Endovascular minimally invasive treatment of the intracranial aneurysms--first 124 cases.

INTRODUCTION: Since May 2005, we have started to treat the intracranial aneurysms endovascular way as an alternative minimally invasive technique to the classic neurosurgery treatment. OBJECTIVE: Studying the patients' demographics, clinical presentation, aneurysm size and configuration, type of coils used for embolization, the percentage of compaction and recanalization (especially in patients who presented with subarachnoid hemorrhage), and immediate complications. METHODS AND RESULTS: An all-inclusive retrospective review of every patient who underwent coils embolization (stent or balloon assisted included) of saccular aneurysms from May 2005 to September 2011 was performed. A total of 116 patients (46 men and 60 women) and 124 aneurysms were treated. A total of 96 patients (41 men and 55 women) underwent follow-up femoral cerebral angiograms (mean follow-up was 25 months and the longest was at 37 months). Five patients required intra-arterial abciximab due to thrombus formation. Four patients had aneurysm rupture while the coil was being advanced. Eleven patients were treated during vasospasm peak. Seven patients had recanalization at 12 months follow-up. DISCUSSION: The average hospitalization period was of 4 days. There is a close relation between Hunt and Hess scale score before treatment and post interventional neurological status. Due to subarachnoid hemorrhage, the vasospasm remains a threat to the patient's neurological status. The treatment of cerebral aneurysms with endosacular embolization by coils is a safe and durable option. The risk of recanalization or re-rupture in our cohort is small compared to series published elsewhere. Larger series of patients are needed to support our evidence.

[Surgical treatment of single brain metastases]. / Tratamentul chirurgical al metastazelor cerebrale unice.

Recent neurosurgical statistics indicate brain metastases as the most frequent intracerebral tumor. Under these circumstances, single brain metastases study and therapeutic management represent a major problem for a neurosurgeon and his efforts to prolong the patient survival rate and improve their quality of life. This study of the surgical treatment of single brain metastases has focused on a survey of the data which highlight most accurately the efficiency of a therapeutic method: general survival data or survival data function of primary neoplasm, mortality rate and causes, data regarding the connection between survival rate and death cause, tumor relapse rate, post surgery complications and post surgery neurological status. This study has surveyed a group of 320 patients presenting single brain metastases, which have been subject to surgery between 2001-2010. Median general survival rate for the patients with single brain metastases in this group was 9.64 months, regardless of the histologic type of the primary neoplasm. These data complies with other studies in the most majority of neurosurgical series which indicate a median survival of 10 months. The study clearly showed that the longest median survival rate was noticed in case of patients with a neurological death cause (12.54 months) and the shortest in case of patients deceased due to the systemic disease dissemination (5.08 months). A good neurological state prior to surgery, administering a complete surgical treatment, followed by radiotherapy and/or chemotherapy, as well as a good therapeutic control of the primary neoplasm are the decisive factors in obtaining the longest survival rate and the lowest risk in triggering systemic dissemination.

The management of the bilateral internal carotid dissection clinical case presentation.

Introduction:We present the case of a 36-year-old patient who was treated in the National Institute of Neurology and Cerebrovascular Diseases in Bucharest - in the neurology and the imagistic departments - for bilateral carotid dissection. Goals: The main goal of this article was to discover the cause that lead to the symptoms of the patient using MRI and angio-MRI.In the process,we tried to dilate the stenosis (due to dissection) on 2 internal carotid arteries by using stents in order to keep the true lumen open. Methods:In order to make a diagnosis we used the Magnetic resonance imaging machine (MRI) (1,5 T from GE), the multislice Computer Tomography (CT) scan (16 detectors from Siemens) and the digital substraction angiography (Siemens Axiom Artis). In addition, we used the same angiography machine for the endovascular procedure. The stents that we used were Wallstents from Boston Scientific Company. Results: The patient left the hospital having a NIHSS=10, with dysarthria and left hemiplegia that were 80% recovered after 2 months. Discussion: The particularity of this case study is the spontaneous bilateral internal carotid dissection. The second dissection might have resulted in being also iatrogenic, due to several attempts of stenting the first one. Conclusions: The successful treatment of this patient was the result of the collaboration between the neurology and neuroradiology departments.The first therapeutic option in carotid dissection has to be stenting, under certain conditions.

[Clinical and epidemiological significance of isolated cultures of Koch bacillus after conclusion of chemotherapy]. / [Cercetari asupra semnificatiei clinice si epidemiologice a culturilor izolate de b.K. ulterioare încheierii chimioterapiei.

In a group of 33 patients from the Gorj, Dolj and Mehedinti Districts positive cultures of Koch bacilli were found after various intervals following the end of chemotherapy. These positive cultures were found after negative cultures were obtained repeatedly during the usual bacteriological monitoring. The "isolated" positive culture was obtained after an interval of 11,7 +/- 8,1 months after the end of the treatment. The average number of colonies in each tube was of 3,8 +/- 3, in most of the cases (63%) there were 1--2 colonies in each tube, and in only 27% there were more than 4 colonies per tube. The development of the germs was slow and the colonies were noted 32 +/- 14 days after seeding in the Löwenstein medium. All the cases have been followed, bacteriologically as well as radiologically on the average for 16 +/- 10,9 months. Chemotherapy was not taken up again in this period. In 2 cases a new positive culture was found, and these patients were considered to have recidives, and were treated again. Of the 26 contacts under the age of 20 years 5 remained uninfected at the end of the cure and did not display allergy during the period of surveillance. None of the allergic contacts developed the disease. It is concluded that after a correct therapy the development of positive cultures during bacteriological surveillance, especially if only few colonies are noted, does not means that there is a recidive, making mandatory the sustained repetition of the bacteriological investigation without taking up again the chemotherapy.