The effect of lateral electrical surface stimulation (LESS) on motor end-plates in an animal model of experimental scoliosis.

The treatment of idiopathic scoliosis is challenging because of its diverse etiology, age of onset, and long duration of intensive treatment. We examined the effect of lateral electrical surface stimulation (LESS) in an animal model of experimental scoliosis (ES) assessing the number of motor end-plates (MEPs) as a study end-point. The control group (n=5) was adapted to the experimental apparatus without stimulation, whereas ES was induced in rabbits by one-sided LESS of the longissimus dorsi muscle (LDM) for a duration of 2 months. The ES group (n=5) were subjected to a short-term corrective electrostimulation applied at the contralateral side of the spine compared to the previous LESS stimulation for 2 h daily for 3 (n=5) or 6 months (n=5). Another group of ES rabbits was subjected to a long-term corrective electrostimulation applied for 9 h daily for 3 (n=5) or 6 months (n=5). LESS applied for 2 months (ES), significantly increased the number of MEPs in LDM. The short-term corrective electrostimulation for 3 months resulted in an increased number of MEPs. However, a decrease was observed in the animals treated for 6 months. The long-term corrective electrostimulation for 3 months did not change the density of MEPs in the LDM, but for 6 months the number of MEPs in the LMD significantly decreased by ES and control groups. Thus, the results of the present study clearly show that the short-term LESS is able to influence both the number of MEPs and the effectiveness of muscle correctional adaptation in a more efficient and harmless manner than the long-term procedure.

Heterogeneity of extraparenchymal primitive neuroectodermal tumors within the craniospinal axis.

Four cases of primitive neuroectodermal tumors (PNETs) with unusual localization (three intraspinal extramedullary and one pontocerebellar) are reviewed. Histologically, they were small round blue cell tumors with diverse patterns. Immunohistochemically, all tumors were positive for at least two neuronal markers, two cases were Mic-2 positive and one showed glial differentiation. The paraffin-embedded tumor specimens were examined by interphase FISH using dual-color probes specific for EWS, HER-2 and BCR loci. Molecular cytogenetic study revealed the presence of EWS rearrangement in two cases and the presence of i(17q) in one tumor. Three tumors exhibited 22 disomy and one was 22 polyploid. Extraparenchymal PNETs within craniospinal axis are heterogeneous from the clinical, histological, immunohistochemical and molecular point of view. These PNETs can be of a central or peripheral type. Multidisciplinary approach is of a basic importance in differential diagnosis of such cases.

Primitive neuroectodermal tumor in the cerebellopontine angle with isochromosome 17q presenting as meningioma in a woman 26 years of age.

An unusual posterior fossa neoplasm in a 26-year-old woman with short history of the cerebellar symptoms is presented. CT and MR images showed the tumor within the cerebellopontine angle, suspected as meningioma. At surgery, the tumor was dura-attached and did not infiltrate the arachnoid. Histologically, the neoplasm was a small blue cell tumor with solid and microcystic pattern, consistent with primitive neuroectodermal tumor (PNET). Immunohistochemically the cells were strongly positive for NCAM and GFAP. Fluorescence in situ hybridization (FISH) was performed with the cosmids G9 and F7 (flanking EWSR1/22q12 region) DNA probes and dual-color spectrum-orange LSI HER-2/neu (17q11.2)/spectrum green CEP17 (17p11.1-q11.1) DNA probe. The presence of isochromosome 17q within neoplastic cells was found. The tumor was classified as a medulloblastoma. We demonstrate the utility of a multidisciplinary approach to nervous system tumor diagnosis. The clinical features together with histological, immunohistochemical, and characteristic molecular alteration allowed classification of the presented case.

[Surgical treatment of lateral extraforaminal lumbar disc herniation]. / Leczenie operacyjne bocznych zewnatrzkanalowych przepuklin jadra miazdzystego w odcinku ledzwiowym kregoslupa.

Extraforaminal lumbar disc herniations with spinal nerve compression are a well-recognised entity. The diagnosis is difficult although the clinical syndrome is quite characteristic. Myelography fails to disclose these lesions, while CT, MRI or discography are helpful. The best approach to the extreme-lateral lumbar disc herniation is microsurgical decompression of the spinal nerve via the intertransverse muscle, ligament and fascia. With this approach, there is no facet destruction and satisfactory nerve root decompression is safe and effective in relieving radicular pain.

[Results of the disk microsurgery of lumbar herniated nucleus pulposus]. / Wyniki leczenia mikrochirurgicznego ledzwiowych przepuklin jadra miazdzystego.

