Este descrisă o tehnică nouă de ventriculostomie translamina terminalis. Această tehnică se utili... more Este descrisă o tehnică nouă de ventriculostomie translamina terminalis. Această tehnică se utilizează de obicei în intervenţii pentru anevrisme erupte, în faza acută. Inovaţia are ca scop reducerea ratei complicaţiilor cauzate de hemoragia subarahnoidiană anevrismală, în special cu extindere în sistemul ventricular, în perioada postoperatorie precoce. Studiul a constat din 13 pacienţi care au fost operaţi cu anevrisme intracraniene erupte, la care paralel s-a efectuat fenestratrea LT cu ventriculostomie translamina terminalis. A fost plasat un cateter intraventricular în ventricolul III, fi xat şi conectat la un sistem de drenare externă pentru monitorizarea ulterioară a tensiunii intracraniene(TIC) si/sau drenare de LCR. Date despre drenarea şi sanarea LCR s-a obţinut în toate cazurile. Complicaţii legate de această procedură nu s-au înregistrat. Ca rezultat, am obţinut o însănătoşire mai timpurie şi cu un scor GOS mai bun la aceşti pacienţi, comparativ cu grupul de pacienţi căror...
Până în ianuarie 2000 au existat doar cazuri sporadice de aneurisme intracraniene diagnosticate ş... more Până în ianuarie 2000 au existat doar cazuri sporadice de aneurisme intracraniene diagnosticate şi tratate specifi c în clinica Neurochirurgie a CŞPNN. După această dată, pe baza datelor clinice şi a investigaţiilor neuroimagistice, au fost diagnosticaţi şi operaţi pacienţi prezentând aneurisme în teritoriul arterelor circulaţiei cerebrale. Lucrarea reprezintă reflectarea experienţei autorului în acest domeniu, fi ind luaţi în studiu 89 de pacienţi internaţi în intervalul ianuarie 2000 – aprilie 2006, cu un raport M:F de 1:2, pacienţii având vârste cuprinse între 16 şi 74 de ani
Diagnosis and management of idiopathic normotesnive hydrocephaliaHidrocefalia normotensivă idiopa... more Diagnosis and management of idiopathic normotesnive hydrocephaliaHidrocefalia normotensivă idiopatică (HNTI) este o maladie caracterizată prin tulburări de mers, incontinență urinară, și demență, care afectează persoanele vârstnice. Diagnosticul și managementul acestor pacienți necesită o abordare multidisciplinară cu o echipă formată din medici neurologi, neurochirurgi și neuro-imagiști. Punctul de pornire este un istoric cuprinzător și examenul neurologic detaliat, cu revizuirea imagisticei cerebrale și efectuarea diagnosticului diferențial. Testarea specifică a HNTI include evaluarea răspunsului pacientului la scurgerea unei cantități mici de lichid cefalorahidian (LCR) prin puncție lombară. La pacienții selectați corect, toate simptomele, inclusiv demența, se pot ameliora după intervenția neurochirurgicală de plasare a șuntului și drenare ventriculară.Диагностика и лечение идиопатической нормотезной гидроцефалии
Neurology Department, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Re... more Neurology Department, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Intracerebral hemorrhage (ICH) is the second most common type of stroke, responsible for about 20% of total number of cerebrovascular accidents. There are many pathologies associated with ICH, some related to common vascular risk factors like hypertension, others related to ruptured saccular aneurysm, and vascular malformation, and others to neurodegeneration like amyloid angiopathy. Case report. We present a series of cases of intracerebral haemorrhages related both to the most common causes and mechanisms of ICH, as well as other, less frequent, pathologies that could manifest as a hemorrhagic stroke. Differential diagnosis is based on hematoma localization, size and shape, age of the patients, and vascular risk factors. We also present data on prognostic factors f...
