OBJECTIVE: The best results in glioblastoma (GBM) are obtained through aggressive treatment comprising maximally radical but safe resection followed by chemoradiotherapy. However, certain patients will undergo only stereotactic biopsy. This paper aims to evaluate life expectancy in GBM patients who underwent only stereotactic biopsy, including the effect of subsequent oncological treatment. PATIENTS AND METHODS: Patients with confirmed GBM histology who had undergone stereotactic biopsy between June 2006 and December 2016 were retrospectively selected. Each patient had received a CT scan, followed by an MRI scan with a contrast agent. None of the patients were amenable to microsurgical resection. RESULTS: Of the 60 patients, 41 (69%) received no subsequent oncological treatment, while 14 (23%) underwent isolated radiotherapy. Mean survival time of all patients was 2.8 months. Those who received no additional treatment had an average survival time of 2.3 months; patients who received any type of oncological treatment was 3.7 months. Of these, those receiving radiotherapy alone had a mean survival of 3.1 months. Patients who received oncological treatment with the Stupp protocol had a survival time of 6.6 months. CONCLUSION: Diagnostic and surgical advances related to GBM treatment mean that radical resections can be performed even in eloquent brain areas. However, patients not indicated for resection will experience a major reduction in life expectancy. Patients who underwent stereotactic biopsy and received some form of oncological treatment experienced slightly increased overall survival relative to patients with a natural disease course. Patients with favorable clinical factors reacted better to treatment.
- MeSH
- biopsie metody MeSH
- dospělí MeSH
- glioblastom * mortalita patologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- naděje dožití * MeSH
- nádory mozku * mortalita patologie terapie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stereotaktické techniky * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Cílem této práce je ukázat technické možnosti volumetrického hodnocení objemu rezidua a zhodnotit vliv přesně definovaného objemu reziduálního nádoru na celkové přežívání (overall survival; OS) u pacientů s glioblastomem (GBM). Soubor a metodika: Retrospektivně byli vybráni dospělí pacienti, kteří podstoupili resekční výkon GBM ve FN Olomouc mezi roky 2012 a 2016. Pacienti byli podrobeni pravidelným klinickým a MR kontrolám každé 3 měsíce. Do studie byly zahrnuty časné pooperační snímky MR. U každého pacienta bylo provedeno segmentování nádorového procesu s následným vytvořením 3D modelu objemu nádoru, což umožnilo výpočet jeho objemu před i po operaci. Výsledky: Výsledky retrospektivní analýzy zahrnovaly 50 pacientů. Naše práce ukázala signifikantní prodloužení OS pouze u skupiny bez postkontrastně se sytícího rezidua (medián OS = 16,1 vs. 6,3 měsíce). Pacienti s kombinací radikální resekce a onkoterapie v Stuppově režimu dosáhli dalšího prodloužení OS s průměrem 19,6 měsíce a mediánem 14 měsíců. Závěr: Naše práce popisuje postup výpočtu objemu pooperačního rezidua GBM s využitím snadno dostupného softwaru. Na základě zjištění této studie bylo dosaženo signifikantně lepších léčebných výsledků u pacientů s úplným odstraněním postkontrastně se sytící části GBM doplněným o co nejradikálnější resekci postkontrastně se nesytící části nádoru.
Aim: The aim of this study is to demonstrate the technical feasibility of volumetric assessment of residual tumor volume and to evaluate the effect of a precisely defined residual tumor volume on overall survival (OS) in patients with glioblastoma (GBM). Materials and methods: Adult patients who underwent surgical resection for GBM in the University Hospital Olomouc from 2012 to 2016 were selected retrospectively. Patients attended regular clinical and MRI follow-up every three months. Early postoperative MRI scans were used in the study. In each patient, tumor segmentation was performed followed by creating a 3D model of tumor volume, which allowed the calculation of its volume both before and after surgery. Results: Results of 50 patients were available for a retrospective analysis. Our study showed a significant prolongation of OS only in the group with no contrast-enhancing residue (median OS = 16.1 vs. 6.3 months) Patients with a combination of radical resection and oncological treatment with the Stupp protocol achieved further prolongation of OS with a mean of 19.6 months and a median of 14 months. Conclusion: Our paper describes the process of calculating the volume of the postoperative residual component of GBM using easily available software. According to the study findings, significantly better therapy results were achieved in patients with complete removal of the contrast-enhancing GBM component, supplemented by the most possible radical resection of the contrast non-enhancing components of the tumor.
