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Introduction: Primary intramedullary spinal cord lymphomas are extremely rare, occurring mainly in immune compromised patients. Case report: We report a case of a 43 years old patient admitted with spinal cord compression. Spinal MRI revealed two thoracic intramedullary tumours. The patients underwent surgery and we performed resection of both primary intramedullary tumours, with favourable neurological outcome. The histopathologic exam was non-Hodgkin lymphoma. The patient underwent adjuvant radiotherapy. Two months later the patient presented thoracic and cerebellar drop metastases, confirmed his to pathologically. Conclusions: The diagnosis of primary intramedullary spinal lymphoma must be kept in mind in patients with myelopathy. Surgery is needed to provide histo pathological samples for positive diagnosis and spinal decompression. Primary intramedullary spinal lymphomas have a propensity to disseminate along the neuraxis. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1-L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life-threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5-T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin-angiotensin-aldosterone activity, peripheral alpha-adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein thrombosis and long-term risk for coronary heart disease and systemic atherosclerosis are also described. Proper prophylaxis, including non-pharmacologic and pharmacological strategies, diminishes the occurrence of the vascular dysfunction following SCI. Each vascular disturbance requires a specific treatment. [ABSTRACT FROM AUTHOR]

The aim of this article is to analyze the effects of the molecular basis of vascular events following spinal cord injury and their contribution in pathogenesis. First of all, we reviewed the anatomy of spinal cord vessels. The pathophysiology of spinal cord injuries revealed two types of pathogenic mechanisms. The primary event, the mechanic trauma, results in a disruption of neural and vascular structures into the spinal cord. It is followed by secondary pathogenesis that leads to the progression of the initial lesion. We reviewed vascular responses following spinal cord injury, focusing on both primary and secondary events. The intraparenchymal hemorrhage is a direct consequence of trauma; it has a typical pattern of distribution into the contused spinal cord, inside the gray matter and, it is radially extended into the white matter. The intraparenchymal hemorrhage is restricted to the dorsal columns, into adjacent rostral and caudal spinal segments. Distribution of chronic lesions overlaps the pattern of the early intraparenchymal hemorrhage. We described the mechanisms of action, role, induction and distribution of the heme oxygenase isoenzymes 1 and 2. Posttraumatic inflammatory response contributes to secondary pathogenesis. We analyzed the types of cells participating in the inflammatory response, the moment of appearance after the injury, the decrease in number, and the nature of their actions. The disruption of the blood-spinal cord barrier is biphasic. It exposes the spinal cord to inflammatory cells and to toxic effects of other molecules. Endothelin 1 mediates oxidative stress into the spinal cord through the modulation of spinal cord blood flow. The role of matrix metalloproteinases in blood-spinal cord barrier disruption, inflammation, and angiogenesis are reviewed. [ABSTRACT FROM AUTHOR]

The aim of this study is the evaluation of laparoscopic treatment in abdominal complications following ventriculoperitoneal (VP) shunt. Methods: We report a retrospective study including 17 patients with abdominal complications secondary to VP shunt for hydrocephalus, laparoscopically treated in our department, between 2000 and 2007. Results: Patients' age ranged from 1 to 72 years old (mean age 25.8 years old). Male: female ratio was 1.4. Abdominal complications encountered were: shunt disconnection with intraperitoneal distal catheter migration 47.05% (8/17), infections 23.52% (4/17) such as abscesses and peritonitis, pseudocysts 11.76% (2/17), CSF ascites 5.88% (1/17), inguinal hernia 5.88% (1/17), and shunt malfunction due to excessive length of intraperitoneal tube 5.88% (1/17). Free-disease interval varies from 1 day to 21 years, depending on the type of complication, short in peritoneal irritation syndrome and abscesses (days) and long in ascites, pseudocysts (months-years). Laparoscopic treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the tube in shunt malfunction due to excessive length of intraperitoneal tube and hernioraphy. One diagnostic laparoscopy was performed in a peritoneal irritation syndrome, which found only CSF ascites. There were no conversions to open surgery. The overall mortality was of 5.88% and postoperative morbidity was of 11.76%. In 7 patients operated for abscesses, peritonitis, pseudocysts, and CSF ascites the shunting system was converted in to a ventriculocardiac shunt. Conclusions: Abdominal complication following VP shunt can be successfully performed laparoscopically. Abdominal surgery required, in selected cases, the repositioning of the distal catheter, frequently as a ventriculocardiac shunt. There are abdominal complications with no indication of surgery, like peritoneal irritation syndrome and CSF ascites. Free-disease interval varies from days (peritoneal irritation syndrome, abscesses) to month-years (pseudocyst, ascites), according to type of complication. [ABSTRACT FROM AUTHOR]