Prezentăm studiul și implementarea în practica neurochirurgicală a tratamentului minim invaziv al... more Prezentăm studiul și implementarea în practica neurochirurgicală a tratamentului minim invaziv al anevrismelor saculare de circulație anterioară a poligonului Willis, prin abord “keyhole” supraorbital. Evaluarea posibilităților de expunere chirurgicală a vaselor circulației anterioare a poligonului Willis, prin abordul „keyhole”, supraorbital, comparativ cu cele clasice. Analiza rezultatelor tratamentului chirurgical al pacienților cu anevrisme saculare de circulație cerebrală anterioară în funcție de abordul utilizat. Constatarea riscului apariției complicațiilor intra- și postoperatorii la pacienții operați cu anevrisme de circulație anterioară, în funcție de abordul cranian utilizat. Rezultatele obținute vin să completeze principiile teoretice de reperaj și planifi care preoperatorie a abordului chirurgical, pentru cliparea anevrismului cerebral
Background: Ultrasonography is an accessible imaging modality that provides real-time guidance wi... more Background: Ultrasonography is an accessible imaging modality that provides real-time guidance with minimal risk or additional time. There is a strong correlation between ultrasonography and postoperative computed tomography when evaluating the extent of tumor resection, suggesting ultrasonography can have significant clinical implications. The objective of this study was to provide more evidence on the usage of ultrasonography in the determination of gross-total resection of brain tumors. Material and methods: This study consisted of a retrospective review of patients treated at the Institute of Neurology and Neurosurgery between 2015 and 2020 for a brain tumor. All patients were treated with ultrasonography and then underwent postoperative tomography with or without contrast within first 3 days after surgery. Results: A total of 85 cases were included. Ultrasonography results showed a strong association with postoperative tomography. Ultrasonography was able to accurately identify...
Bulletin of the Academy of Sciences of Moldova. Medical Sciences
Idiopathic normotensive hydrocephalus (iNPH) is a disease that affects the elderly, characterized... more Idiopathic normotensive hydrocephalus (iNPH) is a disease that affects the elderly, characterized by the classic triad of gait apraxia, urinary incontinence, and minor cognitive impairment or dementia, and cerebral imaging scans show the presence of ventriculomegaly and normal fluid pressure in the fluid c normal puncture. This disease must be in the list of differentiated diagnosis of patients presenting with the above manifestations. If the diagnosis of iNPH is confirmed, it should be treated at an early stage.
Bulletin of the Academy of Sciences of Moldova. Medical Sciences
The association between cerebral sacral aneurysm and pituitary adenoma has not yet been well eluc... more The association between cerebral sacral aneurysm and pituitary adenoma has not yet been well elucidated, with some authors reporting an incidence of up to 7.4%. The cause is not yet fully known. 97% of these aneurysms belong to the anterior cerebral circulation. Description of a case study in which a functional selective expansive process and uninterrupted intracerebral aneurysm of the middle cerebral artery are determined. The 57-year-old patient is diagnosed with pituitary adenoma with cavernous sinus invasion and Cushing’s syndrome. On investigation by MRI and AngioCT, an associated aneurysm of the right cerebral artery on the right, uninterrupted, is incidentally determined. The patient underwent micro-neurosurgery to ablate the saddle formation and the concomitant clipping of the cerebral aneurysm by a classical right approach. After the operation, a partial ablation of the intracavernous adenoma and a definitive clipping of the aneurysm were achieved. The patient is discharged...
Objectives. Normal pressure hydrocephalus is a potentially reversible disease, characterized by a... more Objectives. Normal pressure hydrocephalus is a potentially reversible disease, characterized by a pathological enlargement of the cerebral ventricles, with a normal opening pressure during the lumbar puncture. The characteristic triad of Normal pressure hydrocephalus is dementia, gait disorders, and urinary incontinence. Because this clinical syndrome is potentially reversible by the placement of a ventriculoperitoneal shunt, early recognition and diagnosis are important. Differential diagnosis should be made between forms of communicating hydrocephalus from obstructive or noncommunicating hydrocephalus, in which there is a structural blockage of cerebrospinal fluid circulation (e.g., Sylvius aqueduct stenosis). We aimed to formulate a standard of care for patients diagnosed with idiopathic normal pressure hydrocephalus and to develop a Clinical Protocol within the Institute of Neurology and Neurosurgery, Chișinău, Republic of Moldova. Materials and methods. We conducted an extensiv...
Objectives. The vertiginous, progressive development of the contemporary imaging techniques, such... more Objectives. The vertiginous, progressive development of the contemporary imaging techniques, such as computed tomography and magnetic resonance imaging, apparently led to an increase in the information volume, provided about anatomical structures and investigated pathological processes, but also, deficiencies in rendering information from the imager to the clinician didn’t improve and this is largely due to the fact that the information is still provided by 2D images. To utterly understand how things really are and to plan the surgery correctly, the surgeon relies on imagination, which largely depends on his own experience. To overcome these limitations, 3D technology can provide detailed information about the 3D orientation of normal anatomical structures, in relation to pathological ones. Our aim was to show the importance of 3D volume segmentation as a teaching and preoperative tool for neurosurgical interventions and to demonstrate our experience in clinical practice. Material a...
