bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS
Authors: Matei Claudiu , Filip Dan , Dancu Iulia , Nistor Sofia , Gherman Joseph 
Published: November 2024

Introduction
Thalamus is a high eloquent brain region, because it contains important relay nucleus and is surrounded by vital neural and vascular structures. Cavernous malformations involving deep structures such as the basal ganglia and thalamus account for 5–10% of all cerebral cavernomas and can cause devastating neurological deficits. Surgical approach to thalamic cavernomas is associated with risks of new or worsening neurologic deficits. The benefit of surgery must be carefully weighed on an individualized basis. There are several surgical routes that can be used to approach thalamic lesions, mainly transcortical and interhemispheric approaches. A particular approach should be selected based on the location of the cavernoma in the thalamus to minimize lesion of the unaffected brain.

Methods
We present the case of a 43-year-old right-handed lady with right bleeding posterolateral thalamic cavernoma, admitted to the neurosurgery department of Sibiu MedLife Polisano Hospital in February 2024. The patient underwent surgery, through a transcortical trans-sulcal para-fascicular, navigation guided approach. Preoperative tractography imaging, tubular cerebral corridor retractor system and intraoperative monitoring of the cortico-spinal tract, through motor evoked potentials (transcortical, cortical and subcortical mapping) and of the spinotahamic tract through somatosensory evoked potentials were used. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day.

Conclusions
Thalamus is a complex structure located in a deep brain area and surgery for these region carries high risks, so the surgeon must carefully tailor these patients. The transcortical transsulcal para-fascicular approach is feasible and safe using the cerebral tubular corridor, neuronavigation and neuromonitoring. Advanced surgical technology offers the advantages of minimizing the risks of new neurological deficits.
GIANT LUMBO-SACRAL TUMORS
Authors: Moreanu Mihai-Stelian , Zamfir Ovidiu , Chirtes Alin-Vasile , Dima Augustin , Mitrica Marian 
Published: November 2024

Objectives
Despite comprising just 8% of all spinal tumors, sacral tumors present a long list of issues that should be taken in consideration when neurosurgical approach is tempted. Their unique anatomic location, close relation with neural structures and pelvic organs and high-vascularity are just a few nuances of these type of conditions. This paper outline the importance of a good preoperative and intraoperative management in order to facilitate the maximum recovery of the patients.

Material and Methods
This paper analyses retrospectively a series of 2 cases of giant sacral tumors (>100 cm3) that were operated in our clinic in 2024 by a multidisciplinary team (neurosurgeons and general surgeons). Follow-up data were obtained from the charts and medical records. All the lesions were localised under L4 vertebra with invasion of sacrum.

Results
Our first case was a 47-years old man who accused diffuse mild lumbar pain for more than 2 years, but acutely aggravated in the last months with lumbosacral radicular pain, palsy of the inferior lumbar nerves, urinary incontinence and paraesthesia. MRI showed a giant L5-S2 mass and biopsy diagnostic was myxopapillary ependymoma. Second case was of a young woman with lumbosacral radicular pain debuted a few months ago, whose clinical state worsened rapidly becoming paralytic of lower limbs. MRI showed a giant sacral mass with invasion of the pelvic musculature and surrounding the iliac vessels (intraoperative aspect: sarcoma). Both patients ameliorated postoperatively, and are currently enrolled in a recovery program. Sub-total resection and near-total resection were obtained.

Conclusions
Sacral tumors exhibit a challenge in the field of spine surgery being clinical silence over a period of months and years, and then followed by gross deficit. We diagnosed sacral tumors based on clinical, radiographic and laboratory aspects. Prognostic factors were preoperative clinical status and gross-total resection.
GAMMA KNIFE RADIOSURGERY
Authors: Perin Radu Daniel , Stoica Fery , Neamtu Daniela 
Published: November 2024

Purpose
In the treatment of nasopharyngeal carcinomas, a multimodal approach is always needed. The present study attempts to show the necessity and role of Gamma Knife Stereotactic Radiosurgery in the treatment of this kind of tumors.

