bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technical nuance
Authors: Verma Arvind , Modh Jaimin , Soladhra Krushi , Velani Dharmik 
Published: November 2024

Background. Colloid cyst treatment with purely endoscopic surgery is considered to be safe and effective. Complete capsule removal for gross total resection is usually recommended to prevent recurrence but may not always be safely feasible. Our objective was to go for complete endoscopic surgery using mainly aspiration, manipulation and coagulation with complete capsule resection and discuss the rationale for the procedure.
Methods and materials. A case report with a third ventricle colloid cyst was surgically treated with a complete endoscopic excision using the proper technique.
Results. Our patient underwent Transforaminal endoscopic surgery and the cyst was excised completely and the capsule was removed intentionally. Cyst remnants were absent on postoperative MRI. Mild Intraventricular haemorrhage was an intraoperative complication. Surgery was statistically associated with cyst volume and ventricular size reduction. There were no serious complications postoperatively. Follow-up did not show any recurrence or remnant growth that needed further treatment.
Conclusion. Gross total resection may be the main objective for selected cases and seems to be safer while preserving good results, especially in a limited resource environment. Surgical planning allows the surgeon to choose among the different resection routes and techniques available. Decisions are predominantly based on preoperative imaging and intraoperative findings. Full-endoscopic approach for third ventricle colloid cyst removal is a feasible technique. Cyst aspiration followed by grasping and rotational manoeuvre for the cyst wall provides total removal with the resolution of the obstruction if present and relief of symptoms.
Neuronavigational assisted ventriculo-peritoneal shunt surgery in the idiopathic intracranial hypertension (IIH) patients
Authors: Poonia Nemi Chand , Surendra Jain , Hardika Poonia , Poonia Dev , Chitresh Kumar , Sania Poonia 
Published: November 2024

Object. Lumboperitoneal shunt are commonly used for idiopathic intracranial hypertension (IIH) because of the difficulty of insertion of Ventriculoperitoneal (VP) shunt into normal or small-sized ventricles. The authors showed their experience with VP shunts for IIH with the help of a Neuronavigation system.
Methods. This is a retrospective study of 16 patients of IIH in whom Neuronavigation was used to guide the insertion of a shunt in the ventricle for IIH at our institution. A trial of either acetazolamide or steroid therapy had failed in all patients.
Results. Shunt placement was successful and uncomplicated in each case except for one patient in which shunt failure occurred (6.25%) post-operatively. Outcomes were assessed at 12 months which were favourable regarding symptoms 13 cases (81.25%) got relief in headaches and 4 patients (25%) showed improvement in vision. Misplacement of the shunt occurred in one case postoperatively and Shunt failure occurred in 2 cases (12.50%) during the follow-up period due to ventricular end obstruction. These three patients required shunt revision. Progression of the visual deficit did not occur.
Conclusion. Our results suggest that the Neuronavigation-guided ventriculoperitoneal shunt is a good alternative to Lumboperitoneal shunt in IIH patients.
TREATMENT OPTIONS FOR RECURRENT MALIGNANT DIFFUSE ASTROCYTOMA (WHO GRADE IV)
Authors: Anton Catalin , Agavriloaei Loredana Mariana , Tracicaru Rares Vasile , Turliuc Dana Mihaela 
Published: November 2024

Objectives
We present the case of a 37-year-old female who underwent partial resection in 2018 for a diffuse fibrillary astrocytoma (WHO II) that invaded almost the entire right cerebral hemisphere. The patient followed conventional radiotherapy and chemotherapy. She presents after 6 years of regularly follow-ups with left hemiparesis, intracranial hypertension syndrome and tumor recurrence on MRI. The patient underwent another surgical intervention and the new histopathological diagnosis was diffuse astrocytoma grade IV. Therapeutic options for these patients are limited considering the fact that a gross total resection or a conventional re-irradiation could impact the quality of life. Therefore, exploring new therapeutic methods, such as targeted molecular therapy like EGFR antagonists or proteasome inhibitors, or proton therapy, should be considered.

