Conditions assessed
Cranial and spinal conditions
Neurosurgical assessment for adults and children
Treatment recommendations are individual and based on the relationship between symptoms, clinical examination and investigations.
Cranial conditions
Primary brain tumours
- Lesions arising from brain tissue or neighbouring intracranial structures. MRI can suggest a diagnosis, but the histomolecular type is established through clinical and imaging correlation and, when indicated, histopathological examination and molecular testing.
- Seizures and changes in strength, speech or vision may require assessment; MRI findings are related to the neurological examination.
- Depending on the location and suspected diagnosis, observation, tissue sampling or resection and multidisciplinary assessment are discussed.
Meningiomas
- Tumours arising from the coverings of the brain; many grow slowly, but location and progression matter.
- They may be incidental findings or cause symptoms through compression; successive MRI scans are compared.
- Options may include observation, surgery or radiotherapy in selected cases after individual assessment.
Brain metastases
- Secondary brain lesions caused by the spread of malignant cells from a primary tumour in another organ.
- Assessment brings together brain MRI, neurological symptoms and the overall oncological situation.
- Surgery, radiotherapy and oncological treatment are discussed together, depending on the number of lesions and the patient's condition.
Gliomas and other intra-axial tumours
- Tumours within brain tissue; MRI provides guidance, while tissue analysis may establish the diagnosis.
- Symptoms depend on the affected region: seizures, language difficulties, weakness or cognitive changes.
- Biopsy or resection is weighed against neurological function, followed by a neuro-oncology discussion.
Arachnoid cysts
- Cavities containing fluid similar to cerebrospinal fluid, often present from development.
- Many are incidental findings; assessment considers growth, compression and any genuine relationship to symptoms.
- Follow-up is often sufficient; an intervention is discussed only when supported by clinical and imaging findings.
Hydrocephalus and other CSF circulation disorders
- Accumulation of cerebrospinal fluid can enlarge the ventricles and affect intracranial pressure.
- Symptoms vary with age and cause; the clinical examination and CT/MRI images are reviewed.
- Treatment depends on the mechanism and may include a shunt or an endoscopic procedure in suitable cases.
Subdural haematomas and selected other intracranial collections
- Collections of blood or fluid inside the skull, sometimes following trauma or during anticoagulant treatment.
- Progressive headache, drowsiness, weakness or confusion warrant prompt assessment and imaging.
- Observation or drainage depends on the size, effect on the brain and neurological condition; acute deterioration is an emergency.
Malformations and congenital conditions of the central nervous system
- Developmental changes affecting the brain, skull or cerebrospinal fluid circulation.
- Assessment considers development, neurological examination and associated abnormalities, using age-appropriate imaging.
- Some require monitoring only; others need coordinated assessment and treatment by a team experienced in the condition.
Chiari malformation and associated conditions, in selected cases
- A change at the junction of the skull and spine that may affect cerebrospinal fluid circulation.
- Symptoms are related to MRI findings and associated conditions, including syringomyelia, are sought.
- An MRI measurement alone does not decide whether surgery is needed; monitoring and decompression are discussed according to the clinical picture.
Orbital and orbitocranial conditions — assessment and multidisciplinary management where appropriate
- Lesions in or near the orbit may affect vision, ocular nerves and the skull base.
- Changes in vision or eye movements require ophthalmological assessment and correlation with CT/MRI.
- The plan is agreed with the relevant specialties; the indication and approach depend on the structures involved.
Adult brain tumours
- Primary or secondary brain tumours in adults; an imaging finding is the start of assessment.
- Symptoms, location, mass effect and general health matter.
- The need for biopsy or resection and subsequent oncological treatment are discussed according to the likely diagnosis.
Paediatric brain tumours
- Brain tumours in children require assessment in a paediatric setting, including their effects on development.
- Images are reviewed together with symptoms, age and any signs of hydrocephalus.
- Diagnosis and treatment are planned alongside paediatric oncology and the other necessary specialties.
Meningiomas
- Tumours of the meninges with variable biological behaviour.
- Location, growth on MRI and symptoms matter more than the mere presence of a lesion.
- Observation, surgery and radiotherapy are considered, taking any available histopathology into account.
Gliomas
- A group of tumours arising from glial cells; characterisation may require histological and molecular analysis.
- MRI defines the extent and relationship to functional regions without replacing tissue diagnosis.
- The strategy may include biopsy or resection adapted to neurological function, followed by oncological assessment.