OBJECTIVES Lumbar spinal stenosis is a common degenerative disease, most frequently encountered in the elderly. Lumbar stenosis is a progressive and dynamic process and is characterized by narrowing of the spinal canal due to multifactorial degenerative factors. Spinal stenosis leads to neurological deficits, severely impairing quality of life and requires surgical treatment. MATERIALS AND METHODS We performed a retrospective study including 560 consecutive patients with neurogenic claudication and back pain operated for central lumbar stenosis, in the Fourth Department of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni Bucharest, over a 5-year time period, from June 2014 to June 2019. 59,4% were female and 40,6% were male. Mean age was 66 years old. All patients were clinically and radiologically tested for instability with flexion-extension x-rays. All patients underwent unilateral laminectomy with bilateral spinal canal decompression. RESULTS Of the 560 patients included in our study all were considered "stable". All patients were operated using the unilateral transmedian subspinous approach with bilateral spinal canal decompression. 44.6% of patients were treated for multiple level stenosis. 55.4% were treated for single level stenosis. Postoperative check-ups did not reveal instability syndrome in any patient. Symptom remission was noted in 95.3% of cases. 4.7% of patients had reminiscent back pain that subsided with bed rest. CONCLUSIONS Lumbar stenosis requires surgical treatment. Quality of life is influenced by number of levels involved, pre-operative duration of symptoms, associated spinal pathology and surgical technique. The great majority of patients operated using unilateral laminectomy with bilateral spinal canal decompression experienced favorable results and symptom remission. Destabilization syndrome din not occur in any cases using this surgical technique. [ABSTRACT FROM AUTHOR]

OBJECTIVES Cholesteatomas are benign well-circumscribed tumours formed by the progressive desquamation of a keratinizing stratified squamous epithelium inside a capsule. Their histopathologic aspect is the one of an epidermoid cyst, suggestively named "pearly tumour". It is a very rare tumour with many controversies surrounding it. Although it usually develops within the skull diploe, sometimes it can erode the inner cortical bone and cause mass effect, seizures or venous sinus obstruction. A patient with this kind of lesion is also at risk of developing serious complications such as brain abscesses or aseptic meningitis. Most of these tumours are found in the middle ear and/or mastoid process, while some of them may extend to the skull base from the mastoid. Cholesteatomas with other locations are very rare. MATERIALS AND METHODS We present the very rare case of a giant cholesteatoma located in the left temporal, frontal and parietal bone. RESULTS A 66-years old male was admitted to our clinic for a soft consistency tumour, located in the left parietal bone. The patient's medical history only mentioned hypertension and diabetes. The neurological examination was normal. We performed a gadolinium-enhanced MRI which indicated a massive frontotemporo- parietal extranevraxial tumor arising from the calvaria. The lesion was gadolinophilic, with cystic and tissue components, compressive on the left hemisphere, causing a 17 mm median line shift. The patient was operated and complete resection of the tumor was achieved by a fronto-temporo-parietal craniotomy. Once the craniotomy was performed, a mixed consistency epidural tumor measuring 13/13 cm was revealed, located in the concavity of the bone flap. The dura mater was not infiltrated. The histopathological examination indicated a cholesteatoma. There were no postoperative complications. Extensive imagistic examinations revealed no other cholesteatomas. CONCLUSIONS Cholesteatomas are rare, benign brain tumours. Even though cholesteatomas more frequently occur in the middle ear and skull base, sometimes locations can be surprising. Complete resection is the treatment of choice and it assures cure of the disease. [ABSTRACT FROM AUTHOR]