Material and Methods
We conducted extensive research in two public medical databases for information related to the molecular pathways and management of primary and recurrent malignant astrocytoma and relevant articles were selected. Subsequently, we correlated this information with our direct experience in our case and discussed the observed results.

Results
Treatment modalities for these patients include reintervention, re-irradiation and second line chemotherapeutics. In relapsing cases the goal of reintervention is both to alleviate symptoms and obtain tumoral tissue for immunohistochemical analysis for identification of the new mutations. Conventional re-irradiation for large lesions carries high risks of producing both short-term and long-term side effects, impacting the quality of life. Alternatively, proton therapy minimizes the risk of adverse events due to Bragg peak reducing the irradiation of the surrounding tissue.

Conclusions
Genetic characterization of these lesions can facilitate targeted molecular therapy and help in establishing the prognosis. Re-irradiation of malignant astrocytomas with proton therapy is an effective treatment measure allowing for comparable tumor control to conventional radiotherapy.
MANAGEMENT OF EXTRAMEDULLARY INTRADURAL SPINAL TUMORS
Authors: Balasa Adrian 
Published: November 2024

Spinal tumors are relatively uncommon, accounting for approximately 5%–10% of all central nervous system tumors, with an estimated 70%–80% being located in the intradural extramedullary space. The most common intradural extramedullary tumors are schwannomas, followed by meningiomas. Other less common intradural extramedullary tumors include myxopapillary ependymomas.

The clinical presentation of these tumors is often rather nonspecific, and clinicians must maintain a high index of suspicion when evaluating patients with chronic back pain. Approximately 50% of affected individuals experience nonspecific back pain, whereas radiating pain, motor deficits, and sensory loss often progress gradually.

This study examines the surgical management of intradural spinal tumors treated in our department, focusing on surgical techniques
Some of these benign lesions can pose a surgical challenge due to their location to spinal cord, tumor consistency (densely mineralized / calcified).

Posterior approaches involving laminectomy while preserving facet joints are typically sufficient for the surgical resection of dorsal and dorsolateral tumors.

In conclusion the total surgical removal of these tumors while preserving neurological function remains can pose a surgical challenge especially for those that are densely calcifed and situated anterolateral to spinal cord, but employing standard microsurgical techniques often makes these resections possible.
USE OF AUGUMENTED REALITY IN TREATMENT OF PITUITARY MICROADENOMAS
Authors: Chinezu Rares 
Published: November 2024

Introduction
Transsphenoidal surgery, performed using endoscopic or microscopic techniques, is a safe and effective method for treating neuroendocrine pituitary tumors, including microadenomas. However, the precise location of microadenomas can be challenging to determine, particularly in acromegaly patients, who often exhibit a reduced intracarotid distance. Augmented reality (AR), particularly through heads-up displays (HUD) integrated into surgical microscopes, has been predominantly utilized in transcranial approaches but shows potential in enhancing transsphenoidal procedures.

Aim
This study aims to present the surgical workflow, techniques, and outcomes associated with using AR in microscopic transsphenoidal surgery for pituitary microadenomas.

Material and Methods
All procedures were conducted at the Targu Mures Clinical Emergency Hospital’s Department of Neurosurgery between 2019 and 2024. A total of 15 cases were treated using AR-assisted techniques. While the surgical operative time was comparable to non-AR-assisted procedures, the preoperative setup was more time-consuming and required staging to optimize the surgical workflow. In all cases, surgeons successfully identified and resected the microadenomas without complications related to navigation accuracy.

Conclusions
The findings suggest that integrating AR into transsphenoidal surgery enhances anatomical understanding and precise localization of microadenomas, providing a valuable tool for neurosurgeons. However, AR cannot replace surgical expertise and clinical judgment.
REMEMBER: 30 YEARS SINCE CONSTANTIN ARSENI PASSED AWAY - THE FONDATOR OF ROMANIAN NEUROSURGERY
Authors: Ciurea Alexandru Vlad , Ples Horia , Mohan Aurel , David George , Popa Andrei Adrian 
Published: November 2024

Introduction
The authors will present one of the great personalities of Romanian neurosurgery, Dr Constantin Arseni, who created it in Bucharest, creating the largest university centre of neurosurgery in Europe at that time.