Material and Methods
In this retrospective study, 34 patients were included. All had been previously treated with fractionate radiotherapy, but had local or intracranial recurrence at the time of the Gamma Knife treatment. The patients were treated in the Radiotherapy Laboratory of the Emergency Clinical Hospital “Bagdasar-Arseni”, between 2004 and 2024, initially using a Gamma Knife 4C device, then a Perfection and lately an Esprit model. The purpose of the treatments was total tumor destruction, but also, in a significant number of cases the treatment of debilitating symptoms: epistaxis, secondary trigeminal neuralgia, and oculomotor nerve palsies.

Results and Conclusions
The Gamma Knife treatment determined a significant prolongation of the life span and an improvement in the quality of life, without the occurrence of a significant number of complications. This treatment remains a palliative method, applicable only in selected cases, yet we consider that the number of Gamma Knife treated patients is very small, compared with the general incidence of this disease.
A CASE SERIES OF NINE PATIENTS WITH SPINAL CORD HEMANGIOBLASTOMA
Authors: Pirlea Andrei Daniel , Preda Alexandru-Cristian , Batca Severina Andreea , Catana Marius Constantin 
Published: November 2024

Background
Hemangioblastomas are defined as benign vascular tumors, being located almost exclusively in the cerebellum, brainstem and spinal cord. Spinal cord hemangioblastomas have low frequency. Their occurrence can be associated with von Hippel – Lindau (VHL) disease, but in most cases these tumors arise sporadically. Clinical presentation is usually determined by the mass effect. Thus, gross total resection without significant neurological impairment remains a great challenge. The aim of this study was to evaluate patient outcome after surgical treatment of intramedullary hemangioblastoma.

Methods
The present study included nine patients who underwent surgery for intramedullary hemangioblastoma (histopatologically confirmed) at our neurosurgery clinic between January 2015 and May 2024. There were seven male and two female patients with a mean age of 43.5 years. Operation was recommended based on presence of intramedullary lesion on MR imaging and of neurological deficits, usually progressive. The neurological function was evaluated at admission, discharge and at 6 months and graded according to McCormick scale. In all cases a posterior approach via laminectomy was performed. Location, pre-surgery syringomyelia and recurrence status were also assessed through MR scans.

Results
Tumor localization was exlcusively intramedullary: in the cervical spinal cord in four cases, in the thoracic spinal cord in other four, and in one case it had a lumbar localization. The mean duration from symptomatology onset to surgery was 9.3 months. Presence of tumor on MR imaging was accompanied by syringomyelia in six patients (66.6 %). Complete removal was achieved in all nine cases. Three patients had VHL disease screening at the time of admission. Of those, VHL was confirmed in two. For five patients, neurological functions improved at discharge and significant improvements were reported in seven cases at 6 months in the follow-up period.

Conclusion
Our results showed that gross total resection was effective in improvement of clinical symptoms with a good prognosis considering recurrence rate and McCormick grade evolution at 6 months after surgery.
A RARE CASE OF CROUZON SYNDROME ASSOCIATED WITH INTRACRANIAL MENINGIOMA WITH NASAL EXTENSION
Authors: Popescu G. , Chindris Fl. , Andrasi C.M. , Zaharia M.C. , Gorgan R.M. 
Published: November 2024

Introduction
Crouzon syndrome is a genetic disorder caused by mutations in the FGFR2 gene, leading to premature fusion of cranial sutures (craniosynostosis) and resulting in distinct craniofacial abnormalities such as a beaked nose, shallow orbits causing proptosis, and midface hypoplasia. These patients often experience complications such as vision and hearing loss, and breathing difficulties due to nasal obstruction. Besides craniofacial anomalies, Crouzon syndrome can be associated with intracranial anomalies like meningiomas, making their management complex and multidisciplinary.

Material and Methods
We present the case of a 33-year-old female patient with a history of Crouzon syndrome, giant olfactory groove meningioma treated with gamma-knife in 2008 and 2009, chronic infantile encephalopathy, and behavioral disorder. The patient was admitted with complaints of headache, conductive hearing loss in the left ear, and a vegetative tumor formation in the left nasal fossa. Cerebral MRI and CT scans revealed multiple intracranial and nasal formations

Results
The patient underwent surgical resection of the nasal tumor. Histopathological result was atypic meningioma. Post-operative evolution of the patient was favorable, with no post-operative complications following total ablation of the nasal extension.