Este descrisă o tehnică nouă de ventriculostomie translamina terminalis. Această tehnică se utili... more Este descrisă o tehnică nouă de ventriculostomie translamina terminalis. Această tehnică se utilizează de obicei în intervenţii pentru anevrisme erupte, în faza acută. Inovaţia are ca scop reducerea ratei complicaţiilor cauzate de hemoragia subarahnoidiană anevrismală, în special cu extindere în sistemul ventricular, în perioada postoperatorie precoce. Studiul a constat din 13 pacienţi care au fost operaţi cu anevrisme intracraniene erupte, la care paralel s-a efectuat fenestratrea LT cu ventriculostomie translamina terminalis. A fost plasat un cateter intraventricular în ventricolul III, fi xat şi conectat la un sistem de drenare externă pentru monitorizarea ulterioară a tensiunii intracraniene(TIC) si/sau drenare de LCR. Date despre drenarea şi sanarea LCR s-a obţinut în toate cazurile. Complicaţii legate de această procedură nu s-au înregistrat. Ca rezultat, am obţinut o însănătoşire mai timpurie şi cu un scor GOS mai bun la aceşti pacienţi, comparativ cu grupul de pacienţi căror...
Până în ianuarie 2000 au existat doar cazuri sporadice de aneurisme intracraniene diagnosticate ş... more Până în ianuarie 2000 au existat doar cazuri sporadice de aneurisme intracraniene diagnosticate şi tratate specifi c în clinica Neurochirurgie a CŞPNN. După această dată, pe baza datelor clinice şi a investigaţiilor neuroimagistice, au fost diagnosticaţi şi operaţi pacienţi prezentând aneurisme în teritoriul arterelor circulaţiei cerebrale. Lucrarea reprezintă reflectarea experienţei autorului în acest domeniu, fi ind luaţi în studiu 89 de pacienţi internaţi în intervalul ianuarie 2000 – aprilie 2006, cu un raport M:F de 1:2, pacienţii având vârste cuprinse între 16 şi 74 de ani
Diagnosis and management of idiopathic normotesnive hydrocephaliaHidrocefalia normotensivă idiopa... more Diagnosis and management of idiopathic normotesnive hydrocephaliaHidrocefalia normotensivă idiopatică (HNTI) este o maladie caracterizată prin tulburări de mers, incontinență urinară, și demență, care afectează persoanele vârstnice. Diagnosticul și managementul acestor pacienți necesită o abordare multidisciplinară cu o echipă formată din medici neurologi, neurochirurgi și neuro-imagiști. Punctul de pornire este un istoric cuprinzător și examenul neurologic detaliat, cu revizuirea imagisticei cerebrale și efectuarea diagnosticului diferențial. Testarea specifică a HNTI include evaluarea răspunsului pacientului la scurgerea unei cantități mici de lichid cefalorahidian (LCR) prin puncție lombară. La pacienții selectați corect, toate simptomele, inclusiv demența, se pot ameliora după intervenția neurochirurgicală de plasare a șuntului și drenare ventriculară.Диагностика и лечение идиопатической нормотезной гидроцефалии
Neurology Department, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Re... more Neurology Department, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Intracerebral hemorrhage (ICH) is the second most common type of stroke, responsible for about 20% of total number of cerebrovascular accidents. There are many pathologies associated with ICH, some related to common vascular risk factors like hypertension, others related to ruptured saccular aneurysm, and vascular malformation, and others to neurodegeneration like amyloid angiopathy. Case report. We present a series of cases of intracerebral haemorrhages related both to the most common causes and mechanisms of ICH, as well as other, less frequent, pathologies that could manifest as a hemorrhagic stroke. Differential diagnosis is based on hematoma localization, size and shape, age of the patients, and vascular risk factors. We also present data on prognostic factors f...