Material
After the tragic loss of his mentor Prof. Dr Dumitru Bagdasar in 1946, Dr Constantin Arseni, took over the management of the neurosurgery service at the Central Hospital for Mental, Nervous and Endocrinologic Diseases, the only department of this kind in this country; He was able to have the first Clinic of Neurosurgery from Romania.

For his merits, Dr Constantin Arseni, became an Associate Professor in 1952 and University Professor in 1963. His neurosurgical activity was complex, but mainly focused on tumoral pathology, cerebral and spinal, and also on spinal degenerative disease.

Under Professor C. Arseni, the Neurosurgical Clinic of Bucharest is transformed in 1975 into the “Prof. Dr D. Bagdasar” Clinical Hospital of Neurosurgery, the largest hospital of Neurosurgery in the Europe, with 550 beds and, subsequently, 650 beds. Also, he developed the departments of neurosurgery in each of the biggest university centres in the country; while being the first President of the Romanian Society of Neurosurgery.

Scientific Activity
Scientific activity of Prof. Dr Constantin Arseni includes the numerous publications (54 treaties and monographies), together with all his collaborators, encompassing all domains of neurosurgery: Tumoral, Neuropathological, Vascular, Paediatric, Spinal Degenerative Pathology, Central Nervous System Malformations, History, etc. with high international visibility.

An editorial board under C. Arseni published, with the substantial contribution of the Bucharest Medical Publishing House of the Clinic, the “Treatise of Neurology” in 8 volumes (1979-1981).

Conclusions
Professor Constantin Arseni was a dedicated surgeon, he practiced his job asking from those around him as much as he offered - the maximum. He was a schoolmaster and a teacher in the true sense of word.
Professor Constantin Arseni, Member of the Romanian Academy, was an exemplary professional, a model of conduct, which will forever remain in our memory, of the neurosurgeons, and of the Romanian neurosurgery, leaving behind a legacy hard to match for those who followed him.
IN VIVO INOCULATION OF GBM CELLS IN RATS AND TREATMENT WITH RUXOLITINIB
Authors: Florian Ioan-Alexandru , Susman Valeriu-Sergiu , Ede Bodoki , Soritau Olga , Pestean Petru-Cosmin , Iacob Bogdan-Cezar , Baraian Alexandra-Iulia , Buruiana Andrei , Florian Ioan-Stefan 
Published: November 2024

GlioStat (patent pending) denotes an invention that addresses the current deficiencies of glioblastoma (GBM) chemotherapy by developing a molecularly imprinted drug reservoir that is specifically designed for post-surgical recovery. The goal of our research was to guarantee the long-term release of the antitumor drug ruxolitinib (RUX), which is specifically designed to target residual infiltrative cancer cells, while simultaneously reducing the risk of adverse effects. In order to achieve this goal, we have successfully developed and characterized four distinctive molecularly imprinted polymers (MIPs), with one of them advancing to in vivo experimentation.

The selection of one MIP for further in vivo investigations was guided by the Alamar Blue viability assay on C6 GBM cell cultures, which took into account both the efficacy and the potential toxicity of residual monomers. Over the course of 96 hours, MIP 2 demonstrated the most favorable risk-benefit profile, providing superior efficacy against GBM C6 cells. In contrast, its non-imprinted counterpart (NIP 2) exhibited minimal toxicity.

The protocol involved anesthetising the male Wistar rats, immobilising them on a corkboard, without the use of a stereotactic headholder. After shaving the head and local disinfection with iodine solution, we made a linear sagittal incision and exposed the parietal bones. A 3x3 mm burr hole was made with a pneumatic drill in the right parietal bone, revealing the dura mater. Subsequently, we injected 20,000 C6 GBM cells suspended in 5 microliters of solution in the cerebral parenchyma at a depth of 3 mm. Clinical and imaging control was performed.

