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A V Ciurea

Publications and source records attributed to A V Ciurea.

At least 19 recordsLinked to original sources
PubMed2006

Supratentorial epidural hematoma of traumatic etiology in infants.

INTRODUCTION AND BACKGROUND: Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. In our current communication, we present our data regarding the presentation of infants with EDH, their management, and their long-term outcome. MATERIALS AND METHODS: In a retrospective study, the hospital and outpatient clinic charts and imaging studies (head CT and skull X-rays) of 31 infants with pure, supratentorial EDH of traumatic origin were meticulously reviewed. Children Coma Scale score and Trauma Infant Neurologic Score (TINS) were also reviewed. The most common presenting symptom was irritability, which occurred in 18/31 (58.1%) of our patients. Pallor (in 30/31 patients) and cephalhematoma (in 21/31 patients) were the most commonly occurring clinical signs upon admission; both signs represent signs of significant clinical importance. Surgical evacuation via a craniotomy was required in 24/31 of our patients, while 7/31 patients were managed conservatively. The mortality rate in our series was 6.5% (2/31 patients), and our long-term morbidity rate was 3.2% (1/31 patients). CONCLUSIONS: EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, size of EDH, and presence of midline structure shift on head CT scan. Mortality and long-term morbidity are low with early diagnosis and prompt treatment.

Accidental Falls↗
PubMed2006

[Neuro-ophthalmologic multiple lesions in craniocerebral trauma].

The authors present the case of a child, 8 years old, victim of a car accident, suffering a cranio-cerebral trauma. The posttraumatic injuries were: bitemporal cranial fractures, LE VI nerve palsy with secondary convergent strabismus, left posttraumatic optic neuropathy with poor vision, right deafness, nasal bone fracture, left paramedian mandibular fracture. Four months later the child developed proptosis due to a high-flow carotid-cavernous fistula, on the site of the good eye, RE, which was clinically diagnosed and confirmed by the results of MRI, MRA and cerebral angiography. Considering the ophthalmologic and neurologic risks of this pathologic condition, the surgery was performed, using an external device (Silverstone clamp) with the purpose of progressive and adjustable control of the fistula thrombosis. The postoperative result was fistula thrombosis, preserving the visual acuity and visual field, with a residual hypertonia on the right eye. The peculiarity of the case consist in the small age of the patient and the severity of neuro-ophthalmologic lesions. The child will live for the rest of his life with a single well-seeing eye, whose function could be at risk at any moment, related to the posttraumatic vascular changes at the level of the right cavernous sinus.

Abducens Nerve Diseases↗
PubMed2005

Long-term surgical outcome in patients with intracranial hydatid cyst.

BACKGROUND: Cerebral hydatid cysts account for up to 3.6% of all intracranial space-occupying lesions, in endemic countries. The vast majority of patients affected are children. Computed tomography (CT) and magnetic resonance imaging (MRI) have greatly contributed to a more accurate diagnosis of hydatids. However, correct pre-operative diagnosis still remains quite puzzling. Extirpation of the intact cyst is the treatment of choice, resulting in most cases to a complete recovery. METHOD: In our retrospective study, we have reviewed 76 cases of intra-cranial hydatid disease operated on in our hospital over a 22 year period. Presenting clinical symptoms and signs and the radiological findings on CT and MRI were documented. Albendazole was given preoperatively to patients with giant (>5 cm) or multiple cysts and postoperatively to all patients. The follow-up period ranged from 12 months to 22 years and the outcome was assessed using the Glasgow Outcome Scale (GOS). FINDINGS: Sixty seven (95.7%) of our patients were children. Increased intracranial pressure and papilledema were the predominant findings in this group, whereas focal neurological deficits were most prevalent in adults. CT and MRI revealed round cystic lesions, isodense and iso-intense respectively to cerebrospinal fluid (CSF), with no rim enhancement or perifocal edema. Multiple cysts were identified in 3 cases. Extirpation of the cyst without rupture was accomplished in 56 patients (73.7%). Recurrences occurred in 19 patients (25%). 4 patients (5.3%) died within 6 months after surgery; 3 of these patients had multiple cysts and one died shortly after the operation due to anaphylactic shock following intra-operative rupture of the cyst. CONCLUSION: Long-term follow-up confirms that intracranial hydatid cysts should always be surgically removed without rupture; the outcome remains excellent in these cases. Correct preoperative diagnosis is vital for the successful outcome of surgery. A high index of suspicion is therefore required in endemic areas despite the availability of advanced neuro-imaging. Medical treatment with albendazole seems to be beneficial both pre- and post-operatively. Newer diagnostic methodologies, such as MR spectroscopy and MR diffusion weighted imaging, might lend themselves to the diagnosis of intracranial hydatid cysts.

