department of 

Neurosurgery – SUUB, Bucharest, Romania 

 

INTRODUCTION: Despite cavernous 

malformations of the CNS are pathologically 

similar, intramedullary cavernous 

malformations are very rare lesions, 

increasingly recognized after introduction of 

magnetic resonance image, generating gradual 

neurological decline, with severe deficits or 

acute loss of spinal function. 

PATIENT AND METHODS: We present 

our experience with 2 cervical and 4 thoracal 

spinal intramedullary cavernoma from 2010 to 

2014 searching history, onset of clinical 

manifestation, neurological status, 

radiological findings, operation, and clinical 

outcome. 

RESULTS/RESULT: Among 6 patients 

male were 2 cases; female 4 cases; mean age 

was 42 years (range 25-72 years); mean 

duration of symptoms were 1,5 years (range 5 

days and 2 years) with slowly progressive 

neurological decline. In two cases there was 

acute onset of neurological compromise. In all 

cases diagnosis was made on MRI and lesions 

were possible to be radically excised and gently 

extracted from the hemosiderin-stained bed 

inside of the spinal cord via a laminectomy and 

midline myelotomy with microsurgical 

techniques. The surgical outcome on a mean 

duration of follow up of 12 months were: for 5 

cases - the patients neurological conditions 



 

 

 

 

 
528          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

remarkably improved 1 month later, for 1 case 

no improvement were remarked. 

CONCLUSIONS: Spinal intramedullary 

cavernoma should be early recognized by 

MRI, can be positioned in a precarious 

position and generate significant neurologic 

deficits than cranial cavernomas. For 

symptomatic intramedullary cavernous 

malformations extended to the dorsal surface 

of the spinal cord, total resection with 

microsurgical techniques can offer good or 

excellent outcome, restoring neurological 

status and to stop chronic deterioration and 

acute rebleedng. To asymptomatic patients 

with deeper lesions which entail a higher 

operative risk, but also a surgically manageable 

cause of myelopathy a closed observation is 

mandatory. 

KEY WORDS: intramedullary cavernous 

malformation, microsurgical resection. 

 

FIRST RESULTS OF CYBERKNIFE 

RADIOSURGERY OF MENINGIOMAS 

COMPARED TO INTERNATIONAL 

WORKGROUPS 

Fabian Fehlauer, Thomas Schneider, Karen Piefel, 

Simone Glessmer-Junike, Torsten Maass, Oliver 

Bislich, Nelem Lange, Michael Heinrich 

Seegenschmiedt 

The Radiation Oncology Clinic Hamburg, 

Hamburg, Germany 

 

INTRODUCTION: Outcome-report about 

Cyberknife-Radiosurgery experience of 

intracranial meningeomas (IM) from 

Hamburg, Germany in comparison to 

published datas. 

PATIENT AND METHODS: 28 patients 

(2011–2014) with IM were treated with robotic 

cyberknife radiosurgery (CK-SRS) in our 

centre. Resection before SRS was performed in 

5/28 (21%) cases. 

CK-SRS as primary option in 22/28 (78%), 

recurrent disease in 5/28 (22%). One patient 

was treated after incomplete resection. Target 

volumes varied from 20–130ccm. 

Patients were treated in 1-5 fractions, 

depending on size and location. 30% of lesions 

were meningiomas at high risk (HRM) areas 

closed to optical nerves, pathways or 

brainstem were treated in five fractions. MRI 

follow-up was at 3/ 6/ 12/ 18 and 24 month 

after treatment. 

RESULTS/RESULT: Follow-up extended 

from 6 to 40 months (median 24 months). 

Only minor SRS–toxicities was observed: 

mortality: 0%, morbidity: 3% (grade 1: 

headache 3%, no grade 2 ≥ side effects). No 

patients underwent salvage resection after CK-

SRS. No recurrence until today. No side effect 

on HRM. Results will be comparable to 

literature. 

Non-Robotic systems have equal local 

control but significant higher morbidity (2–

9% vs. 0.5–1% CK). 

CONCLUSIONS: High precision, high 

tumor coverage and the steep dose gradients 

make CK-SRS efficient and safe. Even for 

larger and more complex volumes near organs 

at risk Cyberknife offers a noninvasive SRS-

treatment option. All patients showed 

excellent clinical outcome in terms of high 

local control, minor side effects and good 

quality of life. 



 

 

 

 

 
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KEY WORDS: Radiosurgery, 

Meningiomas, Cyberknife 

 

INTRAMEDULLARY TUMORS: CLINICAL 

FEATURES AND OUTCOMES - 5 YEARS 

EXPERIENCE 

M. Catana1, V.M. Prună1,2, A. Giovani1,  

Oana Rata1, Mariana Cochior1, M.R. Gorgan3 
1Clinical Hospital “Bagdasar-Arseni”, Bucharest, 

Romania 
2Ph.D. Student in Neurosurgery University of 

Medicine and Pharmacy “Carol Davila”, Bucharest 
3Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Intramedullary 

tumors rare lesions. This study discusses the 

clinical features at presentation, the outcomes, 

giving a few hints on tehnical nuances and 

complications. 

PATIENT AND METHODS: This is a 

retrospective review of the data of 41 patients 

with intramedullary tumors admitted for 

treatment in the IVth Neurosurgical 

Department of Bagdasar Arseni University 

Hospital between January 2009 and December 

2013. Only 36 patients were evaluated with 

preoperative and postoperative magnetic 

resonance imaging (MRI) and underwent 

microsurgery. The diagnosis of certainty was 

made on pathological criteria. ASIA score and 

Modified McCormick classification was 

applied to assess neurological function before 

and after surgery. 

RESULTS/RESULT: There were 17 males 

and 19 females with a mean age of 46.8 years. 

Twelve tumors were located in the cervical 

cord, 19 in the thoracic cord, and 5 in the 

conus medullaris. 

Gross total resection (GTR) of the tumor 

was achieved in 29 cases, and subtotal 

resection (STR) was achieved in 7 cases. The 

histopathology proved 25 tumors to be 

ependimomas,6 hemangioblastomas, 5 

astrocitomas. Patients presented with 

nonspecific symptoms and the mean duration 

of symptoms was 37.4 months.. During a mean 

follow-up period of 62.4 months, no 

recurrence or regrowth of the residual tumors 

was observed in the 7 cases of subtotal 

resection on MRI. 92% of patients experienced 

an improvement in the McCormick grade and 

ASIA score and 8 % of patients maintained 

their preoperative status. 

CONCLUSIONS: Excepting high grade 

astrocitomas, Intramedullary tumors are 

benign lesions with a tendency to grow and to 

develop neurological deficit. . The accurate 

diagnosis depends on pathology. For 

symptomatic patients, early surgery should be 

performed before neurological deficits 

deteriorate. When GTR cannot be achieved, 

STR of the tumor for decompression is advised 

as in the current series no regrowth or 

reccurence was observed after STR. 

Postoperative radiotherapy is not 

recommended for these benign tumors. With 

few exceptions tumor resection is associated 

with a good outcome. 

KEY WORDS: Intramedullary tumors, 

ependimoma, astrocytoma. 

