[Percutaneous ventriculoatrial shunt: experience with 179 cases]. / Implantacja zastawki komorowo-przedsionkowej z przezskórnym wprowadzeniem drenu dosercowego--doswiadczenia wlasne na podstawie analizy 179 przypadków.

BACKGROUND AND PURPOSE: The aim of the study was to assess the impact of percutaneous placement of a distal catheter on treatment results in patients with hydrocephalus undergoing ventriculoatrial shunt (VA) implantation. MATERIAL AND METHODS: This retrospective study included 184 patients aged 14-80 years (mean: 48 yrs) with hydrocephalus who were treated with VA shunt between 1990-2003. In 179 patients the cardiac catheter was introduced by catheterization of the internal jugular vein, rarely the subclavian or external jugular vein, using the Seldinger technique and standard equipment for central vein catheterization. The mean follow-up time was 64 months. RESULTS: The most frequent complication related to the method used was an incidental puncture of the carotid artery (5% of cases). Pneumothorax was observed in two cases. None of these complications caused permanent sequelae. Early (<6 months) postoperative complications included shunt infection in the neck region (2 cases), impatience of the cardiac catheter (3), disconnection between the outlet and the cardiac catheter with its subsequent migration (1) and kinking of the distal catheter (1). Late (>6 months) complications included infection along the distal catheter (2 cases), occlusion of the cardiac catheter (4) and its disconnection (1). The mean duration of the procedure was 40 minutes. CONCLUSIONS: Percutaneous placement of the cardiac catheter is a safe procedure which shortens the duration of the operation and minimizes tissue traumatization. This method may contribute to a decreased risk of infection. VA shunt with presented modification may be used in those patients for whom implantation of ventriculoperitoneal shunt is contraindicated.

Cell proliferative activity estimated by histone H2B mRNA level correlates with cytogenetic damage induced by radiation in human glioblastoma cell lines.

We studied the relationship between proliferative activity and radiation-induced DNA damage in human malignant gliomas in vitro. Nine human glioblastoma established cell lines were gamma-irradiated (60Co) over a dose range of 0-10 Gy. H2B and H4 histone mRNA level was assessed with quantitative RT-PCR technique (TaqMan) and histone labeling index (HLI) with in situ hybridization to define proliferation rate, while cytochalasin-block micronucleus assay was performed to measure cytogenetic damage. Micronucleus frequency correlated with H2B mRNA level (Spearman's R up to 0.82 at 8 Gy), HLI, nuclear division index (NDI) and percentage of binucleated cells (%BNC). There was a high correlation between H2B mRNA level and NDI (R = 0.80) as well as %BNC and HLI (R = 0.72). Histone H2B and H4 mRNA level (not significant), HLI, NDI, and %BNC (significant) were higher in cell lines sensitive to DNA damage. Proliferative activity correlates with radiation-induced DNA damage in human glioma cell lines. Histone H2B mRNA level and HLI may be a useful molecular predictor of the tumour response to radiation treatment in gliomas of the same histological grade, however the risk of potentially more rapid tumour-cell repopulation must be considered. Presumed protective activity of histones against radiation-induced DNA damage was not confirmed at the transcript level.

Surgical strategies in the removal of malignant tumors and benign lesions of the anterior skull base.

The choice of surgical approaches to the tumors of the anterior skull base is determined by the location, dimensions of such lesions and their relations to the surrounding structures. Furthermore, the need for the reconstruction of the dura and skull base structures has an important influence on the decision about the surgical procedure. Transfacial approaches provide limited exposure, especially when tumors damage the floor of the anterior cranial fossa and involve the frontobasal dura and brain. Transcranial, craniofacial and subcranial approaches in particular may aid a surgeon in the removal of such lesions, and often these surgical procedures are the only beneficial methods. Our study comprised 15 patients. Transcranial approaches were used in ten cases. In five further cases, we adopted craniofacial or subcranial approaches. Total removal of these lesions was possible in 13 cases. Neither important complications nor death after surgery was observed except for two cases (craniofacial/subcranial approach) where the CSF leak and CNS infection were reported. We deem that the transcranial approach creates a good possibility for total removal of anterior skull base tumors, particularly of the benign lesions, and permits reconstruction of the skull base damaged by the tumor. However, in patients with large malignant tumors, the en bloc resection via the combined craniofacial/subcranial approach achieved better outcome.

[Gene therapy for the treatment of patients with brain gliomas]. / Terapia genowa w leczeniu chorych z glejakami mózgu.

The prognosis of patients with brain gliomas remains poor despite the use of advanced surgical techniques, radio- and chemotherapy. In this respect, gene engineering techniques altering the glioma genome in order to regulate the function of key genes involved in cancerogenesis seem to be promising. The premise for applying a gene therapy in patients with brain gliomas is described, together with basic strategies and results of hitherto performed experimental and clinical studies, mostly with the use of virus vectors. The rapid progress in molecular techniques may enable to overcome methodological problems related to the introduction of the therapeutic gene into the target cell, and thus to improve so far unsatisfactory results of glioma gene therapy. The important role of a neurosurgeon in the process of precise gene vector application to the tumour area should not be underestimated.

[Current therapies for parkinson's disease. Part II: surgical treatment]. / Wspólczesne leczenie choroby Parkinsona. Czesc II: Leczenie chirurgiczne.

Surgical treatment of Parkinson's disease (PD) is indicated in patients with severe neurological symptoms (tremor, bradykinesia, rigidity)--who do not benefit from nor tolerate pharmacological therapy. Surgery for PD modifies the motor system function by lesioning or electrostimulation of thalamic, pallidal or subthalamic nuclei. The technological progress together with refined CNS monitoring enabled wider application of deep brain stimulation (DBS). The efficacy of DBS is comparable with lesioning techniques (thalamotomy or pallidotomy) however bears less adverse effects. Both lesioning and DBS are generally well tolerated by patients. The side effects are mostly transient and neurological complications, if occur, usually do not affect quality of patient's life. Unfortunately, the modern surgery for PD is still very expensive and demanding for a large team of specialists and high technology.

Bilateral chronic subdural hematomas with neurologic symptoms complicating spinal anesthesia.

BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare but potentially fatal complication of spinal anesthesia (SA). This case is intended to highlight the importance of careful follow-up of patients with a chronic headache that develops after SA. CASE REPORT: A 38-year-old woman underwent saphenous vein ligation for varices under SA. On the first postoperative day, she complained of severe postural headache that was controllable with oral analgesics. Two weeks later, bilateral abducens nerve palsy with diplopia developed. Brain magnetic resonance imaging (MRI) showed small bilateral subdural hygromas. Diplopia and headache (no longer postural) were relieved after administration of dexamethasone, but reappeared 6 wks later. This time, MRI showed large subdural hematomas. The patient was treated with burr-hole decompression. CONCLUSIONS: Persistent headache after SA requires careful neurologic and radiologic follow-up for exclusion of chronic intracranial bleeding. Pharmacologic treatment may mask some neurologic symptoms and delay diagnosis of intracranial complications related to SA.