- Klíčová slova
- pooperační reziduum,
- MeSH
- analýza přežití MeSH
- gliosarkom * MeSH
- lidé MeSH
- pooperační období MeSH
- retrospektivní studie MeSH
- reziduální nádor * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and intraoperative technologies, we can remove tumours once deemed inoperable. In our single centre, we have operated on 11 paediatric patients over the course of 8 years. We have performed eight GTR resections and three intended subtotal resections. The postoperative neurological deficit ranged from mild to very severe for motor weakness and none to severe for aphasia after surgery, with all of the patients improving at 3-month follow-up. Radicality in the surgical approach to thalamic gliomas in children has shown significant benefits when compared to more conservative approaches. For children with LGGs, extensive surgical resection is associated with improved prognosis and longer progression-free survival. However, it does not yield the same proportional benefit for HGGs due to its aggressive nature and worse outlook.
- Publikační typ
- časopisecké články MeSH
Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.
- Publikační typ
- časopisecké články MeSH
Background: People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients' well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods: An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results: Thirty-eight European centers completed the survey. Thirty of them offered at least one postsurgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at long term. Twenty-eight of the participating centers offered postsurgical therapies. Patients who stand the highest chances of being included in evaluation and therapy postsurgically are those who underwent awake brain surgery, harbored a low-grade glioma, or showed poor recovery. Nearly half of the respondents offer support programs to caregivers, and all teams recommend them. Treatments differed between those offered to individuals with low-grade glioma vs those with high-grade glioma. The figure of caregiver is not yet fully recognized in the recovery phase. Conclusion: We stress the need for more complete rehabilitation plans, including the emotional and health-related aspects of recovery. In respondents' opinions, assessment and rehabilitation plans should also be individually tailored and goal-directed (eg, professional reinsertion).
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Stroke-like syndrome is defined as a rare, delayed complication of brain oncotherapy. Cases with more favorable brain cancer diagnoses and longer life expectancy have been previously reported, but here we present, for the first time, three long-term survivors of glioblastoma with stroke-like syndromes. METHODS AND RESULTS: Three young or middle-aged patients underwent tumor resection and chemoradiotherapy. They received regular clinical and imaging follow-up with stable neurological status and no signs of tumor recurrence. They exhibited varied signs and symptoms (motor and sensory deficits, aphasia, memory and cognitive disorders, seizures, and headache) accompanied by imaging abnormalities. Stroke-like syndromes developed within 2-5 days and resolved in 2-6 weeks. Diffusion-weighted MRI and T2 brain perfusion abnormalities were demonstrated in all patients. In addition, there was focal T1 MRI contrast enhancement due to blood-brain barrier disruption. In addition to tumor recurrence, classic stroke, encephalitis, metabolic and mitochondrial disorders, and post-seizure swelling should be excluded. The imaging indicated intensive MRI scanning and symptomatic medication (steroids supplemented by antiepileptics, vasoactive agents, etc.) for judicious management. With respect to the course, an invasive procedure was still considered an option. CONCLUSION: All stroke-like syndromes are diagnoses of exclusion. To avoid misinterpretation of imaging findings as glioblastoma recurrence and avert recall oncotherapy or redundant interventions, better understanding of delayed complications of brain tumor therapy is crucial.
- MeSH
- cévní mozková příhoda * komplikace etiologie MeSH
- glioblastom * radioterapie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- magnetická rezonanční tomografie metody MeSH
- nádory mozku * komplikace patologie terapie MeSH
- syndrom MeSH
- záchvaty etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Autoři prezentují kazuistiku vzácného syndromu útlaku nervus interosseus antebrachii anterior ("Kiloh-Nevinův syndrom"). Pacientku nejprve vyšetřili ve spádové neurologické ambulanci. Na základě minimální neuropatie nervus medianus v karpálním tunelu, verifikované na EMG a na základě klinického nálezu byla stanovena diagnóza syndromu karpálního tunelu. Konzilium na Neurochirurgické ambulanci autorského pracoviště konstatovalo nepřítomnost klinických symptomů korespondujících s uvedenou diagnózou, a to vč. EMG nálezu. Doporučené EMG došetření odhalilo neuropatii nervus interosseus antebrachii anterior (Kiloh-Nevinovův syndrom). Pacientka podstoupila, po pokusu o konzervativní terapii, operační výkon s příznivým efektem.