Results of microsurgical discectomy (MSD) carried out in 151 patients with lumbar disc herniations are presented. The advantage of microsurgical discectomy is reduction of surgical trauma, better differentiation of anatomical structures, gentler manipulation around nerve roots and the dural sac, and the possibility of a meticulous hemostasis preventing profuse bleeding. Further advantages of MSD are: possibility of direct insight in intervertebral space, limited risk of peri- and postoperative complications and infection, reduction of nursing care, favourable psychological and cosmetic effects. Also possibility of improving microsurgical technique be performing these frequent in neurosurgical practice procedures is not insignificant. Final results were evaluated 6 months after MSD using the Functional Economic Rating Scale developed by Prolo et al. Very good outcome (score 8-10) was achieved in 129 patients (85.4%), good (score 6-7) in 18 (11.9%) and unsatisfactory only in 4 (2.7%).

[MRI of traumatic superficial temporal artery aneurysm. Case report]. / Obraz MRI urazowego tetniaka powierzchownej tetnicy skroniowej. Opis przypadku.

A case of 14-years-old girl with superficial temporal artery aneurysm is presented. She sustained head injury six weeks before the first symptom. Presence of the recent blunt trauma in confrontation with MRI lead to establishing of the final diagnosis. It must be considered in the differential diagnosis of masses located in the temporal fossa. Surgical resection of the involved segment of the vessel is indicated in the cases without the need of reconstruction. The result of treatment in our case was excellent and all symptoms have resolved. The aneurysmal character of the lesion was confirmed by histopathological examination.

[Repeated operations for recurrent lumbar disc herniations]. / Wielokrotne operacje przepuklin jadra miazdzystego w odcinku ledzwiowym.

A study of 73 patients who underwent reoperation for persistent or new complaints following initial lumbar discectomy is presented. 32 patients showed true recurrence of disc herniation (6 on the contralateral side) and 41 at a different level. 14 patients needed 3rd operation. Final results were evaluated using the Functional Economic Rating Scale elaborated by Prolo. Mean score for group operated on twice was 8.1 according to Prolo and 7.1 for group operated on 3 times.

[Epidural gas aggregation in the course of gaseous degeneration of lumbar intervertebral disk as a cause of foot paresis]. / Obecnosc zewnatrzoponowego gazu sródkanalowo w przebiegu gazowego zwyrodnienia jadra miazdzystego w odcinku ledzwiowym jako domniemana przyczyna niedowladu prostowników stopy.

The finding of gas within the vertebral disc space ("vacuum phenomenon") is relatively common. Degenerative spine disease, gaseous degeneration of the intervertebral disc, and epidural gas were disclosed on imaging study. The epidural gas could be attributed to gaseous disc degeneration. The nerve root in presented patient was compressed by epidural gas. Following surgery the clinical syndrome including foot drop has thoroughly resolved.

Meningiomas of the lateral ventricles of the brain in children.

Meningiomas of the lateral ventricles of the brain are rare tumours, accounting for approximately 0.5-5% of all intracranial meningiomas. Their natural history and symptomatology and the possibilities of early diagnosis are presented. The intraventricular location of the slow-growing benign mass provides a compensatory mechanism in the form of reserve space, which contributes to the delay in clinical demonstration of symptoms and signs. This makes the choice of diagnostic procedure an essential problem. CT and MRI are useful in detecting these masses, and magnetic resonance angiography (MRA) has also proved to be of great value in demonstrating the vascular supply of the tumour. This paper deals with two cases. In case 1 CT, MRI and MRA and in case 2 CT examination proved to be very useful. The tumours were removed by a transcortical approach in the posterior area.

Posterior fossa tumors in children--indications for ventricular drainage and for V-P shunting.

A clinical analysis of 95 patients with posterior fossa tumors treated in the Department of Neurosurgery of the Medical University in Gdansk over a period of 16 years (1979-1995) is presented. The following preoperative factors were studied: localization, size and suspected type of tumor, size of the ventricular system, and presence or absence of the "halo" symptom. The indications for ventricular drainage (Fisher) versus V-P shunting as a preliminary treatment are discussed. Finally, the advantages of each of these procedures are emphasized.

[Gaseous degeneration of the intervertebral disc within the lumbar spine]. / Degeneracja gazowa jadra miazdzystego w czesci ledzwiowej kregoslupa.