Conclusions
This case highlights the complexity of managing patients with multiple neurocranial, especially in the context of genetic disorders like Crouzon syndrome. While the precise incidence of meningiomas in patients with Crouzon syndrome isn't well-documented, it appears to be a rare complication. Due to its complexity, Crouzon syndrome may be associated with other complex pathologies like aneurysms and intracranial tumors, like it was presented in this case. Therefore, a multidisciplinary collaboration is crucial for optimal treatment and long-term follow-up.
SURGICAL CHALLENGES IN CLIPPING LARGE ANEURYSMS IN DISTAL ARTERIAL TERRITORIES
Authors: Radoi Mugurel Petrinel , Ilie Milena-Monica , Covache-Busuioc Razvan-Adrian , Costin Horia Petre , Glavan Luca-Andrei , Serban Matei , Corlatescu Antonio Daniel , Toader Corneliu 
Published: November 2024

Background
By distal arterial territories we mean the arteries located after the main bifurcations of the cerebral arteries. They can occur at multiple sites throughout the course of distal arteries, but most often are found after the bifurcation of the M1 segment of the middle cerebral artery.

Methods
A retrospective review of 18 consecutive patients with large aneurysms located in distal arterial territories, treated by surgical clipping between 2019-2023, was performed. We consider aneurysm larger than 10 mm in diameter as large aneurysm. The data of all our consecutive patients were searched to obtain patient characteristics, details of the aneurysm size and orientation, treatment details, complications and follow up. At admission, the clinical condition of all patients was classified according to the Hunt and Hess scale. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 6 to 54 months (mean 24 months).

Results
Surgical clipping was performed for all aneurysms; only in 2 cases the aneurysm was unruptured. Three patients presented with significant hematoma which required the evacuation of the clot. Most large aneurysms were located in M2 or M3 segments of the MCA (16 patients). Post-operative control angiography was performed in 11 patients (61%), from which we reported a full occlusion of the aneurysm in 10 patients (90%). No perioperative mortality was recorded. The outcome was graded mRankin 0–2 in 83% of the cases (15 patients) at the end of the first postoperative months, and 94.4% (17 patients) at six months follow-up. The most important improvement was recorded for patients graded mRankin 1-2 at the first month follow-up.

Conclusions
The large size of the aneurysm, the size of the neck, as well as the reduced diameter of the parent vessel, represent important trials for the neurosurgeon in the correct clipping of the aneurysm. In some cases, sectioning of the aneurysm dome was necessary for successful clipping.
RECENT DEVELOPMENTS IN ENDOVASCULAR THERAPY FOR CHRONIC SUBDURAL HEMATOMAS USING LIQUID EMBOLIC AGENTS
Authors: Radu Razvan Alexandru , Dorobat Bogdan 
Published: November 2024

Chronic subdural hematomas (cSDH) remain a significant challenge in neurosurgery, particularly among the elderly. Recent
advancements in endovascular therapy, specifically the use of non-adhesive embolic agents, have shown promise in improving outcomes for these patients. This presentation will delve into the latest developments and clinical evidence surrounding this innovative approach.

The discussion will include findings from recent randomized trials that have evaluated the efficacy and safety of embolisation with non-adhesive agents, both as a standalone treatment and in conjunction with traditional surgical methods. Technical outcomes from these studies will be analyzed, highlighting key differences in patient recovery, complication rates, and long-term results between the combined and isolated approaches.

One of the focal points of the presentation will be the technical nuances of performing embolisation, emphasizing the procedural intricacies and the choice of embolic materials. Comparative data will be presented to illustrate the benefits of non-adhesive agents over other embolisation methods, particularly in terms of reducing re-bleeding rates and minimizing invasive interventions.

Additionally, we will explore future implications of widespread adoption of this technique, including its potential to alter standard care practices and improve patient prognoses. Projections will be made regarding the impact on healthcare resources, patient quality of life, and overall survival rates.

