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Danaila I.,National Institute of Neurology and Neurovascular Diseases
Chirurgia (Bucharest, Romania : 1990) | Year: 2012

The aneurysms of the Basilar Artery apex (ABA) are not very common. My personal experience derives from having performed surgery on a number of 3340 patients with cerebral aneurysms at the Department of Vascular Neurosurgery II in Bucharest between 1979 and 2010. In 234 (7%) of the aneurysms they were located in the posterior vasculature. In 146 patients, representing 4.37% of the total number of patients with cerebral aneurysms and 62.39% of those with aneurysms of posterior vasculature, the location was in the basilar artery apex. The mean age of the 146 patients with aneurysms of the basilar artery apex (ABA) was 45.2 years, varying between 34 and 71 years old. Most cases (69 -47.26%) were in the 41-50 years age group. Aneurysms were found in 68 males (46.57%) and 78 females (53.42%) suggesting a slight predominance in female patients. The main reason for hospitalization was subarachnoid haemorrhage. There were four reports of patients having three episodes of subarachnoid bleeding in the three months preceding the surgery. The mean time between the last subarachnoid bleeding and the hospital admission was 26 days, ranging between 1 and 62 days. On admission three patients were in a severe general and neurological state (Hunt IV and V, respectively). The diagnostic assessment for those patients started with computer tomography (CT) followed by brain angiogram for the four main vessels. The main challenges for the surgical treatment of such lesions are due to the complex vascular anatomy of the basilar artery apex, to the direct vicinity of these aneurysms with the base of the skull and with vital neural structures in the interpeduncular fossa as well as due to difficulties in gaining proximal control over them. The post-surgical evolution was excellent and good in 131 (89.72%) of patients, unsatisfactory in 8 patients (5.48%), while 8 patients (5.48%) died. Three of the 8 patients marked by an unsatisfactory evolution presented with right-side hemiballismus and paresis of the 3rd cranial nerve, while other three remained in a vegetative state. Post-operative hydrocephaly was reported in 10 patients (6.8%). RevistaChirurgia. Source

Rosu D.,National Institute of Neurology and Neurovascular Diseases
Romanian Journal of Neurology/ Revista Romana de Neurologie | Year: 2015

The gold standard in dural arteriovenous fistulas (DAVF) evaluation is complete angiography. Treatment options include: conservative management, open surgery, endovascular therapy, stereotactic radiosurgery or multimodality therapy. The goal of microsurgical intervention is DAVF obliteration or selective CVD disconnection. We present a 59 years old male who was brought to the Emergency Department of the National Institute of Neurology and Neurovascular Diseases in a comatose state (GCS-5p). © 2015, Editura Medicala AMALTEA. All rights reserved. Source

Soare A.M.,National Institute of Neurology and Neurovascular Diseases
Journal of medicine and life | Year: 2010

Deficiencies of natural anticoagulants protein C, protein S, antithrombin and activated protein C resistance are components of inherited thrombophilia. Inherited thrombophilia was defined as a genetically determined tendency towards venous thromboembolism, which characteristically occurs in young patients (before 40 to 45 years old), without apparent causes, and tend to recur. There have been many debates about the implication of these defects in arterial thromboses (peripheral artery disease, myocardial infarction, cerebral infarction) in the recent years. The screening for thrombophilia is recommended for young patients with spontaneous thromboses, arterial infarctions, family history of thromboses, personal history of recurrent abortions, with thrombosis of venous dural sinuses or strokes or myocardial infarctions, in patients with venous thrombosis in unusual sites, because the diagnosis of such a disease leads to a treatment that is lifesaving [1,2]. Source

Pais V.,National Institute of Neurology and Neurovascular Diseases | Danaila L.,Spectral Molecular Imaging, Inc. | Pais E.,Spectral Molecular Imaging, Inc.
Ultrastructural Pathology | Year: 2013

The authors analyzed by transmission electron microscopy (TEM) neurosurgical samples obtained from patients with cerebral tumors, neurotrauma, cerebral ischemia, Moyamoya disease, encephalitis, etc. Their observations concern a variety of dying cell types by different programmed death pathways, including apoptosis, paraptosis, autophagy, autoschizis, programmed necrosis, as well as combined and coexisting forms. This ample work pointed out not only the role of TEM in cell death diagnosis, but the biological differences in cell behavior and beneficial or detrimental effects of suicides for homeostasis, survival, or normal functioning of a tissue, like the integrated vascular tissue and brain parenchyma. © Informa Healthcare USA, Inc. Source

Danaila L.,National Institute of Neurology and Neurovascular Diseases
Chirurgia (Romania) | Year: 2012

From a total of 364 patients who underwent surgery for AVMs, 46 (12.63%) had lesions located interhemispherically. The majority of patients have entered the 4th and 5th age decade. The youngest operated patient was 18 years old and the oldest was 64. The most frequent clinical signs encountered were headaches (13 - 28.2%), epilepsy (21 - 45.65%), motor deficits (12 - 26.08%), sensitivity disorders (8 - 17.39%), speech disabilities (4 - 8.69%), visual field deficits (3 - 6.52%), mental disorders (5 - 10.85%) and alteration of consciousness (4 - 8.69%).The initial imagistic examination consisted of a noncontrast computed tomographic scan, followed by a magnetic resonance angiography (MRA) and a digital subtraction angiography. We included the 46 patients into the Spatzler-Martin scale based on the location, the proximity to the eloquent areas, as well as on the type of the venous drainage. Next we show the number of patients included in every grade of the scale. Grade I - 7 (15.21%) patients, Grade II - 17 (36.95%) patients, Grade III - 19 (41.30%) patients and Grade IV - 3 (6.52%) patients. An interhemispheric surgical approach was used for these AVMs. Excellent and good postoperative results has been obtained in 37 (80.43%) patients, fair results in 5 (10.86%), poor in 2 (4.34%) and 2 (4.34%) patients have died. One of the 2 deaths was caused by a haematoma in the bed of the AVM and the other was caused by a pulmonary embolism. Copyright © Celsius. Source

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