PURPOSE OF THE STUDY: The annual number of spinal fusion procedures has been increasing and is well documented worldwide. The O-arm is slowly becoming the standard for transpedicular screw insertion. The accuracy and safety of this method have been confirmed by many studies. Therefore, the learning curve of this method and its use by younger surgeons is the focus of our investigation. Longer operative time and radiation exposure to the patient are its only disadvantages. Our aim was to evaluate the learning curve of neurosurgical residents receiving specialist training and to demonstrate the safety and accuracy compared to the conventional C-arm-guided screw insertion used in the surgical management of spondylolisthesis. MATERIAL AND METHODS: Two groups of patients were evaluated - a retrospective cohort composed of patients with degenerative lumbar spinal instability indicated for C-arm-guided posterior transpedicular screw fixation and a prospective group of patients with the same diagnosis and surgical indication for O-arm-navigated screw insertion. In the retrospective group, the surgeons were largely experienced certified spine surgeons and neurosurgeons, whereas in the prospective group there were mainly neurosurgical residents receiving specialist training under the supervision of a certified physician. Both groups underwent a postoperative CT scan to evaluate the pedicle screw malposition using the Grade system and the anatomical plane of malposition. The operative times for both groups were recorded and for the O-arm navigated group a learning curve from the introduction of the method was generated. The values obtained were statistically analysed. RESULTS: A relatively favourable learning curve of the O-arm-navigation was obtained, with operative times approximating the Carm-guided group at two years after the introduction of the method. Safety of the O-arm navigation applied by less experienced surgeons was confirmed through statistically significantly higher accuracy achieved in the O-arm group at the expense of longer operative times. Also, a significantly lower number of significant Grade 2 and 3 malposition was reported in the O-arm group. DISCUSSION: The higher accuracy of transpedicular screw insertion in the navigation method has been confirmed multiple times. In our study, even in the group of less experienced surgeons. The favourable learning curve of neurological residents receiving specialist training is less documented. Time efficiency of the method and its safety when applied by younger surgeons could help make O-arm navigation the new gold standard in spine surgery. The longer operative time, the purchase price of the device, and a relatively higher radiation exposure to the patient continue to be its disadvantages. CONCLUSIONS: Based on the data obtained, a conclusion can be drawn that the O-arm navigation in spine surgery represents a safer and more accurate method for transpedicular fixation compared to the conventional C-arm technique, even when used by less experienced surgeons. In future, we should focus on increasing its time-efficiency. We are convinced that the navigationassisted spinal instrumentation will soon become a necessity for spine surgery centres. KEY WORDS: O-arm, transpedicular fixation, spondylolisthesis, fusion, navigation, learning curve.