The presentation aims to provide a comprehensive overview of the current state and future potential of endovascular therapy for cSDH, offering valuable insights for neurosurgeons and interventional radiologists seeking to enhance their therapeutic arsenal.
DECISION-MAKING PROCESS IN UPPER BRACHIAL PLEXUS PALSIES - POINT OF NO RETURN?
Authors: Savić Andrija , Lepić Milan , Mićić Aleksa , Grujić Jovan , Rasulić Lukas 
Published: November 2024

Upper brachial plexus palsy is characterized by inability to perform elbow flexion, shoulder abduction, and external rotation. This study presents a comprehensive review of a 40-year experience with upper brachial plexus palsy surgery at a single center, outlining our surgical approach and current management trends.

Surgeries were typically performed between 3 and 6 months after the injury to allow for potential spontaneous recovery. During this period, a total of 1,473 procedures were carried out, targeting various nerve components: C5-C7 roots to upper/middle trunks (n=126), musculocutaneous nerve (n=661), axillary nerve (n=573), and suprascapular nerve (n=113). Functional recovery, defined as M3-M5, was achieved in 85.7% of the cases.

In some cases, exploring and repairing nerve lesions may be ineffective, leaving nerve transfers as the sole viable option. The decision-making process is significantly influenced by preoperative evaluations. When imaging confirms that structural continuity of nerve elements is preserved, preoperative electrodiagnostic testing may not effectively differentiate between preserved and disrupted functional continuity. In contrast, when imaging reveals disrupted structural continuity, the absence of advanced imaging techniques complicates the confirmation of root avulsion and the differentiation between supraganglionic and infraganglionic root injuries.

Final surgical decisions are made intraoperatively, using neuromonitoring to assess the functional continuity of the nerve elements. If functional continuity is maintained, only supraclavicular exploration and decompression may be needed. For infraganglionic root avulsion, supraclavicular nerve grafting might be required based on the extent of the nerve defect. Nerve transfers are reserved for cases involving complete supraganglionic avulsion of all roots.
GAMMA-KNIFE RADIOSURGERY
Authors: Stoica Fery , Perin Radu , Neamtu Daniela 
Published: November 2024

Clinical research to refine and minimize surgical interventions has continued to be one of the most important features of the neurosurgical development during the last half of the XX century. Prof. Lars Leksell, the inventor of the Gamma-Knife radiosurgery (GKRS), was a leader in stereotactic surgery. In addition, he coined the concept of radiosurgery more than 60 years ago. Leksell and his coworkers have defined the indications for radiosurgery and introduced stereotactic techniques into radiosurgery.

Today, GKRS is one of the three generally accepted treatment modalities in the treatment of cerebral AVMs together with microsurgery and endovascular techniques.

The authors present their experience in treating 461 patients harbouring cerebral AVMs with a Leksell Gamma-Knife unit between 2005 and 2023.

The follow-up schedule was a MR examination performed 6 and 12 months after the treatment in order to define if a radiation induced oedema had developed or not, as this represents the beginning and the end of the timer period in which the complications usually occur. If a radiation induced oedema was visible and the patient asymptomatic, the oedema was not treated. After that, a MRI and a MRA examination after two years to define the timing of the angiogram are of need. If the 2-year MR suggests complete AVM occlusion, we always perform an angiogram to verify the occlusion, as we know that a small remnant cannot be definitely excluded by using MR examinations. If the 2-year MR examination reveals a persistent AVM nidus, we postpone the angiogram to 3 years after the treatment. Naturally, as for all patients, a neuroradiological examination can be prompted by clinical symptoms. The outcome of our patients following a GKRS in relation to their age can be summarized as follows:

- AVMs in children: cure rate 86% at 24 months, cure rate 100% at 36 months;
- AVMs in young adults: cure rate 81% at 24 months, cure rate 86% at 36 months;
- AVMs in adults: cure rate 41% at 24 months, cure rate 82% at 36 months.

Predilect areas for oedema were the Parietal lobe and the basal ganglia, and 5 of the 6 patients which developed it had AVMs in excess of 11 cm3.

