The safety and effectiveness of low field intraoperative MRI guidance in frameless stereotactic biopsies of brain tumours-design and interim analysis of a prospective randomized trial.

The aim of the study was to assess the safety and effectiveness of stereotactic brain tumour biopsy (STx biopsy) guided by low-field intraoperative magnetic resonance imaging (iMRI) in comparison with its frameless classic analogue based on a prospective randomized trial. A pilot group of 42 brain tumour patients was prospectively randomized into a low-field iMRI group and a control group that underwent a frameless STx biopsy. The primary endpoints of the analysis were postoperative complication rate and diagnostic yield, and the secondary endpoints were length of hospital stay and duration of operation. The iMRI group (21 patients) and the control group (21 patients) did not differ significantly according to demographic and epidemiological data. No major postoperative complications were noted in either group. In addition, no significant differences in the diagnostic yield (p = 1.00) and length of hospital stay (p = 0.16) were observed. The mean total OR time was 111 ± 24 min in iMRI and 78 ± 29 min in the control group (p = 0.0001). Usage of iMRI may prolong the time of the procedure but seems to be comparable in safety and effectiveness to the standard frameless STx biopsy.

Neuroendoscopy combined with intraoperative low-field magnetic imaging for treatment of multiloculated hydrocephalus in a 7-month-old infant: technical case report.

BACKGROUND: Treatment of multiloculated hydrocephalus in children remains a difficult neurosurgical problem because of the high recurrence rate. Endoscopic septostomy with subsequent ventriculoperitoneal shunting is one of the most widely accepted therapeutic methods. Intraventricular endoscopic surgery combined with intraoperative magnetic resonance (MR) has been used very seldom in infants. CASE REPORT: A 7-month-old infant presented with a history of postnatal hydrocephalus from the germinal matrix and intraventricular hemorrhage, treated with a ventriculoperitoneal shunt. Treatment was complicated by bacterial meningitis. On admission the child presented with symptoms of elevated intracranial pressure, an MR investigation gave evidence of multiloculated hydrocephalus. The patient underwent endoscopic pellucidotomy, followed by fenestration of the septa inside the third ventricle, third ventriculostomy and aqueductoplasty. Endoscopic navigation was supported by serial intraoperative non-contrast T1-weighted MR (0.15 T, Polestar N20, Medtronic) images. They also served for confirmation of the patency of performed fenestrations and for the planning of further steps of the operation. CONCLUSION: Intraoperative low-field MR imaging provided an excellent tool for correct navigation of the endoscope inside the pathological ventricular compartments and for intraoperative assessment of surgical goals.

[Own experience in surgical treatment of intramedullary spinal cord lipomas]. / Wlasne doswiadczenie w chirurgicznym leczeniu tluszczaków wewnatrzrdzeniowych.

The aim of this report is to present own experiences in surgical treatment of extremely rare occurring intramedullary spinal cord lipomas without spinal dysraphism. Our experience with such tumours based on 2 cases out of 15 intramedullary spinal cord tumours that were treated at our department from 1984 to 1997. The tumours were located at C4-C7 and C6-Th6 spinal cord region. The patients were 16-year-old woman and 57-year-old woman. Both patients presented with long history of progressive spinal cord damage with rapid deterioration after mild injury. The diagnosis was based on myelography in one case and on MRI in the second one. In first case the tumour was totally removed and we achieved neurological improvement. In the second case the tumour was subtotally removed and after 12 months on MR examination we found relapse of the tumour without neurological deterioration. We found two types of the tumours. The first one was well separated from the normal spinal cord and easy to remove. In the second it closely adhered to the spinal cord without possibility of total excision. The surgical treatment of intramedullary spinal cord lipomas is very difficult and dangerous but only in this way we can protect the patients from total paralysis and to improve their comfort of the life.

[The effect of early decompression on the extent of changes in spinal cord microcirculation in experimental traumatic injury to the cord in rabbits]. / Wplyw wczesnego odbarczenia na dynamike zmian w mikrokrazeniu rdzeniowym w doswiadczalnym, urazowym uszkodzeniu rdzenia kregowego u królika.

The purpose of the study was the assessment of the effect of compression of the spinal cord after traumatic injury on spinal microcirculation disturbances and the evaluation in what degree early decompression of the cord reduces the degree of these changes. The experimental study was carried out on 20 rabbits. The injury to the cord was produced at the Th9-Th10 level with simultaneous compression causing vertebral canal narrowing by 1/3 of its width. The assessment was based on the results of microangiographic qualitative and quantitative studies. The animals were divided into 4 groups depending on the duration of cord compression 2, 4, 6 and 12 hours. In each group microcirculation studies were done 12 hours after decompression. Prolonged compression was found to increase the extent of microcirculation disturbances, which were most pronounced after 6 hours of compression. In the group of 12-hour compression microcirculation improvement was observed near the focal lesion. It is concluded that possibly early decompression up to 6 hours after trauma can reduce the degree of secondary damage caused by ischaemia.