 

  



 

 

 

 

 
530          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

FRONTOTEMPORAL VERSUS 

BIFRONTAL APPROACH FOR ANTERIOR 

CRANIAL FOSSA MENINGIOMAS 

M.R. Gorgan2, Narcisa Bucur1, Angela Neacsu1, 

Aurelia Mihaela Sandu1, F.M. Brehar2,  

V.M. Pruna1, Catioara Fanica Cristescu1,  

A. Giovani1, Silvia Mara1, Anamaria Gheorghiu1, 

Adrian Barari1 
1Clinical Hospital “Bagdasar-Arseni”, Bucharest 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Meningiomas of 

anterior cranial fossa are represented by 

olfactory groove, tuberculum selae, planum 

sphenoidale, anterior clinoid process and 

orbital roof meningiomas. 

PATIENT AND METHODS: We reviewed 

medical records of patients that underwent 

surgery for anterior fossa meningiomas from 

2009 to 2014, in the Fourth Department of 

Neurosurgery, Emergency Clinical Hospital 

Bagdasar-Arseni. 

RESULTS/RESULT: There were 59 

patients operated in our department. Mean 

age was 55.58 years, sex ratio M/F was 27/32. 

According to grade of resection 46 patients 

(77.97%) had Simpson grade II, 6 patients 

(10.17%) Simpson grade II, 6 patients 

(10.17%) Simpson grade IV and 1 patient 

(1.69%) Simpson grade V. We performed 

frontotemporal approach in 41 cases (69.49%), 

bifrontal approach in 13 patients (22.03%) and 

frontal unilateral approach in 5 cases (8.47%). 

We compared mRS (modified Rankin Score) 

before and following surgery, using Wilcoxon 

test, and we found that 46 patients improved, 

10 patients remained with the same score and 

only 3 patients got worse (Z=-5.352, p=.000). 

We found no difference between 

frontotemporal and bifrontal approaches 

regarding degree of tumor resection, using 

Mann-Whitney test (U=235, p=.394), but 

frontotemporal approach had fewer 

complications. Morbidity was 13.55% and 

mortality 1.69%. Tumor rest/recurrence was 

found in 11 patients (18.64%), and 5 

underwent second surgery and 6 stereotactic 

radiosurgery. 

CONCLUSIONS: Anterior fossa 

meningioma can be operated with favorable 

outcome. Frontotemporal approach offers the 

same chance of complete tumor resection as 

bifrontal approach, but with lower surgical 

risks. Choosing the appropriate approach 

must be individualized. 

Preserving optic nerves, optic chiasm, 

oculomotor nerves and, if possible, olfactory 

nerves is mandatory. 

KEY WORDS frontotemporal approach, 

bifrontal approach, anterior cranial fossa. 

 

GELASTIC SEIZURES IN A PATIENT 

WITH RIGHT PARACENTRAL TUMOUR 

G. Iacob 

University Emergency Hospital, Department of 

Neurosurgery – SUUB, Bucharest, Romania 

 

INTRODUCTION: Gelastic seizure (GS) 

also known as “gelastic epilepsy” is a rare type 

of seizure associated with several different 

conditions such as tumors - hypothalamic 

hamartromas, tuberous sclerosis, 

hemangiomas, post infectious foci, cortical 

temporal dysplasia We report one case of this 

rare condition generated by a right gyrus 

cinguli gr.II astrocytoma. 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         531 

 

 

 

 

 

 

 

PATIENT AND METHODS: Clinical 

presentation: A 27 years, old male, right 

handed, was admitted for a 2 years history of 

very frequent gelastic seizures accompanied 

sometimes by simple motor partial seizures in 

both arms, more often being involved his left 

arm, without impairment of his consciousness 

state. His neurological examination was 

normal. Diagnosis was made on native CT 

scan: minimal hypodense frontal right 

paramedian lesion, cerebral MRI showed a 

small right, parenchymal, homogeneous lesion 

(16/22/15mm), well delimited, involving gyrus 

cinguli, without perilesional edema and mass 

effect, hyperintense both on T1 and T2 MR 

sequences, non-enhancing after Gadolinium. 

The cerebral lesion was also documented on 

EEG and video-EEG recordings. 

RESULTS/RESULT: Using an 

interhemispheric microsurgical approach, 

above the corpus callosum and the right 

pericallosal artery, at the level of gyrus cinguli, 

a yellow-gray, infiltrative tumour, having a 

moderate vascularisation had been identified 

and totally removed. 

The anatomo-pathological analysis 

revealed a grade II astrocytoma. The patient 

recovered very well, without deficits, no 

gelastic seizures or epileptic manifestations; 

three months after operation he is still free of 

seizures. 

CONCLUSIONS: A case of gelastic 

seizures accompanied by simple motor partial 

seizures in both arms, without impairment of 

his consciousness state induced by a grade II 

right gyrus cinguli astrocytoma is described 

and documented by radiological and 

electrophysiological studies. Using 

microsurgical resection, the tumor was totally 

removed, the patient clinical condition 

improved. Without an affective connotation as 

in temporal or hypothalamus topography, 

gelastic seizures are not patognomonic for 

hypothalamic hamartomas and in the case of 

frontal localization of the lesion they can be 

associated with motor involvement of the 

limbs as in our case. 

KEY WORDS: gelastic seizures (GS), 

cerebral astrocytoma. 

 

CHOLINE IN SPINAL CORD PREDICTS 

FUNCTIONAL OUTCOME IN CERVICAL 

SPONDYLOTIC MYELOPATHY 

S.C. Craciunas1, M.R. Gorgan2, C.M. Cirstea3 
1Neurosurgery Department, Bagdasar-Arseni 

Hospital, Bucharest, Romania 
2“Carol Davila” University of Medicine and 

Pharmacy Neurosurgery, Bucharest, Romania 
3Psychological Sci. and Physical Med. & Rehabil, 

Univ. of Missouri, Columbia, MO, USA 

INTRODUCTION: CSM is the most 

common spinal cord dysfunction in patients 

over the age of 50. 

Although neuroimaging has undergone 

spectacular development in recent years, no 

group of predictors has proven reliable enough 

for an accurate prediction of long-term 

functional outcome and/or individual gain 

following surgery in these patients. Magnetic 

resonance spectroscopy (1H-MRS) assesses 

metabolites associated with various neural 

events involved in spinal cord pathology (e.g., 

N-acetylaspartate - NAA, reflective of 

neuronal integrity; Choline - Cho – marker of 

inflammation; lactate - Lac, a marker of 

anaerobic metabolism). Since neurological 



 

 

 

 

 
532          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

recovery appears to be influenced by residual 

spared function, we proposed that the 1H-

MRS measurements of radiologically normal-

appearing (or spared) spinal cord (C2 level) 

can provide valuable prognostic information 

of recovery after decompressive surgery. 

METHODS: Patients underwent clinical 

(functional) evaluations - modified Japanese 

Orthopedic Association Scale (mJOA), 9-Hole 

Peg Test (9-HTP) and Walking Test (WT) / 

time and # steps - one day prior to surgery 

(Time1) and 6 months (Time2) postsurgery. 