OBJECTIVES Almost 20% of all carcinomas of unknown primary site are classified as high grade tumours. With a wide variety of neoplasms being able to metastasize to the skull, the present histopathologic diagnostic techniques are not enough to clearly indicate the primary tumour. Skull metastases are diagnosed in 15-20% of all cancer patients. MATERIALS AND METHODS We report a case of very large multiple metastases in the skull of a 60 years old male patient with no medical history of neoplasms. RESULTS A 60-years old male is admitted to the hospital presenting two cranial tumours, the first of which located parieto-occipital on the right side and the second one frontal on the left side. The neurological examination was normal. We performed investigations that indicated two large osteolytic lesions. The right parieto-occipital one measured 71/73/18 mm and the left frontal one 95/30/17 mm. The frontal tumour was excised during the first surgical intervention, leaving a large bony defect. The dura mater was extremely infiltrated; thus, the lesion was dissected as much as possible while leaving the dura in place. The histopathological examination indicated a poorly differentiated carcinoma metastasis (high grade carcinoma). The right parietooccipital lesion was resected during a second surgical intervention, three weeks after the first one. After removing the tumoral mass, the dura mater appeared infiltrated, similar with the previous intervention. The histopathological examination result was the same with the first one, positive for poorly differentiated carcinoma metastasis. The patient was evaluated with a thoracic CT scan looking for a primary lesion. This investigation revealed a right hilar broncho-pulmonary lesion, most likely the primary tumour that metastasized to the skull. There were no postoperative complications and the patient was referred to an Oncology Hospital and also to the Thoracic Surgery Department. CONCLUSIONS Skull metastases are usually asymptomatic and may sometimes be the first or the only evidence of the malignancy. Positive diagnosis of skull metastases requires extensive examination in order to find the primary tumours. Brain metastases require multimodal treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVES Spinal meningiomas are extramedullary subdural benign tumours with a slow growing rate that arise from the dura mater. Spinal meningiomas account for 39% from all spine tumours. Typically, the first symptoms include radicular compression and, if left untreated, can lead to spinal cord compression. Their most frequent location is the thoracic segment, followed by the cervical one. MATERIALS AND METHODS We retrospectively analysed the records of consecutive patients with cervico-thoracic meningiomas which underwent surgery in The Fourth Department of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni, Bucharest, between January 2009 and December 2018. The aim of this study is to assess clinical features, surgical management and outcome of patients operated for cervico-thoracic meningiomas. RESULTS Fifty-six patients underwent surgery for cervico-thoracic meningiomas. Patients included in the study had a median age of 64 years (varying from 28 to 84 years old) and the majority of patients were females (47 - 83.9%). The most frequent location was the thoracic spine (39 - 69.6%). Gross total resection was achieved in all cases. One patient (1.8%) developed a postoperative hematoma that required reoperation and one patient a CSF fistula (1.8%). CONCLUSIONS Surgical management is mandatory for spinal cord meningiomas, being the only treatment capable to improve the functional outcome and cure the patient. Careful microdissection is needed in order to achieve good results and the outcome is influenced by their position in the axial plane and extent of resection. Following surgery, early mobilization and neuromuscular rehabilitation therapy are recommended for a quick recovery and a good functional outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVES Brain metastases occur in advanced cancer patients and account for more than half of intracranial tumours in adults. Brain metastases require multimodal treatment. Prognosis is generally poor with low survival rate. MATERIALS AND METHODS We performed a retrospective study including patients with brain metastases operated, in two neurosurgical departments (Third and Fourth Departments of Neurosurgery), from Emergency Clinical Hospital Bagdasar-Arseni Bucharest, from January 2009 to December 2018. The aim of this study is to identify prognostic factors associated with survival rate. RESULTS A total number of 674 patients underwent surgery for brain metastases, over a period of time 10 years. Mean age at the time of diagnosis was 57 years and median age was 59 years. 63.4% were males and 36.6% females. The most common symptoms were intracranial hypertension in 39.1% cases, right hemiparesis 30.7% cases, aphasia 8.74%, left hemiparesis 7.7%, ataxia 5.8%, vertigo 2.56% and tonico-clonical seizures in 2.2% of patients. 46.8% of patients had no medical history of cancer. The most frequent location of primary tumour was pulmonary in 54.7% cases, followed by breast cancer in 22.6% and renal cancer in 5.7%. 22.8% of cases had multiple lesions. 26.2% of tumours were found in the right frontal lobe, 14.7% in the left frontal lobe, 11.47% parietal on left, 8.19% parietal on right, 4.9% in vermis. Total resection was obtained in 91.6% cases, subtotal resection in 1.5% and near total resection in 3%. Histopathological exam showed differentiated carcinoma in 52.38%, 23.8% adenocarcinoma, 19% low differentiated carcinoma, anaplastic carcinoma in 1.3% cases and melanoma metastases in 3.4. The outcome was favourable in 97% of patients and 3% were deceased.9.77% of patients also underwent gamma knife radiosurgery. During the long-term follow-up 5.2% of patients presented tumour recurrences and from these patients 85.7% of the recurrent tumours were resected and 14.3% benefit from gamma knife radiosurgery, with good outcome. CONCLUSIONS Survival in patients with brain metastases is poor. Survival rate is positively correlated with primary cancer site, primary cancer control, higher Karnofsky score at admission, location, number of cerebral metastases, rate of resection, leptomeningeal invasion and adjuvant oncologic treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVES Gliomas are the most common primary intracranial tumours. The incidence of brain gliomas is 5.9/100,000 and account for 27% of all brain tumours. More than half are high grade tumours, with poor prognosis and short survival. Surgery is the treatment of choice in gliomas, and high-grade gliomas also require adjuvant therapy. MATERIALS AND METHODS We performed a retrospective study including patients with gliomas operated, in two neurosurgical departments (Third and Fourth Departments of Neurosurgery), from Emergency Clinical Hospital Bagdasar-Arseni Bucharest, from January 2009 to December 2018. The aim of this study is to assess functional outcome, quality of life and survival, according to extent of resection. RESULTS A total number of 1580 patients with brain gliomas underwent surgery over a period of time of 10 years. Mean age was 52.9 years and 56.3% of patients were males. 542(34.30%) patients had low-grade or anaplastic astrocytomas, 310(19.62%) patients had oligoastrocytomas or oligodendrogliomas and 728(46.08%) patients had glioblastomas. Gross total resection was achieved in 1107 (70.06%), near total resection in 213 patients (13.48%), subtotal resection in 62 cases (3.92%) and biopsy was performed in 198 cases (12.53%). Postoperative Karnofsky score improved in 86.65% of patients, remained unchanged in 8.35% and decreased in 5% of cases. 420 patients were operated for recurrences. CONCLUSIONS Extent of resection depends on size and anatomic location of the tumour. Survival is highly influenced by glioma grade, extent of resection, preoperative Karnofsky score, location and tumour size. Functional outcome and quality of life is influenced by tumour location, extent of resection, preoperative Karnofsky score and postoperative complications. [ABSTRACT FROM AUTHOR]