The probability for AVM obliteration is dependent of the dose to the AVM periphery, the volume of the nidus and its localization, best results being recorded in children.
PRESSURE MEASUREMENT IN MOYAMOYA BYPASS SURGERY
Authors: Xu Bin 
Published: November 2024

Background
This study aims to elucidate the clinical and theoretical value of directly measuring donor and recipient arterial pressure pre- and post-superficial temporal artery- middle cerebral artery (STA-MCA) bypass in moyamoya disease (MMD) patients.

Methods
DSA imaging data were prospectively collected from patients diagnosed with bilateral MMD who underwent STA-MCA bypass surgery between 2022 and 2023 and stratified according to the Suzuki stage. The mean arterial pressure (MAP) of the donor and recipient arteries was directly measured during the STA-MCA bypass procedure, and these data were statistically analysed and evaluated.

Results
Among 48 MMD patients, Suzuki grading revealed that 43.8% were in early stages (II and III), while 56.2% were in advanced stages (IV, V, and VI). Predominantly, 77.1% presented with ischemic-type MMD, and 22.9% with hemorrhagic type. Pre-bypass assessments showed that 62.5% exhibited antegrade blood flow direction and 37.5% had retrograde. The mean recipient artery pressure was 35.0 ± 2.3 mmHg, with a mean donor-recipient pressure gradient (?P) of 46.4 ± 2.5 mmHg between donor and recipient arteries. Post-bypass, mean recipient artery pressure increased to 73.3 ± 1.6 mmHg. No significant correlation (r = 0.18, P = 0.21) was noted between ?P and Suzuki staging.
Conclusion
While Suzuki staging offers a morphological description of the cerebral arterial system, preoperative decisions regarding the revascularization procedure in MMD patients should consider the pressure characteristics of the cortical arteries. Our findings provide objective criteria that choosing the anastomosis site in the downstream blood flow of the recipient is a reasonable choice.
TARGETED SURGICAL APPROACH TO MULTIPLE CEREBRAL HYDATID CYSTS WITHOUT SYSTEMIC INVOLVEMENT
Authors: Zaharia M.C. , Filip C.I. , Radu R. , Neacsu A. , Gorgan R.M. 
Published: November 2024

Background
The adult Echinococcus Granulosus resides in the intestines of dogs. Infectious eggs are excreted in the feces. Hydatid infections can affect multiple organs, with the liver being the most commonly involved, followed by the lungs and spleen. Less frequently, the brain, spine, retroperitoneal space, kidneys, and musculoskeletal system can also be affected.

Case Presentation
A 55-year-old male from a rural area, who owns sheep and dogs, presented with symptoms such as poor coordination in his right hand, agraphia, and acalculia. One week prior to admission, he had a sudden loss of consciousness. CT and MRI scans revealed six distinct cystic lesions in the left parietal lobe, extending towards the lateral ventricle. These lesions were well-defined, non-enhancing, and showed minimal perilesional edema. Whole body CT scan showed no additional cysts.

Results
After comprehensive investigations, the patient underwent surgery. A left parietal craniotomy was performed, followed by a C-shaped durotomy. Intraoperative ultrasound was utilized to locate the cysts. A minimal corticectomy was made at the posterior border of the parietal lobe. This exposed a cluster of six hydatid cysts located 1 cm subcortically. The cysts were carefully dissected and individually removed using the Dowling-Orlando technique. The remaining cavity was then flushed with a hypersaline solution. The patient recovered well, with no new neurological. He received therapy with albendazole second day after surgical intervention. Histopathological examination confirmed the diagnosis of hydatid cysts. The patient was discharged on the 10th postoperative day.

Discussion
The Dowling-Orlando technique is a highly effective surgical method for removing cerebral hydatid cysts without causing rupture. Magnification is recommended during the early stages of surgery to avoid damaging the fragile cyst wall and to establish the precise surgical plane. Saline solution is used to dissect the cyst wall from the brain tissue and aid in the removal of the hydatid. Tilting the operation table towards the lesion site and lowering the patient's head assists in the gravity-assisted removal of the cyst.