Also, at Time 1 all patients underwent MRI 

and MRS. High resolution thin-sliced sagittal 

T2-image (TR=1500ms, TE=125ms, 

FOV=200mm, voxel size=0.6 x 0.6 x 0.6) has 

been acquired to reconstruct the spinal 

anatomy. A volume of interest (VOI) with 

dimension of about 10 x 10 x 30 mm3 has been 

placed along the main axis of the cord at C2 

level. For MRS acquisition we used a point-

resolved spectroscopy sequence (PRESS, 

TE=30ms, TR=1500ms, averages=200, flip 

angle 90, spectral width=1000 Hz) with 

chemical shift selective water suppression. 

Three metabolites were quantified: NAA - 

Functional recovery has been defined as the 

change (Δ) between Sessions II and I for 9-

HTP and WT scores (i.e., Δ9-HPT = 9-

HPTSesionII – 9-HPTSessionI) and the 

recovery rate [RR=(mJOA SessionII - mJOA 

SessionI)x100/(18 - mJOA SessionI)] for 

mJOA. Spearman correlation coefficient was 

used to determine the correlations between 

metabolites and functional recovery. At the 

moment, 10 patients have been enrolled in the 

study and four already accomplished the full (6 

months) time course of study. 

RESULTS: Our preliminary results suggest 

that high Cho correlates negatively with RR 

and positively with Δ9-HPT. A similar trend 

has been found between NAA and functional 

tests, but without statistical significance. 

Walking test did not correlate in any way with 

metabolical alterations. Also, the Lac peaks 

were difficult to be detected and poorly 

correlated with functional recovery. However, 

the whole group of patients needs to finalize 

the study in order to draw statistical 

conclusions. 

CONCLUSIONS: High Cho suggests 

remote increased membrane turnover due to 

inflammation/gliosis. 

Inflammatory response in normally 

appearing cervical spinal cord was related to 

functional recovery. Thus, 1H-MRS might be 

a sensitive method to quantify relevant 

metabolite changes in CSM, and consequently 

increase our knowledge of the factors leading 

from these changes to neurological deficits. 

Such objective data would help clinicians to set 

realistic therapeutic goals, by selection of 

individualized rehabilitation strategies based 

on the prediction of functional potential. In 

addition, they can also be helpful as an 

individual prognostic indication to relatives 

and patients. 

Aknowledgments: This study was 

supported by EuroSpine – The Spine Society of 

Europe. 

Neuroendocrine carcinoma of the bran 

invading the frontal sinus. A microsurgical 

resection. 

 

 



 

 

 

 

 
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THE ROLE OF DIFFUSION TENSOR 

IMAGING IN THE EVALUATION OF THE 

CERVICAL SPINAL CORD TRAUMA 

B.F. Iliescu1, M. Dabija1, D. Andronic2, P. Gutu1,  

I. Poeata1 
1“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 
2“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 

These authors contributed equally to this work 

 

Cervical spine trauma with the 

involvement of spinal cord represents a major 

cause of devastating neurologic morbidity 

amongst the young population. The 

management of this condition is undermined 

by a poor level of evidence regarding the 

possible evolution and long-term outcome. 

Numerous efforts have been made in the last 

decades to find the clinical and imaging 

indicators for the neurological and overall 

prognostic of these complex patients. 

However, little can be predicted today and the 

information that reaches the patient and his 

family rely mostly on experience and clinical 

flair. 

We wanted to analyze the quantifiable 

measures comprised within the diffusion 

tensor MRI images and to see how well they 

correlate with the clinical status. We looked at 

the data from 15 patients with cervical spinal 

cord trauma, subaxial, and measured diffusion 

anisotropy, anisotropy diffusion coefficient, 

and fiber length and studied their grade of 

correlation with the neurological performance 

(measured on SLIC scale). 

The results showed a strong correlation 

between clinical and imaging data, suggesting 

that measures of the diffusion tensor imaging 

are a good indicator of the level of neurological 

damage. We present the results and discuss the 

biological and clinical implications. 

 

TOPICAL VANCOMYCINE AND 

BACTERIAL CULTURE FROM 

INTERVERTEBRAL HERNIATED DISC 

PREVENT POSTOPERATIVE 

OSTEODISCITIS 

D. Adam 

“Carol Davila” University of Medicine and 

Pharmacy Neurosurgery, Bucharest, Romania 

 

INTRODUCTION: Osteodiscitis 

represents a serious complication of lumbar 

disc herniation operations. 

The treatment of osteodiscitis is 

controversial and expensive to society. It 

extends over a period of several months from 

diagnosis. Reducing postoperative 

osteodiscitis by using simple measures may 

limit patient's suffering and reduce costs. The 

purpose of this study is to evaluate the early 

diagnosis of bacterial infections of the 

intervertebral disc by isolating germs located 

in the herniated disc fragment and topical 

Vancomycine powder application, along with 

the conventional antiinfective therapy. The 

purpose of this study is to evaluate the early 

diagnosis of bacterial infections of the 

intervertebral disc by isolating germs located 

in the herniated disc fragment and topical 

Vancomycine powder application, along 

with the conventional antiinfective therapy. 

PATIENT AND METHODS: Medical files 

of patients who were operated on for lumbar 

disc herniations during 01.01.2013 - 



 

 

 

 

 
534          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

30.06.2014 were reviewed. The diagnosis of 

lumbar disc herniation was established based 

on the clinical evaluation, confirmed by MRI 

results. The surgical intervention was 

performed by mini-open approach: 

fenestration and foraminotomy completed 

with removal of the herniated disc fragment 

and disc remnants from the intervertebral 

space. A group of 162 patients (group A) 

received conventional therapy for prevention 

of post-operative infections with 2 doses of 

cephalosporin. In the second group of 137 

patients (group B), after the removal of the 

herniated disc fragments, 1g of Vancomycine 

powder was topically applied and the disc 

fragments were bacteriologically analyzed. 

They received the conventional treatment of 

preventing post-operative infections with 

cephalosprin - 2 doses. 

RESULTS/RESULT: The two groups of 

patients were similar in terms of demographic 

characteristics: age, sex, operative level. Out of 

the 162 patients of group A, one patient 

developed postoperative osteodiscitis and was 

treated for 3 months with antibiotics. 

Regarding patients in group B, in four cases 

Staphylococcus was isolated from the disc 

fragments. 

Postoperative treatment for these patients 

with prolonged antibiotic therapy over the 

standard period avoided the developement of 

the clinical picture of osteodiscitis. 

CONCLUSIONS: Postoperative 

osteodiscitis requires prolonged 

antibiotherapy. By using simple measures, like 

topical Vancomycine powder application and 

early isolation of germs from the herniated 

intervertebral disc, followed by the immediate 

establishment of appropriate antibiotic 

treatment, this serious complication is 

avoided. 

KEY WORDS: herniated disc, osteodiscitis, 

Vancomycine, microbiological examination. 

