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The stent-assisted coiling technique is more and more used for the anterior communicating aneurysms (AcomA) treatment due to the increasing incidence of complex and wide-necked aneurysms at this level. Different arrangements of a single stent for assisted coil embolization have been described. The transverse-configuration from A1-Acom-Contralateral A1 stent-assisted coiling procedure was previously reported as a feasible, effective, and relatively safe endovascular technique used to treat wide-necked complex AcomA aneurysms. In this article, we presented a technique involving transverse stenting through the AcomA via the dominant A1 and discuss some particular technical difficulties.

The advancement of intracranial stent technology and techniques has extended the applications of endovascular coiling methods for complex intracranial aneurysms. Coiling of wide-necked and complex bifurcation aneurysms usually requires double stent implantation. Different configurations for double stent-assisted coil embolization have been described. The T-configuration stent-assisted coiling procedure was recently described as a feasible, effective, and relatively safe endovascular technique used to treat wide-necked complex bifurcation aneurysms. In this article, we present the successful management of a complex wide-neck basilar tip aneurysm using a slightly modified T-configuration stent-assisted coiling technique.

Migration of coils represents one of the most challenging complications of endovascular management of cerebral aneurysms with a potentially catastrophic result. In this article, we present the successful management of a coil migration during the endovascular occlusion of an anterior communicating artery aneurysm. A stent fixation technique was used with good vascular repermeabilisation. The reported frequency, risk factors and management strategies are also discussed.

Although endovascular coiling treatment has been widely accepted as the method of choice for intracranial aneurysms, concerns about its durability are still discussed. Attention was largely focused on aneurysm recurrence after coil occlusion with possible unfavourable evolution to a new bleeding episode. We present our experience of a patient with a ruptured anterior communicating artery aneurysm previously treated by endovascular coil embolization that presented over a 4-year period for aneurysm recurrence.

The stent-assisted coil-jailing technique was initially introduced as an effective and secure method in the treatment of large wide-necked intracranial aneurysms. Later on, this technique has proved its efficiency in the safety and optimal treatment of very small aneurysms. In this article, we will present the successful treatment of a very small middle cerebral artery aneurysm using the stent-assisted coil-jailing technique and review the current trends in this type of treatment.

Surgical management of bilateral middle cerebral artery (MCA) aneurysms is particular challenging clinical situation. For these patients various options of surgical treatment are available as unilateral approach, single stage bilateral craniotomy or two stage bilateral craniotomy. We report our experience with a case of bilateral MCA aneurysm which was managed by single stage bilateral pterional craniotomy.

Acute Ischemic stroke in young patients has been increasingly diagnosed with the development of neuroimaging technique. Early endovascular treatment can lead to significant improved functional outcome. We present a case of 19-years old boy with acute ischemic stroke by distal middle cerebral artery occlusion. A selective thrombus aspiration with Penumbra system was performed. Satisfactory recanalization was achieved with significant recovery of the patient.

Treatment of giant thrombosed aneurysm is still a challenge for most of neurosurgeons. We present our experience of a patient with a thrombosed giant middle cerebral artery aneurysm manifesting as headache that developed over a 15-year period. Magnetic resonance (MR), computed tomographic angiography (CTA), and digital subtraction angiography (DSA) have clarified the vascular lesion and directed the therapeutic protocol. An open craniotomy with direct clipping and thrombectomy was performed successfully with an uneventful postoperative course.

Spontaneous dissecting aneurysm of vertebral artery is known as a rare pathological condition causing a subarachnoid hemorrhage in the posterior circulation. The treatment of ruptured vertebral artery dissecting aneurysms is still an important subject of debates in the literature. We present a particular case of ruptured vertebral artery dissecting aneurysms that was treated by only endovascular Guglielmi detachable coils occlusion. A brief review of technical possibilities of treatment of these types of vascular lesions, with their advantages and disadvantages are discussed.

The cerebral vasospasm is still considered the most devastating complication for the patients with aneurysmal subarachnoid haemorrhage. The aim of this study was to evaluate the efficiency of intra-arterial nimodipine administration in cerebral vasospasm diminutions and outcome of the patients.

Asymptomatic associated intracranial lesions are more frequently diagnosed with the utilization of high-resolution imaging. The occurrence of brain tumors together with intracranial aneurysms are a very rare situation. This coexistence is still a diagnostic and therapeutic challenge as no consensus concerning imaging that may cover both type of intracranial lesion was established. We report a case of a 62 years old patient with a meningioma and aneurysm treated in one session with good outcome.

Vertebral body reconstruction after corpectomy using expandable cage has become a common surgical procedure especially at thoracic level. The recent published papers describe the successful use of expandable cages for cervical vertebral body reconstruction. In this paper we present our first experience with expandable cervical cage in the reconstruction of the cervical spine in a patient with cervical spondylotic myelopathy (CSM).

Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies

Traumatic intracranial aneurysms are rare conditions that can be a result of vast head trauma. Different aspects as history, etiology, histopathology, clinical manifestations, diagnosis and treatment options are discussed regarding the literature. A particular case of a pericalosal aneurysm is presented to highlight the importance of keeping in mind that this location can be a site of such aneurysms.

Carotid artery stenting becomes first intention treatment in atheromatous carotis artery stenosis. In this article we present our first experience in carotid artery stentig on 27 consecutive patients. Demographic, clinic and angiographic dates are retrospectively review and technical success rate and postprocedural complication are statistically compared with literature trial studies.

