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   You are here: Home ›› Archive ›› Vol. XV, no. 1
Neuroprotection against surgically induced brain injury
Ligia Tataranu, MD, PhD, M.R. Gorgan, MD, PhD, B.O. Ene, MD, V. Ciubotaru, MD, PhD, Aurelia Sandu, MD, Adriana Dediu, MD
Department of Neurosurgery, “Bagdasar-Arseni” Emergency Hospital, Bucharest, Romania
Keywords: surgery, brain injury, neuroprotection

Neurosurgical procedures are carried out routinely in hospitals across the world. Every neurosurgical procedure, regardless the purpose, involves a certain degree of brain injury that results from the procedure itself because of the unique nature of the nervous system. Brain tissue is at risk of injury by various means, including incisions and direct trauma, electrocautery, hemorrhage, and retractor stretch. Fortunately there are various substances with neuroprotective effect on human brain, with different molecular pathways, which can be used, together with surgical protective measures, as therapeutically drugs preventing brain damage during surgery. Among them steroids, some anesthetic agents intraoperative hypothermia are suggested to provide cerebral neuroprotection, but also new established therapeutic agents, such as erythropoietin and statins, Src tyrosine kinase inhibitor, used clinically in patients for different nonneurological disorders, which have also shown promise as neuroprotectants in experimental studies. Any form of pretreatment that proved effective when used before brain injury may have a significant impact on patient recovery and outcome of procedures. This review is intended to raise the question about neuroprotection methods and agents against surgically induced brain injury available today in neuroscience scientific community and stimulate discussions about future approaches and therapies.

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Progressive parenchymatous intracranial hypertension – Review
St.M. Iencean1, A.V. Ciurea2, N. Ianovici3, I. Poeata3
1Neurosurgery, “Prof. Dr. Nicolae Oblu” Hospital, Iasi, Romania
2Clinical Emergency Hospital “Bagdasar - Arseni” Bucharest, The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
3Clinical Emergency Hospital “Prof Dr Nicolae Oblu” Iasi, The University of Medicine and Pharmacy “Gr.T. Popa”, Iasi, Romania
Keywords: brain gliomas, brain metastases, chronic subdural hematoma, intracranial hypertension, intracranial pressure,
decompensation of intracranial hypertension


The parenchymatous intracranial hypertension is the intracranial pressure increase caused by the intracranial volume modifications due to an intrinsic parenchymatous lesion (expansive intra-parenchymatous lesion, brain edema, etc.) or an extrinsic lesion (tumor, traumatic, infectious extra-parenchymatous compression, etc.). Depending on the location and the development manner, intracranial expansive processes cause the progressive increase in the intracranial pressure and then the occurrence of the ICH syndrome by the development of a supplementary volume. Benign intracranial tumors have a slow volume increasing rate and the neurological syndrome is installed progressively, while the ICH syndrome may occur late. Malign tumors have a rapid development rate and the neurological syndrome occurs precociously. The clinical decompensation represents the aggravation of the symptomatology by the tumor extension or by exceeding the compensating capacities of the intracranial pressure increase.

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Sciatic nerve schwannoma – Case report
Prof M. Gorgan MD PhD, A.M. Sandu, MD, N. Bucur MD PhD, A. Neacsu MD, V. Pruna MD,
A. Voina MD, A. Giovani MD, D. Martin MD, A. Dediu MD
Emergency Clinical Hospital “Bagdasar-Arseni”, Fourth Department of Neurosurgery, Bucharest
Keywords: sciatic schwannoma, peripheral nerve surgery

Background. Schwannomas are common, benign tumors of the sheath of peripheral nerves. Sciatic schwannomas are rare. PURPOSE: We report a case of a large sciatic schwannoma, emphasizing the role of nerve preservation. Material & methods. A 54 years old female was admitted in our clinic for persistent right sciatalgia, and right L5 and S1 motor loss, symptoms lasting for almost 2 years. Patient underwent surgery in a different department, but the operation was stopped, because of excessive bleeding. Results Neurological examination revealed right sciatalgia, right L5 and S1 motor loss and diminished ankle jerk reflex, but failed to reveal relevant symptoms for disc herniation clinical diagnostic. Thigh CT-scan and MRI showed a large (70/80/75 mm) encapsulated, contrast-enhancing tumor, located in the middle third of the posterior thigh, in intimated relation with the sciatic nerve. Associated chronic myeloproliferative syndrome required oncological treatment and surgery postponement. We performed a subtotal resection of a large, solid tumor, infiltrating the sciatic nerve on 4 cm length, with anatomic integrity of sciatic preservation. Histopathological examination found cellular schwannoma. Outcome was favorable, and on follow-up examination the patients present no additional deficits and thigh CT-scan showed any evidence of tumor regrowing. Discussions & Conclusions. Diagnostic is challenging, in many symptoms are attributed to degenerative spinal pathology. Any persistent sciatlagia, with irrelevant lumbar MRI must raise the suspicion of a peripheral sheath tumor, and must be further investigated. Surgery is very demanding and associated co-morbidities must be treated prior surgery. Preserving the integrity of the sciatic nerve, assure favorable outcome, with no additional neurological deficits.

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Ectopic secondary paranasal sinus meningioma with orbital extension
Tatiana Rosca MD, PhD1, Nikolaos Maragkos MD2, Teodora Vladescu MD, PhD1, Gherghescu GH. MD, PhD1
1Neuro-Surgery Department, Clinical Emergency Sf. Pantelimon Hospital, Bucharest, Romania
2Anaesthesiology Department, “Agios Panteleimonas” General Hospital, Pireas Greece
Keywords: ectopic meningioma, proptosis, paranasal sinusis

Background: Description of a meningioma arising from the paranasal sinuses (bilateral frontal and ethmoidal sinus origin). Material and method: A 54-year-old patient with meningioma originating in bilateral frontal and ethmoidal sinus and invading the right orbit. Results. The management of the case is presented. Conclusion. Meningiomas originating in the paranasal sinuses are very rare. They are ectopic and there are only a few cases reported in literature.

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Development of international spinal cord injury data sets
Fin Biering-Sørensen
Executive Committee of the International SCI Standards and Data Sets
Presented at the 6th Congress of the Romanian Society of Neurosurgery 26.09-30.09.2007 Bucharest
Keywords: bony vertebral injury, spinal cord injury, spinal surgery

The purpose of the Core Data Set is to standardize the collection and reporting of a minimal amount of information necessary to evaluate and compare results of published studies. The data are included in the Core Data Set, and are recommended, as a descriptive table in most publications including individuals with SCI. The Core Data Set is available at www.iscos.org.uk, and www.asia-spinalinjury.org, including training cases.

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Selected Abstracts from the 6th National Congress of the Romanian Society of Neurosurgery
26 – 30 Septembre 2007, Bucharest, Romania
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