 

VAGUS NERVE STIMULATION (WHAT IS 

IT, HOW DOES IT WORK, HOW TO 

IMPLANT, RESULTS) 

M.R. Gorgan1,2, F.M. Brehar1,2 
1“Bagdasar-Arseni” Emergency Clinical Hospital, 

Bucharest 
2Clinic of Neurosurgery - “Carol Davila” University 

of Medicine and Pharmacy, Bucharest 

 

INTRODUCTION: Refractory epilepsy 

represents a severe clinic entity which affects 

an important number of patients. One of the 

surgical techniques employed in the 

management of refractory epilepsy is vagal 

neurostimulation (VNS). The authors present 

here the first series of patients with refractory 

epilepsy operated and implanted with vagal 

neurostimulators in Romania, and described 

in detail the surgical technique and the 

preliminary results. 

MATERIAL AND METHODS: Our study 

included 50 patients diagnosed with refractory 

epilepsy, investigated, selected and implanted 

with vagal neurostimulators between October 

2012 and August 2014 in Neurosurgery Clinic, 

"Bagdasar-Arseni" Emergency Hospital. We 

have implanted in all patients the latest model 

of vagal neurostimulator (model 103) using a 

left latero-cervical surgical approach. 

RESULTS: There were 13 children and 37 

adults in this series. The gender distribution 

was: 23 females and 27 males. The medium age 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         535 

 

 

 

 

 

 

 

was 24,8 years. The average period of 

hospitalization was 3,5 days. The medium 

follow-up period was 14 months. There was no 

death in this series and no intraoperative 

incidence. One patient presented dysphagia 

postoperatively which completely remitted 

after two months. 

CONCLUSIONS: VNS represents now a 

safe, quick and efficient surgical procedure 

with a minimum period of hospitalization and 

a short recovery period. 

KEY WORDS: refractory epilepsy, vagal 

neurostimulation. 

 

CEREBRAL VENOUS ETIOLOGY OF 

INTRACRANIAL HYPERTENSION 

St.M. Iencean1, A.St. Iencean2 
1Gr.T. Popa University of Medicine and Pharmacy, 

Iasi, Neurosurgery, Iasi, Romania 
2Emergency Prof. Dr. N. Oblu Hospital, 

Neurosurgery III, Iasi, Romania 

INTRODUCTION: The aim of this study 

was to present the characteristics that 

differentiate between idiopathic intracranial 

hypertension and intracranial hypertension 

caused by intracranial vascular damage. 

PATIENT AND METHODS: This study 

included twenty-one patients, 14 women and 

7 men of 18 – 61 years old. 

The main symptoms and the imaging 

findings diagnosed intracranial hypertension 

in the absence of an expansive intracranial 

process, hydrocephalus and intracranial 

infection. 

RESULTS/RESULT: Cerebral angiography 

with venous phases showed whether there was 

cerebral vascular disease (cerebral venous 

thrombosis, venous sinus thrombosis or 

stenosis). The pressure of the cerebro-spinal 

fluid was determined by repeated lumbar 

puncture with manometry after the exclusion 

of endocranial lesions by cerebral 

explorations. The analysis of the 

symptomatology correlated with the values of 

intracranial pressure, and the imaging findings 

revealed significant differences between these 

two types of intracranial hypertension. 

CONCLUSIONS: Vascular intracranial 

hypertension has a known etiology, such as 

cerebral vascular illness, and a relatively rapid 

increase in intracranial pressure of 

approximately 21 cm H2O. Intracranial 

hypertension caused by intracranial vascular 

damage is named vascular intracranial 

hypertension. The treatment of vascular 

intracranial hypertension is etiologic, 

pathogenic and symptomatic, but that of 

idiopathic intracranial hypertension is only 

symptomatic. 

KEY WORDS: intracranial pressure, 

vascular intracranial hypertension, venous 

sinus stenosis, venous sinus thrombosis 

 

THE ENDOVASCULAR, MINIMAL 

INVASIVE, CEREBRAL ANEURYSMS 

TREATMENT WITH VASCULAR 

REMODELING TECHNIQUES WITH 

STENTS AND BALLOONS 

St. Dima1, M. Lucian2 
1Interventional Neuroradiology, Department of 

Angiography, National Institute of Neurology and 

Cerebrovascular Diseases Bucharest 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy Tg. Mures 

 



 

 

 

 

 
536          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

INTRODUCTION: The large neck 

cerebral aneurysms can be treated 

endovascular way, helped by the remodeling 

techniques with balloons and stents. 

PATIENT AND METHODS: 89 cerebral 

aneurysms at 83 patients treated endovascular, 

minimal invasive, with coils and remodeling 

techniques with 64 balloons and 36 stents. We 

used the balloons and stents to keep the coils 

inside the aneurysm sac. 

RESULTS/RESULT: All the 89 aneurysm 

were coiled and the parent vessels remained 

patent. The recanalization rate of the 

aneurysm at 6 and 12 months follow up was 

6%. 2 cases of stent occlusion because the 

patients did not take the double antiplatlet 

inhibition (with Plavix and Aspirin) after stent 

implantation. 

CONCLUSIONS: Most of the cerebral 

aneurysm can be treated safe in this moment, 

minimal invasive, endovascular way, helped 

by remodeling techniques with stents and 

balloons. 

KEY WORDS: cerebral, aneurysm, 

endovascular, stent, balloons. 

 

SECOND NEUROSURGICAL 

MASTERCLASS CLUJ-

NAPOCAINTRODUCTION TO VASCULAR 

NEUROSURGERY 

Cristina Caterina Aldea1, V. Volovici2, I. Caravan1, 

I.S. Florian1 
1“Iuliu Hatieganu” University of Medicine and 

Pharmacy, Cluj-Napoca, Romania 
2Erasmus University Medical Center, Rotterdam, 

Netherlands 

INTRODUCTION: The second 

Neurosurgical Masterclass, “Introduction to 

Vascular Neurosurgery” was held between 

28th February and 1st March 2014 in Cluj-

Napoca. It was organized by the Students’ 

Scientific Circle of Neurology and 

Neurosurgery under the auspices of the 

Neurosurgical Department of Cluj-Napoca. It 

was addressed to students and residents. 

The previous edition of this event was the 

first known neurosurgical course dedicated to 

medical students, held in July 2013. 

PATIENT AND METHODS: Our course 

was designed to offer first-hand guidance from 

experienced speakers. Before the course, 

participants received a textbook specially 

written for this occasion by students and 

residents under the guidance of the main 

author. The lectures were divided into three 

days. 

RESULTS/RESULT: 281 medical students 

from 8 university centers from Romania and 

abroad participatedin this course. Our 

speakers comprised of a professor of 

neurosurgery, an endovascular specialist, 

residents and students. The lecturers 

encompassing three generations meant that 

the auditorium could witness different stages 

of neurosurgical evolution, the importance of 

experience and mentorship. The first day was 

dedicated to the history of vascular 

neurosurgery. On the second, a review of 

relevant anatomy and neuroimaging were 

provided. On the last day we discussed 

intracranial vascular lesions and case 

presentations. 

CONCLUSIONS: The goal of the course, to 

give participants a guide to the field of vascular 

neurosurgery, was accomplished. We 

managed to create a bridge not only between 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         537 

 

 

 

 

 

 

 

the present and the future generation of 

neurosurgeons, but also between university 

centers. Considering the positive feedback 

provided by the participants these courses will 

continue. 