Authors would like to present a case of an uncommon entrapment syndrome of the anterior antebrachial interosseal nerve ("The Kiloh-Nevin syndrome). Patient was first examined by an ambulatory neurologist. EMG verified minimal neuropathic finding of the median nerve and clinical presentation first lead to the diagnosis of carpal tunnel syndrome. After a neurosurgical consult on the authors departement we found the corresponding clinical presentation misleading including the EMG presentation. Newly recommended EMG uncovered anterior antebrachial interosseal nerve neuropathy (Kiloh-Nevin syndrome). After a failed conservative therapy, patient underwent a surgical intervention with a good outcome.
- MeSH
- elektromyografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mononeuropatie chirurgie diagnóza MeSH
- nervus medianus chirurgie patologie MeSH
- úžinové syndromy * chirurgie diagnóza patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
This prospective population-based study on a group of 132 resected IDH-wildtype (IDH-wt) glioblastoma (GBM) patients assesses the prognostic and predictive value of selected genetic biomarkers and clinical factors for GBM as well as the dependence of these values on the applied therapeutic modalities. The patients were treated in our hospital between June 2006 and June 2015. Clinical data and tumor samples were analyzed to determine the frequencies of TP53, MDM2, EGFR, RB1, BCR, and CCND1 gene aberrations and the duplication/deletion statuses of the 9p21.3, 1p36.3, 19q13.32, and 10p11.1 chromosome regions. Cut-off values distinguishing low (LCN) and high (HCN) copy number status for each marker were defined. Additionally, MGMT promoter methylation and IDH1/2 mutation status were investigated retrospectively. Young age, female gender, Karnofsky scores (KS) above 80, chemoradiotherapy, TP53 HCN, and CCND1 HCN were identified as positive prognostic factors, and smoking was identified as a negative prognostic factor. Cox proportional regression models of the chemoradiotherapy patient group revealed TP53 HCN and CCND1 HCN to be positive prognostic factors for both progression-free survival and overall survival. These results confirmed the influence of key clinical factors (age, KS, adjuvant oncotherapy, and smoking) on survival in GBM IDH-wt patients and demonstrated the prognostic and/or predictive importance of CCND1, MDM2, and 22q12.2 aberrations.
- MeSH
- DNA modifikační methylasy genetika MeSH
- glioblastom * genetika terapie MeSH
- isocitrátdehydrogenasa genetika MeSH
- lidé MeSH
- metylace DNA MeSH
- mutace MeSH
- nádory mozku * genetika terapie MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECT: Idiopathic normal pressure hydrocephalus (iNPH) is the only variant of dementia disorders possibly treatable by neurosurgical intervention. iNPH is a neurodegenerative condition clinically characterized by gait ataxia, urinary incontinence, and memory disturbance. We present one of the largest single-center studies, which was designed to prove efficacy of our low-pressure setting of gravitational valve at all three symptoms of iNPH and to find statistically significant cut-off time for best clinical improvement according to the duration of symptoms. METHODS: Sixty-one consecutive patients (mean age 74.9 ± 5.3) with iNPH were prospectively observed from the time of surgery with minimal 6 months follow-up. All patients underwent implantation of the same type of gravitational valve with the same setting-pro GAV with low opening pressure at 5 cm H2O-and were operated by the same team of 2 neurosurgeons. We statistically evaluated gait disturbance, psychological changes, and incontinence preoperatively and at 6 months after surgery and timing of the surgery according to the duration of symptoms and to the age. RESULTS: Paired t test showed a statistically significant increase in MMSE, a statistically significant decrease in 10-m walk test and 360 deg. rotation test (p < 0.0001). The correlation among the change of the MMSE, the walk test, and the rotation test, and the age and time of symptoms' duration was verified by Pearson's correlation coefficient. Pearson's correlation coefficient showed a medium strong correlation between the change of MMSE and the time of symptoms (r = - 0.580; p < 0.0001) and between the change of the number of steps and the time of symptoms (r = 0.517, p < 0.0001). There was a statistically significant weak (poor) correlation between the change of the walk test and the time of symptoms (r = 0.351, p = 0.006). All 3 ROC tests confirmed optimal cut-off for the best improvement of symptoms as 9.5 months of the symptom duration. CONCLUSIONS: We proved statistical significant optimal cut-off for the best improvement of the symptoms as 9.5 months of the symptom duration. This study also confirmed successful treatment of iNPH with VP shunting using low pressure setting of gravitational valve with overall improvement in 75% and low over drainage complications in 5% We proved statistically significant increase in MMSE, decrease in 10 m walk test and number of steps test, p < 0.0001.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- normotenzní hydrocefalus chirurgie MeSH
