Stent retriever thrombectomy is a safe treatment modality for patients with stroke presenting with BAO. Although the stent retrievers showed a good recanalisation rate, there are currently no randomised clinical trials to assess its clinical efficacy in comparison with the reference treatment.

BACKGROUND AND PURPOSE: Endovascular treatment of wide-neck anterior communicating artery aneurysms can often be challenging. The Woven EndoBridge (WEB) device is a recently developed intrasaccular flow disrupter dedicated to endovascular treatment of intracranial aneurysms. The aim of this study was to investigate the feasibility, safety, and efficacy of the WEB Dual-Layer and WEB Single-Layer devices for the treatment of wide-neck anterior communicating artery aneurysms.

Objective: This study presents the experience of one neurosurgical center in the treatment of 18 consecutive patients with distal anterior cerebral artery (DACA) aneurysms during a 10 years period. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general, and to present technical nuances in surgical treatment. Methods: We analyzed the clinical and radiological data of 18 patients treated between 2005 and 2015. All patients were treated surgically using the microscope. No patients were lost to follow-up. We compared treatment and outcome of ruptured DACA aneurysms (n 18) with all consecutive ruptured aneurysms treated in our clinic during the same period (n 446). Results: DACA aneurysms accounted for 4% of all intracranial aneurysms. They were smaller (median, 5,5 versus 9 mm) We found only one case with associated aneurysms (5,5%). DACA aneurysms presented more often with intracerebral hematomas (39% versus 26%) than ruptured aneurysms in general. Their microsurgical treatment showed the same complication rates (treatment morbidity, 15%) as for other ruptured aneurysms in literature. Their mortality rate was lower (11% versus 24%). Conclusion: Despite their specific anatomic features, and particular surgical technique, with modern treatment methods, ruptured DACA aneurysms have the same favorable outcome and lower mortality as ruptured aneurysms in general.

Introduction: There are four types of Chiari malformations described in the literature. Due to the fact that it is a common finding in the general population (true Chiari being present in 0,75% of the population), Chiari 1 malformation was also called Chiari anomaly. Material and methods: In the last 5 years 17 patients with Chiari I malformation have been treated in our clinic. There were 12 women and 5 men. The mean age was 43 years (between 21 and 60 years). The symptoms were grouped in 6 syndromes: brain stem and bulbar palsy syndrome, cerebellar syndrome, central cord syndrome, paroxysmal intracranial hypertension, scoliosis, pyramidal syndrome. Surgical treatment: According to recent literature patients respond best when operated within 2 years from the onset of symptoms. We recommend early surgery for symptomatic patients. Surgical treatment of Chiari I malformation should accomplish several golds. First of all, there is the obvious need to decompress the lower part of the cerebellum. Chiari I malformation being related to a small posterior fossa, the surgical treatment should realise enlargement of the total volume of the posterior fossa(7, 12). In the author’s opinion the key point in surgical treatment of Chiari 1 malformation should be to reestablish the CSF flow at the level of the foramen of Magendie and foramen magnum. Various approaches were used in the last five years in our clinic for the treatment of symptomatic patients: only osseous decompression in 2 patients; osseus decompression with dural grafting and intradural dissection of adhesions in 4 patients; osseous decompression with dural grafting, intradural dissection, and tonsillar coagulation in 11 patients Results: The long-term (6 months postoperative) surgery-related result was considered excellent if symptoms resolved (7 patients). The result was considered good if the patient experienced significant improvement but also residual symptoms (8 patients). A poor result indicated no change in symptoms (2 patients). As for the surgical technique used, the vast majority of patients with good or excellent outcome at 6 months underwent osseous decompression with dural grafting, intradural dissection, and tonsillar coagulation Conclusions: Regarding Chiari I malformations, the author considers that a proper patient selection is critical to prevent unnecessary procedures and maximize the outcome. In light of this study results and recent literature, the author considers that the surgical gold standard consists in three key steps: posterior fossa craniectomy followed by durotomy and subarachnoid decompression of CSF flow and last duroplasty.

Objectives. The objectives of our clinical study are the evaluation of preoperatory myelic involvement and postoperative follow up, establishing in the mean time the interval and capacity of recovery for adults with primary intramedullary tumors. Material and method. Between January 2001 and December 2008, 14 adult patients diagnosed with intramedullary tumors representing 20,6% of all primary spinal tumors treated in Targu-Mures Neurosurgery Clinic, were studied. The majority of intramedullary tumors were represented by ependymomas (64.3%), followed in equal numbers by astrocytomas and hemangioblastomas (14.3% each) and a rare case of intramedullary epidermoid cyst. Each sign and symptom was monitored with the help of a grading scale going from 5 (asymptomatic patient) to 0 (paraplegia, total absence of functional capacity). Additionally, for monitoring the functional capacity outcome we used the Karnofsky score. The resulted quantitative data of our study was analysed using the T-student test. Results. The major signs of debut were spinal back pain (50%) and motor deficit (35%). The interval between disease debut and diagnostic was variable scaling from one month to 15 years with an average of 28.8 months ± 45.4 months. The clinical status was towards progressive neurological deterioration. At the diagnostic moment all patients presented motor deficit, 12 of them (86%) presented walking disorders, 64% presented sensory deficit and only 12% presented sphincter disturbances. Postoperative evolution was characterized by a transitory neurological deterioration in 57% of cases, the deterioration being recovered during the first 3 months in 75% of cases, in 25% of cases the neurological recovery to preoperatory status extended during a period of 6 months postoperatively. Beyond the interval of 3 months postoperatively, the neurological status was stationary. The main result of surgical intervention was maintenance of preoperative neurological status. Conclusions. The clinical evolution of primary intramedullary tumors in adults was towards progressive neurological deterioration and severe myelic involvement. The surgical intervention maintains rather than improves the preoperative neurological status thus early diagnosis and treatment of this pathology represent the major favorable prognostic factors.