How does early decompressive craniectomy influence the intracranial volume relationship in traumatic brain injury (TBI) patients?

BACKGROUND: Decompressive craniectomy (DC) is a common neurosurgical procedure involving the removal of part of the skull vault combined with subsequent duroplasty. The goal of DC is to produce extra space for the swollen brain and/or to reduce intracranial pressure. In the present study, DC was performed in order to create space for the swollen brain. AIM OF THE STUDY: to compare the volume alteration of selected intracranial fluid spaces before and after DC, to evaluate the volume of post-decompressive brain displacement (PDBD) and the largest dimension of oval craniectomy (LDOC), and to assess the early clinical effects of DC. MATERIAL AND METHODS: The study group consisted of 45 patients with traumatic brain injury (four females and 41 males, mean age 54.5 years) who underwent DC (not later than five hours after admission to hospital) due to subdural haematomas and/or haemorrhagic brain contusions localised supratentorially and diagnosed by computed tomography (CT). The mortality rate in the study group was 40%. Study calculations were performed using Praezis Plus software by Med Tatra, Zeppelin and Pax Station by Compart Medical Systems. For statistical analysis, IBM SPSS Statistics software was used. RESULTS: The DC-related additional space was responsible for a statistically significant increase in the volume of preoperatively compressed intracranial fluid spaces. The mean volume of extra space filled by the swollen brain was 42.2 ml ± 40.7. The best early treatment results were achieved in patients under the age of 55. CONCLUSIONS: DC has limited effectiveness in patients aged over 70 years. In every patient with clamped basal cisterns, a skin incision enabling appropriate LDOC should be planned before surgery. DC should be as large as possible, and the limits of its dimensions should be the limits of anatomical safety.

Polymerase chain reaction based detection of bacterial 16S rRNA gene in the cerebrospinal fluid in the diagnosis of bacterial central nervous system infection in the course of external cerebrospinal fluid drainage. Comparison with standard diagnostics currently used in clinical practice.

BACKGROUND AND PURPOSE: External drainage of cerebrospinal fluid (CSF) is a commonly used neurosurgical procedure. Complications of the procedure comprise central nervous system (CNS) bacterial infections, the frequency of which is estimated at around 6-10%. Detection of these infections is ineffective in many cases. The aim of the study was to evaluate the usefulness of a polymerase chain reaction (PCR)-based detection of bacterial 16S rRNA gene (16S rDNA) in the CSF. MATERIAL AND METHODS: The study group consisted of 50 patients. Clinical signs of CNS infection were monitored and routine laboratory and microbiological tests were performed. The results of standard methods were compared with the bacterial 16S rDNA detection. RESULTS: Using cultures, CNS infection was diagnosed in 8 patients, colonization of the drainage catheter in 6 patients, and sample contamination in 7 patients. In the group of the remaining 29 patients, no positive CSF culture was obtained and 13 of these patients also had all negative results for 16S rDNA detection. For the remaining 16 patients of this group, CNS infection, colonization of the catheter and sample contamination were diagnosed via PCR alone. Routine biochemical CSF tests and blood inflammatory parameters had a supporting value. CONCLUSIONS: Routine hospital tests do not provide rapid and efficient detection of the external drainage related bacterial CNS infection. It is justified to use several diagnostic methods simultaneously. The16S rDNA determination in CSF can increase the probability of detection of possible pathogens.

Decompressive craniectomy in trauma: when to perform, what can be achieved.

SUBJECT: The goal of the study was to evaluate the effectiveness of the decompressive craniectomy (DC) concerning its various parameters. MATERIAL AND METHODS: Forty-five patients were studied (6 female, 39 male, mean age 53 years). All patients were treated because of severe traumatic brain injury. CT was performed before surgery and on the 1st to 3rd days postoperatively, and was evaluated using specific software. Parameters such as diameter of DC, volume of the additional intradural space obtained, and the shift of the midline were measured. RESULTS: In the group of patients treated with unilateral DC, the 11-cm craniectomy resulted in an average of 69 mL of additional space. The best score on the Extended Glasgow Outcome Scale (GOS-E) after DC was in patients younger than 35 years old. CONCLUSION: In our opinion DC is a suitable method of treatment for patients after severe traumatic brain injury. The best results were achieved in a group of patients aged <50 years, in particular <35 years old. DC gives extra additional space for damaged and edematous brain. DC should be performed early enough and should be large enough. Parameters of the DC obtained positive results with regard to patient status, but there are also other factors such as age and initial Glasgow Coma Scale (GCS) score, which can affect outcome.

