[Surgery with neuronavigated mapping of cerebral cavernoma evoking epileptic seizures]. / Leczenie operacyjne naczyniaka jamistego mózgu wywolujacego napady padaczkowe przy uzyciu mapowania neuronawigacyjnego.

INTRODUCTION: Cavernous hemangioma is increasingly recognized as the cause of epilepsy attributed to vasogenic foci. The clinical picture of this lesion is notable for epileptic seizures and intracerebral hemorrhage. Surgical excision of cavernoma remains the most effective antiepileptic modality. Good results of surgery are achieved with the use of modern operative procedures such as stereotaxy and neuronavigation. MATERIAL AND METHODS: Twelve patients with cavernous hemangioma were operated at the Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University, Szczecin, between 1999 and 2008. This group included 10 females aged 7-54 years (mean 24.8 years) and 2 males aged 14-49 years (mean 31.5 years), 7 children (58.3%) and 5 adults (41.7%). Seven patients (58.3%) presented with generalized and the remaining 5 patients (41.7%) with secondarily generalized seizures. The mean time from onset of seizures to surgery was 2.6 months. All patients were operated using preoperative neuronavigated mapping to determine the optimal access to the lesion followed by neuronavigation-guided cavernoma excision. Postoperative neurological status was assessed with GOS scale and antiepileptic treatment outcome with Engel's scale as modified by Moran. RESULTS: The caveroma was completely removed in each case. Postoperative follow-up time was 2-59 months (mean 30.3 months). Neurological status of all patients was category 5 of the GOS scale. Engel's class I outcome was achieved in all patients. Nine patients (75%) were weaned off antiepileptic drugs following normalization of EEG. CONCLUSIONS: The following conclusions were drawn basing on the findings of this study: (1) Neuronavigation offers high precision and low traumatization which reduce the risk of neurological sequellae (neurological deficits and epilepsy) in patients operated for cavernoma; (2) Early resection of cavernoma offers the chance of curing epilepsy.

[The possibilities and limitations of the neuronavigation method in the treatment of intracranial pathology, on the basis of anatomic registering markers and preoperative magnetic resonance imaging]. / Mozliwosci i ograniczenia metody neuronawigacyjnej w leczeniu patologii wewnatrzczaszkowych, w oparciu o anatomiczne markery rejestracyjne i przedoperacyjne badanie tomografii rezonansu magnetycznego.

INTRODUCTION: The evaluation of technical parameters of the system and the evaluation of the influence of changing intraoperative conditions on the accuracy of the indications of the neuronavigational system has the key meaning in the effectiveness on the work ofa neurosurgeon. On the other hand the employment of neuronavigation during an operation on the brain allows to get an insight into the dynamics and directions of the shifts of individual brain structures in regard to themselves and hard integuments. MATERIAL AND METHODS: In the experimental part of the work an analysis was done of the theoretical and actual accuracy of indications of the neuronavigational system obtained after the registering process in modal and clinical conditions. In the clinical part of the work, during the operations of 69 patients with the use of the neuronavigational system an analysis was done of the dynamics and the direction of shifts of the brain's surface and the boundaries of pathological focus in regard to the placement and volume of the pathological focus, volume of the peritumorous edema and the usage of the escape of the cerebrospinal fluid, as well as resulting from those shifts the divergence in the indications of the neuronavigational system. RESULTS AND CONCLUSIONS: A smaller accuracy of the neuronavigational system in clinical than in modal conditions was proved. Anatomical registering markers cause the shifts of areas of greatest accuracy to the face area of patients, not including in its range the back sides of the head and there localized 65.4% of pathological focuses. In model and clinical conditions significant differences between computer error of the RMSE registering process and the marker localization error empirically defined were proved. In result of the analysis of the shifts of the cerebral cortex during the operation of tumors: Meta, Astr. II, Astr. III, GBM, vascular and intrachamberal it was proved that the peritumorous edema, the volume of the pathological focus and the escape of the cerebrospinal fluid statistically significantly influence the shifting of the surface of the cerebral cortex in the craniectomy hole. In effect of the analysis of the shifts of the borders of pathological focuses it was found that the direction of the shifts of borders of pathological focus covered the direction of shifts of the surface of the brain after meningeal decompression, though the value of shifts was incomparably smaller.

[Costotransversectomy and interbody fusion for treatment of thoracic dyscopathy]. / Costotransversectomia ze spondylodeza miedzytrzonowa w leczeniu dyskopatii piersiowej. ocena metody.

INTRODUCTION: Surgical treatment of a thoracic discopathy comprises 4% of all surgeries performed for discopathy. Therefore, analysis of efficacy of particular operative methods used in that scope is limited. We present our analyze modification of costotransversectomy with policarbone cage interbody fusion as the contribution to discussion on optimal operative treatment of thoracic discopathy. MATERIAL AND METHODS: Results of the operative treatment of 14 cases of a thoracic discopathy are analyzed. In 12 cases neurological examination revealed radiculopathy and in 2 cases upper motor neuron involvement. All patients underwent MRI for estimation of level and morphology of discopathy. In one case there was two-level dyscopathy and in the other cases there was one-level discopathy localized in the region between fifth and twelve thoracic vertebrae. The follow up period was of 10 months to 6 years (mean 2 years and four months). During the surgery lateral upper aspect of the intervertebral disc on a one side was exposed. It was accomplished by removal of the head of the rib and the upper aspect of the pedicle located caudally to the intervertebral disc. The policarbone cage was introduced into the intervertebral space after discectomy. RESULTS: In the case with sudden preoperative deterioration of the lower extremities strength there was further postoperative deterioration. During follow up, continuous improvement was observed. In the 12th postoperative month the weakness was minimal. In the other cases immediate postoperative resolution of the pain syndrome and neurological deficits was observed. Postoperative imaging studies reveled appropriate decompression of the spinal canal and localization interbody implant. CONCLUSIONS: 1. Costotransversectomy approach leads to sufficient exposition of the anterior aspect of the spinal canal. 2. Our modification of interbody fusion with policarbone cage gives good results in fusion of compromised motion unit. It makes the approach more attractive in the light of remote surgery effects.

Posterior cervical lateral mass fixation for the management of insufficient anterior stabilization.

PURPOSE: There are clinical situations when anterior fixation alone is not sufficient to adequately stabilize the cervical spine at the level of operation. In vitro biomechanical studies revealed the substantial role of posterior stabilization in such situations. However, no clinical studies of this problem have been published. The usefulness of posterior cervical lateral mass fixation when anterior stabilization failed to offer sufficient spine stability was assessed in the present study. MATERIAL AND METHODS: We enrolled 15 patients who underwent additional posterior fixation due to destabilization of the anterior one. There were five patients with rheumatoid arthritis, six with cervical discopathy, three with cervical trauma, and one with spine tumor. Improvement after posterior fixation was noted in all but one patient. RESULTS: Posterior cervical lateral mass fixation significantly improved cervical spine stability in cases with insufficiency of anterior stabilization. Further investigations on criteria helpful to predict insufficiency of anterior stabilization in cases of multisegmental cervical spine disease are needed.