Objectives: Pituitary adenoma represents the most frequent tumour encountered in the sellar region. We have proposed to review the principles of diagnosis and treatments and to analyze their standard protocol of approaching pituitary lesions. Material and method: We have retrospectively analyzed the cases of pituitary adenoma between Jan 2006 and Dec 2010, we studied presenting symptoms, hormonal status, local extension, surgical approach, tumor histology, type of resection, tumor volume, cavernous sinus invasion, surgical corridors, recurrence rate, intra operative and postoperative complications Results: 72 patients were included in the study, with no significant difference between sexes, the pathology was dominated by pituitary macro adenomas in 47 cases, regarding the hormonal status 51.3% were non secreting pituitary adenomas, the rate of operability in our series was 65.2%, the surgical indication has been given mainly by the hormonal status and involvement of the optic apparatus which in our series was 51%, the invasion of the cavernous sinus has been appreciated according the Knosp criteria (7) and grade 3 and 4 was present in 44% of the cases. The most used surgical approach was the pterional approach in 83% and the remaining 17% by the transsphenoidal approach. The most frequent surgical corridor was represented by the prechiasmatic route in 54%, gross total resection was achieved in 51%. The most frequent postoperative complication encountered in our series was represented from systemic complication the meningitis 13%, as for endocrine complication it was represented by transitory diabetes insipidus in 23.4% and SIADH in 4.2% (2 cases). The follow up at 3 months showed no cases of early recurrence, from the group of patient with STR 6 were sent to radiotherapy. The follow up at 1 year has comprised 3 deaths, 3 cases of hydrocephalus treated with ventriculoperitoneal derivation, 19 cases were with no imagistic or clinical symptoms of tumour and 22 presented with imagistic evidence of stable residual tumour with no clinical symptoms. Conclusions: The main surgical indication in pituitary adenomas is represented by the secreting hormonal status of the patient (excepting prolactin secreting tumours) and the impairment of the vision. The most frequent surgical approach was represented by the transcranial (pterional) approach due to the large dimensions and invasiveness of the tumours presented in our series but also the surgical team preference (in the absence of intracranial endoscopy at those times).

Coexistence of a ruptured intracranial aneurysm with an internal carotid arteries carotid artery occlusion, a contralateral internal carotid artery stenoses and a intracranial venous angioma is infrequent and it suppose a complicate diagnosis and therapeutic management of either disease. We report a case who underwent a first successful microsurgical clipping of the intracranial aneurysm followed by a right carotid artery angioplasty with stenting after two months.

Background: Diffuse infiltrative low-grade gliomas (LGG) of the cerebral hemispheres in the adult are tumors with distinct clinical, histological and molecular characteristics. WHO (World Health Organization) classification recognizes grade II astrocytomas, oligodendrogliomas and oligoastrocytomas. Conventional MRI is used for differential diagnosis, guiding surgery, planning radiotherapy and monitoring treatment response. Advanced imaging techniques are increasing the diagnostic accuracy. Low-grade gliomas have been documented to undergo transformation into high-grade gliomas, and the time interval of this transformation has been reported to generally occur within 5 years in about 50% of patients diagnosed with low-grade gliomas. Methods: We have reviewed all adult patients operated on for hemispheric glioblastoma at N Oblu Hospital in Iasi between 2006 and 2009 and in particular those patients with secondary glioblastoma. Results: from the total 110 cases of glioblastoma, ten of them were secondary to malignant transformation of an previously operated low grade glioma. Of the 10 patients with secondary glioblastoma, the initial histology was: gr II astocytoma in 6 cases, oligoastocytoma in 2 cases and in oligodendroglioma in 2 cases. The mean patient age was 46.1± 0.9 years and the most frequent symptom was represented by seizures 70%, the mean time from the first symptom to diagnosis was 11,2 months. 40% of the cases had subtotal resection and 60% had total resection (defined by the surgeon at the time of operation). 5 patients received radiotherapy postoperatively, 2 received both radio and chemotherapy and 3 had no adjuvant treatment. In our series the median time to malignant transformation was 32,5 months. Conclusions: Younger age, normal neurological examination and oligodendroglial histology are favorable prognostic factors, total/near total resection can improve seizure control, progression-free and overall survival, mean while reducing the risk of malignant transformation. Early post-operative radiotherapy improves progression free but not overall survival. Chemotherapy can be useful both at recurrence after radiotherapy and as initial treatment after surgery to delay the risk of late neurotoxicity from large-field radiotherapy.

Conjunctival malignant melanoma is a rare tumor with a high risk of local recurrence, lymph node and systemic metastases. The aim of this study was to correlate tumor thickness, tumor ulceration, high mitotic rate, epithelioid cells with the presence of metastases and death from conjunctival malignant melanoma. We report the case of a 33-year-old patient who presented with a left eyelid ptosis associated with an eyelid prominence, foreign body sensation in the eye, and bloody discharge, symptoms occurring about one month earlier. Ophthalmologic examination revealed in eyelid conjunctiva two vegetant and ulcerative tumors of 8/6 mm and 3/3 mm. The two tumors were surgically removed with safety margins. The diagnosis of amelanotic malignant melanoma of the conjunctiva with brain metastasis was made by routine morphological methods and immunohistochemical reactions (HMB45, vimentin, S100 protein). Systemic metastases (skin, brain, lung, liver, kidney, peritoneal) and peripancreatic lymph node metastases were detected at 1.9 years after the diagnosis of conjunctival malignant melanoma. The patient died three months after the surgical excision of brain metastasis. Early diagnosis is essential to prevent tumor recurrence, ocular invasion, systemic and lymph node metastases, and preserving visual function.