[Schwannoma of the common peroneal nerve. A differential diagnosis versus rare popliteal cyst]. / Nerwiak oslonkowy nerwu strzalkowego wspólnego w obrebie dolu podkolanowego. Róznicowanie z torbielami zwyrodnieniowymi.

The presented case concerns a patient with neuralgia of the common peroneal nerve and progressive neurological deficit caused by interfascicular growth of schwannoma. The ultrasound diagnostics identified the lesion as a popliteal cyst. Magnetic resonance imaging revealed features of atypical cyst location. Due to the clinical course, it was decided to decompress the nerve trunk. An interfascicular tumor was identified intraoperatively. Particular nerve bundles were separated microsurgically and the tumor of schwannoma morphology was removed. The postoperative course brought resolution of neuralgia and improvement of peroneal nerve function. In the case in question attention was focused on the differential diagnostics of processes located in the popliteal fossa. Imaging examination indicated an atypical cyst location rather than a morphologically solid tumor. The clinical course is essential for determining the nature of the lesion. Decompressing the common peroneal nerve in microsurgical technique allows the prevention of further neurological symptoms in the postoperative course.

[Occipito-cervical fixation in plasmocytoma. Method modification. Technical report]. / Stabilizacja potyliczno-szyjna u chorego w przebiegu szpiczaka. Modyfikacja metody operacyjnej. Nota techniczna.

Intraoperative modification of use and stabilization of the Axon system (Synthes) for occipito-cervical fusion in a patient treated oncologically due to plasmocytoma is presented. Pathological fracture, range of the process and damage of anterior cervical fusion necessitated the use of occipito-cervical stabilization. Different anatomical conditions within the occipital bone in the form of its thinning was observed. Fixing with screws was impossible due to the bone structure. In consequence, modification of stabilization with an ad hoc elaborated technique (burr holes in the occipital bone and stabilization with titanium wire) was implemented. Modifications and specific indications related to the clinical course of plasmocytoma are discussed.

Empyema in spinal canal in thoracic region, abscesses in paravertebral space, spondylitis: in clinical course of zoonosis Erysipelothrix rhusiopathiae.

OBJECTIVES: Erysipelas is an animal disease caused by Gram-positive bacteria Erysipelothrix rhusiopathiae. Among the domestic animals, domestic pig (Sus scrofa f. domestica) suffers most frequently from the disease in human environment. This is a typical animal-borne disease observed mainly in occupational groups employed in agriculture, farming (of animals and birds), fishing and manufacturing industry. METHODS: We are presenting the clinical course of infection (E. rhusiopathiae) and discuss clinical forms. E. rhusiopathiae in humans may have the following clinical course: mild form of skin infection diagnosed as local erythema (erysipeloid), disseminated form of skin infection and the most serious form of infection of systemic course (endocarditis and sepsis). Mild skin infection and local erythema are the most common forms. Very rare case of animal-borne infection course has been presented in which after initial phase the disease was generalised to the abscesses formation in paravertebral space, spondylitis and empyema formation in spinal canal. In the presented clinical case, the patient was suffering from diabetes. It was probably an additional risk factor of the disease generalisation. Patient underwent drainage of empyema in spinal canal, after which his neurological status gradually improved. Antibiotic therapy was implemented and continued for 8 weeks. Such course of erysipelas was not previously described in the literature. RESULTS: After therapy neurological status was improved. In follow MRI control exam empyema and spondylitis was successfully eliminated. CONCLUSIONS: Various complications of the disease, such as endocarditis and heart valves disturbances, are well known and are the most severe complications of the generalised infection. Proper targeted and long-term antibiotic therapy is crucial.

[The role of matrix metalloproteinases and tissue inhibitors of metalloproteinases in invasion of tumours of neuroepithelial tissue]. / Rola metaloproteaz macierzy i tkankowych inhibitorów metaloproteaz w inwazji nowotworów pochodzenia neuroepitelialnego.

Tumour invasion requires degradation of extracellular matrix components and migration of cells through degraded structures into surrounding tissues. Matrix metalloproteinases (MMP) constitute a family of zinc and calcium-dependent endopeptidases that play a key role in the breakdown of extracellular matrix, and in processing of cytokines, growth factors, chemokines and cell surface receptors. Their activity is regulated at the levels of transcription, activation and inhibition by tissue inhibitors of metalloproteinases (TIMP). Changes in expression of MMP and TIMP are implicated in tumour invasion, because they may contribute to both migration of tumour cells and angiogenesis. Alterations of MMP expression observed in brain tumours arouse interest in the development and evaluation of synthetic matrix metalloproteinase inhibitors as antitumour agents.