Prezentăm studiul și implementarea în practica neurochirurgicală a tratamentului minim invaziv al... more Prezentăm studiul și implementarea în practica neurochirurgicală a tratamentului minim invaziv al anevrismelor saculare de circulație anterioară a poligonului Willis, prin abord “keyhole” supraorbital. Evaluarea posibilităților de expunere chirurgicală a vaselor circulației anterioare a poligonului Willis, prin abordul „keyhole”, supraorbital, comparativ cu cele clasice. Analiza rezultatelor tratamentului chirurgical al pacienților cu anevrisme saculare de circulație cerebrală anterioară în funcție de abordul utilizat. Constatarea riscului apariției complicațiilor intra- și postoperatorii la pacienții operați cu anevrisme de circulație anterioară, în funcție de abordul cranian utilizat. Rezultatele obținute vin să completeze principiile teoretice de reperaj și planifi care preoperatorie a abordului chirurgical, pentru cliparea anevrismului cerebral
Background: Ultrasonography is an accessible imaging modality that provides real-time guidance wi... more Background: Ultrasonography is an accessible imaging modality that provides real-time guidance with minimal risk or additional time. There is a strong correlation between ultrasonography and postoperative computed tomography when evaluating the extent of tumor resection, suggesting ultrasonography can have significant clinical implications. The objective of this study was to provide more evidence on the usage of ultrasonography in the determination of gross-total resection of brain tumors. Material and methods: This study consisted of a retrospective review of patients treated at the Institute of Neurology and Neurosurgery between 2015 and 2020 for a brain tumor. All patients were treated with ultrasonography and then underwent postoperative tomography with or without contrast within first 3 days after surgery. Results: A total of 85 cases were included. Ultrasonography results showed a strong association with postoperative tomography. Ultrasonography was able to accurately identify...
Bulletin of the Academy of Sciences of Moldova. Medical Sciences
Idiopathic normotensive hydrocephalus (iNPH) is a disease that affects the elderly, characterized... more Idiopathic normotensive hydrocephalus (iNPH) is a disease that affects the elderly, characterized by the classic triad of gait apraxia, urinary incontinence, and minor cognitive impairment or dementia, and cerebral imaging scans show the presence of ventriculomegaly and normal fluid pressure in the fluid c normal puncture. This disease must be in the list of differentiated diagnosis of patients presenting with the above manifestations. If the diagnosis of iNPH is confirmed, it should be treated at an early stage.
Bulletin of the Academy of Sciences of Moldova. Medical Sciences
The association between cerebral sacral aneurysm and pituitary adenoma has not yet been well eluc... more The association between cerebral sacral aneurysm and pituitary adenoma has not yet been well elucidated, with some authors reporting an incidence of up to 7.4%. The cause is not yet fully known. 97% of these aneurysms belong to the anterior cerebral circulation. Description of a case study in which a functional selective expansive process and uninterrupted intracerebral aneurysm of the middle cerebral artery are determined. The 57-year-old patient is diagnosed with pituitary adenoma with cavernous sinus invasion and Cushing’s syndrome. On investigation by MRI and AngioCT, an associated aneurysm of the right cerebral artery on the right, uninterrupted, is incidentally determined. The patient underwent micro-neurosurgery to ablate the saddle formation and the concomitant clipping of the cerebral aneurysm by a classical right approach. After the operation, a partial ablation of the intracavernous adenoma and a definitive clipping of the aneurysm were achieved. The patient is discharged...
Objectives. Normal pressure hydrocephalus is a potentially reversible disease, characterized by a... more Objectives. Normal pressure hydrocephalus is a potentially reversible disease, characterized by a pathological enlargement of the cerebral ventricles, with a normal opening pressure during the lumbar puncture. The characteristic triad of Normal pressure hydrocephalus is dementia, gait disorders, and urinary incontinence. Because this clinical syndrome is potentially reversible by the placement of a ventriculoperitoneal shunt, early recognition and diagnosis are important. Differential diagnosis should be made between forms of communicating hydrocephalus from obstructive or noncommunicating hydrocephalus, in which there is a structural blockage of cerebrospinal fluid circulation (e.g., Sylvius aqueduct stenosis). We aimed to formulate a standard of care for patients diagnosed with idiopathic normal pressure hydrocephalus and to develop a Clinical Protocol within the Institute of Neurology and Neurosurgery, Chișinău, Republic of Moldova. Materials and methods. We conducted an extensiv...
Objectives. The vertiginous, progressive development of the contemporary imaging techniques, such... more Objectives. The vertiginous, progressive development of the contemporary imaging techniques, such as computed tomography and magnetic resonance imaging, apparently led to an increase in the information volume, provided about anatomical structures and investigated pathological processes, but also, deficiencies in rendering information from the imager to the clinician didn’t improve and this is largely due to the fact that the information is still provided by 2D images. To utterly understand how things really are and to plan the surgery correctly, the surgeon relies on imagination, which largely depends on his own experience. To overcome these limitations, 3D technology can provide detailed information about the 3D orientation of normal anatomical structures, in relation to pathological ones. Our aim was to show the importance of 3D volume segmentation as a teaching and preoperative tool for neurosurgical interventions and to demonstrate our experience in clinical practice. Material a...
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