Surgical Difficulties in a Case of Left Ophthalmic Artery Ruptured Aneurysm Associated with Right ICA hypoplasia - Case Report.

The authors present a rare case of a ruptured left ophthalmic artery aneurysm associated with right ICA hypoplasia in a 49 year old female. The particularity of the case lies in the fact that the patient had a hypoplastic right ICA which was associated with an intracranial aneurysm. In this case we present,surgery was mandatory as it represented the patient'€™s only chance for a favorable outcome, given the lack of an adequate team specialized in endovascular coiling. Unlike many neurosurgical centers in Western Europe and the US where endovascular approaches have overtaken microsurgery, in Romania open microsurgery is frequently performed as it allows neurosurgeons to perfectly control the environment in which they operate and minimizes possible complications of coiling or stenting which become more and more frequent in other countries.

Multidisciplinary management of adult low grade gliomas.

BACKGROUND: Adult hemispheric low grade gliomas (LGG) cover a pathologic spectrum which has specific clinical, histological and molecular characteristics. The optimal management of these tumors is still a controversial topic in international literature. METHODS: We evaluated scientific papers from the literature (Medline and Cochrane Library to date) and we compared the results found there with our experience, trying to create a pattern of treatment of our own. RESULTS AND CONCLUSIONS: The advances in microsurgical and neuromonitoring techniques, as well as in neuroimaging, allow for a more aggressive resection of LGG with a significant improvement in overall survival and quality of life. The potential risks of the "wait and see" policy and the neurotoxicity of radiotherapy are challenged by the benefits of careful surgical resection and up-front chemotherapy. The present day treatment strategy, based on recent evidence, should include a maximal surgical resection when possible, with the full preservation of the patients ability, and delayed radiotherapy. The role of temozolomide in the management of LGG and the identification of the therapeutic modality with the best quality of life profile will be determined by ongoing trials. The further characterization of prognostic relevance of molecular markers and data from advanced imaging techniques needs an intensification of research and validation efforts. ABBREVIATIONS: LGG: low grade gliomas, WHO: World Health Organization, OS: overall survival, PFS: progression-free survival, MRI: Magnetic resonance imaging, MRS: Magnetic resonance spectroscopy, MPFS: malignant progression-free survival, rCBV: Relative Cerebral Blood Volume, QOL: quality of life, FLAIR: Fluid attenuated inversion recovery, MGMT: O6-methylguanine DNA methyltransferase enzyme, DSC MR imaging: Dynamic Susceptibility Contrast Perfusion MR imaging, 1H-MRS: Proton Magnetic Resonance Spectroscopy, IDH1: isocitrate dehydrogenase 1 gene, SPECT: Single-photon emission computed tomography, PET: Positron emission tomography, DTI-FT: Diffuse Tensor Imaging-fiber tracking technique, DES: direct electrical stimulation, EEG: Electroencephalography, EcoG: Electrocorticography, MEP: motor evoked potentials, EMG: Electromyography, AED: anti-epileptic drugs, TMZ: Temozolomide, EORTC: European Organization for Research and Treatment of Cancer, NCCTG: North Central Cancer Treatment Group, RTOG: Radiation Therapy Oncology Group, ECOG: Eastern Cooperative Oncology Group, EOR: extent of resection, Gy: Gray (unit), GyE: gray equivalent, RT: radiation therapy, IMRT: image-guided intensity modulated radiotherapy, FSRT: fractionated stereotactic radiotherapy, SRS: proton therapy or stereotactic radiosurgery, LET: high-linear energy transfer beams, RBE: relative biological effectiveness, CTCAE: Common Terminology Criteria for Adverse Events, PCV: procarbazine, lomustine, and vincristine chemotherapy.

The legacy of Prof. Constantin Arseni. The medical architect behind the Romanian School of Neurosurgery.

The personality of Prof. Dr. Constantin Arseni (1912-1994) is without any doubt a key point in any discussion regarding the history of the Romanian School of Neurosurgery. Now at two decades since the regretted passing-away of Prof. Arseni the authors present several pieces of data regarding the early beginnings of neurosurgery in Romania and how this discipline has evolved over time in our country. Driven by an incredible tenacity Professor Constantin Arseni managed not only to create the first completely independent clinic of neurosurgery in Romania, but also to keep it continuously updated with the latest bibliographic and technological resources available at the time. Professor Arseni's masterpiece, the largest neurosurgical hospital in Europe (at the time of its construction)was supposed to be a completely autonomous institute dedicated to surgery on the human central nervous system. As the Iron Curtain fell and Europe was marked by continuous reforms, the idea of an institute dedicated to the brain was abandoned by the authorities and a multidisciplinary hospital dedicated to neurosurgical emergencies and trauma was born.