Adult↗
PubMed2005

Severe brain injuries in children.

Authors present a seven years retrospective study on 85 cases of severe brain injuries (SBI) in children (GCS </= 8) treated in the Pediatric and ICU Departments of the Clinic Hospital "Bagdasar-Arseni" Bucharest, Romania. The relationship between ICP, GCS on admission, the CT-scan/MRI alteration and the outcome evaluated by the Glasgow Outcome Scale (GOS) were studied in order to highlight the most important factors to improve prognosis. An overall mortality of 25.9% was found in this series. Authors concluded that the ICP values at admission >/= 20 mmHg, the Diffuse Axonal Injury (DAI) on MRI and the GCS on admission are factors of prognosis in SBI in children. The politrauma context is an aggravating factor for SBI in this age group. Other factors which influence GCS on admission may have prognostic importance i.e.: prehospital care, transport time and adequate transport conditions.

Adolescent↗
PubMed1999

Neurosurgical management of brain abscesses in children.

The authors review the management of brain abscesses (BAbs) in 59 pediatric cases. The major surgical procedure used to treat them was repeated puncture and aspiration (51 cases, or 86.44%), excision (8 cases - 13.56%) being of secondary importance. The main etiology was metastatic lesions (24 cases - 40.68%), those due to cyanotic congenital heart disease being the most frequent. Single lesions dominated (41 cases - 69.49%). Gram-positive cocci were the main bacteria involved (31 cases, 52.5%). CT scan represented the main tool in the diagnosis and follow-up. Puncture and aspiration in BAbs led to a significant decrease in mortality (7 cases - 11.86%), and the incidence of seizures and neurological deficits was also reduced. Mortality was significantly correlated with the following factors: consciousness status, multiple BAbs location and hematogenous dissemination. There were recurrences in 11 cases (18.64%), all observed after aspiration procedures. The current concepts for complex management of BAbs, as reflected in recent literature data, are reviewed, with particular emphasis on the use of real-time CT or ultrasound-guided operative techniques.

Brain Abscess↗
PubMed1999

Pediatric neurosurgery--a golden decade.

Pediatric neurosurgery, once an annex of general neurosurgery, has evolved into a well-defined and complex medical specialty. The last 10 years have witnessed major advances in documentation of the minute details of CNS diseases of childhood, refinement of the specific means of action and better adaptation of therapeutic efforts to the requirements of a developing organism. Pediatric neurosurgeons are now increasingly involved in beneficial cooperation within complex medical teams. This fact has by no means diminished the importance of pediatric neurosurgery; rather, in such settings it has proved to have better effects in the struggle for stable long-lasting good results of multi-modal treatments covering all pathological entities. Progress in neurological surgery for patients in the pediatric age group has emerged from the development of supranational scientific structures and from that of specific concepts exchanging channels, so that today pediatric neurosurgeons belong to an extremely specialized medical corps, working in harmony across geographical and socio-economic national features in the interests of humankind's young generation's health.

Child↗
PubMed1997

Neurosurgical management of cerebral astrocytomas in children.

