INTRODUCTION: Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients. MATERIAL AND METHODS: Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate. RESULTS AND CONCLUSIONS: In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.

• MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• meningeální nádory * chirurgie   MeSH
• meningeom * chirurgie   patologie   MeSH
• mikrochirurgie MeSH
• neurochirurgické výkony metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND IMPORTANCE: Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued. CLINICAL PRESENTATION: A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft. CONCLUSION: This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.

• MeSH
• arteria carotis interna chirurgie   MeSH
• arteria cerebri media diagnostické zobrazování   chirurgie   MeSH
• arteria vertebralis diagnostické zobrazování   chirurgie   MeSH
• cerebrovaskulární poruchy * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• revaskularizace mozku * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: The aim of this retrospective study is to analyze a consecutive cohort of brain metastasis (BM) patients treated off clinical trials through combination of surgery and radiotherapy over the last 15 years in a tertiary neurooncology center. MATERIALS AND METHODS: All BM patients operated between 2007-2019 received adjuvant linac-based radiotherapy categorized to whole brain radiotherapy (WBRT) and tumor bed stereotactic radiotherapy. Survival outcomes and local control was analyzed. RESULTS: In total, 118 patients were enrolled, those with stereotactic radiotherapy (41%) had better baseline characteristics mirrored in longer overall survival (OS) [18 vs. 7.1 months, p < 0.001; hazard ratio (HR) 0.47, p = 0.004] with median follow-up of 58 months. Cumulative incidence for local, distant, and extracranial control was not significantly different between groups, with 12-month cumulative control of 22% vs. 18%, 44% vs. 29%, and 35% vs. 32% for stereotactic and WBRT group, respectively. WBRT was an independent factor for better distal brain control. CONCLUSIONS: Real world data demonstrating significantly better overall survival in patients treated with postoperative targeted radiotherapy compared with postoperative WBRT is presented, with no significant difference in cumulative incidence for local or distant brain control. The majority of patients with targeted radiotherapy had a fractionated dose schedule with outcomes comparable to single-dose radiation trials of postoperative targeted radiotherapy.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: The positive effects of goal-directed hemodynamic therapy (GDHT) on patient-orientated outcomes have been demonstrated in various clinical scenarios; however, the effects of fluid management in neurosurgery remain unclear. Therefore, this study was aimed at assessing the safety and feasibility of GDHT using non-invasive hemodynamic monitoring in elective neurosurgery. The incidence of postoperative complications was compared between GDHT and control groups. METHODS: We conducted a single-center randomized pilot study with an enrollment target of 34 adult patients scheduled for elective neurosurgery. We randomly assigned the patients equally into control and GDHT groups. The control group received standard therapy during surgery and postoperatively, whereas the GDHT group received therapy guided by an algorithm based on non-invasive hemodynamic monitoring. In the GDHT group, we aimed to achieve and sustain an optimal cardiac index by using non-invasive hemodynamic monitoring and bolus administration of colloids and vasoactive drugs. The number of patients with adverse events, feasibility criteria, perioperative parameters, and incidence of postoperative complications was compared between groups. RESULTS: We successfully achieved all feasibility criteria. The GDHT protocol was safe, because no patients in either group had unsatisfactory brain tissue relaxation after surgery or brain edema requiring therapy during surgery or 24 h after surgery. Major complications occurred in two (11.8%) patients in the GDHT group and six (35.3%) patients in the control group (p = 0.105). CONCLUSIONS: Our results suggested that a large randomized trial evaluating the effects of GDHT on the incidence of postoperative complications in elective neurosurgery should be safe and feasible. The rate of postoperative complications was comparable between groups. TRIAL REGISTRATION: Trial registration: ClininalTrials.gov, registration number: NCT04754295, date of registration: February 15, 2021.