For the animals that developed tumors, a second therapeutic intervention was performed. The rats were anesthetised, disinfected, and readied in the same manner as before. The burr hole was exposed, with the tumor being partially resected via a “microscooping” technique. Next, 5-10 microliters of MIP2 solution (4 mg/mL) were injected into the parenchyma respective of the tumor bed. Five microliters of thrombin solution were then added (100 UI/mL) to form the fibrin network.

In comparison to the untreated controls and animals treated with free RUX, animals treated with MIP2 exhibited a substantial increase in survival time during the in vivo evaluation, extending from 20 to 50 days. As such, our research had yielded a potentially life-changing drug delivery system in GBM, with the capacity to significantly increase postoperative survival. More in vivo tests should be conducted to validate our findings.
FORESTIER DISEASE
Authors: Gheorge S. , Banica B. , Codin C. , Teleanu D. 
Published: November 2024

Introduction
We present the case of M.E., a 73 year old patient, who presented to his local medical services for progressive dysphagia. Follow-up cervical CT scan revealed ossification of the anterior longitudinal ligament, at C3 - C4, C4 - C5 and C5 - C6 levels, consistent with diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier disease.

Material and Methods
The patient was operated on by a multidisciplinary team (Neurosurgery and O.M.F. surgery). After a left sided vertical cervical incision and dissection of tissue, the spinal cervical levels were identified radiologically, followed by reduction of bony elevations at C3 - C4, C4 - C5 and C5 - C6 using a regular drill tip. Postoperatively the patient’s dysphagia was completely alleviated.

Conclusion
Although Forestier disease is usually identified incidentally, patients may present with decreased neck mobility, cervical pain and dysphagia. While the disease is similar to ankylosing spondylitis, it does not have a genetic component and it mainly affects the cervical and thoracic spines. Surgery may be necessary if dysphagia progresses.
RARE TUMORS OF POSTERIOR CRANIAL FOSSA IN ADULTS
Authors: Ghica T. , Teleanu Daniel Mihai 
Published: November 2024

Objectives
Tumors arising in the posterior cranial fossa pertain to a special category of neoplasm in the manner that they can cause cerebellar syndrome, obstructive hydrocephalus, brainstem compression – cranial nerve dysfunction – and herniation. In the cerebellopontine angle, the most common tumors are acoustic neuromas followed by meningiomas. Among the petroclival tumors, the most common benign tumors are meningiomas and the most common malign tumors are chordomas and metastases. Among jugular foramen tumors, the common tumors are schwannomas, paragangliomas and meningiomas. We report our unit’s experience with the neurosurgical management of rare posterior cranial fossa tumors as compared to the main literature results, taking into consideration the clinical, radiological aspects and the outcome.

Materials and Methods
Retrospective analysis of a single unit cohort of patients diagnosed with rare posterior cranial fossa tumors, who underwent surgical treatment in the Neurosurgery I Department of the University Emergency Hospital Bucharest between 2017 and 2024. Relevant literature review was analyzed, as well as serial clinical examinations, imaging studies, and operative records were taken into consideration.

Conclusions
Depending on the location, size, and pathology of the posterior cranial fossa tumors, there are different treatment options, which include microsurgical resection, observation, stereotactic radiotherapy. These type of lesions still represent a challenge and require electing the most suitable approach whilst preserving the neurologic function of the patient.
SURGICAL RESECTION OF A COMPLEX TUBERCULUM SELLAE MENINGIOMA ENCASING MAJOR ARTERIES
Authors: Higgoda Prasanna Randula 
Published: November 2024

Introduction
Though constituting only a minor proportion (1%) of sellar masses, suprasellar meningiomas pose a significant diagnostic challenge within the region of sellar and suprasellar tumors. Pituitary adenomas, at nearly 90% prevalence, dominate this anatomical region. Distinguishing these two entities is paramount, as both clinical presentation and, to some extent, biochemical profiles exhibit notable overlap. Accurate preoperative differentiation is critical due to the contrasting behaviors of these tumors. Meningiomas, with their robust vascularity supplied by dural and osseous arteries, present a heightened risk of intraoperative hemorrhage.