KEY WORDS: vascular neurosurgery, 

course, students. 

 

MULTIPLE CRANIAL TUMORS IN A 26-

YEAR-OLD MALE WITH 

NEUROFIBROMATOSIS TYPE 2 

Francesca Gabriela Ochea2, Dana Pisica2,  

Adriana Solomon1, V. Ciubotaru1,  

Ligia – Gabriela Tataranu2 
1Clinical Hospital “Bagdasar-Arseni”, Bucharest 
2Clinic of Neurosurgery - University of Medicine 

and Pharmacy “Carol Davila”, Bucharest 

 

INTRODUCTION: Neurofibromatosis 

type 2 is an autosomal dominant inherited 

disorder predisposing to multiple benign 

tumors of the nervous system, such as 

meningiomas, ependymomas, vestibular 

shwannomas and other cranial nerve and 

peripheral schwannomas. Bilateral vestibular 

schwannomas are found in 90–95% of the 

cases and it is reported that 99% of them are 

benign. However, they remain an important 

cause of mortality due to their location. 

PATIENT AND METHODS: In this paper 

we present a case report of a 26-year-old male 

admitted with ataxia, headache, nausea, emesis 

and bilateral sensorineural hypoacusis, 

intracranial hypertension syndrome and 

cerebellar syndrome. The patient also 

presented with significant congenital 

hypotrophy of the lower and upper limbs. The 

cerebral MRI scan revealed multiple cranial 

tumors, schwannomas and meningiomas, 

located in both cerebellopontine angles, right 

lateral ventricle (temporal horn), right frontal 

lobe (paramedial), left frontal lobe 

(parasagittal). The overall aspect suggested the 

diagnosis of neurofibromatosis type 2. Over 

the course of one year, the patient underwent 

3 different neurosurgical interventions, in 

order to improve the neurological 

symptomatology. 

RESULTS/RESULT: The postoperative 

clinical evolution was favorable, without 

subsequent motor deficits. 

The CT scan performed 6 months after the 

last neurosurgical intervention showed no 

tumoral recidivation and no changes in tumor 

size. 

CONCLUSIONS: Due to the benign nature 

of the tumors associated with 

neurofibromatosis type 2, neurosurgical 

resection was used only as a cure for 

complications caused by tumor growth. The 

typical treatment strategy is „watch and wait 

then rescan”, meaning that close monitoring 

of the patient’s neurological status and 

periodic scanning are recommended. 

KEY WORDS: meningioma, 

schwanomma, neurofibromatosis. 

 

PROGNOSIS VALUE OF COMPUTER 

TOMOGRAPHY FOR PATIENTS WITH 

CEREBELLAR HEMORRHAGE IN GOOD 

NEUROLOGICAL STATUS GCS = 13-15 

Al.V. Papacocea1, T. Papacocea3, L. Danalia2 
1Emergency Clinical Hospital, Neurosurgery, 

Ploiesti, Romania 
2“Carol Davila” University of Medicine and 

Pharmacy Neurosurgery, Bucharest, Romania 



 

 

 

 

 
538          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

3Emergency Clinical “St. Pantelimon” Hospital, 

Neurosurgery, Bucharest, Romania 

 

INTRODUCTION: For patients with 

cerebellar hemorrrhage in good neurological 

status (GCS=13-15) sometimes terapeutical 

management may be difficult. In many studies, 

different authors tried to find predictors for 

outcome and determine what the best choice is 

for these patients: surgery or medical 

treatment only. 

PATIENT AND METHODS: We made a 

retrospectiv study of 66 patients with primary 

cerebellar hemorrrhage, admitted in hospital 

in good neurological status (GCS=13-15). We 

have considered three CT factors suitable for 

predicting patient outcome: largest diameter 

of hemorrhage (measured on axial CT), shape 

of the fourth ventricle and aspect of the 

cvadrigeminal cistern. 

RESULTS/RESULT: All patients with 

cerebellar hemorrhage with maximum 

diameter less than 3cm and only 79% of those 

with diameter higher than 3cm had a good 

prognosis. Good prognosis has been related in 

all cases with normal shape of the fourth 

ventricle, in 88% of patients with partial 

compression of V4 and only in 56% of patients 

with complete obliteration. Good prognosis 

has been related in in all cases with normal 

cvadrigeminal cistern, in 84% of patients with 

partial obliteration and only in 63% of patients 

with complete obliteration. 

CONCLUSIONS: 1. Patients in GCS=13-

15 with cerebellar hemorrhage having 

maximum diameter less than 3 cm, normal 

shape of the fourth ventricle and 

cvadrigeminal cistern can receive only medical 

treatment 2. Patients with complete 

obliteration of the fourth ventricle or 

cvadrigeminal cistern have better prognosis 

with early surgery 

KEY WORDS: cerebellar hemorrhage CT 

prognosis. 

 

NEUROENDOCRINE CARCINOMA OF 

THE BRAN INVADING THE FRONTAL 

SINUS. A MICROSURGICAL RESECTION 

V. Munteanu, R. Stanescu 

Neurosurgical Clinic, “Bagdasar – Arseni” Clinical 

Hospital, Bucharest, Romania 

 

Neuroendocrine tumors are rare, 

accounting for less than one percent of all 

malignant disorders. These tumors can only be 

accurately diagnosed when a pathologist 

examines a tissue sample using specialized 

stains that help clarify the cells’ subtype. Urine 

also may be tested for elevated levels of specific 

products that are related to this type of cancer. 

Neuroendocrine carcinomas can originate in 

different locations including the 

gastrointestinal tract, lung, and brain. Some 

tumor cells produce hormones, while other 

cells cause no symptoms. 

CASE REPORT: A 60 years old male 

presented in our hospital for loss of smell, 

headache and for the appearance of an 

epicranial tumor in the frontal region. The 

ENT doctor discovered a tumor inside his 

nose. IRM study discovered a tumor with 

ethmoidal origins that invaded the ethmoidal 

cells, the left frontal sinus, the duramater and 

with mass effect upon the cerebral 

parenchyma. 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         539 

 

 

 

 

 

 

 

RESULTS: The tumor was resected via a 

frontal approach. It had infiltrated the 

ethmoidal cells, the frontal sinus and the 

duramater. We evacuated pus from the frontal 

sinus. Histophatological exam showed a 

neuroendocrine carcinoma. Post-op evolution 

was uneventfull, the pacient being kept for 10 

days under.  

KEY WORDS: Neuroendocrine 

carcinoma, microsurgical resection, pus in the 

frontal sinus. 

 

MULTIPLE BRAIN CAVERNOMAS: 

MICROSURGICAL RESECTION OF TWO 

LESIONS 

V. Munteanu, R. Stanescu 

Neurosurgical Clinic, “Bagdasar – Arseni” Clinical 

Hospital, Bucharest, Romania 

 

BACKGROUND: Cavernomas of the brain 

are congenital lesions clinically divided into 

hereditary and sporadic forms. Multiple 

lesions are usually observed in the familial 

form, whereas the sporadic variant generally 

shows a single cavernoma. In this case we 

describe the case of a patient with two left side 

cavernomas, one pontomezencephalic and the 

other temporoinsular that were treated 

surgically. 