• Publikační typ
• časopisecké články MeSH

BACKGROUND/AIM: Brain metastases (BMs) are the most frequent intracranial tumors in adults and one of the greatest challenges for modern oncology. Most are derived from lung, breast, renal cell, and colorectal carcinomas and melanomas. Up to 14% of patients are diagnosed with BMs of unknown primary, which are commonly characterized by an early and aggressive metastatic spread. It is important to discover novel biomarkers for early identification of BM origin, allowing better management of patients with this disease. Our study focused on microRNAs (miRNAs), which are very stable in frozen native and FFPE tissues and have been shown to be sensitive and specific diagnostic biomarkers of cancer. We aimed to identify miRNAs with significantly different expression in the five most frequent groups of BMs and develop a diagnostic classifier capable of sensitive and specific classification of BMs. MATERIALS AND METHODS: Total RNA enriched for miRNAs was isolated using the mirVana miRNA Isolation Kit from 71 fresh-frozen histopathologically confirmed BM tissues originating in 5 cancer types. Sequencing libraries were prepared using the QIAseq miRNA Library Kit and sequenced on the NextSeq 500 platform. MiRNA expression was further validated by RT-qPCR. RESULTS: Differential analysis identified 373 miRNAs with significantly different expression between 5 BM groups (p<0.001). A classifier model was developed based on the expression of 6 miRNAs (hsa-miR-141-3p, hsa-miR-141-5p, hsa-miR-146a-5p, hsa-miR-194-5p, hsa-miR-200b-3p and hsa-miR-365b-5p) with the ability to correctly classify 91.5% of samples. Subsequent validation confirmed both significantly different expression of selected miRNAs in 5 BM groups as well as their diagnostic potential. CONCLUSION: To date, our study is the first to analyze miRNA expression in various types of BMs using small RNA sequencing to develop a diagnostic classifier and, thus, to help stratify BMs of unknown primary. The presented results confirm the importance of studying the dysregulated expression of miRNAs in BMs and the diagnostic potential of the validated 6-miRNA signature.

• MeSH
• biologické markery MeSH
• dospělí MeSH
• lidé MeSH
• melanom * MeSH
• mikro RNA * genetika   metabolismus   MeSH
• nádory mozku * genetika   MeSH
• nádory neznámé primární lokalizace * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Brain metastases are the most frequent intracranial tumors in adults and the cause of death in almost one-fourth of cases. The incidence of brain metastases is steadily increasing. The main reason for this increase could be the introduction of new and more efficient therapeutic strategies that lead to longer survival but, at the same time, cause a higher risk of brain parenchyma infiltration. In addition, the advances in imaging methodology, which provide earlier identification of brain metastases, may also be a reason for the higher recorded number of patients with these tumors. Metastasis is a complex biological process that is still largely unexplored, influenced by many factors and involving many molecules. A deeper understanding of the process will allow the discovery of more effective diagnostic and therapeutic approaches that could improve the quality and length of patient survival. Recent studies have shown that microRNAs (miRNAs) are essential molecules that are involved in specific steps of the metastatic cascade. MiRNAs are endogenously expressed small non-coding RNAs that act as post-transcriptional regulators of gene expression and thus regulate most cellular processes. The dysregulation of these molecules has been implicated in many cancers, including brain metastases. Therefore, miRNAs represent promising diagnostic molecules and therapeutic targets in brain metastases. This review summarizes the current knowledge on the importance of miRNAs in brain metastasis, focusing on their involvement in the metastatic cascade and their potential clinical implications.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Úvod: Incidence meningeomů po 65. roku života exponenciálně roste. Tento věk je ovšem typický vyšším výskytem komorbidit a benefit operace nemusí být vždy vyšší než její riziko. Optimalizace léčby by proto měla být objektivně posouzena i s využitím skórovacích systémů. Materiál a metodika: Retrospektivní analýzou byla zhodnocena skupina pacientů léčených ve FN Brno v období 2010–2018 (n = 108). Pacienti byli starší 65 let. V léčbě byly uplatňovány tři postupy: strategie „watch and wait“, operace a stereotaktická radiochirurgie. Skupiny pacientů byla vyhodnocena z pohledu výskytu komorbidit a celkového stavu pacienta s ohledem na výběr terapeutické modality. V indikaci k jednotlivým typům léčby se uplatňovaly skórovací systémy. Dále byly v jednotlivých skupinách vyhodnoceny krátkodobá i dlouhodobá morbidita a mortalita. Výsledky: Pozorovali jsme významnou závislost při analýze roční mortality u systému SKALE. Mezi mortalitou a pohlavím, kolaterálním edémem a lokalizací nádoru nebyla nalezena statisticky významná závislost. Naopak věk, velikost nádoru a skóre Karnofsky před zahájením léčby byly významnými prediktory prognózy. Závěr: Individualizovaná analýza pacientů a zkušenosti neurochirurga nadále zůstávají významnými faktory ve výběru léčby u starších pacientů s diagnózou meningeomu. Nicméně skórovací systémy uplatňované u výběru léčebné modality u pacientů vyššího věku umožňují významně optimalizovat léčebný postup a v konečném důsledku prognózu onemocnění.