- pooperační komplikace epidemiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ventrikuloperitoneální zkrat škodlivé účinky přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This study investigated redistributing long inter-set rest intervals into shorter but more frequent intervals at 2 different concentric velocities. Resistance-trained men performed 4 randomised isokinetic unilateral knee extension protocols, 2 at 60°·s-1 and 2 at 360°·s-1. At each speed, subjects performed 40 repetitions with 285 s of rest using traditional sets (TS; 4 sets of 10 with 95 s of inter-set rest) and rest-redistribution (RR; 20 sets of 2 with 15 s inter-set rest). Before and at 2, 5, and 10 min after exercise, tensiomyography (TMG) and oxygenation (near-infrared spectroscopy; NIRS) were measured. NIRS was also measured during exercise, and rating of perceived exertion (RPE) was recorded after every 10 repetitions. At both speeds, RR displayed greater peak torque, total work, and power output during latter repetitions, but there were no differences between TS or RR when averaging all 40 repetitions. The RPE was less during RR at both speeds (p < 0.05). RR increased select muscle oxygen saturation and blood flow at both speeds. There were no effects of protocol on TMG, but effect sizes favoured a quicker recovery after RR. RR was likely beneficial in maintaining performance compared with the latter parts of TS sets and limiting perceived and peripheral fatigue. Novelty Although effective at slow velocities, rest-redistribution was likely more effective during high-velocity movements in this study. Rest-redistribution maintained the ability to produce force throughout an entire range of motion. Rest-redistribution reduced RPE during both high-velocity and high-force movements.
- MeSH
- dospělí MeSH
- kondiční příprava metody MeSH
- lidé MeSH
- mladý dospělý MeSH
- odpočinek fyziologie MeSH
- odporový trénink metody MeSH
- svalová síla fyziologie MeSH
- svalová únava fyziologie MeSH
- tělesná námaha fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- elektrokoagulace metody MeSH
- hematom * diagnóza etiologie chirurgie MeSH
- krk krevní zásobení patologie MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- senioři MeSH
- výsledek terapie MeSH
- warfarin škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíl: Existuje mnoho modifikací chirurgické léčby chronického subdurálního hematomu (CHSDH), nicméně v naprosté většině je prováděna trepanace s drenáží hematomu. Cílem naší studie bylo porovnat dva konkrétní operační postupy – trepanaci a drenáž s peroperačním výplachem hematomu a trepanaci s prostou drenáží. Soubor a metodika: Do studie byli zařazeni pacienti operačně léčení pro CHSDH na našem pracovišti v letech 2011– 2016. Do září roku 2013 byli pacienti léčeni trepanací s výplachem a drenáží, od té doby léčba spočívala jen v trepanaci a drenáži bez výplachu. Změna daného postupu na našem pracovišti byla ovlivněna studiemi prokazujícími obdobné výsledky obou operačních postupů. Rozdělení pacientů dle operačního postupu tedy není zatíženo selekčním bias. Veškeré údaje nutné pro zhodnocení operačních postupů se zaměřením především na hodnocení počtu recidiv byly retrospektivně vyhledány v lékařské dokumentaci. Výsledky byly statisticky zpracovány. Výsledky: Do studie bylo zařazeno 230 pacientů, kteří byli léčeni jedním ze dvou studovaných postupů. Z 81 pacientů, kteří podstoupili operaci s výplachem, došlo k recidivě u 19 pacientů (23,5 %), z toho 4 pacienti (4,9 %) museli následně podstoupit i kraniotomii s exstirpací pouzdra. Chirurgické řešení bez výplachu podstoupilo 149 pacientů, u 42 pacientů (28,2 %) se rozvinula recidiva, z toho 9 pacientů (6,0 %) muselo podstoupit kraniotomii s exstirpací pouzdra. Statistické vyhodnocení neprokázalo signifikantní rozdíl mezi oběma chirurgickými postupy stran efektivity léčby. Závěr: Provedení prosté trepanace a drenáže při léčbě CHSDH je dle dosavadních výsledků stejně účinné jako standardně prováděná trepanace s výplachem a drenáží. Postup bez výplachu, jako méně invazivní a rychlejší, se tedy jeví vhodnější při chirurgické léčbě CHSDH.