CASE DESCRIPTION: A 43 years old male 

was admitted in our hospital for right 

hemiparesis, right cranial nerve IV paresis, 

headache and vomiting. The IRM study 

identified two lesions that were treated 

surgically. The pontomezencephalic lesion 

showed signs of bleeding. 

RESULTS: both lesions were treated 

surgically, the temporoinsular one by opening 

the sylvian valley and the brain stem one by a 

subtemporal approach. Post-op evolution was 

uneventfull.The patient had no additional 

neurological deficits. 

KEY WORDS: Hemangioma, Cavernous, 

Central nervous system, Hemmmorage, 

Familial cerebral cavernous malformation. 

 

POSTERIOR FOSSA CAVERNOUS 

MALFORMATIONS: TREATMENT AND 

SURGICAL OUTCOME – A 5 YEARS 

EXPERIENCE 

A. Giovani 

Clinical Hospital “Bagdasar-Arseni”, Bucharest 

 

INTRODUCTION: Only 15% of 

cavernous malformations are located in the 

posterior fossa, yet this location is associated 

with important neurological deficits and even 

death if left untreated. 

We review here the experience of our 

department with a series of 15 consecutive 

cases. 

PATIENT AND METHODS: We reviewed 

the case files of 15 consecutive cases of 

brainstem and cerebellar cavernous 

malformations operated between January 

2009 and December 2013. Special attention 

was paid to the accuracy of diagnosis as 

predicted by the MRI, to the operative 

protocol and to the follow up. The patients 

were followed on average for 26 months using 

Karnovsky performance score. 

RESULTS/RESULT: We reviewed the case 

files of 15 consecutive cases of brainstem and 

cerebellar cavernous malformations operated 

between January 2009 and December 2013. 

Special attention was paid to the accuracy of 



 

 

 

 

 
540          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

diagnosis as predicted by the MRI, to the 

operative protocol and to the follow up. The 

patients were followed on average for 26 

months using Karnovsky performance score. 

CONCLUSIONS: Total removal should be 

the standard treatment of posterior fossa 

cavernomas and where there is no danger of 

injuring the brainstem, the surrounding 

hemosiderin ring should be removed as well. 

“This paper was co-financed from the 

European Social Fund, through the Sectorial 

Operational Programme Human Resources 

Development 2007-2013, project number 

POSDRU/159/1.5/S/138907 "Excellence in 

scientific interdisciplinary research, doctoral 

and postdoctoral, in the economic, social and 

medical fields - EXCELIS", coordinator The 

Bucharest University of Economic Studies” 

KEY WORDS: brainstem; cavernous 

malformation; surgery. 

 

ANALYSIS OF 98 PATIENTS WITH 

APOPLEXY IN A PITUITARY ADENOMA: 

CLINICAL CHARACTERISTICS, 

MANAGEMENT AND PROGNOSTIC 

FACTORS 

Adriana Solomon¹˒², Ligia Tataranu¹˒²,  

Vasile Ciubotaru¹ 

¹Neurosurgical Clinic, “Bagdasar – Arseni” 

Emergency Clinical Hospital, Bucharest, 

Romania 

²“Carol Davila”University of Medicine and 

Pharmacy, Bucharest, Romania 

 

INTRODUCTION:  Pituitary apoplexy is a 

clinical syndrome characterized by abrupt and 

occasionally catastrophic occurrence of 

hemorrhagic or ischemic infarction of a 

pituitary adenoma. 

MATERIAL AND METHODS:  Between 

January 2009 and December 2013, 98 patients 

were diagnosed with pituitary apoplexy and 

treated in our neurosurgical department from 

“Bagdasar – Arseni” Emergency Clinical 

Hospital, Bucharest, Romania. 

Adequate follow-up was obtained for all 

patients of the study. There were 62 women 

(63.3%) and 36 men (36.7%) with age between 

17 and 75 years old. The mean age at 

admission was 49.9 years. 

RESULTS:  There were 98 tumors with 

pituitary apoplexy, 14 tumors were 

microadenomas (14.3%) and 84 were 

macroadenomas (85.7%). In our study there 

were 64 non-functional adenoma (65.3%), 24 

prolactinomas (24.5%), 7 somatotroph 

adenoma (7.1%) and 3 corticotroph adenomas 

(3.1%). In all cases urgent transnasal 

transsphenoidal approach was made and 

hormonal replacement when needed. The 

histopathological examination confirmed the 

diagnosis of pituitary apoplexy. In all cases 

ocular motility improved after surgical 

decompression, deficits in visual acuity and 

visual field deficits were partially resolved after 

surgery, with better results when surgery was 

done in the first week after diagnosis. 

CONCLUSIONS: Pituitary apoplexy 

represents a true neurosurgical emergency for 

which rapid diagnosis and glucocorticoid 

replacement are the first important steps. 

Urgent transsphenoidal decompression is 

recommended to save life, visual function and 

to have the chance to regain pituitary function. 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         541 

 

 

 

 

 

 

 

ACKNOWLEDGEMENT: This paper was 

co-financed from the European Social Fund, 

through the Sectorial Operational Program 

Human Resources Development 2007-2013, 

project number POSDRU/159/1.5/S/138907 

"Excellence in scientific interdisciplinary 

research, doctoral and postdoctoral, in the 

economic, social and medical fields -

EXCELIS", coordinator The Bucharest 

University of Economic Studies. 

KEY WORDS: apoplexy, pituitary 

adenoma. 

 

PLANUM SPHENOIDALE MENINGIOMA 

– CASE REPORT AND REVIEW OF THE 

LITERATURE 

B.C. Dumitrescu1,2, Tabita Larisa Cazac2,  

V. Ciubotaru¹, Ligia Tataranu1,2 

¹Department of Neurosurgery, Emergency Clinical 

Hospital “Bagdasar-Arseni”, Bucharest, Romania 
2“Carol Davila” University of Medicine and 

Pharmacy, Bucharest, Romania 

 

BACKGROUND: Meningiomas of the 

central subfrontal region originate either from 

the olfactory groove, planum or jugum 

sphenoidale or suprasellar area, accounting for 

about 5% to 10% of all intracranial 

meningiomas in a review of the world 

literature. 

They represent a subgroup of anterior skull 

base meningiomas, planum sphenoidale 

meningiomas being located more anterior and 

in proximity of the olfactory groove location. 

OBJECTIVE: We are reporting a case of a 

planum sphenoidale meningioma successfully 

resected using a classical left pterional 

approach. 

METHODS: A 64-year-old woman 

presented with symptoms of opto-chiasmatic 

syndrome, with progressive visual 

disturbance, headache and nerve compression 

from a planum sphenoidale meningioma. 

Preoperative magnetic resonance imaging 

showed a well-defined suprasellar solid mass 

with homogenous enhacement and a broad 

dural attachement to the planum sphenoidale. 

Surgical resection was performed using a left 

pterional approach. The intra- and 

postoperative courses were uneventful with a 

partial recovery. The opto-chiasmatic 

syndrome persisted but the postoperative 

computer tomography investigation showed 

total surgical removal with no residual tumor. 

