Les adénomes hypophysaires sont opérés par voie endoscopique endonasale (> 99 %) actuellement le gold standard. Nous avons analysé d’une façon rétrospective les cas opérés par voie endoscopique trans-sphénoïdale, dans le service de neurochirurgie au CHRU N.-Oblu, Iasi. Entre 2014 et 2017, 78 interventions ont été effectuées par voie endoscopique trans-sphénoïdale dont 67 pour des adénomes hypophophysaires (64 cas). Les difficultés opératoires rencontrées sont : 1. voie d’abord étroite due aux particularités anatomiques de la cavité nasale (hypertrophie des structures de la cavité nasale, cornet inférieur/moyen 26/19, épine nasale/déviation du septum 12/12, qui ont rendu nécessaire une résection de CM dans 8 cas et un abord binarinaire dans 6 cas. 2. difficultés de repérage notamment des particularités anatomiques de la cavité nasale (muqueuse cicatricielle/polypose 1/1) et du sinus sphénoïdal (conformation complexe ou absence de pneumatisation – 3 cas) 3. particularités fonctionnelles — muqueuse fragile, hémorragique : 7 cas ou avec des synéchies – 6 cas) Interventions difficiles en raison d’hémorragies au niveau de la muqueuse nasale (7 cas), sphénoïdale (2 cas), au moment de la résection tumorale (4 cas), en raison de différentes structures vasculaires, avec 1 cas qui a nécessité la conversion de l’intervention. Les complications intra-opératoires sont représentées par : 1. erreurs d’analyse d’imagerie préopératoires 2. erreurs de technique — lésions vasculaires, lésions des structures fonctionnelles, fuite de LCR 3.données lésionelles, tumeurs fibreuses, invasion du sinus caverneux, diamètre de plus de 4 cm. Les complications postopératoires sont représentées par des complications rhino-sinusales — sécheresse, croûtes, perforation septale, sinusite, mucocèle. Les complications de la voie d’abord endoscopique trans-sphénoïdale peuvent varier de la complication mineure à la complication majeure, mais avec les moyens techniques actuelles et avec un planning préopératoire soigneux ces interventions peuvent se réaliser dans des conditions optimales de sécurité entraînant un risque minime pour le patient.

Intracranial dural arteriovenous fistulae (DAVF) with retrograde cortical venous drainage are uncommon lesions frequently associated with a poor prognosis if left untreated. The treatment of DAVFs with cortical venous drainage by endovascular occlusion of the entire arterial supply or the venous drainage is considered curative. We present our first endovascular experience with use of Onyx via the arterial route in these aggressive fistulas.

Reconstructive surgery of bone defects in the calvarium makes use of a multitude of biological and artificial materials. Due to the increased number of such medical casuistry in the recent years, a special attention was dedicated to the biocompatibility and osteointegrative properties of various types of biomaterials. Titanium emerged to be a promising cranioplasty material due to its excellent mechanical properties and biocompatibility. However, the way the host calvarial bone reacts to the titanium implant has not been fully understood. Here, we evaluate the influence of cranial bone substrate on the osteoconduction and osseointegration of titanium mesh implants. The pattern of bone tissue reaction in the areas of contact with metallic implant is analyzed by means of bone density measurements on the computer tomography images. Twenty-eight patients underwent cranioplasty with titanium mesh implants for bone cranial defects due to different aetiology. With the aid of visual analogue scales, the patients' status (osteointegration degree, comfort and cosmetics) was evaluated after 3 - 14 months since surgery (implantation).

The paper presents the first results of thirty cases of contusion injuries of optic nerve : an analysis of symptoms and the aspect of visual impairment. Indirect injury may damage the optic nerve and this leads to optic nerve contusions. In such cases, the fractures of the base of the skull, involving or not the optic canal, immediately leads to uni or bilateral blindness, stationary or

Diffusion tensor imaging (DTI) contains a wealth of information on molecular diffusion in biological tissues [1,2]. Visualizing the white-matter tracts using diffusion anisotropy maps represents one of the applications with a major impact on neurosurgical case management [3]. Knowledge of the topography, integrity, and involvement by the pathological process of the white matter tracts is an important factor in pre-surgical planning for patients with brain lesions. We have evaluated the clinical utility of a magnetic resonance tractography technique based on DTI. We studied, in a prospective manner, 25 cases with lesions involving salient intracerebral and medullary tumors (22 and 3 cases respectively). All cases followed a preoperative imaging protocol that included DTI on top of the usual MR imaging protocol. We analyzed the DTI findings preoperatively and looked at the significant information that influences the surgical plan: position of the significant white matter tracts, the degree of their involvement in the pathological process and anatomical integrity, relationships with important anatomical landmarks and with the major surgical approach paths. We present the postoperative results and some of the most illustrative cases in the series and compare our results with the similar studies in the literature. Our experience, based on the results of the present study strongly suggests that in depth knowledge of the white matter tracts involvement in an intracerebral or intramedullary pathological process improves significantly the surgical planning in terms of surgical procedure safety and functional outcome.

