[Surgery of multi-sutured craniosynostosis in childhood]. / Operacja synostozy wielu szwów czaszki wiezowatej u dzieci.

According to own critical experience with the treatment of craniosynostoses (1954-81), using various methods from partial morcellement to total ablation of the cranial vault, the author applied (1982-2000) compound surgical decompression in 40 cases of turricephalic craniostenosis due to multisutural craniosynostosis. The surgical approach to the problem was supported by pre- and postoperative observations of computed three-dimensional bone reconstruction, furthermore by investigation of alterations of SPECT detecting the critical areas of most pronounced intracranial tightness of the skull leading to localized and general cerebral blood flow impairment of the developing brain. The application of newer diagnostic methods contributed to deeper understanding of mechanisms concerning neurodevelopmental retardation and behaviour or defect, disturbances as epilepsy, cranial nerve palsy, spastic paresis, hypothalamic-pituitary insufficiency or poor intelectual performance. This made the possible treatment of preoperative clinical symptoms more efficient. By an early operation we solve the disproportion between the too small skull volume limited by premature ossification of sutures which resulted previously in compression of the growing in size, of the maturing brain. In cases of more complex pathology orbitotomies, with a reconstructive advancement of the orbital rim and maxillas should be performed with multidisciplinary cooperation.

[Surgical treatment of clinical syndromes of intractable epilepsy in developmental age]. / Chirurgiczne leczenie zespolów klinicznych padaczki lekoopornej w wieku rozwojowym.

According to a longterm cathamnestic investigation in a series of 2400 patients 80% had favorably responded to medication, 60% are seizure free and in 20% there was significant improvement. In further 20% any therapy has had failed. 200 children have been operated upon because of epilepsy resistant to pharmacological treatment. In 80 classical methods (hemispherectomies, lobectomies topectomies and disconnective techniques) have been performed. In further 120 cases nosologically verified symptomatic epilepsy associated with the leading symptom of untreatable fits due to aetiological lesions as neoplasms, scars, angiomas, cysts lesionectomies extended by focectomies have been performed.

[Surgical treatment of symptomatic surgery in children using classical techniques versus extended lesion surgery and focal lesion surgery]. / Chirurgiczne leczenie padaczki objawowej u dzieci metoda klasycznych operacji czy tez poszerzona lezjonektomia wraz z fokektomia.

In a series of 2400 children 80% had favourablly responded to medication, 60% are seizure-free and in 20% there was significant improvement in further 20% any medication has failed. 200 children have been operated upon because of epilepsy resistant to pharmacological treatment., in 80 = 3% classical methods of removal of the epileptogenic substrate (lobectomies, hemisphereectomies, topectomies and disconnective techniques) have been applied. In 120 cases verified symptomatic epilepsy associated with the leading symptom of untreatable attacks due to aetiological lesions as benign neoplasms, scars, angiomas, cysts lesionectomies extended by focectomies have been performed (with a seizure result of 77.6%). The pathological substrate of the epileptic excitation area has been localized and tailored by repeated diagnostic associated bioelectrical and neuroradiological procedures (EEG, BEAM, SPECT, NMR) Since at least many years after the operation nearly 2/3 of the patients remain seizure-free our methods have proven themselves as a useful and noninvasive tool for the focus localization. The plasticity of the developing brain has resulted in a very impressively favourable outcome particularly in the seizure-free children as far as it concerns the intellectual level and social validation. On neurological testing there was no deterioration. On psychological and neurolinguistic exploration there was an evident improvement of gnostic orientation and quality of life; speech functions are fairly good for current and fluent communication.

[Infection of the shunt system in children treated for hydrocephalus]. / Zakazenie ukladu zastawkowego u dzieci leczonych z powodu wodoglowia.

From 1983 to 1988 25 infected shunt systems were found in 205 hydrocephalic children. Four children were treated successfully with antibiotics given into the shunt system and intravenously. Seventeen shunt systems had to be removed and Rikham reservoir or external drainage implanted. Antibiotics were given both into the ipsilateral ventricle and intravenously. In four children with "low dynamic" hydrocephalus the shunts were removed and antibiotics were given intravenously only. Six patients died, in eight neurological impairment developed.