The finding of gas within the vertebral disc space (vacuum phenomenon) is relatively common. This disorder often presents major diagnostic and therapeutic challenges, especially in the presence of multiple degenerative changes and chronic back pain in elderly patients. The author describes pathophysiology and diagnostics of gaseous degeneration associated with the herniated disc. Degenerative spine disease, gaseous degeneration of the intervertebral disc and epidural gas can be disclosed by imaging studies. The presence of epidural gas is attributed to gaseous disc degeneration. This pathology may cause radicular pain similar to sciatic pain produced by disc herniation. Surgery might be indicated in these cases.

Meningiomas of the lateral ventricles of the brain.

Meningiomas of the lateral ventricles of the brain are rare tumours with an approximate incidence of 0.5-4.5% among all intracranial meningiomas. Four cases of intraventricular meningioma arising from the trigone are presented. In 1-st case the calcified mass was visible on straight radiographs. In 2-nd and 3-rd cases CT and angiography was performed. In 4-th case MRI and MRA proved to be very useful. The tumours were removed by transcortical approach in the posterior parietal area. The available literature on intraventricular meningiomas has been discussed.

[Primary brain lymphoma: diagnostic problems]. / Pierwotny chloniak mózgu--problemy diagnostyczne.

Diagnostic difficulties in a patient with primary malignant lymphoma of the brain are presented. Computerized tomography scans disclosed, at the beginning, a large mass located in the frontocallosal region, and 15 months later another focus in the cerebellum. Differential diagnostic considerations based on CT and NMR pictures, included infectious diseases, demyelinating diseases also metastatic tumours. The patient was successfully treated surgically, and had than radiotherapy.

[Anterior cranial fossa injury with telescopic antenna penetrating through the orbit with rhinorrhea and brain damage]. / Uraz przedniego dolu czaszki teleskopowa antena drazaca przez oczodól z plynotokiem nosowym i uszkodzeniem mózgu.

The authors report a case of injury of the anterior cranial fossa by foreign body penetrating through the orbit with rhinorrhoea and brain damage in a child. Early operation prevented primary and secondary complications.

[Lateral extra-canalicular lumbar disc herniation]. / Boczna zewnatrzkanalowa przepuklina jadra miazdzystego.

A case of 60 years old female with far-lateral disc herniation within lumbar spine is presented. The herniated disc has been excised from the lateral muscle splitting approach with the use of microscope.

[Intracranial epidermal cysts (true cholesteatoma) dermoids]. / Sródczaszkowe torbiele naskórkowe (perlaki prawdziwe, epidermoidy).

Three cases of intracranial epidermoids treated surgically are reported. Typical course, histological appearance, diagnostic value of radiological investigations and surgical procedure are presented. In differential diagnosis dermoids and cholesterol granulomas (cholesteatomas) are widely discussed.

[Spontaneous chronic spinal epidural haematoma in a 14-year-old boy. Case report]. / Przewlekly samoistny krwiak nadtwardówkowy w odcinku piersiowym kregoslupa u 14-letniego chlopca.

An unusual case of a 14-year-old boy with spontaneous chronic spinal epidural haematoma treated surgically with full success is reported. The clinical presentation and aetiology are discussed. The result of treatment depends mainly on the time of duration of neurological deficit. Immediate transfer to neurosurgical department gives a chance of good recovery.

[Evaluation of the results of the treatment of cerebral hematoma in relation to its volume using the "best fit" method]. / Próba oceny wyników leczenia krwiaków sródmózgowych w zaleznosci od objetosci obliczanej metoda "najlepszego dopasowania".

A method is described in which the volumes of intracerebral haematomas were retrospectively measured by a method of best-fitting circles, in 173 consecutive patients. 173 patients were operated on and 41 were treated conservatively. Prognosis in supratentorial haematomas of the volume up to 65 ml is better by 20% when they are treated conservatively. It seems that surgical treatment should be reserved for patients with haematomas over 65 ml presenting progressive deterioration of neurological condition. On the other hand, patients with infratentorial haematoma over 14 ml of volume should be operated on as quickly as possible.

[A case of metastasis of a pineal germinoma to the vertebral canal]. / Przypadek przerzutu szyszyniaka plodowego do kanalu kregowego.

A case of pinealoma is described in a patient aged 16 years who had been treated initially conservatively with ventriculoperitoneal shunting and cobalt irradiation of the whole brain. The spine was not irradiated because of absence of histological examination. After 6 months the patient returned to hospital with paraparesis and pains in the sacral area. Myelography demonstrated contrast stop at the Th10-11 level. The surgically removed tumour was a pinealoblastoma. Improvement was achieved after postoperative treatment with methotrexate, vincristine and belustin.