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Meningiomas involving the spinal compartment are relatively rare compared to the intracranial ones representing between 7,5% and 12,5% of all CNS meningiomas, most of them being located in the intradural compartment respecting the pial layer of the spinal cord. Affecting ten times more often women rather than men, especially in the 5th and 6th decade of life, they pose a difficult diagnostic setting despite modern neuroimagistic techniques. The matter of correct differential diagnosis becomes even more doubtful, most of the patients of that age having also associative degenerative disorders, e.g. lumbar disc herniation. In this case proper neurological examination is the key as we will furthermore demonstrate - the MRI exam being targeted on the level of the sensorial dysfunction and not on the most common region which gives according pathology. The following case presentation can be considered "classic" representing a patient with all the criteria mentioned above including a long history of rheumatologic and chronic back pain medication for pain relief .We used the Frankel Scale for grading the pre- and postoperative neurological status. Acute neurological deterioration (under 24 hours) is an important criteria for admission in emergency unit with around the clock exploration followed by microsurgical operation for the best possible outcome. Coexisting chronic lesions may be left behind and kept under surveillance, operated only when clear signs of health disorder appear. Because there are reported cases of thoracic meningiomas discovered after hernia disc operation and even cases of paraplegia due to a missed lesion, the aim of this article is to emphasize the importance of proper neurological examination preceding any MRI exploration. [ABSTRACT FROM AUTHOR]

Brain metastases are the most common form of malignancy presence in the CNS having a more frequent appearance than primary brain tumors. Although secondary cerebellar tumors represent only 15% of all intracranial metastases, they are quite frequent among primary oncological patients and pose a challenge for all of the medical caretakers starting with the neurosurgeon. Among those, a small percent of patients have multiple cerebellar lesions and the therapeutic challenge turns into a medical controversy, especially when it comes to surgical treatment taking into consideration that the life expectancy is lower than one year. A key asset which we have on our side is the anatomical vicinity these lesions occur, this leading us to take into consideration eliminating as many lesions in one single operative time as possible without changing the position of the head during surgery. Based on a retrospective study which concluded that patients with resection of all lesions tend to have a longer life expectancy, and on modern concepts of risks and benefits of oncological surgery and surgery in general, we followed up on three patients presenting posterior and even multiple posterior fossa metastases, taking into consideration individual comorbidities, tumor aspects and the possibility/opportunity of surgical treatment. It turned out that surgery is a safe and effective treatment option and should not be considered harmful or aggressive especially because all of the patients which were under study had a favorable post-operative prognostic and an improved quality of life. We emphasize furthermore the importance of complete lesion resection in as few interventions as possible followed up by radiotherapy/chemotherapy as a key in prolonging these patients life expectancy taking into consideration that the outcome is directly related to the number of lesions rather to the location or volume of them. [ABSTRACT FROM AUTHOR]

Glioblastoma multiform is one of the most rapidly progressing cerebral tumors and the most aggressive one in our neurosurgical experience. We present the case of a 45 year old patient with very aggressive type of tumor who had come to our service for the following: intense headache, confusion, right hemiparesis installed approximately one month before. IRM scan shows up the presence of a large tumoral mass without a precise border in the left temporal-parietal region which had extended all the way down to the thalamus. The planned intervention used 5-aminolevulinic acid (5-ALA) for the precise removal of the tumor mass, suboptimal because of the risk of lesioning the motor tracts - indicated by the intraoperative electrophysiological monitoring. After surgery the outcome was good with the partial regression of the motor deficit, but only after 3 weeks due to the unexpected tumor growth the neurological status started to decay and even worsened. The patient underwent surgery again with the partial remission of the symptoms although following imagistic controls showed up fast tumor growth once more. He was recommended to oncology service for the beginning of radiotherapy. We consider the evolution and invasion of this tumor in only a 3 weeks period being impressive. [ABSTRACT FROM AUTHOR]