Intracranial meningioma represent a quite frequent pathology but those located in the foramen magnum are quite rare. We have described a small number of cases with their singularities – FMM associated with vagal disorders and associated with multiple aneurysms - operated in a short period of time along with reviewing the literature concerning the topic – frequency, type of approach, clinic signs.

Aim: to identify the possible correlation between demographic data of the patients, site of tumor origin, and pathological characteristics of each subgroup of the posterior fossa meningiomas as the anatomical location of these tumors is a critical determinant of the operative approach that will be chosen. Materials and Methods: We analyzed medical records of 35 patients with posterior fossa meningiomas who underwent surgery between January 2005 and December 2009 at Neurosurgery Department, Iasi. The analysis included: age and gender of the patients, tumor location, and pathologic findings.

Most primary intracranial tumors occur as solitary lesions; multiple locations of one tumor, the occurrence of two different tumors or even collision tumors have been described only in a few patients. Multiple primary brain tumors rarely originate in different tissues. Cases not associated with von Recklinghausen's neurofibromatosis constitute only 0.3% of all primary brain tumors. The association of two primary intracranial tumors of different histogenesis in the same individual is rare, except in cases of phakomatosis or radiation-induced tumors. We present three cases with simultaneous occurrence of meningioma with glioblastoma, pituitary adenoma, and acoustic schwannoma respectively, as shown by MRI on admission. In two cases (meningioma/glioblastoma, and adenoma/meningioma associations) both tumors have been approached in one operation, both tumors being completely removed. In the meningioma/acoustic schwannoma association case only the schwannoma was approached surgically due to poor patient status and meningioma being completely clinically silent. Postoperative recovery was good for all three patients and the 1 year follow up showed no growth for the remnant meningioma. Although the particular tumors diagnosed in all three presented cases represent common primary intracranial tumors, the simultaneous occurrence of each two tumors is rare. Previous reported results failed to consistently show a common genetic mark that could explain the development of two different tumors. However, based on our cases and previous literature, we believe that increased research effort could provide significant insights in the appearance and development of multiple brain tumors.

153 SCREENING FOR COLORECTAL CANCER WITH FECAL OCCULT BLOOD TESTING AND COLONOSCOPY: CORRELATION OF CLINICAL DATA, SITE, SIZE AND DISEASE’S STAGE Iuliana Tarasi, Gabriela Florenţa Dumitrescu, Anca Indrei, P. Plamadeala, Anca Trifan, C. Stanciu, 1 Departament of Gastroenterology, „St. Spiridon” Emergency Clinical Hospital Iasi 2 Department of Pathology, „Prof. Dr. N. Oblu” Emergency Clinical Hospital Iasi 3. Department of Anatomy and Embriology, „Gr.T. Popa” University of Medicine and Pharmacy Iasi 4 Department of Pathology, „St. Mary” Emergency Clinical Hospital Iasi 5 Institute of Gastroenterology Iasi

The authors present five cases of posttraumatic petronosal fistulas. The stress the rarity of these cases, their anatomo-pathological aspects, the pathophysiological consequences of the osteo-meningeal fissure and the necessity of the neurosurgical treatment.

ANALYSANT LES CONDITIONS DE L'ACCIDENT,LA CLINIQUE,L'EXPLORATION PARACLINIQUE ET LA THERAPEUTIQUE DE 100 CAS DE TRAUMATISMES CRANIO-CEREBRAUX ROUTIERS CHEZ LES ENFANTS,LES AUTEURS TIRENT DES CONCLUSIONS CONCERNANT LEUR FREQUENCE ENVERS L'ADULTE,LA FREQUENCE ET LES PARTICULARITES DES LESIONS,LE MECANISME PATHOGENIQUE DE LEUR PRODUCTION AINSI QUE LA GRAVITE DES SEQUELLES NEUROPSYCHIQUES.LES DEDUCTIONS STATISTIQUES ET ANATOMO-CLINIQUES SONT ACCOMPAGNEES PAR DES PROPOSITIONS PROPHYLACTIQUES ET CURATIVES,COMME LA NECESSITE DE L'HOSPITALISATION DE CES MALADES.