[The effect of prolonged spinal cord compression on the extent of morphological changes in experimental spinal cord injury in rabbits]. / Wplyw przedluzajacego sie ucisku na rozleglosc zmian morfologicznych w doswiadczalnym, urazowym uszkodzeniu rdzenia kregowego u królika.

The analysis of early spinal cord decompression influence on the extent of morphological and microvascular changes after traumatic cord injury was the subject of this study, carried out on Polish-breed rabbits divided into two groups. Microvascular changes were evaluated in the first group of 20 animals and morphological changes in the second group of 36 rabbits. The injury causing paraplegia was performed at D9-D10 level by Allen method modified. Every group was subdivided into 4 subgroups depending on the duration of cord compression 2, 4, 6 and 12 hours. Fragments of cord were taken for examination 12 hours after decompression, from sites 0.5, 1.0 and 1.5 cm distant from the injury level. Histopathological analysis was performed by light and electron microscopy and for the analysis of microcirculation with microangiography the Górkiewicz method was used. Great changes were found in nerve fibres, vascular endothelium and microcirculation. The most pronounced lesions were found in the subgroup with 6-hour compression, in the form of haemorrhage, central necrosis and oedema within and around axona as well as destruction of myelin sheaths. Early decompression (within 6 hours) can reduce the extent of morphological and vascular changes.

[Clinical and radiological analysis of lumbar spine stability after hemilaminectomy and laminectomy in cases of lumbar disk excision with simultaneous interbody fusion]. / Kliniczna i radiologiczna ocena stabilnosci kregoslupa ledzwiowego po operacjach usuniecia wypuklin jader miazdzystych krazków miedzykregowycdroga hemilaminektomii lub laminektomii z jednoczasowa spondylodeza miedzytrzonowa.

108 patient were operated on the Neurosurgical Department of the Military Clinical Hospital in Wroclaw since 1989 till 1991. The stability of the lumbar spine after hemilaminectomy and laminectomy with disc excision and interbody fusion was analysed. The period after operation ranged from 6 months to 2 years. Signs of clinical and radiological instability were the base of the study. Respective segmental motions in maximal ante- and retroflexion were calculated. Horizontal intercorporal dislocation was assessed. No signs of instability where found in the analysed material. The results after laminectomy and hemilaminectomy were similar. The failures were not caused by instability.

[Embolization of AVM's of thoracic spinal cord with histoacryl glue]. / Embolizacja naczyniaków odcinka piersiowego rdzenia kregowego za pomoca kleju histoakrylowego.

The authors present two cases of inoperable AVM's of thoracic spinal cord successfully treated by embolization with histoacryl glue (B. Brown Melsungen AG). The glue used for embolization is characterized by instant polymerization when comes in contact with blood. A mass of polymer is visible on X-ray thanks to contrast medium Lipiodol and metallic powder Tungsten that are added to glue and injected together with the latter. In the first case, a female who presented with paraparesis and walked only with assistance embolization performed in one session resulted in neurological improvement enabling independent walking at follow-up 2 yrs later. In the second case of a young male not walking for severe paraparesis embolization performed in three sessions resulted in significant neurological recovery. 10 days after the first session the patient became ambulatory. 6 months after treatment he presented with mild paraparesis and was still ambulatory and leading independent life. In each case embolization was performed after balloon occlusion test during which the function of spinal cord was monitored by somatosensory evoked potentials and neurological assessment.

[Late results of the surgical treatment of spondylolisthesis complicated by injury of the cauda equina]. / Pózne wyniki leczenia operacyjnego kregozmyku powiklanego objawami uszkodzenia ogona konskiego.

In 1971-1985 surgical treatment was carried out of 29 patients in the Neurosurgery Department WAM in Lódz and 5 in the Rehabilitation Centre in Konstancin for spondylolisthesis complicated with signs of cauda equina damage. In the surgical treatment the technique used was that of a combination of neurosurgical approach (full decompression of the nervous elements in the vertebral canal by laminectomy with foraminectomy or facetectomy, removal of protruding discs and osteophytes and parts of the vertebral bodies narrowing the vertebral canal), and orthopaedic procedures (spondylodesis between vertebral bodies posterior spondylodesis and a combination of both techniques). In one case spring alloplasty was done and in one case Harrington's rods were used. The operation was carried out at one time from the same posterior approach. The follow-up was from 1 to 15 years. A very good result was obtained in 20.6% of cases, good in 55.9%, satisfactory in 23.5%. In no case of worsening or lack of improvement were observed.