Aim: There are a lot of modifications for the surgical treatment of chronic subdural haematoma; however, the burr hole drainage is the most common procedure. The aim of our study was to compare two particular surgical procedures: burr hole drainage with preoperative irrigation of the haematoma and simple burr hole drainage. Patients and methods: Patients who were operated on the chronic subdural haematoma at our department between 20112016 were enrolled in the study. Burr hole drainage with irrigation was used till September 2013; since then, patients have undergone burr hole drainage without irrigation. This change in surgical technique at out department was influenced by the studies showing similar results of both surgical techniques. Thus, the distribution of patients according to the surgical technique was not influenced by selection bias. All the data needed for the evaluation of the results of both surgical techniques, especially focusing on assessing recurrences, were found retrospectively in the medical documentation. Results: There were 230 patients in our study who were treated by one of two study procedures. Eightyone patients underwent surgery with irrigation of haematoma, out of which 19 patients (23.5%) developed recurrence and 4 patients (4.9%) had to finally undergo craniotomy and membranectomy. The surgical technique without irrigation of haematoma was performed in 149 patients, and the recurrence was observed in 42 patients (28.2%) and 9 patients (6.0%) had to undergo craniotomy and membranectomy. Statistical evaluation did not prove a significant difference in effectiveness between these two surgical techniques. Conclusion: Simple burr hole drainage is as effective as burr hole drainage with irrigation according to up to date knowledge. The technique without irrigation, as less invasive and faster, seems to be better for the treatment of chronic subdural haematoma.
- MeSH
- chronický subdurální hematom * chirurgie MeSH
- drenáž metody MeSH
- léčebná irigace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trepanace metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cluster sets allow for velocity and power output maintenance, but the literature routinely uses highly fatiguing traditional set protocols. Although such studies have merit, others suggest fatigue should be avoided when training to improve power output, making those cluster set studies less practical. Therefore, the purpose of this study was to compare these set structures when truncating sets using a power-based threshold. Nine males (23.4 ± 0.6 yr) with various sport backgrounds performed 6 sets of back squats with individualized loads that elicited the greatest mean power (MPmax) output (112.7 ± 12.1% of body mass). Each set during the traditional set (TS) protocol included as many repetitions as possible until two consecutive repetitions dropped below 90% MPmax, which was followed by 120 s inter-set rest. The design was identical for cluster sets (CS) but with an additional 20 s intra-set rest after every 2 repetitions. The number of repetitions performed, mean velocity, and mean power output, were analyzed using 2(protocol)*6(set) repeated measures ANOVA. The number of repetitions during CS (51.8 ± 14.4) was greater than TS (31.9 ± 3.7) (p = 0.001), but the average velocity (CS = 0.711 ± 0.069, TS = 0.716 ± 0.081 m·s-1; p = 0.732) and power output (CS = 630.3 ± 59.8, TS = 636.0 ± 84.3 W; p = 0.629) of those repetitions were similar. These data indicate that CS are a viable option for increasing training volume during contemporary training where sets are ended when repetitions drop below velocity or power thresholds.
