Neurochirurgická onemocnění nebo poruchy v graviditě jsou raritní. Nejčastěji se setkáváme s cévní patologií, intrakraniálním nádorem, kraniocerebrálním poraněním či vyhřezlou ploténkou. Rozpoznání klinických příznaků, diagnostika i následná terapie jsou vzhledem k těhotenství obtížné. Klinické příznaky zvýšeného intrakraniálního tlaku jako zvracení či bolesti hlavy mohou být snadno zaměněny za běžné těhotenské potíže. V rámci diagnostiky se snažíme vyvarovat použití ionizačního záření. Terapeutické postupy prozatím nejsou striktně definovány. Doporučení tak vychází většinou z retrospektivních analýz souborů či kazuistik. V přehledném referátu uvádíme nejčastěji se vyskytující neurochirurgické patologie a jejich management.

Neurosurgical illnesses or disorders are rare in pregnancy. Vascular pathologies, intracranial tumors, traumatic brain injury or disc herniation are the most common. Recognition of clinical signs, diagnosis and follow-up treatments can be difficult to manage regarding pregnancy. Vomiting or headache are typical symptoms for both pregnancy as well for increased intracranial pressure. As part of the diagnosis, we should avoid excess usage of radiological examinations. Therapeutic guidelines have not been clearly established; therefore, they are based only on retrospective studies or case reports. In our review article, we present the most common neurosurgical pathologies in pregnancy and their treatment.

• MeSH
• Cerebrovascular Disorders surgery   classification   therapy   MeSH
• Craniocerebral Trauma surgery   classification   therapy   MeSH
• Humans MeSH
• Disease Management MeSH
• Brain Neoplasms surgery   classification   therapy   MeSH
• Neurosurgical Procedures * methods   MeSH
• Practice Guidelines as Topic MeSH
• Pregnant People * MeSH
• Intervertebral Disc Displacement surgery   diagnosis   therapy   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH

Syndrom kaudy equiny (cauda equina syndrome; CES) patří mezi onemocnění s potenciálně vysokou neurologickou morbiditou. Pacienti přicházejí s různě vyjádřeným neurologickým deficitem, zahrnujícím zejména sfinkterové potíže, který je nutné včasně diagnostikovat a správně indikovat chirurgickou léčbu. V naší retrospektivní studii jsme se zaměřili na různé prognostické faktory a jejich vliv na výsledný neurologický stav pacientů s CES. Do studie bylo zařazeno celkově 44 pacientů s CES. Statisticky významným faktorem se ukázala doba trvání příznaků. Pacienti s kratší anamnézou neurologické symptomatologie měli lepší výsledný neurologický stav. Také je průkazně pozitivní vztah mezi vstupním a výstupním skóre, tedy výsledný stav se odvíjí od tíže neurologického deficitu při přijetí pacienta. Ostatní faktory byly statisticky nevýznamné.

Cauda equina syndrome (CES) is a severe neurological condition with potentially high morbidity. Patients usually present with varying degrees of neurological deficit, especially sphincter dysfunction, which needs to be diagnosed early and correctly indicated for surgical treatment. Our retrospective study is focused on the determination of different prognostic factors and their impact on the final neurological outcome of patients with CES. Forty-four CES patients were recruited in the study. The duration of symptoms has proven to be a statistically significant factor in improving the clinical condition. Patients with a shorter medical history of neurological symptomatology had a better neurological outcome. Also, there was a positive relationship between the initial and outcome score, i.e., the outcome status is related to the severity of the neurological deficit on admission. The remaining factors appeared to be statistically insignificant.

• MeSH
• Cauda Equina diagnostic imaging   pathology   MeSH
• Patient Outcome Assessment MeSH
• Middle Aged MeSH
• Humans MeSH
• Neurologic Manifestations MeSH
• Prognosis MeSH
• Retrospective Studies MeSH
• Cauda Equina Syndrome * diagnosis   complications   mortality   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH

• MeSH
• Central Nervous System diagnostic imaging   pathology   MeSH
• Adult MeSH
• Hemangioblastoma * surgery   complications   physiopathology   MeSH
• Pregnancy Complications MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Disease Progression MeSH
• Pregnancy MeSH
• von Hippel-Lindau Disease * surgery   complications   physiopathology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Chronický subdurální hematom (chSDH) je časté neurochirurgické onemocnění zejména ve starší populaci. Článek stručně popisuje epidemiologii, klinický obraz a diagnostiku chSDH. Poskytuje nejaktuálnější pohled na patofyziologii vzniku chSDH, problematiku recidivy a úskalí chirurgické léčby. Detailně popisuje endovaskulární léčbu chSDH pomocí embolizace a. meningea media. Tato metoda se jeví jako velmi slibná v ošetření recidivujícího chSDH. Je technicky jednoduchá, s dobrými výsledky a s minimálními komplikacemi při dodržení základních pravidel embolizačních metod.