A study of astrocytomas occurring in children (mean age 9.13 years) is reported. Two hundred sixty-one cases operated within 10 years (1986-1995) were reviewed. The subtentorial localization was preponderant and was seen in 145 cases (55.04%). The pathological results for supratentorial astrocytomas show an important number of high-grade, malignant astrocytomas--74 cases (64.3%). Surgery was the most important aspect of the treatment. The microscopic tumoral removal was total in 201 cases (77%), subtotal in 37 cases (14.2%); bioptic sampling was done in only 23 cases (8.8%). In grade III and IV astrocytomas, radiotherapy (high-voltage) and chemotherapy were routinely used. The patients were followed-up, both clinically and by CT, between 6 months and 10 years. Neurological evaluation (6 months post-operative) shows a preponderance of minimal sequelae (71%). Clinical signs of recurrences occurred in 56 cases (21.45%). In 37 cases (66.07%), a surgical indication was retained. Cumulative probability of survival of children with intracranial astrocytomas at 1 year was 0.714 and at 5 years was 0.655.

Adolescent↗
PubMed1995

Cerebral hydatid cyst in children. Experience of 27 cases.

The authors present 27 cases of cerebral hydatid cyst (CHCy) treated between 1980 and 1992. These cases of CHCy represent 2.8% of all cases of expansive nontraumatic lesions in children. Most of the patients were between 6 and 10 years of age. There was a substantial prevalence of male patients-18 cases (66.6%). Most of the children with CHCy were from rural areas. The cysts were all located in the cerebral hemispheres (none in the posterior fossa). Usually two or three lobes were affected and the cysts were most often retrorolandic. Only 8 patients (29.6%) also had pulmonary or hepatic infestation. All patients were operated on immediately the diagnosis was established. Operative mortality was very low (1 patient died immediately after surgery). There have been 11 cases of recurrence; all these patients have been reoperated on. Neurological sequelae were mainly partial and general seizures. Epilepsy developed postoperatively in five patients. Paresis, which usually disappears in time, was the most common motor disturbance. Two other important postoperative complications were subdural effusion and ventricular dilatation (six cases). There have been five cases of multiple recurrences (four of these patients have since died). Treatment with albendazole was used in three cases without significant results.

Adolescent↗
PubMed1993

Posterior fossa extradural hematomas in children: report of nine cases.

Extradural post-traumatic posterior fossa hematoma is a rare condition estimated to complicate about 0.13% of all craniocerebral injuries, and represents 5.8% of the entire group of extradural hematomas in our records. Nine cases of posterior fossa extradural hematomas are presented. The clinical picture was dominated by headache, vomiting, and gait ataxia. An occipital fracture was seen in 77.7% of the patients. In all cases, the diagnosis was made by computed tomography. The postoperative evolution was good.

Child↗
PubMed1989

Giant sacro-coccygeal teratoma. Case report.

A case is presented, of a giant teratoma in the sacro-coccygeal region, in a two-year old child. Surgery was performed in two successive stages, one month apart, under CT-scan control. Exeresis of the teratoma was complete. The authors stress the very large volume of the tumor, that extended in the pre-sacral area, and the fact that complete exeresis was mandatory. Eight months after surgery the postoperative evolution was satisfactory. The importance of CT-scans for the postoperative control is stressed, in cases of teratomas extending in the pre-sacral retroperitoneal area.

Child, Preschool↗
PubMed1988

Cerebral abscesses secondary to otorhinolaryngological infections. A study of 386 cases.

A study is presented, of adjacent cerebral abscesses secondary to otorhinolaryngological infections. A total of 386 patients were included. According to frequency, and in relation to the adjacent septic focus the cerebral abscesses were classified as: otogenic--334 cases (86.5%); rhinogenic--47 cases (12.2%); tonsillary--5 cases (1.3%). These abscesses had similar characteristics: they occurred with the highest frequency in the second and the third decade of life, had a higher incidence in males, the otorhinolaryngologic infection had a chronic course with frequent recidives, propagation of the infection from the original focus occurred by continuity or through the venous system, and the clinical picture was marked by symptoms of local and general infection, by meningeal manifestation, and frequently by altered consciousness (somnolence, confusion). Surgical treatment, next to other therapeutic measures (administration of antibiotics, anti-inflammatory drugs, and intensive care) was aimed at improving the vital prognosis. The postoperative mortality was 23.8%. It was also aimed at increasing the functional recovery rate. Neuropsychical sequellae were noted in 54.9% of all cases. After surgery for the cerebral abscess attempts were made at removing the septic focus, preventing any additional risk of cerebral seeding.

