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   You are here: Home ›› Archive ›› Vol. XVI, no. 1
Neurorehabilitation in neurotrauma
Yoko Kato1, Anil Sangli, Sachiko Yamaguchi, Isao Morita, Tetsuo Kanno, Hirotoshi Sano
1Department of Neurosurgery, Fujita Health University, Japan
Keywords: traumatic brain injury, neuro-rehabilitation, coma scales, minimally conscious state,
vegetative state, outcome scales, neurorehabilitatory interventions


Since time immemorial, neurotrauma has been recorded in various continents. The advancement in neurotraumatology ever since Denny Brown and Trussell’s landmark experimental study of concussion, has come a long way with major contributions from neuropathology, neurophysiology, neurochemistry, biomedical sciences, public policies, intensive care medicine and last but not the least, genetics. A simple introduction of lap and shoulder belt have reduced majority of serious accidents. Continuous recording of intracranial pressures, recognition of acute brain swelling with characteristics of cerebral blood flow in brain damage and development of Glasgow coma and outcome scales by a well-designed multi-centered multi-national outcome study in head injuries brought in major changes in squealae and outcome by preventing and reducing the secondary insults. Computed tomography (CT) and improvement in morbidity and mortality of acute extra axial hematomas by immediate surgery, has influenced and guided several organizations in developing research and formulating guidelines for treatment of acute neurotrauma. The recognition of the spectrum in head injury, aids in prevention of injury and measures to improve outcome by ever developing neuro-rehabilitative measures, apart from advancements in the genetic aspects of understanding the brain’s response to injury along with attention to modern principles of neuro-intensive and critical care, has manipulated neurotrauma towards achieving innovative newer frontiers. Assessment of the extent of injury and the deficits in neurotrauma is as challenging as the management itself. Several criteria including the Japanese Coma Scale and the proposition for the international coma scale have been attempted. Once the baseline characters and the psychology1 of the patient is understood along with the extent and nature of the severity of the injury, a defined patterned timescale with a schedule can be created & tailor made to every patient and all out efforts instituted to rehabilitate not only the individual but also the whole family and the society at large.

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The importance of functional MRI (fMRI) in the neurosurgical strategy in brain tumors
Panagiotis D. Toulas M.D.
Neuroradiologist, Institute Euromedica-Encephalos, Athens, Greece
Keywords: epilepsy, functional MRI, brain tumors

Functional MRI (fMRI) is an indirect depiction of the functionality of brain neurons using local changes of circulation. The continuous evolution of MRI led to pulse sequences which could display the circulation of the brain at rest, with or without exogenous contrast agents. fMRI seems capable of determining the dominant hemisphere and the language centers. This is important for the pre-operational evaluation of patients with lesions in the frontal or temporal lobes (tumors or epilepsy resistive to medication), which might have extended centers in these lobes.

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Cerebral cavernoma
I. Poeata1, St.M. Iencean2
1Clinical Emergency Hospital “Prof Dr Nicolae Oblu” Iasi, University of Medicine and Pharmacy “Gr.T. Popa”, Iasi, Romania
2Neurosurgery, Clinical Emergency Hospital “Prof Dr Nicolae Oblu” Iasi, Romania
Keywords: cerebral cavernoma, gamma knife, hemorrhage, surgery

Cerebral cavernoma can be located in any brain region, be of varying size and present with different clinical disorders. Some cases are found incidentally. Conservative treatment is recommended if the patient has an asymptomatic lesion or the malformation is located in a critical brain region but the patient has only minimal symptoms and no history of symptomatic bleeding or the patient has multiple cavernous malformations and the actual symptomatic lesion could not be determined. The main indications for surgery are based on reductions or control of seizures, reversal of symptoms or deficits related to mass effect, and prevention of hemorrhage or recurrent hemorrhage. Generally surgical results are very good.

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Intracranial hypertension due to disorders in the cerebospinal fluid dynamics - Review
St.M. Iencean1, A.V. Ciurea2, I. Poeata3
1Neurosurgery, “Prof Dr Nicolae Oblu” Hospital, Iasi, Romania
2Clinical Emergency Hospital “Bagdasar - Arseni” Bucharest, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
3Clinical Emergency Hospital “Prof Dr Nicolae Oblu” Iasi, University of Medicine and Pharmacy “Gr.T. Popa”, Iasi, Romania
Keywords: cerebrospinal fluid dynamics

The intracranial hypertension due to disorders in the cerebrospinal fluid dynamics is the intracranial pressure increase caused by disorders of the cerebrospinal fluid circulation from at the moment of its formation at the level of the choroid plexuses and until its passage in the venous circulation. The dynamic disorders of the cerebrospinal fluid are: circulation disorders of the cerebrospinal fluid from formation to the resorption place and disorders of the cerebrospinal fluid passage in the venous drainage system (resorption). The obstructive hydrocephalus is caused by a partial or complete obstruction of the ventricular system or by a blockage of the CSF flow. Intracranial hypertension due to resorption disorders or of a meningeal cause is the intracranial pressure increase caused by the reduction in the cerebrospinal fluid resorption due to various causes, which directly affect the resorption mechanisms.