Brain metastases
- Brain involvement from an oncological disease elsewhere in the body.
- The number and volume of lesions, symptoms and systemic disease control are reviewed.
- Local and systemic treatment are coordinated with the oncologist and radiation oncologist according to the patient's goals.
Intraventricular tumours
- Tumours within the brain cavities through which cerebrospinal fluid circulates.
- They may obstruct fluid circulation; MRI shows the location and any hydrocephalus.
- The plan addresses tumour diagnosis and treatment as well as the fluid circulation problem, if present.
Cases requiring a multidisciplinary neuro-oncology discussion
- Cases in which the diagnosis, treatment timing or combination of options requires several specialties.
- Complete imaging studies, histopathology and treatment history are helpful for discussion.
- The joint recommendation may include investigations, observation or staged treatment; the decision is discussed with the patient.
Assessment of these conditions may lead to recommendations for follow-up, further investigations, non-surgical treatment or neurosurgery, depending on the case.
Spinal conditions
Lumbar disc herniation
- Displacement of a lumbar disc fragment may irritate or compress a nerve root.
- Pain radiating down the leg, numbness and weakness are related to the neurological examination and MRI.
- Non-surgical treatment is often the first option; surgery is discussed for deficits or persistent symptoms that match the findings.
Cervical disc herniation
- A cervical disc may compress a nerve root or, sometimes, the spinal cord.
- Arm pain, numbness, weakness or walking difficulties require clinical correlation and cervical MRI.
- Management depends on the affected structure and progression; spinal cord compression and a progressive deficit change the priority of assessment.
Lumbar spinal stenosis
- Narrowing of the lumbar spinal canal may compress the nerves supplying the legs.
- Leg pain or heaviness when walking that improves with rest is assessed alongside the examination and MRI.
- Rehabilitation, symptom treatment and possible decompression are chosen according to functional limitation and agreement with imaging.
Cervical spinal stenosis
- Narrowing of the cervical spinal canal can affect the spinal cord and nerve roots.
- Reduced hand dexterity, imbalance or difficulty walking may indicate myelopathy and require assessment.
- MRI and neurological examination guide monitoring or discussion of decompression, without equating every stenosis with a need for surgery.
Spondylolisthesis and spinal instability — assessment and treatment planning
- Slippage of one vertebra relative to another may be associated with pain, instability or nerve compression.
- Assessment may require standing X-rays, sometimes dynamic views, and MRI if neurological symptoms are present.
- Non-surgical treatment options or the indication for surgical stabilisation are discussed.
Selected spinal tumours
- Tumours that may involve the vertebrae, nerve coverings or spinal cord.
- Progressive pain, weakness, changes in sensation or bladder/bowel function require assessment and MRI.
- Treatment depends on the location, spinal stability and tumour diagnosis; an oncology and spinal team may be required.
Compressive lesions with neurological involvement
- Different lesions may put pressure on the spinal cord or nerve roots.
- Weakness, walking difficulties and bladder/bowel changes determine the priority of examination and imaging.
- Decompression is discussed after identifying the cause; a new or rapidly progressive deficit requires emergency assessment.
Reassessment of persistent pain after spinal surgery
- Pain after an operation can have different causes, including persistent compression, degenerative changes or non-compressive mechanisms.
- Records of the operation, the course of symptoms, and comparison of preoperative and postoperative images are helpful.
- Non-surgical treatment guided by rehabilitation, pain management and neurosurgical reassessment is discussed when indicated.
Cases requiring clinical and imaging correlation before a decision on surgery
- Degenerative MRI changes can also occur without symptoms and do not determine the indication for surgery by themselves.
- The level of pain, distribution of symptoms, strength, reflexes and agreement with the reported lesion are checked.
- The plan may involve further assessment or non-surgical treatment; surgery is discussed only for a well-defined problem.
Not every MRI finding automatically means surgery is needed. The decision is based on agreement between symptoms, clinical examination and investigations.
Paediatric conditions
Paediatric hydrocephalus
- Excess cerebrospinal fluid may enlarge a child's ventricles.
- In infants, head circumference and the fontanelle are monitored; vomiting, drowsiness or abnormal gaze require prompt assessment.
- Ultrasound and MRI/CT are chosen according to the context; shunting or endoscopy is discussed according to cause and age.
Arachnoid cysts
- Fluid-filled cysts that may be identified before birth or during a child's investigations.
- Assessment considers development, neurological signs and any effect on neighbouring structures.