CONCLUSION: In order to obtain a better 

postoperative outcome, the planum 

sphenoidale meningiomas must be diagnosed 

early and the operative procedures are to be 

performed with utmost care and in time. 

 

EGFR INACTIVATION IN COMBINATION 

WITH TEMOZOLAMIDE INDUCED 

SYNERGISTIC CYTOTOXICITY IN LOW 

PASSAGE GLIOBLASTOMA CELL LINE: IN 

VITRO STUDY 

Ada Maria Georgescu1, Ligia Gabriela Tataranu2,3, 

Florentina Serban1, Oana Alexandru1,  

Vrajitoru Alisa1, Roxana Folcuti1, V. Ciubotaru2, 

Anica Dricu1 
1University of Medicine and Pharmacy of Craiova, 

Biochemistry Unit 
2”Bagdasar-Arseni” Emergency Clinical Hospital, 

Bucharest, Neurosurgery Department 
3“Carol Davila” University of Medicine and 

Pharmacy, Bucharest, Romania 

 



 

 

 

 

 
542          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

The central nervous system (CNS) 

tumours are the most common solid tumours. 

Despite the successful introduction of 

multimodal therapy approaches (modern 

surgery, etc) and new cytostatics, the 

prognosis of many brain tumous, especially 

high-grade brain tumours remains grim. Drug 

failures in the clinic may be due to the fact that 

preclinical models do not represent the 

heterogeneity that is observed in human 

tumours. 

Compared to established cell lines, low 

passage cell lines were reported to better 

preserve features of cancer. At low passage, 

cancer cell lines are a mixture of several cell 

populations and should better mimic the 

tumour heterogeneity in vivo. For this reason, 

they are supposed to have better value as 

tumor models. 

In this study, we used a low passage 

primary brain tumour cell line derived from 

glioblastoma tumours, to analyze the effect of 

AG556 (a EGFR inhibitor) alone or in 

combination with Temozolmide (TMZ) (a 

common drug for brain cancer). Both AG556 

(1, 5 and 10μM) and TMZ (1 and 5μM) 

treatment, induced significant cytotoxic effect 

on glioblastoma cells in a dose- and time-

dependent manner. Dual treatment with 

AG556 and TMZ resulted in synergistic 

cytotoxicity at a frequency of 93%, when 

compared to single treatment. 

 

THE EMERGING ROLE OF ALTERNATIVE 

THERAPY IN TARGETING BRAIN 

TUMOURS 

Ligia Tătăranu2,3, Ştefana Oana Purcaru1,  

G. D. Mogoşanu1, Sandra Alice Buteică1,  

Ada Maria Georgescu1, Anica Dricu1* 
1University of Medicine and Pharmacy of Craiova, 

Romania 
2Emergency Hospital “Bagdasar–Arseni”, 

Department of Neurosurgery, Bucharest, Romania 
3“Carol Davila” University of Medicine and 

Pharmacy, Bucharest, Romania 

*Corresponding author e-mail: 

anica.dricu@live.co.uk, 

anica.dricu@webmail.umfcv.ro 

 

Recent studies have shown that more than 

50% of cancer patients use plant compounds 

for alternative and complementary therapies. 

Ligustrum vulgare hydroalcoholic extract 

(LHAE) is used for prevention or treatment of 

several diseases including cancer. 

The aim of this study was to investigate the 

effect of LHAE on the brain tumor cell 

viability. In the present study, we have 

analyzed the effect of LHAE alone and in 

combination with temozolomide (TMZ) or 

doxorubicin (DOXO) on four primary brain 

tumor cell lines in vitro. 

We found that LHAE displayed inhibition 

property against brain tumor cell lines 

including: glioblastoma (GB1B, GB2B, GB8B) 

and astrocytoma (AC1B). Depending on drug 

concentration, period of treatment, LHAE 

induced 40–60% cytotoxicity in glioblastoma 

cells and 60–80% cytotoxicity in low-grade 

astrocytoma cells. At the higher concentration 

used in this study (100 μL/mL), LHAE induced 

more pronounced cytotoxic effects than both 

DOXO and TMZ in all brain tumor cell lines 

analyzed. In general, cytotoxic drugs are 

proposed to act selectivity by targeting cells 

that proliferate rapidly. In our study, we found 

that low proliferative astrocytoma cells were 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         543 

 

 

 

 

 

 

 

more sensitive to single treatment compared 

to rapid proliferative glioblastoma cells. The 

treatment with LHAE failed to exhibit a real 

benefit when combining with a second agent 

TMZ or DOXO, except in the case of GB1B cell 

line where combinatorial treatment, resulted 

in synergistic response in 44% and additive 

response in 22% of the combinations. This 

study underlines the need for identification of 

new molecules able to kill brain tumor cells 

that would facilitate the development of better 

therapeutic approaches. 

 

INDOOR ENVIRONMENTAL QUALITY 

STUDY IN AN EMERGENCY HOSPITAL 

FROM BUCHAREST 

Ilinca Nastase1, Cristiana Croitoru1,  

Andreea Vartires1, Ligia Tătăranu2,3 
1Technical University of Civil Engineering 

Bucharest, CAMBI Research Centre 
2Emergency Hospital “Bagdasar–Arseni”, 

Department of Neurosurgery, Bucharest, Romania 
3“Carol Davila” University of Medicine and 

Pharmacy, Bucharest, Romania 

Email: ilinca.nastase@gmail.com 

 

INTRODUCTION: For the medical staff, 

the hospital is an ongoing environmental work 

space, while for the patients the hospital means 

a temporary space to be healed, before 

returning home. In this context, indoor 

microclimate conditions are perceived 

differently by the patients and the medical 

staff. 

METHODS:  Two types of questionnaires 

were used: for operating rooms and other 

areas, like wards and medical and non-medical 

offices. In parallel, measurements of IEQ most 

important parameters were performed in the 

analyzed building. 

RESULTS: The questions in this survey are 

mostly addressed to evaluate the indoor 

environmental quality and the implications on 

the medical activity. Regarding the air quality, 

it is perceived as low in some medical wards 

and relatively high in the operating zone. 

Measurements of air quality confirmed the 

results of the enquiry. Thermal comfort was 

found to be variable in function of the 

occupants’ activity level. Measured values of 

the Predicted Mean Vote and of the Draft Risk 

were confronted with data collected from 

questionnaires. 

CONCLUSIONS: As it can be observed, 

the survey results are partially in agreement 

with measurements of comfort. In both cases, 

we recorded disagreement between the various 

categories and the experienced comfort 

sensation. It follows the importance of finding 

new strategies for air distribution and 

ventilation in operating rooms: zonal 

ventilation and changing the conception of the 

perforated panels used laminar flow ceilings 

for instance. 

Acknowledgments: This work was 

supported by the grants of the Romanian 

National Authority for Scientific Research, 

CNCS – UEFISCDI, project number: PNII-

PT-PCCA-2011-3.2-1212. 

KEY WORDS: field survey, healthcare, 

indoor comfort. 