[Gunshot wounds of the spine and spinal cord. Neurosurgical tactics]. / Zranienia postrzalowe kregoslupa i rdzenia kregowego -- taktyka postepowania neurochirurgicznego.

In the Department of Neurosurgery, Medical Academy in Lódz in the years 1971-1986 out of 356 injuries to the spine and spinal cord 6 cases (1.7%) were shot wounds. The indications to surgical treatment were: high-grade posttraumatic spinal instability, intense liquorrhoea with threatening meningitis, and violent pains in lower extremities. The clinical material and the tactics of neurosurgical management are described.

[Ossification in the area of the spinal cord arachnoid as the cause of a chronic pain syndrome after spinal fracture]. / Skostnienie w obrebie opony pajeczej rdzenia kregowego jako przyczyna przewleklego zespolu bólowego po przebytym zlamaniu kregoslupa.

Calcifications and ossification in the spinal arachnoid are usually asymptomatic and are revealed accidentally during neurosurgical operations or autopsy. A case is described of ossification of the arachnoid developing after vertebral trauma and causing chronic pain.

[Injury of the deep branch of the ulnar nerve]. / Uszkodzenie gallezi Gleebokiej nerwu lokciowego.

The authors report the clinical material from the Department of Neurosurgery, WAM in Lódz from the last 11 years including cases of damage to the deep branch of the ulnar nerve. In view of the importance of this branch for the function of the hand, damage to it requires very careful surgical management with autogenous graft. Sometimes this is technically difficult in view of the topographic conditions in this area. Damage to the deep branch of this nerve is usually associated with damage to the sensory part of the ulnar nerve, to the median nerve and tendons of finger flexors.

[Neurogenic intermittent claudication]. / Neurogenne chromanie przestankowe.

In the period 1971-1981 operations were carried out in 1114 cases of discopathy or lumbar spondylosis. Three patients in this group had pains of the type of intermittent claudication as the main symptoms. In all these cases narrowing of the vertebral canal was found in the lumbar part caused in two cases by degenerative changes and herniation of the intervertebral discs, and in a third case it was due to an extensive connective tissue scar at the site of previously done laminectomy. The nerve roots of the cauda were relieved from pressure surgically and in all cases pains disappeared. The authors discuss factors contributing to the development of neurogenic intermittent claudication.

[Glomangiomas of atypical location]. / Klebczaki o nietypowym umiejscowieniu.

Glomangiomas are most frequently situated on fingers and toes, especially in the vicinity of the ungual plate. The authors report five cases of glomangiomas of atypical location/in the knee joint, in the vicinity of femoral and tibial epiphyses, and in the subcutaneous tissue on the forearm. The clinical findings are described, stressing the lack of parallelism between the intensity of symptoms and the size of the tumour which rarely exceeds the size of a millet grain. Complete removal of the tumour produces complete disappearance of pain and recurrences are not observed.

[Tactics in radical operations on the spine and spinal cord]. / Taktyka radykalnych operacji w obrebie kregoslupa i rdzenia kregowego.

The authors discuss the tactics in the surgical approach in radical operations on the spinal cord, cauda and spine. The discussion is based on 1972 operations on the spine and spinal cord. The group of radical operations comprises 192 cases. The operative mortality in this material was 1%. The authors believe that the surgical tactics in these diseases should be considerate but also as radical as possible.

[Use of gelatin-resorcinol-formaldehyde glue in the surgical treatment of cerebrospinal rhinorrhea]. / Zastosowanie kleju zelatynoworezorcynowo-formaldehydowego (GRF) w chirurgicznym leczeniu przetok plynu mozgowo-rdzeniowego.

The introduction of tissue adhesives in neurosurgery for treating cerebrospinal fluid fistulas has been a major advance in the operative technique. The authors describe the use of gelatin-resorcin-formaldehyde adhesive (GRF) in the surgical treatment of cerebrospinal fluid fistulas. The method of preparation of GRF, the technique of adhesive application, its clinical use and advantages are described.

[Surgical transposition of the ulnar nerve in progressive paralysis]. / Operacyjne przemieszczenie nerwu lokciowego w przypadku postepujacego jego niedowladu.

The authors present a method of surgical treatment of progressive paresis of the ulnar nerve by means of transposition of this nerve to the anterior aspect of the cubital fossa. This method was used in 35 cases. The most frequent cause of the paresis was old fracture or contusion of the region of the cubital joint. In all cases the therapeutic result was good.