The critical evaluation of the late results after temporal lobectomy performed because of medically refractory complex partial epilepsy (CPE).

Basing on a follow-up study till 27 years of a group of 50 young patients suffering on medically refractory complex partial epilepsy which were treated by temporal lobectomy the author has reached a complete seizure-free result in 66% of them. A critical evaluation of the transient disadaptation syndrome and of a permanent amnesic syndrome in a part of them as well as psychometric memory tests have been performed. The pathophysiological interpretation of the results and selection criteria for the efficient temporal lobectomy have been proposed.

[Neurosurgical treatment of developmental defects of the nervous system (ddns) in infants]. / Neurochirurgiczne leczenie wad rozwojowych uklad nerwowego (wrun) u noworodków i neimowlat.

In a survey of 151 children treated surgically in the earliest period of life the author discusses the complex pathomechanism of damage to the nervous tissues in various age groups indicating important elements in the surgical management which may prevent secondary changes impairing human development in further life periods. In the follow-up 89.4% of children the previously inhibited development was resumed, at the level determined by the preserved nervous structure.

[Intrauterine neurosurgical intervention in a case of congenital hydrocephalus]. / Wewnatrzmaciczna interwencja neurochirurgiczna w przypadku wrodzonego wodoglowia.

The authors point to new perspectives of fetosurgery development in Poland describing a case of hydrocephalus with intracranial haematoma treated by an intrauterine procedure under USG control. After birth the newborn was subjected to an operation for coexistent myelomeningocele and ventriculo-atrial shunt was implanted for prevention of secondary hydrocephalus development. Attention is called to the necessity of observation of indications to these operations, and precise ultrasonographic teratological diagnosis. Legal and deontological problems created by fetosurgery are discussed.

The comprehensive management of brain neoplasms in children.

The author presents the theoretical basis and the complex treatment of brain neoplasms performed in 26 cases in the Paediatric Institute of the Medical Academy in Poznan (Poland) and compares the results with a control group of 13 children exclusively surgically treated. The cathamnestic analysis (till 4 years), using the Karnowsky Rating Scale for evaluation of the results, has shown the superiority of the complex treatment in children, hence the percentage of deaths is four times lower and the favourable clinical course two times more frequent in this group.

[Clinical course of post-traumatic epilepsy in children]. / Przebieg padaczki pourazowej u dzieci.

The authors review critically the traditionally accepted views on post-traumatic epilepsy in children. The analysis is based on 385 children hospitalized for craniocerebral injuries and 42 of these children (10.91%) in whom post-traumatic epilepsy developed. In the pathogenesis of this epilepsy development of essential importance were early beginning and frequently recurring attacks. Serial EEG was useful and the clinical pattern was initially non-characteristic. In the prevention of post-traumatic epilepsy careful prevention of secondary changes and primary neurosurgical management are of particular importance in the acute phase, while the effect of anticonvulsive treatment as prophylaxis is still a problem at issue.

[Epilepsy as an emergency condition]. / Padaczka jako stan naglacy.

The authors analysed 175 calls for the Ambulance Service in the City of Poznan to patients with epilepsy and suggest a schema of emergency therapeutic management and instructions for ambulance personnel for avoiding possible diagnostic and therapeutic errors.

[Classification of clinico-electroencephalographic syndromes in epilepsy in the developmental age]. / Klasyfikacja zespolów kliniczno-elektroencefalograficznych padaczki wieku rozwojowego.

The author describes the clinical-electroencephalographic classification of eleven syndromes of epilepsy in developmental age used by himself, based on verification of 3613 successive patients aged from 0 to 18 years who were treated in the years 1970-1976 and followed up for 5 years in the Poznan Epilepsy Treatment Centre. On the ground of clinical status (seizures and neuropsychiatric findings) and serial EEG records 2746 patients (76%) could have been classified into these epilepsy types. The practical aim of the classification was identification of the focus and circuit of the seizure at a given structural-functional level or organization of the developing brain for guided comprehensive therapy.