 

OUR EXPERIENCE IN A SERIES OF 57 

PATIENTS WITH COLLOID CYSTS OF 

THE THIRD VENTRICLE 

D. Paunescu1,2, M.R. Gorgan1,2, V. Ciubotaru1,  



 

 

 

 

 
544          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

Ligia Gabriela Tataranu1,2 
1Clinic of Neurosurgery, Emergency Clinical 

Hospital Bagdasar-Arseni, Bucharest, Romania 
2University of Medicine and Pharmacy “Carol 

Davila” Bucharest, Romania 

OBJECTIVE: A variety of surgical 

approaches have been described to access and 

remove colloid cysts. Endoscopic approaches 

are least invasive but are used especially in 

cases with 

ventriculomegaly. Transcallosal 

interhemispheric and transcortical approaches 

are typically reserved for patients with 

symptomatic or large asymptomatic cysts 

without any significant hydrocephalus. For 

selected cases ventriculoperitoneal shunt is an 

option. 

MATERIALS AND METHODS: We 

retrospectively analyzed the surgical outcome 

and complications of 57 patients with colloid 

cysts of the third ventricle operated at 

Bagdasar Arseni Emergency Hospital, 

Bucharest, between 2000 and 2014. A detailed 

pre- and post-operative neurological 

assessment was done in all patients. CT or IRM 

scan of the brain was done before and after 

surgery. 

RESULTS: An analysis was performed for 

resection rates, morbidity and mortality based 

on treatment strategy. A total of 32 patients 

were included in the microsurgical group and 

25 patients in the endoscopic group. The 

median maximal cyst diameter was 11.3 mm 

(range 5-37 mm) with no significant 

differences between the two groups. Total 

resection was achieved in 93.75% of the 

microsurgical group compared to 64% of 

endoscopic group (p < 0.001), but with higher 

morbidity in the first group (18.75% compared 

to 12%). The median hospital stay was 5 days 

for endoscopic group and 8 days for 

microsurgical one. There were no deaths 

related to the surgery. 

CONCLUSION: Microsurgical resection 

of colloid cysts is associated with a higher rate 

of complete resection but a higher morbidity 

rate than with endoscopic removal. With 

increasing experience, most of the 

complications are avoidable. 

KEY WORDS: Colloid cyst; third ventricle; 

complications; microsurgery; endoscopy. 

Acknowledgement: This paper was co-

financed from the European Social Fund, 

through the Sectorial Operational Programme 

Human Resources Development 2007-2013, 

project number POSDRU/159/1.5/S/138907 

“Excellence in scientific interdisciplinary 

research, doctoral and postdoctoral, in the 

economic, social and medical fields - 

EXCELIS”, coordinator The Bucharest 

University of Economic Studies. 

 

REPERFUSION SYNDROME IN EARLY 

CHILDHOOD – CASE REPORT 

A. Iordache2, Mihaela Cosman*,  

Alexandra Mihaila2 
1Emergency Hospital "N.Oblu" Iasi 
2University of Medicine and Pharmacy "Gr.T.Popa" 

Iasi 

 

Reperfusion syndrome in children is a rare 

situation. We present the case of 6 month old 

child who had fallen from his mother arms. He 

presented for complete motor deficit 72 hours 

after the traumatic event. We have operated 

him and immediately he improved his motor 



 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4: 504 – 546         545 

 

 

 

 

 

 

 

deficit and afterwards 6 - 12 hours postop he 

became again hemiplegic. We have performed 

angio CT scan which shows signs of 

reperfusion. 

We follow up the infant and he had a good 

clinical outcome although he maintained 

sequels on the CT scan. 

 

THE ROLE OF VIRTUAL ENDOSCOPY IN 

PLANNING ENDOSCOPIC 

TRANSSPHENOIDAL SURGERY FOR 

PITUITARY ADENOMAS 

D. Rotariu1, Z. Faiyad1, B. Iliescu1,2, A. Budu1,  

I. Poeata1,2 
1“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 
2“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 

 

OBJECTIVES: To realize and navigate the 

3D model from CTs of patients and compare 

them to the intraoperative endoscopic images. 

Design: Prospective observational study 

METHODS: The CTs of 15 patients 

proposed for endoscopic approach for 

pituitary adenoma werereconstructed using 

OsiriX (Pixmeo Sarl). Virtual endoscopy (VE) 

was performed prior surgery to assess the 

surgical corridor and particularanatomy. We 

evaluated the inferior and middle turbinate, 

sphenoid ostia (SO), choanal arch, 

sphenoethmoidal recess, sphenoid septa, 

sellarfossa, paraclival carotid prominences. 

The intraoperative endoscopic images were 

compared to the virtual images.  

RESULTS: The virtualimages had a good 

resemblance with the actual surgical images, 

all the structures from the nasal cavity were 

identified and had a perfectmatching except 

the SO which was identified in 8 cases in VE 

vs. 12 intraoperative. All the structures from 

the sphenoid sinus were identifiedwith perfect 

matching except the ipsilateral parcalival 

carotid (10 cases in VE vs. 5 intraoperative) 

The VE could not appreciate the state of 

thesellar floor in none of the cases. 

CONCLUSIONS: The preoperative 

knowledge of the nasal and sphenoid anatomy 

may generate benefits duringthe performance 

of surgeries, anyhow detailed information 

concerning the integrity of structures could 

not be offered by this technique and it offers 

no additional information in cases where the 

sphenoid sinus is fully occupied by tumor or 

not aerated. 

 

AWAKE CRANIOTOMY FOR ELOQUENT 

AREAS TUMORS – CASE REPORT 

M. Cosman1, A. Iordache1,2, G. Ion1, C. Apetrei1,  

A. Cucu1, A. Rotaru3, I. Poeata1,2 
1“Prof. Dr. N. Oblu” Clinical Emergency Hospital, 

Iasi, Romania 
2“Gr. T. Popa” University of Medicine and 

Pharmacy, Iasi, Romania 

 

Nowadays the role of brain tumors surgery 

is to maximize the tissue resection and to 

minimize the postoperative morbidity. 

Lesions located in eloquent area have a high 

risk for a neurological impairment. We 

present the case of a 31- years- old male 

admitted in our department with right-sided 

body hypoesthesia since one month associated 

with general seizures. MRI showed an 

infiltrative lesion located on the left temporo-

parietal region. Because the language area was 



 

 

 

 

 
546          Selected abstracts of the 40th Congress of the RSN 

 

 

 

 

 

 

 

trapped in the tumor and due to imagistic 

difficulty in specifying the involvement of the 

motor area we managed surgically this patient 

using the technique of awake craniotomy. The 

outcome was favorable with no neurological 

deficit. The histology was low grade glioma. 

Because remnant infiltrative part of the tumor 

exists on postop images, chemo and 

radiotherapy was applied. The patient has a 2 

years neurological free outcome until now and 

not imagistic modifications. We present this 

case together with pre/postop images; follow 

up images, histology, anesthesia for awake 

craniotomy protocol and treatment protocol. 

This method allows intraoperative brain 

mapping with identification and protection of 

functional cortex and it provides a good 

alternative for intraoperative functional 

monitoring in lesion located in eloquent areas.