- A cyst without symptoms can be monitored; growth or symptomatic compression may justify discussing treatment.
Chiari malformation
- A feature of the cranio-cervical junction, sometimes associated with disturbed fluid circulation or syringomyelia.
- Paediatric assessment may consider pain, balance, swallowing and other symptoms related to MRI findings.
- Observation or treatment is chosen according to symptoms, progression and associated conditions.
Filum terminale and selected spinal dysraphisms
- Some developmental abnormalities may tether the spinal cord and restrict its movement within the spinal canal.
- Changes in walking, weakness, lumbar skin signs or urinary symptoms may justify investigations.
- MRI and, where appropriate, urological assessment help decision-making; the appearance of the filum alone does not establish the indication for surgery.
Spina bifida — neurosurgical assessment and multidisciplinary care
- A defect in spinal closure with variable severity and neurological involvement.
- Assessment considers strength, mobility, bladder function and possible associated hydrocephalus.
- Care involves neurosurgery, paediatrics, urology, orthopaedics and rehabilitation; the plan is adapted to the form of the condition and the child's needs.
Craniosynostosis — multidisciplinary care
- Premature closure of one or more sutures may alter the shape and growth of the skull.
- Examination of head shape and development determines the need for imaging and associated assessments.
- Treatment and timing are discussed within a craniofacial team; not every skull asymmetry is craniosynostosis.
Plagiocephaly — assessment and guidance
- Head asymmetry may be positional but must be distinguished from premature closure of a suture.
- Skull shape, neck movement and changes over follow-up are assessed.
- Repositioning and physiotherapy may be discussed for positional forms; other measures depend on age, severity and diagnosis.
Brain and spinal tumours in children
- Tumour lesions of a child's brain or spine, with types and progression that differ from those in adults.
- Symptoms may include walking difficulties, repeated vomiting, seizures or weakness; imaging assessment is adapted to age.
- Decisions about biopsy, resection and subsequent treatment are made within a multidisciplinary paediatric team.
Other congenital malformations of the nervous system
- Congenital abnormalities outside the categories above may have very different consequences.
- Prenatal history, development and examination guide the need for MRI and other specialties.
- Monitoring, developmental support or an intervention is discussed only for a well-supported indication.
Neurosurgery in older adults
Normal pressure hydrocephalus
- Gait, cognitive and urinary symptoms can have different causes; some warrant assessment for normal pressure hydrocephalus.
- Neurological examination, gait assessment and MRI/CT findings are considered together; a single negative tap test does not exclude the diagnosis.
- A ventriculo-peritoneal shunt is discussed for selected patients after assessing the balance of risks and benefits.
Neurosurgical assessment in later life
- Chronological age alone does not determine whether surgery is appropriate.
- Frailty, independence, associated conditions, treatments and the patient's goals are assessed together.
- The plan may include observation, rehabilitation, non-surgical treatment or surgery; antithrombotic medicines must not be stopped without the team's advice.
In some situations, the best assessment involves collaboration with neuroradiology, oncology, radiotherapy, neurology and other relevant specialties.
Techniques and approach
A well-planned operation starts before the first incision.
In cranial neurosurgery, the choice of approach starts with each patient's anatomy, the location of the lesion and protection of neural and vascular structures. The aim is effective treatment with as little tissue injury as possible, without compromising operative safety.
Preoperative imaging and planning
- Advanced processing of MRI and CT images using specialist software.
- Individual three-dimensional planning of the surgical approach.
- Identification of important anatomical structures and the operative trajectory.
Microsurgery and minimally invasive approaches
- Microsurgical and neuroendoscopic techniques.
- Individual cranial approaches, with limited scalp incisions or supraorbital approaches in suitable cases.
- Hair preservation without shaving when operative conditions allow.
Intraoperative guidance and precision
- Neuronavigation.
- Image-guided brain biopsies.
- Intraoperative ultrasound (IOUS).
Monitoring and protecting neurological function
- Intraoperative neuromonitoring (IONM).
- Awake surgery for selected indications and with a specialist team.
- Intracranial pressure monitoring when needed, as a diagnostic and monitoring procedure.
The right approach for each patient
Minimally invasive does not simply mean a smaller incision. It means a carefully planned operation, choosing the most suitable surgical route and protecting important anatomical structures.
Techniques are selected according to the individual case, medical indication and available resources.
Consultation and second opinion
Appointments through Spitalul Sf. Constantin, Brașov.