Clinical Case
A 53-year-old woman presented with a two-month history of worsening headaches and gradual vision loss. Neurological examination revealed only visual acuity decline. Her hormone profile showed elevated prolactin but lacked clinical features of prolactin excess, suggesting a possible prolactin-secreting pituitary macroadenoma. A contrast-enhanced MRI confirmed a significant sellar and suprasellar mass with homogeneous enhancement, extending to the right paramedian region and encasing the right internal carotid artery (ICA) at its critical segment involving the cavernous and supraclinoid portions. Furthermore, the right middle meningeal artery (M1) and anterior cerebral artery (A1) originated from this same location, highlighting the high surgical risk. Surgical resection was deemed necessary. The patient underwent a right pterional craniotomy, revealing a grayish, extradural soft mass lesion encasing the ICA bifurcation. Careful microsurgical dissection with basal devascularization was performed, followed by near-complete tumor removal using an ultrasonic aspirator to minimize damage to the encased arteries. Postoperative follow-up CT scan confirmed successful near-total tumor ablation.

Conclusion
This case underscores the critical role of meticulous preoperative diagnosis in managing complex sellar tumors. While pituitary adenomas dominate this region, suprasellar meningiomas, despite their rarity, demand a high index of suspicion. Overlapping clinical and biochemical presentations highlight the reliance on advanced imaging for accurate differentiation. The intricate vascularity of meningiomas, as exemplified by the encasement of critical arteries in this case, necessitates meticulous surgical technique with devascularization strategies. This successful near-complete tumor removal emphasizes the importance of such surgical expertise in navigating these diagnostically challenging sellar lesions.
AWAKE SURGERY DURING 5-ALA HIGH GRADE GLIOMA FLUORESECNCE GUIDED RESECTION
Authors: Matei Claudiu , Filip Dan , Dancu Iulia , Nistor Sofia , Gherman Joseph 
Published: November 2024

Introduction
Awake surgery (AS) is currently the gold standard for low-grade glioma located in language brain areas to provide patients with the best prognosis with a high quality of life. A recent meta-analysis by Gerritsen et all (2019) also suggests that AS with direct cortical stimulation for high grade gliomas (HGG) provides a better outcome. Direct cortical stimulation and subcortical mapping during AS allows the surgeon to detect regions of the cortex and white matter tracts involved in specific functions of language, semantics, syntax, phonetics, or phonology. 5-ALA fluorescence-guided tumor resection is a technique that offers the advantage of better delineating high-grade glioma, increasing the chance of achieving gross total tumor resection, improving overall survival.

5-ALA is a metabolic tracer with a risk of photosensitisation and for 48 hours after administration the patient must be kept in a dark environment avoiding the risk of skin reactions. For this reason, during the operation including in the awake phase we have to keep the same low light exposure conditions, which could sometimes pose some difficulties for the operating team.

Material and Methods
We present a case operated in MedLife Polisano Hospital in May 2023, for frontal HGG, using AC together with 5-ALA fluorescence. The patient was evaluated preoperatively with MRI, MPRAGE contrast and DTI tractography, which was fused to the navigation system during surgery. The operation was performed with asleep-awakeasleep technique and in the awake phase we used the Boston test for naming, specific questions and calculation tests with direct cortical stimulation by the Penfield bipolar technique and monopolar subcortical mapping with the Raabe suction probe, adapted to our Natus Medical intraoperative monitoring system. Surgery was performed in semi-dark conditions with a tablet, turning on dim light tunning.

Results
In the awake phase we obtained speech arrest, semantic and phonological paraphrases, which allowed us to determine the brain areas, cortical and subcortical regions, involved in language functions. Thus we performed a total tumor resection with language-preserving. There were no incidents during surgery and the patient was discharged in good condition on the 5th postoperative day.

Conclusions
Brain tumor surgery is multimodal, using many tools and techniques. The use of AS together with 5-ALA fluorescence-induced resection is safe and provides the prerequisites to achieve gross total tumor resection while preserving language functions.