Chronic subdural hematoma (chSDH) is a common neurosurgical disease that affects mostly elderly patients. In this article we briefly discuss epidemiology, clinical presentation and radiographic features of chSDH. The article provides in-depth review of chSDH pathophysiology, recurrence and complications of surgical treatment. Middle meningeal artery embolization seems to be safe and successful endovascular treatment of recurrent chSDH with low complication rate.

• MeSH
• Hematoma, Subdural, Chronic * diagnostic imaging   physiopathology   therapy   MeSH
• Angiography, Digital Subtraction MeSH
• Endovascular Procedures * methods   statistics & numerical data   MeSH
• Humans MeSH
• Embolization, Therapeutic methods   statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Cysts complications   MeSH
• Adult MeSH
• Hydrocephalus * surgery   diagnosis   complications   MeSH
• Blindness, Cortical * etiology   MeSH
• Humans MeSH
• Brain surgery   pathology   MeSH
• Neuroimaging methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

Cíl: Epidurální hematom (EDH) je potencionálně život ohrožující stav, který patří mezi traumatická poranění mozku. Léčba EDH vyžaduje včasnou diagnostiku s optimální léčbou, aby se zabránilo následnému neurologickému poškození. U dospělých pacientů klinický průběh obecně odpovídá rozsahu intrakraniální léze. U pediatrických pacientů však EDH představuje diagnostickou výzvu, a to kvůli různým vlastnostem této entity. Terapeutický přístup by proto měl být založen na klinickém stavu pacienta a na jeho individuálních potřebách. Cílem této studie bylo popsat a zdůraznit odlišné aspekty EDH u různých věkových skupin. Prezentujeme také kohortovou studii z našeho pracoviště. Materiál a metody: Do retrospektivní studie byli zařazeni dospělí i pediatričtí pacienti s rozvinutým EDH, kteří byli hospitalizováni v letech 2009–2019. Statisticky byla analyzována všechna získaná data vč. demografických údajů, mechanizmu poranění, charakteristik hematomu, souvisejících mozkových patologií, typu léčby a délky hospitalizace. Výsledky: Do studie bylo zařazeno 74 dospělých a 80 dětských pacientů. Průměrný věk u dospělých byl 42,4 let a 8,5 let u dětí. Nejčastějšími příčinami rozvoje EDH byly pády s rozdílnou etiologií. Většina dospělých pacientů byla léčena chirurgicky kvůli významnému neurologickému deficitu a dalším intrakraniálním patologiím. Dětští pacienti byli většinou léčeni konzervativně. Překvapivě nebyl rozdíl týkající se typu terapie u pediatrické skupiny tak významný, jak jsme předpokládali. Závěr: V práci jsme popsali specifika EDH u dospělých i dětských pacientů s důrazem na klinické i radiologické rozdíly. U dětí bývá často popisován indolentní průběh, i přes přítomnost významného EDH. Včasná diagnostika, optimální volba terapie a individuální přístup mohou předcházet rozvoji neurologického deficitu.

Aim: Epidural hematoma (EDH) is a potentially life-threatening condition that belongs to the complex of traumatic brain injuries. The management of EDH requires early diagnosis with optimal treatment to prevent subsequent neurological impairment. In adults, the clinical course generally corresponds to the extent of an intracranial lesion. However, in pediatric patients, EDH represents a diagnostic challenge due to the different features of this entity. Therefore, the therapeutic approach should be based on the patient‘s clinical status and individual requirements. The aim of this study was to describe and highlight the different aspects of EDH in the various age groups. We also present a cohort study from our hospital. Materials and methods: Adult and pediatric patients admitted to the hospital between 2009 and 2019 with developed EDH were retrospectively reviewed. All data including demographic information, mechanism of injury, characteristics of hematoma, associated brain pathologies, treatment, and duration of hospitalization were acquired and statistically analyzed. Results: Seventy-four adult and eighty pediatric patients were included. The mean age in the adult group was 42.4 years and 8.5 years in the pediatric group. The most common causes of EDH were falls of different etiologies. The majority of adult patients were managed surgically due to significant neurological deficits and other cranial pathologies. Pediatric patients were predominantly treated conservatively. Surprisingly, the difference regarding the type of therapy was not as significant in the pediatric group as we assumed. Conclusion: We described specific features of EDH in adult and pediatric patients with emphasis on clinical and radiological differences. In children, the indolent course is often described, despite the presence of significant EDH. Early diagnosis, optimal choice of therapy, and individual approach can prevent the development of neurological deficits.