• MeSH
• bederní obratle * chirurgie   MeSH
• chirurgie s pomocí počítače metody   přístrojové vybavení   MeSH
• délka operace MeSH
• fúze páteře přístrojové vybavení   metody   výchova   MeSH
• kostní šrouby MeSH
• křivka učení * MeSH
• kurzy a stáže v nemocnici MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• spondylolistéza * chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY Tranexamic acid as a haemostatic agent is commonly used in multiple medical branches. Over the last decade, there has been a steep rise in the number of studies evaluating its effect, i.e. blood loss reduction in specific surgical procedures. The aim of our study was to evaluate the effect of tranexamic acid on reducing intraoperative blood loss, postoperative blood loss into the drain, total blood loss, transfusion requirements, and development of symptomatic wound hematoma in conventional single-level lumbar decompression and stabilization. MATERIAL AND METHODS The study included patients who had undergone a traditional open lumbar spine surgery in the form of single-level decompression and stabilisation. The patients were randomized into two groups. The study group received a 15 mg/kg dose of tranexamic acid intravenously during the induction of anaesthesia and then again 6 hours later. No tranexamic acid was administered to the control group. In all patients, intraoperative blood loss, postoperative blood loss into the drain, and therefore also total blood loss, transfusion requirements and potential development of a symptomatic postoperative wound hematoma requiring surgical evacuation were recorded. The data of the two groups were compared. RESULTS The cohort includes 162 patients, 81 in the study group and the same number in the control group. In the intraoperative blood loss assessment, no statistically significant difference between the two groups was observed; 430 (190-910) mL vs. 435 (200-900) mL. In case of post-operative drain blood loss, a statistically significantly lower volume was reported after the tranexamic acid administration; 405 (180-750) mL vs. 490 (210-820) mL. When evaluating the total blood loss, a statistically significant difference was also confirmed, namely in favour of the tranexamic acid; 860 (470-1410) mL vs. 910 (500- 1420) mL. The reduction of total blood loss did not result in a difference in the number of administered transfusions; transfusions were given to 4 patients in each group. A postoperative wound hematoma requiring surgical evacuation developed in 1 patient in the group with the tranexamic acid and in 4 patients in the control group, but the difference was not statistically significant with respect to the insufficient group size. No patient in our study experienced complications associated with tranexamic acid application. DISCUSSION The beneficial effect of tranexamic acid on reducing blood loss in lumbar spine surgeries has already been confirmed by numerous meta-analyses. The question remains in what types of procedures, at what dose and route of administration its effect is significant. To date, most of the studies have explored its effect in multi-level decompressions and stabilizations. Raksakietisak et al., for instance, report significant reduction in total blood loss from 900 (160, 4150) mL to 600 (200, 4750) mL following an intravenous injection of 2 bolus doses of 15 mg/kg tranexamic acid. In less extensive spinal surgeries, the effect of tranexamic acid may not be that distinct. In our study of single-level decompressions and stabilizations, no reduction in the actual intraoperative bleeding was confirmed at the given dosage. Its effect was seen only in the postoperative period in a significant reduction of blood loss into the drain, thus also in the total blood loss, although the difference between 910 (500, 1420) mL and 860 (470, 1410) mL was not that significant. CONCLUSIONS By intravenous application of tranexamic acid in 2 bolus doses in single-level decompression and stabilization of the lumbar spine a statistically significant reduction in postoperative blood loss into the drain and also total blood loss was confirmed. The reduction in the actual intraoperative blood loss was not statistically significant. No difference was observed in the number of administered transfusions. Following the tranexamic acid administration, a lower number of postoperative symptomatic wound hematomas was recorded, but the difference was not statistically significant. Key words: tranexamic acid, spinal surgeries, blood loss, postoperative hematoma.

• MeSH
• antifibrinolytika * MeSH
• hematom prevence a kontrola   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• kyselina tranexamová * MeSH
• lidé MeSH
• pooperační krvácení prevence a kontrola   farmakoterapie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Muž ve věku 68 let s těžkým kraniofaciálním poraněním byl endoskopicky operován pro nasální likvoreu. Během operačního výkonu byl nalezen v levém nosním průduchu zaklíněný plastový předmět tvaru sklíčka brýlí, který jsme extrahovali. Z pacientovy dokumentace bylo následně zjištěno, že se jedná o vycestovalý akrylátový implantát spodiny orbity, která byla chirurgicky ošetřena po poranění obličejového skeletu před třiceti pěti lety. Raritní na tom je i zjištění, že pacient byl řadu let vyšetřován na otorinologickém pracovišti pro hnisavý výtok z levé dutiny nosní a zhoršenou ventilaci. Pacient podstoupil i endoskopické vyšetření dutiny nosní, při kterém bylo dokonce vysloveno podezření na intranasální nádor, který ale nebyl histologicky potvrzen.

A 68-year-old man with severe craniofacial trauma underwent endoscopic surgery for nasal cerebrospinal fluid leak. During the operation, a plastic object in the shape of a spectacle lens was found wedged in the left nasal passage, which we extracted. As subsequently established from the patient’s documentation, it was a dislodged acrylic implant originally placed at the base of the orbit which was surgically treated after an injury to the facial skeleton thirty-five years ago. What is also rare about this is the fact that the patient had been examined for many years at the otorhinology department for purulent discharge from the left nasal cavity and impaired ventilation. The patient had also undergone an endoscopic examination of the nasal cavity during which an intranasal tumor was even suspected, but it was not histologically confirmed.