- MeSH
- lidé MeSH
- mladý dospělý MeSH
- sportovci MeSH
- vzpírání * fyziologie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
Cíl: Možnost předoperační detekce v. emissaria mastoidea pomocí HRCT a standardního CT při plánování retrosigmoideální kraniotomie, jenž je využívaná k přístupům do oblasti angulus pontocerebellaris. Metodika: Bylo vyhodnoceno celkem 100 nativních CT (4,5 mm silné řezy) a 100 CT v tenkých řezech - HRCT (1 mm silné řezy). Snímky byly získány z informačního systému PACS Fakultní nemocnice v Olomouci (FNOL). Hodnotili a srovnávali jsme jednotlivé zastoupení vena emissaria mastoidea při zobrazení standardním CT a HRCT na pravé i levé straně a zajímala nás senzitivita vyšetření v závislosti na rozměru kostěného kanálu pro žílu, tedy foramen mastoideum. Výsledky: Při vyšetření nativním CT nebylo ani jedno emissarium zobrazeno v 71 případech na pravé a v 62 případech na levé straně. Jedno emissarium bylo zobrazeno ve 28 případech na pravé a v 36 případech na levé straně. Více než jedno pak bylo poměrně vzácné a tvořily jej významné spojky širší než 3,5 mm. HRCT poskytuje vyšší senzitivitu detekce drobných emissarií, která nebyla ve velké většině na standardním CT patrná, v tomto případě bylo možné detekovat i poměrně vzácně zastoupená foramina mastoidea v počtu 3 až 4. Zatímco při zobrazení emissarií širších než 3 mm není rozdíl statisticky významný, u emissarií se šířkou kanálu menší než 2 mm je již rozdíl statisticky významný. Závěr: Benefit HRCT při plánování retrosigmnoideální kraniotomie je nesporný a pomáhá eliminovat řadu potencionálních komplikací.
Objective: Pre-operative detection of mastoid emissary veins using HRCT and standard CT in retrosigmoid craniotomy planning, which is used to access the cerebel-lopontine angle area. Methods: A total of 100 native CT scans (4.5 mm thick slices) and 100 CT scans in thin slices - HRCT (1 mm thick slices) were evaluated. Images were obtained from the PACS Information System of the Faculty Hospital in Olomouc (FNOL). We evaluated and compared individual occurence of mastoid emissary vein in standard CT and HRCT scans on both sides, left and right, and we were interested in the sensitivity of the examination depending on the size of bone canal for the vein, i.e. mastoid foramen. Results: In the native CT scan, there was no emissary visible in 71 cases on the right and 62 cases on the left. One emissary was visible in 28 cases on the right and 36 cases on the left. More than one was a relatively rare case and it was formed by significant connections wider than 3.5 mm. HRCT provides a higher detection sensitivity for small emissaries, which were mostly invisible in a standard CT scan, in this case it was also possible to detect a relatively rare case of 3-4 mastoid foramina. While the difference is not statistically significant when the emissaries are larger than 3 mm, in emissaries with the width of channel less than 2 mm it already becomes statistically significant. Conclusion: Benefit of HRCT in retrosigmnoid craniotomy planning is indisputable and helps to eliminate many potential complications.
- MeSH
- foramen magnum anatomie a histologie krevní zásobení MeSH
- kraniotomie * metody MeSH
- lidé MeSH
- mostomozečkový úhel chirurgie patologie MeSH
- mozkové žíly anatomie a histologie diagnostické zobrazování MeSH
- neuralgie trigeminu etiologie farmakoterapie chirurgie MeSH
- počítačová rentgenová tomografie metody přístrojové vybavení MeSH
- předoperační vyšetření přístrojové vybavení MeSH
- týlní kost anatomie a histologie krevní zásobení MeSH
- vestibulární schwannom chirurgie MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Mastoid emissary vein is especially important from the neurosurgical point of view, because it is located in variable number in the area of the occipitomastoid suture and it can become a source of significant bleeding in surgical approaches through the mastoid process, especially in retrosigmoid craniotomy, which is used for approaches to pathologies localized in the cerebellopontine angle. Ideal imaging method for diagnosis of these neglected structures when planning a surgical approach is high-resolution computed tomography. The aim of this work was to provide detailed information about this issue. METHODS: We studied a group of 295 skulls obtained from collections of five anatomy departments and the National Museum. Both quantitative and qualitative parameters of the mastoid foramen were evaluated depending on side of appearance and gender. Individual distances of the mastoid foramen from clearly defined surface landmarks (asterion, apex of mastoid process, foramen magnum) and other anatomical structures closely related to this issue (width of groove for sigmoid sinus, diameters of internal and external openings of mastoid foramen) were statistically processed. RESULTS: The most frequently represented type of the mastoid foramen is type II by Louis (41.2%). The differences between right and left sides were not statistically significant. In men there was a higher number of openings on the right side and in qualitative parameters the type III and IV predominated, whereas in women the types I and II were more frequent. In men, greater distances from the mastoid foramen were observed when evaluating qualitative parameters for defined surface landmarks. Mean size of the external opening diameter was 1.3 mm; however, several openings measured up to 7 mm. CONCLUSIONS: Despite excellent knowledge of anatomy, however, good pre-operative examination using imaging methods and mastering of microsurgical techniques create the base for successful treatment of pathological structures in these anatomically complex areas.