• MeSH
• Surgical Procedures, Operative MeSH
• Child MeSH
• Adult MeSH
• Hematoma, Epidural, Cranial * therapy   MeSH
• Conservative Treatment MeSH
• Humans MeSH
• Brain Injuries therapy   MeSH
• Retrospective Studies MeSH
• Age Factors MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH

PURPOSE: To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome. METHODS: Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery-trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied. RESULTS: Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients. CONCLUSIONS: Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.

• MeSH
• Hematoma, Subdural, Acute epidemiology   etiology   surgery   MeSH
• Anticoagulants therapeutic use   MeSH
• Anticonvulsants therapeutic use   MeSH
• Decompressive Craniectomy statistics & numerical data   MeSH
• Adult MeSH
• Epilepsy drug therapy   epidemiology   MeSH
• Glasgow Coma Scale MeSH
• Glasgow Outcome Scale MeSH
• Platelet Aggregation Inhibitors therapeutic use   MeSH
• Craniocerebral Trauma complications   MeSH
• Craniotomy statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neurosurgical Procedures statistics & numerical data   MeSH
• Alcoholic Intoxication epidemiology   MeSH
• Reoperation statistics & numerical data   MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sex Factors MeSH
• Trephining statistics & numerical data   MeSH
• Age Factors MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

Assessing sex and population affinity is an important part of the process of biologically identifying unknown human remains, and the skull is usually one of the best structures for assessing both these components of the biological profile. Population affinity is known to be a hugely important variable when estimating sex because the manifestation of sexually dimorphic traits, body size or social and behavioural habits differs across populations. Therefore, for forensic purposes, the estimation of ancestry is a necessary step in the identification of bone remains. The present study improves on the results of a previously developed virtual method using the exocranial surface for sex estimation and assessing population affinity. The ability to assess these components of the biological profile was successfully tested on 208 individuals from two recent European populations. The original classifier was based on geometric morphometric analyses (CPD-DCA, PCA, SVM) and was able to assess the sex of individuals belonging to one French population with an accuracy exceeding 90 % Musilová et al. [1]. To improve the reliability of the method, the Czech population sample was added to the dataset, yielding the highest accuracy of 96.2 %; using the combined dataset, the reliability of the method was 91.8 %. Secondly, we used the same method utilizing inter-population differences to classify individuals based on the shape of the skull. The greatest accuracy rate was 92.8 %, which makes our method a promising tool for sex estimation and assessing population affinity.

• MeSH
• Principal Component Analysis MeSH
• White People MeSH
• Adult MeSH
• Skull diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Forensic Anthropology MeSH
• Machine Learning MeSH
• Support Vector Machine MeSH
• Sex Determination by Skeleton methods   MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH
• France MeSH

Determination of sex is one of the most important and challenging disciplines in biological anthropology. Creating a robust tool for sexing crania is crucial for forensic anthropology, especially in this period of migration, travel, and globalization, when different populations are mixed together in one region. Many different approaches to sex estimation using the skull have been published; however, population specificity and oscillation of variable sexual dimorphism typically reduces their effectiveness. The aim of this study was to create a robust classifier using virtual anthropology without the use of a CT scanner. The entire cranial surface was analyzed using coherent point drift-dense correspondence analysis and classification was performed using a support vector machine with a radial kernel, minimizing subjective error. The study sample consisted of 103 CT scans of a recent southern French population. Virtual scans of 52 males and 51 females (age from 18 to 92) were analyzed using 3D software systems (Rapidform, Avizo, Morphome3cs) and innovative approaches in geometric morphometrics. Leave-one-out crossvalidation was also applied. Sex differences in shape and form were displayed by colour scale maps. The whole cranial surface was significantly different between males and females in size (form). Sexual dimorphism was significantly lower in senile skulls. The most exclusive areas were the supraorbital region, orbits, cheek bones, nasal apertures, mastoids, and external occipital protuberances. The method provided a high level of classification accuracy (90.3%) in sexing male and female skulls and is a valuable tool for sex determination.

• MeSH
• Adult MeSH
• Skull anatomy & histology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Forensic Anthropology MeSH
• Support Vector Machine MeSH
• Sex Determination by Skeleton methods   MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• France MeSH