• Klíčová slova
• intranasální cizí předmět,
• MeSH
• cizí tělesa * chirurgie   diagnóza   patologie   MeSH
• endoskopie metody   MeSH
• lidé MeSH
• nosní dutina chirurgie   patologie   MeSH
• nosní přepážka diagnostické zobrazování   zranění   MeSH
• poranění obličeje MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

Úvod: Dekompresivní kraniektomie (DK) je život zachraňující neurochirurgický výkon s několika technickými možnostmi provedení. Cíl: Cílem této studie bylo porovnat výsledky operační techniky DK s duroplastikou a bez provedené duroplastiky na dvou neurochirurgických pracovištích. Metodika: Retrospektivní bicentrická studie hodnotila výskyt komplikací (tj. infekční, likvorová píštěl, hematom) u jednotlivých technik. Výsledky: Ve studii nebyl prokázán statisticky signifikantně vyšší výskyt komplikací jako jsou infekce (p = 0,539), likvorová píštěl (p = 0,826) či hematom (p = 0,720). V obou sledovaných souborech po kranioplastice nebyly zaznamenány infekční komplikace nebo likvorová píštěl. Komplikace ve formě hematomu byla statisticky nevýznamná (p = 0,155). Byl zjištěn statisticky významný rozdíl v operačním čase kranioplastiky provedené po DK s duroplastikou (medián 53 min) a po DK bez provedené duroplastiky (medián 90 min; p = 0,006). Závěr: DK bez provedení duroplastiky je potenciální bezpečná varianta, která není zatížená vyšším výskytem komplikací ve smyslu infekce nebo vzniku likvorové píštěle a hematomu.

Background: Decompressive craniectomy (DC) is a life-saving neurosurgical procedure with several technical options. Aim: The aim of this study was to compare the results of the DC surgical technique with and without duroplasty performed at two neurosurgery departments. Methods: A retrospective bicentric study evaluated the occurrence of complications (i.e., infection, cerebrospinal fluid fistula, hematoma) in both compared techniques. Results: The study did not demonstrate a statistically significantly higher incidence of complications such as infection (P = 0.539), cerebrospinal fluid fistula (P = 0.826) or hematoma (P = 0.720). No infectious complications or cerebrospinal fluid fistula were recorded in both observed groups after cranioplasty. The complication in the form of hematoma was statistically insignificant (P = 0.155). A statistically significant difference was found in the operative time of cranioplasty performed after DC with duroplasty (median 53 min) and after DC without duroplasty (median 90 min; P = 0.006). Conclusion: DC without duroplasty is a potentially safe option that is not burdened by a higher incidence of complications in terms of infection or the formation of cerebrospinal fluid fistula and hematoma.

• Klíčová slova
• duroplastika, kranioplastika,
• MeSH
• dekompresní kraniektomie metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• traumatické poranění mozku * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Coccygodynia, or tailbone pain, is the most common in women after trauma (complicated childbirth, fall). This pain can be treated conservatively (by using analgesics, local injections, physiotherapy) or by surgical coccygectomy. In the presented article, a set of five female patients is evaluated, in whom, after the failing conservative therapy, coccygectomy was indicated for persistent coccygodynia. In all female patients, improvement of their clinical condition and alleviation of pain were reported. Coccygectomy has its place in the management of coccygodynia and in correctly chosen patients significant pain reduction can be expected. Key words: coccygodynia, coccyx, coccygectomy, trauma.