- MeSH
- foramen magnum anatomie a histologie diagnostické zobrazování chirurgie MeSH
- kraniotomie škodlivé účinky metody MeSH
- lidé MeSH
- mostomozečkový úhel anatomie a histologie diagnostické zobrazování chirurgie MeSH
- pooperační komplikace prevence a kontrola MeSH
- processus mastoideus anatomie a histologie diagnostické zobrazování chirurgie MeSH
- venae jugulares anatomie a histologie diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Úvod: Kranioplastika vlastní kostí je zákrok indikovaný u pacientů po provedené dekompresivní kraniektomii. Přestože se jedná o elektivní výkon, literární údaje uvádějí výskyt komplikací až kolem 30 %. Cílem této práce je prezentace zkušeností našeho pracoviště s kranioplastikou vlastní kostí uloženou v podkoží mezogastria. Metoda: Retrospektivně jsme vyhodnotili soubor 92 pacientů, kteří podstoupili kranioplastiku po dekompresivní kraniektomii s využitím autologního štěpu deponovaného v podkoží mezogastria. Pacienti byli klinicky i radiologicky vyšetřeni před operací, šest týdnů a jeden rok po ní. Hodnotili jsme výskyt akutních komplikací – hematomu v ráně a pozdních komplikací – infekce a osteoresorpce. Důležitým aspektem byl také pooperační kosmetický efekt a dyskomfort plynoucí z uložení kostní ploténky. Výsledky: Četnost komplikací v našem souboru činila 25 %. Nejčastěji se vyskytovaly komplikace pozdní s četností 13 %. Jednalo se zejména o osteoresorpci kostní ploténky (4,3 %) a infekční komplikace (4,3 %). Akutní komplikace se v souboru vyskytly s četností 10,9 %. Nejzávažnější byl mozkový edém nejasného původu vedoucí ke smrti pacienta. Neuspokojivý kosmetický efekt, stejně jako dyskomfort v místě uložení ploténky se vyskytly ve dvou případech. Závěr: Kranioplastika je ve srovnání s jinými elektivními výkony zatížena vyšším rizikem komplikací, přesto považujeme využití subkutánně deponované kostní záklopky za levnou a vhodnou alternativu kryoprezervace či allogenních náhrad.
Introduction: Cranioplasty with autologous bone flap is indicated in patients who have undergone decompressive craniectomy. Although it is an elective procedure, literature data indicate complication rates of up to 30%. The aim of this paper is to present our experience with cranioplasty with the patient's own bone flap stored subcutaneously in the mesogastrium. Methods: We retrospectively analyzed a set of 92 patients who had undergone cranioplasty after decompressive craniectomy using autologous graft preserved subcutaneously in the mesogastrium. The patients were clinically and radiologically examined before the surgery, and six weeks and one year after surgery. We evaluated the incidence of acute complications – wound hematoma, and late complications – infection and bone resorption. The postoperative cosmetic effect and patient discomfort from the stored bone flap also constituted an important aspect. Results: The frequency of complications in our study group was 25%. Late complications were the most common, occurring with a frequency of 13%. These were mainly resorption of the bone flap (4.3%) and infectious complications (4.3%). Acute complications occurred with a frequency of 10.9% in our patient group. The most serious complication was cerebral edema of unknown origin leading to death of the patient. Unsatisfactory cosmetic effect as well as discomfort at the site where the flap was stored occurred in two cases. Conclusions: Cranioplasty is associated with a higher risk of complications in comparison with other elective procedures. Nevertheless, we regard cranioplasty with subcutaneously preserved bone flap as an inexpensive and suitable alternative to cryopreservation or alloplastic materials.