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Posterior fossa arteriovenous malformations - Case report
Angela Neacsu MD, Prof Radu Mircea Gorgan MD PHD, Narcisa Bucur MD PhD, Aura Sandu MD, Mihai Viorel Pruna MD
First Neurosurgical Clinic, Fourth Neurosurgical Department
Clinic Emergency Hospital “Bagdasar-Arseni”, Bucharest
Keywords: arteriovenous malformation, infratentorial location, posterior fossa

The posterior fossa arteriovenous malformation (AVM) is uncommon and different from other intracranial AVM in its natural history, diagnosis, treatment, prognosis, and other features. The authors present the case a 19 years old woman admitted for comatose state, GCS=6 points, left hemiparesis, flexion of right limbs on noxious stimuli, mydriasis with bilaterally preservation of oculomotor reflex and acute respiratory failure. Cerebral CT scan showed an intraparenchymal hematoma, located into the posterior cranial fossa, within the vermin, measuring 2.8/3.2 cm, with important surrounding edema, intraventricular bleeding within the third and fourth ventricle, massive infratentorial subarachnoid hemorrhage and acute hydrocephalus. Cerebral four vessels angiography showed an infratentorial AVM (arteriovenous malformation), located within the right cerebellar hemisphere, with a nidus, measuring around 3 cm maximal diameter, in the craniocaudal direction. The AVM had arterial feeders coming from the right posterior cerebral artery and superior cerebellar artery and venous drainage into the Galen vein, Herophil torculla, and right lateral sinus. We conclude the diagnosis of right ruptured cerebellar hemisphere AVM, grade Martin-Spetzler III, Hunt and Hess 5 and the choice treatment was open surgery. Authors insist on neurosurgical strategy for treatment which in our case conducted to excellent results.

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Gamma-Knife: Radio surgery in Greece
Efficiency of the method for patients with vestibular schwannomas (clinical assessment)
Ch.A. Seferis
Gamma Knife Department, Hygeia Hospital, Athens, Greece
Keywords: Gamma-Knife, radio surgery, vestibular schwannomas

Vestibular schwannomas are histologically benign tumors which arise from the Schwann cells in the acoustic division of the 8th cranial nerve. It is important to distribute the lowest possible dose during the "visual" route of the facial nerve around the ventricular part of the tumor, as the latter is located at the pontomedullary junction on the anterior margin of the internal auditory duct. We can note that using doses of gamma irradiation we can satisfactorily control the volume of the lesion, as is confirmed by the patients' bi-annually follow-up appointments while there are a low percentage of adverse events that involve the cranial nerves.

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Bilateral optic malignant astrocytoma in a 3 year old child with NFI – Case presentation
Bogdan Iliescu1, M. Vukic2, Ziyad Faiyad1, Ramona Filipescu*, Ion Poeata1
1-3rd Neurosurgery Department, “Prof. Dr. N. Oblu” Clinical Emergency Hospital
2-Department of Neurosurgery, Medical School University of Zagreb, Zagreb, Croatia
*Neurosurgery Department, “St Mary” Children’s Hospital
Keywords: malignant astrocytoma, neurofibromatosis type 1, optic nerve, optic chiasm

We present a rare case of a 3 year old child with a fast-growing bilateral exophtalmus in the context of neurofibromatosis type 1. We analyze the particularities of the clinical and imagistic aspects of the case, and discuss them in the light of pathological diagnosis (malignant astrocytoma) and imagistic follow-up.

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Consideration on hemicraniectomy
Horatiu Stan, Bogdan Suciu, Alexandru Iosif, Adriana Cocis
Department of Neurosurgery, “Bagdasar-Arseni” Emergency Hospital, Bucharest, Romania
Keywords: cerebral edema, decompressive hemicraniectomy, malignant cerebral infarction, traumatic head injuries

Decompressive hemicraniectomy is a surgical technique used to relieve the increased intracranial pressure. There is no standardized surgical technique to clearly state the minimum area of the cranial vault needed to obtain the best results. The aim of the current paper is to present our surgical technique and experience used in performing hemicraniectomies, technique that we consider optimal for his purpose. Our experience consists in 17 operated cases and eleven patients (64.7%) were long term survivors.

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Biomechanics and biometry of the anterior skull base
Irina Dobrin1, Patrick Courtheoux2, N. Dobrin3, I. Poeata4, N. Ianovici4
1Emergency Military Hospital “Dr. I. Czihac”, Emergency Department
2CHU-Caen, France
3Clinical Hospital No.3, Iasi, Neurosurgery Department
4University of Medicine and Pharmacy “Gr.T. Popa”, Iasi
Keywords: skull base, skull base symmetry, facial asymmetry

We present here some interesting points of view concerning the biomechanics aspects of the skull base. Also several problems are studied concerning the skull base symmetry with some pathological implications.

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