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Daniel Mihai Teleanu

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Articles signed on Romanian Journal of NEUROLOGY:

A PERMANENT NEUROSURGICAL CHALLENGE: LOW GRADE GLIOMAS

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Romanian Journal of Neurology, Volume XV, No. 4, 2016
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

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A PERMANENT NEUROSURGICAL CHALLENGE: LOW GRADE GLIOMAS

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ABSTRACT

Introduction. The utilization of Magnetic Resonance Spectroscopy (MRS) brings an important piece of information to an overall MR study, thus aiding the physician in making an accurate assumption regarding the histological grade of a tumor. The purpose of this study is to verify the reliability of MRS in correctly diagnosing both the nature of tumors and their grade.
Material and methods. This is an observational study that was conducted from January 2011 to June 2016 on 49 patients confirmed to be low-grade gliomas (LGG) by pathological examination, who were admitted in our Neurosurgery Department in this period. Both retrospective and prospective data were collected. Inclusion criteria comprise unique tumoral lesion at the moment of diagnosis, follow-up for at least one year. Exclusion criteria included: other types of tumors with any location, patient refusal to undergo histopathological examination of the resected tissue, uncompliant and non-collaborating patients. Of all patients, 22 were subjected to an MRS study which suggested the presence of a low-grade glioma subsequently confirmed by the pathological examination.
Results. MRS has been shown to provide accurate non-invasive diagnosis of LGG’s, by analyzing the concentration of metabolites inside the lesions which tend to be specific for these tumours: relatively elevated levels of N-acetylaspartate and creatine with reduced levels in the concentration of choline and absent lipids and lactate. It has also been observed that pre-operative MRS assists the physician in selecting the optimal place for biopsy, so that the pathological examination provides conclusive results.
Conclusions. With the increased availability of MRI technology, MRS comes as a milestone in the advancement of more accurate and patient-friendly methods of diagnostic for pathologies as LGG’s which constitute a permanent challenge for neurosurgeons. The results of this study underlines the importance of MRS as a method for follow up patients with LGG, but cannot replace the need for obtaining bioptic tissue for pathological examination, especially after the new grading system of WHO, which was published in June 2016. This new grading system takes into account the molecular biology in predicting the natural history of cerebral tumours.

Keywords: magnetic resonance spectroscopy, low grade glioma, management, biopsy

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MANAGEMENT OF SPONTANEOUS INTRACEREBRAL HEMORRHAGE – A REVIEW

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Romanian Journal of Neurology, Volume XIII, No. 1, 2014
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

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ICMJE- Recommendations

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Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

MANAGEMENT OF SPONTANEOUS INTRACEREBRAL HEMORRHAGE – A REVIEW

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ABSTRACT

Spontaneous intracerebral hemorrhage (SICH) is defined as a bleeding into the brain parenchyma which occurs in the absence of trauma or surgery. Medical and surgical management of SICH is complex. Medical management comprises of: treatment of arterial hypertension, treatment of increased intracranial pressure, anticonvulsant agents (recommended in supratentorial SICH). Many randomized studies have been conducted to compare surgical and medical management of SICH and the conclusions were not favourable to surgery. Still, early surgical intervention remains an option in some cases. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those with progressive neurological deterioration. Patients with cerebellar hemorrhages larger than 3 cm, with brainstem compression and hydrocephalus and those exhibiting neurological deterioration should undergo surgical evacuation of the clot. Contraindications for surgery are: brainstem hemorrhages, small hemorrhages, elderly patients with Glasgow Coma Scale score less than 5. Evidence-based recommendations regarding the role of surgery in SICH are needed.

Keywords: spontaneous intracerebral hemorrhage, management, surgery

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DECOMPRESSIVE CRANIECTOMY IN DEEP SPONTANEOUS INTRACEREBRAL HEMORRHAGES

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Romanian Journal of Neurology, Volume XIII, No. 2, 2014
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

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ICMJE- Recommendations

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Promoting Global Health

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DECOMPRESSIVE CRANIECTOMY IN DEEP SPONTANEOUS INTRACEREBRAL HEMORRHAGES

ABSTRACT

The aim of this study was to analyze efficacy and safety of decompressive craniectomy (DC) in deep spontaneous intracerebral hemorrhage (SICH). Neurosurgical management of SICH is still a controversial issue. Surgical techniques are diverse, from the open large craniotomy, to the minimally invasive techniques like stereotactic aspiration of the SICH, endoscopic evacuation and stereotactic catheter drainage after instillation of thrombolytic agents. Decompressive craniectomy lowers intracranial pressure and improves outcome in patients with SICH. We studied 11 patients with spontaneous intracerebral hemorrhage treated with DC without hematoma evacuation and compared them with patients treated by best medical treatment. We analyzed the patients from clinical (age, sex, the underlying pathology, Glasgow Coma Scale), neuroimagistic (signs of herniation, localization and size of hematoma, midline shift, hematoma expansion) and surgical (time to and indication for surgery) points of view. The outcome after 30 days was apreciated as good (modified Rankin Scale 0–3) or poor (modified Rankin Scale 4–5). Eleven patients (median age 59 years) with deep SICH were treated by DC. Seven patients showed signs of herniation. Nine patients had good and 2 had poor outcomes. Two patients of the surgery group died versus 6 patients from the medical treatment group. We conclude, based on this small cohort, that DC can reduce mortality in some cases. Larger prospective studies are needed to assess safety and efficacy of this method.

Keywords: decompressive craniectomy, surgery, spontaneous intracerebral hemorrhage (SICH)

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LHERMITTE-DUCLOS DISEASE ASSOCIATED WITH MENINGIOMA – A RARE CASE

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Romanian Journal of Neurology, Volume XIII, No. 4, 2014
ISSN 1843-8148  |  e-ISSN 2069-6094
ISSN-L 1843-8148
DOI: 10.37897/RJN

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DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
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ICMJE- Recommendations

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Promoting Global Health

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LHERMITTE-DUCLOS DISEASE ASSOCIATED WITH MENINGIOMA – A RARE CASE

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ABSTRACT

Lhermitte-Duclos disease (LDD), also known as dysplastic gangliocytoma of the cerebellum is a benign disease, extremely rare, characterized by loss of normal cerebellar cortical architecture and focal thickening of the folia. Lhermitte-Duclos disease as a major CNS manifestation of Cowden disease is a rare condition. The association between Lhermitte-Duclos disease and meningioma is even more rare, only few cases having been documented in the literature. We present a very rare case of a 53-year-old woman who was admitted in our department for recurrent episodes of headache and epilepsy. Magnetic resonance imaging revealed the presence of a well-defined lesion with an abnormal laminated pattern of cortical architecture involving most of the right cerebellar hemisphere, compressing the fourth ventricle and also a meningioma. Complete removal of the meningioma and partial removal of the cerebellar lesion was performed and histopathological exam confirmed Lhermitte-Duclos disease.

Keywords: Lhermitte Duclos disease, meningioma

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