Introduction: The incidence of meningiomas increases exponentially after the age of 65. However, this age is characterized by a higher incidence of comorbidities and the benefit of the surgery may not always exceed its risk. Treatment optimization should therefore be objectively assessed using scoring systems as well. Materials and methods: A retrospective analysis evaluated the group of patients treated at the Brno University Hospital between 2013–2018 (N = 108). Patients were older than 65 years of age. Three procedures were considered in the treatment: watch and wait strategy, surgery and stereotactic radiosurgery. The groups of patients were evaluated in terms of the incidence of comorbidities and the outcome of the patients with regard to the choice of treatment modality. Scoring systems were used in the indication for individual types of treatment. Furthermore, short-term and long-term morbidity and mortality were evaluated in individual groups. Results: Significant dependence in the analysis of annual mortality in the SKALE system has been proved. No statistically significant relationship was found between mortality and sex, collateral oedema, and tumour location. In contrast, age, tumour size, and Karnofsky score before treatment were significant predictors of prognosis. Conclusion: Individualized patient analysis and neurosurgeon experience continue to be important factors in treatment selection in elderly patients with a diagnosis of meningioma. However, the scoring systems used to select a treatment modality in elderly patients make it possible to significantly optimize the treatment process and, ultimately, the prognosis of the disease.

• Klíčová slova
• skórovací systémy,
• MeSH
• komorbidita MeSH
• lidé MeSH
• meningeom * chirurgie   MeSH
• pooperační komplikace MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• práce podpořená grantem MeSH

S roční incidencí 5/100 000 je meningeom nejčastějším primárním intrakraniálním extraaxiálním nádorem. Je to většinou pomalu rostoucí nádor vyrůstající z arachnoideálních buněk. U dospělých tvoří přibližně 30 % všech intrakraniálních nádorů. U dětí je vzácný. Významně častěji se vyskytuje u žen. Většina těchto nádorů je benigní povahy. Klinická manifestace je závislá na lokalizaci a velikosti tumoru. V terapii se uplatňuje především chirurgická léčba, jejíž cílem je totální odstranění nádoru, které často znamená úplné vyléčení pacienta. Prognózu pacienta určuje anatomické umístění, radikalita resekce a histologický typ nádoru dle WHO. Některé meningeomy, zejména meningeomy báze lební, které často utiskují nebo obrůstají velké cévy a hlavové nervy a dále infiltrativně rostoucí meningeomy, které často odpovídají histologicky vyššímu gradingu dle WHO, jsou velmi těžko chirurgicky odstranitelné. Důležitým faktorem při léčbě meningeomů je také celkový stav a interní komorbidity u pacienta. Další léčebnou modalitou je radiochirurgie. Alternativou spíše stále experimentální zůstává hormonální terapie.

With an annual incidence of 5/100,000, meningioma is the most common primary intracranial extraaxial tumor. It is usually a slow-growing tumor growing from arachnoid cells. In adults, they make up approximately 30% of all intracranial tumors. They are rare in children. Meningiomas occurs significantly more common in women. Most of the tumors are benign. The clinical manifestation depends on the location and size of the tumor. In therapy, surgical treatment is most important, the aim is total removal of the tumor, which often means a complete cure of the patient. The patient's prognosis is determined by the anatomical location, radicality of the resection and the histological type of the tumor according to the WHO classification. Some meningiomas, especially skull base meningiomas, which often compress or overgrow large vessels and cranial nerves, and infiltratively growing meningiomas, which often correspond to a histologically higher grade according to the WHO classification, are very difficult to remove. An important factor in the treatment of meningiomas is also the general condition and internal comorbidities of the patients. Another treatment modality is radiosurgery. Hormone therapy remains a rather experimental alternative.