• MeSH
• bolesti zad MeSH
• kostrč zranění   chirurgie   MeSH
• lidé MeSH
• lumbalgie * etiologie   chirurgie   MeSH
• muskuloskeletální bolest * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

AIMS: Angiotensin converting enzyme inhibitors (ACEI) have been recently discussed in connection with the medical treatment of chronic subdural haematoma (CSDH). They may improve the treatment results. The objective of our study was to evaluate the impact of ACEI on the development of CSDH. The first question was to assess the impact of ACEI on postoperative CSDH healing. The second was to assess the impact of ACEI on the development of CSDH as such. PATIENTS AND METHODS: The study recruited patients treated surgically for CSDH at our department in the 2013-2018 period. Based on medical records, we retrospectively evaluated the clinical condition of the patients, their history (mainly pharmacological - the use of ACEI) and the course of treatment focussing on the reoccurrence of disease necessitating further therapeutic interventions. For the purpose of evaluating the impact of ACEI on postoperative CSDH healing, the patients were divided into two groups: those using ACEI and those without this medication. The results were compared. We also compared the prevalence of ACEI use in patients with CSDH with the prevalence of ACEI in the comparable population. The difference of the rates allowed us to evaluate the impact of ACEI on the development of CSDH itself. RESULTS: Of the 217 patients after surgery for CSDH, 79 continued the use of ACEI; the remaining 138 patients did not use this medication. Patients using ACEI after the surgery experienced a recurrence in 24 (30.4%) cases; patients without ACEI in 37 (26.8%) cases. A negligibly higher number of recurrences was recorded in patients with postoperative use of ACEI, but this difference was not statistically significant (P=0.574). Of a total of 230 patients who underwent surgery for CSDH, 81 were using ACEI chronically (35.2%). In the control group of 100 patients, 38 (38.0%) patients used ACEI. The difference was not statistically significant (P=0.629), so it is not possible to assume that ACEIs influence the development of CSDH as such. CONCLUSION: The initial high hopes for a positive ACEI effect on the healing of CSDH are now waived after the publication of several recent studies. According to our present knowledge, the development of CSDH does not appear to be influenced by ACEI use.

• MeSH
• chronický subdurální hematom * farmakoterapie   etiologie   MeSH
• drenáž MeSH
• inhibitory ACE škodlivé účinky   MeSH
• lidé MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Sacroiliac joint dysfunction is defined as a permanent chronic pain originating from the sacroiliac joint, limiting the patient's daily activities. The purpose of this study was to evaluate the effectiveness of the minimally invasive sacroiliac joint stabilization by triangular titanium implants in patients with sacroiliac joint dysfunction. MATERIAL AND METHODS The prospective study evaluated the patients who had underwent a minimally invasive sacroiliac joint stabilization for sacroiliac joint dysfunction with the use of iFuse® implants. The surgery was performed solely under fluoroscopic guidance or together with the use of O-arm O2® mobile imaging system. The clinical condition, the Visual Analogue Scale preoperatively and one year postoperatively, previous surgeries in the lumbar spine region, the use of O-arm and occurrence of complications were recorded. The minimum follow-up period was 1 year. RESULTS The group was composed of 20 patients, of whom 4 men and 16 women. The mean age was 48.9 years. The surgeries covered 21 sacroiliac joints. Improvement of the clinical condition was reported in 17 cases (81.0%), no relief was observed in 4 cases (19%). The mean VAS score was 6.1 points preoperatively and decreased to 2.9 points postoperatively (p=0.0001). CONCLUSIONS The minimally invasive sacroiliac joint stabilization should be reserved for patients experiencing an intractable pain originating from the sacroiliac joint, in whom all non-operative therapy failed. Key words: minimally invasive sacroiliac joint stabilization, sacroiliac joint dysfunction, O-arm.