Bacterial Infections↗
PubMed1984

Subarachnoid empyemas. Considerations in connection with 55 cases.

The authors present data concerning the nosologic frame of the subarachnoid empyemas. Aspects such as incidence, predominance in males (65.4% of all cases), involvement of subjects in their II-nd--IV-th decade, and the complex pathogeny of this affection are discussed. From the bacteriologic viewpoint the predominance of the monomicrobial flora is stressed, mainly staphylococcus strains (24.4% of all cases). The clinical picture consists in a severe infectious syndrome, intracranial hypertension syndrome (27.2% of all cases), neurologic syndrome (motor deficit in 81.8% of the cases, focal attacks in 43.6% of all patients), meningeal syndrome (83.6% of all cases), and psychical disturbances (in 89% of the patients). Of the para-clinical investigations performed cerebral angiography provided conclusive data in 88.5% of all cases. Surgical treatment was applied in 50 of the patients using various methods with an overall death-rate of 26%. The early diagnosis is stressed, as well as the necessity to apply surgical therapy using the bone-flap method, and full surgical cure of the primary infectious focus.

Adult↗
PubMed1983

Cerebral abscesses of unknown origin. General report.

The authors present the etio-pathogenic, anatomo-pathological, clinical, and therapeutic aspects of cerebral abscesses of unknown origin. Prognostic and neuropsychical problems are also outlined, which may be related to performance of surgical interventions. A personal series of 108 cases is presented in detail. Cerebral abscesses of unknown origin represent 13.3% of a total of 810 cerebral abscesses hospitalized in the Neurosurgical Clinic from Bucharest between 1936 and 1979. The significant number of this type of cerebral suppuration is stressed, and the authors discuss the diagnostic and the therapeutic difficulties of this affection. On the other hand the authors mention the high number of postoperative neuropsychical sequellae (70%). The overall mortality rate of the group was 29.7%.

Adolescent↗
PubMed1982

Etiological data on cerebral abscesses.

The authors stress the particular value of the bacteriological examination of the contents of cerebral abscesses. A homogeneous series of 188 cases is presented, of cerebral abscesses diagnosed between 1970 and 1979 in The Neurosurgical Clinic of Bucharest and etiological aspects are discussed in connection with 172 cases in which bacteriological investigations have been performed. In 131 of the patients the abscess contained a single strain of bacteria, in 13 other cases there were polymicrobial abscesses, and in 28 cases of cultures remained sterile. The preponderance of the gram-negative flora in these cases is stressed. Finally, the authors make a detailed description of the correlation between the etiology and the pathogenic, anatomic, evolutive and prognostic aspects of cerebral abscesses.

Bacteria↗
PubMed1982

Rhinogenic cerebral abscesses.

The authors present a detailed description of a series of 46 personal cases of rhinogenic cerebral abscesses, diagnosed and treated in the Clinic of Neurosurgery of Bucharest between 1936 and 1979. Of the total number of cerebral abscesses the rhinogenic ones represent 5.67% and 11.70% of the total of adjacent abscesses. The authors make an exhaustive analysis of etiopathogenic, clinical, anatomic and therapeutic aspects of this type of cerebral abscesses. They stress the interest of the multi-locular forms which make up 45.65% of the total number of rhinogenic cerebral abscesses. Finally the results are presented, of the surgical treatment, and the neuropsychical sequelae.

Brain Abscess↗
PubMed1982

Metastatic cerebral abscesses in the frame of cyanogenic congenital cardiopathies.

The authors present a detailed study, based on their personal experience, of a total of 17 cases metastatic cerebral abscesses occurring in the frame of cyanogenic congenital cardiopathies. A complete review of data in the literature in connection with this type of abscesses is also presented, including etiopathogenic, pathologic and clinical aspects, as well as the evolution and the treatment of these affections. The reserved prognosis of these lesions is stressed, and the surgical solution of these abscesses is emphasized. The late post-operative sequellae are also discussed.

Brain↗