• MeSH
• lidé MeSH
• meningeom * chirurgie   diagnóza   MeSH
• neurochirurgické výkony MeSH
• terciární prevence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Mozkové metastázy jsou závažnou komplikací nádorového onemocnění. Postupem času se zvýšila radikalita a bezpečnost resekčních výkonů díky pokroku v zobrazovacích metodách mozku, peroperačnímu elektrofyziologickému monitorování a přístrojovému vybavení, a současně se snížila operační mortalita a morbidita. Chirurgická resekce je stále první zvažovanou terapeutickou možností. Indikuje se především u pacientů se solitární mozkovou metastázou v přístupné lokalizaci, v dobrém klinickém stavu a s příznivou prognózou. Relativně kontraindikována je v případě nekontrolovaného nádorového onemocnění, špatného klinického stavu, v případě radiosenzitivních nádorů, špatné prognózy onemocnění a přítomnosti více než tří mozkových metastáz. Je možné chirurgicky ošetřit i dvě nebo tři metastázy, což může být v ale některých aspektech diskutabilní. Stejně tak je tomu u rekurentních metastáz, kde jednoznačná obecná doporučení nejsou definována, a preferuje se individuální přístup se zohledněním řady prognostických faktorů.

Brain metastases are a serious complication of cancer. There has been an increase in the radicality and safety of resection procedures due to advances in brain imaging methods, perioperative electrophysiological monitoring and instrumentation, while reducing surgical mortality and morbidity. Surgical resection is still considered the first therapeutic option. It is indicated mainly in patients with solitary brain metastasis in an accessible location, in good clinical condition and with a favorable prognosis. It is relatively contraindicated in the case of uncontrolled cancer, poor clinical condition, in the case of radiosensitive tumors a poor prognosis and the presence of more than three brain metastases. It is possible to surgically treat two or three metastases, which may be debatable in some aspects. In a similar way it is for recurrent metastases, where unambiguous general recommendations are not defined, and an individual approach is preferred, taking into account a number of prognostic factors.

• MeSH
• lidé MeSH
• metastázy nádorů MeSH
• nádory mozku * chirurgie   radioterapie   sekundární   MeSH
• neurochirurgické výkony MeSH
• radiochirurgie metody   MeSH
• radioterapie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Mozkové metastázy jsou závažnou komplikací nádorového onemocnění. Díky pokroku v zobrazovacích metodách mozku, peroperačním elektrofyziologickém monitorování a přístrojovém vybavení došlo ke zvýšení radikality a bezpečnosti jejich chirurgické resekce současně se snížením jejich mortality a morbidity. Chirurgická resekce je stále první zvažovanou terapeutickou možností. Je doporučována především pro pacienty se solitární mozkovou metastázou v přístupné lokalizaci, v dobrém klinickém stavu a příznivou prognózou. Relativně kontraindikována je v případě nekontrolovaného nádorového onemocnění, špatného klinického stavu, v případě radiosenzitivních nádorů, špatné prognózy onemocnění a přítomnosti více než tří mozkových metastáz. Chirurgická terapie u dvou nebo tří metastáz je také možná, ale její role může být v některých aspektech diskutabilní. Stejně tak je tomu v případě rekurentních metastáz, kde obecná doporučení nejsou jednoznačně definována a preferuje se individuální posouzení na základě řady prognostických faktorů.

Brain metastases are serious complication of cancer. Progress in brain imaging, intraoperative electrophysiological monitoring and neurosurgical equipment have increased the extent of the resection and safety of neurosurgical operations while reducing mortality and morbidity. Surgical resection is still the first considered therapeutic option. It is especially recommended for patients with solitary cerebral metastasis in accessible localization, in good clinical conditions and with favourable prognosis. It is relatively contraindicated in the case of uncontrolled cancer disease, poor clinical conditions, in the case of radiosensitive tumours, poor disease prognosis and presence of more than three cerebral metastases. Surgical therapy for two or three metastases is also possible, but its role may be questionable in some aspects. General recommendations are not clearly defined in the case of recurrent metastases as well, and individual assessment is preferred based on the evaluation of the number of prognostic factors.

• MeSH
• chirurgie operační MeSH
• lidé MeSH
• metastázy nádorů MeSH
• nádory mozku * chirurgie   sekundární   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH