Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Cílem karotické endarterektomie je prevence ischemické cévní mozkové příhody, jedné z nejčastějších příčin trvalého postižení či úmrtí ve vyspělých zemích. Současná indikační doporučení jsou založena dominantně na hodnocení stupně stenózy způsobené aterosklerotickým plátem. Přestože je známo, že charakter plátu může souviset s jeho rizikem klinické symptomatologie, zatím není vyjádřen v současných doporučeních American Heart Association (AHA). Na vývoj a charakter plátu má nejspíše velký význam hemodynamika v karotickém řečišti. Cílem našeho projektu je popsat vztah mezi hemodynamickými parametry a charakterem karotického plátu. Správnost našich matematických kalkulací chceme potvrdit pomocí laboratorních modelů karotických stenóz. Vizí našeho projektu je získat nástroj, který by dokázal včas diferencovat rizikové pláty od těch méně rizikových a poskytl možnost časné intervence před rozvojem klinické symptomatologie a tím zefektivnil význam preventivních opatření, jakým je karotické endarterektomie.; The goal of carotid endarterectomy is prevention of ischemic stroke, one of the most common causes of morbidity or mortality in developed countries. The current indication criteria are primarily based on the grade of stenosis caused by the atherosclerotic plaque. Even though it is known that the character of atherosclerotic plaque may be associated with the risk of clinical symptoms, this parameter is not expressed in the recommendations of the American Heart Association (AHA). The development and the character or the plaque are probably influenced by the hemodynamics in the carotid arteries. The goal of our project is to describe the relationship between the hemodynamic parameters and the character of the plaque. The mathematical calculations will be verified with laboratory modelling. The vision of our project is to obtain a tool that would help in early differentiation between risky and less risky plaques and provide the possibility of early intervention before the onset of clinical symptomatology thus making the preventive measures, such as carotid endarterectomy, more effective.
- Keywords
- Iktus;, Hemodynamika;, Stenóza karotidy;, Nestabilní aterosklarotický plát;, Stroke;, Hemodynamics;, Carotid stenosis;, Unstable atherosclerotic plaque;,
- NML Publication type
- závěrečné zprávy o řešení grantu AZV MZ ČR
- MeSH
- Surgical Procedures, Operative methods MeSH
- Child MeSH
- Endoscopy classification methods MeSH
- Craniopharyngioma * surgery diagnostic imaging diagnosis therapy MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Neurosurgical Procedures * classification methods instrumentation MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Keywords
- transkraniální přístup,
- MeSH
- Surgical Procedures, Operative methods MeSH
- Adult MeSH
- Endoscopy classification methods MeSH
- Craniopharyngioma * surgery diagnostic imaging diagnosis therapy MeSH
- Humans MeSH
- Disease Management MeSH
- Neurosurgical Procedures * classification methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
Neurochirugie je zásadní pro získání histologických vzorků, provádění správných chirurgických výkonů, pro indikace k výkonům a následné pooperační sledování. V posledních letech došlo jak ke zpřesnění indikací neurochirurgických intervencí, tak ke snížení komplikací. Zásadní je použití moderních zobrazovacích, navigačních a elektrofyziologických technik. Péče o pacienty s nádory je však multioborová, proto je nezbytná kooperace s dalšími odbornostmi.
Neurosurgery plays a crutial role in obtaining histological samples, in performance of adequate surgical procedures, in decision about surgical procedures and postoperative follow-up. Indications of neurosurgical procedures has been refined as well as the rate of complications has been reduced. Modern imaging, navigation and eletrophysiological techniques are of utmost importance. Care has to be multidisciplinar, thus cooperation between key care givers is vital.
- MeSH
- Astrocytoma surgery diagnosis pathology MeSH
- Chemoradiotherapy methods MeSH
- Ependymoma surgery diagnosis pathology MeSH
- Glioblastoma diagnosis pathology therapy MeSH
- Glioma diagnosis classification therapy MeSH
- Craniopharyngioma surgery diagnosis MeSH
- Humans MeSH
- Lymphoma diagnosis pathology therapy MeSH
- Meningioma surgery diagnosis pathology MeSH
- Neoplasm Metastasis diagnosis therapy MeSH
- Central Nervous System Neoplasms * diagnosis classification therapy MeSH
- Pituitary Neoplasms surgery diagnosis pathology MeSH
- Spinal Cord Neoplasms diagnosis therapy MeSH
- Neurosurgical Procedures methods MeSH
- Neoplasm Grading MeSH
- Neuroma, Acoustic surgery diagnosis MeSH
- Check Tag
- Humans MeSH
Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice" and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.
Objective: Pituitary adenoma surgery has evolved rapidly in recent decades. This study aims to determine current practice across a wide range of European neurosurgical centers. Methods: A list of eligible departments performing pituitary adenoma surgery was created. The survey consisted of 58 questions. For analysis, the departments were divided into four subgroups: academic/nonacademic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice," and geographical regions. Results: Data from 254 departments from 34 countries were obtained. In 108 centers (42.5%), <30 pituitary adenomas were operated per year. Twenty (7.9%) centers performed >100 adenoma surgeries per year. Number of neurosurgeons performing endonasal surgeries are as follows: 1 in 24.9% of centers and 2 in 49.8% of centers. All residents assisted endonasal surgeries in 126 centers (49.8%). In 28 centers (21.1%), all residents performed endonasal surgery under supervision during residency. In 141 centers (56.8%), the endoscopic approach was used in >90% of the surgeries. Regular pituitary board (either weekly or once a month) meetings were held in 147 centers (56.3%). Nonfunctioning adenomas represent >70% of pituitary caseload in 149 centers (58.7%). Conclusions: In our survey, most centers perform less than 100 surgeries for pituitary adenomas. In most centers, pituitary surgeries are performed by one or two neurosurgeons. Residents have a limited exposure to this type of surgery, and the formal pituitary board is not a standard. Nonfunctioning adenomas make up most of surgically treated adenomas. This study can serve as a benchmark for further analyses of pituitary adenoma centers in Europe.
- Publication type
- Journal Article MeSH
- MeSH
- History, 20th Century MeSH
- Humans MeSH
- Neurosurgery * history MeSH
- Neurosurgeons history MeSH
- Patient Care Team MeSH
- Check Tag
- History, 20th Century MeSH
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Intracranial Aneurysm surgery diagnosis MeSH
- Intracranial Arteriovenous Malformations surgery diagnostic imaging diagnosis MeSH
- Hemangioma, Cavernous surgery diagnosis MeSH
- Craniocerebral Trauma surgery diagnosis classification MeSH
- Humans MeSH
- Spinal Cord surgery MeSH
- Cerebellopontine Angle surgery pathology MeSH
- Brain Neoplasms surgery diagnostic imaging diagnosis MeSH
- Neurosurgical Procedures * classification methods MeSH
- Peripheral Nerves surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- Keywords
- resekce nádoru, makroadenom,
- MeSH
- Adrenocorticotropic Hormone physiology MeSH
- Acromegaly etiology pathology MeSH
- Dopamine Antagonists therapeutic use MeSH
- Cushing Syndrome surgery etiology pathology therapy MeSH
- Child MeSH
- Gigantism etiology MeSH
- Contraindications MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Pituitary Neoplasms * surgery diagnostic imaging classification complications pathology therapy MeSH
- Neurosurgical Procedures MeSH
- Puberty, Precocious MeSH
- Prolactinoma physiopathology pathology therapy MeSH
- Radiosurgery MeSH
- Growth Hormone physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
