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120<br />
with acute sixth nerve paresis, apparently without<br />
identifi able cause. BTX-A chemo denervation of<br />
the ipsilateral medial rectus was done, with favorable<br />
outcome and disappearance of diplopia; 6<br />
months after, patient was fully recovered. The last<br />
patient presented with left sixth nerve palsy, started<br />
14 months ago, after a craniocerebral trauma p<strong>ro</strong>duced<br />
by accident, with marked diplopia. Sixth<br />
nerve function was completely abolished. She underwent<br />
surgery: half lateral transposition of superior<br />
and inferior rectus (Hummelscheim technique)<br />
and medial rectus recession on the affected eye was<br />
performed. Evolution was good, with recovery of<br />
fusion at distance and near.<br />
VI nerve palsy app<strong>ro</strong>ach is different, depending<br />
on the etiology, onset and degree of neu<strong>ro</strong>muscular<br />
dysfunction. Interdisciplinary cooperation is mandatory<br />
for p<strong>ro</strong>per management of sixth nerve palsy.<br />
Key words: sixth nerve palsy, quality of life,<br />
treatment<br />
Specifi c features in brain metastasis aft er<br />
amelanoti c malignant melanoma<br />
V. Pruna 1 , M. Gorgan<br />
“Bagdasar-Arseni” Clinic Emergency Hospital,<br />
Bucharest, Romania<br />
1Student in Neu<strong>ro</strong>surgery “Ca<strong>ro</strong>l Davila” University<br />
of Medicine and Pharmacy Bucharest,<br />
Faculty of Medicine, Department of Neu<strong>ro</strong>surgery<br />
Abstract<br />
The incidence of brain metastases in patients<br />
with malignant melanoma ranges f<strong>ro</strong>m 6-43% of<br />
cases. Amelanotic melanoma is met only in 2-8%<br />
of cases with malignant melanoma. Melanoma is<br />
one of the most common malignancies that metastasize<br />
to the brain. Most common location of malignant<br />
melanoma is the skin, retina, brain and nail<br />
bed. Brain metastases are frequently associated<br />
with intratumorale hemorrhage. The current treatment<br />
includes: surgery, radiosurgery (Gamma-<br />
Knife, LINAC or WRBT), chemotherapy, immunotherapy<br />
and multimodal. Surgery is the treatment<br />
of choice and radiosurgery (Gamma-Knife or<br />
LINAC) is a therapeutic alternative.<br />
Case presentation<br />
We choose to present the case of 58-years-old<br />
men with a f<strong>ro</strong>ntal brain metastasis of amelanotic<br />
malignant melanoma. Cranial MRI (native and<br />
REVISTA MEDICALÅ ROMÂNÅ – VOLUMUL LIX, NR. 2, An 2012<br />
contrast) highlights a left f<strong>ro</strong>nto-basal tumor, with<br />
high signal intensity on T1 weighted images (T1WI)<br />
and high signal intensity on T2 weighted images<br />
(T2WI), policystic, about 54/46/50 mm in size,<br />
with perilesional edema and mass effect that moves<br />
the midline to the right. The patient underwent surgery.<br />
Histological examination: malignant amelanotic<br />
melanoma.<br />
Key words: amelanotic malignant melanoma,<br />
brain metastasis, intratumorale hemorrhage, surgery,<br />
LINAC<br />
Unruptured anterior communicati ng artery<br />
aneurysm encased in a giant tuberculum<br />
sellae meningioma. Case report<br />
Bogdan Constanti n Dumitrescu¹,<br />
Mircea Radu Gorgan<br />
¹Student in Neu<strong>ro</strong>surgery, University of Medicine and<br />
Pharmacy “Ca<strong>ro</strong>l Davila” Bucharest,<br />
Faculty of Medicine, Department of Neu<strong>ro</strong>surgery<br />
Clinic of Neu<strong>ro</strong>surgery, Third Department<br />
of Neu<strong>ro</strong>surgery, Emergency Clinical Hospital<br />
Bagdasar-Arseni, Bucharest<br />
Abstract<br />
We present a 64-year-old man with symptoms of<br />
optic chiasm and nerve compression f<strong>ro</strong>m a giant<br />
tuberculum sellae meningioma with unruptured<br />
anterior communicating artery aneurysm encased.<br />
Preoperative magnetic resonance imaging disclosed<br />
that the aneurysm was completely enclosed in the<br />
tumor, but angiographic studies did not reveal any<br />
important arterial nar<strong>ro</strong>wing. The embedded<br />
aneurysm caused neither SAH nor intratumoral<br />
hemorrhage. All of these factors pointed to little<br />
adhesion between the tumor and the encased<br />
arteries. Surgery was performed a week after<br />
admission and the intraoperative fi ndings revealed<br />
that the tumor did not adhere too much to the<br />
enclosed vasculature except for a little part attached<br />
to the left ICA. The aneurysm was safely clipped<br />
after piecemeal removal of the tumor, which was<br />
fi nally extirpated without fear of aneurysm rupture,<br />
and with a good visual outcome. To treat both the<br />
tumor and aneurysm simultaneously, careful stepwise<br />
operative p<strong>ro</strong>cedures were essential.