OBJECTIVES Spondylolisthesis is a degenerative disease, characterized by forward slippage of a lumbar vertebra on the vertebral body below. Treatment of degenerative spondylolisthesis is still controversial. Vertebral instability is sometimes associated with degenerative spndylolisthesis which is why the surgical treatment with vertebral fixation still needs careful consideration. MATERIALS AND METHODS We performed a retrospective study including patients with operated degenerative spondylolisthesis from Fourth Departments of Neurosurgery), Emergency Clinical Hospital Bagdasar-Arseni Bucharest, from January 2014 to December 2018. The aim of this study is to assess postoperative results of two main surgical techniques, posterior decompression of neural elements alone and decompression followed by spinal stabilization +/- fusion. RESULTS A total number of 560 patients were operated for spondylolisthesis over a 5-year time period. Male/female ratio was 1.2. All patients underwent functional examination using radiography of the spine, lumbar region (flexion/extension) and were categorized in two main groups: patients with vertebral column instability and patients with vertebral column stability. 24% patients had decompression only and 76% of patients had decompression plus stabilization, of which 15% with fusion. Both surgical techniques were associated with favourable outcome, pain relief and neurological improvement. Early mobilization was possible in 80% of cases, most of these patients belonging to the decompression and spinal stabilization group. CONCLUSIONS Surgery is the treatment of choice in patients with symptomatic spondylolisthesis. Outcome is dependent on surgical technique. Decompression plus stabilization permits early mobilization of patients and is associated with shorter hospitalization. [ABSTRACT FROM AUTHOR]