Autoři vyhodnotili výsledky exstirpace koloidní cysty endoskopickým přístupem. Soubor tvořilo 11 po sobě jdoucích pacientů operovaných pomocí rigidního endoskopu s dosažením radikální resekce a nutností pouze jedné konverze na otevřený mikrochirurgický transkortikální přístup. Indikace operačního přístupu byla vždy prováděna individuálně na podkladě předoperačního zobrazení a zkušeností autorů se snahou o minimalizaci pooperační morbidity. Vyšší věk a asociace hydrocefalu se zdají být významnějšími rizikovými faktory pro pooperační psychické změny než samotný operační přístup. Autoři se zamýšlejí nad limity a technickými možnostmi endoskopického přístupu léčby s důrazem na individuální předoperační rozvahu dle MR zobrazení, charakteru obsahu cysty a dalších aspektů.
The authors assessed the results of colloid cyst extirpation by an endoscopic approach. The sample consisted of eleven consecutive patients with a rigid endoscope surgery achieving radical resection and requiring one conversion to open microsurgical transcortical access only. The surgical approach was always indicated individually based on preoperative imaging and experience of the authors and with an effort to minimize postoperative morbidity. Increasing age and concurrent hydrocephalus seem to be more important risk factors for postoperative psychological changes than the actual surgical approach. The authors reflect on the limits and technical potential of endoscopic treatment approach and emphasize the need for individualized approach based on preoperative MRI imaging, the content of the cysts and other aspects.
- Klíčová slova
- endoskopická exstirpace,
- MeSH
- dospělí MeSH
- endoskopie * metody využití MeSH
- hydrocefalus MeSH
- koloidní cysty * diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- neurochirurgické výkony * metody MeSH
- neurozobrazování metody využití MeSH
- počítačová rentgenová tomografie využití MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Diastematomyelie je vzácná vrozená vada patřící mezi spinální dysrafizmy a obvykle je asociována se syndromem míšního ukotvení. Diastematomyelie je tvořena dvěma polovinami rozštěpené míchy s vlastními durálními vaky, které jsou rozděleny osteokartilaginózním septem. Tato vada bývá diagnostikována především v dětském věku. U dospělých je vzácná a dominujícím příznakem je bolest. Autoři prezentují kazuistiku ženy ve věku 44 let s diastematomyelií, která si stěžovala na chronické bolesti zad a progredující slabost dolních končetin. U pacientky jsme provedli laminektomii, deliberaci míchy a plastiku durálního vaku. Po operaci pacientka zůstala bez neurologického deficitu a udávala výraznou úlevu od bolestí.
Diastematomyelia is a rare congenital defect, a type of spinal dysraphisms, often associated with the tethered cord syndrome. Diastematomyelia is formed by the two halves of the split spinal cord that each has own dural sac separated by a rigid or fibrotic septum. This defect is mainly diagnosed in children. Pain is the dominant symptom in adult patients. The authors present a case of a woman aged 44 years with diastematomyelia who complained of chronic back pain and progressive weakness in her legs. In this patient, laminectomy was performed, the spinal cord released and the dural sac restored. After the surgery, the patient had no neurological deficits and reported significant pain relief. Key words: diastematomyelia in adults – tethered cord syndrom – split cord malformation The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Klíčová slova
- syndrom míšního ukotvení, rozštěpové malformace míchy, rozštěp míchy,
- MeSH
- bederní obratle * chirurgie radiografie MeSH
- defekty neurální trubice * diagnóza etiologie chirurgie MeSH
- dospělí MeSH
- dura mater chirurgie MeSH
- laminektomie MeSH
- lidé MeSH
- lumbalgie etiologie MeSH
- magnetická rezonanční tomografie MeSH
- neurochirurgické výkony MeSH
- páteř chirurgie patologie radiografie MeSH
- počítačová rentgenová tomografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