• MeSH
• chirurgie s pomocí počítače * MeSH
• fúze páteře * MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• sakroiliakální kloub diagnostické zobrazování   chirurgie   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Cíl: Cílem práce bylo stanovit roli prognostických možností proteinu S 100B jako možného biochemického markeru u pacientů s kraniocerebrálním poraněním. Soubor a metodika: Do pilotní studie bylo zařazeno celkem 22 pacientů s kraniocerebrálním poraněním verifikovaným CT. Byla sledována hladina proteinu S 100B do 3 h a dále po 8, 12, 24 a 72 h od úrazu. Výsledky: Při měření do 3 h od úrazu byly naměřeny nejvyšší hodnoty – medián 0,624 (0,166; 1,250) μg/l, které v následujících hodinách statisticky signifikantně poklesly. Prokázali jsme významnou středně silnou negativní korelaci mezi hodnotami proteinu S 100B naměřenými ve všech časech a vstupními hodnotami Glasgow Coma Scale (GCS), přičemž nejsilněji korelovaly po 72 h. Nebyla prokázána významná závislost hladin proteinu S 100B na věku pacientů. U sdružených poranění byla prokázána vyšší vstupní hladina proteinu – medián S 100B 1,250 (1,180; 3,380) μg/l než u izolovaných kraniotraumat – medián 0,438 (0,154; 0,681) μg/l. U pacientů s neuspokojivým klinickým stavem (GCS ≤ 12) 4. den hospitalizace byly prokázány významně vyšší hodnoty proteinu S 100B po 24 a 72 h. Nejspolehlivější predikce příznivého klinického stavu 4. den (GCS ≥ 13) byla možná po 72 h při hladině proteinu S 100B ≤ 0,132 μg/l se senzitivitou 94,1 % a specificitou 100 %. Závěr: Studie podporuje možnost potenciálního prognostického použití sérové hodnoty proteinu S 100B u pacientů s kraniocerebrálním traumatem.

Aim: The aim of this study was to explore prognostic capabilities of protein S 100B as a possible biochemical marker in patients with traumatic brain injury. Materials and methods: In this pilot study, we enrolled 22 patients with a traumatic brain injury verified on CT. S 100B levels were measured within 3 h and later on after 8, 12, 24 and 72 h following the trauma. Results: Initial checks of levels within 3 h following the trauma proved to be at a peak median 0.624 (0.166; 1.250) μg/L, and in the following hours the values declined with statistical significance. We proved a significant moderate negative correlation between the values of protein S 100B measured at all time checkpoints with initial Glasgow Coma Scale (GCS) values, with the highest correlation after 72 h. We did not prove any significant dependency of the levels of protein S100B and patient’s age. Higher levels of protein S 100B were found in patients with additional injuries with a median of 1.250 (1.180; 3.380) μg/L compared to patients with isolated traumatic brain injury with a median of 0.438 (0.154; 0.681) μg/L. Patients with unsatisfactory clinical outcome (GCS ≤ 12) on Day 4 were found to have higher levels of protein S 100B after 24 and 72 h. The most reliable cut-off level of protein S 100B for predicting favorable clinical outcome (GCS ≥ 13) on Day 4 was possible after 72 h at the level of ≤ 0.132 μg/L with 94.1% sensitivity and 100% specificity. Conclusion: The study supports the potential prognostic use of serum S 100B protein in patients with with traumatic brain injury.

• Klíčová slova
• Glasgow Coma Scale,
• MeSH
• klinická studie jako téma MeSH
• kraniocerebrální traumata * diagnóza   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• poranění mozku * diagnóza   MeSH
• S-100 kalcium vázající protein G, podjednotka beta * analýza   MeSH
• stupeň závažnosti nemoci MeSH
• ukazatel závažnosti úrazu MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.

• MeSH
• adenom * diagnostické zobrazování   chirurgie   MeSH
• baze lební * diagnostické zobrazování   chirurgie   MeSH
• chirurgie s pomocí počítače * metody   MeSH
• dospělí MeSH
• hypofýza * diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory hypofýzy * diagnostické zobrazování   chirurgie   MeSH
• neuronavigace metody   MeSH
• peroperační doba MeSH
• pilotní projekty MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• senioři MeSH
• transanální endoskopická chirurgie * metody   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské 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