OBJECTIVES Cavernomas are rare, well circumscribed and benign, angiographically occult, low-flow vascular malformations, composed of irregular sinusoidal vascular channels, lacking smooth muscle and elastic fibers. Brain cavernomas account for 10-25% of all brain vascular abnormalities and 75% of them are located in the supratentorial space. They usually present with an acute onset represented by seizures and headache. Most of these lesions are deeply-seated inside brain parenchyma and have a slow growth-rate before diagnosis, marked by multiple subclinical bleeding episodes. Given their small diameter and deep location, the intraoperative localization and surgical resection represents a challenge in most cases of cavernomas. MATERIALS AND METHODS We retrospectively reviewed the case files of patients with supratentorial cavernomas who underwent surgery between January 2001 and December 2018 in the IVth Neurosurgery Department in "Bagdasar-Arseni" Clinical Emergency Hospital. RESULTS The inclusion criteria (surgical resection, supratentorial cavernomas) were met by 127 patients, of which 82 (64.6%) were male. The mean age (±SD) was 41.2 (±13.5) years. On admission, 80 (63%) patients presented seizures, 75 (59%) headache, 23 (18.1%) motor deficits, 24 (19.7%) sensory deficits. Forty-six patients (36.2%) presented with haemorrhage from the cavernoma on admission. For deep-seated lesions, the surgical resection was guided by intraoperative neuronavigation combined with 3D ultrasound. Patients with lesions situated in eloquent areas underwent preoperative brain mapping using navigated transcranial magnetic stimulation. Complete surgical resection was performed in all cases. Forty-seven patients (58.8% - 47/80) were seizure-free at follow-up and 33 patients (41.2% - 33/80) presented low frequency pattern of seizures, fully controlled with antiepileptic medication. CONCLUSIONS Microsurgery is the only curative treatment for intracranial cavernomas. The objective of surgery is gross total resection including the resection of the hemosiderin ring, in order to achieve an efficient seizure control, while avoiding secondary neurological deficits. [ABSTRACT FROM AUTHOR]

Introduction. Communication with family members may contribute to adaptation to the psychological stress to the disease. Materials and methods. We studied a case of a woman with terminalstage brain glioblastoma. The case particularity was the blockage of communication with the patient's family. The study was conducted by questionnaires and direct observation, trying to identify causes, effects and solutions to this situation. Results. The medical staff proved to be, in 93.75%, fully interested in the care provided to the patient, 68.75% with empathetic attitude towards her. The most important factor that led to communication blockage was the patient's family; the main stress factor in the activity of the department was identified to be the attitude of the patient's husband. Conclusions. Communication within the palliative care team should be based on mutual respect, trust and truth. Communication gap affects equally the central element of the team (the patient) and other members (family, medical staff). [ABSTRACT FROM AUTHOR]

The aim of this article is to analyze cardiac dysfunctions occurring after spinal cord injury (SCI). Cardiac dysfunctions are common complications following SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. We reviewed epidemiology of cardiac disturbances after SCI, and neuroanatomy and pathophysiology of autonomic nervous system, sympathetic and parasympathetic. SCI causes disruption of descendent pathways from central control centers to spinal sympathetic neurons, originating into intermediolateral nuclei of T1-L2 spinal cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant cardiac dysfunction. Impairment of autonomic nervous control system, mostly in patients with cervical or high thoracic SCI, causes cardiac dysrrhythmias, especially bradycardia and, rarely, cardiac arrest, or tachyarrhytmias and hypotension. Specific complication dependent on the period of time after trauma like spinal shock and autonomic dysreflexia are also reviewed. Spinal shock occurs during the acute phase following SCI and is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe bradycardia and hypotension. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life-threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5-T6). Besides all this, additional cardiac complications, such as cardiac deconditioning and coronary heart disease may also occur. Proper prophylaxis, including nonpharmacologic and pharmacological strategies and cardiac rehabilitation diminish occurrence of the cardiac dysfunction following SCI. Each type of cardiac disturbance requires specific treatment.

Cranial traumas have different particularities in infants, toddlers, preschool child, school child and teenagers. The assessment of these cases must be individualized according to age. It is completely different in children that in adults. Trauma scales, very useful in grading the severity and predicting outcome in traumatic brain injury, used in adults must be adapted in children. Children have age-related specificity and anatomic particularities, for each of this period of development. Neurotrauma scales, specific for infants and children, such as Pediatric Coma Scale, Children's Coma Score, Trauma Infant Neurological Score, Glasgow Coma Scale, Liege Scale are reviewed, as well as neurotrauma outcome scales, like Glasgow Outcome Scale, modified Rankin score, KOSCHI score and Barthel Index. The authors present these scales in an exhaustive manner for thoroughgoing pediatric neurotrauma standards.